Matrix Metalloproteinases 9 Testing Using Immunoassay Kit in Oculoplastic Outpatient Clinic Patients

Purpose@#We assessed the association between the results of tear film-based matrix metalloproteinases 9 (MMP-9) immunoassay and the diagnosis of patients who visited an oculoplastic outpatient clinic. @*Methods@#We conducted a retrospective analysis of the MMP-9 immunoassay results in 1,703 eyes from 1,703 patients who presented with ocular discomfort at an oculoplastic outpatient clinic. The MMP-9 immunoassay results were analyzed in correlation with the final oculoplastic diagnosis of the patients. @*Results@#In total, 1,126 of 1,533 eyes demonstrated positive expression of MMP-9. No statistically significant differences were observed in MMP-9 expression based on sex (p = 0.107) and age (p = 0.510). Furthermore, 120 of 169 eyes with thyroid eye disease (71.0%, p < 0.001), 145 of 161 eyes with nasolacrimal duct obstruction (90.1%, p < 0.001), 282 of 375 eyes with nasolacrimal duct stenosis (75.2%, p < 0.001), 190 of 238 eyes with entropion (79.8%, p < 0.001), 19 of 23 eyes with ectropion (82.6%, p < 0.001), and 370 of 567 eyes with dry eye syndrome (65.3%, p < 0.001) exhibited positive MMP-9 expression. @*Conclusions@#The MMP-9 immunoassay is a noninvasive, convenient, and rapid test that evaluates ocular surface inflammation. Most patients with oculoplastic diseases exhibit positive MMP-9 expression. These findings provide valuable information for guiding diagnostic and management decisions in patients with oculoplastic conditions.

Analysis of the Success Rate of Silicone Tube Intubation According to Lacrimal Endoscopy Findings

Purpose@#In patients with lacrimal passage obstruction, the location and severity of the obstruction observed in lacrimal endoscopy were evaluated with respect to the success rate of silicone tube intubation. @*Methods@#We conducted a retrospective chart review of 120 eyes of 74 patients who underwent lacrimal endoscopy (RUIDO fiberscope; Fibertech Co., Tokyo, Japan)-assisted silicone tube intubation from August 2018 to October 2019. The analysis included clinical characteristics, irrigation test results, lacrimal endoscopic findings, and analyzed factors associated with surgical success. The location and severity of the obstruction observed by lacrimal endoscopy were classified. @*Results@#Of the 120 eyes that received lacrimal endoscopy-assisted silicone tube intubation, 101 eyes (84.2%) were successful in surgery. Canalicular stenosis in 41 eyes (34.2%), canalicular obstruction in 35 eyes (29.2%), nasolacrimal duct stenosis in 24 eyes (20.0%), and nasolacrimal obstruction in 28 eyes (23.3%) were observed in lacrimal endoscopy. Regardless of the location of the obstruction of the canaliculus and nasolacrimal duct, it was observed that surgical success was affected by the severity of the obstruction (p = 0.041 and p = 0.018, respectively). @*Conclusions@#The severity of the lacrimal passage obstruction observed during lacrimal endoscopy was shown to have a statistically significant effect on the success rate of lacrimal endoscopy-assisted silicone tube intubation. However, the location of the obstruction in the lacrimal passage did not have a statistically significant effect on the success rate.

Analysis of the Success Rate of Silicone Tube Intubation According to Lacrimal Endoscopy Findings

Purpose@#In patients with lacrimal passage obstruction, the location and severity of the obstruction observed in lacrimal endoscopy were evaluated with respect to the success rate of silicone tube intubation. @*Methods@#We conducted a retrospective chart review of 120 eyes of 74 patients who underwent lacrimal endoscopy (RUIDO fiberscope; Fibertech Co., Tokyo, Japan)-assisted silicone tube intubation from August 2018 to October 2019. The analysis included clinical characteristics, irrigation test results, lacrimal endoscopic findings, and analyzed factors associated with surgical success. The location and severity of the obstruction observed by lacrimal endoscopy were classified. @*Results@#Of the 120 eyes that received lacrimal endoscopy-assisted silicone tube intubation, 101 eyes (84.2%) were successful in surgery. Canalicular stenosis in 41 eyes (34.2%), canalicular obstruction in 35 eyes (29.2%), nasolacrimal duct stenosis in 24 eyes (20.0%), and nasolacrimal obstruction in 28 eyes (23.3%) were observed in lacrimal endoscopy. Regardless of the location of the obstruction of the canaliculus and nasolacrimal duct, it was observed that surgical success was affected by the severity of the obstruction (p = 0.041 and p = 0.018, respectively). @*Conclusions@#The severity of the lacrimal passage obstruction observed during lacrimal endoscopy was shown to have a statistically significant effect on the success rate of lacrimal endoscopy-assisted silicone tube intubation. However, the location of the obstruction in the lacrimal passage did not have a statistically significant effect on the success rate.

A Case of Corneal Dysplasia with Identification of POLH Gene Variants in Xeroderma Pigmentosum

PURPOSE: To discuss the clinical course and diagnosis of corneal dysplasia in a xeroderma pigmentosum patient based on a genetic evaluation. CASE SUMMARY: A 42-year-old female visited our clinic for decreased left visual acuity and corneal opacity. She had undergone several surgeries previously due to the presence of basosquamous carcinoma in the left lower eyelid, neurofibroma, and malignant melanoma of the facial skin. The patient showed repeated corneal surface problems, with a suspicious dendritic lesion; however, antiviral therapy was ineffective, and herpes simplex virus polymerase chain reaction results were negative. Despite regular follow-ups, the patient showed neovascularization around the corneal limbus and an irregular corneal surface. We performed corneal debridement with autologous serum eye drops for treatment. The patient's visual acuity and corneal surface improved after the procedure. The impression cytology result was corneal dysplasia. In whole exome sequencing, two pathogenic variants and one likely pathogenic variant of the POLH gene were detected. CONCLUSIONS: This is the first genetically identified xeroderma pigmentosum case with ophthalmological lesions of the eyelid and cornea in Korea. Debridement of the irregular corneal surface and autologous serum eye drop administration in xeroderma pigmentosum could be helpful for improving visual acuity.

A Case Report of Occipital Lobe Epilepsy and Related Optical Coherence Tomography Findings

PURPOSE: In the present case report, visual pathway damage confirmed by retinal ganglion cell layer (GCL) damage on optical coherence tomography (OCT) in occipital lobe epilepsy was described. CASE SUMMARY: A 25-year-old female with idiopathic generalized epilepsy developed visual blurring followed by a generalized seizure. On brain magnetic resonance imaging (MRI), very subtle changes of the cortex in the left parietooccipital lobe were observed. Two days after the attack, even after the disappearance of epileptiform wave on electroencephalogram (EEG), visual acuity in both eyes was 0.5 and a perimetry revealed nearly complete visual defect in both eyes. OCT showed severe thinning of GCL and mild thinning of retinal nerve fiber layer (RNFL). No additional seizure attack occurred thereafter. One month after the attack, her visual acuity was recovered to 1.0 in both eyes and her left visual hemifield defect was recovered. However, even 6 months after the attack, her right visual hemifield defect and GCL damage persisted in both eyes. CONCLUSIONS: We reported a case in which the visual pathway damage caused by occipital lobe epilepsy was identified using OCT, despite very subtle changes in brain imaging. This case indicated GCL thinning is an objective and prognostic index for the irreversible visual field defect in occipital lobe epilepsy.

Analysis of Myopic Progression in Childhood Using the Korea National Health and Nutrition Examination Survey

PURPOSE: To investigate the degree, distribution, and change in refractive error in the pediatric population 5 to 20 years of age. METHODS: We collected data from 7,695 subjects aged 5 to 20 years who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2012. Non-cycloplegic refractive error was measured using an autorefractor. Mean spherical equivalent calculated from the measured refractive error data in both eyes was used. The subjects were categorized into mild, moderate, or high refractive abnormality or emmetropia according to the degree of refractive error. The degree and distribution of refractive error in all subjects and age-matched subjects were analyzed. The change in refractive error was analyzed according to age. RESULTS: Mean refractive error of the study subjects was -1.82 diopters. As subject age increased, myopia increased from +0.04 diopters at 5 years of age to -2.88 diopters at 20 years of age. Myopia was observed in 66.2% of subjects and accounted for only 18.5% of the 5-year-old subjects, but increased to 84.3% in the 20-year-old subjects. The rate among all study subjects was -0.19 diopters per year. The greatest myopic progression rate (-0.46 diopters per year) among all age groups was in subjects 7 to 9 years of age. Myopic progression continued until 16 years of age. CONCLUSIONS: The ratio of pediatric myopia subjects between 5 and 20 years of age was high in Korea. The rate of myopic progression was the fastest in subjects 7 to 9 years of age. After 16 years of age, myopic change paused.