Korean Journal of Ophthalmology : KJO最新文献_第8页

Trabecular Microbypass Stent Insertion for Medically Uncontrolled Glaucoma in a Patient with Central Serous Chorioretinopathy: A Case Report. 中枢性浆液性脉络膜视网膜病变患者经药物控制的青光眼植入小梁微搭桥支架一例报告。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0123

Won Kyung Park, Chungkwon Yoo, Ji-Hye Park, Yong Yeon Kim

Dear Editor, Filtering surgery is indicated for treatment of glaucoma when medication or laser treatment is not sufficient to lower intraocular pressure (IOP); however, the use of topical corticosteroid is mandatory in its postoperative period for modulation of wound healing process to minimize the risk of bleb failure [1]. Such postoperative steroid use may activate the development or progression of central serous chorioretinopathy (CSC) in eyes with or at risk of CSC [2-4]. In this regard, angle-targeted minimally invasive glaucoma surgery (MIGS) may be a better surgical option in glaucoma patients comorbid with CSC because of the shorter use of weaker steroids. Here we describe a case where in whom trabecular microbypass stents were inserted to treat medically uncontrolled glaucoma in an eye with CSC. Written informed consent was obtained from the patient. A 68-year-old male patient with bilateral open angle glaucoma was referred due to uncontrolled IOP of his right eye despite maximal medical treatment. He had been using Hypadil (nipradilol 0.25%; Kowa, Nagoya, Japan), Alphagan-P (brimonidine 0.15%; Allergan, Seoul, Korea) and Travatan (travoprost 0.004%; Alcon, Korea) for 3 years and intolerant to dorzolamide/timolol fixed combination eyedrops. He also had systemic hypertension, diabetes mellitus and dermatitis treated with oral corticosteroids. On initial examination, corrected visual acuity and IOP of his right eye was 20 / 25 and 25 mmHg, respectively. Fundoscopy revealed macular edema in the right eye. Optical coherence tomography (OCT) showed the subretinal f luid and enlarged choroid beneath the macula of the right eye (Fig. 1A). Fluorescein and indocyanine green angiography demonstrated a focal lesion with fluorescein leakage in the same location. Although glaucoma surgery deemed necessary for control of medically unresponsive IOP of his right eye, we were concerned about the postoperative use of corticosteroid and the possible postoperative exacerbation of CSC. Therefore, we followed him up 3 weeks after cessation of the oral corticosteroid. We also added systemic acetazolamide 250 mg three times a day to his antiglaucoma medications. Thereafter, the subretinal fluid decreased on OCT; however, IOP of the right eye was 22 mmHg. To minimize the amount and duration of postoperative steroid use, trabecular microbypass stent insertion was performed in his right eye. Briefly, under the topical anesthesia a 2.2-mm temporal corneal incision was created in the right eye. After intracameral injection of the Provisc (Sodium hyaluronate 10 mg/ mL; Alcon, Seoul, Korea), two iStents (Glaukos, San Clemente, CA, USA) were inserted into at the nasal iridocorneal angle under visualization using a Swan Jacob gonioprism lens (Fig. 1B). His IOP of the right eye was lowered to 11 mmHg at postoperative day 1 and has remained below 17 mmHg with use of two antiglaucoma medications for the next 12 months. Fluorometholone 0.02% (Santen, Osaka, Japan) eyedrop w

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引用次数: 0

Preoperative and Postoperative Factors Affecting Functional Success in Anatomically Successful Retinal Detachment Surgery. 影响解剖成功视网膜脱离手术功能成功的术前和术后因素。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0057

Mehmet Eren Guner, Melis Kabaalioglu Guner, Zafer Cebeci, Nur Kır

Purpose: To investigate preoperative and postoperative factors affecting functional success in anatomically successful retinal detachment surgery.

Methods: Seventy-five eyes of 75 patients with rhegmatogenous retinal detachment who underwent anatomically successful surgery from 2014 to 2019 with more than 1 year follow-up were included in the study. Demographic characteristics, ocular examination findings, preoperative and postoperative spectral domain optic coherence tomography images were retrospectively evaluated.

Results: The mean age was 53.9 ± 17 years (range, 11-85 years). The mean follow-up period was 36.7 ± 16 months (range, 14-72 months). The mean best-corrected visual acuity of the patients before surgery was 1.35 ± 1.24 and at postoperative 12 months was 0.66 ± 0.5 logarithm of the minimum angle of resolution. Patients who were operated in 7 days of visual symptoms onset were found to have better visual acuity at the first and subsequent postoperative exams. Preoperative proliferative vitreoretinopathy, vitreous hemorrhage, and extent of retinal detachment were found to have a negative effect on functional success at 12 months. Regeneration of the outer retinal layers had a positive effect on visual acuity at 12 months but did not significantly increase visual acuity after 12 months. Multivariate analysis showed that preoperative external limiting membrane integrity was significantly associated with better functional outcomes.

Conclusions: Early intervention, presence of preoperative external limiting membrane integrity, and restoration of postoperative outer retinal layers positively affected functional success. The presence of preoperative vitreous hemorrhage, preoperative proliferative vitreoretinopathy, and the extent of retinal detachment had a negative effect on prognosis at 12 months.

目的:探讨影响解剖性视网膜脱离手术功能成功的术前、术后因素。方法:选取2014 - 2019年解剖成功手术的75例孔源性视网膜脱离患者75只眼，随访1年以上。回顾性评价人口统计学特征、眼部检查结果、术前和术后光谱域光学相干断层扫描图像。结果:患者平均年龄53.9±17岁(范围11 ~ 85岁)。平均随访36.7±16个月(14 ~ 72个月)。患者术前平均最佳矫正视力为1.35±1.24，术后12个月平均最佳矫正视力为0.66±0.5最小分辨角的对数。在视力症状出现7天内手术的患者在第一次和随后的术后检查中发现视力较好。术前增殖性玻璃体视网膜病变、玻璃体出血和视网膜脱离程度对12个月的功能成功有负面影响。视网膜外层的再生对12个月后的视力有积极的影响，但对12个月后的视力没有显著的提高。多因素分析显示，术前外限制膜完整性与较好的功能预后显著相关。结论:早期干预、术前外限制膜完整性的存在和术后视网膜外层的恢复对功能成功有积极影响。术前玻璃体出血、术前增殖性玻璃体视网膜病变和视网膜脱离程度对12个月的预后有负面影响。

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引用次数: 0

Fractal Dimension of Peripapillary Vasculature in Primary Open-Angle Glaucoma. 原发性开角型青光眼乳头周围血管的分形维数。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0089

Chae Hyun Song, Seok Hwan Kim, Kyoung Min Lee

Purpose: To compare the fractal dimensions of the peripapillary microvasculature as obtained by optical coherence tomography angiography (OCTA) between primary open-angle glaucoma (POAG) and controls.

Methods: Optic nerve head and peripapillary area images were taken using the 20° × 20°-scan of Spectralis OCTA (Heidelberg Engineering) in 97 subjects (64 POAG patients, 33 control patients). The optic nerve head microvasculature was evaluated according to predefined slabs: the superficial vascular complex (SVC) and the avascular complex (AVC). The en face image of each slab was processed by ImageJ software (National Institutes of Health) in order to calculate the vessel density and the fractal dimension using the box-counting method. For comparison, the peripapillary retinal nerve fiber layer (RNFL) thickness was obtained from Spectralis OCT circle scans. The utilities of the parameters for discriminating between the POAG and control groups were assessed using areas under the receiver operating characteristic curves (AUCs).

Results: The SVC fractal dimension was lower in the POAG than in the control group (p < 0.001), while AVC showed no intergroup difference (p = 0.563). The fractal dimension showed a good correlation with the vessel density in both SVC and AVC (both p < 0.001). In a multivariable regression analysis, the SVC fractal dimension was negatively correlated with age (p < 0.001) and axial length (p < 0.001) and positively correlated with average RNFL thickness (p < 0.001), while the AVC fractal dimension was positively correlated with the Bruch's membrane opening size (p = 0.013). In terms of diagnostic utility, the AUC was significantly larger for the average RNFL thickness (AUC, 0.889) than for the SVC fractal dimension (AUC, 0.772; p = 0.008).

Conclusions: The fractal dimension of SVC was associated with the average RNFL thickness and was reduced in POAG patients. Fractal dimension analysis could be used in evaluating peripapillary vascularity by OCTA.

目的:比较原发性开角型青光眼(POAG)与对照组的光学相干断层血管造影(OCTA)所获得的乳头周围微血管分形维数。方法:采用Spectralis OCTA (Heidelberg Engineering) 20°× 20°扫描，对97例患者(POAG患者64例，对照组33例)的视神经头部和乳头周围区域进行扫描。视神经头微血管按照预先设定的标准进行评估:浅血管复合体(SVC)和无血管复合体(AVC)。采用ImageJ软件(美国国立卫生研究院)对各板的正面图像进行处理，采用箱形计数法计算血管密度和分形维数。为了比较，通过Spectralis OCT圆扫描获得乳头周围视网膜神经纤维层(RNFL)厚度。使用受试者工作特征曲线(auc)下的面积来评估区分POAG组和对照组的参数的效用。结果:POAG组SVC分形维数低于对照组(p < 0.001)， AVC组间差异无统计学意义(p = 0.563)。SVC和AVC的分形维数与血管密度呈良好的相关性(p < 0.001)。在多变量回归分析中，SVC分形维数与年龄(p < 0.001)、轴向长度(p < 0.001)呈负相关，与RNFL平均厚度呈正相关(p < 0.001)， AVC分形维数与Bruch膜开口大小呈正相关(p = 0.013)。在诊断效用方面，平均RNFL厚度(AUC, 0.889)的AUC显著大于SVC分形维数(AUC, 0.772;P = 0.008)。结论:SVC分形维数与RNFL平均厚度相关，POAG患者分形维数降低。分形维数分析可用于OCTA评价乳头周围血管状况。

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引用次数: 1

Dacryoendoscopic Findings in the Failed Silicone Tube Intubations without Dacryoendoscopy. 未经泪镜检查硅胶管插管失败的泪镜检查结果。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0087

Do Ah Kim, Helen Lew

Purpose: To investigate the clinical characteristics and dacryoendoscopic findings and clinical efficacy of silicone tube intubation (STI) in the patients who referred to our center due to failed with conventional STI.

Methods: We retrospectively reviewed the medical records of 61 cases from 50 patients who underwent STI or endoscopic dacryocystorhinostomy using dacryoendoscopy from January 2016 to May 2021. Clinical characteristics, tear meniscus height, lacrimal irrigation test, dacryocystographic findings, dacryoendoscopic findings and surgical outcomes were evaluated.

Results: The study included 12 male and 38 female patients (mean age, 64.1 ± 13.2 years). In the preoperative lacrimal irrigation test, passage was found in 33 eyes (54.1%) and no passage in 28 eyes (45.9%). The causes of lacrimal duct obstruction were in the order of stenosis (31.1%), mucus (27.9%), membrane (24.6%), granulation (13.1%), and stone (3.3%), and the location were in the order of nasolacrimal duct (39.3%), lacrimal sac (36.1%), canaliculus (21.3%), and inferior meatus (3.3%). As for the characteristics of obstruction, the secretory type was 21 eyes (34.4%), and structural change type was 40 eyes (65.6%). The STI group consisted of 57 eyes (93.4%) and endoscopic dacryocystorhinostomy consisted of four eyes (6.6%). The overall success rate was 83.9%. Clinical results were correlated with dacryoendoscopic finding (p = 0.015), but not with lacrimal irrigation test or dacryocystography. The structural change type had a higher surgical success rate than the secretory type (84.4% vs. 66.7%, p = 0.015). In particular, the structural change type showed higher success rate than the secretory type below the lacrimal sac (95.5% vs. 61.9%, p = 0.034).

Conclusions: STI using dacryoendoscopy has a higher surgical success rate than conventional STI since dacryoendoscopy provides direct visualization of nasolacrimal duct obstruction. It could be useful in increasing the surgical success rate in patients with structural changes below lacrimal sac.

目的:探讨因常规性传播感染(STI)治疗失败而转诊至我中心的患者硅胶管插管(STI)的临床特点、泪镜检查结果及临床疗效。方法:回顾性分析2016年1月至2021年5月，50例经性传播感染或内镜下泪囊鼻腔造口术的61例患者的病历。评估临床特征、泪半月板高度、泪道冲洗试验、泪囊造影结果、泪镜检查结果和手术结果。结果:男性12例，女性38例，平均年龄64.1±13.2岁。术前泪道冲洗试验中，33眼(54.1%)发现通道，28眼(45.9%)未发现通道。泪管梗阻的原因依次为狭窄(31.1%)、粘液(27.9%)、膜(24.6%)、肉芽(13.1%)、结石(3.3%)，发生部位依次为鼻泪管(39.3%)、泪囊(36.1%)、泪小管(21.3%)、下泪道(3.3%)。梗阻特征为分泌型21眼(34.4%)，结构改变型40眼(65.6%)。STI组57只眼(93.4%)，内窥镜泪囊鼻腔造口术4只眼(6.6%)。总成功率为83.9%。临床结果与泪镜检查结果相关(p = 0.015)，但与泪冲洗试验或泪囊造影术无关。结构改变型手术成功率高于分泌型(84.4%比66.7%，p = 0.015)。特别是泪囊以下结构改变型比分泌型成功率高(95.5%比61.9%，p = 0.034)。结论:泪道内窥镜下行STI手术成功率高于常规STI，因为泪道内窥镜可直接显示鼻泪管阻塞。对于泪囊以下结构改变的患者，可提高手术成功率。

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引用次数: 4

External Subretinal Fluid Drainage and Vitrectomy in Exudative Retinal Detachment Secondary to Central Serous Chorioretinopathy: A Case Report. 中央浆液性脉络膜视网膜病变继发于渗出性视网膜脱离1例。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0099

Ji Young Moon, Se Joon Woo, Soo Chang Cho

Dear Editor, Bullous central serous chorioretinopathy (bCSC) is an atypical variant of CSC, characterized by exudative retinal detachment, especially in inferior quadrants [1]. Subretinal pigment epithelium (sub-RPE) fibrin and increased hydrostatic pressure in pigment epithelial detachment (PED) is speculated to induce a RPE tear [2]. Subsequently, intense accumulation of subretinal fluid (SRF) leads to exudative retinal detachment. Proper treatment choice for bCSC is unclear. Removal of risk factors, focal laser, photodynamic therapy (PDT), and surgery can be applied [2]. There are two methods for surgical draining SRF: internal and external approach. Internal drainage may lead to retinotomy-associated rhegmatogenous retinal detachment (RD) [3]. Pars plana vitrectomy (PPV) with external drainage does not need retinotomy, allowing laser photocoagulation with an improved view using perfluorocarbon liquid (PFCL) and immediate retinal reattachment [4]. We report a case of bCSC treated with external drainage and vitrectomy in which the retina was reattached and maintained without recurrence for more than 1.5 years. Informed consent was obtained from the patient for publication of this case report and relevant images. A 51-year-old male patient presented with blurred vision in his right eye that started 5 days ago. Uncorrected visual acuity was 20 / 20, and intraocular pressure was normal in both eyes. Anterior segment was unremarkable. Fundus showed inferior bullous RD and no breaks in the right eye (Fig. 1A). Fundus was normal in the left eye. Perifoveal PEDs were found in the right eye (Fig. 1B). SRF increased the day after admission (Fig. 1C, 1D). Fluorescein angiography showed multiple perifoveal leaking points, a main inferonasal leaking point, and consequent pooling to the subretinal space (Fig. 1E, 1F). Optical coherence tomography (OCT) showed RPE tear at the site corresponding to the main leaking point (Fig. 1G). Exudative RD secondary to CSC (i.e., bCSC) was diagnosed and laser photocoagulation at leaking points was performed. On the 3rd day of admission, best-corrected visual acuity (BCVA) was 20 / 40, fundus showed shifting of SRF after sleeping on one side (Fig. 1H). Indocyanine green angiography shows hyper-permeable and dilated choroidal vessels (Fig. 1I). SRF decreased in OCT (Fig. 1J). He was discharged on the 5th day of admission. However, SRF increased significantly, and BCVA was 20 / 67 at outpatient visit at 5 days after discharge. We decided to transfer him for PDT. The next day, he was transferred to another hospital. BCVA decreased to finger count. Exudative RD was extended and prominent (Fig. 1K, 1L). Therefore, PDT was considered ineffective. After waiting 1 week, RD was further extended, and surgery was performed by SJW (Fig. 1M-1O). External drainage, PPV with perfluorocarbon liquid, endolaser, and intravitreal sulfur hexafluoride 18% gas injection were performed (Supplementary Video 1). Three months after surgery, BCVA w

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引用次数: 0

Thin but Nonkeratoconic Cornea: A Case Report. 薄而非角膜锥形角膜1例报告。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0053

Na Eun Kim, Si Yoon Park, Hyun Min Ahn, Ikhyun Jun, Kyoung Yul Seo, Tae-Im Kim

Dear Editor, The cornea is composed of five layers: epithelium, Bowman layer, stroma, Descemet membrane, and endothelium. In addition to healthy layers, it is also important to maintain necessary layer thickness to assure integrity and function. In previous studies, central corneal thickness less than 500 μm was regarded as clinically thin and was observed in a subpopulation of healthy young adults [1]. Central corneal thickness less than 480 μm is regarded as extremely thin cornea and is highly suggestive for keratoconic or ectasic cornea [2]. But standard measurement or thickness to diagnosis thin cornea remain debated [3]. Here, we introduce a case of extremely thin cornea, less than 400 μm, that was nonkeratoconic. The patient provided written informed consent for publication of her examination results and images. A 26-year-old female patient first visited Severance Hospital for refractive surgery evaluation. She had no previous systemic or ocular disease. Also, she had no family history for ocular disorder within three generations of her family. She has worn soft contact lenses about two or three times per week for 10 years but had stopped using them for 2 weeks before the examinations. The best-corrected distant visual acuities were 20 / 20 in both eyes. The manifest refraction was –5.50 Sphere –2.50 Cylinder × 180° in the right eye and –7.00 Sphere –2.00 Cylinder × 180° in the left eye. Fig. 1A-1H show the images of both eyes. The slit-lamp examination (Fig. 1A, 1E) for both eyes did show thin cornea without any other sign suggesting hypoxia or mechanical trauma on cornea. Fundus examination for both eyes also showed no remarkable sign. Corneal thickness measured with Scheimpflug tomography (Pentacam; Oculus, Wetzlar, Germany) was 383 μm at the thinnest point, 385 μm for the corneal apex of the right eye, 389 μm at the thinnest point, and 391 μm for the corneal apex of the left eye. Topography with placido-scanning-slit system (ORBscan II; Bausch & Lomb, Rochester, NY, USA), noncontact tono-pachymetry (NT-530P; Nidek, Gamagori, Japan), and specular microscope (EM-4000; Tomey, Nagoya, Japan) also showed central corneal thickness less than 400 μm, about 10% difference among measuring methods. Elevation and curvature maps of both eyes showed symmetric bow-tie pattern with-the-rule topography (Fig. 1D, 1H). In sagittal curvature map, inferior-superior asymmetry index was 1.0 for each eye, regarded as normal. Indices representing irregularity of cornea curvature, index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, index of height asymmetry, index of height decentration, and the smallest radius of sagittal/axial corneal curvature were all within normal range. The Belin/Ambrósio enhanced ectasia display (BAD) showed no significant elevation from a reference surface. The corneal thickness spatial profile curve showed progressive thickening of the cornea from the thinnest point to the periphery, wit

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引用次数: 0

Dynamic Ranges of Retinal Nerve Fiber and Optic Nerve Head Parameters Measured Using Optical Coherence Tomography in Glaucoma: A Longitudinal Study. 使用光学相干断层扫描测量青光眼视网膜神经纤维和视神经头参数的动态范围:纵向研究。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0048

Nala Shin, Gi Seok Park, Kyung Nam Kim, Young Hoon Hwang

Purpose: To evaluate the dynamic range of retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters measured using optical coherence tomography (OCT) in conditions ranging from nonglaucomatous status to advanced glaucoma by longitudinal observation.

Methods: A total of 15 eyes from 12 participants with glaucoma progression from a nonglaucomatous status to advanced glaucoma were included. The RNFL and ONH parameters were compared between the nonglaucomatous and advanced stages within the same eye. The absolute and relative changes in OCT parameters were analyzed.

Results: The median highest intraocular pressure was 42.5 mmHg (interquartile range, 37.5 to 54.5 mmHg), and the final mean deviation of the visual field test was -24.68 dB (interquartile range, -23.93 to -31.13 dB). The median relative changes in RNFL thickness were -40.6% in the overall area, and -51.9%, -21.4%, -51.1%, and -41.8% in the superior, nasal, inferior, and temporal quadrants, respectively (all p < 0.05). Relative changes in the rim area, disc area, average cup to disc ratio, vertical cup to disc ratio, and cup volume were -56.64%, 0.59%, 62.10%, 66.0%, and 337.90%, respectively (all p < 0.05, except for disc area with a p-value of 0.753).

Conclusions: The dynamic range of the RNFL thickness ranged from 40.6% to 51.9%, and the dynamic range of the ONH parameters ranged from 56.64% to 337.90%. During the course of glaucoma progression, the cup volume showed the widest dynamic range. However, the disc area did not show significant changes.

目的:通过纵向观察，评价光学相干断层扫描(OCT)在非青光眼状态到晚期青光眼状态下视网膜神经纤维层(RNFL)和视神经头(ONH)参数的动态范围。方法:12例青光眼从非青光眼发展到晚期青光眼的患者共15只眼。比较同眼非青光眼和晚期青光眼的RNFL和ONH参数。分析OCT参数的绝对变化和相对变化。结果:眼压最高中位数为42.5 mmHg(四分位数范围为37.5 ~ 54.5 mmHg)，视野测试最终平均偏差为-24.68 dB(四分位数范围为-23.93 ~ -31.13 dB)。RNFL厚度的中位相对变化在整个区域为-40.6%，在上、鼻、下、颞象限分别为-51.9%、-21.4%、-51.1%、-41.8%(均p < 0.05)。边缘面积、椎间盘面积、平均杯盘比、垂直杯盘比和杯体积的相对变化分别为-56.64%、0.59%、62.10%、66.0%和337.90% (p < 0.05，椎间盘面积p值为0.753)。结论:RNFL厚度动态范围为40.6% ~ 51.9%，ONH参数动态范围为56.64% ~ 337.90%。在青光眼的发展过程中，杯容积表现出最宽的动态范围。但椎间盘面积未见明显变化。

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引用次数: 0

Immunoglobulin G4-related Ophthalmic Disease of the Caruncle: A Case Report. 免疫球蛋白g4相关性眼痈病1例报告

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0076

Gyeong Min Lee, NamJu Kim, Jin Ho Paik

Dear Editor, Immunoglobulin G4-related disease (IgG4-RD) is a rare systemic disease that affect various organs with elevated serum IgG4 levels and marked IgG4-positive lymphoplasmacytic infiltration [1]. In the field of ophthalmology, IgG4-related ophthalmic disease (IgG4-ROD) is most commonly found in the lacrimal gland, but also found in diverse ocular adnexal tissues such as the extraocular muscles, infraorbital nerve, and eyelid [2]. IgG4-ROD of the caruncle has not been described previously. The authors describe a patient with IgG4-ROD of the caruncle along with literature review. Informed consent for publication of the clinical photograph was obtained from the patient. A 41-year-old male patient presented with a mass in the left caruncle. The lesion was noted to have been present for a period of 2 weeks. Examination revealed a single, asymptomatic, round pinkish protruding mass in the left caruncle (Fig. 1A, 1B). There were no complaints of pain, discharge, or bleeding. The patient’s medical history and family history were unremarkable and a systemic search found no papules or nodular skin lesions. Magnetic resonance imaging revealed no abnormal mass lesion in the orbit. Under local anesthesia, the lesion was excised completely. On gross examination, it was a 0.3 × 0.3 × 0.4-cm mass. Histopathologic examination revealed nodular lymphoid proliferation with follicular hyperplasia pattern composed of several hyperplastic follicles and increased IgG4 positive cells (>300 cells per high-power field; IgG4 to CD138 ratio, >40%) (Fig. 1C-1J). Serum IgG4 level was not elevated. It was diagnosed as possible IgG4-ROD of caruncle with progressively transformed germinal center type of lymph nodes [1,3]. IgG4-RD is characterized by infiltrate of IgG4 positive plasma cells and elevated serum IgG4 levels, which can affect various organs [1]. In general, histopathological features of IgG4-RD are a dense lymphoplasmacytic infiltrate, storiform-type fibrosis, and obliterative phlebitis. However, in organs such as the lymph node, lung, minor salivary glands, and lacrimal glands, storiform-type fibrosis and obliterative phlebitis usually absent [3]. IgG4-ROD is a condition that IgG4-RD occurs in the ocular adnexal organs and most commonly affect the lacrimal gland, followed by trigeminal nerve branch, extraocular muscles, and orbital fat tissue [2]. However, it has never been reported in the caruncle. The caruncle contains skin elements, conjunctiva, and lacrimal glands, which can lead to a variety of disease entity. A case series of the caruncular lesion, lymphoid lesions were reported to be rare, with a frequency of about 3% [4]. However, since many ocular adnexal lesions, previously diagnosed as lymphoid hyperplasia or idiopathic orbital inflammation, have been rediagnosed as IgG4-ROD [5], some of the lymphoid caruncular lesions could also be rediagnosed as IgG4-ROD. In conclusion, we present the first case of possible IgG4-ROD in the caruncle. Although rare

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引用次数: 0

How to Better Treat Patients with Intermittent Exotropia: A Review of Surgical Treatment of Intermittent Exotropia. 如何更好地治疗间歇性外斜视:手术治疗间歇性外斜视的综述。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0043

Jeong-Min Hwang

Intermittent exotropia (X(T)) is the most common form of strabismus, especially in Asians. Treatment of X(T) includes occlusion, overminus lens, and surgery, of which, surgery is the mainstay of treatment. Commonly performed surgical procedures for X(T) are bilateral lateral rectus muscle recession or unilateral lateral rectus recession with medial rectus resection; however, it is unclear which of the two surgeries is more effective. The purpose of this review is to provide an insight on the surgical treatment of X(T). Randomized controlled trials, comparative observational studies, and case series with a large number of patients as well as a long follow-up period of over a year were included.

间歇性外斜视(X(T))是最常见的斜视形式，尤其在亚洲人。X(T)的治疗包括闭塞、过负晶状体和手术，其中手术是主要的治疗方法。常用的X(T)手术是双侧外直肌萎缩或单侧外直肌萎缩合并内侧直肌切除术;然而，目前尚不清楚这两种手术中哪一种更有效。本综述的目的是为X(T)的手术治疗提供见解。包括随机对照试验、比较观察性研究、大量患者的病例系列以及一年以上的长时间随访。

引用次数: 2

Ischemic Proliferative Retinopathy in a Korean Patient with Cutis Marmorata Telangiectatica Congenita: A Case Report. 韩国先天性毛细血管扩张性皮肤缺血性增生性视网膜病变1例报告。

Q3 Medicine

Korean Journal of Ophthalmology : KJO

Pub Date : 2022-12-01 DOI: 10.3341/kjo.2022.0107

Min-Ji Kim, Sang Jin Kim

Dear Editor, Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital vascular anomaly, clinically diagnosed based on cutaneous features [1]. It is characterized by congenital persistent reticular erythema, that does not respond to local warming, and the absence of venectasisa within skin lesions. Histopathological examination revealed dilation of the veins and capillaries within the dermal layer of the skin [2]. Systemic manifestations related to CMTC include body asymmetry, syndactyly, neurological disorders, and ocular abnormalities [3]. Ocular abnormalities include glaucoma, retinal vascular abnormalities, retinal perfusion defects, and retinal detachments [4,5]. Herein, we report a case of ischemic proliferative retinopathy in a Korean patient with CMTC. The Institutional Review Board of Samsung Medical Center waived the need for informed consent (No. 2022-02-058). A 1-month-old Korean male patient, diagnosed with CMTC, was referred to the retina clinic for evaluation of accompanying ophthalmic abnormalities. The patient was born via Cesarean section due to oligohydramnios at 38 weeks of gestation and weighed 2.3 kg. After birth, tachypnea and cyanosis were observed, and the patient was admitted to the neonatal intensive care unit. Echocardiography revealed pulmonary hypertension. On physical examination performed at the time of admission, pinkish blue colored reticular erythema was observed on the face, upper extremities, and lower extremities, and CMTC was diagnosed based on characteristic clinical f indings (Fig. 1A, 1B). On anterior segment slit-lamp examination, no abnormalities were observed in the cornea, iris, or lens. Fundus examination showed abnormally dilated retinal vessels with peripheral avascular retinas in both eyes and vitreous hemorrhage in the right eye (Fig. 1C, 1D). An examination under general anesthesia was performed, and intravenous fluorescein angiography revealed an extensive nonperfusion area and retinal neovascularization in both eyes (Fig. 1E-1H). Laser ablation of the avascular retina with laser indirect ophthalmoscope was performed on the nonperfusion areas of both eyes. After 1.5 months of laser photocoagulation, retinal hemorrhage was absorbed, and retinal neovascularization regressed completely. The patient died of pulmonary hypertension 3 months after laser photocoagulation, and no further follow-up was possible. Dedania et al. [5] reported variable ocular involvement with frequent retinal vascular abnormalities in patients with CMTC. Avascular retina was detected in six of nine patients and two patients showed retinal detachment. As ischemic proliferative retinopathy accompanied by CMTC may progress rapidly and can cause retinal detachment and blindness, the authors recommended prompt comprehensive ophthalmic evaluation in infants with suspected CMTC. In summary, we report the case of a Korean patient with ischemic proliferative retinopathy accompanied by CMTC treated with laser photocoagulat

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