From Homogeneity to Turing Pattern: Kinetically Controlled Self-Organization of Transmembrane Protein.

Understanding the spatial organization of membrane proteins is crucial for unraveling key principles in cell biology. The reaction-diffusion model is commonly used to understand biochemical patterning; however, applying reaction-diffusion models to subcellular phenomena is challenging because of the difficulty in measuring protein diffusivity and interaction kinetics in the living cell. In this work, we investigated the self-organization of the plasmalemma vesicle-associated protein (PLVAP), which creates regular arrangements of fenestrated ultrastructures, using single-molecule tracking. We demonstrated that the spatial organization of the ultrastructures is associated with a decrease in the association rate by actin destabilization. We also constructed a reaction-diffusion model that accurately generates a hexagonal array with the same 130 nm spacing as the actual scale and informs the stoichiometry of the ultrastructure, which can be discerned only through electron microscopy. Through this study, we integrated single-molecule experiments and reaction-diffusion modeling to surpass the limitations of static imaging tools and proposed emergent properties of the PLVAP ultrastructure.

Sunlight-Activatable ROS Generator for Cell Death Using TiO2/c-Si Microwires.

Solar-driven reactive oxygen species (ROS) generation is an attractive disinfection technique for cell death and water purification. However, most photocatalysts require high stability in the water environment and the production of ROS with a sufficient amount and diffusion length to damage pathogens. Here, a ROS generation system was developed consisting of tapered crystalline silicon microwires coated with anatase titanium dioxide for a conformal junction. The system effectively absorbed >95% of sunlight over 300-1100 nm, resulting in effective ROS generation. The system was designed to produce various ROS species, but a logistic regression analysis with cellular survival data revealed that the diffusion length of the ROS is ∼9 µm, implying that the most dominant species causing cell damage is H2O2. Surprisingly, a quantitative analysis showed that only 15 min of light irradiation on the system would catalyze a local bactericidal effect comparable to the conventional germicidal level of H2O2 (∼3 mM).

USP14 Inhibition Regulates Tumorigenesis by Inducing Autophagy in Lung Cancer In Vitro.

The ubiquitin-proteasome system is an essential regulator of several cellular pathways involving oncogenes. Deubiquitination negatively regulates target proteins or substrates linked to both hereditary and sporadic forms of cancer. The deubiquitinating enzyme ubiquitin-specific protease 14 (USP14) is associated with proteasomes where it trims the ubiquitin chain on the substrate. Here, we found that USP14 is highly expressed in patients with lung cancer. We also demonstrated that USP14 inhibitors (IU1-47 and siRNA-USP14) significantly decreased cell proliferation, migration, and invasion in lung cancer. Remarkably, we found that USP14 negatively regulates lung tumorigenesis not only through apoptosis but also through the autophagy pathway. Our findings suggest that USP14 plays a crucial role in lung tumorigenesis and that USP14 inhibitors are potent drugs in lung cancer treatment.

Reconstruction of Large Orbital Posterior Floor Wall Fracture Considering Orbital Floor Slope Using Endoscope.

PURPOSE: Reconstruction of a large orbital fracture extending to the posterior wall of the maxillary sinus is difficult and challenging. In this study, the authors present transconjunctival or transcaruncular approach using endoscopy and layered porous polyethylene barrier sheets to manage large orbital floor wall fracture. METHODS: A retrospective review of all patients who underwent reconstruction of large orbital floor wall fractures between June 2009 and July 2015 was conducted. Patient demographics, degree of enophthalmos, ocular motility and diplopia test results, and surgical complications were reviewed. RESULTS: This study included 53 eyes of 53 patients. The mean time from trauma to surgery was 34.1 days (range, 1-360 days). The average postoperative follow-up period was 6.1 months (range, 3-14 months). The degrees of enophthalmos preoperatively, and 1 week, 1 month, and 3 months postoperatively were -1.98 mm (range, -1.5 to -3 mm), 0.13 mm (range, -1.0 to +1.5 mm), -0.09 mm (range, -2.0 to +1.5 mm), and -0.43 mm (range, -2.0 to +1.0 mm), respectively. The mean improvement in enophthalmos at 3 months postoperation was 1.55 mm (P < 0.001). There was only 1 patient with residual 2 mm enophthalmos at 3 months postoperation. There were no definite surgical complications in any patient. CONCLUSION: Sufficient dissection to the posterior extent of the fracture and reconstruction of the orbital floor slope are the most important surgical factors to prevent residual enophthalmos. The authors believe using an endoscope and layered porous polyethylene are effective techniques in challenging patients with large orbital wall fracture.

Modified Full Thickness Graded Blepharotomy for Upper Eyelid Retraction Associated With Thyroid Eye Disease in East Asians.

PURPOSE: To evaluate the functional and cosmetic outcomes of modified full thickness graded blepharotomy when used for East Asian patients with upper eyelid retraction of thyroid eye disease (TED). METHOD: Medical records of each patient who underwent modified full-thickness blepharotomy at Korea University Guro Hospitals from January 2009 to February 2014 to correct upper eyelid retraction resulting from TED were retrospectively reviewed. RESULTS: Modified full-thickness graded blepharotomies were performed on 22 eyelids of 18 patients. The most common preoperative upper eyelid retraction-associated symptom was asymmetry of the upper eyelid (14 patients, 77.7%) followed by discomfort (10 patients, 55.5%), photophobia (5 patients, 27.7%), and epiphora (4 patients, 22.2%). Most preoperative symptoms improved after blepharotomy (Table 1). Preoperatively, upper eyelid retraction (MRD1; midpupil marginal reflex distance) ranged from 2.3 mm to 6.8 mm (mean, 5.23 ± 0.89) in 22 lids; postoperatively, lid retraction significantly decreased to 3.26 ± 1.23 mm (P = 0.03 by independent t test) (Table 2). Lid retraction was divided into 3 groups according to severity; a severe group (5 eyelids, 27.7%), a moderate group (14 eyelids, 63.6%), and a mild group (3 eyelids, 13.6%). The MRD1 improved regardless of severity (P = 0.03 in the severe group, P = 0.02 in the moderate group, and P = 0.04 in the mild group by independent t test). The MRD1 improvement did not differ significantly among groups (P = 0.08 by Pearson χ t test). At 6 months postoperatively, the midpupil marginal reflex distance was the perfect height in 13 of 22 lids (59.0%), with a mean reduction of 3 mm, whereas 7 of 22 eyelids (31.8%) were at acceptable height and 2 eyelids (9.0%) showed failure. Overall, 18 eyelids (90.9%) exhibited objectively satisfactory results (perfect or acceptable) at 6 months after surgery (Table 3). CONCLUSIONS: Modified graded full thickness eyelid blepharotomy is a reliable and safe method for upper eyelid lengthening for East Asian patients with upper eyelid retraction of TED that offers excellent functional and cosmetic results.

Clinical Results of Modified Frontalis Suspension Technique Using Preserved Fascia Lata for Congenital Ptosis.

PURPOSE: The purpose of this study was to evaluate the clinical results of modified frontalis suspension technique with preserved fascia lata and to analyze the results according to age and preoperative ptosis degree. METHODS: This study involved a retrospective review of the electronic medical records of congenital ptosis patients who underwent unilateral or bilateral frontalis sling surgery using preserved fascia lata between March 1, 2004 and December 31, 2012. RESULTS: Seventy-seven patients (99 eyes) were included in the study. The mean age of the patients at the time of surgery was 6.2 ±â€Š6.7 years. Mean follow-up time was 5.4 ±â€Š3.2 years. Among 77 patients, 22 patients (28.5%) had a mild degree of ptosis, 39 (50.6%) had moderate, and 16 (20.7%) had a severe degree of ptosis. A satisfactory result (good and fair) was achieved in 65 of the 77 patients (84.4%) and a poor result was recorded in 12 patients (15.5%). Preoperative ptosis degree had no effect on the surgical success rate (19/22 [86.3%] in the mild group versus 34/39 [87.1%] in the moderate group versus 12/16 [75%] in the severe group, P = 0.243). There was no significant difference in surgical success rate between the unilateral and bilateral ptosis groups (45/55 [81.8%] versus 20/22 [90.9%], P = 0.479 respectively), between sexes (41/46 [89.1%] in male versus 24/31 [77.4%] in female, P = 0.271), or age groups (52/60 [86.6%] in younger group versus 13/17 [76.4%] in elder group, P = 0.526). Recurrence of ptosis did not differ according to the preoperative ptosis degree (3/22 [13.6%] in the mild group, 5/39 [12.8%] in the moderate group, and 2/16 [12.5%] in the severe group, P = 0.994). Age also had no influence on the ptosis recurrence. The preoperative marginal reflex distance 1 of 0.41 ±â€Š1.06 mm increased to 1.67 ±â€Š0.80 mm postoperatively (P = 0.000). CONCLUSIONS: The authors identified the long-term efficacy of preserved fascia lata in frontalis sling surgery with a modified frontalis suspension method for all age groups of patients. There was a small rate of recurrence (12.9%) over a maximum of 9 years of follow-up, which was corrected with additional surgery.

Analysis of Surgical Outcome After Levator Advancement by Assessing Changes in Eyelid Contour.

PURPOSE: The authors analyzed changes in eyelid contour after levator advancement by measuring multiple radial midpupil lid distance (MPLD). METHODS: The study enrolled 61 eyes of 61 patients with involutional ptosis who underwent levator advancement from 2 oculoplastic surgeons from September 2008 to December 2013. An analysis of upper lid contours was performed using front gaze photographs of the preoperative and postoperative states and comparing them to the front gazes of normal patients. Conventional and 12 oblique midpupil lid distances were measured every 15 degrees across the temporal (105, 120, 135, 150, 165, and 180 degrees) and nasal (75, 60, 45, 30, 15, and 0 degrees) fields of the eyelid fissure using custom software. RESULTS: Ptosis patients had low temporal eyelid height and significantly decreased MPLD at all angles compared with normal controls. Compared with the preoperative eyelid, all MPLD angles were significantly increased after surgery, and the temporal peak height of the eyelid was recovered. CONCLUSIONS: The normal shape and temporal peak height of eyelids should be considered for levator advancement surgery with ptosis. The authors retrospectively compared postoperative changes in eyelid contour to modify the method of surgery.

Analysis of Lid Contour in Thyroid Eye Disease With Upper and Lower Eyelid Retraction Using Multiple Radial Midpupil Lid Distances.

PURPOSE: The aim of this study was to analyze upper and lower eyelid contours in adult patients with thyroid eye disease (TED) and normal adults using a software program that measures multiple radial midpupil lid distance (MPLD). METHODS: Analysis targeted 61 eyes from 61 normal adults who had never undergone eyelid surgery or ophthalmic surgery and 63 eyes from 63 patients with TED. Digital pictures of primary gaze were analyzed using custom software. Conventional MPLD (90°, 270°) and 12 oblique MPLDs were collected every 15° across the temporal (105°, 120°, 135°, 150°, 165°, 180°) and nasal (75°, 60°, 45°, 30°, 15°, 0°) sectors of the upper eyelid. For lower eyelid contours, 9 oblique MLPDs in the temporal sector (255°, 240°, 225°, 210°, 195°) and nasal sector (285°, 300°, 315°, 330°) of the lower eyelid were analyzed. RESULTS: From all angles, the MPLD of patients with TED was larger than that of the control group. The mean difference between the 2 groups was larger for the upper eyelid (0° ∼ 180°) than the lower eyelid (195° ∼ 330°). When comparing symmetry by dividing into each angle, the ratio of 90°/270° (MRD1/MRD2) demonstrated greater in patients with TED (P = 0.000). Temporal/nasal eyelid contour symmetry in the upper eyelid, investigated using the distance ratio of the nasal sector/temporal sector (15°/165°, 30°/150°, 45°/135°, 60°/120°, 75°/105°), was significantly smaller in patients with TED (P < 0.05). However, there was no significant difference between the 2 groups regarding temporal/nasal eyelid contour symmetry of the lower eyelid (330°/210°, 315°/225°, 300°/240°, 285°/255°). CONCLUSIONS: Radial MPLD is effective for analyzing eyelid contour. In our study, lateral flare of upper lid retraction and flat appearance of lower lid retraction were distinct characteristics in patients with TED. Consideration of eyelid contour in patients with TED may improve corrective surgery for eyelid retraction.

Endoscopic Reconstruction of Isolated Orbital Floor Wall Fracture Considering Orbital Floor Slope.

PURPOSE: To present a surgical technique for the reconstruction of the orbital floor slope in patients of isolated orbital floor fracture and to evaluate the effectiveness of this technique. METHODS: The authors conducted a retrospective review of all patients who underwent reconstruction of isolated orbital floor wall fracture between June 2010 and July 2015. The authors reviewed patient demographics, degree of enophthalmos, ocular motility and diplopia test results, and surgical complications. RESULTS: This study included 33 eyes from 33 patients. The mean time interval from trauma to surgery was 24.9 days (range, 5-360 days). The average postoperative follow-up period was 7.4 months (range, 3-28 months). The degree of enophthalmos preoperatively and 1 week, 1 month, and 3 months postoperatively was -1.55 mm (range, -3 to -0.5 mm), 0.22 mm (range, -0.5 to +1.0 mm), -0.06 mm (range, -1.0 to +1.0 mm), and -0.13 mm (range, -0.5 to +0.5 mm), respectively. The mean improvement in enophthalmos at postoperative 3 months was 1.41 mm compared with that in the preoperative data (P value <0.001). There were no patients with residual enophthalmos greater than 1 mm after reconstruction. CONCLUSION: Endoscopic orbital floor slope reconstruction in isolated orbital floor wall fracture using a layered porous polyethylene barrier implant is a very useful surgical technique for safely identifying the posterior margin of a fracture and easily reconstructing the orbital floor slope. The demonstration of slight exophthalmos of the corrected side about 1 to 2 mm at the end of the operation was also necessary.

Secondary Reconstruction of Residual Enophthalmos Using an Endoscope and Considering the Orbital Floor and Medial Wall Slope.

PURPOSE: To present a transconjunctival and transcaruncular endoscopy approach involving layered porous polyethylene barrier implants to manage residual posttraumatic enophthalmos and to evaluate the effectiveness of this technique. METHODS: The authors performed a retrospective review of all patients who underwent secondary reconstruction of orbital wall fractures because of residual enophthalmos between June 2008 and July 2015. Patients' demographics, degree of enophthalmos, ocular motility, diplopia test results, and surgical complications were reviewed. RESULTS: This study included 16 eyes (4 right eyes and 12 left eyes) of 16 patients (14 males and 2 females). The mean time interval from trauma to surgery was 7.1 months (range, 1-18 months). The average postoperative follow-up period was 6.4 months (range, 3-18 months). The degree of enophthalmos preoperatively and at 1 week, 1 month, and 3 months postoperatively was -2.47 mm (range, -2 to -3 mm), 0.5 mm (range, -0.5 to +2.5 mm), -0.06 mm (range, -0.5 to +1.5 mm), and -0.44 mm (range, -1.5 to +1.0 mm), respectively. There were no definite surgical complications in any patients. CONCLUSION: Dissection to the posterior margin of the fracture and reconstruction of the orbital floor slope are the most important surgical factors to prevent residual enophthalmos and scarring with recurrent diplopia. Demonstration of slight exophthalmos of the corrected side of about 1 to 2 mm at the end of the operation is also necessary. The authors believe that surgery using an endoscope and layered porous polyethylene is very useful for secondary reconstruction.

CCN3 overexpression inhibits growth of callosal projections via upregulation of RAB25.

The cysteine-rich 61/connective tissue growth factor 3 (CCN3) is a member of the CCN family of secreted multifunctional proteins involved in a variety of cellular processes including migration, adhesion, and differentiation. Previous studies have shown that CCN3 is expressed in the developing rat central nervous system, and enhanced CCN3 expression is highly correlated with tumorigenesis. However, the expression pattern and influence of abnormal CCN3 expression during mouse cortical development remains to be elucidated. Here, we show that CCN3 expression in mice is first detectable at embryonic day 15 and increases until postnatal day 21. We overexpressed CCN3 in mouse cortical neurons using uni- and bilateral electroporation. Our in vivo overexpression experiments showed that elevated CCN3 expression inhibited the axonal outgrowth of callosal projection neurons. Moreover, we identified the small GTPase RAB25 as a downstream effector molecule of CCN3 using transcriptomic analysis with CCN3 overexpressed in cortical tissue. In vivo ectopic expression of RAB25 or the dominant-negative RAB25-T26N also revealed that the GTPase activity of RAB25 is involved in the CCN3-mediated regulation of neuronal outgrowth. Taken together, our results suggest that tight regulation of CCN3 expression is necessary for normal cortical neuronal connectivity during development, and RAB25 negatively regulates neuronal differentiation as a downstream effector of CCN3.

A low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminium garnet laser for the treatment of café-au-lait macules.

BACKGROUND: Café-au-lait macules (CALMs) are a common pigmentary disorder. Although a variety of laser modalities have been used to treat CALMs, their efficacies vary and dyspigmentation may develop. OBJECTIVE: We evaluated the clinical efficacy and safety of a low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser for the treatment of CALMs. METHODS: In a preliminary investigation, 6 patients underwent a split-lesion comparative study with 532- and 1064-nm Q-switched Nd:YAG laser treatment. In total, 32 patients with 39 CALMs were enrolled in a subsequent prospective trial to evaluate the treatment with a low-fluence 1064-nm Q-switched Nd:YAG laser. RESULTS: In the preliminary study, the 1064-nm treatment group had a more favorable response and a shorter recovery time. In a subsequent prospective trial of a 1064-nm laser, 74.4% of the lesions showed a clinical response with clearance of ≥50.0%. The treatment regimen was well tolerated; 15.4% of patients experienced adverse events. LIMITATIONS: The study participants were followed for 6 months, and there were no relevant treatment controls in the prospective trial group. CONCLUSION: Low-fluence 1064-nm Q-switched Nd:YAG laser therapy afforded good clinical improvement for treating CALMs.

Association of rhinostomy shape and surgical outcome after endoscopic endonasal dacryocystorhinostomy.

PURPOSE: The purpose of this study was to investigate surgical outcomes and complications after endoscopic endonasal dacryocystorhinostomy (EDCR) in relation to rhinostomy shape. METHODS: A retrospective electronic medical record review of patients who underwent EDCR for primary acquired nasolacrimal duct obstruction (PANDO) was performed. Surgical success rates and postoperative complications were compared among three groups of patients in relation to rhinostomy shape (alcove, cavern, or concealed cavern). RESULTS: A total of 280 patients (358 eyes) were included in the study. Of the 358 eyes, 194 rhinostomies were alcove-shaped, 157 were cavern-shaped, and 7 were concealed cavern-shaped. There were no patients with flat-shaped rhinostomies. The nasal cavity was wider in patients in the alcove group than those in the cavern and concealed cavern groups (p = 0.012). The mean time to tube removal was longest in the concealed cavern group (p = 0.029). There were no significant differences in anatomical success rates among the three groups (p = 0.338). With regard to functional success for patients with anatomically patent DCR, the cavern and concealed cavern groups had significantly poorer results than the alcove group (p = 0.001). Functional success rates were 91.6 %, 84.8 %, and 57.1 % for the alcove, cavern, and concealed cavern groups, respectively. Development of postoperative granuloma was more frequent in the concealed cavern group (85.7 %) than in the alcove (29.3 %) or cavern groups (26.1 %) (p= 0.003). Multiple logistic regression models for surgical outcome showed that rates of functional failure after EDCR were influenced by patient age and rhinostomy shape (odds ratio 1.824, p = 0.045 for age; odds ratio = 9.605, p = 0.000 for rhinostomy shape) (Table 5). CONCLUSIONS: The incidence rate of symptomatic epiphora after EDCR was approximately 12 %, and this result may have been associated with cavernous and concealed rhinostomy shapes. For patients with persistent epiphora and anatomically patent DCR, it is important to identify rhinostomy shape by endoscopy in order to differentiate causes of functional failure.

Clinical Characteristics and Effectiveness of the Lateral Tarsal Strip and Medial Spindle Procedure.

This study was undertaken to evaluate the clinical characteristics and efficacy of the lateral tarsal strip (TS) and medial spindle procedure (MS). We conducted a retrospective chart review of the patients who underwent TS and MS between September 2008 and July 2011 by a single surgeon (S.H.B.). Data were collected on patient age, sex, laterality, diagnosis, procedures performed simultaneously, follow-up duration, postoperative complications, and surgical outcomes. One hundred eleven eyelids of 74 patients who underwent TS and 41 eyelids of 29 patients who underwent MS were included in this study. Patients' mean age was 61.5 years (range, 24-82) in the TS group and 68.2 years (range, 45-89) in the MS group. The most common diagnoses were lower lid laxity (54.1%) and involutional entropion (26.1%) in the TS group, and punctal ectropion in the MS group (95.1%). The percentage of patients who underwent an additional simultaneous procedure was 86.5% of the TS group and 92.7% of the MS group. Endoscopic dacryocystorhinostomy was the most commonly performed simultaneous procedure in both TS and MS groups (28.1% and 65.8%, respectively). Success rates were 96.4% in the TS group and 97.6% in the MS group. In the TS group, 3 eyelids (2.7%) required reoperation. The most common complication was chemosis in both TS and MS groups (51.4% and 50%, respectively). TS and MS are commonly performed simultaneously with other surgical procedures. These procedures aim to resolve lower lid laxity and punctal ectropion as well as relieve the symptoms of epiphora by stabilizing medial and lateral lid laxity. This review of the clinical features and effectiveness of MS and TS procedures provides useful information for clinicians.

The Paradoxical Predominance of Medial Wall Injuries in Blowout Fracture.

PURPOSE: To evaluate the type and cause of orbital blowout fractures in Korea. DESIGN: Retrospective, observational case series. METHODS: Patients who underwent reconstruction for blowout fracture from March 2004 to April 2013 at Korea University Guro and Ansan Hospitals were included in this study. Patient demographics and orbital computed tomography (CT) scans were reviewed. On CT, ethmoid air cell septa, blowout fracture type, and other combined fractures were analyzed. Blowout fracture was classified as affecting up to 4 areas: the floor lateral to the infraorbital canal, the floor medial to the canal, the maxilla-ethmoidal strut ("inferomedial" strut), and the medial wall. Furthermore, trauma type and associated injury were reviewed. The results of adolescent patients and adult patients were compared, as were those of males and females. RESULTS: The study included 659 eyes of 659 patients; mean patient age was 31.01 ±â€Š14.27 years. In total, 513 (77.85%) patients were male and 146 (22.15%) were female. The most common blowout fracture type was medial wall fracture, followed by floor wall, floor and medial wall without inferomedial strut, and floor and medial wall fracture with inferomedial strut, in that order. Interestingly, patients with floor wall blowout fracture were younger (26.87 ±â€Š12.90 y) than other groups: medial wall fracture (32.35 ±â€Š14.64 y, P < 0.0001), floor and medial wall fracture (35.22 ±â€Š14.49 y, P < 0.0001), and floor and medial wall fracture involving the maxillaethmoidal strut (32.62 ±â€Š13.75 y, P = 0.002). The number of ethmoidal air cell septa was lowest in the medial wall fracture group (3.62 ±â€Š0.67): floor wall fracture (4.07 ±â€Š0.69, P < 0.0001), floor and medial wall fracture (3.90 ±â€Š0.78, P < 0.0001), and floor and medial wall fracture involving the maxilla-ethmoidal strut (4.05 ±â€Š0.72, P = 0.001). CONCLUSIONS: Our study demonstrated that the blowout fracture type distribution in Korea varied from the results of many other studies. Medial wall fracture is the most common among the 4 types, and anatomic variance, such as number of ethmoid air cell septa, could influence blowout fracture type, especially in medial wall fracture.

Effectiveness of Synthetic Polyurethane Foam as a Nasal Packing Material in Endoscopic Endonasal Dacryocystorhinostomy.

PURPOSE: To compare the effects of 2 nasal packing materials, synthetic polyurethane foam (absorbable) and expandable polyvinyl acetate (nonabsorbable), on the surgical success rate and postoperative complications after endoscopic endonasal dacryocystorhinostomy (EDCR). METHODS: A retrospective medical review of 459 patients (580 eyes) who underwent EDCR for primary acquired nasolacrimal duct obstruction at Korea University Guro Hospitals from January 2009 to February 2014. Surgical success rate (anatomical, functional), postoperative complications (granuloma, synechia, bleeding, and infection) were compared between the 2 groups, absorbable (318 eyes) and nonabsorbable (262 eyes). RESULTS: The absorbable group showed better results in surgical success rate regarding anatomical (90.5% versus 76.3%, P = 0.00) and functional (89.3% versus 75.9%, P = 0.00). Granulomas developed less frequently in the absorbable group (24.5% versus 38.9%, P = 0.00). Also, bleeding and crust were less frequent in the absorbable group (P = 0.00). Infections were less frequent in the nonabsorbable group (1.52%) compared with the absorbable group (7.86%, P = 0.00). The rate of revision surgery was lower in the absorbable group (7.86% versus 20.9%, P = 0.00). As for the influence of secondary outcomes to the surgical success by multiple logistic regression, granulomas had the largest effect on surgical success either anatomical or functional (odds ratio = 82.393 to anatomical and 44.058 to functional). Synechia had the second largest effect on surgical success (odds ratio = 11.897 to anatomical and 9.605 to functional). CONCLUSIONS: The authors suggest that using a synthetic polyurethane foam as a nasal packing material is not only a surgical option, but also a crucial and essential procedure in EDCR.

Epidemiology of Oculoplastic and Reconstructive Surgeries Performed by a Single Specialist With 15 Years' Experience at a Tertiary Center.

PURPOSE: To evaluate the prevalence of oculoplastic surgeries performed in a tertiary hospital in South Korea and to highlight the proper choice of surgery according to disease. METHOD: Retrospective chart review was conducted over a 12-month period (March 2013 to February 2014) on all of the patients who underwent oculoplastic and reconstructive surgery by a single oculoplastic specialist with 15 years' experience. RESULTS: A total of 656 patients were enrolled in the current study. Of them, 355 patients (54.1%) had eyelid surgery, 151 patients (23.0%) had orbital surgery, and 150 patients (22.8%) had lacrimal surgery. Orbital surgery was more commonly performed in men (122 male patients versus 29 female patients, P = 0.00 by Pearson chi-squared test) and was also more common in younger patients than in other surgery groups (56.3 years in eyelid surgery versus 39.3 years in orbital surgery versus 46.9 years in lacrimal surgery, P = 0.001 by Pearson chi-squared test). Blepharoplasty was the most common eyelid surgery, contributing 24.2% of total eyelid surgeries, followed by lid mass excision (68 patients, 19.1%), Hotz operation (59 patients, 16.6%), and levator advancement (47 patients, 13.2%). Among orbital surgeries, reconstruction of orbital wall fractures was the most common, and was performed in 89 patients (58.9%) of total orbital surgeries, followed by orbital tumor debulking surgery (25 patients, 16.5%) and orbital decompression for dysthyroid optic neuropathy (19 patients, 12.5%). Endoscopic endonasal dacryocystorhinostomy (DCR) was the most common lacrimal surgery (84 patients), occurring in 56% of total lacrimal surgeries, followed by Monoka tube intubation (16 patients, 10.6%) for congenital nasolacrimal duct obstruction and conjunctivo-DCR using Jones tube (12 patients, 8%). CONCLUSIONS: Eyelid-related conditions, especially cosmetic blepharoplasty, were among the most commonly encountered surgeries in the Oculoplastics Department of a tertiary care hospital in South Korea. Blowout fracture repair and endoscopic DCR were the most common in orbital and lacrimal surgery. The authors hope that the current survey will contribute to the surgical training of ophthalmology residents and, on a larger scale, health care policies.

Clinical Effectiveness of Monocanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction Under Nasal Endoscopic Visualization of the Terminal End of the Obstructed Nasolacrimal Duct.

PURPOSE: To evaluate the cause of nasolacrimal duct obstruction through confirmation by nasal endoscopic findings of Hasner's valve and to report the success rate of monocanalicular silicone intubation (MCI) for the management of congenital nasolacrimal duct obstruction (CNLDO). METHODS: Seventy-seven eyes of 56 patients with CNLDO underwent MCI under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct at the Korea University Ansan Hospital and Guro Hospital from October 2008 to March 2013. The following demographic information was analyzed: age, sex, endoscopic findings of Hasner's valve during operation, complications, and outcomes. The main outcome measures were disappearance of epiphora symptoms beginning the first 2 months after removal of the silicone tube. The silicone tube was removed under topical anesthesia in the office between 2 and 3 months, postoperatively. RESULTS: The mean (± SD) age of the study population was 29.8 (± 26.9) months (range: 6 months to 12 years). Under nasal endoscopic view, 45 ducts (58.4%) had a thin membranous obstruction or had a simple stenotic opening of Hasner's valve. Seven ducts (9.1%) had thick obstructing membranes with probe passage under the lateral nasal mucosa. Twenty-three ducts (29.9%) showed the probe tip protruding through balloon-like nasal mucosa. Two ducts (2.6%) appeared to have probe protrusion through a stretchable valve. The overall success rate was 89.6% (69/77). The incidence of tube prolapse and tube loss was 18.2% (14 eyes) and 13.0% (10 eyes), respectively. No other complications were observed. CONCLUSIONS: Monocanalicular silicone intubation under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct can be an effective procedure for the management of CNLDO.

Analysis of lower eyelid aging in an Asian population for customized lower eyelid blepharoplasty.

PURPOSE: The objectives of this study were to evaluate the factors that contribute to aging in the lower eyelids and periorbital changes in Asians and to analyze the contribution of different anatomic factors before surgery. METHODS: We analyzed photographs and examination findings of 108 patients older than 80 years who had consultations for lower eyelid blepharoplasty. Structural changes were categorized to 7 anatomical categories, and each category was scored from 0 to 3 based on severity. The total point for each category for all patients was divided by the 456 total possible points and was considered a cumulative contribution score for that category. "A uniqueness score" for each patient was calculated as the maximum score in 1 category divided by the patient's total score to reflect the percentage contribution of the patient's most severe anatomic problem. RESULTS: A total of 108 cases (51 male and 57 female patients) were evaluated. The mean age was 57 ± 11 years (age range, 30-75 years). The cumulative contribution score for each category was as follows: orbital fat prolapse 33.8 (medial 15.3, central 11.7, lateral 6.8), skin laxity 22.3%, periorbital hollow 20.8 (tear trough 15.5, lateral orbital rim 5.3), septal confluence 9.5, orbicularis oculi muscle hypertrophy 3.6, triangular malar mound 3.4, and eyelid fluid 0.5. The average uniqueness score was 40.1%, and skin laxity and orbital fat prolapse had the highest average uniqueness score, but no single category played a dominant role in most patients. Medial orbital fat prolapse and skin laxity had the highest proportion of grade 3 scores of 9.5% and 6.7%, respectively. When the patients were grouped according to age, either younger than 50 years or older than 50 years, there was a prominent difference in orbital fat prolapse and skin laxity between the 2 groups. CONCLUSIONS: Various anatomic factors were related to periorbital changes in Asian patients. Understanding of the complex factors that contribute to periorbital changes during the aging process may allow for adequate and customized surgery for each patient and help in prevention of postoperative complications.

Primary diffuse large B-cell non-Hodgkin lymphoma of the paranasal sinuses presenting as cavernous sinus syndrome.

Primary paranasal sinus lymphoma is an uncommon malignancy that accounts for only 0.17% of all lymphomas and is often difficult to diagnose. Initially, tumors in this area cause very few symptoms and are at an advanced stage at the time of diagnosis. Ophthalmologic signs and symptoms occur early in the disease process because of close proximity of the orbit to the paranasal sinuses. We report on a case of primary malignant lymphoma of the sphenoid and ethmoid sinuses with involvement of the cavernous sinus, initially presenting with ophthalmologic signs and symptoms in association with cavernous sinus syndrome.