Dry Eye Assessment of Patients Undergoing Endoscopic Dacryocystorhinostomy for Nasolacrimal Duct Obstruction Combined with Dry Eye Syndrome

Purpose@#To evaluate the prevalence of dry eye symptoms after endoscopic dacryocystorhinostomy (EDCR) for patients with primary acquired nasolacrimal duct obstruction (PANDO) combined with dry eye syndrome. @*Methods@#The patients diagnosed with PANDO combined with dry eye syndrome who underwent EDCR were divided into two groups according to the questionnaire about dry eye symptoms after surgery. The medical records were retrospectively analyzed. Before and after surgery, we compared the tear meniscus height, tear breakup time, and the presence of corneal punctuate epithelial erosion. The level of dry eyes of patients after surgery was assessed by using the Korean guidelines for the diagnosis of dry eye. @*Results@#At 6 months after EDCR, the proportion of patients with dry eye symptoms was 30% in a total of 80 patients. The duration of epiphora and tear breakup time after EDCR were higher in the group without dry eye symptoms and the proportion of eyes with corneal punctuate epithelial erosion after EDCR was higher in the group with dry eye symptoms. About 15% of total patients started treatment with a dry eye of level 2 or higher. @*Conclusions@#About 15% of patients who underwent EDCR for PANDO combined with dry eye syndrome developed significant dry eye syndrome after surgery. The short onset of epiphora was associated with the development of the dry eye symptoms. Therefore, it is necessary to evaluate dry eye syndrome before surgery, and surgeons should be careful about this.

Effect of COVID-19 Pandemic on Myopia Progression in Pediatric Patients Treated with Atropine Eyedrops

Purpose@#We investigated the impact of the COVID-19 pandemic on myopia progression in pediatric patients who received low-dose atropine (0.01%) eye drops. @*Methods@#We retrospectively analyzed the medical records of pediatric patients who received ≥ 12 months of low-dose atropine (atropine sulfate 0.01%) eye drops for myopia. The beginning of the COVID-19 pandemic was defined as February 2020. Patients were divided into two groups for comparative analysis. Patients in group A received low-dose atropine for ≥ 12 months between July 2013 and January 2020, whereas patients in group B received low-dose atropine between February 2020 and July 2021; atropine eye drops were administered once daily. The spherical equivalent and axial length of the right eye were measured at the initiation of treatment and after 12 months. @*Results@#Among the 72 patients, 34 in group A received low-dose atropine before the COVID-19 pandemic, whereas 38 in group B received low-dose atropine after the COVID-19 pandemic. After 12 months of treatment with low-dose atropine eye drops, the changes in spherical equivalent were -0.58 ± 0.47 diopters (D) in group A and -0.84 ± 0.56 D in group B (p = 0.045). Moreover, the changes in axial length were 0.30 ± 0.23 mm in group A and 0.50 ± 0.31 mm in group B (p = 0.011). @*Conclusions@#The efficacy of low-dose atropine eye drops in pediatric myopia patients has decreased since the beginning of the COVID-19 pandemic.

Osteoma Cutis on Eyelid

PURPOSE@#To present the first report describing lesions of osteoma cutis on the upper eyelid and medial canthus.CASE SUMMARY: A 4-year-old female complained of a right upper eyelid mass. The examination showed a well-delineated, mild bluish-colored, hard mass over the upper eyelid and the medial canthus measuring 10 × 10 mm and 2 × 2 mm. During the cutaneous examination, her forearm, left shin, right dorsum of the foot, neck, and abdominal wall also showed well-delineated, mild bluish-colored, immobile hard masses, similar to the upper eyelid mass. A right upper eyelid and medial canthus mass excision was performed and a biopsy specimen was collected. Hematoxyline and eosin staining showed a mature bone in the dermis with spicules of bone and osteoblasts. She was finally diagnosed with osteoma cutis on the upper eyelid and the medial canthus.@*CONCLUSIONS@#Osteoma cutis is a rare, benign skin disorder characterized by bone formation in the skin. Albright hereditary osteodystrophy, which causes a metabolic disorder, should also be considered to prevent complications.

Specific Visual Symptoms and Signs of Meares-Irlen Syndrome in Korean

PURPOSE: To discriminate the visual symptoms and signs of Meares-Irlen syndrome (MIS) and nonspecific dyslexia from other ophthalmologic diseases (NODs). METHODS: Forty-five patients were enrolled. Thirty four of the patients with MIS whose symptoms improved with tinted lenses comprised MIS group. The other 11 patients whose reading difficulty improved with other ocular therapy and did not require tinted lenses comprised NODs group. The main symptoms causing dyslexia and associated ocular diseases were evaluated. RESULTS: The mean age was 17.9 +/- 9.5 years in MIS group, and 19.3 +/- 11.0 years in NODs group. In MIS group, the most common symptoms while reading were difficulty to move lines (85%), doubling (53%), and difficulty in bright condition (27%). On the other hand, blurring was the most common symptom in NODs group (45%). The associated ocular diseases in the two groups were refractive error (79% and 73%), dry eye (29% and 18%), and exophoria (6% and 27%), respectively. CONCLUSIONS: Doubling, difficulty to move lines, and difficulty in bright condition while reading are main specific symptoms in MIS compared to nonspecific dyslexia from other ophthalmologic disorders.

Which Keratometer is Most Reliable for Correcting Astigmatism with Toric Intraocular Lenses?

PURPOSE: To evaluate the accuracy of preoperative keratometers used in cataract surgery with toric intraocular lens (IOL). METHODS: Twenty-five eyes received an AcrySof toric IOL implantation. Four different keratometric methods, a manual keratometer, an IOL master, a Pentacam and an auto keratometer, were performed preoperatively in order to evaluate preexisting corneal astigmatism. Differences between the true residual astigmatism and the anticipated residual astigmatism (keratometric error) were compared at one and three months after surgery by using a separate vector analysis to identify the keratometric method that provided the highest accuracy for astigmatism control. RESULTS: The mean keratomeric error was 0.52 diopters (0.17-1.17) for the manual keratometer, 0.62 (0-1.31) for the IOL master, 0.69 (0.08-1.92) for the Pentacam, and 0.59 (0.08-0.94) for the auto keratometer. The manual keratometer was the most accurate, although there was no significant difference between the keratometers (p > 0.05). All of the keratometers achieved an average keratometric error of less than one diopter. CONCLUSIONS: Manual keratometry was the most accurate of the four methods evaluated, although the other techniques were equally satisfactory in determining corneal astigmatism.

Clinical Study on Acute Conjunctivitis after Endoscopic Dacryocystorhinostomy with Silicone Tube Intubation

PURPOSE: To investigate the incidence and clinical course of acute conjunctivitis after endoscopic dacryocystorhinostomy (DCR) with silicone tube intubation. METHODS: A retrospective study was conducted on 547 eyes in 517 patients who had undergone endoscopic DCR with silicone tube intubation between 2005 and 2009. The onset, incidence and symptoms of acute conjunctivitis, the effect of silicone tube intubation on acute conjunctivitis, and the effect of acute conjunctivitis on the success rate of DCR were investigated. RESULTS: The incidence of acute conjunctivitis was 3.8%. The mean age of 21 patients with acute conjunctivitis was 52.6 +/- 14.3 years and the mean follow-up period of those was 18.0 +/- 6.4 months after surgery. All the cases of acute conjunctivitis were resolved with topical antibiotic treatment after silicone tube removal. The success rates between patients with and without conjunctivitis were not significantly different (80.95% and 88.97%, respectively; p = 0.282). However, 4 patients with surgical failure had a longer time from onset of acute conjunctivitis to the removal of the silicone tube than 17 patients with surgical success (0.22 months and 1.13 months, respectively; p = 0.047). A higher rate (76.2%) of conjunctivitis developed in patients with granuloma around the surgical ostium. CONCLUSIONS: A correlation may exist between acute conjunctivitis and granuloma in patients with DCR with silicone tube intubation. Acute conjunctivitis did not appear to influence the surgical results, although a delayed timing of silicone tube removal in patients with conjunctivitis could decrease the success rate.

A Modified Technique of Bicanalicular Silicone Tube Intubation in Congenital Nasolacrimal Duct Obstruction

PURPOSE: To introduce a modified technique of bicanalicular silicone tube intubation, which can reduce slitting of the canaliculus and protrusion of the tube. METHODS: This study included 46 patients who underwent modified surgery for Congenital Nasolacrimal Duct (CNLD) obstruction. To be included in this study, patients were older than 13 months and had a history of failed probing. Using our modified technique, tube lengths can be appropriately adjusted by either pulling or releasing the tube at the medial canthus until a tube loop is in place without any tension to the upper and lower canaliculi. Two threads of silicone tube were tied together using 5-0 nylon over a silicone sponge (5x5 mm) and left within the nasal cavity for several months without fixation to the nasal mucosa. A successful surgery was clinically defined as no epiphora and no dye retention in the conjunctival sac. RESULTS: The mean age of patients at the time of surgery was 32.8 (+/-18.9) months. There were 22 males and 24 females. Prior to intubation, patients had been probed an average of 1.5 (+/-1.3) times, and the mean follow-up period was 12.6 (+/-14.2) months. The tube was removed at 5.4 (+/-1.3) months postoperatively on average. The success rates were 88%. Tube protrusions occurred in three eyes, and canalicular splittings were recorded in two eyes. No other serious complications were encountered. CONCLUSIONS: This new technique might enable us to remarkably reduce both protrusion and slitting of the canaliculus in bicanalicular silicone intubation for congenital nasolacrimal duct obstruction.

Clinical Outcome of Diffractive Multifocal Aspheric Intraocular Lens

PURPOSE: To compare the clinical outcome between Tecnis ZM900 and Tecnis ZA9003. METHODS: We reviewed 20 eyes of 11 patients implanted with Tecnis ZM900 and 20 eyes of 20 patients implanted with Tecnis ZA9003. The clinical outcomes of these two intraocular lenses were evaluated one month after operation and consisted of distant, intermediate, and near visual acuity; depth of focus; contrast sensitivity; wavefront aberration; and patient satisfaction. Six months after the operation a reevaluation was performed for the group who had received the Tecnis ZM 900 implant. RESULTS: Near and intermediate vision was better in the Tecnis ZM900 group. There were no statistical differences between the two groups with respect to distant vision and wavefront aberration. Contrast sensitivity was better in the Tecnis ZA9003 group and depth of focus was deeper in the Tecnis ZM900 group. There were no statically significant differences in the result between one month and six month after the operation. CONCLUSIONS: The Tecnis multifocal ZM900 IOL can be effective at improving patient satisfaction after cataract surgery as well as for correcting presbyopia.