Comparison of Intralesional Triamcinolone Acetonide Injection Efficacy for Chalazion According to Age and Lesion Size

Purpose@#The purpose of this study was to compare the efficacy of intralesional triamcinolone acetonide injection in the treatment of chalazion according to age and size of the lesion. @*Methods@#We performed a retrospective chart review of 108 patients (108 lesions) who underwent intralesional triamcinolone acetonide injections between January 2017 and February 2018. Patients were divided into three groups according to their age and size of the lesion and evaluated with respect to the treatment success and complications. @*Results@#Cumulative treatment success of intralesional triamcinolone acetonide injection was 69.4% with the first injection and 80.6% with the second injection in 108 lesions. With respect to age, 30 lesions were observed in patients under the age of 7 years, 22 lesions were found in patients aged 7 to 16 years, and 56 lesions were observed in patients who were 17 years or older; cumulative treatment success percentages with second injections were 86.7%, 81.8%, and 76.8% respectively. Twenty-seven lesions were under 10 mm in size, 70 lesions ranged from 10 to 15 mm, and 11 lesions were sized 16 to 20 mm; cumulative treatment success percentages were 85.2%, 80%, and 72.7% respectively. Although the results were not statistically significant. @*Conclusions@#Intralesional triamcinolone acetonide injection in chalazion is more effective for smaller lesions and younger pediatric patients.

Lower Eyelid Desmoplastic Trichoepithelioma

Purpose@#To report a rare case of lower eyelid desmoplastic trichoepithelioma.Case summary: A 56-year-old woman presented to our clinic with a slow-growing, painless, recurrent mass located in the temporal area of the left lower eyelid margin. Surgical incision had been performed on a similar mass 4 years before. On examination, a 7 × 2-mm firm, nodular, nontender mass was palpable in the left lower eyelid. The lesion was isolated from the surrounding tissues and completely excised. Histopathologically, the excised mass showed small strands of basaloid cells, keratinous cysts, and focal calcification. These findings supported a diagnosis of eyelid desmoplastic trichoepithelioma. @*Conclusions@#Because of its rarity and solitary features, eyelid desmoplastic trichoepithelioma can be confused with sclerosing basal cell carcinoma. Thus, the goal of surgical therapy should be complete excision; histopathological analysis should be also performed.

A Case of Upper Eyelid Schwannoma

PURPOSE: To report a rare case of upper eyelid schwannoma presenting as a chalazion. CASE SUMMARY: A 54-year-old male presented to our clinic with a slowly growing, painless recurred mass located in the middle area of the right upper eyelid margin. Surgical incision had been performed on a similar mass two year previous, although no histological analysis had been performed. On examination, a 4 × 3-mm-sized, firm, nonpigmented mass was palpable in the right upper eyelid, and no signs of neurofibromatosis were present elsewhere. The lesion was initially thought to be an eyelid mass, so we performed an excisional biopsy under local anesthesia. The lesion was easily isolated from the surrounding tissue and was excised completely. Histopathologically, the excised mass showed a compact arrangement of spindle cells forming palisades with Verocay bodies (Antoni A patterns). Immunohistochemistry revealed diffuse and strong S-100 protein positivity. These findings resulted in the diagnosis of eyelid schwannoma. CONCLUSIONS: Because of its rarity and solitary feature, eyelid schwannoma can be confused with chalazion. Thus, ophthalmologists should consider schwannoma in the differential diagnosis of a slowly growing, painless recurred mass or a lesion with malignant transformation after incomplete excision.

Surgical Outcomes of Endonasal Revision Surgery for Failed DCR According to Number of Silicone Tubes

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.

Diagnosis and Treatment of Chronic Canaliculitis

PURPOSE: To report on the clinical manifestations, species and treatments of patients with chronic canaliculitis. METHODS: From August 2003 to February 2012, 77 eyes of 77 patients who were diagnosed with chronic canaliculitis at our hospital were retrospectively analyzed. RESULTS: The mean period from the onset of symptoms to diagnosis was 4.7 months. The most common systemic disease associated with chronic canaliculitis was diabetes (18 eyes, 23%), and 13 eyes (17%) were related to punctual plug insertion. Main symptoms consisted of epiphora with discharge and pouting punctum. In the culture results of 55 eyes, streptococci, staphylococci, and actinomyces among other bacteria were identified. Seventy-two eyes (94%) were cured with one-snip punctoplasty with curettage. CONCLUSIONS: Chronic canaliculitis is rare, and the clinical aspect can be obscured by chronic conjunctivitis, thus the diagnosis is often delayed. In patients who have systemic diseases such as diabetes or past history of punctual plug insertion, chronic canaliculitis should be differentiated by observing the punctum more closely. If the diagnosis is accurate at the time, chronic canaliculitis could be easily cured by a relatively simple procedure such as one-snip punctoplasty with curettage.

A Case of Localized Merkel Cell Carcinoma on the Upper Eyelid

PURPOSE: To report a case of Merkel cell carcinoma on the left upper eyelid without metastasis and its immunohistochemical features. The carcinoma was successfully treated with excisional surgery and prophylactic radiation therapy. CASE SUMMARY: A 76-year-old woman presented to the hospital complaining of a 0.6 x 0.9-cm-sized painless and purplish-red colored mass that had grown rapidly on her left upper eyelid margin over the previous two months. An excisional biopsy was performed. On immunohistochemical examination of the lesion, the tumor cells expressed immunoreactivity for synaptophysin and were negative for LAC and cytokeratin, confirming the diagnosis of Merkel cell carcinoma. Additional surgery was performed because the surgical margins were positive. No other primary or metastatic lesions were found. The patient was treated with local prophylactic irradiation and remained disease-free at her 10-month follow-up visit.

Clinical Results of Different Surgical Procedures in Correcting Involutional Entropion

PURPOSE: To evaluate the long-term effectiveness of different surgical procedures according to horizontal eyelid laxity in correcting involutional entropion. METHODS: This retrospective study reviewed 104 eyes of 79 patients with involutional lower eyelid entropion who underwent surgical repair. The 62 eyes with horizontal eyelid laxity were classified as group I. In 17 eyes of group I, we performed the lateral tarsal strip procedure alone (group Ia), while in 45 eyes of group I, we performed the lateral tarsal procedure and Quickert suture (group Ib). The 42 eyes without horizontal eyelid laxity were classified as group II. In 13 eyes of group II, we performed a lower eyelid retractor reinsertion procedure only (group IIa), and in 29 eyes of group II, we performed combined lower eyelid retractor reinsertion and orbicularis resection (group IIb). RESULTS: The recurrence rate in these four surgical subsets (group Ia , group Ib, group IIa, group IIb) was 11.7%, 0%, 15.4%, and 6.9%, respectively, with an average follow-up of 11 months. Six recurrent eyelids and two overcorrected eyelids successfully underwent procedures to correct recurrent entropion and ectropion, respectively. CONCLUSIONS: The lateral tarsal strip procedure is an effective approach for achieving long-lasting correction of involutional entropion with horizontal eyelid laxity, whereas the lower eyelid retractor reinsertion procedure is an effective approach for achieving long-lasting correction for involutional entropion without horizontal eyelid laxity. Use of the Quickert suture reduced the need to repeat the lateral tarsal strip procedure and additional orbicularis resection decreased the need to repeat the lower eyelid retractor reinsertion procedure.

Medial Canthal Reconstruction with Bilobed Flap

PURPOSE: We report 2 cases treated with bilobed flap surgery for medial canthal reconstruction. METHODS: Two patients with black and painless lid mass, 1 x 1 cm size, developed at medial canthal area were excised, and medial canthal reconstruction was performed. Biopsy was done before the surgery, showing basal cell carcinoma. We designed and rotated bilobed flap to reconstruct medial canthal defect caused by the radical excision, and sutured it at the incision margin of the skin. RESULTS: Pathologic examination was done after the surgery, confirming basal cell carcinoma. No marginal cancer cell were detected. Cancer relapse did not occur during 12 months of follow-up. We obtained satisfactory results in all patients, not only clinically but also cosmetically. CONCLUSIONS: It is considered that the bilobed flap procedure is effective for reconstruction of medial canthal defect developed after eyelid tumor excision and offer a good prognosis.

Exophthalmos due to Blue Rubber Bleb Syndrome

PURPOSE: Blue rubber bleb syndrome (BRBNS) is a rare disorder characterized by multiple, distinctive cavernous hemangiomas of the skin, and gastrointestinal tract. We investigated the surgical treatment and clinical findings for multiple hemangiomas in the orbit of a patient who had BRBNS on the skin and liver. METHODS: A 33-year-old white woman visited our clinic with the chief complaint of continuous exophthalmos of one year duration. She did not complain of ocular pain or decreased visual acuity. Nine years previously, her medical history showed the removal of a mass from her left arm, the result of histopathologic examination was multiple hemangiomas. Check-up for gastrointestinal lesions by colonoscopy was negative and all hematological parameters were normal. The orbital mass was surgically removed. Histopathological finding showed it to be the same as hemangioma. RESULTS: Multiple bluish nodules on the skin, visceral hemangioma, multiple hemangiomas in orbit led to the diagnosis of BRBNS. CONCLUSIONS: Multiple hemangiomas in orbit should be suspected as BRBNS, and therefore systemic evaluation is required to consider the association with BRBNS.

A Case of MALToma Found in Bilateral Lacrimal Gland and Hard Palate

PURPOSE: Lymphoma originated from MALT is common in stomach but infrequently found in bronchus, salivary gland, thyroid gland and orbit. We report a case of multifocal MALToma in bilateral main lacriamal gland, hard palate without systemic metastasis. METHODS: A 45-year-old male without known systemic disease visited with movable mass in left upper eyelid for 5 months. RESULTS: We found the mass which was hot uptaked by whole body SPECT in left main lacrimal gland and hard palate. By excisional biopsy, the mass was diagnosed as MALToma. After 1 year it recurred in contralateral main lacrimal gland. It was diagnosed as the same MALToma by excisional biopsy. Relapse and other metastasis have not been observed yet up to now(November, 2002) , since we treated radiation therapy.

Primary Lid Tuberculosis Occuring at Preaponeurotic Portion after upper Lid Blepharo plasty

Tuberculosis of the lid is a rare disease that usually extends directly from surrounding tissues such as paranasal sinuses and lacrimal glands, or occurs possibly as a result of hematogenous spread. Primary tuberculous infection of lid also rarely occurs. The earliest lesion is a brownish red, soft papule that develops into an indurated nodule or plaque that may ulcerate. There is usually prominent lymphadenopathy. The diagnosis is established through tuberculin skin testing, stains for acid-fast organisms, and cultures. If diagnosis is delayed, complications including extensive orbital tissue damages, cold abscess, cutaneous fistula, and cicatricial ectropion may ensue. Lid tuberculosis should be differentiated from other granulomatous lesions of eyelid and also from other more commonly occuring orbital tumors. The combination therapy of Isoniazid, Rifampin, and Pyrazinamide is recommended for lid tuberculosis. We experienced a patient presenting with painless upper eyelid nodule that occurred about 3 weeks following upper lid blapharoplasty and treated her with anti-tuberculous medications after histological diagnosis of lid tuberculosis has been made. So, we report this rare case of lid tuberculosis with literature.

Clinical Characteristic of Lacrimal Ductal Cyst

PURPOSE: Through 13 cases of lacrimal ductal cysts which were diagnosed by clinical or histopathological findings, we investigated the clinical characteristic and the effect of cyst excision on lacrimal secretion. METHODS: As a primary treatment, cyst excisions(6 cases), marsupialzations(4 cases), and needle aspirations(3 cases) were performed and their results were compared. Pre-and postoperative lacrimal secretion tests(Schirmer I & BST) were performed on 10 cases which underwent cyst excision either primarily or secondarily(due to recurrences). A biochemical analysis of cyst fluid and serum IgA level was also done on 7 cases. RESULT: There were no recurrences on 6 surgically excised cases, but 1 out of 4 cases with marsupia-lizations and all 3 cases with needle aspirations recurred and underwent cyst excisions secondarily. Two out of 10 surgically excised cases showed reduced value of postoperative lacrimal secretion tests. Cyst fluid IgA levels were higher than that of serum in all 7 cases. CONCLUSION: The higher cyst IgA level may signify the presence of an active secretory precess within cyst walls. A complete cyst excision seems to be the best treatment choice for the prevention of recurren-ces and marsupialization is also considered as an alternative treatment modality. The cyst excision itself does not seem to affect lacrimal secretion.

One Case of Sebaceous Carcinoma that Masquerades as a Chronic Unilateral Blepharo conjunctivitis

Sebaceous carcinoma of the eyelid is a rare tumor that usually arises from tarsal sebaceous gland. Because the clinical manifestations can masquerade as unilateral recurrent chalasion or chronic blepharoconjunctivitis, its diagnosis may be delayed. Therefore, early biopsy for diagnosis is needed for the persistently recurring unilateral blepharoconjunctivitis. The masquerade syndrome was first described in 1967 by Theodore and Irvine as chronic blepharoconjunctivitis due to an underlying conjunctival carcinoma. While the originally described neoplasms were squamous cell carcinomas, many of the tumors producing this clinical picture are believed to be sebaceous in origin. We experienced a case of pathologically confirmed sebaceous carcinoma of the eyelid which originally masqueraded as chronic blepharoconjunctivitis and was treated with topical antibiotics and steroids for 1 year and 8 months, finally being treated by partial orbital exenteration.

Phagocytosis and Acid Phosphatase Activity against Candida Albicans in Cultured Rabbit Keratocyte

It has been reported that keratocytes endocytose foreign particles both in vitro and in vivo, suggesting the active participation of keratocytes in corneal wound healing and host defense mechanism. This study was conducted to investigate the phagocytosis of keratocytes against Candida albicans[C.albicans]and the intracellular response after phagocytosis. C.albicans were fixed with glutaraldehyde and then coated with fibronectin. After exposing these C.albicans to the cultured rabbit keratocytes, the phagocytosis of keratocytes against C.albicans was evaluated by light microscope[LM]and transmission electron microscope[TEM], while the intracellular response was evaluated by changes of acid phosphatase activity. Also the study about latex beads was performed at the same time to know even if keratocytes can phagocytose foreign particles, regardless of wheather or not the particles are biodegradable. After Wright staining, phagocytosed latex beads and C.albicans were observed on LM and these were recognized to be surrounded by limiting membranes inside the cytoplasm of keratocytes on TEM. The phagocytic rates of fibronectin-coated were increased to 1.5 times , as compared with that of non-coated group. Acid phosphatase activities were higher in C.albicans-exposed groups than in control[keratocytes cultured without C.albicans or latex beads]during the culture period of 24 hours and they also increased according to culture duration and reached to the plateau after 12 hours. In comparison with non-coated group, fibronectin-coated groups showed a increasing tendency of acid phosphatase activity. These results suggest that keratocytes can phagocytose not only foreign particles but also C.albicans and that fibronectin may act as effective opsonin on phagocytosis, and that keratocytes phagocytosing C.albicans increase acid phosphatase activity to digest engulfed C.albicans when corneal stroma was wounded or inflammed.

Us efulness of Standard Electro retinogram in the Early Diagnosis of Diabetic Retinopathy: Analysis using Receiver Operating Characteristic(ROC) Curve

Authors recorded standard electroretinogram in two groups of diabetic patients. Group A, consisted of 60 eyes with no visible diabetic retinopathy and Group B, 30 eyes with mild nonproliferative diabetic retinopathy. The electroretinogram was recorded according to the standard electroretinogram procedure recommanded by the ISCEV. In rod and cone response, the amplitude of b wave were 329.0+/-46.9 microvoltin Group A and 308.8+/-37.8 microvoltin Group B. The implicit time of b wave were 40.5+/-3. 0microvoltin Group A and 45.8+/-5.4microvolti n Group B. The summed amplitude of oscillatory potentials were 125.7+/-38.7microvolt in Group A and 112.0+/-17.7microvoltin Group B. Above results indicate that for the disgnostic criteria for diabetic retinopathy, the amplitude and implict time of b wave, and the summed amplitude of oscillatory potentials in maximal combined response were useful. On receiver operating characteristic(ROC) curves in maximal combined response, cut off value for the amplitude and implicit time of b wave were 315 microvoltand 42ms espectively. Cut off value for the summed amplitude of oscillatory potentia-als was 118 microvolt. In results, on ROC curve, the implicit time of b wave in maximal combined response was most accurate, and the summed amplitude of oscillary potentials was the next, followed by the amplitude of b wave in the maximal combined response.

Clinical Experience with Black-Diaphragm Intraocular Lens in Traumatic (Postoperative) Aniridia and Aphakia

When aniridia is associated with aphakia after trauma, traditional implantation of posterior chamber IOL has some technical difficulties owing to lack of iris support and weakness of zonule, but especially big problem lies in that it cannot satisfy improvement of symptoms such as photo phobia, epiphora and visual acuity simultaneously. For the purpose of correcting these two diseases, specially designed artificial lens (Black-Diaphragm IO-LMORCHER IOL) has been introduced and is being used currently. Black-Diaphragm IOL may have some postoperative complications such as persistent intraocular inflammation, corneal endothelial cell damage, cystoid niacular ederna, and increased intraocular pressure. On 6 patients (4 rnales, 2 females) who had aniridia associated with aphakia after trauma authors implanted Black-Diaphragm IOL into ciliary sulcus by transscleral fixation. During average of 7.3 months follow up periods, we observed corneal ederna, hyphema, vitreous hernorrhage in I eye (I case) but, in the remaining 5 eye.

Surgical Management of Infectious Endophthalmitis: Early Vitrectomy vs Late Vitrectomy

Authors investigated the effect of the timing of vitrectomy for endophthalmitis on the final visual acuity, by retrospectively reviewing the clinical records of patients who have undergone pars plana vitrectomy for the treatment of endophthalmitis from Feb. 1990. Twenty one cases(21 eyes) were included who were followed up for 6 months or longer after surgery and intravitreal injection of antibiotics. 14 cases were male. The age ranged from 28 to 81 years, with mean age of 40.5 years. Ten cases arose from intraocular surgeries, with 7 cases of early-onset and 3 cases of late-onset, the other 10 cases were related to ocular trauma and the remaining one case was associated with a filtering bleb. Intravitreal injections, subconjunctival injections and topical eye instillation of antibiotics were preformed as an initial treatments on cases whose retina were invisible due to severe inflammatory media opacities. Those cases who did not respond to initial treatments were divide into two groups: one which underwent early vitrectomy within 2 days, and the other which underwent late vitrectomy after 2 days. Ten out of 12 cases among early vitrectomy group and 3 out of 9 cases among late vitrectomy group obtained final vision of 0.1 or better. The cases which underwent early vitrectomy showed good visual prognosis with statistical significance(P<0.05). Therefore, authors suggest that management of endophthalmitis with initial severe inflammatory reactions should include early diagnosis, and early vitrectomy with intravitreal infection of antibiotics for recovery of maximal visual acuity.