Scleral Buckling under a Slit-lamp Illumination System with a Contact Wide-angle Viewing Lens Compared with an Indirect Ophthalmoscope

PURPOSE: To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope. METHODS: By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups. RESULTS: Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001). CONCLUSIONS: Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.

Eyelid Mass as Initial Presentation of Breast Cancer: A Case Report

PURPOSE: We report a case in which eyelid mass was the initial presentation of breast cancer. The diagnosis of breast cancer was made after lid biopsy. CASE SUMMARY: A 41-year-old female patient presented with a painful mass on the left lower lid after 1 month. There was a pinkish mass in the lateral portion of the tarsal conjunctiva, and computed tomography revealed a mass with an irregular margin on the lower lid connected to the left lacrimal gland. Biopsy was performed at the tarsal conjunctiva of the left eye, and histopathologic examination was suggestive of malignant epithelial cell neoplasm, especially metastatic carcinoma in the breast. The patient was diagnosed as having invasive ductal cancer, for which she is currently receiving chemotherapy. CONCLUSIONS: Metastases to the eyelid are very rare, accounting for less than 1% of all malignant eyelid lesions. We report a patient who presented with an eyelid mass as the initial presentation of breast cancer, which was diagnosed with metastatic breast cancer.

Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

PURPOSE: To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens. METHODS: Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit. RESULTS: There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation. CONCLUSIONS: In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

PURPOSE: To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens. METHODS: Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit. RESULTS: There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation. CONCLUSIONS: In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.