Clinical Outcome of Conjunctivodacryocystorhinostomy / 대한이비인후과학회지

Background and Objectives@#The conjunctivodacryocystorhinostomy (CDCR) is rarely performed in epiphora, which is caused by complete proximal bicanalicular obstruction. The purpose of this study is to analyze the characteristics, clinical results and complications of patients who underwent CDCR.Subjects and Method We enrolled 12 patients who underwent CDCR due to proximal canalicular obstruction from 2006 to 2019. We retrospectively analyzed the causes of epiphora, trauma history, the cause of revision operation and the clinical outcome. @*Results@#A total of 12 patients (7 males and 5 females) underwent CDCR (mean age 46 years). The causes of trauma were such as laceration (n=7, 58%) and iatrogenic (n=1, 8%), idiopathic obstruction (n=4, 33%). After the initial surgery, 5 patients (41%) were categorized in good outcome and the Jones tube was located well in 6 (50%) patients. Revision surgery was performed in 6 (50%) cases, with 4 cases having good outcome. The success rate of CDCR, including revision surgery, was increased to 83%. Most common cause of revision surgery was tube migration. In addition, the subjective outcome in patients with traumatic causes were worse but it had no statistical significance compared to that of patients with idiopathic and iatrogenic causes (p=0.07). @*Conclusion@#About a half of the patients had good recovery rate after the initial operation. The outcome increased to 83% after revision operation. The success rate of CDCR for traumatic patients was worse than for those with idiopathic and iatrogenic causes. It seems that accompanied eyelid damage in traumatic patients may have affected the result of success rate.

Comparison of Postoperative Results According to Fungus Ball Extension in Maxillary Sinus / 대한이비인후과학회지

Background and Objectives@#Fungus ball is the most common type of fungal sinusitis commonly associated with good prognosis. However, postoperative results depending on the extent of the lesion has not been investigated. This study aimed to identify differences in postoperative results depending on the location and extent of the fungus ball.Subjects and Method Medical records of 165 patients who underwent endoscopic sinus surgery and who were diagnosed with fungus balls by biopsy from 2010 to 2019 were retrospectively reviewed. Patients were classified into four grades according to the location and extent of the fungus ball based on their endoscopic and CT findings. Poor outcome is defined as any pathologic signs such as nasal secretion, granulation, and polyps or narrowing of the natural ostium observed postoperatively according to Kennedy’s criteria, whereas good outcome is defined as absence of pathologic signs. @*Results@#A total of 23 patients were Grade 1, 38 Grade 2, 67 Grade 3, and 37 Grade 4. Grades 1 and 2 were mostly asymptomatic. However, as the location of the fungus ball became closer to the natural ostium, patients complained postnasal drip and purulent discharge. Grades 3 and 4, who have much severe and more extensive lesions than those of Grades 1 and 2, had poor outcome (p=0.007) and took longer time to completely recover (p<0.001). @*Conclusion@#Wound healing was delayed and poor when the fungus ball was located closer to the natural ostium of the maxillary sinus. Therefore, preoperative consultation using endoscopic and CT findings could be useful for predicting their postoperative results.

Screening of A1555G mDNA Variant Using U-TOP™HL Genotyping Kit in Korean Family with Progressive Hearing Loss / 대한이비인후과학회지

Recently, real-time polymerase chain reaction (PCR) using the U-TOP™HL Genotyping Kit has been introduced to detect genetic hearing loss caused by certain type of gene variants popularly found in Korea. The mitochondrial 12S ribosomal ribonucleic acid (rRNA) genes are related to aminoglycoside induced or non-syndromic, sensorineural hearing loss. Among them, 1555A>G is commonly found and reported worldwide. We are presenting the case of a mother and a son, who were screened by real-time PCR using the U-TOP™HL Genotyping Kit and were found both to have the mitochondrial 12s rRNA 1555A>G variant with a different hearing loss phenotype. This report encourages clinicians to use this or similar screen methods for patients with familial hearing loss.

Primary Squamous Cell Carcinoma of the Orbit

PURPOSE: Normal squamous cells do not exist in the orbit. Therefore squamous cell carcinoma of the orbit is rare and usually arises as a secondary tumor from distant metastasis or local invasion. The authors herein describe the first case of primary squamous cell carcinoma of the orbit in Korea. CASE SUMMARY: A 74-year-old female presented with a 2-month history of left upper eyelid swelling and ocular pain. On physical examination, a round, firm, fixed and tender mass was palpable in the superomedial side of the left orbit. Magnetic resonance imaging (MRI) showed 21 mm x 15 mm x 20 mm-sized irregular soft tissue mass with indistinct margin and peripheral enhancement in the superomedial portion of the left orbit, and incisional biopsy of the mass was performed. Histopathological examination showed clusters of squamous cells with polymorphic nuclei and interspersed keratin pearls, consistent with findings of well-differentiated squamous cell carcinoma. Despite extensive systemic work-up, there was no sign of extraorbital malignancy. The patient received left exenteration and adjuvant radiation therapy. Ten months after enucleation, a 12 mm x 14 mm sized firm mass developed on the left forehead, and excisional biopsy and frontalis rotational flap reconstruction were performed. Histopathological examination of the mass was consistent with well-differentiated squamous cell carcinoma. The patient remained alive 17 months after diagnosis without evidence of local recurrence or distant metastasis. CONCLUSIONS: Primary squamous cell carcinoma should be considered in the differential diagnosis of acutely progressing tumors of the orbit.

Dacryocystographic Findings in Unilateral Epiphora with Patent Lacrimal Drainage System

PURPOSE: To evaluate the morphologic change in the lacrimal drainage system using dacryocystography in patients with unilateral epiphora with patent lacrimal drainage system. METHODS: Clinical records of patients referred to our clinic for epiphora between October 2007 and August 2011 were reviewed. The study group included 38 patients who had symptoms of unilateral epiphora with patent lacrimal drainage system. The studied patients included 10 males and 28 females with ages varying between 24 and 72 years. RESULTS: Abnormal dacryocystographic findings in the tearing eye were 78.9% and abnormal dacryocystographic findings in the asymptomatic eye were 47.4%. Common abnormal findings included distal nasolacrimal duct stenosis, distal nasolacrimal duct dilatation and nasolacrimal sac dilatation. CONCLUSIONS: In many cases, morphologic change in the lacrimal drainage system was observed in patients with unilateral epiphora with patent lacrimal drainage system. Dacryocystographic findings may contribute in devising a treatment plan for these patients.

Eccrine Ductal Carcinoma Arising in the Eyelid

PURPOSE: Eccrine ductal carcinoma is an extremely rare tumor that arises in the eccrine sweat glands. The authors of the present study describe a case of an eyelid mass diagnosed as eccrine ductal carcinoma. CASE SUMMARY: A 74-year-old woman visited our institute with a 3-month history of a mass in the left medial canthus. The lesion appeared as a solitary nodule with central ulceration. A magnetic resonance imaging (MRI) of the orbit showed a relatively well enhanced 0.8 cm x 0.8 cm-sized ovoid soft tissue mass. A mass excision was performed under frozen section control. The tumor was completely excised with margin clearance and medial canthal reconstruction was performed. Histopathological examination revealed a tumor composed of numerous duct-like structures lined with pleomorphic cuboidal epithelium that was diagnosed as eccrine ductal carcinoma of the eyelid. CONCLUSIONS: This is the first description of eccrine ductal carcinoma in a patient in Korea. The possibility of the eccrine ductal carcinoma should be considered in the differential diagnosis in an elderly patient with an eyelid mass.

Correlation Between Multifocal Electroretinography and Visual Acuity After Resolution of Diabetic Macular Edema

PURPOSE: To evaluate the prognostic value of multifocal electroretinography (mfERG) after a decrease of retinal thickness in eyes with diabetic macular edema (DME). METHODS: Sixty patients (60 eyes) underwent intravitreal injection of triamcinolone acetonide or bevacizumab for diabetic macular edema. Eyes were divided into three groups, according to foveal thickness : Group A (==800 micrometer, n=20 eyes). Best-corrected visual acuity (BCVA) and mfERG responses from the most central seven hexagons were analyzed both before and after treatment. RESULTS: The pre-injection P1 amplitudes of mfERG correlated significantly with end-point BCVA in Groups A and B (p0.05) in Group C. CONCLUSIONS: The level of P1 amplitudes of mfERG may be a useful tool to predict visual outcomes after a decrease of retinal thickness in patients with diabetic macular edema.

A Case of Dislocation of the Globe into the Maxillary Sinus after Orbital Wall Fracture

PURPOSE: We report a case of a 38-year-old man who suffered a blowout fracture of the orbital wall with an intact eyeball entrapped within the maxillary sinus after trauma. CASE SUMMARY: The 38-year-old man was admitted to the emergency room after sustaining a work-related trauma. His chief complaints were loss of vision and bleeding from the left periorbital area. He had no light perception and no eyeball was found in the orbit. Facial CT revealed that the intact eyeball was entrapped within the maxillary sinus. The condition of the optic nerve was difficult to ascertain. Ten hours after post-trauma, reduction surgery was done with a graft from the iliac bone. Ruptured extraocular muscles were not primarily sutured. After four months, vitrectomy was performed on the left eye. The eyeball was repositioned in its place. He had no light perception. Extraocular motility improved at the last follow-up examination. CONCLUSIONS: We report the dislocation of the eyeball globe into the maxillary sinus after a blowout fracture. Visual acuity showed no light perception as a result of central retinal artery occlusion and optic nerve injury. We were able to obtain a good aesthetic and functional result after the operation.

Multifocal Electroretinography After Reattachment of Macula-Off Retinal Detachment

PURPOSE: To assess macular function by multifocal electroretinography after reattachment of macula-off retinal detachment and to evaluate relationship between duration of macular detachment (DMD) and functional recovery. METHODS: Nineteen patients (19 eyes) with macula-off rhegmatogenous retinal detachment underwent pneumatic retinopexy or scleral buckling. Retinal reattachment was obtained successfully in all patients. Duration of follow-up of all patients is at least more than 12 months. Eyes were divided into 2 groups, corresponding to the DMD : Group A (within 7 days, n=9 eyes), Group B (>7 days, n=10 eyes). The amplitudes and implicit times of N1-wave and P1-wave of mfERGs in Area 1 (Ring 1), Area 2 (Ring 1+2) were compared between Group A and B and between Group A and control group. RESULTS: The P1 amplitudes in Area 1 and 2 were significantly different between Group A and B (P0.05). There were no significant difference of all data between Group A and control in Area 1 and 2 (P>0.05) The implicit times of N1, P1 were not significantly different between Group A and B. CONCLUSIONS: The DMD plays a key role in recovery of visual function after reattachment. The mfERG is a useful tool to evaluate the recovery of macular function after reattachment of macula-off retinal detachments.

Results of Trabeculectomy Using Modified Scleral Flap Suture Technique in Comparison with Standard Trabeculectomy

PURPOSE: To evaluate the efficacy of trabeculectomy using modified scleral flap suture technique METHODS: We retrospectively reviewed the medical records of 52 patients (55 eyes) who had undergone trabeculectomy from January 2003 to January 2007. Standard trabeculectomy was performed for 29 eyes of 27 patients, modified trabeculectomy for 26 eyes of 25 patients. We changed suture site of scleral flap corner about 1mm medially from original site and added tight suture to both lateral margins of scleral flap to prevent overflow in modified group. In both groups, most of patients were injected 0.1 ml of 0.02 mg/ml mitomycin-C (MMC) subconjunctivally and the others 0.1 ml of 0.04 mg/ml MMC. We evaluated intraocular pressure (IOP), complication, morphology of filtering bleb, cumulative success rates. RESULTS: Argon laser suturelysis was performed postoperatively in about half cases of both groups. The IOPs of modified group were consistently lower than those of standard group for 24 months except postoperative 1 day and 1 week. There was a significant difference of IOP at postoperative 2 months and 12 months (p<0.05). No significant difference of complications was found between two groups. The diffuse bleb with microcyst was found in 19 eyes (73%) of modified group and 17 eyes (59%) of standard group. From Kaplan-Meier survival analysis, cumulative success rates of modified group were higher than those of standard group (p<0.05). CONCLUSIONS: Trabeculectomy using modified scleral flap suture appears to give better IOP control than standard trabeculectomy.

A Case of Optic Neuropathy Associated with MELAS Syndrome

PURPOSE: The purpose of this case report is to describe accompanying ocular findings, especially optic neuropathy, in a patient with MELAS syndrome. METHODS: A 10-year-old male patient who had lactic acidosis and neurological symptoms (loss of consciousness, vomiting, epilepsy, decreased vision, and constricted visual field), underwent a brain magnetic resonance imaging (MRI) scan and a molecular genetic analysis. RESULTS: A diagnosis of cerebral infarction due to occlusion in the right posterior cerebral artery was made and confirmed by MRI scan. The diagnosis of MELAS syndrome was confirmed by performing molecular genetic analysis demonstrating the transformation of the mitochondrial tRNAleu(UUR) gene (MTTL1) A to G(3243). According to the ocular examinations, the patient's left eye showed decreased vision, hemianopsia, relative afferent pupillary defects, mild swelling of optic nerve, and decreased amplitude on visual evoked potential exam. CONCLUSIONS: We encountered a case of MELAS syndrome involving optic neuropathy, which can (although rarely) occur with this syndrome. Therefore, in patients with an optic neuropathy of uncertain etiology, clinicians should consider performing comprehensive ocular exams and molecular genetic exams to rule out the possibility of genetic diseases.

A Case of Optic Neuropathy Associated with MELAS Syndrome

PURPOSE: The purpose of this case report is to describe accompanying ocular findings, especially optic neuropathy, in a patient with MELAS syndrome. METHODS: A 10-year-old male patient who had lactic acidosis and neurological symptoms (loss of consciousness, vomiting, epilepsy, decreased vision, and constricted visual field), underwent a brain magnetic resonance imaging (MRI) scan and a molecular genetic analysis. RESULTS: A diagnosis of cerebral infarction due to occlusion in the right posterior cerebral artery was made and confirmed by MRI scan. The diagnosis of MELAS syndrome was confirmed by performing molecular genetic analysis demonstrating the transformation of the mitochondrial tRNAleu(UUR) gene (MTTL1) A to G(3243). According to the ocular examinations, the patient's left eye showed decreased vision, hemianopsia, relative afferent pupillary defects, mild swelling of optic nerve, and decreased amplitude on visual evoked potential exam. CONCLUSIONS: We encountered a case of MELAS syndrome involving optic neuropathy, which can (although rarely) occur with this syndrome. Therefore, in patients with an optic neuropathy of uncertain etiology, clinicians should consider performing comprehensive ocular exams and molecular genetic exams to rule out the possibility of genetic diseases.