A Case of Lacrimal Gland MALT Lymphoma in a Patient with Primary Sjögren's Syndrome

PURPOSE: To report a case of lacrimal gland mucosa-associated lymphoid tissue (MALT) lymphoma in a patient with primary Sjögren's syndrome and Behcet's disease. CASE SUMMARY: A 49-year-old female patient with primary Sjögren's syndrome and Behcet's disease presented with a one-year history of painless upper and lower eyelid swelling in her right eye. Lacrimal gland incisional biopsy was performed, and the patient was diagnosed with malignant lymphoma (extranodal marginal zone B cell lymphoma of MALT). No distant metastases were detected on whole-body computed tomography or positron emission tomography, and the patient was treated with Rituximab, Cyclophosphamide, Vincristine, Prednisone (R-CVP) regimen chemotherapy. After 8 consecutive chemotherapy cycles, her eyelids appeared normal externally, and partial regression was found radiologically. CONCLUSIONS: The possibility of MALT lymphoma should be considered as a differential diagnosis if patients with autoimmune diseases such as primary Sjögren's syndrome show eyelid swelling or palpable mass.

A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma

PURPOSE: To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient with recurrent sphenoid wing meningioma. CASE SUMMARY: A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningioma despite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposure keratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keratic precipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performed followed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed no chamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed. CONCLUSIONS: Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma, corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.

A Case of Anterior Synechiolysis with Lamellar Corneal Dissection in Penetrating Keratoplasty

PURPOSE: To report a case of anterior synechiolysis with lamellar corneal dissection in penetrating keratoplasty. CASE SUMMARY: In an eye with graft failure and anterior synechiae, we performed anterior synechiolysis with a healon needle after lamellar dissection using vacuum trephine to visualize the anterior chamber during penetrating keratoplasty. Additionally, the remnant corneal layer was removed using corneal scissors. A donor cornea was harvested using a vacuum trephine and the corneal button was sewn in place with 10-0 nylon. We observed a well grafted cornea and well formed anterior chamber with no anterior synechiae observed on follow-up. CONCLUSIONS: In patients with anterior synechiae, the cornea can be dissected from the anterior synechiae completely using lamellar corneal dissection in penetrating keratoplasty to visualize the anterior chamber.

A Case of Pigmented Free-Floating Posterior Vitreous Cyst

PURPOSE: To report a case of a 59-year-old female with a free-floating monolateral vitreous cyst localized in the posterior vitreous in the left eye. CASE SUMMARY: A 59-year-old female who complained of an intermittent floater in the left eye for 3 months visited our clinic. She had been suffering from visual disturbance for approximately 3 months. There was no previous history of trauma, infection, or inflammatory disorders. The best corrected visual acuity was 20/20 in both eyes. On fundoscopic exam, a 3-4 disc diameter (DD) sized, brown-colored pigmented vitreous cyst was detected at the inferior temporal side of the posterior vitreous in her left eye. B-scan ultrasound confirmed the presence of an echo-free cystic formation that was free from surrounding vitreous strands or other adhesions located at the posterior vitreous. No specific findings or leakage were observed on fluorescein angiography. We followed-up the patient periodically (1 month, 3 months, and 6 months after the initial visit) and monitored whether the size or location of the cyst had changed. At every follow-up exam, the size or location of the cyst was stationary and the patient's visual acuity was 20/20 in the affected eye, thus we suggested she should be followed-up periodically for her cyst without any intervention. CONCLUSIONS: We report a case of a patient with no previous ocular history or impaired vision who had a free-floating vitreous cyst localized in the posterior vitreous in the left eye. The disease did not appear to progress or become aggravated over a short-term follow-up period and no specific treatment was required.

Magnification Effect of the Capsulorhexis by the Cornea

PURPOSE: The purpose of this study is to measure the magnification of the capsulorhexis by the cornea using open ring guided capsulorhexis (ORGC) during cataract surgery. The study also investigated the magnification changes according to anterior chamber depth and corneal power. METHODS: The subjects comprised 40 eyes from 37 patients whose astigmatism was lower than 0.25 D and who had cataract surgery using ORGC from December 2011 to April 2012. ORGC was set on the anterior capsule and photographs were obtained using a camera connected to a surgical microscope after attaching a ruler around the limbus. The pixel number of 5 mm gradations on a ruler and the inner diameter of ORGC were measured using ImageJ. The inner diameter of ORGC was known to be 5.30 mm and the size of ORGC in the snapshot was therefore calculated by proportional expression. After corneal power and anterior chamber depth were identified, the magnification effect was evaluated. RESULTS: The 37 subjects were composed of 19 males and 21 females, and their average age was 64.8 years. The average depth of the anterior chamber was 3.28 mm, and the average corneal power was 43.534 D. The measured inner diameter of ORGC was 6.14 mm (SD: +/-0.16 mm) and the average magnification of the capsulorhexis was 115.9% (SD: +/-3.1%). The results showed that in the case of shallow anterior depth and low corneal power, the magnification was low equivalent to 110%. However, when the anterior chamber was deep and the corneal power was high, the magnification was greatly increased to 120%. CONCLUSIONS: The capsulorhexis was magnified to an average of 115.9% by the cornea during cataract surgery. In particular, it is necessary to consider capsulorhexis size in cases with deep anterior chamber and high corneal power, because the magnification will be greater in those cases.