Ocular circulation change in optic disc melanocytoma - a case report and a review of the literature.

BACKGROUND: Ocular circulation in optic disc melanocytoma (ODM) has not yet been well evaluated. We quantitatively evaluated longitudinal changes in the morphology and circulation hemodynamics of the disc and macula using optical coherence tomography angiography (OCTA) and laser speckle flowgraphy (LSFG) in a patient with optic disc melanocytoma. CASE PRESENTATION: A 50-year-old woman was referred to our hospital due to a dark pigmented tumor over the superior optic disc area of the left eye noted on physical examination. At the first visit, the patient's best-corrected visual acuity (BCVA) was 20/20 in both eyes, and the intraocular pressure (IOP) was 17 and 18 mmHg in the left and right eyes, respectively. Fluorescein angiography (FA) showed blockage of fluorescence in the topography of the lesion, and indocyanine green angiography (ICGA) showed hypofluorescence at all times. On LSFG, a low mean blur rate (MBR) was noted in the optic disc all area (MBRa) and tissue (MBRt) compared to the contralateral eye at the first visit and at the 3-month follow-up. A relatively low MBR was also detected in the macular area of the affected eye and the tumor itself. OCTA detected blood vessel networks in the deep retinal layer of the tumor. The visual field showed no specific defects. During follow-up, there was no tumor enlargement or vision decrease. CONCLUSIONS: We found that a lower MBR of the disc and macula area was noted on LSFG in this patient with optic disc melanocytoma, and it was continually observed at the 3-month follow-up. Although blood vessel networks in the deep retinal layer of the tumor were detected by OCTA, vascular compromise in the surrounding disc area and macula was found. Therefore, these results further increase our knowledge about the role that circulation impairment plays in the pathogenesis of the disease while vision is unaffected.

Conjunctival melanoma: A 20-year survey in a comprehensive medical center.

BACKGROUND: To better understand population-specific tumor characteristics and behavior of conjunctival melanoma in Asian. METHODS: A retrospective cohort enrolled patients with primary conjunctival melanoma treated and followed up at Chang Gung Memorial Hospital (CGMH) in Taiwan between 1995 and 2015. Basic characteristics such as age, gender, tumor size, cell type, location, and TNM stage were recorded. Prognostic parameters included disease free interval, local recurrence, distant metastasis, and survival were analyzed. RESULTS: There were 20 patients enrolled in the study hospital between 1995 and 2015. All were histological proved by pathologists. Their mean age at diagnosis was 57.8 ± 15.9 years. The mean follow-up time was 68.7 ± 55.8 months. Mean tumor thickness was 6.5 ± 5.9 mm. Six patients developed local recurrence. Twelve patients had distant metastasis. Ten patients died from conjunctival melanoma. The 10 patients had greater mean tumor thickness (8.4 ± 7.5 mm) and shorter mean survival time (40.2 ± 24.1 months). Tumor thickness was found as a prognostic factor for survival time (HR = 1.15, P = 0.01). Age, gender, T stage, and tumor location were not significantly associated with survival. CONCLUSION: Different tumor characteristics were found in this cohort. Higher metastasis and mortality rate could suggest a more aggressive disease pattern. Tumor thickness was indicated as a prognostic factor for survival time and was greater in size in cases with distant metastasis. Early and more invasive intervention with closely follow-up may be indicated in these cases.

Correction of involutional entropion with retractor redirection.

The study aims to report the surgical outcome of a retractor redirection procedure for involutional entropion repair for Asians. The study included all cases diagnosed with involutional entropion and significant ocular irritation who presented from 2008 to 2012. Sixty-seven eyelids in 54 patients were included in this study. All cases were operated on by one surgeon and had a minimum of 12-months follow-up. Success was defined as cases showing no recurrence of entropion with forceful eyelid squeezing postoperatively. A retrospective chart review was performed to assess the success rate, recurrences and complications of the procedure. During a mean follow-up period of 26.2 months (range, 12-53 months), 5 patients died during the study period. Two eyelids (3%) of one patient had a recurrence at 34 months postoperatively. One eyelid (1.5%) with a significant horizontal laxity developed postoperative ectropion and required a secondary horizontal shortening procedure. No other postoperative complications or dissatisfaction were reported. The retractor redirection procedure aims to repair the retractors and prevent orbicularis muscle overriding via inserting the retractors to the anterior lamellae. It yields a long-term success rate of 95.5% and is an effective technique for correcting involutional entropion.

Using A modified quickert procedure combined with prolapsed fat and preseptal orbicularis muscle removal to correct involutional lower eyelid entropion in Asians.

PURPOSE: To propose a modified Quickert procedure combined with prolapsed fat and preseptal orbicularis muscle removal which corrects involutional lower eyelid entropion, and to validate the procedure as an adequate surgical management according to anatomical deformities and pathogenesis of Asian patients. METHODS: Ninety-five patients (45 men, 50 women; 108 eyelids [55 right eyes, 53 left eyes]) who underwent this modified surgical procedure with a minimum follow-up period of 2 months were examined. All pre- and post-operative evaluations and surgical procedure were performed exclusively from the same oculoplastic surgeon. Postoperative results, recurrence rate, and complications were assessed. RESULTS: The mean follow-up period was 13.33 months (range, 2-67 months). Of the 108 eyelids, 4 developed recurrent entropion with trichiasis, corresponding to an overall recurrence rate of 3.70%. No major complications, such as overcorrection (ectropion), symblepharon, infection, or wound dehiscence, occurred during the follow-up period after surgery. Of these 4 eyelids exhibiting recurrence, 3 occurred within 10 months and 1 occurred 49 months after surgery. Three recurrent patients received secondary surgery for re-correction with successful results. CONCLUSION: The modified Quickert procedure combined with prolapsed fat and preseptal orbicularis muscle removal not only demonstrated safety and effectiveness, but also led to low rate of recurrence and complications. It could be a strategy for correction of involutional entropion in Asian patients.

Feasibility Study of the Flatness of a Plastic Injection Molded Pallet by a Newly Proposed Sequential Valve Gate System.

The investigation of plastic pallet molding, assisted by a sequential valve gate system, has not yet been performed due to the limitations of the pallet scale. Furthermore, at present, the application of recycled plastics by chemical industries has become extremely popular around the world. This study aimed to determine pallet flatness experimentally and numerically using recycled polypropylene with a large-scale pallet. Short-shot testing on injection molding was performed to obtain short-shot samples for confirmation of the flow front during simulated filling. The real injected pallet profile, which was measured by an ATOS, was compared after confirmation to the numerical profile of the pallet. The pallet's flatness was accurately compared to the real experimental and numerical results. By adjusting the temperature of the cooling channel within the cavity plate to 55 °C, the flatness of the pallet achieved by the newly proposed sequential valve gate-opening scheme was about 7 mm, which meets the height directional warpage standard determined by the pre-set sequential scheme. The numerical flatness is in line with existing flatness values for pallets. Furthermore, the proposed cooling temperature gives the highest yield in terms of pallet molding from the perspective of the stakeholders.

Fabrication of a facial prosthesis for a 13-year-old child by using a point-and-shoot three-dimensional scanner and CAD/CAM technology.

Patients cannot wear ocular prostheses after undergoing orbital exenteration. They require a facial prosthesis to obtain a more favorable appearance, which greatly affects their social life and psychological health. In addition, conventional prosthesis-making processes require substantial time and expense. The economic burden is particularly heavy on children, who may require many prosthesis replacements as they mature. We report a method of fabricating a facial prosthesis by three-dimensional (3D) facial scanning and 3D printed for a 13-year-old girl who underwent partial orbital exenteration for malignant ciliary body medulloepithelioma 2 years ago. The patient's facial contour was captured with a hand-held, point-and-shoot 3D scanner. A facial prosthesis was designed using a mirror image technique with 3D modeling software and 3D printed. The prosthesis was then postprocessed and cast in silicone rubber. An ocular prosthesis was integrated into the facial prosthesis. The prosthesis was retained by prosthetic adhesives. This digitally assisted, impression-free method may lower the cost and effort of making facial prostheses and improve patient comfort, especially for children.

Evaluation of Microcirculation in Optic Nerve Head Using Laser Speckle Flowgraphy in Active Thyroid Eye Disease.

Background: Laser speckle flowgraphy (LSFG) can be used to estimate optic nerve blood flow. This study used LSFG to evaluate optic nerve microcirculation in patients with thyroid eye disease (TED). Methods: This was a retrospective review of patients with active TED who underwent LSFG between October 2020 and June 2021. The mean blur rate (MBR) for different severities of active TED was analyzed by one-way analysis of variance (ANOVA). Results: A total of 30 patients (60 eyes) with a diagnosis of active TED who underwent LSFG were included. The mean age was 49 (range, 33-74) years. Mean best-corrected visual acuity was the worst in the group with sight-threatening active TED (0.29 ± 0.33 logarithm of the minimum angle of resolution, p = 0.01). The MBR-overall was the highest in the group with mild active TED (28.5 ± 2.7), followed by that in the moderate to severe (23.6 ± 3.2), and in the sight-threatening (20.2 ± 4.3) active TED groups (p < 0.001). The MBR-vessel was 57.1, 47.0, and 39.3 in the mild, moderate to severe, and sight-threatening active TED groups, respectively (p < 0.001). The MBR-tissue was 16.9, 14.4, and 12.0 in the mild, moderate to severe, and sight-threatening active TED groups, respectively (p < 0.001). Conclusions: This study demonstrates that optic nerve blood flow is lower with more severe active TED. In addition, LSFG is an effective, objective, and noninvasive method for evaluating the severity of TED.

Prevalence, Risk Factors, and Prognostic Factors of Primary Malignant Bone Neoplasms with Bone Metastasis at Initial Diagnosis: A Population-Based Study.

Background: Bone metastasis (BM) has been proven to be responsible for the poor prognosis of primary malignant bone neoplasms (PMBNs). We aimed to identify the prevalence, risk factors, and prognostic factors for PMBNs patients with BM based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods: 4,758 patients diagnosed with PMBNs from 2010 to 2018 were selected from the SEER database. All patients were divided into two groups: the BM group or the non-BM group. Pearson's chi-square test and Fisher's exact method were used to assess baseline characteristics, and logistic regression analysis was applied to assess risk factors. In addition, a nomogram was constructed based on the results of Cox regression analysis among 227 patients with BM. The good performance and clinical applicability of the nomogram were tested by the concordance index, operating characteristic curve, area under the curve, calibration curves, and decision curve analysis. Results: 227 (4.8%) patients had metastasis to bone at diagnosis. Primary site outside the extremities (axial: odds ratio, OR = 1.770; others: OR = 1.951), Ewing sarcoma (OR = 2.845), larger tumor size (5-8 cm: OR = 3.403; >8 cm: OR = 5.562), tumor extension beyond the periosteum (OR = 2.477), and regional lymph node metastasis (OR = 2.900) were associated with a higher risk of BM at the initial diagnosis of PMBNs. Five independent prognostic factors were found in the survival analysis: pathological type (chondrosarcoma vs. osteosarcoma: hazard ratio, HR = 0.342; Ewing sarcoma vs. osteosarcoma: HR = 0.592; and chordoma vs. osteosarcoma: HR = 0.015), marital status (HR = 2.457), pulmonary metastasis (HR = 1.934), surgery at the primary site (HR = 0.164), and chemotherapy (HR = 0.084). A nomogram based on these prognostic factors could be a good predictor of cancer-specific survival. Conclusions: We identified the prevalence, risk factors, and prognostic factors correlated with BM in PMBNs patients. The related nomogram could be a practical tool for therapeutic decision-making and individual counseling.

Long-Term Results of Autologous Auricular Cartilage Graft Applied in Anophthalmic Orbits Unable to Wear Prosthesis.

In anophthalmic patients, shallow lower fornices make wearing ocular prostheses impossible and maintaining normal social activities difficult. This study retrospectively investigated the long-term surgical outcomes of autologous auricular cartilage grafting for contracted orbits. From 1995 to 2013, 29 anophthalmic contracture sockets with inadequate lower fornices and poor prosthesis retention presented to Chang Gung Memorial Hospital in Linkou, Taiwan, were treated using this surgical method. The success rate, aesthetic outcome, recurrence, and complications were analyzed. Among the 29 patients, 15 were women, 14 were men, their mean age was 45 years, and the mean follow-up time was 52 months (range = 6-159 months). Satisfactory lid position was achieved in 25 cases (86%), and lower fornix retraction recurred in four cases (14%). Neither donor site morbidity nor auricular deformity was noted during the follow-up period. Therefore, an auricular cartilage graft can be used successfully as a compatible spacer for anophthalmic patients with shallow lower fornices and prosthesis-fitting problems in long-term follow-up.

Klebsiella pneumoniae Orbital Cellulitis: Clinical Manifestations and Outcomes in a Tertiary Medical Center in Taiwan.

PURPOSE: To report six cases of Klebsiella pneumoniae orbital cellulitis without preceding endophthalmitis. METHOD: Retrospective chart review. RESULTS: We reported four females and two males admitted to our hospital for Klebsiella pneumoniae orbital cellulitis proven by computed tomographies and bacterial cultures from May 1995 to March 2017. Proptosis, conjunctival congestion, and chemosis and limitation of ocular motility were present in all six patients. Four patients had decreased visual acuities, and three of them recovered completely after treatment. The origin of the infection was sinus in four patients, skin wound in one patient, and sepsis presumably caused by a dental procedure in one patient. Three of all six patients had underlying diabetes mellitus. Two patients had orbital cellulitis before they were diagnosed of diabetes during hospital stay. CONCLUSION: Diabetes may be a risk factor of Klebsiella pneumoniae orbital cellulitis, especially for those of nonsinus origin.

Early Versus Late Canalicular Laceration Repair Outcomes.

PURPOSE: To determine whether delayed repair of traumatic canalicular laceration affects the final outcome. DESIGN: Retrospective case series. METHODS: The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed. RESULTS: There were 23 failed cases among 301 patients (7.6%) who had a repair within 48 hours and 3 failed cases among 33 patients (9.1%) who had a repair after 48 hours (P = .732). The mean operation time was 62 minutes in the early group and 66.3 minutes in the delayed group, which showed no significant difference (P = .371). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury. CONCLUSIONS: Delayed canalicular repair in unstable patients did not lead to poor results. An elective scheduling surgery, instead of an urgent repair, is feasible for an experienced surgeon.

Colored corn starch dust explosion-related ocular injuries at a Taiwan water park: A preliminary report from a single medical center.

PURPOSE: To elucidate the manifestations of ocular injuries in the colored corn starch dust explosion at a Taiwan water park. METHODS: This is a retrospective, non-comparative, consecutive-interventional case series. Fifty explosion-injury patients on 27 June 2015 treated at Chang-Gung Memorial Hospital, Linkou, were included. Thorough ophthalmic examinations were based on emergent triage and consecutive ophthalmological consultations. Multiple ocular and systemic parameters were assessed. RESULTS: Of the 100 eyes in the 50 cases reviewed, 22 cases were male and 28 cases were female. The mean age was 22.08 ± 4.64 years, and the mean burn total body surface area (TBSA) of patients was 45.92 ± 20.30%. Of the 50 patients, 20 had Grade 1 ocular burns, and the others were without ocular involvement. Two of the 20 cases that presented Grade 1 ocular burns died within 1 month due to other systemic complications. The most common ocular manifestations among those with ocular injuries included periocular swelling (75%), followed by conjunctival chemosis (65%), conjunctival hyperemia (50%), singed eyelashes (20%), cornea epithelial defects (10%), and punctate keratopathy (5%). It is worth mentioning that one patient developed herpes simplex keratitis due to stress 3 weeks after being burned. Half of the 50 patients had facial burns. Specifically, the patients with a greater TBSA presented more significant ocular-burn manifestations than those patients with lower TBSA. CONCLUSION: Prompt ophthalmologic consultations are particularly necessary for mass burn-casualty patients with facial burns, inhalation injuries, and greater TBSA. The inspection and control of all ignition sources and the manipulation of dust with low concentrations and in an open space are crucial factors to prevent future dust explosions.

Use of extraocular muscle flaps in the correction of orbital implant exposure.

PURPOSES: The study is to describe a new surgical technique for correcting large orbital implant exposure with extraocular muscle flaps and to propose a treatment algorithm for orbital implant exposure. METHODS: In a retrospective study, seven patients with orbital implant exposure were treated with extraocular muscle flaps. All data were collected from patients in Chang Gung Memorial Hospital, Taiwan during 2007-2012. All surgeries were performed by one surgeon (Y.J.T). Patient demographics, the original etiology, details of surgical procedures, implant types, and follow-up interval were recorded. Small exposure, defined as exposure area smaller than 3 mm in diameter, was treated conservatively first with topical lubricant and prophylactic antibiotics. Larger defects were managed surgically. RESULTS: Seven patients consisting of two males and five females were successfully treated for orbital implant exposure with extraocular muscle flaps. The average age was 36.4 (range, 3-55) years old. Five patients were referred from other hospitals. One eye was enucleated for retinoblastoma. The other six eyes were eviscerated, including one for endophthalmitis and five for trauma. Mean follow-up time of all seven patients was 19.5 (range, 2-60) months. No patient developed recurrence of exposure during follow-up. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results. CONCLUSIONS: The most common complication of orbital implant is exposure, caused by breakdown of the covering layers, leading to extrusion. Several methods were reported to manage the exposed implants. We report our experience of treating implant exposure with extraocular muscle flaps to establish a well-vascularized environment that supplies both the wrapping material and the overlying ocular surface tissue. We believe it can work as a good strategy to manage or to prevent orbital implant exposure.

Synergistic effect of silicate clay and phosphazene-oxyalkyleneamines on thermal stability of cured epoxies.

Amine substitution of hexachlorocyclophosphazene (HCP) with poly(oxypropylene)diamines (POP) afforded HCP-POP adducts which were subsequently intercalated into a layered silicate clay. The relative thermal stabilities of the epoxies cured with the phosphazene-amines and the intercalated clays were studied. The organoclays, with the confined HCP-POP from 400 and 2000 g/mol M(w) amines, are nongelled products when using 1/6 M ratio of HCP/POP starting materials in tetrahydrofuran solvent. The intercalation of HCP-POP polyamine salts into sodium montmorillonite afforded the HCP-POP-embedded organoclays with an expanded interlayer silicate spacing (2.4-5.1 nm) from the original 1.2 nm spacing (X-ray diffraction). The effect of silicate clays was evaluated by blending the HCP-POP/clay hybrids into a two-component epoxy system (diglycidyl ether of 4,4'-isopropylidenediphenol (BPA) and a diamine) and fully cured to form solid materials. The distribution of the exfoliated silicate platelets in the matrix was analyzed by transmission electronic microscopy (TEM). Thermal gravimetric analysis (TGA) indicated an enhanced thermal stability for the HCP/clay epoxy nanocomposites, with a delayed weight-loss pattern (temperature of weight loss at 10% (T(10 wt.%)) from 360 to 385 degrees C and temperature of weight loss at 85% (T(85 wt.%)) from 598 to 696 degrees C), compared to the pristine epoxies. By comparing these epoxies with different amounts of phosphazene and/or silicates, the TGA revealed a synergistic effect for the presence of both phosphorous and silicate components. Furthermore, the epoxies had improved physical properties such as hardness (from 3H to 5H) and surface adhesion (observed by scanning electron microscope (SEM) on fracture surface).