Anatomical changes in idiopathic epiretinal membrane at 2-year follow-up assessed using spectral domain optical coherence tomography and optical coherence tomographic angiography.

PURPOSE: To evaluate anatomical changes in the low-stage partial attachment-type idiopathic epiretinal membrane (iERM) over 2 years. METHODS: Data from patients with low-stage partial attachment-type iERM (stage 2) were analyzed. The main outcome measures were anatomical changes, including changes in the foveal avascular zone (FAZ) area, vessel density (VD) in the vascular plexus, and thickness of retinal sublayers during the follow-up period. RESULTS: Thirty patients (mean age: 68±12 years) were included in the study. The FAZ area on the superficial vascular plexus (SVP) significantly decreased from baseline (0.12±0.08 mm2) to month 24 (0.10±0.08 mm2, p=0.024). However, the FAZ area on the deep vascular plexus (DVP) did not significantly decrease from baseline (0.15±0.13 mm2) to month 24 (0.14±0.14 mm2, p=0.099). VDs on both the SVP and DVP did not show significant change from baseline (29.51±8.14% vs. 28.35±5.63%) to month 24 (29.79±9.77%, p=0.564 vs. 28.17±5.75%, p=0.417). Parafoveal ganglion cell and inner plexiform layer (GCIPL) thickness decreased from baseline (108.77±13.61 µm) to month 24 (103.03±15.54 µm, p=0.004). The central total retinal layer thickness did not significantly change from baseline (396.07±64.86 µm) to month 24 (392.04±72.72 µm, p=0.570). CONCLUSION: Even in low-stage ERM, inner retinal changes, including GCIPL thickness, occurred during follow-up periods, which might be owing to degenerative changes or centrifugal movement.

Clinical factors affecting the rate of exodrift after surgery in patients with basic intermittent exotropia.

We investigated the period of postoperative exodrift during follow-up and clinical factors that affect the rate of exodrift after surgery in the patients with intermittent exotropia (IXT). A retrospective review of medical records of patients with exodrift who underwent bilateral rectus recession for IXT was performed. Exodrift was defined as angle of deviation greater than 10 prism diopters (PD) at distance and near. The median survival period of postoperative exodrift was analyzed using Kaplan Meier survival analysis. The patients were divided into two groups according to the median period of postoperative exodrift (early and late group). The weighted Cox's proportional hazards regression analysis to investigate the risk factors that affect rate of postoperative exodrift was performed. A total of 108 patients was included. The preoperative angle of deviation at distance and near were 30.3 ± 7.2 PD and 29.5 ± 8.6 PD, respectively. The median survival period of postoperative exodrift was 24 months (range, 6-48 months).The angle of deviation at postoperative day 1 in early and late group were - 3.8 ± 5.5 PD (range, - 16-8 PD) and - 7.7 ± 4.6 PD (range, - 16-4 PD) (p < 0.01). Minus value means esodeviation. In regression analysis, the angle of deviation at postoperative day 1 was the significantly related with rate of exodrift (p < 0.01). The median period of exodrift after surgery was 24 months, angle of deviation at postoperative day 1 could affect the rate of exodrift in patients with IXT.

Correlation Between Lacrimal Syringing Test and Dacryoscintigraphy in Patients With Epiphora.

The purpose of this study was to evaluate the correlation between the lacrimal syringing test (LST) and dacryoscintigraphy (DSG) in patients with epiphora. The authors retrospectively reviewed the clinical records of patients who underwent both LST and DSG from March 2016 to February 2018. From this, 636 eyes of 336 patients with a mean age of 61.20 ±â€Š11.93 years (range, 22-86 years) were included. The concordance rate between LST and DSG was 43.7% (278 eyes). The sensitivity of DSG was 68.78%, and specificity was 30.99%. Factors of age and sex were analyzed in terms of concordance. The authors categorized age into 2 groups of younger and older than 65 years. Only sex was found to affect the results, with a much higher concordance rate in the female group than the male group. The lack of correlation between the tests indicates that the LST and DSG methods are complementary to each other. There is no single reliable method for testing patency of the lacrimal drainage system. Therefore, physicians should refer to these tests as complementary in a clinic setting.

Idiopathic Orbital Inflammation With Superior Rectus and Levator Complex may be Misdiagnosed as Involutional Ptosis.

Idiopathic orbital inflammation (IOI) is a benign inflammatory disease usually confined to the orbit. Two middle-aged patients with IOI have been reported who could have been misdiagnosed as involutional ptosis. Two patients presented to the clinic with eyelid ptosis. One patient's erythrocyte sedimentation rate was slightly increased; the other patient's immunoglobulin G4 (IgG4), IgG, and thyroid-stimulating hormone results were higher than the upper limits of normal. The computed tomographic images and orbit magnetic resonance imaging tests showed an inflammatory condition around the droopy eyelids. They were both admitted to the hospital with diagnosis of IOI, and intravenous antibiotic and steroid treatment were administered, which improved their symptoms.

A Comparison of Surgical Outcomes of Two Combination Surgeries for Involutional Entropion: Fixing 3 vs 2 Pathologic Components.

The purpose of this study was to compare the surgical outcomes of two combinational surgeries for involutional entropion: Inferior retractor tightening (IRT) + lateral tarsal strip (LTS) + skin muscle excision (SME) vs LTS + SME. The authors reviewed the records of 2 groups which were made up of 80 (85 eyelids) and 58 (63 eyelids) involutional entropion patients with 71.4 and 71.8 years on average respectively. The 2 groups were categorized into Group A and Group B by different surgical techniques. The former underwent IRT + LTS + SME surgery between April 2004 and February 2014, while the latter received LTS + SME surgery between March 2014 and February 2018. The authors evaluated the surgical outcomes of 2 combinational surgeries. In Group A, 84 out of 85 (98.8%) lids were successfully corrected and 1 (1.2%) lower eyelid suffered from recurrence during the follow-up period of 26.5 ±â€Š4.6 months. Two canthal deformity cases occurred in this group. In Group B, 62 out of 63 (98.2%) lids were successfully treated and there was 1 (1.8%) case of recurrence during the follow-up period of 21.0 ±â€Š10.0 months. No cases of complications were noted. IRT + LTS + SME procedure took 26.4 ±â€Š2.4 minutes and LTS + SME procedure took 20.6 ±â€Š3.9 minutes (P < 0.001). The LTS + SME technique exhibited a comparable success rate with the IRT + LTS + SME operation. LTS + SME appeared to be significantly faster and safer compared to the IRT + LTS + SME procedure.

The Characteristics of Lower Eyelid Reverse Ptosis After Reconstruction of Orbital Floor Wall Fracture Using Transconjunctival Approach.

The purpose of this study was to evaluate the changes of lower eyelid position and the incidence of reverse ptosis after reconstruction of orbital floor fracture. The authors retrospectively reviewed the clinical records of patients who received reconstruction of orbital floor wall fractures between 2014 and 2017. Digital photographs were taken preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Main measurements were marginal reflex distance 2 (MRD 2), which was measured by analyzing the digital photographs using ImageJ software. Among 264 patients with orbital wall fracture, The authors enrolled 32 eyes (18 right eyes and 14 left eyes) of 32 patients (21 males and 11 females) with a mean age of 32.1 years (range, 16-57 years). 7 (21.9%) of 32 patients had reverse ptosis at postoperative 3 months. When MRD2 of affected eye was compared based on the fellow eye, 7 patients with reversed ptosis showed a definite MRD 2 decrease (>1 mm) of affected eye from postoperative 1 month. Age showed a significant negative correlation with the difference of MRD2 between affected and fellow eye at postoperative 1 and 3 months (r = -0.378, P = 0.033 and r = -0.372, P = 0.036, respectively). Postoperative complications were not observed in all patients. The transconjunctival access in orbital floor wall surgery is a safe and useful surgical approach. However, some may have a reverse ptosis postoperatively, especially older patients. Reverse ptosis is a major clinical finding that should not be overlooked in post-operative follow-up.

A Patient With Periorbital Necrotizing Fasciitis by Klebsiella pneumoniae.

Periorbital necrotizing fasciitis (NF) is a very rare disease with a mortality rate of 10% to 20%, requiring rapid diagnosis and active treatment. The most common causative organism is Group A ß-hemolytic Streptococcus, and trauma, operative incisions, pre-existing ulcers, or injection sites may be predisposing factors for periorbital NF. In this study, the subject, who had a medical history of diabetes mellitus and chronic liver disease, developed periorbital NF suddenly and without any specific triggering factors, and Klebsiella pneumoniae was identified in a necrotic tissue biopsy. Klebsiella pneumoniae has not been reported as a causative organism of periorbital NF. It is believed that latent infection with K pneumoniae, which caused a brain abscess in the patient 2 years prior, caused inflammation around the periorbit by hematogenous spread. The authors were able to manage the patient successfully by performing total exenteration and reconstructing the affected site using a transverse rectus abdominis myocutaneous flap procedure.

Changes in translucency of resin composites after storage in salivary esterase.

BACKGROUND: Dental resin composites are degraded by salivary enzymes, but the enzymatic influence on the translucency of resin composites has not been determined. PURPOSE: The purpose of this study was to evaluate the changes in translucency of resin composites after storage in the salivary enzyme esterase (ETE, porcine liver esterase, 400 mU/mL) compared with those in phosphate-buffered saline (PBS). MATERIALS AND METHODS: The colors of specimens of three brands of resin composites of various shades were measured after polymerization and polishing (baseline), and after immersion in PBS or ETE for 9 weeks; measurements were determined over white and black backgrounds according to the CIELAB color scale (established by Commission Internationale de l'Eclairage). The final specimen thickness was 1.75 mm. Translucency parameter (TP) was obtained by calculating the color difference between the specimen over a white background and that over a black background. Two-factor, repeated-measures analysis of variance was used to compare differences. RESULTS: TP values varied among and within different shade designations and also among different brands of resin composites. TP values were significantly changed after immersion in PBS and ETE and were influenced by the brand of resin composites, but they were not influenced differently by the immersion solutions of PBS and ETE (p = .05). CLINICAL SIGNIFICANCE: Translucency of dental resin composites is an important esthetic consideration. Based on the results of this study, the influence of salivary esterase on the changes in translucency of dental resin composites is not significantly different from that of phosphate-buffered saline. Therefore, it can be concluded that the enzymatic effects of saliva do not adversely alter the translucency of dental resin composites.

Influence of porcine liver esterase on the color of dental resin composites by CIEDE2000 system.

The objectives of this study were to evaluate the changes in color and color coordinates of dental resin composites after immersion in porcine liver esterase (PLE, 400 mU/mL; a substitute for salivary hydrolase) with CIEDE2000 color system, and to compare those with CIELAB color system. Color of resin composites was measured after immersion in PBS (phosphate buffered saline; control) or PLE up to nine weeks. Color difference (delta E00) and changes in lightness (L'), red-green parameter (a'), yellow-blue parameter (b'), and chroma (C') with CIEDE2000 system were compared. Correlation in the changes of color with CIEDE2000 and CIELAB systems was determined. Delta E00 values after a 9-week immersion in PLE were 0.7-2.8, which were not higher than those in PBS except for a few cases. Changes in b' and C' values after a 9-week immersion in PLE were generally lower than those in PBS, and were in the range of -4.0 to -0.1 and -4.0 to -0.1, respectively. Therefore, the influence of porcine liver esterase on the changes of color and color coordinates was negligible with CIEDE2000 color system. There was a significant correlation between color differences (delta E00 vs deltaE*ab) with CIEDE2000 and CIELAB systems [correlation coefficient (r) = 0.95, p < 0.01].