Efficacy of adjuvant mitomycin-C and triamcinolone-impregnated nasal packing for endoscopic dacryocystorhinostomy.

AIM: To compare the success rate and complications of adjuvant use of mitomycin C and triamcinolone-impregnated biodegradable nasal packing (TABP) in endoscopic dacryocystorhinostomy (DCR). And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR. METHODS: A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed. The patients were randomly divided into three groups: Group A included patients treated without intraoperative mitomycin C but with TABP, Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing, and Group C included patients treated with intraoperative mitomycin C and TABP. RESULTS: The results revealed no significant difference in the overall success rates between Groups A (86.8%) and B (89.2%; P=0.377). However, Group C (97.5%) showed a significantly higher overall success rate than Groups A and B. The incidence of granulomas was significantly lower in group C (5%) than in Groups A (20.8%) and B (15.2%; P=0.009). Other complications, such as crust, synechiae, and revision surgery, did not differ significantly among the three groups. CONCLUSION: The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate. Additionally, there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

Binocular function in patients with intermittent exotropia accompanied by unilateral congenital ptosis.

Patients with intermittent exotropia (IXT) have a wide range of binocular deficits. This study aims to evaluate the effect of ptosis on the binocular function of patients with IXT. Clinical records of 45 IXT patients with congenital ptosis (IXT-ptosis group) and 58 age-matched IXT patients without ptosis (IXT only group) who presented for eye examination between January 2017 and June 2020 were retrospectively reviewed. Patients with amblyopia were excluded to rule out the effects of visual acuity on binocularity. Best-corrected visual acuity (BCVA), the magnitude of exodeviation at distance and at near, stereopsis, and office-based control scores at the first visit were reviewed. The binocular functions of the two groups were compared. The mean ± SD age of the overall patients was 6.6 ± 2.7 years. There were no significant differences in the distribution of age, sex, spherical equivalent refraction, or BCVA between the two groups (all p > 0.05). Although the office-based control scores at distance and near were slightly worse in the IXT-ptosis group, the differences were not statistically significant (at distance, 2.8 ± 1.87 vs. 2.2 ± 1.13, p = 0.08; at near, 1.8 ± 0.67 vs. 1.6 ± 0.74, p = 0.11). Furthermore, the IXT-ptosis group had worse stereopsis at distance (p = 0.01). There were no significant differences between the two groups in near stereopsis or exodeviation magnitude (p > 0.05). A larger proportion of patients had suppression on the Bagolini test in the IXT-ptosis group than in the IXT-only group (p = 0.04). The IXT-ptosis group had worse distance stereoacuity, and a larger proportion of patients had suppression on the Bagolini test than the IXT only group. In IXT patients, the presence of coexisting ptosis can have a further deleterious impact on binocular function.

Characteristics of Postoperative Anisocoria After Medial Orbital Wall Fracture Repair.

ABSTRACT: The purpose of this study was to present the clinical characteristics and etiology of patients with anisocoria after medial wall fracture repair. This study was a retrospective, noncomparative case series of postoperative anisocoria after medial orbital wall fracture repair. Data regarding patient demographics, laterality, signs and symptoms at presentation, interval between injury and surgery, fracture size using orbital computed tomography, pupil size of mydriasis, time of discovery of postoperative mydriasis, time of resolution of anisocoria, surgical outcomes, and complications were collected. Twelve patients were included in this study. The mean interval between injury and surgery was 19.17 ±â€Š4.95 (range, 12-30) days. The mean fracture size of the anteroposterior meridian was 25.22 ±â€Š2.15 (range, 21.8-28.4) mm and that of the horizontal meridian was 16.02 ±â€Š2.02 (range, 12.5-21.2) mm. Postoperatively, unilateral pupil dilation was observed at a mean of 5.33 ±â€Š1.61 (range, 3-8) hours after surgery, and mean pupil size was 5.13 ±â€Š0.61 (range, 4-6) mm in the dilated eye and 3.29 ±â€Š0.26 (range, 3-3.5) mm in the normal eye. The dilated pupils all recovered within a mean of 3.42 ±â€Š1.08 (range, 2-5) days. Postoperative anisocoria after medial orbital wall blowout fracture surgery may occur in delayed repair of the posterior location of large fractures. Transient mydriasis caused by parasympathetic nerve injury returned to normal pupil size.

IgG4-related disease presenting as recurrent scleritis combined with optic neuropathy.

BACKGROUND: We report a case of atypical presentation of IgG4-related disease (IgG4-RD) with recurrent scleritis and optic nerve involvement. CASE PRESENTATION: A 61-year-old male presented with ocular pain and injection in his left eye for 2 months. Ocular examination together with ancillary testing led to the diagnosis of scleritis, which relapsed in spite of several courses of steroid treatment. After cessation of steroid, the patient complained of severe retro-orbital pain and blurred vision. His best corrected vision was count finger, the pupil was mid-dilated and a relative afferent pupillary defect was found. Funduscopic examination demonstrated disc swelling. Magnetic resonance imaging (MRI) showed enhancing soft tissue encasing the left globe, medial rectus muscle and optic nerve. Systemic work-up revealed multiple nodules in right lower lung and a biopsy showed histopathological characteristics of IgG4-RD. Long-term treatment with corticosteroids and a steroid-sparing agent (methotrexate) led to significant improvement in signs and symptoms with no recurrence for 2 years. CONCLUSIONS: This case highlights the significance of IgG4-RD in the differential diagnosis of recurrent scleritis. IgG4-RD may cause optic neuropathy resulting in visual loss. Early diagnosis and proper treatment can prevent irreversible organ damage and devastating visual morbidity.

Lacrimal Ductal Fistula After Lateral Canthoplasty.

We report a rare case of lacrimal ductal fistula in a patient who underwent esthetic lateral canthoplasty. A 37-year-old woman was referred to our hospital with tearing in right eye after cosmetic lateral canthoplasty of both eyes. The patient was treated with silicone tube intubation at a local medical center, but the symptoms were not resolved. Lacrimal sac irrigation tests and paranasal computed tomography (CT) were performed to analyze the possibility of lacrimal pathway obstruction. However, there was no evidence of acquired lacrimal duct stenosis. The teardrop leaked out through a small orifice in the right lateral canthal area and it increased in size over time. We identified lacrimal ductal fistula and performed lacrimal fistulectomy. The tearing at right lateral canthus area was resolved. There were no more recurrences nor any other complications 2 years after surgery.

Relationship Between Visual Acuity and Corneal Curvature Change in Children After Epiblepharon Surgery.

PURPOSE: To determine the relationship between visual acuity and corneal curvature change in children after epiblepharon correction surgery by corneal topography. METHODS: The authors retrospectively reviewed the data of 62 children (121 eyes) who had epiblepharon surgery. The authors measured keratometric values of corneal curvature for 2 corneal zones: central 3 and 5 mm zone. Two zones were classified into 4 areas, including nasal, superior, temporal, and inferior area. Visual acuity and keratometric values were estimated preoperatively and at 1, 3, and 6 months postoperatively. The authors analyzed the correlation between visual acuity and corneal curvature change in 4 areas of the 2 zones. RESULTS: There were statistically significant differences between preoperative and postoperative visual acuity 1 month after surgery. At postoperative 3 months, the inferior and superior areas of the 3 mm corneal zone were much flatter than before surgery (P < 0.05). Corneal curvature only at the inferior area of the 3 mm zone had significantly a negative correlation with postoperative visual acuity at 3 and 6 months (r =  -0.275, P = 0.02 and r = -0.351, P = 0.01, respectively). However, visual acuity had no significant correlation with corneal curvature change in any of the areas of the 5-mm corneal zone. CONCLUSIONS: The authors found that corneal curvature has significantly become flattened in the superior and inferior areas of the 3 mm corneal zone, postoperatively. Furthermore, inferior area in the 3 mm corneal zone affected only on the visual acuity improvement after postoperative 3 months.

Comparison of Orbital Preadipocyte Adipogenesis Between Pediatric and Adult Graves Ophthalmopathy.

To investigate the difference of adipogenesis in orbital preadipocytes between pediatric and adult Graves ophthalmopathy (GO) under lipopolysaccharide (LPS)-induced inflammation in vitro.Orbital preadipocytes from pediatric and adult GO patients during eyelid or orbital surgery were cultured. The orbital preadipocytes in pediatric and adult GO were divided into group A and group B. In group A, pediatric and adult orbital preadipocytes were differentiated in adipogenesis media without LPS intervention, respectively. In group B, pediatric and adult orbital preadipocytes were incubated in culture medium containing 1 mg/L LPS for 48 hours before stimulation to differentiate into mature adipocytes in adipogenesis media. The expressions of adipogenic transcription factors, PPAR-γ and C/EBP-α, were determined by real-time polymerase chain reaction on day 7. On day 14, the cells were stained with oil red O to observe the intracellular lipid accumulation.In group A without LPS intervention, the pediatric orbital preadipocytes showed increased expression of PPAR-γ, C/EBP-α, and intracellular lipids accumulation than the adult orbital preadipocytes. In a group B with LPS intervention, both pediatric and adult preadipocytes showed higher rates of adipogenesis than in group A. Additionally, the increase in adipogenesis was greater in the pediatric preadipocytes.The pediatric orbital preadipocytes demonstrated increased adipogenesis than adult preadipocytes in GO without LPS-induced inflammation. Adipogenesis of the pediatric orbital preadipocytes was more affected and upregulated as compared to that of the adult preadipocytes by LPS-induced inflammation.

Porous Polyethylene Implant Associated With Delayed Orbital Complications and Osteomyelitis After Orbital Reconstruction.

Orbital implants are commonly used to repair orbital blowout fractures, to restore the functional and anatomical structure of the orbit. Porous polyethylene implants are a type of alloplastic implant and are widely used for orbital reconstruction as micropores facilitate the growth of fibers and blood vessels through the material. Rare complications associated with porous polyethylene implants used to treat blowout fractures include delayed orbital inflammation and osteomyelitis. The authors describe a 68-year-old man who presented with a 5-year delayed porous polyethylene implant infection and cicatricial ectropion with osteomyelitis after an orbital blowout fracture repair. The patient underwent surgery to incision and drainage of orbital abscess with ectropion correction surgery. He was treated with intravenous antibiotics for 6 weeks due to osteomyelitis and made a good recovery.

Changes in Corneal Curvature After Epiblepharon Surgery in Children.

PURPOSE: We aimed to determine the change in corneal topography for 2-different corneal zones and 4-quadrants after epiblepharon correction in children. METHODS: We retrospectively reviewed 39 patients (74 eyes) who underwent epiblepharon surgery. Keratometry measurements of corneal curvature were performed for 2 optical zones defined as circular areas with a radius of 3 and 5 mm from the corneal apex. Each optical zone was divided into quadrants (nasal, superior, temporal, and inferior). Keratometry readings for each quadrant of zone were compared between the preoperative and postoperative examinations (at 1, 3, and 6 months). The correlation between corneal astigmatism and curvature change was analyzed for each quadrant of the 3-mm optical zone. RESULTS: At 1 month postoperatively, the inferior and superior quadrants of the 3-mm optical zone became significantly flatter compared with the preoperative state, and this phenomenon became more pronounced at 3 months postoperatively (P < 0.05). However, no significant postoperative change in corneal curvature was noted for any quadrant of the 5-mm optical zone. There was a statistically significant correlation between the change in astigmatism and corneal curvature for the superior and inferior quadrants of the 3-mm optical zone (R = 0.394, P < 0.05; R = 0.460, P < 0.05; respectively). CONCLUSIONS: Astigmatism reduction was affected by corneal flatness in the inferior rather than the superior quadrant. Epiblepharon surgery results in reduction of corneal steepness at the vertical axis of the 3-mm optical zone, which correlates to astigmatism reduction.

Ocular Motility After Repair of Combined Medial and Inferior Orbital Wall Fractures With Extended Conjunctival Incision With Inferior Oblique Reattachment.

PURPOSE: To describe ocular motility and effectiveness of an extended conjunctival incision with reattachment of the inferior oblique muscle to repair combined orbital medial and inferior wall fractures. METHODS: The authors retrospectively studied 20 eyes from 20 patients who underwent combined orbital medial and inferior wall fractures surgery with reattachment of the inferior oblique muscle from January 2007 to December 2011. Single large L-shaped implant was inserted into the fracture site. All patients were evaluated preoperatively and postoperatively at 1, 3, and 6 months, by computed tomography, Hertel exophthalmometry, the Hess test of ocular motility, and the Goldmann diplopia test. RESULTS: Sixteen patients (80%) had no significant enophthalmos or diplopia after surgery. Inferior oblique motility was not changed in 12 patients (60%) after reattachment of the inferior oblique muscle. After 1 month, inferior oblique underaction was presented in 8 patients (40%) and in 4 patients (20%) after 6 months. Finally, only 2 patients (10%) had the inferior oblique underaction remained, it was not improved. CONCLUSIONS: The extended conjunctival incision with reattachment of the inferior oblique muscle for combined orbital wall fracture repair offers a wide surgical field and space for a single large implant insertion and corrects the enopthalmos. The reattachment of the inferior oblique muscle does not contribute to the development of inferior oblique underactions or diplopia that was resolved spontaneously within 6 months after surgery.

Comparison Between Continuous Buried Suture and Interrupted Buried Suture Methods for Double Eyelid Blepharoplasty.

PURPOSE: The objective of this study was to compare the surgical outcomes between interrupted and continuous buried suture methods in double eyelid blepharoplasty in Koreans. METHODS: Medical records of 204 patients (392 eyes) who underwent double eyelid operation by buried suture method and who were followed up for at least more than 3 months were reviewed. Patients were divided into 2 groups according to the buried suture method; an interrupted group (88 patients) and a continuous group (116 patients). RESULTS: The rate of loss of formed double eyelid is 19.3 % (17 of 88 patients) in interrupted buried method and 8.6 % (10 of 116 patients) in continuous group (P = 0.026). One patient experienced an exposure of suture knot in a continuous group, whereas 5 patients experienced an exposure of suture knot and 1 patient suffered from granuloma in an interrupted group (P = 0.021). CONCLUSIONS: The continuous buried suture method has a lower rate of the loss of double folds and less complication than the interrupted buried suture method for double fold formation in Koreans.