RESUMEN
Conjunctival goblet cells (CGCs) are mucin-secreting cells in the eye and play essential roles for ocular surface homeostasis. Since various ocular surface pathologies are related to CGC dysfunction, CGC examination is important for the evaluation of ocular surface conditions. Recently we introduced moxifloxacin-based fluorescence microscopy (MBFM) for non-invasive CGC imaging. However, the imaging speed was up to 1 frame per second (fps) and needed to be improved for clinical applications. In this study, we developed a high-speed moxifloxacin-based, extended depth-of-field (EDOF) microscopy system that operates at a maximum imaging speed of 15 fps. The system used a deformable mirror for the high-speed axial sweeping of focal plane during single-frame acquisitions. The acquired images contained both in-focus and out-of-focus information, and deconvolution was used to filter the in-focus information. The system had a DOF of 800 [Formula: see text], field-of-view of 1.2 mm ×1.2 mm, and resolution of [Formula: see text]. Its performance was demonstrated by real-time, breathing-motion-insensitive CGC imaging of mouse and rabbit models, in vivo. High-speed EDOF microscopy has potentials for non-invasive, real-time CGC examinations of human subjects.
Asunto(s)
Conjuntiva , Células Caliciformes , Animales , Conjuntiva/diagnóstico por imagen , Células Caliciformes/metabolismo , Humanos , Microscopía Fluorescente/métodos , Moxifloxacino/metabolismo , ConejosRESUMEN
The aim of this cross-sectional study was to investigate congenital abnormalities of the retinal vasculature (CARVs) in patients with neurofibromatosis type I (NF-1). Forty-eight patients (96 eyes) with NF-1 diagnosed according to the National Institutes of Health (NIH) criteria and 48 healthy controls were included in this study. Standard fundus photographs were obtained for each subject to evaluate the presence and frequency of CARVs. The sensitivity, specificity, and diagnostic accuracy of different cut-off numbers of CARVs were compared with those of the NIH criteria. Forty-four (91.7%) patients in the NF-1 group demonstrated either supranumeraty optic disc vessels or triple branching of the retinal vasculature, and 22 patients (45.8%) demonstrated both findings. The frequencies of these two CARVs were significantly different between the two groups (p < 0.00001). A cut-off value of either one for supranumerary optic disc vessels or triple branching showed the highest accuracy along with sensitivity and specificity of 91.7% and 87.5%. CARVs such as supranumerary optic disc vessels or triple branching were frequently observed in NF-1 patients, and their occurrence was unrelated to the age of patients. Thus, these CARVs could be added as new ophthalmologic manifestions for NF-1 and may potentially enable early diagnosis of NF-1.
Asunto(s)
Neurofibromatosis 1/patología , Vasos Retinianos/anomalías , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Neurofibromatosis 1/diagnóstico , Disco Óptico/irrigación sanguínea , Vasos Retinianos/diagnóstico por imagen , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. METHODS: This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). RESULTS: Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from - 0.5 to - 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). CONCLUSIONS: The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.
Asunto(s)
Efusiones Coroideas/diagnóstico , Cuerpo Ciliar/diagnóstico por imagen , Glaucoma de Ángulo Cerrado/diagnóstico , Presión Intraocular/fisiología , Miopía/diagnóstico , Refracción Ocular/fisiología , Agudeza Visual , Adulto , Niño , Efusiones Coroideas/inducido químicamente , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Glaucoma de Ángulo Cerrado/inducido químicamente , Glaucoma de Ángulo Cerrado/fisiopatología , Humanos , Masculino , Microscopía Acústica , Persona de Mediana Edad , Miopía/inducido químicamente , Miopía/fisiopatología , Estudios RetrospectivosRESUMEN
PURPOSE: To describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients. METHODS: This is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis. RESULTS: Of the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation. CONCLUSIONS: Although the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.
Asunto(s)
Blefaroptosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Blefaroplastia/métodos , Blefaroptosis/diagnóstico , Blefaroptosis/cirugía , Niño , Preescolar , Párpados/cirugía , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Músculos Oculomotores/cirugía , Reoperación , República de Corea/epidemiología , Estudios RetrospectivosAsunto(s)
ADN Mitocondrial/genética , Atrofia Óptica Hereditaria de Leber/genética , Mutación Puntual , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Análisis Mutacional de ADN , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Atrofia Óptica Hereditaria de Leber/diagnóstico , Factores de Tiempo , Adulto JovenAsunto(s)
Inmunoglobulina G/inmunología , Linfoma de Células B de la Zona Marginal/complicaciones , Enfermedades Orbitales/etiología , Diagnóstico Diferencial , Humanos , Linfoma de Células B de la Zona Marginal/diagnóstico , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/inmunología , Neoplasias Orbitales/complicaciones , Neoplasias Orbitales/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Silicone rod is a commonly used synthetic suspension material in frontalis suspension surgery to correct blepharoptosis. The most challenging problem and a decisive drawback of the use of silicone rod is a considerable rate of ptosis recurrence after surgery. We examined patients with recurred ptosis and assessed the physical and micromorphological properties of implanted silicone rods to determine the causative mechanisms of recurred ptosis after frontalis suspension using silicone rod. METHODS: This is a prospective observational case series of 22 pediatric patients with recurred ptosis after frontalis suspension using silicone rods for congenital ptosis. Implanted silicone rods were observed and removed during the operation for correction of recurred ptosis. The removed silicone rods were physically and micromorphologically evaluated to determine the cause of recurrence. RESULTS: Pretarsal fixation positions migrated upward, whereas suprabrow fixation positions migrated downward during ptosis recurrence. The breaking strength of implanted silicone rods was reduced by approximately 50% during 3 years. Cracks, debris, and loss of homogenous structure with disintegration were observed on scanning electron micrographs of implanted silicone rods in patients with recurred ptosis. Preoperative severe degree of ptosis also contributed to recurred ptosis. CONCLUSIONS: Recurrence of ptosis after frontalis suspension using silicone rod was associated with physical changes of implanted silicone rods, including positional migration, weakened tensile strength, and micromorphological changes in combination with patients' characteristics.
Asunto(s)
Materiales Biocompatibles/efectos adversos , Blefaroptosis/patología , Prótesis e Implantes/efectos adversos , Siliconas , Blefaroptosis/congénito , Blefaroptosis/cirugía , Preescolar , Femenino , Humanos , Lactante , Masculino , Ensayo de Materiales , Estudios Prospectivos , RecurrenciaRESUMEN
PURPOSE: To compare the efficacy and safety of combination therapy with orbital irradiation and systemic steroids versus steroid monotherapy in the management of active Graves' orbitopathy (GO). METHODS: The clinical charts of 127 patients with active inflammation due to GO who received intravenous steroid pulse therapy as a first-line treatment with or without orbital radiotherapy between 2010 and 2014 were reviewed. Patients were divided into two treatment groups: 1) combined orbital radiotherapy and steroid pulse therapy (SRT group) and 2) steroid pulse therapy only (ST group). Primary outcome measures included clinical activity score (CAS); NOSPECS classification; ocular motility impairment; and exophthalmos at 1, 3, 6, and 12 months after treatment. The secondary outcome measure was the change in orbital, extraocular muscle (EOM), and fat volume after treatment measured by orbit computed tomography. RESULTS: Sixty-eight patients were included in the SRT group, and 59 patients were in the ST group. In both treatments, CAS and NOSPECS were significantly reduced. In the comparison of the degree of change from baseline between the groups, the SRT group demonstrated more improvement in NOSPECS and scores of ocular motility. Orbital, EOM, and fat volume significantly decreased in the SRT group; however, only fat volume was reduced in the ST group. Compressive optic neuropathy after treatment developed in 0 % of the SRT group and 3.4 % (2/59) of the ST group. Reactivation of inflammation occurred in 11.8 % (8/68) of the SRT group and 28.8 % (17/59) of the ST group. CONCLUSIONS: Orbital radiotherapy in combination with steroid treatment significantly improved ocular motility by reducing EOM volume in patients with active GO.
Asunto(s)
Glucocorticoides/administración & dosificación , Oftalmopatía de Graves/tratamiento farmacológico , Oftalmopatía de Graves/radioterapia , Metilprednisolona/administración & dosificación , Órbita/efectos de la radiación , Terapia Combinada , Fraccionamiento de la Dosis de Radiación , Exoftalmia/fisiopatología , Femenino , Oftalmopatía de Graves/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Motilidad Ocular/diagnóstico por imagen , Trastornos de la Motilidad Ocular/fisiopatología , Músculos Oculomotores/diagnóstico por imagen , Músculos Oculomotores/fisiopatología , Órbita/diagnóstico por imagen , Quimioterapia por Pulso , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
AIMS: To establish the novel concept of a functional eyelid centre to determine the optimal point for eyelid lifting in ptosis surgery. METHODS: This was a prospective study of 112 patients with congenital ptosis. The functional eyelid centre was defined as the point where the eyelid contour showed the best appearance when the upper eyelid was lifted manually. In patients who underwent frontalis suspension surgery using silicone rods, the postoperative outcome was assessed according to the fixation point of the rod. RESULTS: The average horizontal fissure width and the distance from the medial canthus to the mid-pupillary line were 21.9 and 10.1â mm, respectively. The functional eyelid centre was located 4.28±0.98â mm temporal to the mid-pupillary line. The outcomes of silicone rod surgeries were excellent when the rod was fixated 4.4â mm nasal and 3.9â mm temporal from the functional eyelid centre. These positions corresponded to 0.1â mm nasal and 8.2â mm temporal from the mid-pupillary line. CONCLUSIONS: The functional eyelid centre was located slightly temporal to the mid-pupillary line. A better eyelid contour in ptosis surgery is produced when eyelid lifting is centred around the functional eyelid centre.
Asunto(s)
Blefaroplastia/métodos , Blefaroptosis/cirugía , Párpados/anatomía & histología , Blefaroptosis/congénito , Blefaroptosis/fisiopatología , Niño , Preescolar , Fascia Lata/trasplante , Femenino , Humanos , Lactante , Masculino , Músculos Oculomotores/cirugía , Elastómeros de Silicona , Técnicas de SuturaRESUMEN
OBJECTIVE: To assess impaired quality of life (QOL) of Korean patients with thyroid eye disease (TED) using the TED-QOL questionnaire, to evaluate the adaptability of the questionnaire, and to assess the correlation between TED-QOL and scales of disease severity. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Total of 90 consecutive adult patients with TED and Graves' disease were included in this study. METHODS: TED-QOL was translated into Korean and administered to the patients. The results were compared with clinical severity scores (clinical activity score, VISA (vision loss (optic neuropathy); inflammation; strabismus/motility; appearance/exposure) classification, modified NOSPECS (no signs or symptoms; only signs; soft tissue; proptosis; extraocular muscle; cornea; sight loss) score, Gorman diplopia scale, and European Group of Graves' Orbitopathy Classification). RESULTS: Clinical scores indicating inflammation and strabismus in patients with TED were positively correlated with overall and visual function-related QOL (Spearman coefficient 0.21-0.38, p < 0.05). Clinical scores associated with appearance were positively correlated with appearance-related QOL (Spearman coefficient 0.26-0.27, p < 0.05). In multivariate analysis, age, soft-tissue inflammation, motility disorder of modified NOSPECS, and motility disorder of VISA classification had positive correlation with overall and function-related QOL. Sex, soft-tissue inflammation, proptosis of modified NOSPECS, and appearance of VISA classification had correlation with appearance-related QOL. In addition, validity of TED-QOL was proved sufficient based on the outcomes of patient interviews and correlation between the subscales of TED-QOL. CONCLUSIONS: TED-QOL showed significant correlations with various objective clinical parameters of TED. TED-QOL was a simple and useful tool for rapid evaluation of QOL in daily outpatient clinics, which could be readily translated into different languages to be widely applicable to various populations.