Two Case Reports of a Purtscher-like Retinopathy Occurring after Retrobulbar Anesthesia

PURPOSE: Although there are significant risks, retrobulbar anesthesia is commonly used for eye surgery. We report two cases of Purtscher-like retinopathy, a rare complication. CASE SUMMARY: (Case 1) A 76-year-old female visited our hospital because of decreased vision. She underwent right cataract surgery with retrobulbar anesthesia. After 7 days, she had decreased visual acuity (VA) and a constricted visual field. Multiple white spots and cotton wool spots around the optic nerve and post pole, macular edema (ME), and subretinal fluid (SRF) were found using a fundus examination. A non-perfusion area and staining of the vascular wall were seen using fluorescence angiography. Although carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were performed, the ME and SRF persisted. After intravitreal aflibercept was injected twice (2-month interval), the ME and SRF decreased and remained stable. (Case 2) A 61-year-old male underwent left cataract surgery with retrobulbar anesthesia. After anesthesia, the VA of the left eye was 10 cm finger count. The fundus examination showed multiple hemorrhage blots and retinal hemorrhages, and hyperfluorescence around the optic nerve and post pole; vascular wall staining revealed a Purtscher-like retinopathy. Left carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were then performed. After treatment, the VA of the left eye, ME, and SRF were improved at the 4-month follow-up. CONCLUSIONS: We report rare complications of retrobulbar anesthesia, with active and timely treatment having a positive impact on the visual prognosis.

Changes of the Individual Retinal Layer Thickness in Non-proliferative Diabetic Retinopathy in Type 2 Diabetes

PURPOSE: To compare retinal layer thickness in non-proliferative diabetic retinopathy in type 2 diabetic patients as measured by optical coherence tomography. METHODS: A total of 108 eyes from 71 patients, between January 2015 and July 2016, were included in this study. Of these, 39 eyes were included in the control group, 38 eyes in the diabetic group without non-proliferative diabetic retinopathy, and 31 eyes in the non-proliferative diabetic retinopathy group (NPDR). We measured the thickness of each retinal layer by optical coherence tomography (OCT). A total of ten layers were evaluated including the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retinal layer (IRL), outer retinal layer (ORL), and the total retinal layer (TRL). We compared the superior, inferior, nasal, and temporal regions at 1–3mm from the central fovea. RESULTS: RNFL was thinner in the superior region of the NPDR, as compared with that of the control group, showing statistical significance (p = 0.016). The thickness of all regions in the GCL, IPL, and IRL were decreased in NPDR, as compared to the control group with statistical significance. In addition, the thickness of the superior region in the GCL, IPL, and IRL showed statistically significant differences between controls and the no diabetic retinopathy (DR) group (p = 0.026, 0.003, 0.003). The thickness of the INL, OPL plus ONL, RPE, and ORL in all three groups showed no significant difference. The differences in the decreased thickness in the IRL were similar to that of TRL. CONCLUSIONS: Retinal neurodegeneration was observed in the IRL, which included changes to the RNFL, GCL, and IPL in early type 2 diabetes before microvascular injury was apparent. Thorough control of blood glucose is required in early diabetes, and further studies to delay retinal neurodegeneration are required. OCT might have an important role in early diagnosis and follow up of diabetic retinopathy.

A Case of Choroidal Metastasis Caused by Lung Cancer

PURPOSE: To report a case of choroidal metastasis caused by lung cancer in a young female who had no history. CASE SUMMARY: A 31-year-old female presented with decreased vision for 1 week. Fundus examination revealed an orange colored choroidal tumor and serous retinal detachment at superotemporal area of the optic disc on the left eye. On chest X-ray, atypical pneumonia or hematogenous metastasis was shown. Additionally, mammography, chest-abdomen computed tomography, lumbar magnetic resonance imaging, and transbronchial lung biopsy were performed and the patient was finally diagnosed with adenocarcinoma. The patient started systemic chemotherapy and visual acuity improved after 1 month. Tumor size and subretinal fluid also decreased. The tumor disappeared 2 months later and there was no recurrence. CONCLUSIONS: There are only few cases in which choroidal metastasis was observed in a young female patient with no history who had decreased visual acuity and was later diagnosed with lung cancer. Authors report this case because a satisfactory result was obtained from chemotherapy alone.

A Case of Extramedullary Plasmacytoma in the Lacrimal Excretory System

PURPOSE: To report a case of extramedullary plasmacytoma in the lacrimal excretory system. CASE SUMMARY: A 56-year-old female patient suffering from chronic epiphora for 1 year and having a non-tender, fixed palpable mass in the medial canthus of the eyelid visited the outpatient clinic. Orbital CT showed the non-enhancing mass was located along the right lacrimal sac and nasolacrimal duct and protruded into the nasal cavity. Biopsy was performed at the Otolaryngology Department. Based on histopathological examination, the mass was diagnosed as extramedullary plasmacytoma and the patient was treated with a total dose of 4500 cGy radiation (25 times in 1 month). After the 28-month follow-up period, the mass was not observed on Sinus CT and there was no recurrence. Additionally, no specific lesion was found during nasal endoscopy. CONCLUSIONS: We report a case of extramedullary plasmacytoma in the lacrimal excretory system successfully treated by radiation therapy.

Long-Term Evaluation of Tumor Removal at the Eyelid Margin Using a Radio-Frequency Electrosurgical Unit

PURPOSE: To evaluate the long-term follow-up results of the eyelid margin tumor resection using a radio-frequency electrosurgical unit. METHODS: We retrospectively reviewed the medical records of 53 patients (55 eyes) diagnosed with eyelid margin tumor and who underwent eyelid tumor resection using a radio-frequency electrosurgical unit more than 5 years prior. Age, gender, undergoing a biopsy, recurrence,- and complications were examined through phone questions and the out-patient department. RESULTS: The study included 23 eyes of 22 males and, 32 eyes of 31 females, (age range 8.6-76.8 years). Surgical success rate was 95% (52 of 55 eyes) and mean follow-up period was 8.9 years. Thirty-four of 55 patients underwent a biopsy, and the most common cases were intradermal nevus and compound nevus (13 cases each), 2 cases of basal cell carcinoma (5.9%), 2 cases of actinic keratosis (5.9%), and, 2 cases of chronic inflammation (5.9%). Other cases included 1 case of squamous papilloma (2.9%) and 1 case of fibrosis (2.9%). There were 3 cases of recurrence. Eyelash-related complications after surgery occurred in 3 cases of trichiasis or distichiasis. CONCLUSIONS: Eyelid margin tumor resection using a radio-frequency electrosurgical unit is simple and showed high success rate. Additionally, it is considered as an effective method in the eyelid margin tumor resection due to low recurrence and complication rates in the long-term follow-up.

Uveitis in Both Eyes Associated with Sweet's Syndrome

PURPOSE: To report a case of uveitis in both eyes caused by Sweet's syndrome. CASE SUMMARY: A 66-year-old male presented with decreased visual acuity in his left eye. Three years prior he was diagnosed with Sweet's syndrome, with symptoms such as chill, fever and, maculopapular rash on the chest. At initial physical examination, he had 3 or 4+ inflammatory cells and flare in the anterior chambers of both eyes, as well as hypopyon in his left eye. Under the suspicion of uveitis caused by Sweet's syndrome, he was rescribed an IV steroid injection and topical steroid agent. Three days later, his visual acuity improved to 0.3 in the right eye and 0.2 in the left eye. Hypopyon in the left eye disappeared and inflammatory cells decreased to 1~2+. He showed signs of recurrence in both eyes after 5 months and was treated with posterior subtenon triamcinolone injection in each eye. The patient showed no signs of recurrence for 10 months after injection. CONCLUSIONS: We report a case of uveitis caused by Sweet's syndrome treated with a steroid agent resulting in good prognosis. To the best of our knowledge, this is first case of uveitis caused by Sweet's syndrome reported in Korea.

Clinical Evaluation of Lacrimal Gland Ductal Disease

PURPOSE: To investigate the clinical characteristics and management of lacrimal gland ductal disease, a rare disease often mistaken for other diseases. METHODS: A retrospective chart review of 11 patients (11 eyes, 5 males, 6 females) diagnosed with lacrimal ductal disease between March 2007 and April 2013 was performed. RESULTS: Among 11 eyes in 11 patients, 4 were diagnosed with dacryops and 7 with lacrimal gland ductulitis initiated by dacryolith. The mean age of the subjects was 47.9 years (range, 30-80 years). Lacrimal gland ductulitis patients received treatment for conjunctivitis or hordeolum for several months. Four cases involved the right eye and 7 cases involved the left eye. Symptoms included foreign body sensation, pus-like discharge and palpable mass. Biopsy was performed in 3 cases and showed no specific findings. Patients with dacryops underwent marsupialization, whereas patients diagnosed with lacrimal gland ductulitis underwent excision and dacryolith curettage. During the 2-month follow-up period, all cases showed no signs of recurrence or complications. CONCLUSIONS: Lacrimal gland ductal disease can be mistaken for other diseases such as conjunctivitis, hordeolum, or orbital cyst, thus requiring accurate diagnosis and appropriate management.

A Survey on Contact Lens Care in Young Adolescent Student

PURPOSE: The present study was conducted to gather valid data for promoting public eye health among adolescent contact lens wearers by investigating the current practices of contact lenses wearers. METHODS: A questionnaire regarding use and care of contact lenses was distributed to middle and high school students. A total of 920 students (472 males, 448 females) were enrolled and the purpose of the study was explained to the students. RESULTS: Among all student, 49% had myopia (male 44%, female 54%) and 12% hyperopia (male 12%, female 13%). In addition, 70% of the subjects chose to wear glasses for vision correction, 27% (male 4%, female 50%) reported they have worn contact lenses and 64% of those were soft contact lenses. The age for starting contact lenses was between 14-16 years of age (63%). Most students (95%) purchased their contact lenses from an optical store. Many (89%) cleaned the contact lenses with cleaning solution on a daily basis, however, only 25% of the students received instructions on how to clean the lens properly. Common complaints associated with use in descending order were hyperemia (31%), foreign body sensation (19%), tearing (16%), pruritis (13%), and keratitis (9%). The subjects reported that the main cause of complications was due to the users' lens handling (93%). CONCLUSIONS: The present study findings showed many adolescents have misleading knowledge regarding use of contact lenses. There is a need for better education of young contact lens users regarding the contact lens care.

Lateral Geniculate Body Evoked Potentials Elicited by Visual and Electrical Stimulation

PURPOSE: Blind individuals who have photoreceptor loss are known to perceive phosphenes with electrical stimulation of their remaining retinal ganglion cells. We proposed that implantable lateral geniculate body (LGB) stimulus electrode arrays could be used to generate phosphene vision. We attempted to refine the basic reference of the electrical evoked potentials (EEPs) elicited by microelectrical stimulations of the optic nerve, optic tract and LGB of a domestic pig, and then compared it to visual evoked potentials (VEPs) elicited by short-flash stimuli. METHODS: For visual function measurement, VEPs in response to short-flash stimuli on the left eye of the domestic pig were assessed over the visual cortex at position Oz with the reference electrode at Fz. After anesthesia, linearly configured platinum wire electrodes were inserted into the optic nerve, optic track and LGB. To determine the optimal stimulus current, EEPs were recorded repeatedly with controlling the pulse and power. The threshold of current and charge density to elicit EEPs at 0.3 ms pulse duration was about ±10 microA. RESULTS: Our experimental results showed that visual cortex activity can be effectively evoked by stimulation of the optic nerve, optic tract and LGB using penetrating electrodes. The latency of P1 was more shortened as the electrical stimulation was closer to LGB. The EEPs of two-channel in the visual cortex demonstrated a similar pattern with stimulation of different spots of the stimulating electrodes. We found that the LGB-stimulated EEP pattern was very similar to the simultaneously generated VEP on the control side, although implicit time deferred. CONCLUSIONS: EEPs and VEPs derived from visual-system stimulation were compared. The LGB-stimulated EEP wave demonstrated a similar pattern to the VEP waveform except implicit time, indicating prosthetic-based electrical stimulation of the LGB could be utilized for the blind to perceive vision of phosphenes.

The Change of Microaneurysm in Diabetic Retinopathy Patients Who Undergo Intravitreal Avastin (Bevacizumab) Injection

PURPOSE: To evaluate microvascular change (microaneurysm) in diabetic retinopathy patients who undergo intravitreal bevacizumab injection using fluorescein angiography (FAG). METHODS: Thirty one eyes of 31 diabetic retinopathy patients undergoing intravitreal bevacizumab injection (1.25 mg/0.05 mL) in only 1 eye were included in this study. The control group (31 eyes) consisted of the fellow eyes. We excluded cased with intravitreal bevacizumab injection in both eyes and medial opacity obscuring three fundus image due to vitreous hemorrhage. The microaneurysmal change was analyzed at the same site the circle with optic disc radius and macula using FAG 2 to 4 months after injection. RESULTS: The average number of microaneurysms was 42.58 +/- 33.93 and significantly decreased to 28.74 +/- 28.06 after intravitreal bevacizumab injection (p < 0.05). The decrease of 35.70 +/- 24.79% in the treatment group was statistically higher than 13.95 +/- 38.21% in the control group with the fellow eyes (p < 0.05). CONCLUSIONS: In the present study, intravitreal bevacizumab injection reduced neovascularization, cystoid macular edema. Therefore this data can be used for future research on microvascular changes in the retina.

Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

PURPOSE: To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation. METHODS: A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed. RESULTS: Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 +/- 0.66 and logMAR 1.51 +/- 0.66, respectively (p < 0.05). CONCLUSIONS: This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.

Outcome and Significance of Silicone Oil Tamponade in Patients with Chronic Serous Retinal Detachment

PURPOSE: To evaluate the effectiveness of silicone oil tamponade in patients with chronic serous retinal detachment (SRD) persisting for three months after the resolution of ocular inflammation. METHODS: A total of 17 eyes of 17 patients diagnosed with chronic SRD persisting for three months after the resolution of ocular inflammation and with high risk of phthisis bulbi by secondary ocular hypotony and macular detachment by subretinal fibrous membrane formation were subjected to surgical intervention. Subjects underwent silicone oil tamponade after surgical drainage of subretinal fluid. Retrospective analyses on anatomical and functional success rates were then performed. RESULTS: Anatomical success with retinal reattachment was observed in ten of the 17 eyes (58.82%), while functional success measured as difference in the best-corrected visual acuity before and after the surgery were logarithm of the minimum angle of resolution (logMAR) 1.95 +/- 0.66 and logMAR 1.51 +/- 0.66, respectively (p < 0.05). CONCLUSIONS: This study suggests that, in patients with chronic SRD despite prolonged medical treatment and resolution of inflammation, surgical drainage of subretinal fluid with silicone oil tamponade can achieve anatomical and functional success.

The Effect of Dacryocystorhinostomy and Septoplasty Combination Surgery for Lacrimal Obstruction with Septal Deviation

PURPOSE: To evaluate the clinical effect of endonasal dacryocystorhinostomy (DCR) and septoplasty combination surgery for lacrimal obstruction in patients with nasal septal deviation. METHODS: The study group consisted of 24 eyes of 24 lacrimal obstruction patients with nasal septal deviation who had undergone endonasal DCR combined with septoplasty from 2006 to 2012. The types of lacrimal obstruction included nasolacrimal duct obstruction (18 cases), common canaliculus obstruction (5 cases) and lower lacrimal duct obstruction (1 case). The operations' procedure was as follows: first, an otorhinolaryngologist performed septoplasty and then, an ophthalmologist performed endonasal DCR. For catamnesis observation after the surgery, the operations' results and nasal complications were retrospectively analyzed. RESULTS: A total of 24 eyes of 24 patients were included in the present study. Eight patients were males, 16 patients were females and the mean patient age was 52.1 years. During 15.5 months of catamnesis, loss of epiphora was observed in 20 cases, improvement in epiphora was found in 3 cases, and the functional and anatomical success rate was 95.8% (23/24). Eight cases of postoperative complication were observed, 7 cases of granuloma were found in the bony ostium and surrounding area, and 1 case of synechia was found in the nasal cavity. CONCLUSIONS: The combination surgery of endonasal DCR and septoplasty provides a wider surgical view, allowing for an easier nasal cavity treatment, rendering the operation and after-care less difficult, as well as reducing the risk of surrounding tissue damage. This method is adequate for preventing complications after surgery and offers a better prognosis.

Effect of the Simultaneous Operation of Levator Resection and Frontalis Suspension for Congenital Ptosis

PURPOSE: To determine retrospectively if a simultaneous frontalis suspension could change the result of undercorrection observed during levator resection in congenital ptosis patients with poor levator functions. METHODS: Eight eyes in the present study were from 5 infants, 4 infants had congenital ptosis and 1 infant had blepharophimosis. The average age was 3.3 years (range: 1.5 to 6.9 years). If the upper lid margin was not positioned on the superior limbus after performing levator resection under general anesthesia, the height of the upper lid margin was controlled by simultaneous frontalis suspension. RESULTS: The average follow-up period was 29.8 months. After surgery on both eyes, all 8 cases showed good results and sudden relapse did not occur. Exposed corneal erosion was observed in 6 eyes, but with artificial tears, eye drops, and ointment there were significant improvements within 1 month in all cases. At final examinations, 6 out of 8 eyes showed excellent or good results; undercorrection in 2 eyes was observed and the lateral portion of ptosis in 1 eye was observed as an eye complication. CONCLUSIONS: If undercorrection caused by levator resection occurs in patients with congenital ptosis, the combination of frontalis suspension surgery may reduce undercorrection and any recurrence that might appear after surgery.