Lacrimal drainage obstruction in gastric cancer patients receiving S-1 chemotherapy.

BACKGROUND: This study was conducted to determine the incidence and clinical characteristics of lacrimal drainage obstruction (LDO) in patients receiving S-1 chemotherapy. PATIENTS AND METHODS: Consecutive 170 patients with gastric cancer who underwent curative surgery and received adjuvant S-1 chemotherapy were enrolled. S-1 was administered orally (40 mg/m2 b.i.d. on days 1-28 every 6 weeks) for 1 year. Ophthalmologic examinations were carried out on patients complaining of epiphora. RESULTS: Thirty-one patients (18%) developed epiphora. Among 31 patients, 25 underwent ophthalmologic examinations and 22 (88%) were diagnosed with LDO. The median time to the onset of LDO was 2.9 months. The most common site of obstruction was the nasolacrimal duct [86% (19/22)]; punctal [23% (5/22)] and canalicular obstruction [14% (3/22)] were also noted. In multivariate analysis, total gastrectomy [versus partial gastrectomy: hazard ratio (HR), 2.9; P=0.014] and creatinine clearance<50 ml/min (versus ≥50 ml/min: HR, 2.9; P=0.038) were independent risk factors for the development of LDO. CONCLUSION: Considering the high incidence of LDO in patients receiving S-1 chemotherapy, oncologists should be alert to epiphora and cooperate with ophthalmologists in the early stages to improve the quality of life of patients and avoid more complicated ophthalmologic procedures.

Efficacy of chemotherapy as a first-line treatment in ocular adnexal extranodal marginal zone B-cell lymphoma.

BACKGROUND: Radiotherapy is commonly used as a first-line treatment for localized ocular adnexal extranodal marginal zone B-cell lymphoma (EMZBL), despite its ophthalmologic complications. This study was undertaken to analyze the efficacy of first-line chemotherapy in treating EMZBL. Chemotherapy was followed by radiotherapy only in recurrent cases. PATIENTS AND METHODS: Twenty-one patients with histologically confirmed EMZBL were treated with combination of cyclophosphamide, vincristine, and prednisolone (CVP). Radiotherapy was given to CVP failure cases. RESULTS: CVP alone resulted in overall response rate of 100% [complete remission (CR), 76.2%]. After a median follow-up of 58 months, 14 (66.7%) of 21 cases were disease free with CVP alone, while seven cases showed disease progression, including two extra-orbital and five local failures. Radiotherapy was delivered to five local failure cases, who subsequently achieved CR with late ophthalmologic complications. There were tolerable adverse events associated with CVP. CONCLUSIONS: Front-line CVP, in conjunction with radiotherapy in recurrent cases, is effective and well tolerated in patients with localized ocular adnexal EMZBL.

Long-term outcome of conjunctival fixation sutures to the sclera for prolapsed subconjunctival orbital fat.

PurposeTo report long-term outcome of new surgical technique for prolapsed subconjunctival orbital fat.Patients and methodsRetrospective study was conducted on 48 eyes of 37 patients who underwent excision of prolapsed subconjunctival orbital fat with conjunctival fixation to the sclera. Complications and recurrence were evaluated.ResultsThe mean follow-up period was 39 months (range, 8-101 months). Two eyes (4.4%) developed recurrence at 4 and 8 years after surgery. No long-term complication was found.ConclusionsThe new surgical technique to manage prolapsed subconjunctival orbital fat using conjunctival fixation to the sclera was very useful and effective, with few recurrence and no long-term complication.

Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10-year experience.

PURPOSE: To analyze the surgical outcomes of external dacryocystorhinostomy (DCR) and the risk factors associated with functional failure. METHODS: We reviewed the medical records of 769 patients who underwent external DCR for primary lacrimal drainage obstruction between 2005 and 2014. Recorded data included intraoperative anatomical findings, postoperative diagnosis, and surgical outcomes. We performed univariate and multivariate analyses to identify risk factors for functional failure. RESULTS: Of the 769 cases, primary nasolacrimal duct obstruction (NLDO) was diagnosed in 457 cases; common canalicular obstruction in 228 cases; and canalicular obstruction in 84 cases. Anatomical success was achieved in 98.8% (760/769) and functional success in 81.9% (630/769) of the cases. An analysis of 760 anatomically successful DCRs showed that common canalicular obstruction (OR=1.752, P=0.014) and canalicular obstruction (OR=2.058, P=0.015) were independent risk factors for functional failure. In a subgroup analysis of patients with primary NLDO, patients with a small lacrimal sac had a significantly higher risk of functional failure (OR=2.500, P=0.018). CONCLUSIONS: The overall surgical outcomes of external DCR were favorable in this case series. Site of obstruction was an important risk factor for functional failure in cases with primary lacrimal drainage obstruction. A small lacrimal sac was also found to be a risk factor for functional failure in cases with primary NLDO.

Clinical features of intratarsal keratinous cysts.

PURPOSE: Intratarsal keratinous cysts (IKCs) have been frequently misdiagnosed as chalazia or epidermal cysts. We reviewed a series of cases of IKCs to identify clinical features that distinguish IKCs from other eyelid diseases. METHODS: We retrospectively reviewed the medical records of 17 suspected IKC patients between January 2004 and September 2014. RESULTS: Seventeen patients who were clinically suspected to have IKC were enrolled. All patients presented with non-inflamed eyelid nodules fixed to the tarsus. Among them, 12 biopsy specimens were available and 11 patients (91.7%) were diagnosed with IKC, with a pathological finding of stratified squamous cell lining with keratin material. The mean patient age was 55.1 years (31-71). Six patients had a surgical history of incision or incomplete excision of the lesion, followed by recurrence. On eyelid eversion, five patients showed a white-yellow nodule, and three patients had a bluish cystic lesion. The diameter of the nodules ranged from 4 to 10 mm. The intracystic material was a milky white fluid. Ten patients underwent a complete surgical excision including partial tarsectomy and there was no recurrence. CONCLUSIONS: IKC can be distinguished from other intratarsal lesions by a characteristic tarsal nodule fixed to the tarsus. To prevent recurrence, complete excision with partial tarsectomy is needed.

Adjuvant lateral canthal advancement in the surgical management of exophthalmic eyelid retraction.

The eye is convergent from the orbital axis when in the primary gaze position; greater projection of the lateral sclera results from the posterior location of the lateral orbital rim relative to the medial orbital rim. If the horizontal tarsal ligamentous band cannot lengthen to accommodate an increasingly exophthalmic globe in thyroid ophthalmopathy, a horizontally tight eyelid with increased exposure of the lateral sclera will result; thus, temporal flare is accentuated. Lateral canthal advancement was developed as an adjuvant procedure to reduce temporal flare in the surgical repair of thyroid-related eyelid retraction. Lateral canthal advancement is a theoretically rational and effective adjunct to retractor recession when horizontal tightness of the eyelid is present. In the horizontally tight eyelid, lateral canthal advancement is effective in enhancing the effect of retractor recession and in reducing temporal flare.

Ancient schwannoma of the orbit.

The ancient schwannoma is a rare variant of a neurilemoma with a course typical of a slow-growing benign neoplasm. Histologically, it can be confused with a malignant mesenchymal tumor because of increased cellularity, nuclear pleomorphism, and hyperchromatism. Despite the degree of nuclear atypia, mitotic figures are absent. We describe the clinical and histopathologic features of an ancient schwannoma of the orbit.

Hydroxyapatite implantation with scleral quadrisection after evisceration.

BACKGROUND AND OBJECTIVES: In contrast to the literature on enucleation, reports of hydroxyapatite (HA) implantation during evisceration are limited; however, those that have been published mention the high HA exposure rate. The authors examined the scleral quadrisection procedure to evaluate its effect on cosmetic appearance and the prevention of HA exposure after evisceration. PATIENTS AND METHODS: The authors analyzed the surgical outcomes of 17 patients who had undergone an HA implantation with scleral quadrisection after evisceration between November 1994 and November 1995. RESULTS: In each case, the authors were able to use HA implants of 18 mm or more. During follow-up (average 10.7 months), there were no cases of conjunctival erosion, HA exposure, implant migration, significant enophthalmos, or superior sulcus deformity. All of the patients, 7 of whom had a ball- and-socket prosthesis, were satisfied with their cosmetic appearance and prosthetic motility. More than 11 weeks after evisceration, all 10 studied patients had complete, round uptakes with orbital bone SPECT (single photon emission computed tomography). CONCLUSION: For good cosmetic appearance and for the prevention of implant exposure, scleral quadrisection is a safe and effective procedure for HA implantation after evisceration.

Epiblepharon of the lower eyelid: classification and association with astigmatism.

To determine a classification system for epiblepharon of the lower eyelid and to evaluate a possible correlation between lower lid epiblepharon and astigmatism. Three morphologic characteristics (skin fold, cilia touching the cornea and corneal erosion) were observed by slit-lamp biomicroscopic examination and Polaroid pictures in 186 eyes of 102 patients with epiblepharon of the lower lid. In 112 eyes, cycloplegic refractions performed. A classification system reflecting the severity of epiblepharon was then sought, and the incidences and type of astigmatism were evaluated. Epiblepharon of the lower lid could be classified according to the height of skin fold, the area of cornea touched by cilia and the area of corneal erosion. There was significant agreement between these three classifications. The incidence of astigmatism of 0.5D or more was 54%; most was 'with-the-rule', regardless of a patient's age. In addition to the representative nature of other characteristics, skin fold height can be easily measured without the need for slit-lamp examination in children and is closely related with the amount of skin which should be excised during surgery to correct epiblepharon. A classification system using skin fold height may therefore be the most appropriate method. In addition, there may be a correlation between lower lid epiblepharon and astigmatism.

The outcome of cryotherapy for retinopathy of prematurity (ROP) according to ROP location.

Cryotherapy has been shown to be an effective treatment for retinopathy of prematurity (ROP) stage 3+. However, the outcome of cryotherapy is less favorable in zone 1 ROP than in zone 2 ROP. We suspected whether there may be differences in the outcomes of cryotherapy if the zone of ROP is further divided. So we reviewed the records of 85 premature infants (145 eyes) who had undergone cryotherapy for ROP. The frequencies of favorable outcome were 42.9% of 14 eyes (zone 1), 78.9% of 38 eyes (posterior zone 2), 92.9% of 70 eyes (mid zone 2), and 100.0% of 23 eyes (anterior zone 2), respectively (p < 0.001). These results suggest that the more posteriorly the ROP is located, the less favorable the outcome of cryotherapy.

Change of refraction in premature infants after cryotherapy for retinopathy of prematurity between the age of six months and three years.

To investigate the chronological change of refraction in premature infants after cryotherapy for retinopathy of prematurity (ROP), cycloplegic refractions had been performed at 6 months and 3 years after term in premature infants who underwent cryotherapy for ROP. The changes of refractions between the two study ages were evaluated not only in the total cryo-treated eyes, but also in the subdivided groups according to the posterior pole appearances. In the total 61 eyes of 32 premature infants, mean spherical equivalents were -4.05D vs. -5.94D (6 months vs. 3 years) (p = 0.0001). In the normal posterior pole group (48 eyes), mean spherical equivalents were -3.45D vs. -5.68D (6 months vs. 3 years) (p = 0.0000), and in the abnormal posterior pole group (13 eyes), -6.28D vs. -6.86D (6 months vs. 3 years) (p = 0.6496). These results mean that there is a myopic progressive change between 6 months and 3 years after term in the cryo-treated eyes for acute ROP and it is more evident in the eyes with normal posterior pole.

Effect of the absence of heat shock protein 70.1 (hsp70.1) on retinal photoreceptors in normal and rd mice.

The purposes of this study are to elucidate the retinal changes of heat shock protein 70.1 (hsp70.1) knockout mice and to compare them between in normal and in retinal degeneration (rd) mice. Eyes of hsp70.1 wild type (+/+) and knockout (-/-) mice in the C57BL/6 or FVB genetic backgrounds respectively, which were reared in the normal environment, were examined by fundus photography, electroretinography, light microscopy, terminal dUTP nick-end labeling (TUNEL) stain, and immunohistochemistry. In C57BL/6 mice, fundus photography showed no changes between hsp70.1+/+ and -/- mice at 1 and 6 months of age. Electroretinographic examination showed a tendency of decreased amplitude of a- and b-wave with aging in both genotype, but there were not different statistically. The ratios of the thickness of inner nuclear and outer nuclear layer to the retinal thickness were respectively decreased with aging in both genotype, but there were not different statstically. TUNEL assay showed a few positively labeled cells in the ganglion cell, inner nuclear and outer nuclear layers and the immunohistochemistry showed no immunopositivity of hsp70 in the inner segments of photoreceptor cell layer in both genotype. In rd mice, fundus photography showed a narrowing of the retinal vessels at the age of 4 weeks, however, there were no differences of retinal changes including pigment epithelial layer in both genotype. Electroretinographic examination at the postnatal 2, 3 and 4 weeks showed no differences between them. Loss of photoreceptor cell and outer nuclear layers showed no differences in both genotype. In conclusion, there were no differences of the retinal changes at least under the normal environmental condition in hsp70.1+/+ and -/- mice. These results show that hsp70.1-/- mice can be used to study the role of hsp70.1 to the external stress to the retina.

Extraocular muscle changes after cryotherapy for retinopathy of prematurity and the development of strabismus in premature infants.

To find out whether the cryotherapy for the treatment of the retinopathy of prematurity (ROP) causes structural changes of the extraocular muscle (EOM), and also whether the changes are related with the occurrence of strabismus. To examine the acute stage change, we conducted a transconjunctival cryotherapy around the superior rectus muscle of a rabbit and resected it 0, 3, 7, 14, and 28 days after the cryotherapy. In observing chronic changes, we first categorized patients who had an esotropia surgery into groups, one of which combined prematurity and cryotherapy and one group affected by prematurity but without having had cryotherapy. Then we compared the change of EOM with that of a fullterm infant group. In a rabbit, edema, acute inflammatory cells and a large amount of degenerated muscle fibers were observed immediately after the cryotherapy and on the 3rd day. On the 7th day, regenerated muscle fibers were observed and on the 14th day, the inflammatory cells decreased and the amount of regenerated muscle fiber increased. On the 28th day, abnormal findings were not observed any more and the muscle was found to be normal. When chronic changes of EOM in human on 1 1/2 to 8 1/2 years after cryotherapy, there were no abnormal findings observed in three groups. From the study, we can infer that cryotherapy can cause acute inflammation and necrosis of muscle fiber but such an acute change will improve and does not result in structural change in the long term. Therefore, the occurrence of strabismus in patients with ROP is considered to be attributable to reasons other than injury of EOM.

Frontalis sling operation using silicone rod for the correction of ptosis in chronic progressive external ophthalmoplegia.

AIMS: The aim of the study was to evaluate the results of the frontalis sling operation using silicone rod for the correction of ptosis in chronic progressive external ophthalmoplegia patients. METHODS: Chronic progressive external ophthalmoplegia patients who received the frontalis sling operation using silicone rods from 1999 to 2006 were included in this study. The medical records were retrospectively reviewed and the clinical characteristics and postoperative surgical results of these patients were analysed. This study was a retrospective, non-randomised, interventional case series and the main outcome measures were margin reflex distance, eyelid contour and corneal status. RESULTS: Seven patients were recruited (one male and six female). The mean age at the time of operation was 29.6 (range 15-62) years. Two patients had unilateral ptosis and five patients had bilateral ptosis. The mean follow-up period was 22.7 (range 1-61) months. Satisfactory lid height was achieved in all patients. Although corneal erosions were detected in five patients 1 month after surgery, these findings eventually resolved in three patients 2 months later, after the use of artificial tear eyedrops and ointments. CONCLUSION: The frontalis sling operation using silicone rod can safely and effectively correct ptosis in chronic progressive external ophthalmoplegia patients without serious corneal complications.

Management of moderate-to-severe Marcus-Gunn jaw-winking ptosis.

OBJECTIVE: To report the results of levator excision and frontalis suspension for moderate-to-severe Marcus-Gunn jaw-winking ptosis. DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Twenty-four patients with moderate-to-severe Marcus-Gunn jaw-winking ptosis (21 unilateral and 3 bilateral) were treated surgically between 1978 and 1997 by one surgeon. INTERVENTION: Levator excision either in the involved eyelid or in both eyelids, followed by bilateral frontalis suspension, was performed. MAIN OUTCOME MEASURES: Postoperative improvement of jaw-winking was determined. The surgical results of ptosis surgery were assessed as good, fair, or poor based on habitual upper eyelid heights and symmetry. RESULTS: Postoperative follow-up periods ranged from 6 months to 153 months, with an average of 36.9 months. After levator excision in a total of 27 eyelids exhibiting jaw-winking, 10 eyelids (37.0%) showed complete resolution of jaw-winking, and 13 eyelids (48.2%) showed mild winking (1 mm or less) on the lateral jaw movement only (functionally and cosmetically not a problem). In four eyelids (14.8%), these results were not recorded. In the group of five patients undergoing bilateral frontalis suspension and levator excision only on the involved side, final results were good in two patients (40%) and poor in three (60%). Of the 19 patients who underwent bilateral levator excision, final results were good in 13 (68.4%) and fair in 6 (31.6%). CONCLUSIONS: For moderate-to-severe jaw-winking ptosis, bilateral frontalis suspension after bilateral levator excision generally provided satisfactory correction of both jaw-winking and ptosis.

The anatomy of midfacial ptosis.

PURPOSE: To investigate the anatomic and histologic changes present in midfacial ptosis. METHODS: Experimental study applying gross anatomic and histologic techniques to formalin-preserved and fresh-frozen cadaver heads with and without midfacial ptosis. High-resolution surface coil magnetic resonance imaging (MRI) was performed to obtain radiologic correlations. RESULTS: The orbitomalar ligament was further characterized by identification of a well-developed lateral component in the sub-superficial musculoaponeurotic plane; abnormalities of this important supporting structure were present in the subcutaneous plane in 8 of 10 specimens with midfacial ptosis. The zygomatic and masseteric cutaneous ligaments also were further characterized on a gross anatomic level, and histologic evidence of these two structures was produced. The subcutaneous components of the zygomatic and masseteric cutaneous ligaments were attenuated or not identifiable in 40% and 30% of specimens with midfacial ptosis, respectively. High-resolution surface coil MRI provided exquisite correlations of midfacial anatomy. CONCLUSIONS: The lateral component of the orbitomalar ligament provides major osteocutaneous midfacial support. Subcutaneous attenuation of the orbitomalar, masseteric cutaneous, and zygomatic ligaments was associated with midfacial ptosis.