[show abstract][hide abstract] ABSTRACT: To elucidate risk potentiality of frontline radiotherapy associated cataracts in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML).
Data from eight consecutive patients of 41 total OAML patients who had undergone cataract surgery after frontline radiotherapy were analyzed.
The median patient age was 46 years (range, 36 to 69 years). The median total radiation dose was 3,780 cGy (range, 3,060 to 4,500 cGy), and the mean duration from radiation irradiation to cataract surgery was 36.60 ± 8.93 months. Preoperative lens opacification was primarily at the posterior lens subcapsule, and best-corrected visual acuity (BCVA) was 0.43 ± 0.21. Patients underwent the phacoemulsification surgical procedure with posterior chamber intraocular lens insertion. The average BCVA improved to 0.90 ± 0.14 after cataract surgery. Two patients underwent posterior continuous curvilinear capsulorhexis, and one had posterior capsule rupture. For posterior capsule opacification (PCO), three patients received Nd:YAG laser posterior capsulotomy after the initial surgery, and one patient is currently under consideration for laser posterior capsulotomy.
Radiotherapy increased posterior subcapsule opacification at a relatively young age in primary OAML. Phacoemulsification was a manageable procedure without severe complications, and final visual outcomes were good. However, because after-cataracts progressed earlier than did senile cataracts, close follow-up should be considered for PCO management.
Korean Journal of Ophthalmology 08/2013; 27(4):243-8.
[show abstract][hide abstract] ABSTRACT: We report two cases of unilateral upper eyelid swelling with multiple small lumps as an unusual complication of autogenous fat injection for cosmetic forehead augmentation.
Two female patients were referred to our clinic for unusual unilateral eyelid swelling, with multiple small lumps. The duration of symptoms differed in each case, but both patients had a history of autogenous fat injection for cosmetic forehead augmentation at a local plastic surgery clinic. The lumps were small (diameter 5 mm~10 mm), palpable, hard, and nonmobile, and were evaluated by magnetic resonance imaging (MRI). Lumps from the eyelids of two patients were excised under general anesthesia. All of the masses were located deeply and found near the superior orbital rim or lateral orbital rim. The lumps exhibited chronic inflammation with fibrosis. Some of the lumps showed foamy histiocytic aggregation and foreign body lipogranuloma, resulting from iatrogenic fat injection. After excision, all masses and swelling disappeared, and moderate ptotic eyelid or lagophthalmos of affected eyes also improved.
To our knowledge, eyelid swelling with multiple lumps in the eyelid is a very rare complication of autogenous fat injection for cosmetic forehead augmentation. This report should be helpful for ophthalmic clinicians who encounter these unusual symptoms.
[show abstract][hide abstract] ABSTRACT: We report a case of lacrimal gland fistula formation after cosmetic lateral canthoplasty in a young Asian woman.
A 34-year-old woman, who twice underwent lateral canthoplasties of both eyes with additional upper eyelid blepharoplasty, developed clear fluid discharge from a small draining tract near the lateral canthus after being operated on with cosmetic lateral canthoplasty. Assuming that lacrimal gland fistula has developed, we differentiated the tract from the lacrimal gland using a Bowman probe and performed lacrimal gland fistulectomy, which resolved the discharge, leaving no complications.
To our knowledge, this is the first case of lacrimal gland fistula after cosmetic lateral canthoplasty, and surgeons performing this procedure should be aware of lacrimal gland herniation and fistula tract formation, especially in patients who have undergone multiple eyelid surgeries.
The Journal of craniofacial surgery 07/2013; 24(4):1317-1318. · 0.81 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE: We report the surgical outcomes of acellular human dermal allografts for repair of large conjunctiva defects in primary or secondary orbital implant insertion. METHODS: This retrospective chart review examined 12 eyes in 12 patients who underwent primary or secondary orbital implant insertion using Medpor® and acellular human dermal allografts to decrease conjunctival tension. Only patients with at least 6 months follow-up were included. The procedure was successful if there was no exposure until the last eye-clinic visit and the patient could wear a prosthesis. It failed if additional surgery was needed to correct the orbital implant exposure. RESULTS: The mean follow-up was 24.5 (range 6-54) months. Seven patients had primary orbital implant insertion, and five had secondary orbital implant insertion with acellular human dermal allografts. All enrolled patients had successful outcomes without exposure of the central conjunctiva. Two underwent additional surgery to correct fornix contracture and regain a cosmetically good prosthesis. Of these, one patient received additional acellular human dermal grafts and had a fair outcome. The other patient ultimately required fornix reconstruction with an autologous graft using oral mucosa. CONCLUSION: Orbital implant insertion with acellular human dermis grafts had good surgical outcomes. The procedure could be effective for patients with insufficient conjunctival tissue to cover an orbital implant and a high probability of developing orbital implant exposure if tension was created by excessive direct conjunctival closure.
Albrecht von Graæes Archiv für Ophthalmologie 05/2013; · 1.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate the surgical outcome of the endoscopic dacryocystorhinostomy (DCR) without thermal tools such as cautery, drill and illuminator. The study is a retrospective analysis of patients in a tertiary care unit for oculoplastic surgery. The participants enrolled into the study are a retrospective series of 127 consecutive endonasal DCRs performed between January 2008 and March 2011. The surgical procedure in this conventional endoscopic transnasal DCR involved a manual osteotomy of the frontal process of the maxilla and removal of the lacrimal bone by punch without illuminator, cauterization and drill. We evaluated the result of the manual Endo-DCR technique without cauterization or drilling-assisted technique. Data of 127 eyes were reviewed. Full success was achieved in 90.5 % (115/127) of manual Endo-DCR technique with an average follow-up period of 6 months. Our study appears to show favorable results compared to other previously published outcomes including Endo-DCR surgery with thermal equipments. No thermal tool methods in endonasal DCR can achieve a good surgical success rate. Therefore, the newest tools, cauterization, drilling or illumination, are generally not necessary for endoscopic dacrycystorhinostomy.
Archives of Oto-Rhino-Laryngology 02/2013; · 1.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: Fibroepithelial polyp (FEP) is a benign tumor of mesodermal origin, composed of varying amounts of stroma covered by epithelium. The skin and the genitourinary tract are the most common sites of FEP. Uncommon locations of FEP include the inferior turbinate of the nasal cavity, bronchi, and the pharynx. To date, there has been no report of orbital FEP. The authors describe a patient with congenital orbital FEP arising from the lateral canthal area. This congenital FEP was completely excised successfully through an anterior orbitotomy without any complications, with no evidence of recurrence after 25 months.
Ophthalmic plastic and reconstructive surgery 01/2013; · 0.69 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose: To investigate the effects of rapamycin on the TNF-α-induced secretion of interleukin-6 (IL-6) and IL-8 in orbital fibroblasts and its possible mechanism. Materials and methods: Orbital fibroblasts were obtained from patients with thyroid-associated ophthalmopathy. IL-6 and IL-8 levels were measured by enzyme-linked immunosorbent assays. The down-regulation of PDCD4 was performed by PDCD4 siRNA transfection. Results: Rapamycin significantly enhanced TNF-α-induced IL-6 and IL-8 secretion from orbital fibroblasts. Down-regulation of PDCD4 by PDCD4 siRNA transfection reduced TNF-α-induced IL-6 and IL-8 secretion from orbital fibroblasts. In addition, TNF-α was found to promote the mTOR-dependent proteasome-mediated degradation of PDCD4. Rapamycin increased PDCD4 expression via the inhibition of TNF-α-induced PDCD4 degradation in orbital fibroblasts. Conclusion: Rapamycin enhances the TNF-α-induced secretion of IL-6 and IL-8 by suppressing PDCD4 degradation in orbital fibroblasts.
Current eye research 01/2013; · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: AIMS: Our objective was to evaluate the effects of secondary porous orbital implantation 10 years after the primary evisceration in anophthalmic patients. PATIENTS AND METHODS: This study is a retrospective case series. Secondary orbital implant insertion was performed for 25 anophthalmic patients (25 eyes) who had experienced primary evisceration more than 10 years earlier. Under general anesthesia, secondary enucleation removing the contracted sclera, including the optic nerve, was performed, and diverse types of porous orbital implants were inserted. After surgery, changes in the socket and ocular prosthesis motility, and improvements in esthetic appearance were evaluated. RESULTS: For 24 of the 25 eyes, the patients were satisfied. In 17 eyes, ocular motility was higher than "fair" and showed improvement. Deep superior sulcus deformity was improved to "good" in 8 eyes, and enophthalmos was improved to "fair" in 15 eyes. Combined procedures to correct lid malposition and fornix contracture were successful, and these additional operations to correct the prolonged complications of anophthalmos might have reduced the frequency of implant exposure. CONCLUSION: In older anophthalmic patients with considerable concomitant socket contracture and cosmetic concerns, secondary porous orbital implant insertion may improve esthetics and the motility of the ocular prosthesis.
The Journal of craniofacial surgery 11/2012; · 0.81 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this case report we describe a 27-year-old man who presented with progressive enophthalmos for 5 months without any other associated ocular symptoms such as pain, diplopia, or visual disturbance. Computed tomography showed that his progressive enophthalmos originated from a frontoethmoidal mucocele and this caused destruction of the lamina papyracea and shrinkage of the ethmoidal air cell. Finally the enlarged orbital space caused an inward deviation of the eyeball. Endoscopic marsupialization was successfully performed by an otolaryngologist and did not result in any ophthalmologic sequelae. Although frontoethmoidal sinus mucoceles mostly frequently originates from orbital mucoceles, enophthalmic manifestations are very rare. Enophthalmic conditions are not as responsive to surgical interventions as exophthalmic conditions.
Korean Journal of Ophthalmology 06/2012; 26(3):212-5.
[show abstract][hide abstract] ABSTRACT: Silicone tube intubation (STI) has been known as a standard treatment modality with functional nasolacrimal duct obstruction (FNDO). Recently, dacryocystorhinostomy (DCR) is suggested for FNDO treatment. However, there are no data for comparison according to the surgical types in FNDO patients. This study aimed to compare success rates of three different lacrimal drainage surgeries in FNDO patients. Consecutive patients (153 eyes) who were treated with surgical intervention due to FNDO were analyzed. Patients were divided into three groups according to the type of surgery undertaken: STI, endoscopic DCR (Endo-DCR), and external DCR (Ext-DCR). Symptomatic improvements in epiphora were evaluated using the following scoring system: 1, complete resolution (indicative of success); 2, partial resolution; and 3, no resolution or worsening of the condition. At months 3 and 6, the Endo-DCR group had the highest success rate (84.4 and 81.3 %), but there were no statistically significant differences in epiphora scoring among the patients. Epiphora was significantly improved after surgery by week 2 in the Endo-DCR group (p = 0.0339) and by week 3 in the STI group (p = 0.0161). There were no patients in the Endo- or Ext-DCR group with a score of 3 at month 6, but 4 of 6 (3.7 %) in the STI group had score of 3 at month 6 and underwent additional DCR for epiphora. Our results suggest that Endo-DCR offers the highest success rates in FNDO treatments in terms of the rapid and complete resolution of epiphora.
Archives of Oto-Rhino-Laryngology 05/2012; · 1.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: In the present study, we evaluated the ophthalmologic outcomes of 24 patients who received chemotherapy and/or radiotherapy for the treatment of non-conjunctival ocular adnexal mucosa-associated lymphoid tissue-type (MALT) lymphoma. Ophthalmologic outcomes were assessed in patients who received chemotherapy and/or radiotherapy from March 2004 until May 2010. Outcomes were determined according to common symptoms following chemotherapy and/or radiotherapy, which consisted of decreased visual acuity, dry eye symptoms, retinopathy, optic neuropathy, increased intraocular pressure, and blepharitis. Nine patients received chemotherapy alone, eight patients received radiotherapy alone, and seven patients received chemotherapy with additional radiotherapy (chemoradiation therapy). Patients treated by chemotherapy alone showed better ophthalmologic outcome scores (mean score, 1.56) than those treated by radiation alone or chemoradiation therapy (mean score, 4.01). In conclusion, the treatment of ocular adnexal lymphoma including radiotherapy showed poor ophthalmologic outcomes due to radiation-induced complications. Recently, many new treatment options have emerged, such as immunotherapy or radioimmunotherapy. In the future study, to select a better treatment modality with fewer complications, well-designed prospective trials with ophthalmologic outcomes are needed.
Annals of Hematology 04/2012; 91(9):1393-401. · 2.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: Orbital fibroblasts are now recognized as the key effectors in the development of thyroid associated ophthalmopathy (TAO). TAO is clinically apparent in approximately 50% of patients with Graves' hyperthyroidism. High levels of plasma free fatty acids (FFAs) are frequently seen in patients with hyperthyroidism. Palmitate is one of the most abundant FFAs in plasma and aggravates inflammation by promoting secretion of pro-inflammatory cytokines in various cells. In the present study, we characterized orbital fibroblasts from patients with TAO and then examined the effect of palmitate on the production of pro-inflammatory cytokines and hyaluronic acid (HA) in orbital fibroblasts.
Orbital fat explants were obtained from patients with TAO undergoing orbital decompression surgery (n=5). The fibroblasts were characterized by antibodies specific for fibroblast markers and Thy-1 (cluster differentiation 90, CD90) by immunostaining and flow cytometry. We then investigated the capability of orbital fibroblasts to secrete cytokines and HA in response to interleukin (IL)-1β using an enzyme-linked immunosorbent assay (ELISA). The effect of palmitate on cytokine and HA production in orbital fibroblasts was examined at the protein level by ELISA and at the mRNA level by quantitative real time RT-PCR. The level of phosphorylation of mitogen-activated protein kinase (MAPK)s, including p38 MAPK (p38), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK), was measured by immunoblot analysis. We then examined the role of MAPKs on palmitate-induced cytokine production using specific inhibitors to p38, ERK, and JNK, respectively.
The orbital fibroblasts from patients with TAO were Thy-1- positive fibroblasts (>90%) with the ability to secrete IL-6, IL-8, monocyte chemotactic protein-1 (MCP-1), and HA in response to IL-1β. Treatment with palmitate induced significant production of IL-6 and MCP-1, but not IL-8 and HA, in orbital fibroblasts. IL-6 and MCP-1 expression by palmitate were differentially regulated by MAPKs. IL-6 expression was mediated by the p38, ERK, JNK pathways, whereas MCP-1 expression was mediated by ERK and JNK, but not by p38, in palmitate-treated orbital fibroblasts.
We show the possible involvement of palmitate in the promotion of inflammation within orbital tissues. This finding may be helpful for understanding the development of TAO in patients with hyperthyroidism.
[show abstract][hide abstract] ABSTRACT: The purpose of the study was to evaluate the clinical effects of bicanalicular double silicone stents in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty for monocanalicular and common canalicular obstruction. Bicanalicular double silicone intubation in endoscopic transnasal dacryocystorhinostomy with lacrimal trephination was performed in 58 eyes of 54 patients (5 men, 49 women; mean age: 55.9 ± 14.9 years) with epiphora due to monocanalicular and common canalicular obstruction between November 2007 and August 2010. We reviewed the records of subjects who had undergone the same surgery with a bicanalicular single intubation for same disease between March 2004 and October 2007 as controls (56 eyes of 50 patients). We evaluated age, gender, the operative side, the site of canalicular obstruction, and the effects of double silicone intubation. Complications relating to the silicone tube were also investigated. The double-stent group showed higher anatomical success rates (91.4%) and functional success rates (82.8%) than the single-stent group (75.0 and 69.6%, respectively) (p = 0.034 and p = 0.103, respectively). Bicanalicular double silicone stenting in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty may be an effective treatment for monocanalicular and common canalicular obstructions. This may also reduce more invasive surgery including Jones tube insertion (p = 0.038).
Archives of Oto-Rhino-Laryngology 12/2011; 269(6):1605-11. · 1.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study reports on the long-term surgical outcomes after the insertion of porous Medpor orbital implants into anophthalmic sockets.
A retrospective chart review of 314 eyes from 314 patients who underwent evisceration, enucleation and secondary procedures using Medpor orbital implants was completed focusing on implant-associated complications and their corrective methods as surgical outcomes.
The mean follow-up was 50 months (range 6-107 months). The most common complication was blepharoptosis (n=33, 10.5%). Other postoperative complications were exposure (n=14, 4.5%) and implant infection (n=3, 1%). The complications were successfully managed by surgical repair and/or conservative care.
Using Medpor resulted in similar surgical outcomes, in terms of the types and frequencies of complications, as other kinds of porous orbital implants.
The British journal of ophthalmology 11/2011; 96(4):494-8. · 2.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: To identify the microscopic characteristics of lower eyelid retractors in Korean individuals and to elucidate age-related changes in lower eyelid retractors.
Eighteen Korean lower eyelids from formalin-fixed cadavers were stained with Masson's trichrome. Specimens were divided into two groups based on age at death (group A, ≤65 years; group B, >65 years), and the microscopic findings were analyzed and compared by light microscopy.
The capsulopalpebral fascia (CPF) had distinct junctions and no fusion with orbital septum in 14 eyelids (77.8%). The CPF was fused with the orbital septum in only two eyelids (11.1%). Although not significant, the inferior tarsal muscle was closer to the tarsus in group A (1.24 ± 0.71 mm) than group B (2.14 ± 1.18 mm, p = 0.07), and the tarsal height tended to be longer in group B (4.71 ± 0.55 mm) than group A (4.16 ± 1.01 mm, p = 0.20). Tarsal fatty infiltration was more evident in group B.
The CPF was rarely fused with the orbital septum in our sample of Korean lower eyelids. Although we did not identify any remarkable age-related changes in lower eyelid structures, there was a tendency for the lower retractor to loosen from the tarsus and for increased fatty infiltration in the lower eyelids from elderly individuals.
Korean Journal of Ophthalmology 10/2011; 25(5):344-8.
[show abstract][hide abstract] ABSTRACT: This phase II trial evaluated the efficacy and safety of tandem consolidation using (90)yttrium ibritumomab tiuxetan ((90)Y-IT) and high-dose therapy (HDT) with autologous peripheral blood stem cell transplantation (PBSCT) in high-risk patients with diffuse large B-cell lymphoma (DLBCL) who were in primary remission. Eleven patients with high-risk DLBCL were enrolled. All patients had achieved complete or partial response after six to eight cycles of rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) as a frontline chemotherapy. Subsequently, the patients received one to two courses of ifosfamide-containing regimen for peripheral blood stem cell mobilization and harvesting. First consolidation with (90)Y-IT was performed, followed by second consolidation using HDT with PBSCT. All patients received (90)Y-IT therapy, but three patients did not undergo PBSCT. During the median follow-up period of 18.1 months, 9 of 11 patients exhibited disease progression, and 8 patients died. The estimated 2-year progression-free survival was 18.2%, and overall survival was 36.4%. Adverse events following (90)Y-IT consolidation were primarily transient hematologic toxicities. The present pilot study suggests that tandem consolidation therapy using (90)Y-IT followed by HDT with autologous PBSCT is not feasible for treatment of high-risk patients with DLBCL in remission after R-CHOP. In addition, this treatment failed to provide beneficial effects for the clinical outcome of subsequent PBSCT.
Annals of Hematology 02/2011; 90(9):1075-82. · 2.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: The American Joint Committee on Cancer has proposed the tumor, node, metastasis (TNM) staging system to overcome the limitations of the Ann Arbor staging system for ocular adnexal lymphoma. We performed this study to evaluate the feasibility of the TNM staging system for ocular adnexal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (OAML). The data form 66 total eyes from 54 patients with biopsy-confirmed OAML according to World Health Organization classification were retrospectively analyzed. Using the TNM staging system, we reclassified all patients into two categories: (1) T1N0M0 stage group (n = 26), for patients with lymphoma involving only the conjunctiva; and (2) above T1N0M0 or bT1N0M0 stage group (n = 28), for patients with lymphoma extending to the orbit, eyelid, or adjacent structures, and/or bilateral OAML. After a 24-month median follow-up period for all patients, the T1N0M0 group revealed higher progression-free survival (PFS) than the above T1N0M0 or the bT1N0M0 group (P = 0.041). In a separate analysis of only 50 patients categorized as Ann Arbor stage IE, the T1N0M0 group demonstrated higher PFS (100%) than the above T1N0M0 or the bT1N0M0 group (84.7%; P = 0.067). Our data show that the poor prognostic group classified as Ann Arbor stage IE can be further distinguished by using the TNM staging system. Thus, further studies to develop treatment strategies for reducing relapse after treatment for OAML should use the TNM staging system.
American Journal of Hematology 12/2010; 86(3):262-6. · 4.00 Impact Factor