Increased Intraocular Pressure after Extensive Conjunctival Removal: A Case Report

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.

Increased Intraocular Pressure after Extensive Conjunctival Removal: A Case Report

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.

Part-Time Occlusion Therapy for Anisometropic Amblyopia Detected in Children Eight Years of Age and Older

PURPOSE: To determine the outcome of part-time occlusion therapy in children with anisometropic amblyopia detected after they were 8 years of age. METHODS: We analyzed 29 eyes with anisometropic amblyopia in children 8 years of age and older. The mean age was 8.79+/-0.98 (range 8~12) years old. The subjects whose best-corrected visual acuity (BCVA) did not improve by two lines or better within 2 weeks of wearing glasses full-time were prescribed occlusion therapy for 6 hours a day outside of school hours, along with the instruction to wear glasses full-time. Subjects who complied with occlusion for more than 3 hours a day were considered to comply well. RESULTS: The major component of the anisometropia was hyperopia in 51.7% of the subjects, and hyperopia plus astigmatism was found in 24.1%. The mean pretreatment BCVA score was 0.51+/-0.23 (LogMAR). Compliance was 89.66%. The mean posttreatment BCVA was 0.03+/-0.01 (LogMAR), and the success rate, based on a posttreatment BCVA of 0.1 (LogMAR) and better, was 96.43%. It took an average of 4.79+/-3.35 months to reach the desired posttreatment BCVA. The mean posttreatment stereopsis was 79.78+/-37.61 seconds of arc. The recurrence rate was 8%. The visual improvement was related to the degree of compliance (p=0.000). The time taken to reach the posttreatment BCVA was shorter in subjects with a better pretreatment BCVA (p=0.019), but it did not relate to the compliance (p=0.366). CONCLUSIONS: The most common component of anisometropia detected after 8 years of age was hyperopia. The part-time occlusion therapy, which had been carried out after school hours, was successful in most cases.

Two Cases of Klebsiella Pneumoniae Endogenous Endophthalmitis Treated with Sulperazone

PURPOSE: To report and review 2 cases of Klebsiella Pneumoniae endogenous endophthalmitis showing multi drug resistance that were treated with sulperazone. METHODS: Sulperazone was administered to two patients with Klebsiella Pneumoniae endogenous endophthalmitis: a 51-year-old male with orbital cellulitis who showed no response to vancomycin, ceftazidime, and amikacin for 6days; and a 67-year-old female who showed no response to cefotaxime, and amikacin. RESULTS: Proptosis and inflammation began to improve after changing to sulperazone. Therefore, enucleation and debridement could be avoided. CONCLUSIONS: Good results were obtained by use of Sulperazone which inactivates beta-lactamase irreversibly and which showed bactericidal effect to multi drug resistant Klebsiella Pneumoniae endogenous endophthalmitis.

A Case of Kimura's Disease of the Eyelid

PURPOSE: Kimura's disease is an uncommon, chronic inflammatory disorder of unknown etiology which occurs predominantly in Orientals and presents with tumor-like swellings mainly in the head and neck region. Orbital and ocular adnexal cases are rare. We report a case of Kimura's disease of the eyelid. METHODS: A 52-year-old male presented with a 10-year history of intermittently recurrent swelling and a painless mass of the left upper eyelid. The mass was resected and biopsied for histological examination. RESULTS: The case was diagnosed with Kimura's disease by the clinical and histopathologic findings.