Surgical Anatomy of Deep Lateral Wall by Adults Cadavers and Computed Tomography

PURPOSE: We investigated the surgical anatomy of the deep lateral orbital wall via dissection of Korean cadavers and analysis of the orbit in normal adults using computed tomography. METHODS: Twelve cadavers were used to determine the exact anatomic index of the orbital lateral wall, and computed tomography images of 20 patients were used for surgical anatomic measurements during deep lateral orbital wall decompression. Additionally, the anatomic indexes measured in the cadavers and in the computed tomography study were compared and analyzed. RESULTS: In the cadaver study, the mean distance from the orbital rim to the end of the superior orbital fissure was 36.7 +/- 1.98 mm, to the rim of the frontosphendoial suture was 18.2 +/- 1.92 mm, and from the end of the superior orbital fissure to the inferior orbital fissure was 17.1 +/- 1.19 mm. In the computed tomography study, the mean value from the orbital rim to the end of the superior orbital fissure was 39.2 +/- 2.46 mm, and from the rim to the frontosphenoidal suture was 17.8 +/- 1.56 mm. CONCLUSIONS: The present study regarding the surgical index of the lateral orbital wall in Koreans will assist surgeons to safely and confidently perform deep lateral orbital wall decompression.

A Case of Ocular Benign Lymphoid Hyperplasia Treated with Bevacizumab Injection

We report the first case of ocular benign lymphoid hyperplasia (BLH) treated with subconjunctival injection of bevacizumab (Avastin). A 27-year-old man presented to our clinic with conjunctival masses and limbal neovascularization. An incisional biopsy yielded the diagnosis of BLH. The patient was subsequently given a subconjunctival injection of bevacizumab (1.25 mg / 0.1 mL). The patient did not experience recurrence or malignant metaplasia during the one-year follow-up period. In patients with conjunctival BLH, subconjunctival injection of bevacizumab can be a useful treatment option in patients unable to undergo a surgical procedure due to limbal neovascularization.

Five-Layered Reinforcing Amniotic Membrane Transplantation for Treatment of Deep Corneal Ulcer or Perforation

PURPOSE: To evaluate the efficacy of five-layered reinforced amniotic membrane (AM) transplantation for treating deep corneal ulcer or perforation. CASE SUMMARY: We performed a five-layered reinforced AM transplant in three cases of corneal ulceration or perforation using mechanical compressed lyophilized AMs. In all cases, the perforated cornea healed with re-epithelization within 2 weeks and the ocular surface was stabilized for more than 1 year. CONCLUSIONS: Five-layered reinforced AM transplantation may be an alternative method for treating deep corneal ulcers or perforations.

A Case of Crystalline Keratopathy in Monoclonal Gammopathy of Undetermined Significance (MGUS)

A 62-year-old female visited our clinic with progressively decreased vision in both eyes beginning 12 years prior. Idiopathic corneal opacity in all layers of the cornea was found in both eyes. One year later, we performed penetrating keratoplasty on the undiagnosed right eye. During post-surgical follow-up, corneal edema and stromal opacity recurred, and penetrating keratoplasty was performed two more times. The patient's total serum protein level, which had previously been normal, was elevated prior to the final surgery. She was diagnosed with monoclonal gammopathy of undetermined significance. We made a final diagnosis of monoclonal gammopathy-associated crystalline keratopathy after corneal biopsy. Monoclonal gammopathy-associated crystalline keratopathy is difficult to diagnose and may lead to severe visual loss. A systemic work-up, including serologic tests like serum protein or cholesterol levels, is needed in patients with unexplainable corneal opacity.

Clinical Findings and Results of Low Vision Devices in Pediatric Patients with Albinism

PURPOSE: To assess clinical features and efficacy of spectacles and low vision devices in pediatric patients with albinism. METHODS: A retrospective study was performed of 15 pediatric patients with albinism for whom glasses and low vision devices had been prescribed to determine subjective satisfaction and objective improvement in visual acuity (VA), strabismus, contrast sensitivity, number of reading letters during 1 minute with refractive correction and low vision devices. RESULTS: The median refractive correction was +0.12 +/- 5.45 diopter (D) spherical equivalent with -0.71 +/- 3.62 D astigmatism. Most patients complained of reading difficulty and photophobia. Hand-held magnifier and Keplerian telescope were commonly prescribed low vision devices. In addition, VA, strabismic deviation, contrast sensitivity and number of reading letters during 1 minute significantly improved after wearing glasses and low vision devices. CONCLUSIONS: The present study showed a significant improvement in corrected VA, alignment and subjective symptoms in pediatric patients with albinism by wearing glasses and low vision devices. Additionally, high compliance can improve final patients' satisfaction through using training of low vision devices.

A Case of Fusarium Deep Keratitis Following Scleral Graft

PURPOSE: To report a case of drug-resistant Fusarium deep keratitis following sclera graft. CASE SUMMARY: A 48-year-old woman, who underwent excision of the pterygium nine years previous, received a scleral graft for scleromalacia and ocular pain. After surgery, due to melting of the scleral graft and the presence of Fusarium deep keratitis, she received surgical and intensive medical treatment including three intracameral injections of antifungal agent, administration of topical voriconazole 1%, scleral re-graft, autologous conjunctival graft, and amniotic membrane transplantation. Nevertheless, the patient's ocular condition deteriorated with increased hypopyon, corneal opacity, and perforation. Enucleation was ultimately performed.