Conjunctival myxoma: A case report and review of a rare tumor.

RATIONALE: Conjunctival myxoma is a rare benign tumor, which can mimic more common conjunctival lesions such as a cyst, lymphangioma, amelanotic nevus, neurofibroma, amelanotic melanoma, or lipoma. We describe a patient with the conjunctival myxoma, who was initially misdiagnosed as a conjunctival cyst. This case report includes intraoperative photographs and various immunohistochemical staining images. PATIENTS CONCERNS: A 55-year-old woman presented with a painless mass in the superotemporal conjunctiva of the left eye, which she had noticed 1 month ago. The patient had no previous history of trauma or eye surgery. Slit-lamp examination revealed a well-circumscribed, freely movable, pinkish, semi-translucent mass on the temporal bulbar conjunctiva, suggestive of a conjunctival cyst. DIAGNOSES: Histopathological analysis showed stellate- and spindle-shaped cells within the loose myxoid stroma, confirming a diagnosis of conjunctival myxoma. INTERVENTIONS: The conjunctival lesion was completely excised under local anesthesia. OUTCOMES: After 4 months of follow-up, the patient remained in good health without recurrence of the conjunctival lesion and no evidence of any systemic abnormality. LESSONS: Myxoma is an extremely uncommon benign tumor derived from primitive mesenchyme. Considering the rarity of the tumor and its similarity to other conjunctival tumors, diagnosis can be challenging. Ophthalmologists should consider myxoma as a possible differential diagnosis when encountering conjunctival lesions. Surgical excision is essential to confirm the diagnosis and careful systemic evaluation is required to prevent potentially life-threatening underlying systemic conditions.

Effects of Topical Anti-Glaucoma Medications on Outcomes of Endoscopic Dacryocystorhinostomy: Comparison with Age- and Sex-Matched Controls.

BACKGROUND: This study analyzed the effects of topical anti-glaucoma medications on the surgical outcomes of endoscopic dacryocystorhinostomy (EDCR) in nasolacrimal duct obstruction (NLDO). METHODS: This retrospective study included patients who underwent EDCR for NLDO between September 2012 and April 2021. Thirty patients with topical anti-glaucoma medications and 90 age- and sex-matched controls were included. RESULTS: The success rate of EDCR was higher in the control group than in the anti-glaucoma group (97.8% vs. 86.7%, p = 0.034). Univariate and multivariate logistic regression analyses identified prostaglandin analogs as the most influential risk factor for EDCR success among anti-glaucoma medication ingredients (p = 0.005). The success rate of the group containing all four anti-glaucoma medication ingredients was statistically significant (p = 0.010). The success rate was significantly different in the group of patients who used anti-glaucoma medication for >24 months (p = 0.019). When multiplying the number of drug ingredients by the duration in months, the group > 69 showed a significantly decreased success rate (p = 0.022). Multivariate logistic regression analysis identified the number of anti-glaucoma medications as the most significant risk factor for EDCR success (odds ratio, 0.437; 95% confidence interval, 0.247 to 0.772; p = 0.004). CONCLUSIONS: The authors suggest that the anti-glaucoma medications might cause NLDO and increase the failure rate after EDCR. Therefore, when performing EDCR in patients using topical anti-glaucoma medications, surgeons should consider the possibility of increased recurrence after EDCR in clinical outcomes.

Progression of optic atrophy in traumatic optic neuropathy: retrograde neuronal degeneration in humans.

OBJECTIVE: We used optical coherence tomography (OCT) to document the time course of retrograde neuronal degeneration following indirect optic nerve injury. METHODS: We retrospectively studied patients diagnosed with unilateral indirect traumatic optic neuropathy (TON). Patients with total or near-total optic atrophy were included. All patients underwent complete ophthalmological examinations, including OCT imaging, within 1 day and at 1, 2, 3, 4, 6, 8, 12, 24, and 48 weeks after trauma. RESULTS: The mean thicknesses of the circumpapillary retinal nerve fiber layer (cpRNFL) and macular retinal ganglion cell-inner plexiform layer (mGCIPL) decreased significantly at 2 weeks after trauma (p = 0.027 and p = 0.043). Changes in mGCIPL thickness preceded changes in cpRNFL thickness. The rates of reduction in mGCIPL and cpRNFL thicknesses were greatest between 2 to 4 weeks and 4 to 6 weeks after trauma. The reduction in mGCIPL thickness then slowed, and stabilized at 12 weeks after trauma. The proportions of cpRNFL and mGCIPL losses at 2, 4, 6, 8, and 12 weeks compared to 24 weeks were 17.1, 33.7, 59.8, 77.9, and 87.9% and 30.0, 73.3, 76.1, 88.3, and 97.9%, respectively. CONCLUSIONS: OCT revealed optic atrophy progression 2 weeks after trauma, which was most rapid from 2 to 6 weeks, and then gradually stabilized. Loss of retinal ganglion cell bodies and dendrites seemed to precede the axonal degeneration. Observations of morphological changes in retinal layers using OCT in TON patients improve our understanding of retrograde neuronal degeneration of the central nervous system.

A Novel Technique for Measuring Ocular Duction Ranges.

Purpose: To report a novel technique for measuring ocular ductions and evaluate its performance in normal participants. Methods: We developed a laser pointer technique (LPT), a novel technique for quantitative measurement of ocular ductions. The device consists of a screen and headset with a laser pointer. Participants rotate their head while wearing the headset maintaining fixation on an optotype in the center of the screen until the target becomes blurry. Twenty-eight healthy volunteers were enrolled. The ocular ductions were measured with the LPT and compared to those of the Goldmann perimeter technique (GPT). Results: The mean horizontal and vertical duction ranges were 95.2° ± 10.1° and 84.1° ± 10.8° using the LPT, respectively, and 113.2° ± 14.1° and 105.8° ± 12.5° using the GPT, respectively; both were significantly greater in the GPT than LPT (both P < 0.05). The total time required for testing was shorter with the LPT compared to the GPT (56.1 ± 4.5 seconds and 92.3 ± 11.6 seconds, P = 0.003). Both the LPT and GPT measurements showed excellent intraobserver repeatability, and LPT showed better interobserver repeatability. Conclusions: Considering its reproducibility, accuracy, and simplicity, the LPT is expected to be useful for evaluating patients with ocular motility disorders as a first-order evaluation in the absence of sophisticated examination devices. Translational Relevance: The laser pointer technique, the new method for measuring ocular ductions, could be useful for evaluating patients with ocular motility disorders in clinical practice.

Risk Factors for Orbital Implant Extrusion after Evisceration.

This study analyzed risk factors for extrusion of orbital implants after evisceration by comparing patients with and without implant extrusion. METHODS: We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2019 at the Chungnam National University Hospital. Age, sex, underlying systemic diseases, axial length of the fellow eye, the cause of evisceration, endophthalmitis type, implant type and size, and preoperative computed tomography findings were evaluated. Logistic regression analysis was used to identify the risk factors for implant extrusion. RESULTS: Of the 140 eyes of 140 patients, extrusion occurred in five eyes (3.6%). Endophthalmitis (odds ratio (OR), 15.49; 95% confidence interval (CI), 1.70 to 2038.56; p = 0.010), endogenous endophthalmitis (OR, 18.73; 95% CI, 3.22 to 125.21, p = 0.002), orbital cellulitis (OR, 320.54; 95% CI, 29.67 to 44801.64; p < 0.001), implant size (OR, 0.50; 95% CI, 0.30 to 0.79; p = 0.004), and hydroxyapatite for the implant (OR, 0.07; 95% CI, 0.00 to 0.66; p = 0.016) were risk factors for implant extrusion in univariate logistic regression analysis. Multiple logistic regression analysis identified orbital cellulitis as the only risk factor for extrusion (OR, 52.98; 95% CI, 2.18 to 15367.34; p = 0.009). CONCLUSIONS: Evisceration with primary orbital implantation is a feasible option in endophthalmitis, but the risk of extrusion should be taken into consideration. When performing evisceration in a patient with orbital cellulitis, secondary implantation should be carried out only after any infection is controlled.

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis.

PURPOSE: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. METHODS: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). RESULTS: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). CONCLUSIONS: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

Multiple facial candidal abscesses after self-administered acupuncture in a patient with undiagnosed diabetes mellitus: a case report.

BACKGROUND: Facial abscess caused by Candida albicans infection is a rare condition even in immunocompromised patients, and only a few cases have been reported. To our knowledge, this is the first case of multiple facial candidal abscesses caused by self-administered acupuncture in an undiagnosed diabetes mellitus patient. CASE PRESENTATION: A 57-year-old woman who had self-acupuncture treatment 2 weeks previously, presented with a 1-week history of progressive left eyelid swelling, erythema, and pain. Despite the antibiotic treatment, the lesion progressed. Surgical incision and drainage was performed and Candida albicans was isolated from the obtained pus culture. The patient was diagnosed with type 2 diabetes mellitus based on a random serum glucose level of 350 mg/dl and 9.2% HbA1c. The abscess resolved after seven incision and drainage cycles and 4 weeks of intravenous fluconazole treatment with an appropriate control of diabetes mellitus. CONCLUSION: Unusual organisms and underlying immunocompromised condition should be suspected in cases of recurrent abscess showing an inadequate response to antibiotic treatment.

Effects of Miosis on Anterior Chamber Structure in Glaucoma Implant Surgery.

We investigated changes in anterior chamber (AC) structure after miosis in phakic eyes and pseudophakic eyes with glaucoma. In this prospective study, patients scheduled for glaucoma implant surgery were examined using anterior segment optical coherence tomography before and after miosis. Four AC parameters (AC angle, peripheral anterior chamber (PAC) depth, central anterior chamber (CAC) depth, and AC area) were analyzed before and after miosis, and then compared between phakic and pseudophakic eyes. Twenty-nine phakic eyes and 36 pseudophakic eyes were enrolled. The AC angle widened after miosis in both the phakia and pseudophakia groups (p = 0.019 and p < 0.001, respectively). In the phakia group, CAC depth (p < 0.001) and AC area (p = 0.02) were significantly reduced after miosis, and the reductions in PAC depth, CAC depth, and AC area were significantly greater than in the pseudophakia group (all p < 0.05). Twenty-five patients (86.2%) in the phakia group and 17 (47.2%) in the pseudophakia group had reduced CAC depth (p = 0.004). Although miosis increased the AC angle in both groups, AC depth decreased in most phakic eyes and a substantial number of pseudophakic eyes. Preoperative miosis before glaucoma implant surgery may interfere with implant tube placement distant from the cornea during insertion into the AC.

Urban Particulate Matters May Affect Endoplasmic Reticulum Stress and Tight Junction Disruption in Nasal Epithelial Cells.

BACKGROUND: Exposure to airborne urban particulate matter (UPM) has been closely related to the development and aggravation of respiratory disease, including sinonasal disorders. OBJECTIVE: The aims of this study were to investigate the effect of UPM on nasal epithelial tight junctions (TJs) and mucosal barrier function and delineate the underlying mechanism by using both in vitro and in vivo models. METHODS: In this study, human nasal epithelial cells (hNECs) and BALB/c mice were exposed to UPMs. UPM 1648a and 1649 b were employed. TJ and endoplasmic reticulum (ER) stress marker expression was measured using western blot analysis and immunofluorescence. TJ integrity and nasal epithelial barrier function were evaluated by transepithelial electric resistance (TER) and paracellular flux. In addition, the effects of N-acetyl-L-cysteine (NAC) on UPM-induced nasal epithelial cells were investigated. RESULTS: UPM significantly impaired the nasal epithelial barrier, as demonstrated by decreased protein expression of TJ and ER stress markers in human nasal epithelial cells. This finding was in parallel to reduced transepithelial electrical resistance and increased fluorescein isothiocyanate-dextran permeability. Pretreatment with NAC decreased the degree of UPM-mediated ER stress and restored nasal epithelial barrier disruption in human nasal epithelial cells (hNEC) and the nasal mucosa of experimental animals. CONCLUSION: These data suggest that UPMs may induce nasal epithelial barrier dysfunction by targeting TJs and ER stress could be related in this process. Based on these results, we suggest that suppression of this process with an inhibitor targeting ER stress responses could represent a novel promising therapeutic target in UPM-induced sinonasal disease.

Modified ocular surface disease index as a screening criteria for dry eye syndrome presenting after successful dacryocystorhinostomy.

OBJECTIVE: To find preoperative screening criteria for dry eye syndrome (DES) that present after successful endoscopic dacryocystorhinostomy (EDCR). METHODS: We retrospectively analyzed medical records of 110 patients who underwent EDCR for nasolacrimal duct obstruction. DES diagnostic criteria were defined as tear break-up time (TBUT) less than 10 seconds, and ocular surface disease index (OSDI) score greater than 13 points. After EDCR, patients were divided into DES group and control group according to the DES diagnostic criteria. Preoperative OSDI score alone or in combination of preoperative TBUT and OSDI score were used to find screening criteria, which could discriminate the two groups preoperatively with a high positive predictive value (PPV). Criteria A was set same as the diagnostic criteria of DES, and Criteria B and C were set to improve PPV by increasing specificity while maintaining similar sensitivity to Criteria A. RESULTS: Thirty patients (27.3%) were diagnosed with DES after EDCR, while 80 patients (72.7%) were normal. In patients with DES, preoperative TBUT was not different (p = 0.851), but OSDI score was significantly higher (p<0.001). Criteria A showed a sensitivity of 73.3%, specificity of 55.0%, and PPV of 38.0%. Criteria B and C excluded preoperative TBUT, which had no difference between the two groups, and set screening criteria with preoperative OSDI score alone. Criteria B (preoperative OSDI score of 19.6 points or more) showed a sensitivity of 75.0%, specificity of 60.6%, PPV of 41.7% and AUC of 0.739 (p < 0.001). Criteria C was consisted of 5 out of 12 OSDI items that showed significant differences between the two groups; blurred vision, reading, working with a computer, low humidity, and air conditioning. Criteria C (preoperative 5-item OSDI score of 24.4 points or more) was a better predictability, with a sensitivity of 75.0%, specificity of 71.3%, PPV of 49.5%, and AUC of 0.804 (p < 0.001). The AUC of Criteria C was significantly higher than that of Criteria B (p = 0.0037). CONCLUSION: DES occurred after successful EDCR in 27.3% of patients, and an OSDI questionnaire helped to screen DES. The predictability could improve using the modified OSDI score which showed noticeable difference in five OSDI items before and after EDCR.