Efficacy and Safety of a Fixed Combination of Bimatoprost (0.03% w/v) and Timolol (0.5% w/v) for Patients with Open-angle Glaucoma

Purpose@#We investigated the efficacy and safety of a fixed combination of bimatoprost (0.03% w/v) and timolol (0.5% w/v) (Ganfort® , Allergan Inc., Irvine, CA, USA; fixed combination of bimatoprost-timolol, BTFC) for open-angle glaucoma patients. @*Methods@#We included 25 right eyes with open-angle glaucoma treated with eye drops. The drops were changed to the BTFC without a wash-out period. The therapeutic and adverse effects were evaluated by comparing the intraocular pressure (IOP) before the change to that at 1, 4, 7, and 10 months thereafter. @*Results@#The mean IOP before the instillation of eyedrop and the mean reduction of IOP at each time was 18.66 ± 8.22 mmHg (n = 21) and 2.47 ± 3.19 mmHg (13.24%) at 1 month, 19.05 ± 8.54 mmHg (n = 18) and 3.68 ± 5.55 mmHg (19.32%) at 4 months, 16.68 ± 2.52 mmHg (n = 16) and 2.13 ± 2.87 mmHg (12.77%) at 7 months, and 20.07 ± 9.91 mmHg (n = 14) and 2.79 ± 4.48 mmHg (13.90%) at 10 months (p < 0.05). Side effects included soreness (two eyes, 7.7%), red eye and allergic symptoms (three patients, 11.5%), and discomfort (three patients, 11.5%); there were no severe adverse events such as permanent vision loss or systemic side effects. @*Conclusions@#BTFC reduced the IOP of open-angle glaucoma patients without causing permanent vision loss or any other serious side effects.

Positional Intraocular Pressure of Vitrectomized and Normal Fellow Eyes

PURPOSE: To compare posture-induced intraocular pressure (IOP) changes in vitrectomized eyes and normal eyes of patients who had vitrectomy in one eye. METHODS: A total of 31 patients older than 20 years of age who underwent vitrectomy were enrolled in the study. At least six months after vitrectomy, we measured IOP in both eyes using a rebound tonometer 10 minutes after the patient assumed sitting, supine, right lateral decubitus, and left lateral decubitus positions. Patients with a history of ocular surgery (not including vitrectomy) or recent medication use associated with IOP were excluded. IOP and ocular parameters of vitrectomized and normal fellow eyes were compared. For the decubitus position, IOP values of dependent and nondependent eyes were compared. RESULTS: No significant difference was observed in IOP between vitrectomized and normal eyes in the sitting and supine positions. The IOP for dependent eyes (on the lower side in the lateral decubitus position) was significantly higher than the IOP for nondependent eyes in both right lateral decubitus (right vitrectomized eye 19.31 ± 4.20 vs. 16.71 ± 4.02 mmHg, p < 0.001; left vitrectomized eye 18.35 ± 1.75 vs. 16.04 ± 3.02 mmHg, p = 0.003) and left lateral decubitus (right vitrectomized eye 17.32 ± 4.63 vs. 19.15 ± 3.83 mmHg, p = 0.004; left vitrectomized eye 16.19 ± 1.81 vs. 18.12 ± 2.29 mmHg, p < 0.001) positions. CONCLUSIONS: IOP was higher in the dependent than the nondependent eye in the lateral decubitus position, for both vitrectomized and nonoperated eyes.

Positional Intraocular Pressure between Phakic and Pseudophakic Eyes after Cataract Surgery in a Single Eye

PURPOSE: In the present study, the dependence of intraocular pressure (IOP) on body position was compared between pseudophakic and phakic eyes after cataract surgery performed at least 3 months prior. METHODS: IOP was measured in 214 patients over 40 years of age who received cataract surgery at least 3 months prior. The present study included 104 patients who did not have any other ocular disease which could influence visual acuity or IOP. The IOP was measured in 4 different positions, sitting, supine, right decubitus, and left decubitus by a single skilled researcher using Icare tonometer. In addition, IOP was compared between the phakic and pseudophakic eyes, specifically, the dependent eye in the decubitus position. RESULTS: The comparison between the phakic and pseudophakic eyes in patients after cataract surgery in a single eye showed IOP was not different between the sitting and supine positions; however, in the decubitus position, IOP in the dependent eye was significantly higher than the non-dependent eye (p = 0.001). Additionally, regardless of lens status, IOP was significantly higher in the dependent eye than non-dependent eye. CONCLUSIONS: Both body position and lens status can affect IOP. After cataract surgery, regardless of lens status, IOP was higher in the dependent eye than non-dependent eye of patients in the decubitus position.

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy

PURPOSE: To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). METHODS: Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0). RESULTS: Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 +/- 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 +/- 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 +/- 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 +/- 0.8 to 3.8 +/- 0.5 mm postoperatively. CONCLUSIONS: The customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.

The Relationship between Vitamin D and Glaucoma: A Kangbuk Samsung Health Study

PURPOSE: To investigate the relationship between vitamin D and glaucoma. METHODS: This retrospective, cross-sectional study included subjects who underwent a health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were reviewed by ophthalmologists. The ophthalmologists determined if an eye was glaucomatous based on the criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and by the appearance of the retinal nerve fiber layer and optic disc. If the subjects previously underwent an ophthalmologic examination, they were enrolled based on the documented history. In addition to fundus photographs, each participant underwent a systemic examination including blood sampling and sociodemographic and behavioral questionnaires. The subjects were divided into five groups according to serum 25-hydroxyvitamin D (25(OH)D) level. Multivariate logistic regression models were constructed to assess possible associations between elevated glaucoma risk and systemic factors with a p < 0.2 on univariate analysis. RESULTS: Of the 169,208 subjects older than 20 years, 123,331 were eligible for the study. There was no difference in the prevalence of glaucoma according to quintile of serum 25(OH)D level based on sex (p = 0.412 for males, p = 0.169 for females). According to the multivariable-adjusted logistic analysis, the odds ratio of glaucoma for the fourth quintile was significantly lower than that of the first quintile in females (odds ratio, 0.713; 95% confidence interval, 0.520 to 0.979). CONCLUSIONS: Lower 25(OH)D level was significantly associated with an elevated risk of glaucoma in females compared with higher 25(OH)D level. Further evaluation is needed to investigate the relationship between glaucoma and vitamin D.

A Case of Rosai-Dorfman Disease Affecting the Palpebral Conjunctiva

PURPOSE: To report a single case of Rosai-Dorfman disease of the palpebral conjunctiva with a review of the relevant literature. CASE SUMMARY: A 39-years-old woman presented with a palpebral conjunctival mass 3 weeks in duration on both eyes. The patient had a history of excisional biopsy of lymphadenitis and wanted to remove the mass for cosmetic reasons. An excisional biopsy was performed to obtain a diagnosis for proper management. The histopathologic examination of the lesion showed an intensive proliferation of monotonous and histiocytoid cells beneath the epidermis. Immunohistochemical staining for the S-100 protein was positive and anti-CD1A antibody was negative. Five months after mass excision, there was no evidence of recurrence.

Clinical Characteristics of Intermittent Exotropia Patients who Have Improved due to Corrected Refractive Errors

PURPOSE: To evaluate clinical features of patients who have experienced decreased exodeviation after refractive error correction. METHODS: Thirty-four patients who experienced decreased exodeviation after refractive error correction between 2003 and 2010 were evaluated. Visual acuity, refractive errors, reported age at onset, duration of wearing glasses, stereopsis, and function of fusion were evaluated. RESULTS: The present study included 34 patients with intermittent exotropia. Before correcting refractive errors, the mean visual acuity was 0.34 +/- 0.27 for the right eye and 0.37 +/- 0.27 for the left eye according to log MAR. After refractive error correction, mean visual acuity improved to 0.12 +/- 0.11 for the right eye and 0.11 +/- 0.11 for the left eye according to log MAR. Before correcting refractive errors, the amount of deviation was 18.1 +/- 7.4 PD at near and 13.5 +/- 8.4 PD at far. However, after correcting refractive errors, the amount of deviation decreased to 5.8 +/- 8.6 PD at near and 4.5 +/- 7.6 PD at far (p < 0.05). CONCLUSIONS: The clinical characteristics of children who have decreased exodeviation after correcting refractive errors is shown by a greater amount of deviation at near than at distance and good fusional vergence and stereoacuity. Because correcting refractive errors by wearing appropriate glasses can decrease exodeviation, the authors of the present study recommend correcting refractive errors as the initial management for exotropia.

Botulinum Toxin A Treatment for Patients with Periorbital Spasm after Facial Nerve Paresis

PURPOSE: To evaluate clinical features of periorbital spasm and facial asymmetry in the patients who recovered poorly from Bell's palsy and facial trauma and to investigate the effect of Botulinum toxin A as a treatment for periorbital spasm and facial asymmetry. METHODS: Between November 2001 and January 2010, Botulinum toxin injection was performed in 17 patients who had blepharospasm and facial asymmetry following poor recovery from facial palsy. The past history, trauma history, clinical manifestation of blepharospasm, Botulinum toxin A injection dose, injection site, frequency of injection, and duration of effect was evaluated. Data was analyzed using the Mann-Whitney U test, SPSS 12.0. RESULTS: The mean number of injections was 2.7 +/- 2.4 times and the mean dose per injection unit was 12.2 +/- 1.2 units. The Botulinum toxin effect lasted 6.9 +/- 5.5 months in Bell's palsy patients, and 8.0 +/- 4.2 months in trauma patients. There was no significant difference between the 2 groups. Most patients reported improvement of periorbital spasm and facial asymmetry. After treatment, 1 patient complained of epiphora and 1 patient complained of ptosis; conservative treatment was performed for these patients. CONCLUSIONS: Blepharospasm can be treated and a cosmetic improvement in facial symmetry can be achieved by Botulinum toxin A injection in the patients who recover poorly from facial palsy.

The Clinical Usefulness of Aerodynamic Test Using the Airway Interruption Method in Patients with Laryngeal Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The airway interruption method was developed as a combination of the measurement of expiratory pressure, mean air flow, intensity, and frequency. We evaluated the clinical usefulness of the airway interruption method in measuring vocal frequency, vocal intensity, mean air flow rate and expiratory air pressure. MATERIALS AND METHODS: We performed phonatory function tests in the patients with vocal nodule (n=380), vocal polyp (n=41), vocal sulcus (n=20), laryngitis (n=72), vocal paralysis (n=10) and glottic cancer, T 1 (n=5). And these results were compared with normal values which were reported previously. In 91 patients with vocal nodule and 5 patients with polyp, phonatory function test was followed up after laryngomicrosurgery and compared with preoperative test. RESULTS: In patients with vocal nodule and polyp, mean air flow rate was significantly increased (p<0.05). In polyp, these differences were greater than nodule group. In vocal paralysis, mean air flow rate was significantly increased than other groups. In glottic cancer (T1), expiratory air pressure was significantly increased than other groups. In laryngitis and sulcus vocalis, mean air flow rate was increased in some phonation methods. But their differences were less significant than other groups. After laryngomicrosurgery, mean air flow rate and expiratory air pressure were decreased in both groups. CONCLUSION: The aerodynamic test using the airway interruption method is a noninvasive, easy to perform and reliable for evaluation of aerodynamic conditions at the glottis. This research finds that the interruption method is effective both in evaluation of the treatment and in postoperative assessments of the laryngeal disorder patients.

Effects of External Nasal Dilators on Nasal Respiration and Patency in HealthyKorean Adults: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although physiological effects of external nasal dilators (ENDs) were recently reported on white and black people, there are no available data on Asians. Nasal geometry is affected by many factors such as race, age, or sex. The aim of this study is to evaluate the effects of ENDs on nasal respiration and patency in healthy Korean adults. MATERIALS AND METHODS: One hundred healthy Korean adults (50 females and 50 males, aged 20 to 39 years) without nasal complaints, history of sinonasal surgery, nor major structural abnormalities of the nose were recruited. All subjects were required to assess their own sensation of nasal respiration on a 100 mm visual analog scale. Minimal cross-sectional areas (MCAs) and volumes from 0 cm to 5 cm from the nostril (V5s) of both nasal cavities were measured by acoustic rhinometry and added together to obtain the total MCA and V5, respectively. All measurements before application of an END were compared with those 5 minutes after application. RESULTS: The sensation of nasal respiration improved significantly after application of an END in both female and male. The END increased MCA and V5 significantly in both sexes. These acoustic rhinometric changes resulted in 21.1% (male) and 20.5% (female) increment in MCA and 10.0% (male) and 12.5% (female) increment in V5, respectively. However, there were no significant correlations between changes in the subjective and objective parameters. CONCLUSION: ENDs significantly improve the subjective sensation of nasal respiration and increase MCA and nasal cavity volume in healthy Korean adults. However, this improvement in nasal patency does not always coincide with the improvement in the subjective feeling of nasal respiration.