Old-age-onset subconjunctival juvenile xanthogranuloma without limbal involvement.

BACKGROUND: Juvenile xanthogranuloma (JXG) is a benign idiopathic cutaneous granulomatous tumor occurring primarily in infants less than 1 year old, and less commonly found in older children and adults. To date, however, there have been no reports of patients aged >50 years with cornealscleral JXG without limbal involvement. We describe here a 58-year-old woman with subconjunctival JXG without limbal involvement. CASE PRESENTATION: A 58-year-old female was referred for evaluation of a subconjunctival mass in her left eye, found incidentally 2 weeks earlier. Examination revealed a protruding yellow-orange subconjunctival mass just below the 6-o'clock limbus of her left eye, measuring 6.0 × 4.5 mm, but not extending into the cornea. The overlying conjunctival epithelium was intact, and a feeding vessel was observed between the mass and the episclera. The subconjunctival lesion was excised under local anesthesia, by dissecting the mass from the overlying conjunctiva and underlying sclera. The conjunctiva was reattached to the sclera without creating a bare area. Hematoxylin and eosin-stained sections showed that the mass was a mixed inflammatory lesion containing dense infiltrations of epithelioid histiocytes with foamy cytoplasm, lymphocytes, and plasma cells, as well as multinucleated Touton giant cells with the characteristic circumferential ring of nuclei. Immunohistochemical staining showed that the lesion was positive for the macrophage marker CD68 and negative for the Langerhans cell markers S-100 protein and CD1a, indicating that the lesion was a xanthogranuloma. The patient has been followed up for 12-months without recurrence. CONCLUSIONS: JXG can occur as a solitary subconjunctival mass even in older adults, and immunohistochemistry is useful in differential diagnosis. Simple excision with careful dissection may be effective for subconjunctival JXG.

Surgical correction of epiblepharon using an epicanthal weakening procedure with lash rotating sutures.

BACKGROUND: To describe a new surgical technique in patients with lower eyelid epiblepharon using an epicanthal weakening procedure with lash rotating sutures. METHODS: Charts of patients with epiblepharon who underwent surgical correction using an epicanthal weakening procedure with lash rotating sutures were reviewed retrospectively. The preoperative severity of corneal erosion was graded and compared with the postoperative keratopathy. Postoperative surgical outcomes, complications and subjective satisfaction were also evaluated. RESULTS: 202 eyes of 101 patients were evaluated in this study. The preoperative cilia-corneal touch was corrected and keratopathy was improved, especially towards the medial aspect of the lower lid. There were four eyes (2.0%) of recurrent cilia-corneal touch, but none required reoperation. Cosmetic outcomes were considered to be 'very satisfied' in 95 patients, 'satisfied' in 6 patients, and no patients indicated 'neutral' or 'dissatisfied' results. CONCLUSIONS: In patients with epiblepharon with an epicanthal fold, surgical correction using an epicanthal weakening procedure with lash rotating sutures is a simple and effective method for correction, particularly when evaluating the medial portion of the lower eyelid. This method also produces a favourable cosmetic outcome with minimal scar formation.

Comparison of contamination rates between preserved and preservative-free fluoroquinolone eyedrops.

BACKGROUND: To evaluate the antimicrobial effectiveness of preservative-free fluoroquinolone products compared with benzalkonium chloride containing fluoroquinolones using the challenge test provided by the United States Pharmacopeia (USP) and the in-use test. METHODS: 1. Challenge test: to compare the growth of microorganisms between different fluoroquinolone preparations, four test organisms, including Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Aspergillus niger were chosen among five microorganisms listed by USP 2004. The inoculated products were sampled for microbial survivors at days 7, 14, and 28 following initial inoculation at room temperature. The number of surviving organisms were calculated as a Log10 reduction from the original inocula. 2. In-use test: a total of 100 bottles were collected after instillation of preservative-free fluoroquinolone eyedrops in volunteer patients after 1 week of use. The remaining fluid and tips of the bottles were cultured. Colonies on the plates were counted at the end of the incubation period. All microorganisms were identified by Gram staining and biochemical assays. RESULTS: 1. Challenge test: preservative-free gatifloxacin and levofloxacin demonstrated a lower log reduction against A. niger than preserved fluoroquinolones and preservative-free moxifloxacin at all time points. 2. In-use test: There was no contamination identified on plates inoculated by preservative-free quinolone bottles after 1 week of use in this study. CONCLUSIONS: Physicians should be aware of the lower antifungal preservative effectiveness of some preservative-free fluoroquinolone preparations than preserved ones.

Effects of brimonidine timolol fixed combination therapy on anterior ocular segment configuration.

PURPOSE: To assess the effects of brimonidine and of brimonidine and timolol fixed combination (BTFC) therapy on the pupil and angle structures in both normal subjects and in open angle glaucoma patients. METHODS: For the first study, 60 healthy normal subjects were divided into 2 groups. In group 1, brimonidine was administered to the right eye and timolol to the left eye. In group 2, a BTFC was administered to the right eye and pilocarpine 2% to the left eye. All subjects had a full ophthalmic examination including IOL master, ORB II scan and three times of Visante OCT both before and after instillation of the eyedrops. After testing, we analyzed the pupil size, anterior chamber depth and anterior chamber angle parameters including angle opening distance, trabecular-iris space area, angle recess area and trabecular-iris angle. In the second study, we evaluated the effects of BTFC therapy on the anterior chamber over time through reviewing ORB scan data of glaucoma patients who had instilled BTFC for at least 6 months (n = 126). RESULTS: Brimonidine and BTFC therapy caused miosis and widening of most of the anterior chamber angle parameters without changing the anterior chamber depth. The effects of BTFC on the angle were likely to be greater than those resulting from the use of pilocarpine. The miotic effects remained during instillation of BTFC. CONCLUSION: Brimonidine and BTFC cause passive miosis with angle widening; these results could be applied in the treatment of various types of glaucoma.

Asymmetry of diurnal intraocular pressure fluctuation between right and left eyes.

PURPOSE: To evaluate diurnal curves of intraocular pressure (IOP) in the right and left eyes of non-glaucomatous patients. METHODS: We measured IOP during waking hours and in habitual positions in 102 non-glaucomatous patients every 2 hr between 09.00 hr and 23.00 hr using a Goldman applanation tonometer. Individual factors and biometries were measured and associated with diurnal IOP variations. RESULTS: There was no significant difference in IOP variation between the right and left eyes over eight time-points (repeated measure anova, P = 0.995). The mean coefficient of IOP in the right and left eyes at the eight time-points ranged from 0.806 to 0.887. Forty-one (40.2%), 15 (14.7%) and five (4.9%) patients showed at least one asymmetrical IOP variation over seven time intervals at the cut-off value ≥ 2, ≥ 3 and > 3 mmHg, respectively. Mean incidence of asymmetrical IOP variation was 10.9 ± 1.6% at ≥ 2 mmHg, 2.9 ± 0.8% at ≥ 3 mmHg and 0.8 ± 0.4% at > 3 mmHg. Age, differences in anterior chamber depth, lens thickness and axial length showed several significant associations with the incidence of asymmetrical IOP variation. CONCLUSION: Diurnal variation of IOP showed asymmetry between right and left eyes in patients without glaucoma. Ageing and differences in local ocular factors between bilateral eyes may affect the incidence of asymmetrical IOP variation.

Localized retinal nerve fiber layer defects associated with cotton wool spots.

PURPOSE: To introduce four cases of localized retinal nerve fiber layer (RNFL) defects after emergence of retinal cotton wool spots (CWSs). METHODS: Four patients were evaluated for localized RNFL defects after the appearance of CWSs. Depending on the patient, they were followed up from the beginning of treatment to up to 19 years after the initial events. Fundus photos and other glaucoma examinations, including Stratus optical coherence tomography (OCT) and visual field examinations, were performed during the follow-up visits. RESULTS: The localized RNFL defects remained stable without any progression for as long as 19 years. CONCLUSIONS: Nonprogressive RNFL defects may occur after the appearance of CWSs, which the examiner may not be able to detect. Clinicians may need to consider not only visual field results and OCT findings but also disc configuration, RNFL defects, and fundus findings to decide on the proper diagnosis and treatment of patients suspected to have glaucoma.

Evaluation of anterior lenticonus in alport syndrome using tracey wavefront aberrometry and transmission electron microscopy.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of Tracey wavefront aberrometry (Tracey Technologies, Houston, TX) and transmission electron microscopy for the detection of anterior lenticonus in Alport syndrome. PATIENTS AND METHODS: Tracey wavefront aberrometry was used to treat a patient with bilateral anterior lenticonus who had a history of Alport syndrome. For transmission electron microscopic examination, anterior lens capsules were obtained during clear lens phacoemulsification and intraocular lens implantation. RESULTS: Spherical aberrations were the predominant higher-order aberrations in the internal optics of both eyes. The Tracey wavefront aberrometer showed that most of the irregular astigmatism originated from the lenticular portion. Transmission electron microscopy of the specimens showed anterior lens capsules with decreased thickness and multiple dehiscences. CONCLUSION: Tracey wavefront aberrometry and transmission electron microscopy are effective tools for evaluation of anterior lenticonus in Alport syndrome.

Changes in astigmatism after surgery for epiblepharon in highly astigmatic children: a controlled study.

PURPOSE: To evaluate changes in astigmatism after corrective surgery in highly astigmatic epiblepharon patients compared with nonepiblepharon patients. METHODS: We retrospectively reviewed the charts of 37 patients with epiblepharon and 35 patients without epiblepharon, but with initial astigmatism > or =2 D. Demographic data and preoperative data for best-corrected visual acuity, degree of astigmatism, and astigmatism axis were obtained. Postoperative data were collected at 1, 3, 6, and 12 months and at 2 years. RESULTS: The mean age at surgery was 5.1 +/- 1.5 years. The mean amount of cylinder was 3.27 +/- 0.97 D before surgery and 2.62 +/- 1.07 D at 2 years after surgery. Linear mixed measures analysis, which was used to compare the mean cylinder between the epiblepharon and nonepiblepharon groups, showed significant group-time interaction (p < 0.01). Patients who were younger and had greater initial cylinder showed significantly greater decreases in the cylinder during 2 years of follow-up (p < 0.05). CONCLUSIONS: Significant astigmatic changes were found after surgical correction in epiblepharon patients with 2 D of astigmatism or greater compared with nonepiblepharon patients, and these changes were more significant in patients of younger age and with greater astigmatism. A high prevalence of epiblepharon during the critical period for visual development warrants physician interest in early surgery and visual rehabilitation in highly astigmatic epiblepharon patients.