Agreement between Two Swept-Source Optical Coherence Tomography Biometers and a Partial Coherence Interferometer

Purpose@#To evaluate the level of agreement between ANTERION (Heidelberg Engineering, Heidelberg, Germany), OA-2000 (Tomey, Nagoya, Japan), and IOLMaster 500 (Carl Zeiss AG, Jena, Germany). @*Methods@#Fifty-one eyes of 51 patients were included in the study. Flat keratometry (K) and steep K, vector component of astigmatism (Jackson cross-cylinder at 0° and 90° [J0] and Jackson cross-cylinder at 45° and 135° [J45]), anterior chamber depth, and axial length were compared using the three devices. Repeated measures analysis of variance was conducted to compare the mean values of the biometrics. Pearson correlation test was conducted to analyze the correlations of the measured values, and a Bland-Altman plot was used to assess the agreement between the three devices. The predicted intraocular lens power of each device was compared to the others using the SRK/T, Haigis, Barrett Universal II, and Kane formulas. @*Results@#All K values measured using ANTERION were flatter than those of other instruments. However, good agreement was observed for flat K (ANTERION - OA-2000; 95% limits of agreement [LoA], 0.86 diopters [D]) and steep K (ANTERION - OA2000; 95% LoA, 0.93 D) and OA-2000 - IOLMaster 500 (95% LoA, 0.93 D). J0 and J45 vector components of astigmatism were not statistically different; however, the agreements were poor between the devices (95% LoA ≥1.97 D). Anterior chamber depth values of ANTERION and OA-2000 were interchangeable (95% LoA, 0.15 mm). The axial length showed a high agreement (95% LoA ≤0.17 mm) among the three devices. The predicted intraocular lens powers of the three devices were not interchangeable regardless of formulas (95% LoA ≥1.04 D). @*Conclusions@#Significant differences in ocular biometrics were observed between ANTERION and the other two devices. This study demonstrated that only axial length showed good agreement among devices.

Meibomian Gland Dysfunction Associated with Bortezomib in a Multiple Myeloma Patient

Purpose@#This study reports a case of meibomian gland dysfunction associated with bortezomib, which is a treatment of choice for multiple myeloma.Case summary: A 59‐year‐old female patient presented to our hospital with a complaint of dryness that had worsened for 2 months and eye discharges that were difficult to remove even after washing her face. The patient had been diagnosed with multiple myeloma 5 months prior and had undergone four cycles of bortezomib therapy. Slit‐lamp microscopy revealed a number of pouting of the meibomian gland (MG) orifices in both eyes. Meibography revealed that more than one‐third and less than twothirds of the total MG area of both upper lids were lost and more than two‐thirds of the total MG area of both lower lids were lost. No clinically significant improvements were noted at 8 months despite thorough eyelid hygiene therapy, including warm compresses, topical antibiotics, steroids, and artificial tears. However, when the patient revisited our clinic 2 months after completing bortezomib treatment, the subjective symptoms had improved and all of the pouting of MG orifices had disappeared. There was no significant difference in the MG dropout area for either eye compared with the observations from a previous visit during bortezomib treatment. @*Conclusions@#Clinicians should be aware that MG dysfunction may occur or worsen in patients receiving bortezomib treatment and should consider this when establishing a treatment plan for meibomian dysfunction or when educating patients.

Use of Topical Cyclosporin and Tacrolimus for Recurrent Subepithelial Infiltrates after Epidemic Keratoconjunctivitis

Purpose@#To report a case of recurrent subepithelial infiltrates (SEIs) after epidemic keratoconjunctivitis (EKC), which improved with the use of topical cyclosporin and tacrolimus.Case summary: A 33‐year‐old female patient with bilateral EKC developed multiple SEIs, which were worse in the left eye, after applying topical antibiotics and steroid for 3 weeks. She was administered 0.5% loteprednol etabonate every 2 hours, which was gradually tapered to once a day, and 0.1% cyclosporine once daily. However, the SEIs recurred. Therefore, 0.1% cyclosporine was administered twice a day in both eyes and the frequency of administration of steroid eye drops was increased. The dose of steroid eye drops was reduced, but two attempts to taper the dose failed. SEIs in the right eye improved with the use of 0.1% cyclosporine. However, SEIs in the left eye recurred on tapering the steroid dose. Therefore, topical 0.02% tacrolimus ointment was administered once daily in the left eye. After 2 weeks of using tacrolimus, the topical steroids were discontinued. SEIs were well‐controlled for 6 months with 0.1% cyclosporine administered 1‐2 times/day in the right eye and 0.02% tacrolimus administered 1 time/3 days in the left eye. @*Conclusions@#Topical cyclosporine and tacrolimus can minimize the requirement for steroids, and treat chronic and recurrent SEIs after EKC.

Agreement between Scheimpflug Camera and the Swept-source Optical Coherence Tomography Measurements in Keratometry and Higher-order Aberrations

Purpose@#To evaluate the compatibility of corneal curvature and astigmatism, and higher-order aberrations (HOAs) measured by the Scheimpflug camera Pentacam HR and the swept-source optical coherence tomography ANTERION. @*Methods@#This prospective study included normal subjects with no ophthalmic history. Steep keratometry (K), flat K, astigmatism and its axis of the anterior and posterior surfaces, total corneal power, and HOAs using the two instruments were compared. To compare the mean values of the measurements, a paired t-test was used. Bland-Altman analysis was applied to assess the agreement between the two devices. @*Results@#Fifty-three eyes of 53 subjects were evaluated. There were statistically significant differences for steep K, astigmatism, and vector J0, J45 in the anterior surface and total corneal power between the two devices (p 0.81, p 0.78, p 0.37, p < 0.05). Most HOAs, except for the horizontal trefoil, showed clinically acceptable agreements. The total root mean square of HOAs was not significantly different between the two devices (p = 0.122). @*Conclusions@#Most of the keratometric values cannot be used interchangeably. However, the vectoral component of astigmatism showed clinically good agreement. Several HOAs have statistically significant differences; however, almost all HOAs showed acceptable agreements, except for the horizontal trefoil.

Agreement between Scheimpflug Camera and the Swept-source Optical Coherence Tomography Measurements in Keratometry and Higher-order Aberrations

Purpose@#To evaluate the compatibility of corneal curvature and astigmatism, and higher-order aberrations (HOAs) measured by the Scheimpflug camera Pentacam HR and the swept-source optical coherence tomography ANTERION. @*Methods@#This prospective study included normal subjects with no ophthalmic history. Steep keratometry (K), flat K, astigmatism and its axis of the anterior and posterior surfaces, total corneal power, and HOAs using the two instruments were compared. To compare the mean values of the measurements, a paired t-test was used. Bland-Altman analysis was applied to assess the agreement between the two devices. @*Results@#Fifty-three eyes of 53 subjects were evaluated. There were statistically significant differences for steep K, astigmatism, and vector J0, J45 in the anterior surface and total corneal power between the two devices (p 0.81, p 0.78, p 0.37, p < 0.05). Most HOAs, except for the horizontal trefoil, showed clinically acceptable agreements. The total root mean square of HOAs was not significantly different between the two devices (p = 0.122). @*Conclusions@#Most of the keratometric values cannot be used interchangeably. However, the vectoral component of astigmatism showed clinically good agreement. Several HOAs have statistically significant differences; however, almost all HOAs showed acceptable agreements, except for the horizontal trefoil.

The Effect of Eyeliner Tattoo on Meibomian Gland Dysfunction and the Ocular Surface

PURPOSE: To determine whether eyeliner tattoo affects the meibomian gland (MG) and ocular surface.METHODS: The medical charts of an eyeliner tattoo group (16 eyes of 8 patients) and a control group (16 eyes of 18 patients) were retrospectively reviewed. The ocular surface disease index questionnaire, ocular surface staining score, tear film break-up time (TBUT), upper eyelid abnormality, meibum expressibility and quality, and MG loss and tear film lipid layer thickness (LLT) which measured with LipiView® (TearScience, Morrisville, NC, USA) were compared. In the tattoo group, the correlation between the distance from the MG orifice to the tattoo pigment and other indices were analyzed.RESULTS: Compared to controls, the tattoo group had a significantly higher ocular surface disease index (p = 0.002), shorter TBUT (p < 0.001), higher vessel engorgement of the upper lid (p = 0.016), poorer meibum expressibility and quality (p = 0.006 and p < 0.001, respectively), higher MG loss (p < 0.001), and thinner LLT (p = 0.024). In the tattoo group, the closer the tattoo was to the MG orifice, the more the upper lid vessel was engorged and the more MG loss occurred (r(s) = −0.560, p = 0.024; r(s) = −0.563, p = 0.023, respectively), and a thinner LLT was observed (r(s) = 0.567, p = 0.022).CONCLUSIONS: Eyeliner tattoos may be related to changes in the lid margin, loss of the MG, and thinning of the LLT.

Report of Bilateral Acute Angle-closure Crisis Induced by Serotonin-norepinephrine Reuptake Inhibitors

PURPOSE@#This study reports a case of bilateral acute angle-closure crisis induced by two kinds of serotonin-norepinephrine reuptake inhibitors (SNRIs), duloxetine and tramadol.CASE SUMMARY: A 55-year-old female visited our clinic, complaining of bilateral visual impairment, ocular pain, and headache, which began 2 days after taking several drugs including duloxetine and tramadol for the purpose of back pain relief. On the day of the first visit, her uncorrected visual acuity was 0.04 in the right eye and 0.02 in the left eye, and the intraocular pressure (IOP) was 45 mmHg in the right eye and 51 mmHg in the left eye. The anterior chamber was shallow and the anterior chamber-angle was closed in both eyes on gonioscopy. There was mild nuclear sclerosis of both lenses. Assuming drug-induced bilateral acute angle-closure crisis, all medications were discontinued, and IOP-lowering agents were prescribed. The symptoms, visual acuity, and IOP improved; however, both anterior chambers were still shallow and the iridocorneal angle was still closed in both eyes. Laser iridotomy was tried in the right eye but failed because the pupils were not completely constricted, and iris bleeding occurred. Phacoemulsification and posterior chamber lens insertion were conducted in both eyes, and her visual acuity, IOP, anterior chamber depth, and iridocorneal angle have been stable at 9 months since her first visit.@*CONCLUSIONS@#The combined administration of SNRI may cause bilateral acute angle-closure attacks.

Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients

PURPOSE: To evaluate the morphological changes of meibomian glands and dry eye syndrome in patients with type II diabetes. METHODS: The medical records of 72 diabetic patients referred to the ophthalmology clinic for the evaluation of diabetic retinopathy, who had dry eye symptoms, were retrospectively reviewed. RESULTS: A total of 72 patients, with an age of 56.3 ± 13.3 years, were analyzed. The group with diabetic retinopathy (52 patients) had a significantly lower tear film break-up time (p = 0.046), lower Schirmer's test value (p = 0.005), and higher percentage of upper (p = 0.036) and lower (p = 0.017) meibomian gland area losses than the group without diabetic retinopathy (20 patients). According to multilinear regression analyses considering sex, age, and diabetes-related characteristics, the Schirmer's test value was significantly lower with increasing stage of diabetic retinopathy (β = −1.180, p = 0.016). The percentage of upper meibomian gland area loss was significantly increased with increasing age (β = 0.605, p < 0.001), glycosylated hemoglobin (β = 1.881, p = 0.011), and stage of diabetic retinopathy (β = 4.458, p = 0.001). The percentage of lower meibomian gland loss area was significantly increased with increasing age (β = 0.443, p = 0.001) and stage of diabetic retinopathy (β = 4.879, p = 0.001). CONCLUSIONS: In patients with type 2 diabetes, the more severe the diabetic retinopathy, the more likely the meibomian gland loss will occur, so careful and appropriate treatment should be conducted.

Repeatability and Reproducibility of Tear Meniscus Evaluations Using Two Different Spectral Domain-optical Coherence Tomography

PURPOSE: To evaluate the repeatability and reproducibility of inferior tear meniscus measurements using two different spectral domain-optical coherence tomography (OCT), and to compare the inter-device agreements between these devices. METHODS: Two examiners evaluated the tear meniscus depth (TMD) and tear meniscus height (TMH) of 20 eyes in 20 normal subjects using Cirrus OCT and Spectralis OCT with the examiners calculating the TMD and TMH. We analyzed intra-examiner repeatability, inter-examiner reproducibility, and inter-device agreement. RESULTS: The average TMD measurements using the Cirrus OCT and Spectralis OCT devices were 151.25 ± 41.53 µm and 139.10 ± 40.56 µm by examiner 1, respectively, and 152.03 ± 42.77 µm and 138.35 ± 39.70 µm by examiner 2, respectively. The TMHs were 291.90 ± 100.19 µm and 245.43 ± 66.44 µm by examiner 1, respectively, and 288.25 ± 98.72 µm and 244.23 ± 60.69 µm by examiner 2, respectively. The TMDs and TMHs measured using these OCT devices were not statistically significant for intra-examiner and inter-examiner measurements (all, p > 0.05). These devices showed high repeatability (intraclass correlation coefficient ≥ 0.991) for intra-examiner TMD and TMH measurements and the inter-examiner coefficient of variation ranged from 2.04% to 4.32%. The 95% limits of agreement between the two devices were −66.13 to 91.95 µm for TMD and −127.18 to 217.68 µm for TMH. CONCLUSIONS: Both OCT devices are useful for conducting inferior tear meniscus measurements. The inter-device agreement was poor, and the devices were not interchangeable.

Distribution and Characteristics of Meibomian Gland Dysfunction Subtypes: A Multicenter Study in South Korea

PURPOSE: We sought to evaluate the distribution and characteristics of meibomian gland dysfunction (MGD) and the treatment patterns for symptomatic MGD patients in South Korea. METHODS: One hundred ninety-six right eyes of 196 MGD patients were enrolled. For each patient, meibum expressibility in the central eight glands in both the upper and lower eyelids was examined. Each upper and lower eyelid was separately classified into one of the following three subtypes: nonobvious obstructive (low-delivery without lid margin abnormality), obvious obstructive (low-delivery with lid margin abnormality), and hypersecretory (high-delivery with lid margin abnormality). All treatment plans were also recorded. RESULTS: The mean number of expressible glands of the central eight glands in the upper eyelids (3.9 ± 2.6) was significantly higher than that in the lower eyelids (2.2 ± 2.4, p < 0.001). Obvious obstructive MGD was the most common subtype, followed by the hypersecretory and nonobvious obstructive subtypes in both the upper and lower eyelids. Of the 196 subjects, 38 (19.4%) had upper and lower eyelids that were assigned to different categories. Eyelid hygiene was the most prescribed treatment (74.5%), followed by lubricant eye drop usage (71.5%). Physicians tended to determine treatment plans based on the subtype of the upper eyelid rather than that of the lower eyelid. CONCLUSIONS: The majority of subjects were classified as having the obvious obstructive subtype of MGD, and 19.4% had upper and lower eyelids that were different subtypes. Eyelid hygiene was the most prescribed treatment for MGD patients, and treatment patterns were mostly determined based on the subtype of the upper eyelids.

Medical Litigations Associated with Cataract Surgery in Korea

BACKGROUND: To analyze the results of court rulings about medical litigations related to cataract surgery in Korea. METHODS: We collected 50 anonymized judgements regarding cataract surgery between 2000 and 2016 and analyzed the reasons for the medical litigations, the court rulings, the reasons for compensation, and the amount claimed and finally awarded. RESULTS: Forty-eight litigations (96%) resulted from errors in treatment, and the reasons were as follows: endophthalmitis, dissatisfaction of visual outcome or ocular discomfort, bullous keratopathy or corneal opacity, retinal detachment, glaucoma or vitreous hemorrhage due to the progression of an underlying diabetic retinopathy, and others in order. Two litigations (4%) arose due to errors in diagnosis. Among the 50 final cases, 21 litigations (42%) were decided in favor of the plaintiff, and 29 litigations (58%) were decided against the plaintiff and dismissed. Ten cases awarded damages to the plaintiffs because of a violation of duty of care, and 11 cases awarded damages due to a violation of informed consent. When comparing cases with errors in diagnosis to cases with errors in treatment, there was no significant difference in the relative risk of a defendant's verdict (P = 0.503). The total amount of awarded damages was KRW 439,124,496 (USD 399,204), and the average amount was KRW 20,910,690 (USD 19,010). CONCLUSION: Nearly half of the cases were decided in favor of the plaintiff due to the violation of informed consent. This study's results will be helpful in understanding the results of medical litigations regarding cataract surgery and reducing future lawsuits.

A Case of Recurrent Scleritis Associated with Menstrual Cycle

PURPOSE: To describe a case of recurrent scleritis associated with a patient's menstrual cycle. CASE SUMMARY: A 27-year-old woman presented to our ophthalmology department with redness and pain in her left eye over 2 days. She received laser-assisted in situ keratomileusis surgery for both eyes 6 years prior and was diagnosed with scleritis in her left eye 3 years prior. She was referred to rheumatologic department to determine if she had auto-immune disease, but the systemic review was negative. She was diagnosed with idiopathic scleritis and was treated with oral Methylprednisolone to provide symptom relief. However, her symptoms exhibited a recurrent pattern. These symptoms regularly affected her during the 2-3 days before menstruation, which had been occurring for more than 10 years, beginning when she was a middle school student. The symptoms affected both eyes and did not improve when treated with topical non-steroid anti-inflammaroty drugs (NSAIDs), topical steroids, or oral NSAIDs. However, her symptoms were relieved when treated with oral steroids. Beginning with her pregnancy and extending through her delivery and breast-feeding periods, follow up had been interrupted, but she noted that recurrence episodes were rare during this time. To this day, her symptoms appear once per month and are controlled through oral steroids. CONCLUSIONS: Literature reviews have revealed no such case reports regarding recurrent scleritis associated with the female menstrual cycle. If cyclic recurrence of scleritis episodes is present in a female patient, a careful history should be taken in order to evaluate any possible associations with the menstrual cycle.

Progression of Visual Field Loss and Body Mass Index in Normal Tension Glaucoma

PURPOSE: To evaluate the association between body mass index (BMI) and visual field (VF) progression in normal tension glaucoma (NTG) patients. METHODS: We reviewed the medical records of 78 eyes of 78 NTG patients who were treated with eye drops for more than 18 months. Age, sex, existence of hypertension (HTN), diabetes mellitus (DM), refractive error, baseline intraocular pressure (IOP), IOP reduction ratio, baseline VF indices including mean deviation (MD) and pattern standard deviation, VF progression rate (MD slope, dB/year), number of eye drops, and BMI were analyzed. The progression of VF was determined by glaucoma change probability analyses (STATPAC 2) using a Humphrey field analyzer. RESULTS: The mean follow-up in consecutive eyes was 4.4 ± 2.7 years. A total of 18 eyes showed progression and 60 eyes did not. The VF progression rate (p 0.05). However, multiple linear regression analyses showed that a lower BMI was significantly associated with faster VF progression in the progression group (β = 0.078; standard error = 0.030; p = 0.027). CONCLUSIONS: In the group in which VF loss progressed despite treatment with eye drops, a lower BMI was associated with progression of VF loss in NTG patients.

Corneal Thickness Measurements Using 2 Kinds of Spectral Domain Optical Coherence Tomography, Pentacam, Ultrasound Pachymetry

PURPOSE: To compare the measurements of central corneal thickness (CCT) obtained using two kinds of spectral domain optical coherence tomography (OCT), Pentacam®, and ultrasound pachymetry (USP). METHODS: CCT was measured by Cirrus OCT®, Spectralis OCT®, Pentacam®, and USP in 32 eyes from 32 subjects without ocular disease of the anterior segment. RESULTS: The average CCT measurements using Cirrus OCT®, Spectralis OCT®, Pentacam®, and USP were 549.2 ± 28.7 µm, 545.2 ± 25.4 µm, 554.0 ± 27.8 µm, and 548.4 ± 27.9 µm respectively. The measurements were significantly highly correlated with each other (Pearson's correlation coefficient r > 0.9, all p-values < 0.001), but were significantly different (p < 0.001). The CCT 95% limits of agreement between Cirrus OCT® and Spectralis OCT®, Cirrus OCT® and Pentacam®, Cirrus OCT® and USP, Spectralis OCT® and Pentacam®, and Spectralis OCT® and USP were 27.70 µm, 26.1 µm, 26.97 µm, 22.91 µm, 35.59 µm, and 32.15 µm, respectively. CONCLUSIONS: The CCT values measured using the four devices were highly correlated with each other, but the measurement using Pentacam® was significantly thicker than that using USP. The measurements of the two kinds of spectral domain OCT were similar to those using USP. Therefore, these differences should be considered in clinical use, and measurements cannot be considered interchangeable.

Measurement of Precorneal Tear Film Using Scheimpflug Camera and Relationship with Parameters for Dry Eye

PURPOSE: To compare the anterior segment parameters including precorneal tear film thickness (PTFT) using Pentacam(R) (Oculus, Wetzlar, Germany) between normal control and dry eye groups and to examine the relationships between the PTFT and other parameters for dry eye. METHODS: The present study included 23 normal controls (31 eyes) and 25 patients with dry eyes (31 eyes). We compared measurements including PTFT, corneal thickness and astigmatism using Pentacam(R) and analyzed the correlations among the PTFT and fluorescein tear break-up time (FBUT), Schirmer I test (without anesthesia), and ocular surface disease index (OSDI). RESULTS: The mean PTFT in dry eyes (21.1 +/- 2.0 microm) was significantly thinner than in normal eyes (37.6 +/- 2.0 microm; p < 0.01). In the dry eye group, the corneal thickness was thicker than in the normal eye group but there were no clinically significant differences. The dry eye group experienced more frequent and severe corneal astigmatism compared with the normal group. OSDI scores showed a weak negative correlation with objective clinical measures of dry eye (FBUT, Schirmer I test) but was not statistically significant. However, OSDI was statistically significantly negatively correlated with PTFT (r = -0.46, p < 0.01). The PTFT showed a weak positive correlation with FBUT and Schirmer I test without statistical significance. CONCLUSIONS: The mean PTFT using Pentacam(R) in the dry eye group was thinner than in the normal group. Additionally, the PTFT was correlated with subjective symptoms. Therefore, the PTFT measurement using Pentacam(R) could be considered a useful method for diagnosis and treatment of dry eye.

Comparison of Corneal Higher-Order Aberrations Measured with Two Instruments Using Scheimpflug Camera System

PURPOSE: To compare the corneal higher-order aberrations (HOAs) of normal young subjects using Galilei(TM) G4 (Zeimer, Port, Switzerland) and Pentacam(R) (Oculus Inc., Wetzlar, Germany). METHODS: Corneal HOAs were measured using Galilei(TM) G4 and Pentacam(R) in 41 healthy individuals (41 eyes). Intraclass correlation coefficients (ICCs) were obtained to evaluate the repeatability of the 2 devices. Differences in HOAs between the 2 instruments were analyzed with a paired t-test and correlations evaluated. RESULTS: All ICCs measured using Galilei(TM) G4 and Pentacam(R) showed more than moderate repeatability (>0.81) except trefoil, tetrafoil, 4th and 5th HOAs. When comparing the measurements obtained with Galilei(TM) G4 and Pentacam(R), total HOAs, spherical aberration (SA), secondary astigmatism and 5th total HOAs were statistically significantly different between the 2 device (all p < or = 0.001). In addition, Galilei(TM) G4 and Pentacam(R) showed discrepancy among all corneal HOAs items. Although the total corneal HOAs and the SA were significantly correlated, other HOA measurements generally exhibited a low correlation. CONCLUSIONS: Corneal HOAs obtained by the 2 instruments cannot be used interchangeably due to their differences and discrepancy although corneal HOAs measured using Galilei(TM) G4 and Pentacam(R) showed relatively high repeatability.

Relationship between Dry Eye Parameters and Anterior Corneal Higher-Order Aberrations Measured by Two Different Instruments

PURPOSE: To compare the corneal first surface higher-order aberrations (HOAs) of normal subjects and patients with dry eye using KR-1W(R) (Topcon Corp., Tokyo, Japan) and Pentacam(R) HR (Oculus Inc., Dutenhofen, Germany). We analyzed the relationship between the aberrations and the diagnostic parameters of dry eye. METHODS: We evaluated anterior corneal HOAs in 71 normal eyes and 71 dry eyes using KR-1W(R) and Pentacam(R). Dry eye patients were examined for fluorescein staining, tear break-up time (TBUT), and Schirmer I test. Ocular Surface Disease Index (OSDI) was used for assessment of subjective symptoms in dry eye patients. RESULTS: HOAs measured by both instruments were greater in the dry eye group than in the control group, although HOAs using KR-1W(R) only achieved statistical significance. The anterior corneal HOAs measured by the 2 instruments were significantly correlated with superficial punctate keratitis. Moreover, TBUT and the Shirmer I test negatively correlated, and OSDI positively correlated, with anterior corneal HOAs. CONCLUSIONS: The HOAs in patients with dry eye were significantly different from controls and tended to increase with disease severity. KR-1W(R) might be more useful than Pentacam(R) to detect tear film instabilities.

A Case of an Isolated Abscess in an Extraocular Muscle

PURPOSE: To report the case of an isolated abscess in an extraocular muscle. CASE SUMMARY: We report a case of an isolated abscess in an extraocular muscle in a patient who was treated with systemic chemotherapy for precursor B lymphoblastic leukemia. A 54-year-old female who had undergone systemic chemotherapy for precursor B lymphoblastic leukemia presented with right ocular pain and limited eye movements. On ophthalmic examination, she had elevated intraocular pressure (IOP) and limited upward and downward gaze. MRI (magnetic resonance imaging) examination revealed an isolated abscess in right inferior rectus muscle. Although the patient was treated with empirical intravenous antibiotics and IOP-lowering agents, the size of the abscess increased, as confirmed by MRI findings. Therefore, we performed a pus drainage procedure by the transconjunctival approach. We were not able to find any residual abscess lesions on CT scans 3 months postoperatively. The patient's ocular pain disappeared and the limited eye movements improved significantly 6 months postoperatively. CONCLUSIONS: There have been no case reports of an isolated abscess in an extraocular muscle in Korea. For immunocompromised patients unresponsive to systemic empirical antibiotic treatment, an early pus drainage procedure by the transconjunctival approach may be a useful and effective therapeutic method in the management of an idiopathic isolated abscess in an extraocular muscle.

Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

PURPOSE: To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients under 50 years of age versus patients 50 years of age or older at the time of diagnosis. METHODS: A retrospective chart review was performed of 102 patients who were diagnosed with HZO between January 1, 2008 and December 31, 2010. Baseline demographics and clinical characteristics between patients with an onset of HZO under the age of 50 years and patients with an onset of HZO at the age of 50 years or older were compared. RESULTS: Similar numbers of patients were affected with HZO in the younger and older age groups (n = 44, 43.1%, vs. n = 58, 56.9%). The mean +/- SD of age was 50.6 +/- 21.8 years (range, 3-89 years) and the most common decade of HZO onset was between 50 and 59 years. Gender and disease laterality were not statistically different between the 2 groups. No significant difference was found regarding the presence of any ocular manifestation between the groups; however, anterior uveitis was more frequent in the younger patients (p = 0.04). The number of patients with immunosuppressive therapy was higher in the younger age group (p = 0.01). CONCLUSIONS: HZO-affected patients under the age of 50 years and older than 50 years were equally distributed, with the most common decade of onset between the age of 50 and 59 years. Younger patients had a higher incidence of anterior uveitis and immunosuppressive therapy due to underlying systemic diseases.

A Case of Intramuscular Hemanagiomas of Upper Eyelids

PURPOSE: We report a case of intramuscular hemangioma (IMH) in upper eyelid-misdiagnosed as pseudotumor-along with its pathologic findings. CASE SUMMARY: A 48-year-old male patient presented with three months of upper eyelid swelling in his left eye of no symptom relief with oral corticosteroid for 5 weeks. Computed tomography findings show diffuse enhancement in left upper eyelid suggested for pseudotumor and retreated with oral corticosteroids and intralesional corticosteroid injections. However, lid inflammation was not improved. The patient underwent incisional biopsy. CONCLUSIONS: Microscopically, the lesion was composed of proliferating vessels of various sizes between the individual muscle fibers. Intramuscular hemangioma that is rarely presented benign tumor in the head and neck region can be presented by diffuse swelling mimicking the pseudotumor rather than a palpable mass.