Synthetic Fiber Granuloma Misdiagnosed as Chalazion in an 8-year-old Child

Purpose@#We report a case of conjunctival synthetic fiber granuloma, which was misdiagnosed as chalazion. Case summary: An 8-year-old female patient, without any previous medical illness or ocular trauma history, visited our hospital with a prolonged mass-like lesion in the left lower palpebral conjunctiva. In her detailed medical history, she said that she often played with her doll's hair. The conjunctival mass first occurred 1 week before her visit to the private clinic. At that time, eye drop treatment was initiated under the diagnosis of chalazion. The child showed no improvement; thus, incision and curettage were performed. The mass in the conjunctiva continued to persist, so she was transferred to the hospital for a biopsy. Slit-lamp examination revealed a patterned agglomeration of fiber strands inside the mass. Complete excisional biopsy was performed under general anesthesia. Histopathological examination revealed a fibrous foreign body in the birefringence, with granulomatous inflammation surrounding it. The patient was diagnosed with synthetic fiber granuloma. @*Conclusions@#Conjunctival synthetic fiber granulomas are easily mistaken as chalazion. If specific fibrous strands are entangled inside the mass on slit-lamp examination, diagnosis and treatment through therapeutic excisional biopsy are required under clinical suspicion.

Synthetic Fiber Granuloma Misdiagnosed as Chalazion in an 8-year-old Child

Purpose@#We report a case of conjunctival synthetic fiber granuloma, which was misdiagnosed as chalazion. Case summary: An 8-year-old female patient, without any previous medical illness or ocular trauma history, visited our hospital with a prolonged mass-like lesion in the left lower palpebral conjunctiva. In her detailed medical history, she said that she often played with her doll's hair. The conjunctival mass first occurred 1 week before her visit to the private clinic. At that time, eye drop treatment was initiated under the diagnosis of chalazion. The child showed no improvement; thus, incision and curettage were performed. The mass in the conjunctiva continued to persist, so she was transferred to the hospital for a biopsy. Slit-lamp examination revealed a patterned agglomeration of fiber strands inside the mass. Complete excisional biopsy was performed under general anesthesia. Histopathological examination revealed a fibrous foreign body in the birefringence, with granulomatous inflammation surrounding it. The patient was diagnosed with synthetic fiber granuloma. @*Conclusions@#Conjunctival synthetic fiber granulomas are easily mistaken as chalazion. If specific fibrous strands are entangled inside the mass on slit-lamp examination, diagnosis and treatment through therapeutic excisional biopsy are required under clinical suspicion.

Thermal Profile of Pulse Precision Capsulotomy: In vivo and In vitro Infrared Thermography Study

Purpose@#This study aimed to elucidate the thermal safety of precision pulse capsulotomy (PPC) via in vivo and in vitro evaluation of the thermal profile using infrared thermography. @*Methods@#This prospective observational study enrolled 15 eyes from 15 participants who underwent cataract surgery using the Zepto PPC. All patients underwent temperature measurements of the incision site and the entire cornea using an infrared thermographer during the capsulotomy procedure. To accurately analyze the temperature change of the Zepto PPC, infrared thermography was performed with the Zepto handpiece while exposed to air and then in porcine eyes. Moreover, in each case, the difference in temperature change according to the use of an ophthalmic viscosurgical device (OVD) was also checked to determine the temperature buffering effect. @*Results@#In the clinical evaluations, the mean temperature elevation around the corneal incision and time duration from baseline to peak temperature during the Zepto capsulotomy were 4.0°C ± 1.9°C and 4.43 ± 1.26 seconds, respectively, with a mean peak temperature of 32.6°C ± 2.0°C. The mean peak temperature and rise time of the naïve Zepto nitinol ring, as measured from the bottom side, were 109.0°C ± 22.9°C and 43.40 ± 11.06 seconds in the experimental procedures, respectively. In the porcine eyes, the mean elevation of temperature and rise time of the Zepto nitinol ring were 6.2°C ± 1.6°C and 11.67 ± 2.08 seconds with the use of OVDs, and 10.5°C ± 3.3°C and 14.00 ± 3.61 seconds without OVDs, respectively. @*Conclusions@#Zepto PPC has the potential to generate extremely high thermal energy, according to an in vitro study. However, the temperature rise of the Zepto capsulotomy can be minimized by using OVDs.

Simultaneous Triple Microbial Keratitis

No abstract available.

A Case of Monocular Gonococcal Conjunctivitis in an Adult Male / 계명의대학술지

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis

C-type Anterior Lamellar Keratoplasty Using Cryopreserved Leftover Cornea for Terrien's Marginal Degeneration

PURPOSE: To report a case of Terrien's marginal degeneration treated with C-type anterior lamellar keratoplasty using cryopreserved leftover cornea. CASE SUMMARY: A 63-year-old female visited our clinic because of left ocular discomfort and visual deterioration over several years. The patient had +2.25 Dsph = -5.00 Dcyl × 111° of astigmatism, and best corrected visual acuity was 20/20. Microscopic slit lamp examinations revealed an approximately 10.0 mm width semilunar shaped stromal opacity with surrounding stromal lipid deposit, as well as superficial neovascularization with thinning at superior perilimbal cornea. Anterior segment optical coherence tomography confirmed extreme thinning at the opacified cornea. The patient was diagnosed with Terrien's marginal degeneration. To prevent corneal perforation, C-type anterior lamellar keratoplasty using cryopreserved leftover cornea was performed. After 18 months after operation, donor graft was successfully attached via the anterior segment optical coherence tomography and microscopic slit lamp examination and graft rejection was not observed. CONCLUSIONS: C-type anterior lamellar keratoplasty using a cryopreserved cornea can be an effective therapeutic strategy for Terrien's marginal degeneration.

Acute Bilateral Anterior Uveitis after a Single Intravenous Infusion of Zoledronic Acid in Metastatic Breast Cancer

No abstract available.

A Case of Therapeutic Keratoplasty Using Cryo-preservative Cornea in Candida albicans Keratitis

PURPOSE: To report a case treated with therapeutic keratoplasty using a cryo-preserved cornea in a patient with Candida albicans keratitis. CASE SUMMARY: A 77-year-old female visited our clinic because of left ocular pain and visual disturbance for 3 days. Microscopic slit lamp examination revealed a 1.2 mm sized round corneal epithelial defect with deep stromal infiltration, brownish pigmentation and signs of inflammation with cyclitic membranes in the anterior chamber. On suspicion of Candida keratitis, we performed penetrating keratoplasty using a cryo-preserved donor cornea in Optisol-GS® (Bausch & Lomb, Irvine, CA, USA) solution with excision of the infected iris and colony of the anterior chamber. After the procedure, injection of intravitreal or intracameral amphotericin B and voriconazole were administered alternately. At 2 weeks after the second surgery, infection signs disappeared. At the follow-up in the outpatient clinic, signs of infection were not observed. CONCLUSIONS: Therapeutic keratoplasty using a cryo-preserved donor cornea can be an immediate and effective therapeutic strategy for Candida albicans keratitis.

Accuracy of Three Intraocular Lens-power Formulas in Predicting Refractive Outcomes in Different Intraocular Lenses

PURPOSE: To compare the accuracy of different power-calculation formulas in predicting the postoperative refraction of three-piece and one-piece intraocular lenses (IOL). METHODS: We retrospectively reviewed the medical records of 74 eyes (62 patients) that had undergone cataract surgery involving implantation of one of two IOLs―the SENSAR® AAB00 1-Piece Acrylic IOL (44 eyes), or the Hoya® VA60BB 3-Piece Acrylic IOL (30 eyes)―between October 2014 and March 2015. Axial length was measured using an optical low-coherence refractometry (Lenstar®), and biometry was then calculated by the pre-installed Lenstar program, which used the SRK/II, Sanders-Retzlaff-Kraff/Theoretical (SRK/T), and Hoffer Q formulas. Mean absolute error (MAE) and mean numeric error (MNE) were measured 1 day, 1 week, 1 month, and 2 months after surgery. RESULTS: Using the SRK/T and Hoffer Q formulas, the one-piece IOL group differed significantly from the three-piece IOL group in terms of the MNE obtained 1 month and 2 months after surgery. Across all formulas and time points, there were no significant differences between the groups in terms of MAE. CONCLUSIONS: There was no significant difference between the different power-calculation formulas. Starting 1 month after surgery, the three-piece IOL group showed myopic postoperative refraction compared to the predictive spherical equivalent using the SRK/T and Hoffer Q formulas.

Tear Stasis Caused by Severely Protruded Lacrimal Puncta Treated by Novel Punctal Fixation Technique

No abstract available.

A Case of Beauveria Bassiana Keratitis Confirmed by Gene Sequencing

PURPOSE: To report a case of Beauveria bassiana keratitis that was confirmed by gene sequencing. CASE SUMMARY: A 70-year-old man presented to our hospital with complaints of ocular pain and deterioration of the visual acuity in his left eye after injury caused by a wood branch one week previously. Visual acuity in the left eye was 20/400 at the time of the first visit. Slit lamp examination showed a central 0.7 x 2.5-mm-sized epithelial defect surrounded by cellular infiltration in the stroma. Scraping of the corneal lesion for microbiological examinations was performed. Initial Gram stain, potassium hydroxide (KOH) mount, and culture were negative. However, fungal hyphae were observed on a KOH mount of the repeated corneal scraping specimen, and a Beauveria species was suspected based on the culture. Beauveria bassiana was confirmed using a MicroSEQ(R) D2 large-subunit ribosomal DNA fungal sequencing kit. Natamycin eye solution was initially instilled bihourly (every two hours), but the persistent epithelial defect and progressive stromal melting finally resulted in a descemetocele. Temporary and permanent amniotic membrane transplantations were performed, and amphotericin B eye solution was administered bihourly (every two hours). The ulcerous lesion gradually improved with no evidence of recurrence. CONCLUSIONS: Recently, cases of fungal keratitis have been increasing. Therefore, molecular diagnosis methods such as gene sequencing can be helpful in diagnosis and in improving the prognosis of fungal keratitis caused by rare fungi, as we found in this case.

Clinical Features of Posterior Capsule Rupture during Phacoemulsification Performed by Novice Ophthalmologists

PURPOSE: To report the related factors of posterior capsule rupture and the difference of postoperative visual prognosis after phacoemulsification by analyzing clinical features of the surgery performed by ten novice ophthalmologists. METHODS: We retrospectively evaluated electronic medical records of 326 patients (412 phacoemulsification cases) who underwent surgery by novice ophthalmologists certified by the Board of Ophthalmology after a resident training program. RESULTS: The number of cataract surgeries performed by each surgeon within the ophthalmology fellowship period (6 months - 2 years) ranged from 16 to 75 eyes, and perioperative posterior capsule ruptures occurred in 64 of 412 eyes (15.5%). Factors such as age, sex, laterality, axial length and clinical courses were not related to the rate of posterior capsule rupture. Nucleosclerosis was significantly related to the posterior capsule rupture rate and was especially higher in the group with a grade higher than five compared to that in the groups with a grade less than 5 based on the Lens Opacities Classification System III (p = 0.033). Factors of surgeon's subspecialty, nucleofractis method, and period between residency and the fellowship were not related to the posterior capsule rupture rate, except when considering anesthetic methods. The posterior capsule rupture rate was less frequent in the retrobulbar surgery group than the topical surgery group (p = 0.046). Postoperative visual outcomes were significantly different at postoperative day one and one month (p = 0.023, 0.022, respectively) but not at postoperative two months (p = 0.059). CONCLUSIONS: Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in posterior capsule rupture rate between nucleosclerosis and anesthesia groups. Postoperative visual outcome differed at postoperative day one and one month but not after two months postoperatively.

Clinical Features of Posterior Capsule Rupture during Phacoemulsification Performed by Novice Ophthalmologists

PURPOSE: To report the related factors of posterior capsule rupture and the difference of postoperative visual prognosis after phacoemulsification by analyzing clinical features of the surgery performed by ten novice ophthalmologists. METHODS: We retrospectively evaluated electronic medical records of 326 patients (412 phacoemulsification cases) who underwent surgery by novice ophthalmologists certified by the Board of Ophthalmology after a resident training program. RESULTS: The number of cataract surgeries performed by each surgeon within the ophthalmology fellowship period (6 months - 2 years) ranged from 16 to 75 eyes, and perioperative posterior capsule ruptures occurred in 64 of 412 eyes (15.5%). Factors such as age, sex, laterality, axial length and clinical courses were not related to the rate of posterior capsule rupture. Nucleosclerosis was significantly related to the posterior capsule rupture rate and was especially higher in the group with a grade higher than five compared to that in the groups with a grade less than 5 based on the Lens Opacities Classification System III (p = 0.033). Factors of surgeon's subspecialty, nucleofractis method, and period between residency and the fellowship were not related to the posterior capsule rupture rate, except when considering anesthetic methods. The posterior capsule rupture rate was less frequent in the retrobulbar surgery group than the topical surgery group (p = 0.046). Postoperative visual outcomes were significantly different at postoperative day one and one month (p = 0.023, 0.022, respectively) but not at postoperative two months (p = 0.059). CONCLUSIONS: Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in posterior capsule rupture rate between nucleosclerosis and anesthesia groups. Postoperative visual outcome differed at postoperative day one and one month but not after two months postoperatively.

A Case of Phoma glomerata Keratitis Occurred in Recurrent Herpes Simplex Keratitis Cicatrix

PURPOSE: To report a case of Phoma glomerata keratitis occurring in recurrent herpes simplex keratitis cicatrix. CASE SUMMARY: A 63-year-old male patient was admitted to our hospital with complaints of abrupt visual deterioration and ocular pain in his left eye. He was treated for recurrent herpes simplex keratitis in the same eye 12 years prior. Because central desmatocele was observed as a result of advanced corneal stromal melting, Gram staining, Potassium Hydroxide (KOH) mount, and culture were performed in corneal scrape specimens. On microbiological evaluation, a Phoma species was detected and Phoma glomerata was diagnosed using DNA sequencing method. Two consecutive amniotic membrane transplantations were performed with topical antifungal agents. The lesion was not improved when using topical amphotericin B and natamycin eyedrops, thus fluconazole eyedrops were used additionally. The corneal infection was resolved with central thick opacification. CONCLUSIONS: In the present case, herpetic keratitis was the main underlying causative factor because the patient had no past history of trauma. When diverse appearances of keratitis occur in herpes simplex keratitis patients, clinicians need to consider the concurrence of fungal infection, especially Phoma glomerata, a rare fungal organism.

Clinical Features of Refractive Accommodative Esotropia According to Degree of Hypermetropia

PURPOSE: This study examined differences in clinical patterns according to the hyperopia level in refractive-accommodative esotropia patients. METHODS: Ninety-four refractive-accommodative esotropia patients were divided into 3 groups according to hyperopia level: group 1, > or = +1.00D and or = +3.00D and or = +5.00D. The following factors were analyzed retrospectively: the initial corrective visual acuity, the final corrective visual acuity, the angle of esotropia with or without hyperopic correction, the recovery time to orthophoria after hyperopic correction, the change in hyperopia level, and the frequency of amblyopia. RESULTS: The angles of esotropia without hyperopic correction in groups 1, 2 and 3 were 18.4+/-7.3PD, 22.9+/-8.5PD, and 25.7+/-10.4PD, respectively. The angle of esotropia was found to be significantly greater in the group with the higher level of hyperopia (P=0.01). The monthly change in hyperopia in groups 1, 2 and 3 was 0.018+/-0.02D, 0.028+/-0.03D and 0.043+/-0.03D. The change was greater in the group with the higher level of hyperopia (P=0.009). CONCLUSIONS: In refractive-accommodative esotropia patients, the more the hyperopia without correction increases, the more the angle of esotropia without correction increases, and the larger the reduction of hyperopia after correction becomes.

The Effects of Optic Disc Factors on Retinal Nerve Fiber Layer Thickness Measurement in Children

PURPOSE: We analyzed the effect of the changes of the optic disc area (ODA) caused by the axial length and the refractive error, and the consequent changes of the distance from the optic disc margin to the circular scan (OD-CS) of Optical coherence tomography (OCT) on the measurement of the retinal nerve fiber layer thickness(RNFLT) were examined. METHODS: One hundred two eyes of 51 children (age range 4 to 15 years) were measured using OCT including the RNFLT. For the ODA and the OD-CS, the relative area formed by the ODA and the circular scan was obtained. In addition, the correlation of the refractive error and the axial length to the optic disc factors was assessed. RESULTS: As hyperopia progresses to myopia, the axial length became longer, the ODA became smaller (r=-0.442, p=0.000) and the OD-CS showed a tendency to increase (r=0.471, p=0.000). As the OD-CS became longer, the measured average RNFLT decreased significantly (r=-0.248, p=0.012), and the ODA and the OD-CS showed a significant correlation to the RNFL thickness that was measured in the nasal and inferior areas, the S2, N2 and N3 areas and the I1 area. CONCLUSIONS: As ODA becomes smaller and the OD-CS becomes longer, the RNFLT measured in the nasal and inferior areas, the S2, N2, N3, I1 area has a tendency to be thinner. Hence, consideration of the disc area is required when interpreting the RNFLT of these eyes.

Resolution of Severe Macular Edema in Adult Coats' Disease with Intravitreal Triamcinolone and Bevacizumab Injection

A 47 year old male patient visited our hospital with the chief complaint of deterioration of the visual acuity in the left eye. The fundus examination revealed thick hard exudates, multiple aneurysms and telangiectasias of the retinal vessels in the posterior pole. Fluorescein angiography demonstrated massive leakage over an area of the aneurysms. Optical coherence tomography (Stratus OCT; Zeiss-Humphrey, Dubin, CA) revealed diffuse and marked thickening of the retina. Laser photocoagulation was performed under the diagnosis of Coats' disease. However, the treatment could not be performed satisfactorily. On the first and 6th weeks, an intravitreal injection of bevacizumab and triamcinolone acetonide was administered, and laser photocoagulation was again attempted. The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection. At one week after the intravitreal bevacizumab injection, there was no improvement. An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema. Therefore, laser photocoagulation was performed sufficiently on telangiectasias. The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.