Eyelid Blink Characteristics in Patients with Ptosis Assessed Using Cellphone Camera before and after Levator Resection

Purpose@#To compare the eyelid blink characteristics of patients with ptosis assessed using a cellphone camera before and after levator resection. @*Methods@#In this prospective study, pictures and videos of eyelid blinking were obtained from 40 eyes (20 patients with ptosis) at a margin reflex distance 1 (MRD1) of 3.0 mm or less before and 1 month after levator resection. MRD1, palpebral fissure height (PFH), levator function, inter-blink interval, and blink duration, rate, and velocity were measured. The patients were also divided into those aged < 70 or ≥ 70. @*Results@#MRD1, PFH, and blink velocity increased, and blink duration decreased, after levator resection. In the ptosis group aged less than 70 years, the levator function and blink velocity increased preoperatively, while MRD1, PFH, levator function, and blink velocity increased postoperatively. The blink velocity showed a positive correlation with MRD1 and PFH. @*Conclusions@#Although no significant changes were observed in levator function postoperatively, the blink velocity increased significantly. Blink velocity may be useful for the evaluation of ptosis and as an indirect measure of levator function.

Whirling technique for thyroid fine needle aspiration biopsy: a preliminary study of effectiveness and safety

Purpose@#This study was aimed to compare thyroid fine needle aspiration biopsy (FNAB) techniques (conventional vs. whirling) in terms of cell harvesting ability ex vivo, the unsatisfactory rate and complication rate in vivo, and multi-operator performance in a phantom study. @*Methods@#In the ex vivo study, cell counts per background at ×100 magnification were compared between both techniques. In the in vivo study, 70 patients who underwent whirling FNAB from July 2019 to November 2019 were retrospectively compared to 140 matched patients who underwent conventional FNAB from January 2018 to November 2019 regarding the unsatisfactory rate and complication rate. As a subgroup analysis, thyroid nodules in difficult biopsy situations (nodule diameter <10 mm and location within 3 mm from major anatomical structures) were compared. In the phantom study, eight operators with varying experience recorded levels of dexterity and needle tip visualization, and their preferences for both techniques. @*Results@#In the ex vivo study, cell counts were comparable between both techniques in all thyroid nodule mimickers (80.0% vs. 87.5%, P=0.178). In the in vivo study, the unsatisfactory rate was comparable between the two groups (15.7% vs. 12.9%, P=0.859). In the subgroup analysis, the whirling technique demonstrated a lower unsatisfactory rate (5.9% vs. 24.2%, P=0.045) and a lower complication rate (0% vs. 6.1%, P=0.553). In the phantom study, the whirling technique demonstrated better dexterity and needle tip visualization and was preferred by all operators. @*Conclusion@#This newly proposed whirling technique for thyroid FNAB may be effective and safe, especially in difficult biopsy situations.

Endovascular Treatment of a Lumbar Spinal Epidural Arteriovenous Fistula with Radiculopathy:A Case Report

Spinal epidural arteriovenous fistulas (SEDAVFs) are rare spinal vascular malformations that are difficult to diagnose and treat. SEDAVFs can be asymptomatic; however, symptoms can arise from the compression of adjacent nerve roots by dilated vein and perimedullary venous reflux, caused by shunting into the epidural venous plexus. A 31-year-old male presented to our institution with a 2-year history of progressively worsening low-back pain, radiating thigh pain, and sensory changes in his lower extremities. MRI and CT angiography demonstrated dilated epidural vascular lesion compressing the nerve root. The SEDAVF was embolized with multiple coils, which alleviated the nerve root compression from the engorged venous varix and improved the patient’s radiculopathy. Our experience from this case shows that endovascular coil embolization using the transarterial approach can be an effective treatment for SEDAVF and an alternative to surgical ligations.

Analysis of Eyelid Blink Characteristics in Patients with Ptosis Using a Smartphone Camera

Purpose@#To compare eyelid blink characteristics between patients with ptosis and healthy controls using a smartphone camera. @*Methods@#The ptosis group consisted of 20 senile aponeurotic ptosis patients with margin reflex distance1 ≤2.5 mm and the control group consisted of 10 healthy subjects without ptosis. The ptosis group was further divided into two groups based on an age cutoff of 70 years. Palpebral fissure height, levator function, margin reflex distance1, inter-blink interval, blink duration, blink rate, and blink velocity were measured and compared between the three groups based on photographs of the eyelids and videos of blinking taken with a smartphone camera. @*Results@#The palpebral fissure height, levator function, margin reflex distance1, and blink velocity were lower in the ptosis groups than in the control group but these values did not differ between the two ptosis groups. The palpebral fissure height, levator function, and margin reflex distance1 were correlated with blink velocity. In the receiver operating characteristic (ROC) curve of blink velocity, the area under the receiver operating characteristic (AUROC) curve value was as high as 0.969 and the cut-off value was 32.36 mm/s. @*Conclusions@#It is possible to analyze eyelid blink characteristics using a smartphone camera and the results confirmed that palpebral fissure height, levator function, margin reflex distance1, and blink velocity were lower in the senile aponeurotic ptosis group than in the healthy control group and were unaffected by age. Additionally, blink velocity is valuable for diagnosis of ptosis due to the correlation between the degree of ptosis, blink velocity, and the ROC curve of blink velocity.

Mucosa-Associated Lymphoid Tissue Lymphoma of the Cheek Mimicking Benign Entities: a Case Report

The prevalence of cheek lymphoma, especially a mucosa-associated lymphoid tissue lymphoma (MALT), is very rare. Non-specific symptoms and image findings of cheek lymphoma may mimic benign entities and make it difficult to diagnose. In this case report, we present a case of MALT lymphoma of the cheek mimicking benign entities on computed tomography and magnetic resonance imaging.

Mucosa-Associated Lymphoid Tissue Lymphoma of the Cheek Mimicking Benign Entities: a Case Report

The prevalence of cheek lymphoma, especially a mucosa-associated lymphoid tissue lymphoma (MALT), is very rare. Non-specific symptoms and image findings of cheek lymphoma may mimic benign entities and make it difficult to diagnose. In this case report, we present a case of MALT lymphoma of the cheek mimicking benign entities on computed tomography and magnetic resonance imaging.

Analysis of Eyelid Blink Characteristics in Patients with Ptosis Using a Smartphone Camera

Purpose@#To compare eyelid blink characteristics between patients with ptosis and healthy controls using a smartphone camera. @*Methods@#The ptosis group consisted of 20 senile aponeurotic ptosis patients with margin reflex distance1 ≤2.5 mm and the control group consisted of 10 healthy subjects without ptosis. The ptosis group was further divided into two groups based on an age cutoff of 70 years. Palpebral fissure height, levator function, margin reflex distance1, inter-blink interval, blink duration, blink rate, and blink velocity were measured and compared between the three groups based on photographs of the eyelids and videos of blinking taken with a smartphone camera. @*Results@#The palpebral fissure height, levator function, margin reflex distance1, and blink velocity were lower in the ptosis groups than in the control group but these values did not differ between the two ptosis groups. The palpebral fissure height, levator function, and margin reflex distance1 were correlated with blink velocity. In the receiver operating characteristic (ROC) curve of blink velocity, the area under the receiver operating characteristic (AUROC) curve value was as high as 0.969 and the cut-off value was 32.36 mm/s. @*Conclusions@#It is possible to analyze eyelid blink characteristics using a smartphone camera and the results confirmed that palpebral fissure height, levator function, margin reflex distance1, and blink velocity were lower in the senile aponeurotic ptosis group than in the healthy control group and were unaffected by age. Additionally, blink velocity is valuable for diagnosis of ptosis due to the correlation between the degree of ptosis, blink velocity, and the ROC curve of blink velocity.

The Change of Eyebrow Height According to Frontalis Muscle Function after Upper Lid Blepharoplasty

Purpose@#The purpose of this study is to evaluate the change in eyebrow position and three parts of brow according to frontalis muscle (FM) function after upper lid blepharoplasty. @*Methods@#We subdivided 45 patients who had undergone upper eyelid blepharoplasty into three groups according to FM function: Group 1 (Poor, <4 mm), Group 2 (Good, ≥4 mm and <8 mm), and Group 3 (Excellent, ≥8 mm). Photographs of patients were taken before and three months after surgery. We analyzed brow descent and brow-to-pupil (BPD), brow-to-medial canthus distance (BMCD), brow-to-lateral canthus distance (BLCD) of each group. @*Results@#Mean FM function was measured as follows: Group 1 (2.11 ± 0.94 mm), Group 2 (6.2 ± 1.24 mm), Group 3 (10.25 ± 1.25 mm). There was no significant difference in the degree of eyebrow height change between Group 2 and 3, but Group 1 showed significant eyebrow height descent compared Group 2 and 3 (p < 0.05). In all three groups, the lateral brow position was significantly lowered compared to middle or medial brow position after blepharoplasty (p < 0.04). After blepharoplasty, 3 eyebrow ptosis occurred in Group 1, not in Group 2 and 3. @*Conclusions@#Patients with poor FM function less than 4 mm (Group 1) and BLCD of all group showed significant eyebrow descent after blepharoplasty. Since the weaker FM function and FM connection with eyebrow, the more lowered eyebrow after blepharoplasty, the evaluation of FM function may help predict the lowering of eyebrow height after blepharoplasty and decide whether to perform brow lift at the same time.

Melatonin in the colon modulates intestinal microbiota in response to stress and sleep deprivation

Background/Aims@#Stress is closely related to the deterioration of digestive disease. Melatonin has potent anti-inflammatory properties. The objective of this study was to determine the effect of water stress (WS) and sleep deprivation (SD) on intestinal microbiota and roles of melatonin in stressful condition. @*Methods@#We used C57BL/6 mice and specially designed water bath for stress and SD for 10 days. We measured melatonin concentrations in serum, feces, and colon tissues by high-performance liquid chromatography. Genomic DNA was extracted from feces and amplified using primers targeting V3 to V4 regions of bacterial 16S ribosomal RNA genes. @*Results@#Compared to the control, melatonin concentration was lower in the WS and SD. Fecal concentration was 0.132 pg/mL in control, 0.062 pg/mL in WS, and 0.068 pg/mL in SD. In colon tissue, it was 0.45 pg/mL in control, 0.007 pg/mL in WS, and 0.03 pg/mL in SD. After melatonin treatment, melatonin concentrations in feces and colon tissue were recovered to the level of control. Metagenomic analysis of microbiota showed abundance in colitogenic microbiota in WS and SD. Melatonin injection attenuated this harmful effect. WS and SD showed decreased Lactobacillales and increased Erysipelotrichales and Enterobacteriales. Melatonin treatment increased Akkermansia muciniphila and Lactobacillus and decreased Bacteroides massiliensis and Erysipelotrichaceae. @*Conclusions@#This study showed that stress and SD could affect intestinal dysbiosis and increase colitogenic microbiota, which could contribute to the aggravating digestive disease. Melatonin concentrations in feces and colon tissue decreased under WS and SD. Melatonin treatment brought recovery of melatonin concentration in colon tissue and modulating dysbiosis of intestinal microbiota.

Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience / 신경중재치료의학

Purpose@#We present ultrasound-guided percutaneous low-dose thrombin (200–250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups. @*Materials and Methods@#From April 2012 to May 2018, 8425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a “whirlpool” hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test. @*Results@#Most of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups. @*Conclusion@#Ultrasound-guided percutaneous low-dose thrombin injection (200–250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.

Objective Verification of Physiologic Changes during Accommodation under Binocular, Monocular, and Pinhole Conditions

BACKGROUND: To objectively investigate accommodative response to various refractive stimuli in subjects with normal accommodation. METHODS: This prospective, non-randomized clinical trial included 64 eyes of 32 subjects with a mean spherical equivalent −1.4 diopters (D). We evaluated changes in accommodative power, pupil diameter, astigmatic value, and axis when visual stimuli were applied to binocular, monocular (dominant eye, non-dominant eye, ipsilateral, and contralateral), and pinhole conditions. Visual stimuli were given at 0.25 D (4 m), 2 D (50 cm), 3 D (33 cm), and 4 D (25 cm) and accommodative response was evaluated using open view binocular autorefractor/keratometer. RESULTS: The accommodative response to binocular stimulus was 90.9% of the actual refractive stimulus, while that of the monocular stimulus was 84.6%. The binocular stimulus induced a smaller pupil diameter than did the monocular stimulus. There was no difference in accommodative response between the dominant eye and non-dominant eye or between ipsilateral and contralateral stimuli. As the refractive stimuli became stronger, the absolute astigmatic value increased and the direction of the astigmatism axis became more horizontal. Pinhole glasses required 10%–15% less accommodative power compared with the monocular condition. CONCLUSION: Binocular stimuli enable more precise and effective accommodation than do monocular stimuli. Accommodative response is composed of 90% true accommodation and 10% pseudo-accommodation, and the refractive stimulus in one eye affects the contralateral eye to the same extent. This should be taken into account when developing guidelines for wearing smart glasses while driving, as visual stimulation is applied to only one eye, but far distance attention is constantly needed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03557346

Low-dose Prasugrel in Patients with Resistance to Clopidogrel for the Treatment of Cerebral Aneurysms: Follow-up of over 6 Months / 신경중재치료의학

No abstract available.

A Case of Steatocystoma Simplex and Sebaceous Gland Hyperplasia of the Bilateral Lacrimal Caruncle

PURPOSE: A case of bilateral lacrimal caruncle steatocystoma simplex and sebaceous gland hyperplasia, which rarely occurs in the periocular area, is reported. CASE SUMMARY: A 42-year-old female presented with a bilateral caruncular mass, which had been growing for a few months. A physical examination revealed soft, non-tender, rounded masses and no other ophthalmic findings. Under local anesthesia, the masses were completely excised. In the histopathological examination, a cystic mass containing a sebaceous gland in the stratified squamous epithelium cyst wall was found. A hyperplastic sebaceous gland and a dilated sebaceous gland duct were also found. Steatocystoma simplex and sebaceous gland hyperplasia, respectively, were diagnosed. There was no recurrence or complication after excision. CONCLUSIONS: Steatocystoma simplex and sebaceous gland hyperplasia are benign tumors that rarely occur in the lacrimal caruncle. They can be diagnosed and treated by complete excision. Steatocystoma simplex and sebaceous gland hyperplasia should therefore be considered as differential diagnoses of a lacrimal caruncle mass.

Phenotypic and genotypic analyses of an attenuated porcine reproductive and respiratory syndrome virus strain after serial passages in cultured porcine alveolar macrophages

The porcine reproductive and respiratory syndrome virus (PRRSV) is a globally ubiquitous swine viral pathogen that causes major economic losses worldwide. We previously reported an over-attenuated phenotype of cell-adapted PRRSV strain CA-2-P100 in vivo. In the present study, CA-2-P100 was serially propagated in cultured porcine alveolar macrophage (PAM) cells for up to 20 passages to obtain the derivative strain CA-2-MP120. Animal inoculation studies revealed that both CA-2-P100 and CA-2-MP120 had decreased virulence, eliciting weight gains, body temperatures, and histopathologic lesions similar to those in the negative control group. However, compared to CA-2-P100 infection, CA-2-MP120 yielded consistently higher viremia kinetics and enhanced antibody responses in pigs. All pigs inoculated with CA-2-MP120 developed viremia and seroconverted to PRRSV. During 20 passages in PAM cells, CA-2-MP120 acquired 15 amino acid changes that were mostly distributed in nsp2 and minor structural protein-coding regions. Among these changes, 6 mutations represented reversions to the sequences of the reference CA-2 and parental CA-2-P20 strains. These genetic drifts may be hypothetical molecular markers associated with PRRSV macrophage tropism and virulence. Our results indicate that the PAM-passaged CA-2-MP120 strain is a potential candidate for developing a live, attenuated PRRSV vaccine.

Effect of vitamin C on azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced colitis-associated early colon cancer in mice

BACKGROUND/OBJECTIVES: The objective of this study was to investigate the effects of vitamin C on inflammation, tumor development, and dysbiosis of intestinal microbiota in an azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced inflammation-associated early colon cancer mouse model. MATERIALS/METHODS: Male BALB/c mice were injected intraperitoneally with AOM [10 mg/kg body weight (b.w)] and given two 7-d cycles of 2% DSS drinking water with a 14 d inter-cycle interval. Vitamin C (60 mg/kg b.w. and 120 mg/kg b.w.) was supplemented by gavage for 5 weeks starting 2 d after the AOM injection. RESULTS: The vitamin C treatment suppressed inflammatory morbidity, as reflected by disease activity index (DAI) in recovery phase and inhibited shortening of the colon, and reduced histological damage. In addition, vitamin C supplementation suppressed mRNA levels of pro-inflammatory mediators and cytokines, including cyclooxygenase-2, microsomal prostaglandin E synthase-2, tumor necrosis factor-α, Interleukin (IL)-1β, and IL-6, and reduced expression of the proliferation marker, proliferating cell nuclear antigen, compared to observations of AOM/DSS animals. Although the microbial composition did not differ significantly between the groups, administration of vitamin C improved the level of inflammation-related Lactococcus and JQ084893 to control levels. CONCLUSION: Vitamin C treatment provided moderate suppression of inflammation, proliferation, and certain inflammation-related dysbiosis in a murine model of colitis associated-early colon cancer. These findings support that vitamin C supplementation can benefit colonic health. Long-term clinical studies with various doses of vitamin C are warranted.

Diagnostic Performance of Diffusion-Weighted Steady-State Free Precession in Differential Diagnosis of Neoplastic and Benign Osteoporotic Vertebral Compression Fractures: Comparison to Diffusion-Weighted Echo-Planar Imaging

PURPOSE: To evaluate the diagnostic performance of diffusion-weighted steady-state free precession (DW-SSFP) in comparison to diffusion-weighted echo-planar imaging (DW-EPI) for differentiating the neoplastic and benign osteoporotic vertebral compression fractures. MATERIALS AND METHODS: The subjects were 40 patients with recent vertebral compression fractures but no history of vertebroplasty, spine operation, or chemotherapy. They had received 3-Tesla (T) spine magnetic resonance imaging (MRI), including both DW-SSFP and DW-EPI sequences. The 40 patients included 20 with neoplastic vertebral fracture and 20 with benign osteoporotic vertebral fracture. In each fracture lesion, we obtained the signal intensity normalized by the signal intensity of normal bone marrow (SI norm) on DW-SSFP and the apparent diffusion coefficient (ADC) on DW-EPI. The correlation between the SI norm and the ADC in each lesion was analyzed using linear regression. The optimal cut-off values for the diagnosis of neoplastic fracture were determined in each sequence using Youden's J statistics and receiver operating characteristic curve analyses. RESULTS: In the neoplastic fracture, the median SI norm on DW-SSFP was higher and the median ADC on DW-EPI was lower than the benign osteoporotic fracture (5.24 vs. 1.30, P = 0.032, and 0.86 vs. 1.48, P = 0.041, respectively). Inverse linear correlations were evident between SI norm and ADC in both neoplastic and benign osteoporotic fractures (r = −0.45 and −0.61, respectively). The optimal cut-off values for diagnosis of neoplastic fracture were SI norm of 3.0 in DW-SSFP with the sensitivity and specificity of 90.4% (95% confidence interval [CI]: 81.0–99.0) and 95.3% (95% CI: 90.0–100.0), respectively, and ADC of 1.3 in DW-EPI with the sensitivity and specificity of 90.5% (95% CI: 80.0–100.0) and 70.4% (95% CI: 60.0–80.0), respectively. CONCLUSION: In 3-T MRI, DW-SSFP has comparable sensitivity and specificity to DW-EPI in differentiating the neoplastic vertebral fracture from the benign osteoporotic vertebral fracture.

Acute and 13-week subchronic toxicological evaluations of turanose in mice

BACKGROUND/OBJECTIVES: Turanose, α-D-glucosyl-(1→3)-α-D-fructose, is a sucrose isomer which naturally exists in honey. To evaluate toxicity of turanose, acute and subchronic oral toxicity studies were conducted with ICR mice. MATERIALS AND METHODS: For the acute oral toxicity study, turanose was administered as a single oral dose [10 g/kg body weight (b.w.)]. In the subchronic toxicity study, ICR mice were administered 0, 1.75, 3.5, and 7 g/kg b.w. doses of turanose daily for 13 weeks. RESULTS: No signs of acute toxicity, including abnormal behavior, adverse effect, or mortality, were observed over the 14-day study period. In addition, no changes in body weight or food consumption were observed and the median lethal dose (LD₅₀) for oral intake of turanose was determined to be greater than 10 g/kg b.w. General clinical behavior, changes in body weight and food consumption, absolute and relative organ weights, and mortality were not affected in any of the treatment group for 13 weeks. These doses also did not affect the macroscopic pathology, histology, hematology, and blood biochemical analysis of the mice examined. CONCLUSION: No toxicity was observed in the acute and 13-week subchronic oral toxicology studies that were conducted with ICR mice. Furthermore, the no-observed-adverse-effect level is greater than 7 g/kg/day for both male and female ICR mice.

Measurement of Orbital Volume from Different Slice Thickness Facial Computed Tomography Scans Using a Semi-automatic Program

PURPOSE: To compare the orbital volume calculated from various slice thickness facial computed tomography scans using a semi-automated computer program. METHODS: Axial and coronal scans of 2, 2.5, 3 mm slice thickness facial computed tomography scans were used to measure the orbital volume. The cross-sectional area was determined from each slice using a semi-automated computer program (MATLAB 2009a®, MathWorks, Inc., Natick, MA, USA), and then the volume was calculated from serial reconstruction of the cross sections. RESULTS: The measured value in the 2 mm images was 33.14 ± 2.37 cm³ in the right orbit and 34.32 ± 2.60 cm³ in the left orbit for the axial scans, and 35.54 ± 3.58 cm³ in the right orbit and 34.96 ± 4.05 cm³ in the left orbit for the coronal scans. In the 2.5 mm images, the values were 33.28 ± 3.35 cm³ in the right orbit and 33.73 ± 4.10 cm³ in the left orbit for the axial scans, and 35.24 ± 3.98 cm³ in the right orbit and 35.10 ± 3.93 cm³ in the left orbit for the coronal scans. In the 3 mm images, the values were 33.23 ± 2.70 cm³ in the right orbit and 33.39 ± 2.69 cm³ in the left orbit for the axial scans, and 33.20 ± 3.64 cm³ in the right orbit and 32.95 ± 3.45 cm³ in the left orbit for the coronal scans. In the 3 mm image, there was not a significant difference in the calculated volume between the axial and coronal scans (p(3mm) = 0.62). CONCLUSIONS: Because there is no difference in the results of the orbital volumetric measurements between three other slice thicknesses in the axial scan, using axial scan images with a computer program that semi-automatically calculates orbital volume is useful. In addition, the volume measured by thick slice images has more reproducibility than the volume measured by thin slice images.

A Case of Actinomycosis of an Orbital Subperiosteal Abscess in a Patient with Type 2 Diabetes Mellitus / 임상당뇨병

Orbital and paranasal actinomycosis have not been commonly reported. We report a case of this uncommon infection, which was improved after endonasal endoscopic drainage and antibiotics. A 53-year-old woman with type 2 diabetes mellitus complained of inability to lift her right upper eyelid and painful swelling over the preceding two days. Broad-spectrum antibiotics did not resolve her lesion. In ophthalmic examination, decreased visual acuity, upper and medial gaze limitation, and a relative afferent pupillary defect of her right eye were observed. Computed tomography of the orbit showed aggravated orbital cellulitis, preseptal cellulitis, subperiosteal abscess, and maxillary and ethmoid sinusitis. After endonasal endoscopic drainage and systemic antibiotics, her clinical symptoms dramatically improved. Microbiological analysis of the maxillary excisional biopsy showed Actinomycosis. This case is of interest due to the rare orbital presentation of actinomycosis infection and the importance of appropriate surgical drainage and long-term antibiotics treatment in such cases. Because delayed diagnosis and treatment of rhino-orbital actinomycosis can cause permanent vision loss or intracranial abscess, it requires careful clinical attention.

Prognosis of Ocular Injury Caused by Wasp Sting: Case Reports

PURPOSE: In the present study, the prognosis of ocular injury caused by a wasp sting was evaluated in two cases: Case 1 was treated by anterior chamber irrigation and Case 2 was simultaneously treated by anterior chamber irrigation and vitrectomy. CASE SUMMARY: Both patients had unilateral damage and complained of severe eye pain and blurred vision. Severe corneal edema, conjunctival injection, marked anterior chamber inflammatory reaction and the wasp sting through the cornea at the anterior chamber were observed in both cases. In Case 1, anterior chamber irrigation was performed, however, corneal edema was not recovered. Six months after the wasp sting, phthisis was observed. In Case 2, anterior chamber irrigation and vitrectomy were simultaneously performed, corneal edema decreased and epithelial healing occurred. Four months after the wasp sting, the eyeball was stable, but there was no wave on the electroretinogram. CONCLUSIONS: Unlike the ocular damage resulting from a bee sting, the ocular damage from a wasp sting causes severe toxic reactions and results in poor prognosis. Aggressive treatment including vitrectomy is necessary shortly after wasp sting injury to save both the vision and eyeball.