Relationship between Thyrotropin Binding Inhibitory Immunoglobulin and Strabismus-associated Thyroid Eye Disease Stability

Purpose@#To investigate the relationship between thyrotropin binding inhibitory immunoglobulin (TBII) and deviation angle stability in strabismus-associated thyroid eye disease. @*Methods@#A total of 25 strabismus-associated thyroid eye disease patients who were followed up for > 6 months without surgery were enrolled. To investigate the correlation between TBII levels and changes in the deviation angle, a test period of 6 months from the date of TBII measurement was established and 55 test units of the corresponding TBII levels were obtained. @*Results@#The deviation angle had a positive correlation with the TBII levels (r = 0.473, p < 0.001), but did not correlate with sex, age, and thyroid hormone levels. Changes in the horizontal, vertical, and total deviation angles were significantly greater in the high-TBII test units compared to the normal-TBII test units (p= 0.029, = 0.032, and = 0.009, respectively). @*Conclusions@#TBII levels were related to deviation angle stability in strabismus-associated thyroid eye disease. TBII may be a useful indicator for deviation angle stability in these patients over a period of 6 months.

Cystic Solitary Fibrous Tumor of the Orbit

Purpose@#To present a case of a cystic solitary fibrous tumor (SFT), the first report of its kind in Korea, along with a review of the literature of SFTs affecting the orbit.Case summary: A 71-year-old male was referred to our practice due to diplopia for 2 years and 6 months. On ophthalmologic examination, 10-mm proptosis and inferolateral globe displacement were observed in the left eye, and extraocular movements were limited in all directions of gaze. A facial computed tomography scan and magnetic resonance imaging showed a lobulated, well-enhanced mass in the superonasal extraconal space. The tumor appeared to be heterogeneous; cystic tissue was suspected. An excisional biopsy was performed through anterior orbitotomy to remove the mass (dimensions, 43 × 30 × 28 mm3). Histological examination showed the tumor to be composed of spindle cells in collagenous tissue. Immunohistochemical staining was positive for CD34, CD99, and orbital SFT with cystic changes. @*Conclusions@#SFT arising in the orbit is extremely rare but should be considered in the differential diagnosis of progressing unilateral proptosis, keeping in mind that this condition may be accompanied by cystic changes.

Cystic Solitary Fibrous Tumor of the Orbit

Purpose@#To present a case of a cystic solitary fibrous tumor (SFT), the first report of its kind in Korea, along with a review of the literature of SFTs affecting the orbit.Case summary: A 71-year-old male was referred to our practice due to diplopia for 2 years and 6 months. On ophthalmologic examination, 10-mm proptosis and inferolateral globe displacement were observed in the left eye, and extraocular movements were limited in all directions of gaze. A facial computed tomography scan and magnetic resonance imaging showed a lobulated, well-enhanced mass in the superonasal extraconal space. The tumor appeared to be heterogeneous; cystic tissue was suspected. An excisional biopsy was performed through anterior orbitotomy to remove the mass (dimensions, 43 × 30 × 28 mm3). Histological examination showed the tumor to be composed of spindle cells in collagenous tissue. Immunohistochemical staining was positive for CD34, CD99, and orbital SFT with cystic changes. @*Conclusions@#SFT arising in the orbit is extremely rare but should be considered in the differential diagnosis of progressing unilateral proptosis, keeping in mind that this condition may be accompanied by cystic changes.

Two Cases of Epibulbar Osseous Choristoma

Purpose@#To report two cases of epibulbar osseous choristoma and a review of the literature.Case summary: A 26-year-old male and a 50-year-old female without any past medical history or history of ocular trauma were referred to our clinic due to an incidental epibulbar mass. The masses were located in superotemporal subconjunctiva and inferotemporal subconjunctiva, respectively, and excisional biopsies were performed. The masses revealed epibulbar osseous choristoma. There was no recurrence of disease or postoperative complication. @*Conclusions@#When asymptomatic subconjunctival or an extraocular mass especially located at the temporal side is found, epibulbar osseous choristoma should always be considered.

Two Cases of Epibulbar Osseous Choristoma

Purpose@#To report two cases of epibulbar osseous choristoma and a review of the literature.Case summary: A 26-year-old male and a 50-year-old female without any past medical history or history of ocular trauma were referred to our clinic due to an incidental epibulbar mass. The masses were located in superotemporal subconjunctiva and inferotemporal subconjunctiva, respectively, and excisional biopsies were performed. The masses revealed epibulbar osseous choristoma. There was no recurrence of disease or postoperative complication. @*Conclusions@#When asymptomatic subconjunctival or an extraocular mass especially located at the temporal side is found, epibulbar osseous choristoma should always be considered.

Prevalence of Dry Eye Syndrome and Association with Life Behaviors in Adolescents

PURPOSE: To investigate the prevalence and risk factors of dry eye syndrome (DES) among adolescents based on the Ocular Surface Disease Index (OSDI) questionnaire. METHODS: A questionnaire survey was conducted on middle and high school students in Daejeon. DES was diagnosed by an OSDI score ≥ 13. According to the OSDI score, DES was classified as mild (13-22 points), moderate (23-32 points), or severe (33-100 points). Additionally, responses to the questions regarding adolescents' life behaviors including the duration of electronic device use per week (cellphone, computer, TV), study hours per day, sleeping hours per day, contact lenses use, glasses use, and humidifier use were analyzed to determine the associations with DES. RESULTS: Of 332 students, DES was diagnosed in 147 (44.3%), and 54 (16.3%) complained of severe DES. The prevalence of DES was higher in female students (p = 0.004), long-time electronic device users (divided on the basis of the mean value, 15.3 hours per week, p = 0.011), and contact lenses users (p = 0.001). The prevalence of DES was 53.9% in groups with ≥ 14 hours of electronic device usage time per week, 40.2% in groups with ≥ 7 hours, and 33.7% in groups with < 7 hours (p = 0.002). The duration of electronic device use per week was a significant risk factor of DES for male students, and contact lenses use was a significant risk factor of DES for female students (p = 0.009). CONCLUSIONS: The prevalence of DES was high among adolescents. Long-time electronic device usage and contact lenses wear were associated with DES and increased the risk of DES.

Analysis of Pediatric Patients Referred for Decreased Vision of Unknown Origin

PURPOSE: To identify causes of conditions presenting with low vision without distinct abnormities in pediatric patients and to determine the appropriate diagnostic approach for those conditions. METHODS: We retrospectively reviewed medical records of pediatric patients with amblyopia, suspicious amblyopia or visual impairment of unknown origin referred by primary care providers. Patients were classified into 2 groups, amblyopia and visual impairment of unclear origin. In this study, we reviewed and analyzed the visual impairment of unclear origin. RESULTS: Of 152 patients, 94 patients were classified as amblyopia and 58 patients were classified as visual impairment of unclear origin. Among those with visual impairment of unclear origin, 26 patients (44.8%) were classified as functional visual loss, 23 patients (39.7%) as normal corrected visual acuity, 8 patients (13.8%) as organic disease and 1 (1.7%) patient could not be classified. Fundus examination revealed abnormal findings in all patients classified as organic disease. Six patients had optic atrophy and 2 had abnormalities on the macula. Ten patients had an orbital magnetic resonance imaging (MRI) scan. Only 1 of 10 MRI scans showed causative abnormality, however, the patient showed an optic atrophy on fundus examination before the MRI scan. CONCLUSIONS: Clinicians need to consider a high prevalence of functional visual loss and possibility of occult organic disorders when they evaluate pediatric patients presenting with decreased vision without distinct abnormities. MRI scan is recommended for only selected cases, when optic atrophy is not present.

Comparison of Partial Interferometry and Ultrasound A-scan for Axial Length Measurement in Retinal Vein Occlusions

PURPOSE: To evaluate the significance of axial length, which is a known risk factor of retinal vein occlusion, we measured the axial lengthby using contact A-scan sonography and partial interferometry and compared the two values. METHODS: This study included 19 patients complaining of visual symptoms and who were diagnosed with unilateral retinal vein occlusion (RVO) with macular edema (ME). Affected eyes were classified as the study group, and healthy fellow eyes were classified as the control group. We measured the central macular thickness (CMT) and axial length (AL) of the affected and fellow eyes and compared them. CMT was measured by optical coherence tomography (Stratus OCT, Carl Zeiss, Jena, Germany), and AL was measured by interferometry (IOL Master®, Carl Zeiss, Jena, Germany). RESULTS: In RVO patients, CMT was significantly different between affected eyes (485.7 ± 111.3 µm) and fellow eyes (197.8 ± 29.7 µm; p < 0.001). Axial length measured by A-scan sonography was 23.06 ± 0.86 mm in the affected eyes and 23.28 ± 0.93 mm in the healthy eyes, which was statistically different (p < 0.001). However, using partial interferometry, the AL was 23.35 ± 0.87 mm in the affected eyes and 23.38 ± 0.95 mm in the healthy eyes. No significant difference was found. CONCLUSIONS: We confirmed that short AL, which was once thought to be a risk factor of RVO, results from the properties of the instruments used for measurement. Moreover, we verified that partial interferometry is more accurate for measurement of AL than A-scan sonography when retinal vein occlusion is associated with ME.

Amaurosis Fugax Associated with Ipsilateral Internal Carotid Artery Agenesis

PURPOSE: We report a case of amaurosis fugax associated with ipsilateral internal carotid artery agenesis. CASE SUMMARY: A 50-year-old woman presented with amaurosis fugax in her left eye; the frequency of episodes of the condition had recently increased to once a month. She had a history of hypertension and dyslipidemia, and was under medical therapy. The visual acuity of both eyes was 20/20. Slit-lamp examination was normal except for pseudophakia. Ophthalmoscopy revealed a myopic tigroid fundus and a myopic tilted disc. No abnormalities were evident in fluorescein fundus angiography. Brain computed tomography showed that the left bony carotid canal was absent, and magnetic resonance angiography showed that the left internal carotid artery was also absent. She was diagnosed with left internal carotid artery agenesis. Other neurological and hematological parameters were within normal ranges. The amaurosis fugax spontaneously disappeared and has not recurred over the past 12 months. Our case, although rare, suggests that amaurosis fugax may be associated with internal carotid artery agenesis.