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ABSTRACT: To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR).
A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material.
A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson's chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05).
Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.
Korean Journal of Ophthalmology 04/2013; 27(2):73-80.
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ABSTRACT: PURPOSE:: To introduce a new surgical technique for repairing large medial wall fractures stably with insufficient bony structures. METHODS:: This is a case series of 29 patients who underwent surgery for repairing large medial wall fractures using the new supporting implant technique in Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. Medical records and radiologic images of the patients were reviewed retrospectively. The outcomes evaluated were the incidence and the degree of diplopia and enophthalmos, and orbital volume restoration after surgery. The institutional review board approved this study, and the study adhered to the tenets of the Declaration of Helsinki. RESULTS:: Orbital reconstruction using the supporting implant technique was performed without any complications. The incidence of diplopia was 51.7% including 6.9% of significant diplopia before and 27.6% with no significant diplopia 3 months after surgery (p = 0.022). The average enophthalmos was successfully corrected from 0.93 mm preoperatively to 0.36 mm at 3 months postoperatively (p = 0.001). Orbital volume was corrected from 25.71 to 23.59 cm after surgery, which was not significantly different from the contralateral unaffected orbit (p = 0.157). CONCLUSIONS:: The supporting implant technique is a simple and effective surgical method that provides sufficient support and prevents implant migration in large medial orbital wall fractures.
Ophthalmic plastic and reconstructive surgery 03/2013; · 0.69 Impact Factor
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ABSTRACT: Purpose: To evaluate the clinical manifestations of tear production, distribution and drainage in the essential blepharospasm patients, and to analyse the changes after botulinum toxin A injection in these patients. Methods: This prospective study was performed in 23 patients with essential blepharospasm treated with Botulinum neurotoxin A (BoNT-A; Dysport, Ipsen Biopharm, UK) from November 2010 to February 2011. Ocular examinations, including frequency and severity of blepharospasm, tear break up time (BUT), Schirmer's test, lower lid tear meniscus height (TMH) measured by optical coherence tomography (OCT, rtvue software version 3.5; Optovue Inc., Fremont, CA, USA), and dacryoscintigraphy using 99m technetium pertechnetate, were performed before and 2 weeks after BoNT-A injection. We asked all patients about changes in the dry eye symptom score, before and after treatment. Results were analysed with independent t-test using spss software version 12.0 for Windows XP, (SPSS Inc., Chicago, IL, USA). Results: Botulinum neurotoxin A treatment relieved blepharospasm in all patients. Mean injection dose was 38 ± 5.6 units. After injection, mean tear BUT was significantly increased from 4.7 ± 4.9 to 6.6 ± 1.6 seconds (p = 0.001) Lower TMH increased in all three points and most notably at the lateral point (p = 0.05). On dacryoscintigraphy, tear drainage velocity was not affected by BoNT-A treatment. But Tc-99m 50% clearance time in interpalpebral fissure significantly increased from 1564 to 2220 seconds on the time activity curve (p = 0.027). Subjective dry eye symptoms also improved in 16 patients (70%) after injection. Conclusion: Tear film stability and TMH increased, but tear drainage velocity was not affected by BoNT-A treatment. Overall Tc-99m 50% clearance time in interpalpebral fissure significantly increased, and tear storage from mild lateral lower eyelid laxity increased after BoNT-A injection. Botulinum neurotoxin A injection was also effective for combined dry eye symptom in the essential blepharospasm patients.
Acta ophthalmologica 03/2013; 91(2):e108-12. · 2.44 Impact Factor
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JAMA ophthalmology. 02/2013;
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ABSTRACT: PURPOSE: To determine whether meibomian gland dysfunction (MGD) is a possible cause of ocular discomfort in patients wearing an ocular prosthesis, with the paired normal eye used as a control. METHODS: Thirty consecutive patients with a unilateral ocular prosthesis completed a questionnaire designed to identify MGD-related ocular symptoms. Both eyelids of each patient underwent slit lamp examination, meibography imaging, and Fourier-domain (FD) optical coherence tomography (OCT) scanning. Intra-individual comparison of main outcome measures between the eyelids of a prosthetic eye and paired normal eyelids was performed using Wilcoxon signed-rank test. A linear mixed model was used to investigate an association between ocular symptoms and condition of meibomian gland/tear parameters. RESULTS: The eyelids with an ocular prosthesis exhibited significantly higher scores for ocular symptoms, lid margin abnormality, meibomian gland expression, and meibography compared to the normal eyelids (p<0.01 for all scores). Tear parameters in the eyelid of a prosthetic eye, assessed with FD OCT, were significantly lower than those of the normal eyelid (p<0.01 for all scores except tear meniscus angle). The ocular symptom score was significantly positively correlated with the meibography score and negatively correlated with tear parameters (p<0.01 for all parameters, linear mixed model). CONCLUSIONS: Compared to paired normal eyelids, the eyelids with an ocular prosthesis exhibited significant signs of MGD. These results indicate that clinical assessment and management recommendations for MGD may benefit patients with prosthetic eyes, especially those with ocular discomfort.
The British journal of ophthalmology 01/2013; · 2.92 Impact Factor
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ABSTRACT: Cigarette smoking is known to aggravate Graves' orbitopathy (GO) severity by enhancing adipogenesis. We investigated the effect of quercetin, an antioxidant, on adipocyte differentiation induced by cigarette smoke extract (CSE) in primary cultured orbital fibroblasts (OFs) from GO patients. Freshly prepared CSE was added to the cells and H2O2 was used as a positive control. Intracellular reactive oxygen species (ROS) generation and adipogenesis were measured. The expressions of proteins peroxisome proliferator-activated receptor (PPAR) γ, CCAAT-enhancer-binding proteins (C/EBP) α and β, and heme oxygenase-1 (HO-1), an antioxidant enzyme , were examined during adipogenic differentiation. In result, CSE and H2O2 dose-dependently stimulated intracellular ROS production in normal and Graves' OFs. The effect of 2% CSE was similar to that of 10 μM H2O2; both concentrations were noncytotoxic and were used throughout the experiment. Quercetin pretreatment reduced the ROS generation stimulated by either CSE or H2O2 in preadipocyte OFs. CSE and H2O2 stimulated adipocyte differentiation in cultured OFs. The addition of quercetin (50 or 100 μM) suppressed adipogenesis. Quercetin also suppressed ROS generation in differentiating OFs during adipogenesis stimulated by CSE and H2O2. Additionally, the expressions of PPARγ, C/EBPα, and C/EBPβ proteins were reduced in the quercetin-treated OFs. Quercetin also reduced the CSE- and H2O2-induced upregulation of ROS and HO-1 protein in differentiated OFs and preadipocyte OFs. As shown in this study, quercetin inhibited adipogenesis by reducing ROS in vitro, supporting the use of quercetin in the treatment of GO.
Journal of Endocrinology 11/2012; · 3.55 Impact Factor
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ABSTRACT: BACKGROUND: To evaluate the efficacy of subconjunctival triamcinolone injection for treating upper eyelid retraction caused by thyroid-associated ophthalmopathy (TAO). METHODS: Prospective single blind randomized clinical trial. Patients diagnosed with TAO-associated eyelid retraction and/or swelling <6 months before study onset were randomly assigned to triamcinolone-injected (group I; 55 patients, 75 eyes) or observation-only (group II; 40 patients, 59 eyes) populations. Group I received 1-3 injections of 20 mg triamcinolone acetate into the subconjunctival eyelid, between the conjunctiva and Muller's muscle, at 3-week intervals. Group I was followed up at 3, 6, 9, and 24 weeks post-injection, and group II was evaluated at 9 and 24 weeks after initial visit. Eyelid swelling and retraction were each graded on a 0-3 scale. Treatment was stopped after 1-2 injections if both swelling and retraction resolved completely or if retraction and swelling scored 0/1 or 1/0 without functional or cosmetic patient concerns. Treatment success was defined at 9 and 24 weeks post-injection if eyelids were normal or when treatment was terminated because of early clinical resolution. We compared baseline clinical data between success and failure group evaluated at 9 and 24 weeks in group I, and investigated short-term and long-term success prognostic factor using multiple logistic regression analysis in each group I and II. RESULTS: Swelling and retraction decreased significantly more in group I than in group II. Significantly more eyes had severe swelling (≥ grade 2) in group I (67 %) than in group II (34 %) upon initial evaluation (p < 0.01); this difference disappeared at 9 and 24 weeks. Fewer severely retracted eyes were observed in group I than in group II at 9 and 24 weeks (p < 0.01). Significantly more eyes in group I achieved success at both 9 and 24 weeks (59 %, 75 %) than in group II (39 %, 57 %) (p = 0.03, p = 0.04 respectively). Higher initial retraction grades (2-3) predicted a higher chance of post-injection failure versus the reference group (grade 0-1) at 9 and 24 weeks in group I, with adjusted odds ratios (aOR) 45.4 (95 % CI = 5.9-351.1, p < 0.01) and aOR 11.6 (95 % CI = 2.3-58.5, p < 0.01) respectively. Similarly in group II, initial retraction grade was associated with the failure at 9 and 24 weeks, with aOR 10.3 (95 % CI = 1.8-59.6, p < 0.01) and aOR 5.9 (95 % CI = 1.3-25.9, p < 0.05) respectively. Transient intraocular pressure elevation was observed in three eyes of two patients, although all ocular pressures were normalized within 1 month using anti-glaucoma medication. CONCLUSIONS: Subconjunctival triamcinolone injections were very effective in resolving eyelid swelling and retraction in recent-onset TAO. However, the symptom-reducing effect of triamcinolone was modest and less effective in patients initially presenting with severe retraction grades. As intraocular pressure may rise after steroid injection at upper eyelid, the treatment should be avoided in patients suspected to have glaucoma.
Albrecht von Graæes Archiv für Ophthalmologie 09/2012; · 2.17 Impact Factor
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ABSTRACT: Purpose. We investigated the effects of quercetin on fibrotic markers and matrix metalloproteinases (MMPs) in primary cells and whole orbital tissues from Graves' orbitopathy (GO). Methods. Orbital fat tissues were harvested from GO for primary cell and tissue cultures during orbital fat decompression. To determine noncytotoxic dose and time of quercetin treatment, 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and LDH release assay were performed. The effects of quercetin on fibrosis were evaluated according to a scratch wound closure assay, and Western blotting for expression of fibronectin, collagen Iα, α-smooth muscle actin with or without TGF-β stimulation, and MMP-2, -7, -9, and tissue inhibitor of metalloproteinase-1 with or without IL-1β stimulation. The gelatinolytic activities of MMP-2 and MMP-9 were measured using gelatin zymography. In tissue cultures, MMP secretion and MMP and collagen Iα mRNA levels were determined by enzyme-linked immunosorbent assays and reverse transcription-polymerase chain reaction (RT-PCR), respectively. Results. Quercetin significantly inhibited cell migration at nontoxic concentrations. In primary cells, quercetin dose-dependently downregulated expression of TGF-β-stimulated fibronectin and collagen Iα, and IL-1β-enhanced MMP-2 and MMP-9. However, without IL-1β stimulation, 10-50 μM of quercetin increased MMP-2 expression and activity, but dose-dependently suppressed MMP-9 expression and activity. In tissue cultures, quercetin dose-dependently inhibited MMP-2 and -9 activity and secretion, but 30 and 50 μM of quercetin increased tissue MMP-2 mRNA. MMP-9 and collagen Iα mRNA levels were dose-dependently suppressed. Conclusions. Quercetin inhibited fibrotic markers and affected MMP-2 and MMP-9 activities in primary cell and orbital fat tissue cultures from GO at nontoxic concentrations. Our results support the potential use of quercetin for active inflammation and treatment or prevention of chronic fibrosis in GO.
Investigative ophthalmology & visual science 08/2012; 53(9):5921-9. · 3.43 Impact Factor
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ABSTRACT: The authors report a case of orbital paraganglioma--an extremely rare orbital tumor. A 31-year-old woman presented a well-defined localized mass in the superotemporal extraconal aspect of the left orbit. Lateral orbitotomy of the left eye for excisional biopsy was performed, but the tumor could not be excised completely because of bleeding and involvement of critical structure. Histopathology and immunohistochemical analysis established the diagnosis. Gamma knife surgery was used as an alternative modality and resulted in stabilization of the tumor and preservation of her vision. We report a rare case of orbital paraganglioma, successfully managed with radiosurgery after incomplete excision.
The Journal of craniofacial surgery 07/2012; 23(4):1127-8. · 0.81 Impact Factor
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ABSTRACT: Interleukin (IL)-17 and T helper 17 (Th17) cells are reported to be involved in many autoimmune diseases. The aim of this study is to investigate the involvement of IL-17 in the pathogenesis and disease activity of Graves' ophthalmopathy (GO).
Sixty-two GO patients and 19 healthy controls were recruited. Serum concentrations of cytokines, IL-17, IL-6, IL-23, and IL-16, were measured using multiplexed microsphere-based flow cytometric immunoassays. GO hormonal parameters, clinical activity score (CAS), exophthalmometry, and extraocular muscle involvement were evaluated, and relationships with cytokine concentrations were analyzed.
The concentration and positive detection rates of serum IL-17 were significantly higher in patients with GO than in controls. The serum levels of IL-17 in active GO patients were higher than that of inactive GO patients. Serum IL-17 concentration had significant correlation with CAS (p < 0.001).
The increased serum level of IL-17 and related cytokines in GO patients and the correlation of IL-17 concentration with the clinical activity scores suggest that IL-17 may play a pathophysiological role in GO.
Albrecht von Graæes Archiv für Ophthalmologie 07/2012; 250(10):1521-6. · 2.17 Impact Factor
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ABSTRACT: The authors previously reported that quercetin significantly inhibits interleukin (IL)-1β-induced increases of proinflammatory cytokines in cultured primary orbital fibroblasts from Graves' orbitopathy (GO). This study investigated the inhibitory effect of quercetin on inflammation in cultured whole orbital tissue.
Orbital fat tissues from GO and normal samples were cultured with or without non-toxic concentrations of quercetin. Lactate dehydrogenase (LDH) release was used to identify non-toxic concentrations of quercetin. IL-6, IL-8, IL-1α, IL-1β and tumour necrosis factor alpha (TNFα) proteins were measured in tissue culture supernatants by ELISA, and gene transcript levels were determined using quantitative PCR, expressed as relative fold changes of threshold cycle value relative to the control group.
The maximal non-cytotoxic treatment of quercetin was 100 μM for 72 h, based on the considerably low LDH release with these conditions. IL-1β, IL-6 and TNFα protein levels corrected for tissue weight were significantly higher in supernatants of GO samples than normal controls (p<0.05). Quercetin reduced IL-6, IL-8 and TNFα protein production in supernatants of all GO samples (n=4) in a dose-dependent manner; however, only the reduction in IL-6 was statistically significant (p<0.05). Quercetin had a significant suppression of tissue IL-6, IL-8, IL-1β and TNFα mRNA expression in cultured orbital tissues from three GO samples relative to untreated control tissue (p<0.05).
Inhibition of proinflammatory cytokines by the natural product quercetin in both primary orbital fibroblasts and tissue culture provides the basis for its potential use as an anti-inflammatory agent in the treatment of GO.
The British journal of ophthalmology 06/2012; 96(8):1117-21. · 2.92 Impact Factor
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ABSTRACT: PurposeTo measure tear nerve growth factor (NGF) concentrations in cases of active thyroid-associated ophthalmopathy (TAO) before
and after glucocorticoid treatment, and to correlate NGF levels with disease inflammatory activity and thyroid autoantibody
concentration.
MethodsThe study involved 20 patients with active TAO and 20 age- and gender-matched controls. Tear break-up time (BUT) was obtained,
the Schirmer test was performed, and tear NGF/total protein ratio was measured in control subjects and patients with active
TAO before, and 2 and 4weeks after, steroid treatment.
ResultsTear BUT and Schirmer values significantly increased after 2 and 4weeks of steroid treatment (p < 0.001 and p = 0.004 respectively). Baseline tear NGF/total protein ratio was higher in patients with active TAO than in control subjects,
and the ratio significantly decreased after 2 and 4weeks of steroid treatment (p < 0.001). Tear NGF/total protein ratio did not correlate with inflammatory activity score, exophthalmos value and thyroid
binding inhibiting immunoglobulin (TBII) level (p > 0.05).
ConclusionsTear NGF may have a specific role in ocular surface inflammation, which protects against ocular surface damage in patients
with active TAO. Anti-inflammatory treatment significantly reduced the level of NGF in tears, increased tear film stability
and production, and decreased congestive symptoms.
Albrecht von Graæes Archiv für Ophthalmologie 04/2012; 248(2):271-276. · 2.17 Impact Factor
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ABSTRACT: To compare the postoperative outcomes of large orbital fractures repaired with porous polyethylene (PP) channel implants (PPCIs) and PP titan barrier implants (PPTBs).
Medical records of 42 patients who underwent surgical reconstruction for a large orbital fracture with either PPCI or PPTB were reviewed retrospectively. The degree of diplopia, determined with a binocular single vision test, and enophthalmos, measured by a Hertel exophthalmometer, was compared between 2 implant groups. Orbital volumes were calculated using CT scans and the measuring tool.
Of the 42 patients examined, 16 received PPCI and 26 received PPTB. No significant difference in the degree of diplopia was observed between the 2 implant groups before surgery, and 1 and 3 months after surgery (p = 0.256, 0.408, and 0.432, respectively). Preoperative average enophthalmos measuring 1.28 mm and 1.04 mm was successfully corrected to 0.19 mm and 0.25 mm 3 months after reconstruction with PPCI and PPTB, respectively. The fractured orbit volumes and nonfractured contralateral orbit volumes were 24.96 ± 2.32 cm3 and 23.18 ± 1.733 cm in the PPCI group, and 26.80 ± 2.10 cm3 and 24.13 ± 2.28 cm3 in the PPTB group, respectively. After surgery, the fractured orbit volumes significantly decreased to 23.39 ± 2.82 cm3 in the PPCI group and to 23.53 ± 1.74 cm3 in the PPTB group; these values were not significantly different from that of the nonfractured orbit (p = 0.681 for PPCI and 0.204 for PPTB).
Porous polyethylene channel implant and PPTB are both effective implant materials for the repair of large orbital fractures; however, PPTB has the additional benefit of not requiring screw fixation.
Ophthalmic plastic and reconstructive surgery 03/2012; 28(3):176-80. · 0.69 Impact Factor
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ABSTRACT: To predict eyelid height after frontalis suspension using autogenous fascia lata for congenital ptosis.
Retrospective, observational case series.
Eighty eyes of 54 children who underwent frontalis suspension using autogenous fascia lata were included. The amount of intraoperative eyelid lift and the postoperative change in eyelid height were assessed 6 months after surgery by reviews of photographs and medical records. The amount of operative eyelid lift was measured from 2 different baselines, and each amount was compared with the amount of real change in eyelid height after surgery. The difference between those was measured.
The postoperative eyelid height stabilized 3 months after surgery. The average amount of operative eyelid lift was 5.91 mm with anesthesia-induced lagophthalmos and 3.51 mm without. The amount of real change in eyelid height after surgery was 3.24 ± 1.14 mm. In less severe ptosis (< 3 mm of lift), an average operative lift of 2.03 mm resulted in 2.53 mm of elevation, whereas in more severe ptosis (≥ 4 mm of lift), an average operative lift of 3.98 mm resulted in only 3.72 mm of elevation 6 months after surgery. The preoperative palpebral fissure (P = .002) and anesthesia-induced lagophthalmos (P < .001) were significant factors influencing postoperative eyelid height.
Postoperative eyelid height may predicted be more accurately by compensating for anesthesia-induced lagophthalmos and adjusting the palpebral fissure to be larger than the desired eyelid height for patients with more severe ptosis.
American journal of ophthalmology 02/2012; 153(2):334-342.e2. · 3.83 Impact Factor
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ABSTRACT: To investigate the surgical outcome of rectangular 4-snip punctoplasty, a modification of rectangular 3-snip procedures, using objective measurements.
Noncomparative case series.
The medical charts of patients who underwent rectangular 4-snip punctoplasty for severe punctal stenosis with at least 6 months follow-up were reviewed. Before surgery and at 1 and 6 months after surgery, subjective evaluation of tearing was assessed using Munk scores. The size of the punctum was graded based on slit-lamp examination, and measurement of tear meniscus height was done using Fourier-domain optical coherence tomography.
A total of 45 eyes (26 patients) were studied. The subjective epiphora score was significantly reduced after surgery and maintained until 6 months after the surgery (χ2 for trend test, P<.001). The grade of the punctum size was also significantly enlarged after surgery and the enlarged punctum was maintained until 6 months after the surgery (χ2 for trend test, P<.001). The mean preoperative tear height (452.4±249.3 μm) was significantly reduced both at 1 month after surgery (341.6±207.9 μm; P=.003, paired t test) and at 6 months after surgery (362.1±212.6 μm; P=.004, paired t test). The functional success rate was 93.3% and anatomic success rate was 88.9% at 6 months after surgery.
Rectangular 4-snip punctoplasty was an anatomically and functionally effective procedure for severe punctal stenosis patients, maintaining large puncta for fairly long periods.
American journal of ophthalmology 01/2012; 153(4):769-73, 773.e1-2. · 3.83 Impact Factor
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ABSTRACT: To evaluate the sociodemographic factors of myopia and the care of myopia in Korean children.
We acquired data from 8,633 children who had completed the Health Interview Survey portion of the third Korea National Health and Nutrition Examination Survey. We assessed the prevalence of eye problems in subjects younger than 19. Sociodemographic factors that affect myopia and myopia care were identified by multivariate logistic regression analysis.
The prevalence of child myopia in Korea was 22.6%. The results indicated a significant association between increasing age and myopia. There was a relation between the prevalence of myopia and income level. Participants living in homes owned by their parents or in urban areas as well as those with disabilities were more likely to have myopia. In terms of myopia care, age and monthly household income were significant factors.
Public education and strategies such as a national vision screening programs are needed for appropriate vision care as children get older, and more effort needs to be made in assisting disabled persons with vision care.
Japanese Journal of Ophthalmology 01/2012; 56(1):76-81. · 0.92 Impact Factor
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ABSTRACT: Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin, and is often associated with rheumatoid disease. A 42-year-old woman presented for evaluation of a hard palpable mass on the left upper eyelid. After everting the eyelid, a large papillomatous mass with a broad base was identified on the superior area of the tarsus. The lesion was partially excised posteriorly under local anesthesia, and pathologists identified the mass as calcinosis cutis. The patient had no systemic or trauma history, and the serum levels of calcium and phosphorous were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for a protruding papillomatous mass of the tarsal plate, and surgical debulking could be a viable option for large protruding lesions, although more follow-up is necessary to monitor regrowth.
Korean Journal of Ophthalmology 12/2011; 25(6):440-2.
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ABSTRACT: The authors experienced a case with ocular ischemia with hypotony following injection of a dermal filler for augmentation rhinoplasty. Immediately after injection, the patient demonstrated a permanent visual loss with typical fundus features of central retinal artery occlusion. Multiple crusted ulcerative patches around the nose and left periorbit developed, and the left eye became severely inflamed, ophthalmoplegic, and hypotonic. Signs of anterior and posterior segment ischemia were observed including severe cornea edema, iris atrophy, and chorioretinal swelling. The retrograde arterial embolization of hyaluronic acid gel from vascular branches of nasal tip to central retinal artery and long posterior ciliary artery was highly suspicious. After 6 months of follow up, skin lesions and eyeball movement became normalized, but progressive exudative and tractional retinal detachment was causing phthisis bulbi.
Ophthalmic plastic and reconstructive surgery 11/2011; 27(6):e152-5. · 0.69 Impact Factor
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ABSTRACT: To investigate the bacterial infection of silicone tubes removed from patients who underwent dacryocystorhinostomy (DCR) and assess the correlation between the culture results and postoperative clinical features.
Retrospective observational case series.
Consecutive epiphora patients who underwent external or endoscopic DCR surgery were reviewed. The postoperatively removed silicone tubes were cultured. Preoperative canalicular stenosis and nasal septal hypertrophy, postoperative inflammation, membranous obstruction of nasal mucosa, and the duration of silicone intubation were reviewed. Correlations between the results of bacterial culture and clinical features were verified.
A total of 39 silicone tubes removed from 33 patients were cultured: 34 (87.2%) external DCR cases and 5 (12.8%) endoscopic DCR. Culture provided positive results in 37 cases (94.9%). A total of 52 isolates were identified: 73.1% gram-positive bacteria, 23.1% gram-negative bacteria, and 3.8% fungi. Of the gram-positive organisms, 73.9% were Staphylococcus aureus. Most of the gram-negative organisms were Pseudomonas aeruginosa, found in 5 eyes. The time of tube placement was significantly longer in cases with P. aeruginosa than in those with other bacteria (P = .001). The rate of pseudomonas infection was significantly higher in cases with revision than in those without revision (P = .001). Final surgical failure was significantly related with canalicular stenosis (P = .017), pus discharge at extubation (P < .001), history of endoscopic revision (P = .001), and pseudomonal infection (P = .010).
Various bacterial species were cultured from removed silicone tubes. Although many of them were normal flora, P. aeruginosa infection showed significant relation with membranous obstruction of nasal mucosa, prolonged silicone intubation, and surgical failure.
American journal of ophthalmology 09/2011; 153(2):253-257.e1. · 3.83 Impact Factor
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ABSTRACT: Purpose: Fourier-domain optical coherence tomography (FD ODT) for the evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used FD OCT to evaluate the height of the lower lid tear film at three points in normal adults and compared it with two watery eye groups. Methods: We prospectively evaluated with FD OCT 25 normal subjects and 44 patients with a watery eye. Twenty-three patients with primary acquired nasolacrimal duct obstruction (PANDO) and 21 patients with functional nasolacrimal duct obstruction (FNLDO) were enrolled. Three images were obtained by three vertical FD OCT scans centred on the lower eyelid and inferior cornea, the medial limbus and the lateral limbus. The tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) were measured with computer calipers and compared at three points between the two groups. Results: Watery eyes have significantly greater median TMHs at three points (medial: 584 μm, central: 592 μm, lateral: 470 μm) than controls (274, 291, 205 μm, p < 0.001). Medial and central TMHs were higher than lateral TMH in controls and watery eyes. TMD and TMA also increased significantly in watery eyes (p < 0.001). There was a significant increase in central TMH compared to medial TMH in FNLDOs than in PANDOs (p < 0.05). Conclusion: Fourier-domain OCT is a valuable clinical tool in the evaluation of TMH in normal and watery eyes. TMH at three points can be a useful clinical parameter that investigates changes of lower tear meniscus pattern in both PANDO and FNLDO groups.
Acta ophthalmologica 07/2011; · 2.44 Impact Factor
