The Effect of Eyebrow Asymmetry by Ptosis Correction Operation on Senile Upper Lid Ptosis Patients

Purpose@#To evaluate the effect of a ptosis correction operation on eyebrow position of senile upper lid ptosis patients. @*Methods@#A retrospective study of 140 eyes of 70 patients who had a ptosis correction operation between June 2011 and July 2018 was conducted. Marginal reflex distance 1 and brow height were measured preoperatively and at 1 month and 3 months postoperatively. Patients were divided into two groups, according to whether brow height asymmetry was symmetrized (≤1 mm) or not after the operation. @*Results@#The average brow height decreased after the operation (19.3-18.3 mm, p = 0.00), as did the brow height symmetricity (2.7-2.3 mm, p = 0.01). The symmetric group were older and had a higher female ratio than the asymmetric group, as well as a smaller preoperative brow symmetricity. @*Conclusions@#Brow height and brow asymmetry were reduced by ptosis correction of senile upper lid ptosis patients. The symmetrization rate was higher in patients who were older, female, and who had smaller preoperative brow symmetricity.

Time-dependent Response of Eyelid Height with a Single Drop of 2.5% Phenylephrine in Korean Ptotic Patients

Purpose@#We sought to investigate the temporal changes of eyelid height after phenylephrine instillation in Korean patients with and without ptosis to determine the time points of the first and maximum reactions. @*Methods@#The phenylephrine test was performed on 16 eyes of 12 ptotic patients (group I) and 24 eyes of 12 normal control subjects (group II) in our hospital between September 2017 and March 2018. One drop of 2.5% phenylephrine was instilled and the marginal reflex distance 1 (MRD1) was measured at 15 seconds before instillation and the following time points after instillation: at 15-second intervals for the initial 5 minutes and at 5-minute intervals until a total of 20 minutes was reached (i.e., at 10, 15, and 20 minutes). @*Results@#In group I patients, the first reaction appeared at 5 minutes (p = 0.034), while the maximum eyelid height after the first reaction was reached at 15 minutes (p = 0.025) and was maintained until 20 minutes. In group II subjects, the first reaction appeared at 5 minutes (p = 0.034), while the maximum eyelid height was reached at 10 minutes (p = 0.015) and was maintained until 20 minutes. There was no significant difference in the response of eyelid height based on time (p = 0.122) between the two groups. @*Conclusions@#Our analysis of phenylephrine test results in Korean ptotic patients revealed a significant increase occurred in the eyelid height after 5 minutes; meanwhile, the maximum eyelid height was reached at 15 minutes and was maintained until 20 minutes after instillation.

Efficacy and Safety of Letibotulinum Toxin A for the Treatment of Essential Blepharospasm

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Exploring Brow Position Changes with Age in Koreans

PURPOSE: Several studies have described age-associated brow drooping in Westerners. However, there are few studies that address brow drooping in the Asian population, and especially in the Korean population. Therefore, we studied brow position changes with age in Korean individuals. METHODS: A total of 300 adults older than 18 years were enrolled. The ImageJ program was used to analyze digital photos of the patients by measuring the following parameters: marginal reflex distance-1, brow-to-pupil distance, nasal ala-lateral brow distance, lateral brow plumb line, and the angle formed by the line from the mid pupil to the midline of the brow and a line from the midline of the brow to the lateral brow. We divided the patients into three groups (18 to 40, 41 to 60, older than 61) and compared them using the ANOVA test. RESULTS: Group A included 100 patients between 18 and 40 years of age. Group B included 100 patients between 41 and 60 years of age. Group C included 100 patients older than 61 years. There were significant differences between groups A and C and between groups B and C with regard to marginal reflex distance-1, brow-to-pupil distance and the angle. Lateral brow plumb line showed significant difference only between groups A and B. Nasal ala-lateral brow distance was not significantly different across the three groups. CONCLUSIONS: We sought to describe the physiologic facial changes that occur in Korean individuals. We also hoped to establish guidelines for ptosis corrective surgery. We used various parameters to characterize the aging process in Asians. Our data demonstrated that, like Westerners, Koreans experience lateral brow drooping with age; however, this change was only significant in the group aged >61 years.

Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora

PURPOSE: To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation. METHODS: The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus. RESULTS: The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection. CONCLUSIONS: The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.

Classification of Lacrimal Punctal Stenosis and Its Related Histopathological Feature in Patients with Epiphora

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.

Learning Curve for Endoscopic Endonasal Dacryocystorhinostomy

PURPOSE: To elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) based on the results of EE-DCR performed by three surgeons at three different tertiary hospitals. METHODS: A retrospective review of the medical records of 386 eyes of 337 patients who had undergone EE-DCR by three surgeons at three tertiary hospitals and who were available for a >6-month postoperative observation period was conducted. The success of a given surgery was determined based on the results of a test performed during the patient's last outpatient visit to the hospital. The learning curve was identified by dividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing their success rates. RESULTS: The overall success rate of the entire study population was 86.3%. The success rates for each of three surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyes each, all three surgeons showed a significant increase in surgery success rates after their first group of 30 eyes (p 90% (A, 94.4%; B, 90.8%; C, 95.4%). CONCLUSIONS: A surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgical skill for this procedure.

Surgical Outcome of Minimal Resection with Full Thickness Rotating Suture Technique for Lower Lid Epiblepharon

PURPOSE: To introduce the minimal skin and orbicularis oculi muscle resection with the full thickness rotating suture technique for lower lid epiblepharon and to assess its surgical outcome. METHODS: A retrospective review of medical records was performed on lower lid epiblepharon patients who were followed for more than 6 months after surgical correction performed between January 2004 and December 2015. All surgeries were performed by one surgeon using minimal skin and orbicularis oculi muscle resection and the full thickness rotating suture technique for lower lid epiblepharon correction. RESULTS: A total of 943 lower lid epiblepharon patients (403 male, 540 female) were included in the analysis. The mean patient age was 6.7 ± 2.4 years, and the mean postoperative follow-up was 12.9 ± 7.2 months. Eyelid shape and function were well maintained in 904 patients (95.9%), with no recurrence during follow-up. Among the recurrent cases (39 patients [4.1%]), 19 patients (2%) underwent a second correction surgery. CONCLUSIONS: Minimal skin and orbicularis oculi muscle resection with the full thickness rotating suture technique for lower lid epiblepharon showed good surgical outcome with few complications and high success rate.

Comparison of Orbital Anatomy in Korean and Caucasian Patients Using Computed Tomography

PURPOSE: In this study we analyzed and compared the orbital anatomy in Korean and Caucasian subjects using computed tomography (CT) measurements. METHODS: Two observers performed a cross-sectional, retrospective analysis of 44 CT scans of subjects (22 Koreans, 22 Caucasians) with no appreciable orbital or globe disease. Ten length measurements and 3 angle measurements of various orbital aspects were obtained. Analysis was performed to determine if changes in these parameters were associated with race. RESULTS: Anterior medial interorbital length was 24.05 +/- 2.00 mm in Korean and 21.96 +/- 1.96 mm in Caucasian subjects. Anterior vertical orbital length was 34.19 +/- 1.67 mm in Korean and 35.03 +/- 1.18 mm in Caucasian subjects. The anterior medial interorbital length and anterior vertical orbital length (p < 0.05) were significantly different. Interorbital angle was 47.69degrees +/- 1.49degrees in Korean and 46.15degrees +/- 2.19degrees in Caucasian subjects; the difference was statistically significant (p < 0.05). CONCLUSIONS: Compared with Caucasians, the orbit of Korean subjects has a narrower orbital opening and longer interorbital distance. The present study regarding the anatomy of Korean and Caucasian orbits will assist physicians with the evaluation and treatment of orbital diseases.

Pleomorphic Adenoma with Sarcomatous Change in a Lacrimal Gland

A 69-year-old man was referred with left exophthalmos. Computed tomographic (CT) findings detected a well-circumscribed mass in the left side of the intraorbital cavity. At that time, he refused the further evaluation and treatment. About three years later, the size of the mass had enlarged, and the patient's symptoms were getting worse. The mass was completely removed with frontotemporal craniotomy and superolateral orbitotomy. In operative findings, the mass had originated in the lacrimal gland and was well-encapsulated without invasion to the surrounding tissue. In the pathologic findings, the tumor consisted of pleomorphic adenoma with osteosarcomatous change of stromal components. Postoperatively, the adjuvant radiotherapy was done four weeks later. The patient's symptoms were improved. The pleomorphic adenoma with osteosarcomatous change is extremely rare and appropriate treatment is not clearly established. We would like to report this rare case with a review of the literature.

Surgical Outcomes of Levator Resection in Ptosis Patients with Deep Superior Sulcus

PURPOSE: To investigate the characteristics and postoperative complications of ptosis patients with deep superior sulcus following levator resection surgery. METHODS: Records of 33 ptosis patients (59 lids) with deep superior sulcus who underwent levator resection surgery from March 2008 to May 2013 were reviewed retrospectively. Operation success rate, reoperation rate, preoperative and postoperative marginal reflex distance 1 (MRD1), and levator function were compared and postoperative complications were evaluated. RESULTS: The patient's mean age was 65.8 years. The MRD1 was -1.0 +/- 1.4 mm preoperatively, 2.5 +/- 1.2 mm at 1 month after surgery, and 2.3 +/- 1.1 mm at 3 months after surgery. Operation success rate was 84.8%. At 1 month after surgery, 52.5% of lids had lagophthalmos as a surgery complication but later all recovered. Additionally, 44.1% of the patients had worn therapeutic contact lenses postoperatively for 7.0 +/- 12.1 days. CONCLUSIONS: Occurrence rate of postoperative lagophthalmos was higher than in other previous studies suggesting a tendency for overcorrection in levator resection surgery for ptosis patients with deep superior sulcus. Additionally, levator resection surgery is cosmetically as well as functionally very effective for deep superior sulcus.

Calculated Brain CT Angiography Volumes of Lacrimal Glands in Normal Korean Orbits

PURPOSE: To determine the size range of lacrimal glands calculated from Brain CT angiography. METHODS: A retrospective review of 107 CT scans of 214 orbits was performed. Aquaris Intuition Viewer software was used to calculate the volumes. RESULTS: The mean volume of the lacrimal gland was 0.655 cm3 in right orbits and 0.595 cm3 in left orbits, 0.616 cm3 in men and 0.625 cm3 in women. There was a significant difference between right and left (p = 0.012) but no difference between men and women (p = 0.725). Linear regression analyses revealed that there was an inverse relationship between gland volume and age (Pearson r = -0.433, p < 0.001). CONCLUSIONS: This is the first study to report the normal volume range of Korean lacrimal glands as measured by CT scans. A difference was detected in the volume between right and left lacrimal glands. The volume of the lacrimal gland decreased with age, and there were no gender differences.

The Clinical Features of Ocular Myasthenia Gravis in Thyroid-Associated Ophthalmopathy

PURPOSE: There are some challenges to accurate diagnosis of ocular myasthenia gravis (MG) in thyroid-associated ophthalmopathy (TAO) patients because the clinical features of these diseases are similar. The aim of this study was to discuss the clinical features and treatment options that may help differentiate these 2 diseases. METHODS: We performed a retrospective analysis using the medical records of patients who visited our clinic and were diagnosed with ocular MG and TAO, from January 2002 to December 2012. The diagnosis of Ocular MG was made on the basis of clinical symptoms and signs with laboratory evaluation, including assays for antithyroid and antiacetylcholine receptor (AchRAb) antibodies, and the Ice, neostigmine, and electromyography tests. RESULTS: Of the 9 ocular MG patients with associated ophthalmopathy, 5 were male and 4 were female. The mean age was 36 +/- 16.0 years and the follow-up period was 45.6 +/- 36.6 months. Graves' disease (8 patients) was predominant and all patients showed abnormal thyroid function. Atypical symptoms and/or mild clinical features were predominant in ocular MG patients with TAO. Positive test results were obtained as follows: Neostigmine test 33.3%, electromyography 44.4%, ice test 77.8% and anti-AchR titer test 77.8%. Thyroid function test results were abnormal in all patients. In 3 patients who were first diagnosed with TAO, symptoms remained persistent despite steroid therapy then improved dramatically by administration of an anti-acetylcholinesterase agent. These patients were diagnosed with ocular MG in conjunction with TAO. CONCLUSIONS: Patients with thyroid disease who show atypical features, symptomatic changes with fatigue, odd appearing ptosis, and who, do not exhibit good response to treatment of TAO need to be examined for ocular MG with additional tests and treatment.

Ptosis Repair Using Preserved Fascia Lata with the Modified Direct Tarsal Fixation Technique

PURPOSE: To evaluate the clinical outcome of frontalis sling operation using preserved fascia lata with modified direct tarsal fixation in congenital ptosis patients. METHODS: Forty-seven congenital ptosis patients (60 eyes) who underwent a frontalis sling operation using preserved fascia lata with modified direct tarsal fixation method between March 2001 and December 2008 with a mean follow-up time of 52 months (range, 26 to 122 months) were included in this study. The medical records were reviewed retrospectively. RESULTS: A retrospective chart review was conducted in patients who were diagnosed with congenital ptosis and underwent frontalis suspension surgery using preserved fascia lata with modified direct tarsal fixation from 2001 through 2008 at Dong-A University Hospital. The patients were 34 males and 14 females. The age of the patients ranged from 1 to 18 years with an average age of 4.51 years. At a mean follow-up of 60 months, good final results were achieved in 46 eyes (76.6%), fair in 8 eyes (13.3%), and poor in 6 eyes (10%). The poor results consisted of undercorrection of 1 eye and recurrence in 5 eyes. The accumulative survival rate was 87.2%, with all recurrences occurring within 12 months postoperatively. CONCLUSIONS: Frontalis sling operation by preserved fascia lata with modified direct tarsal fixation appears to be an effective treatment for severe congenital ptosis, showing good long term results.

The Clinical Characteristics of Thyroid Orbitopathy in Thyroid Dysfunction Pediatric Patients

PURPOSE: To investigate the clinical characteristics and treatment methods for pediatric thyroid-associated orbitopathy in pediatric patients with thyroid disorders. METHODS: To determine the prevalence and clinical characteristics of pediatric thyroid-associated orbitopathy, we retrospectively analyzed the medical records of 34 patients admitted to the Pediatrics Department of our institution between September 2010 and September 2012. The patients had been diagnosed with autoimmune thyroid disorder and were admitted for treatment of thyroid-associated orbitopathy. RESULTS: In the 24.1 months of follow-up observation, 14 patients were diagnosed with Graves' disease (41.2%) and 20 patients with Hashimoto's thyroiditis (58.8%). Of the 34 patients, 15 (44.1%) developed eye symptoms. Among the eye symptoms, lid swelling was the most prevalent in 41.2% of patients, followed by eyelid retraction in 23.5%, lid lag in 17.6%, conjunctival injection in 14.7%, proptosis in 8.8%, and extraocular muscle hypertrophy in 17.6%. Severe impairment of visual acuity, visual field, and ocular motility were not observed in our study. Although eyelid surgery was performed in 3 cases, most patients were treated conservatively. CONCLUSIONS: Pediatric thyroid-associated orbitopathy was frequently observed in patients with Graves' disease and Hashimoto's thyroiditis. Compared to adults, children showed milder disease manifestation and progression, and the disease could be managed with conservative treatment.

Density of Orbital Fat and Extraocular Muscle in Thyroid-Associated Myopathy and Idiopathic Orbital Myositis

PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.

Clinical Features and Treatment of Peripunctal Tumors

PURPOSE: To investigate the clinical features and treatment results in peripunctal tumors. METHODS: A retrospective medical record review was conducted on patients that were clinically diagnosed with peripunctal tumor from October 2005 to June 2011 in Dong-A University Hospital. RESULTS: Twenty nine peripunctal tumors were identified. Five cases (17.2%) were involving upper eyelid and 22 cases (75.9%) were involving lower eyelid. Two cases (6.9%) were involving both upper and lower eyelid, which one of them were involving the conjunctiva as well. One of the patients (3.5%), underwent simple observation without surgery. Simple surgical resection and biopsy were performed in 7 cases (24.1%), and additional silicone tube intubation or Minimonoka insertion were carried-out in 21 cases (72.4%). Histology revealed 15 cases (53.6%) of melanocytic nevus, 5 cases (17.9%) of basal cell carcinoma, 2 cases (7.1%) of seborrheic keratosis, and others including malignant melanoma, squamous papilloma, epidermal cyst, and et cetra. CONCLUSIONS: In conclusion, Peripunctal tumors are mostly found on the lower lids and, they are surgical resection and biopsy should be considered in all cases of peripunctal tumors since they have a potential for spreading to the lacrimal system. It is advised to perform a silicone tube intubation or minimonoka insertion along with the surgical excision to preserve the function of the punctum.

Long-Term Results of Silicone Tube Intubation in Patients with Common Canalicular Stenosis

PURPOSE: To evaluate the clinical effects of silicone tube intubation in patients with epiphora and a narrow common canaliculus. METHODS: We conducted a retrospective chart review of 107 patients (169 eyes) who underwent silicone tube intubation for treatment of canaliculus between August 2008 and August 2010 and who were followed for more than 12 months. The patients were divided into 3 groups: patients with canalicular stenosis (A), patients with common canalicular stenosis (B), and patients with nasolacrimal duct stenosis (C). Successful treatment was defined as attainment of the predefined requisites, which included improvements in the clinical symptoms following surgery, an adequate passage of tears resulting from post-operative probing and syringing, and continued improvement to the time of the patients' final follow-up visit. In contrast, surgical failure was defined as the lack of post-operative symptom improvement, and recurrence was defined as the appearance of epiphora following the silicone tube extubation. RESULTS: The average follow-up duration for the entire group of patients was 30.5 months. The success rates of Group A, Group B, and Group C were 66%, 75.4%, and 56.3%, respectively, demonstrating that Group B attained the highest success rate. These success rates are similar to rates resulting from other types of surgery such as canaliculodacryocystorhinostomy. CONCLUSIONS: Silicone tube intubation can be considered a relatively simple and effective surgical technology for the long-term treatment of patients with a narrow common canaliculus.

A Comparison of 2-Octyl Cyanoacrylate Adhesives versus Conventional Suture Materials for Eyelid Wound Closure in Rabbits

PURPOSE: To evaluate the clinical efficacy and histopathological tolerance of 2-octyl cyanoacrylate versus conventional suture materials for eyelid wound closure in rabbits. METHODS: We performed an experimental study on 16 eyes of eight New Zealand albino rabbits. Eyelid incisions of 15 mm were done 4mm from the upper eyelid margin in both eyes. The eyes of the rabbits were divided into two groups: eyelid incisions of the right eye were closed by a 2-octyl cyanoacrylate adhesive (group A) and eyelid incisions of the left eye were closed by 7-0 nylon sutures (group B). At 1, 2, 4, and 8 weeks after surgery, the rabbits were macroscopically examined and then sacrificed. The specimens of their eyelid tissues were stained by a hematoxylin and eosin stain and Masson-trichrome stain, and were observed under microscope. RESULTS: Both eyelid surgical closure methods were found to be equally efficacious in fixing the eyelids of groups A and B, and their clinical efficacy was similar. Histopathological findings of the hematoxylin and eosin stain of group A showed less inflammatory infiltration than group B at 2 weeks. There were no significant histopathological differences between the two groups at 1, 4, and 8 weeks. The degree of fibrosis of the Masson-trichrome stain was similar between the two groups at 8 weeks. CONCLUSIONS: The 2-octyl cyanoacrylate adhesive proved to be an effective eyelid closure method and was very well tolerated by the skin surface. 2-Octyl cyanoacrylate could be used as an alternative tissue adhesive for eyelid wound closure along with conventional suture materials.

Clinical Correlation of Lacrimal Sac Pathologic Findings of Lacrimal Sac from Dacryocystorhinostomy

PURPOSE: To determine the correlation of the clinical characteristics and histopathologic findings of lacrimal sac after external dacyrocystorhinostomy (DCR). METHODS: From March 2008 to June 2009, 49 lacrimal sac tissues of 47 patients were obtained after external DCR and divided according to fibrosis and inflammatory findings. The correlation of preoperative duration of symptoms with NLD obstruction, symptoms of recurrence and outcomes of the operation to the histopathologic findings were retrospectively evaluated. RESULTS: The mean age of the patients was 58.83 +/- 11.49 years and the mean duration of preoperative symptoms was 65.2 +/- 69.05 months. Forty-three cases (88%) maintained good openings and 30 cases (61%) had no recurring symptoms over 6 months after the operation. Among the significant symptoms, severe subepithelial inflammations were observed more frequently at shorter duration. However, the fibrosis showed a positive relation with the preoperative duration of symptoms (Spearman correlation test, p<0.05). Most failures were found in the severe inflammation and fibrosis groups and were recovered with anti-inflammatory treatment. CONCLUSIONS: Inflammation and fibrosis of the lacrimal sac could be an important prognostic and predictive factor of outcomes of DCR.