Long-term Efficacy of Dacryoendoscopy-guided Recanalization and Silicone Tube Intubation

Purpose@#To investigate the long-term efficacy of dacryoendoscopy-guided recanalization and silicone tube intubation in patients with obstruction in the lacrimal drainage system and to identify factors related to surgical outcome. @*Methods@#We retrospectively reviewed the medical records of patients with primary nasolacrimal duct obstruction and canalicular obstruction who underwent dacryoendoscopy-guided recanalization and silicone tube intubation between August 2014 and March 2016. Factors related to surgical outcome were examined and compared between the success group (eyes with complete response and partial response) and the failure group. Kaplan-Meier survival analysis and multivariable logistic regression analysis were used to analyze the success rate according to the factors found to have statistical significance. @*Results@#The study included 74 eyes of 51 patients. The mean age of the patients was 60.3 ± 10.0 years (range, 34–80 years). The success group consisted of 66 eyes (89.2%) (complete response, 56 eyes, 75.7%; partial response, 10 eyes, 13.5%) and the failure group consisted of eight eyes (10.8%). The median follow-up period was 58 months (range, 6.5–72 months), and the overall success rate was 89.2%. Compared to the eyes with preoperative lacrimal irrigation test of partial passage, the eyes with no passage were associated with a lower success rate (95.9% vs. 76.0%, p = 0.01). Postoperative inflammation was also associated with a lower success rate (96.6% vs. 60.0%, p < 0.001). @*Conclusions@#Dacryoendoscopy-guided recanalization and silicone tube intubation is effective and can be considered a first choice of treatment for eyes which show partial passage in the lacrimal irrigation test. The management of postoperative inflammation is essential to ensure surgical success.

Treatment for Functional Failure after Primary Endonasal Dacryocystorhinostomy

Purpose@#To analyze the results of secondary silicone tube insertion in patients exhibiting persistent epiphora despite acquiringanatomical patency after primary endonasal dacryocystorhinostomy. @*Methods@#We conducted a retrospective review of 23 patients (37 eyes) seen at our department from December 2006 to April2018 for primary endonasal dacryocystorhinostomy. These patients exhibited anatomical patency but experienced persistentepiphora, requiring secondary silicone tube re-insertion. @*Results@#The average age at reintubation with a silicone tube was 59.8 years, and the average follow-up was 14.8 months. Theinterval between the primary endonasal dacryocystorhinostomy and secondary silicone tube re-insertion was approximately24.5 months. The silicone tube re-insertion, was successful for 33 of 37 eyes with four eyes exhibiting partial improvement. Thus,there were no failed outcomes based on subjective symptoms. @*Conclusions@#After primary endonasal dacryocystorhinostomy, when tearing symptoms persist despite no evidence of anatomicalproblems, our results show that secondary silicone tube re-insertion is a safe and effective procedure for patients experiencingfunctional failure.

Efficacy and Safety of Letibotulinum Toxin A for the Treatment of Essential Blepharospasm

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Thelazia Callipaeda Infestation with Tarsal Ectropion

PURPOSE: To report a case of Thelazia callipaeda infestation with tarsal ectropion.CASE SUMMARY: A 79-year-old man presented with epiphora and a sensation of a foreign body in his right eye that had persisted for several months. On the initial examination, he had conjunctival injection, conjunctival follicles, telangiectasia of the lid margins, meibomian gland dysfunction, and tarsal ectropion. We performed a lateral tarsal strip operation to treat the tarsal ectropion. During surgery, we identified and removed four parasites (about 1–2 cm in length and 0.5 mm in width) that had not been apparent on slit lamp examination. The parasites were identified as Thelazia callipaeda. The patient's symptoms subsequently improved considerably; he has followed up to the present time without recurrence.CONCLUSIONS: In the presence of continuous extraocular inflammation, as with infestation by Thelazia callipaeda, ectropion can be induced by several possible causes. Involutional ectropion can be accelerated mechanically through rubbing. Other causes include inferior force from inflammation of the connective tissue and temporary blepharospasm.

Clinical Results of Anti-adhesion Adjuvants after Endonasal Dacryocystorhinostomy

PURPOSE: Various absorbable anti-adhesion agents have been used to prevent postoperative synechia formation after endonasal surgery. The purpose of this study was to evaluate the anti-adhesion effects of HyFence and Mediclore after endonasal dacryocystorhinostomy (DCR) compared to a mixed solution of hyaluronic acid and sodium carboxymethylcellulose (Guardix-Sol). METHODS: In this retrospective study, endonasal DCR and silicone tube intubation were performed on 198 eyes of 151 patients. Three different anti-adhesion adjuvants were applied to the osteotomy site in the nasal cavity after standard endonasal DCR procedures. The subjects were classified into three respective groups: group A (71 eyes, Guardix-Sol 1.5 g), group B (89 eyes, HyFence 1.5 mL), and group C (38 eyes, Mediclore 1 cc). The three groups were evaluated by asking patients about subjective symptoms and by performing lacrimal irrigation tests and endoscopic examinations. RESULTS: There were no statistically significant differences in age, sex, timing of tube removal, or follow-up period among the three groups. There were no statistically significant differences in success rates among the three groups (p = 0.990, 91.5% [65 / 71], 92.1% [82 / 89], and 92.1% [35 / 38], respectively). CONCLUSIONS: HyFence and Mediclore are safe and effective adjunctive modalities following endonasal DCR compared to Guardix-Sol. Therefore, these agents can be considered good alternatives to Guardix-Sol to increase the success rate of endonasal DCR in treating patients with poor prognosis.

Two Cases of Endogenous Endophthalmitis That Progressed to Globe Rupture

No abstract available.

Eyelid Mass as Initial Presentation of Breast Cancer: A Case Report

PURPOSE: We report a case in which eyelid mass was the initial presentation of breast cancer. The diagnosis of breast cancer was made after lid biopsy. CASE SUMMARY: A 41-year-old female patient presented with a painful mass on the left lower lid after 1 month. There was a pinkish mass in the lateral portion of the tarsal conjunctiva, and computed tomography revealed a mass with an irregular margin on the lower lid connected to the left lacrimal gland. Biopsy was performed at the tarsal conjunctiva of the left eye, and histopathologic examination was suggestive of malignant epithelial cell neoplasm, especially metastatic carcinoma in the breast. The patient was diagnosed as having invasive ductal cancer, for which she is currently receiving chemotherapy. CONCLUSIONS: Metastases to the eyelid are very rare, accounting for less than 1% of all malignant eyelid lesions. We report a patient who presented with an eyelid mass as the initial presentation of breast cancer, which was diagnosed with metastatic breast cancer.

Alternating and Relapsing Migratory Orbital Myositis

No abstract available.

A Case of Fungal Ball Causing Acute Dacryocystitis

PURPOSE: We report a case of fungal ball after Endoscopic Dacryocystorhinostomy (DCR) in a 40-year-old female patient. CASE SUMMARY: A 40-year-old female patient was admitted to our hospital for left lower eyelid tenderness and bloody discharge from the lacrimal punctum. During a planned endoscopic DCR, the sac was opened after the osteotomy, and 2 fungal balls were found in the lacrimal sac. The masses were 7 × 5 mm and, 9 × 5 mm sized, irregularly shaped, and red in color. Aspergillus fumigatus was diagnosed pathologically. Postoperative paranasal sinus magnetic resonance imaging showed no residual fungal ball. During follow-up, the patient showed patent rhinostomy opening, and there was no evidence of fungal infection on nasal endoscopic finding. CONCLUSIONS: Although Aspergillus fumigatus is a rare cause of canalicular obstruction, fungal ball development in the lacrimal sac can cause acute dacryocystitis.

Fibroepithelial Polyp on the Eyelid Margin: A Case Report

PURPOSE: Fibroepithelial polyps on the eyelid or orbit have not been previously reported in Korea. Herein, we report our experience with a case of a primary localized fibroepithelial polyp of the eyelid. CASE SUMMARY: A 78-year-old male patient presented with a round mass on the lower eyelid which has been noticed 1 week prior. There was no pain and no tenderness. The mass was removed and excisional biopsy was performed. Histopathologic examination revealed findings suggestive of a fibroepithelial polyp. There was no local recurrence during 4 months of follow-up. CONCLUSIONS: Fibroepithelial polyp should be considered when determining the type of eyelid mass.

A Case of Primary Orbital Peripheral T-cell Lymphoma with Panniculitis-like Features

PURPOSE: To report a case of complete remission of primary orbital peripheral T-cell lymphoma with panniculitis-like features after chemotherapy. CASE SUMMARY: A 57-year-old healthy female presented with periorbital swelling and symptoms of diplopia. The patient was first treated with high-dose systemic corticosteroids, however, symptoms persisted. Therefore, anterior orbitotomy with excisional biopsy was performed for diagnostic purposes. On microscopic examination, the excised mass showed localized dense lymphocyte infiltrates, and cytologic atypia was observed under a high-power field. On immunehistochemical examination, tumor cells were positive for CD3 and CD8 but negative for CD4, CD20 and CD56. Based on histopathological results, primary orbital peripheral T-cell lymphoma with panniculitis-like features was diagnosed. Additionally, molecular pathological testing was positive for Epstein-Barr virus. Subsequently, the patients underwent chemotherapy and complete remission was obtained. CONCLUSIONS: Peripheral T-cell lymphoma often manifests as systemic symptoms, including lymph node enlargement and B symptom. The primary form of the disease in an orbit is very rare, and has a poor prognosis with a high mortality rate because the disease quickly progresses. Herein, the authors report a rare case of a healthy patient without any past medical history who achieved complete remission of a fast-growing primary orbital T-cell lymphoma with no preceding systemic symptoms.

A Case of a Cyst Containing a Parasite and Misdiagnosed as a Dermoid Cyst

PURPOSE: To introduce a case of a cyst containing a parasite misdiagnosed as a dermoid cyst, which is to the best of our knowledge, the first report in Korea of a parasite in a cyst located at the medial side of the orbit. CASE SUMMARY: A 31-year-old male visited the hospital with a 2-year history of a slowly growing mass at the medial side of the right orbit. The patient had a history of mass excision in the same location 18 years previously, however, biopsy was not performed at that time. Orbital computed tomography and magnetic resonance imaging revealed a 5.0 × 1.4 × 1.8 cm³ well-defined T1 high signal intensity unilocular cyst, thus our first impression was a dermoid cyst. The cyst was surgically removed with anterior orbitotomy. The cyst ruptured during the operation, and thus complete aspiration of the cystic fluid and in situ irrigation with antibiotics were performed. Histopathological examination revealed a fragmented adult parasite worm with chronic granulomatous change. CONCLUSIONS: A differential diagnosis for orbital cyst based on clinical and radiological results is difficult. Thus, histopathological confirmation is required. A cyst containing a parasite located in the orbit has rarely been reported. A full examination of all infected patients must be conducted for parasite infection.

Long-term Surgical Outcomes of the Multi-purpose Conical Porous Synthetic Orbital Implant

PURPOSE: We present clinical results of the use of the multipurpose conical porous synthetic orbital implant (MCOI) in surgical procedures of evisceration, enucleation, and secondary enucleation in ophthalmology patients. METHODS: A retrospective review was performed of 59 eyes in which conical implants were used, including 36 cases of eviscerations, 11 enucleations, and 9 secondary enucleations. In all of the cases, the follow-up period was greater than six months between 2004 and 2013. The results focus on documenting surgical findings, as well as postoperative complications among patients. RESULTS: Superior sulcus deformities were found in six eyes (10.2% of conical implant patients), and two eyes received additional surgical interventions to correct the deformities (3.4%). Blepharoptosis was found in four eyes (6.8%), two of which received upper eyelid blepharoplasty (3.4%). Fornix shortening was reported in only one eye (1.7%). Forty-one eyes had a satisfactory cosmetic appearance after the final prosthetic fitting of conical implants (69.5%). The most frequent postoperative complication was orbital implant exposure, which seemed to occur when the preoperative status of the conjunctiva, Tenon's capsule, and sclera preservation were poor in the eyes of the patients. CONCLUSIONS: There was a lower incidence of blepharoptosis and fornix shortening with the MCOI in comparison to spherical implants, while the incidence of orbital implant exposure was similar with the MCOI in comparison to other types of orbital implants. In addition, the MCOI may have advantages with respect to postoperative cosmetic outcomes.

A Case of Carcinoma Ex Pleomorphic Adenoma at 1st Operation

PURPOSE: To report a case of carcinoma ex pleomorphic adenoma observed during the patient's first operation. CASE SUMMARY: A 63-year-old female presented with proptosis and ptosis that was aggravated 1 year prior. On preoperative CT image, a 32 x 20 x 21 mm-sized well demarcated mass (suspected as pleomorphic adenoma) was observed and was removed entirely by anterolateral orbitotomy. The excised mass surface was uneven but the capsule appeared intact on gross examination. Hard, yellow-colored and soft, dark-colored materials were found concurrently on cross section. The histological examination showed malignant cells as part of the soft material and was diagnosed as carcinoma ex pleomorphic adenoma. CONCLUSIONS: We report a case of carcinoma ex pleomorphic adenoma of the lacrimal gland that presented with malignant change during the patient's first operation. Supposedly, during the process of mass growth, minimal rupture occurred causing malignant transformation. Clinically, although a mass is believed benign based on imaging, the possibility of malignant transformation of a tumor increasing rapidly or enlargement causing development of rapid proptosis should be considered.

Outcomes of Endoscopic Dacryocystorhinostomy in Patients Receiving Radioactive Iodine Therapy for Thyroid Carcinoma

PURPOSE: To evaluate the outcomes of endonasal or external dacryocystorhinostomy in patients who underwent radioiodine therapy due to thyroid cancer. METHODS: We reviewed retrospectively clinical and microbiological records of patients who had endonasal or external dacryocystorhinostomy after taking radioiodine therapy for thyroid cancer between January 2006 and December 2012. RESULTS: Twenty-three female adult patients with an average age of 50 years (range, 25 to 72 years) were identified. Seven patients underwent unilateral surgery and 16 had bilateral surgery. Among 39 eyes, 1 eye had combined nasal septoplasty, 3 eyes had external dacryocystorhinostomy and 36 eyes had endonasal dacryocystorhinostomy. Dacryocystorhinostomy was performed within 12 months after the last 131I dose in 3 cases and 2 (5%) presented with the symptom of epiphora. The major cause of symptomatic recurrence was restenosis of the lacrimal nasal mucosa due to the formation of scar tissue, thus, the patients underwent revision surgeries. The remaining 37 of the 39 eyes (95%) showed improvement of symptoms. CONCLUSIONS: Most patients who underwent dacryocystorhinostomy after 131I therapy due to thyroid cancer showed successful outcomes, especially after more than 1 year post-operatively. The major cause of nasolacrimal duct obstruction was a scar tissue formation in the nasal cavity mucosa.

Clinicopathological Characteristics of Malignant Eyelid Tumor in Korea

PURPOSE: To determine the clinical characteristics of patients with malignant eyelid tumors in Korea. METHODS: We performed a retrospective review of the medical records of 73 patients with malignant eyelid tumors who were histologically diagnosed at Seoul St. Mary's hospital from April 2004 to September, 2012 and followed for 6 months or longer. RESULTS: Of 73 cases, 41 (56.2%) were diagnosed as basal cell carcinoma, 17 (23.3%) as squamous cell carcinoma, 11 (15.1%) as sebaceous gland carcinoma, 3 (4.1%) as malignant melanoma, and 1 (1.4%) as basosquamous cell carcinoma. The mean age at diagnosis was 68.4 +/- 11.5 years. Tumors developed more commonly on the lower lid (54.8%). Most cases were treated by complete resection of tumors and eyelid reconstruction (95.9%). The prognosis of patients with basal cell carcinoma and squamous cell carcinoma was good, while that of the other tumors was relatively poor. CONCLUSIONS: The most common diagnosis was basal cell carcinoma (56.2%). Recurrence after complete surgical excision and reconstruction was uncommon.

A Case of Huge Pilocytic Astrocytoma Causing Eyeball Subluxation

PURPOSE: To report a relatively rare case of huge pilocytic astrocytoma of the optic nerve and optic chiasm causing eyeball subluxation. CASE SUMMARY: An eight-year-old male presented with proptosis and visual loss in the left eye for one year. The radiological findings showed a 2.9 x 2.7 x 4.2-cm tumor on the left optic nerve and optic chiasm. For diagnosis and treatment, the patient underwent tumor resection and enucleation. Pathohistological analysis of the tumor specimen revealed pilocytic astrocytoma, which is classified by the World Health Organization as a grade I astrocytic tumor. CONCLUSIONS: Astrocytoma is a tumor of the brain that affects children more often than adults. In general, gross-total resection of pilocytic astrocytoma is expected to be curative due to the non-invasive feature of the tumor. Considering pilocytic astrocytoma as differential diagnosis of orbital tumor in children with symptoms of rapidly progressive proptosis and decreased visual acuity is important because occurrence in the optic nerve and optic chiasm is possible.

Clinical Analysis of Epithelial Tumors of the Lacrimal Gland

PURPOSE: To analyze the clinical and radiologic findings and to evaluate the treatment and prognosis of epithelial tumor patients. METHODS: We retrospectively reviewed clinical and radiologic findings of 36 patients who had been histopathologically diagnosed with epithelial tumors of the lacrimal gland after biopsy and surgery at Seoul St. Mary's Hospital from May 2005 to October 2012. RESULTS: Among the patients with epithelial tumors of the lacrimal gland based on histopathological findings, there were 21 cases of pleomorphic adenoma, seven cases of dacryops, four cases of adenoid cystic carcinoma, two cases of adenocarcinoma, one case of benign oncocytoma, and one case of mucoepidermoid carcinoma. The characteristic clinical finding of epithelial tumors of the lacrimal gland was proptosis (52.7%). In contrast with benign epithelial tumors of the lacrimal gland, the characteristic clinical findings of malignant epithelial tumors of the lacrimal gland were limitation of motion (57.1%), diplopia (57.1%), ocular pain (42.9%), and decreased visual acuity (42.9%). The mean duration of the symptoms of malignant epithelial tumors (5.0 +/- 4.2 months) was shorter than that of benign epithelial tumors (11.2 +/- 11.1 months) (t-test, p = 0.034). In radiologic CT and MRI findings, there was minimal bony destruction in two cases of pleomorphic adenoma and calcification in one case of pleomorphic adenoma. Malignant epithelial tumors of the lacrimal gland, in contrast to benign tumors, showed characteristic bony destruction (57.1%), poorly marginated tumor outline (42.9%) and calcification (14.3%). The 57.1% of patients in this study with malignant tumors were treated with chemotherapy and radiotherapy after surgical treatment, and there was one case (14.3%) of recurrence after treatment. CONCLUSIONS: Careful analysis of clinical and radiologic findings can lead to early diagnosis of malignant tumors.

Risk Potentiality of Frontline Radiotherapy Associated Cataract in Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma

PURPOSE: To elucidate risk potentiality of frontline radiotherapy associated cataracts in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML). METHODS: Data from eight consecutive patients of 41 total OAML patients who had undergone cataract surgery after frontline radiotherapy were analyzed. RESULTS: The median patient age was 46 years (range, 36 to 69 years). The median total radiation dose was 3,780 cGy (range, 3,060 to 4,500 cGy), and the mean duration from radiation irradiation to cataract surgery was 36.60 +/- 8.93 months. Preoperative lens opacification was primarily at the posterior lens subcapsule, and best-corrected visual acuity (BCVA) was 0.43 +/- 0.21. Patients underwent the phacoemulsification surgical procedure with posterior chamber intraocular lens insertion. The average BCVA improved to 0.90 +/- 0.14 after cataract surgery. Two patients underwent posterior continuous curvilinear capsulorhexis, and one had posterior capsule rupture. For posterior capsule opacification (PCO), three patients received Nd:YAG laser posterior capsulotomy after the initial surgery, and one patient is currently under consideration for laser posterior capsulotomy. CONCLUSIONS: Radiotherapy increased posterior subcapsule opacification at a relatively young age in primary OAML. Phacoemulsification was a manageable procedure without severe complications, and final visual outcomes were good. However, because after-cataracts progressed earlier than did senile cataracts, close follow-up should be considered for PCO management.

A Case of Conjunctival Myxoma Invading the Caruncle

PURPOSE: To report a rare case of conjunctival myxoma invading the caruncle. CASE SUMMARY: A 46-year-old man presented with a medical canthal conjunctival mass in his left eye. The mass was a semi-transparent, yellowish, movable mass 10 mm x 6 mm in size in the subconjunctival space. There was no pain and no tenderness. Excisional biopsy of the mass was performed. Histopathologic examination revealed findings suggestive of myxoma. CONCLUSIONS: Relatively transparent, movable, yellowish to pinkish conjunctival masses at medial canthal area without pain or tenderness can be diagnosed as myxoma on biopsy and myxoma can be seen at caruncle.