Removal of Eyelid Epidermal Cyst Using High-Frequency Radio-Wave Electrosurgery

PURPOSE: To introduce an effective new surgical approach with high-frequency radio-wave electrosurgery to remove eyelid epidermal cysts. METHODS: Thirteen patients (13 eyes) with eyelid epidermal cysts were enrolled in the present study. All patients underwent high-frequency radio-wave electrosurgery (Ellman surgitron(R)) to remove the epidermal cyst. The results were analyzed retrospectively, after a follow-up of more than 6 months. RESULTS: At 6 months postoperatively, all eyes showed no recurrence of epidermal cyst. Additionally, no complications were reported by any patient. CONCLUSIONS: High-frequency radio-wave electrosurgery is an effective procedure to remove eyelid epidermal cyst without recurrence.

Quickert Suture Using Nonabsorbable Suture Material for Lower Lid Entropion

PURPOSE: To introduce the modified Quickert suture for lower lid entropion, using nonabsorbable suture material. METHODS: From October, 2011 to June, 2012, a total of 11 patients (12 eyes) with lower lid entropion, in poor general condition or who did not want extensive surgery, were recruited for the present surgery. Three small skin incisions were made at the medial, central, and lateral areas, just below the lower cilia. With double armed 6-0 nylon, each needle was inserted in the inferior conjuctival fornix and the 2 ends of the suture were tied and buried at the point of the skin incision site. Sutures were made at the medial, central and lateral areas. RESULTS: The patients consisted of 4 males and 7 females with an average age of 71.3 +/- 8.4 years (54-82 years). The patients were followed up the patients for an average of 13.9 +/- 2.4 months postoperatively. All patients were satisfied with the outcome, and there were no recurrences. CONCLUSIONS: Quickert suture is a simple and effective method, for correcting lower lid entropion by inducing scar formation with absorbable suture materials, but the effect duration is limited. Because the modified Quickert suture utilizes its own tension with a nonabsorbable suture material, the effect lasts as long as the suture material remains. It is a useful and practicable method for patients, in poor general condition or not wanting extensive surgical procedures.

Quickert Suture Using Nonabsorbable Suture Material for Lower Lid Entropion

PURPOSE: To introduce the modified Quickert suture for lower lid entropion, using nonabsorbable suture material. METHODS: From October, 2011 to June, 2012, a total of 11 patients (12 eyes) with lower lid entropion, in poor general condition or who did not want extensive surgery, were recruited for the present surgery. Three small skin incisions were made at the medial, central, and lateral areas, just below the lower cilia. With double armed 6-0 nylon, each needle was inserted in the inferior conjuctival fornix and the 2 ends of the suture were tied and buried at the point of the skin incision site. Sutures were made at the medial, central and lateral areas. RESULTS: The patients consisted of 4 males and 7 females with an average age of 71.3 +/- 8.4 years (54-82 years). The patients were followed up the patients for an average of 13.9 +/- 2.4 months postoperatively. All patients were satisfied with the outcome, and there were no recurrences. CONCLUSIONS: Quickert suture is a simple and effective method, for correcting lower lid entropion by inducing scar formation with absorbable suture materials, but the effect duration is limited. Because the modified Quickert suture utilizes its own tension with a nonabsorbable suture material, the effect lasts as long as the suture material remains. It is a useful and practicable method for patients, in poor general condition or not wanting extensive surgical procedures.

A Case of Central Retinal Artery Occlusion after Chiropractic Manipulation of the Neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.

The Efficacy of Preoperative Routine Otorhinolaryngologic Referral Before Endonasal Dacryocystorhinostomy

PURPOSE: To determine if routine otorhinolaryngologic referral prior to endonasal dacryocystorhinostomy (EN-DCR) is necessary. METHODS: Two hundred thirty-seven eyes of 178 patients who were supposed to undergo EN-DCR were prospectively analyzed. Nasal endoscopy was performed by an ophthalmologist and the patients who had severe abnormality were referred to an otorhinolaryngologist. The patients were classified into 3 groups after a preoperative examination by an ophthalmologist and an otorhinolaryngologist; the number and success rate of each group were then investigated. Group A consisted of patients who had no nasal cavity abnormality, Group B consisted of patients with a nasal cavity abnormality but who received no treatment, and Group C consisted of patients who had a nasal cavity abnormality and received otorhinolaryngologic treatment. RESULTS: The number of subjects in each group was 156 in Group A (87.7%), 12 in Group B (6.7%), and 10 in Group C (5.6%). The number of patients who were referred to the otorhinolaryngologist was 22 (12.3%). There was no statistical significance of success rate between the groups. CONCLUSIONS: Routine nasal endoscopic examination should be performed by an ophthalmologist prior to EN-DCR. Only patients with severe abnormal findings should be referred to an otorhinolaryngologist as the results from the present study show the percentage of patients having significant nasal abnormalities was found to be low (12%) and the success rate of EN-DCR revealed no statistical significance between the groups. This could help patients by saving time and expense.

A Case of Bilateral Endogenous Pantoea Agglomerans Endophthalmitis with Interstitial Lung Disease

We here in report a case of bilateral endogenous endophthalmitis caused by Pantoea agglomerans (P. agglomerans) in a patient who had interstitial lung disease and was treated with oral corticosteroids. A 72-year-old man presented with decreased visual acuity in both eyes nine days after he received oral corticosteroids. He had marked uveitis, cataracts, and vitreous opacities. Cultures were taken of blood, aqueous humor, and vitreous. We initially suspected a fungal etiology and treated him with antifungal drugs; however, the intraocular disease progressed without improvement. Vitreous culture was positive for P. agglomerans. The patient underwent pars plana vitrectomy with cataract surgery bilaterally, followed by a 2-week course of antibiotics. The final visual acuity was 20/25 in the right eye and 20/200 in the left eye. This is the first report of bilateral endogenous endophthalmitis caused by P. agglomerans in Korea; it is also the first case reported outside of the United States.

Clinical Features and Preventions of Ocular Injuries Associated With Mistaken Use of Superglue as Eyedrops

PURPOSE: To investigate the clinical features and prevention of ocular injuries associated with the mistaken use of superglue as eyedrops. METHODS: Medical records of 13 patients with ocular superglue injury who visited our hospital from January 1, 2002 to December 31, 2004 were analyzed. The clinical features of ocular superglue injury and causes of using superglue instead of eyedrops for each patient were analyzed. RESULTS: The present study involved 15 eyes of 13 patients, including seven men (53.8%) and six women (46.2%), ranging from 6 to 72 years of age, with a mean age of 38.4 years. Ocular superglue injuries were corneal abrasion in all patients. The bonding of eyelids (eight cases, 61.5%) and eyelashes (two cases, 15.4%) were identified. Ocular injuries were treated conservatively and resolved without complications. The major cause of mistaken use of superglue was similarly packaged eye drops (11 cases, 84.6%). Other causes included poor eyesight (one case) and unsupervised children (one case). CONCLUSIONS: The availability of eyedrops in various ocular diseases has recently increased, and superglue is found in many households, wherefore incidence of ocular superglue injuries can increase. Therefore, modifying the design of superglue bottles and providing proper education for patients to prevent ocular superglue injury is important.

Treatment of the SmartPLUG-related Canaliculitis

PURPOSE: To report on the treatment approach of canaliculitis related to SmartPLUG use and its clinical manifestation. METHODS: A retrospective chart review of eight patients who had canaliculitis after the insertion of the SmartPLUG was conducted. RESULTS: Seven out of eight cases with canaliculitis related to the SmartPLUG required extraction of the SmartPLUG. While four cases were removed with only retrograde massage, two cases required surgical treatment. CONCLUSIONS: Canaliculitis related to SmartPLUG use is rarely reported. However, canaliculitis as a complication is difficult to treat and often leads to surgery. In canaliculitis related to SmartPLUG use, retrograde massage as a non-surgical method for the simple and effective removal of the SmartPLUG can be beneficial.

Success Rates According to the Shape of Rhinostomy After Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the success rates according to the shape of rhinostomy after endonasal dacryocystorhinostomy. METHODS: We analyzed 131 patients (188 cases) who had undergone endonasal dacryocystorhinostomy with a minimum follow-up of 6 months. After surgery, all cases were classified into flat, alcove, concave, or concealed concave types according to Jane's rhinostomy classification. Patency to irrigation and improved symptoms were considered indicative of a successful outcome. RESULTS: There were 81 flat type patients (125 cases), 31 alcove type patients (42 cases), 19 concave type patients (21 cases), and no cases were classified as concealed concave type. The success rates were 75.2%, 85.7%, 81.0% respectively, and the most common cause of failure was the formation of granulation within the ostium. The success rates did not significantly vary according to the shape of rhinostomy (p=0.144). CONCLUSIONS: The success rates after endonasal dacryocystorhinostomy of flat, alcove, and concave types in turn were 75.2%, 85.7%, and 81.0%.

A Case of Wegener's Granulomatosis Misdiagnosed as Ocular Tuberculosis

PURPOSE: To report a case of Wegener's granulomatosis misdiagnosed as ocular tuberculosis. METHODS: A 65-year-old man who was treated with anti-tuberculosis medications as suspected pulmonary tuberculosis was referred from the department of internal medicine for visual loss over months. His initial visual acuity was counting fingers at 30 cm in the right eye and there was a chorioretinal scar involving the macula on fundus examination. At that time, we thought that the lesion was a tuberculosis-related chorioretinal scar and so he was treated with anti-tuberculosis medications. There was a recurrent bilateral anterior uveitis during three months from the initial visit. RESULTS: After 14 months, he was examined by otorhinolaryngologist due to a saddle nose deformity and Wegener's granulomatosis was diagnosed based on positive Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and nasal mucosal biopsy. At that time, ocular examination revealed the necrotizing scleritis in both eyes and orbital CT showed bony destruction of medial and inferior orbital wall without proptosis in both eyes. We had treated with oral cyclophosphamide and prednisone. CONCLUSIONS: We experienced a case of Wegener's granulomatosis with chorioretinal scar misdiagnosed as ocular tuberculosis. In conclusion, we should differentially diagnose Wegener's granulomatosis from suspected ocular tuberculosis.