A Comparison of Axial Length, Keratometry, and Measured White-to-white Using Different Devices

PURPOSE: To compare the accuracy and clinical usefulness of various devices by measuring axial length, keratometry, and white-to-white. METHODS: In 64 eyes of 56 cataract patients, axial length was measured using Galilei™, Lenstar®, and A-scans, and keratometry was measured using Galilei™, Lenstar®, and ARK. In 86 eyes of 74 cataract patients, white-to-white was measured using Galilei™ and Lenstar®. RESULTS: The average axial length measurements using Galilei™, Lenstar®, and A-scans were significantly correlated (p < 0.001), but without a statistically significant difference (p = 0.611). The 95% agreement range was the smallest at 0.22 mm for the Lenstar® and A-scans. The average mean K using Galilei™, Lenstar®, and ARK were significantly correlated (p < 0.001), but without a statistically significant difference (p = 0.657). The 95% agreement range was relatively small at 1.83 D for Lenstar® and ARK. The average white-to-white using Galilei™ and Lenstar® were significantly correlated (p < 0.001), with a statistically significant difference (p = 0.011). The 95% agreement range was 2.20 mm. CONCLUSIONS: Axial length, keratometry, and white-to-white measured by different devices were highly correlated and were not statistically different; however, agreement was low between measurements. It is therefore important to consider these findings when using them equally.

Tear Meniscus Evaluation Using Optical Coherence Tomography in Meibomein Gland Dysfunction Patients

PURPOSE: This study compared tear meniscus parameters between normal control, aqueous tear deficient dry eye, and meibomein gland dysfunction groups using Fourier-domain optical coherence tomography (FD-OCT). METHODS: This study included 33 normal eyes, 79 aqueous tear-deficient dry eyes (ATD), and 48 meibomein gland dysfunction dry eyes (MGD). Following routine examination including Schirmer test, tear break-up time, corneal staining, and tear meniscus parameters such as tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were obtained using FD-OCT. The differences among groups were assessed. RESULTS: The averages of TMH, TMD, and TMA were 295.58 +/- 58.36 microm, 166.67 +/- 30.43 microm, and 0.0360 +/- 0.01100 mm2 in normal eyes, respectively, 226.43 +/- 42.18 microm, 147.44 +/- 38.38 microm, and 0.0209 +/- 0.01015 mm2 in ATD, respectively, 272.81 +/- 64.21 microm, 159.37 +/- 44.05 microm, and 0.0295 +/- 0.01271 mm2 in MGD, respectively. Tear meniscus parameters were significantly lower in ATD. Tear meniscus parameters in MGD were higher than ATD and lower than normal eyes, but the TMA was the only statistically significant value. CONCLUSIONS: Although tear meniscus parameters in MGD were higher than ATD, they could not be distinguished from normal eyes. Tear meniscus evaluation using FD-OCT could be a useful measurement system in classification and treatment choice for dry eye patients.

A Case of Periocular Necrotizing Fasciitis of Odontogenic Origin

PURPOSE: We report a case of periocular necrotizing fasciitis originating from dontogenic infection. CASE SUMMARY: A 53-year-old man, who had suffered from severe periodontitis one week prior, visited our clinic due to a 2-day history of rapidly progressing left mandibular and periorbital swelling and pain. By the time of his visit, he had lost vision in the left eye and had moderate swelling, expression of pus, and skin explosion with necrotizing discoloration of the left lid and lower facial area. MRI of the orbits revealed soft tissue necrosis, gas accumulation, and subperiosteal abscess formation of the left orbit. CONCLUSIONS: Through the diagnosis of necrotizing fasciitis originating from an odontogenic infection, the proper administration of antibiotics and surgical management were achieved. As a result, we were able to preserve the eye.

A Case of Primary Lipogranuloma in Eyelid

PURPOSE: We report one case of primary giant lipogranuloma in the whole upper lid. CASE SUMMARY: A 37-year-old man with a left whole upper lid mass that developed 3 months prior to admission visited our hospital. Biopsy was performed, and lipogranuloma was diagnosed. We attempted to remove the lesion by non-surgical local triamcinolone injection with no effect, so we finally removed the lipogranuloma by surgical resection. In the postoperative histological findings, the upper lid mass showed variously sized multiple cystic spaces surrounded by macrophage infiltration and fibrosis consistent with lipogranuloma. CONCLUSIONS: We report the first case of primary giant lipogranuloma in the upper eyelid in Korea. We considered repeated intralesional triamcinolone injections to be a better treatment method than surgical resection. Final surgical resection might be more effective, however, after an intralesional steroid injection to reduce the size of the lipogranuloma.

A Case of Primary Lipogranuloma in Eyelid

PURPOSE: We report one case of primary giant lipogranuloma in the whole upper lid. CASE SUMMARY: A 37-year-old man with a left whole upper lid mass that developed 3 months prior to admission visited our hospital. Biopsy was performed, and lipogranuloma was diagnosed. We attempted to remove the lesion by non-surgical local triamcinolone injection with no effect, so we finally removed the lipogranuloma by surgical resection. In the postoperative histological findings, the upper lid mass showed variously sized multiple cystic spaces surrounded by macrophage infiltration and fibrosis consistent with lipogranuloma. CONCLUSIONS: We report the first case of primary giant lipogranuloma in the upper eyelid in Korea. We considered repeated intralesional triamcinolone injections to be a better treatment method than surgical resection. Final surgical resection might be more effective, however, after an intralesional steroid injection to reduce the size of the lipogranuloma.

A Case of Ectopic Lacrimal Adenoid Cystic Carcinoma Developing in the Nasal Orbit

PURPOSE: We report a case of ectopic adenoid cystic carcinoma developed on the nasal orbital side adjacent to the nasal cavity. METHODS: A 60-year-old man developed progressive right ocular proptosis and pain for 3 years. The patient had undergone regular medical examination in a hospital but eventually visited our hospital due to aggravated symptoms. Orbit MRI and CT showed a 24 x 36 x 17 mm-sized lower signal mass on the medial side of the right medial rectus muscle and also showed erosion of the orbital bone in the superior and medial orbital walls. An endoscopic biopsy was done after transferring him to the ENT department. A frozen section of the tissue in the operating room showed no malignant evidence, and the mass was excised by endoscopic surgery. The permanent pathological result was adenoid cystic carcinoma. The authors recommended orbital exenteration, but the patient refused the procedure and was seen in follow-up visits after receiving chemotherapy and radiologic therapy. Some orbital mass remained in the posterior orbital area immediately directly after endoscopic excision. The patient underwent his first session of Cyberknife radiosurgery therapy after concurrent chemotherapy and radiologic therapy. CONCLUSIONS: Ectopic adenoid cystic carcinoma should be considered as a differential diagnosis of nasal orbital mass lesions.

A Case of Primary B-cell Lymphoblastic Lymphoma of the Orbit in a Pediatric Patient

PURPOSE: We report a case of orbital B-cell lymphoblastic lymphoma in a 7-year-old boy. METHODS: A 7-year-old boy presented with proptosis and periorbital swelling of his left eye following a periorbital blunt trauma 1-month prior. During the course of routine ophthalmologic and radiologic examinatinos, the swelling spontaneously subsided without specific treatment. An outpatient follow-up was planned, but the swelling recurred 6 months later. An orbital CT and MRI showed an irregular mass with an indistinct margin in the left orbit, for which an incisional biopsy was performed. RESULTS: The orbital mass consisited of monotonous small to medium sized lymphoid cells with evenly dispersed open chromatin, thin nuclear membrane and inconspicuous nucleoli. Immunohistochemistry revealed that the cells were positive for CD79a and TdT, but negative for CD3 and CD5. These findings were compatible with a diagnosis of B cell lymphoblastic lymphoma. CONCLUSIONS: Lymphoblastic lymphoma of the orbit should be suspected and considered in the differential diagnosis for children with acutely progressing orbital mass.

Influence of Preoperative Corneal Thickness to Postoperative Astigmatism and Endothelial Cell in Keratoconus Penetrating Keratoplasty

PURPOSE: Corneal transplantation is ultimately required in progressed keratoconus, although initial treatment involves a non-surgical method. We attempted to explore the time point at which corneal transplantation becomes necessary by comparing of postoperative astigmatism and corneal endothelial cells between hydrop and non-hydrop groups. METHODS: Among keratoconus patients who received corneal transplantation between January 2000 and January 2003 from one surgeon, postoperative Sim K, astigmatism, endothelial cells and visual acuity were checked and compared with preoperative data in 20 hydrops eyes and 16 non-hydrops eyes. Finally we evaluated the correlation of postoperative astigmatism with preoperative astigmatism and decreased corneal thickness. RESULTS: There was no significant difference in postoperative Sim K, astigmatism, visual acuity, or endothelial cell reduction rate between the two groups, and the correlation of postoperative astigmatism with large preoperative astigmatism and thin cornea was also not significant. CONCLUSIONS: There is no prognostic difference between eyes undergoing penetrating keratoplasty prior to and after the development of hydrops. Based on our results, keratoconus should be treated conservatively until corneal transplantation becomes inevitable.

The Comparison of Optic Disc Analysis between Heidelberg Retina Tomopgraph and Optical Coherence Tomography

PURPOSE: The purpose of this study was to evaluate whether there is the significant difference in the parameters associated with the optic nerve head between HRT and OCT. We also evaluated the influence of a tilted optic disc, temporal neural rim loss and peripapillary atrophy, in high myopia particularly. METHODS: Two hundred and sixty-eight eyes of 147 patients evaluated HRT and OCT disc analysis, were enrolled retrospectively to evaluate differences in common parameters (e.g., disc area, cup area, CD area ratio, rim area, and rim volume) among the two examination, using a paired t-test. RESULTS: Disc area, cup area and CD area ratio were greater when measured by OCT than HRT. Rim area and volume were smaller by OCT measures than by HRT. There was no difference in disc area and cup area of the high myopia group, but measures of CD area ratio were greater in OCT. Rim area and volume had higher measures in HRT of patients with high myopia. CONCLUSIONS: Because HRT and OCT analyze different optic nerve heads, the common parameters of HRT cannot be applied to OCT. In the high myopia group, tilted optic disc was not different between the two examinations, but OCT was superior in detecting the problem of temporal rim loss and an RPE margin that had been worrisome according to peripapillary atrophy was not a serious problem according to OCT.

Comparison of Surgical Results for Idiopathic Macular Hole: Fluid-Gas Exchange vs. Fluid-Air Exchange

PURPOSE: In pars plana vitrectomy for macular hole, internal limiting membrane (ILM) peeling, fluid-gas exchange, prone position for more than one week are generally needed. However, the authors modified these surgical procedures. After vitrectomy, we performed ILM peeling with Indocyanine green (ICG) dye and fluid air exchange and kept the patient prone position for one day. We then compare the clinical results and analyze possible factors affecting surgical outcomes. METHODS: Data were reviewed from a retrospective study on Group I, form whom vitrectomy, fluid gas exchange, and ILM peeling without ICG were completed, and on Group II, for whom vitrectomy, fluid air exchange, and ILM peeling with ICG were completed. We evaluated the anatomical and functional success statistically. RESULTS: The anatomical success rate was 79% and 94% and the functional success rate was 42% and 88% in groups I and II respectively. Furthermore, preoperative visual acuity significantly affected the visual outcome. CONCLUSIONS: Without having to maintainl face-down position for a long time, successful anatomical and functional outcomes were obtained through fluid air exchange and prone position for one day. This result suggests that complete ILM peeling with ICG shortens the required duration of tamponade and allows for less stringent maintenance of face-down position.