Jin Ho Jeong

New surgical approach for limbal dermoids in children: simple excision, corneal tattooing, and sutureless limboconjunctival autograft.

Purpose: To evaluate the efficacy of combined surgery of simple excision, corneal tattooing, and a sutureless limboconjunctival autograft in pediatric patients with grade 1 limbal dermoids. Methods: We treated 4 eyes of 4 patients with combined surgery of corneal tattooing and a sutureless limboconjunctival autograft with simple excision of limbal dermoids. Preoperative and postoperative visual acuity, postoperative recovery time, cosmetic improvements, patient compliance, and complication rates were reviewed. Results: The mean follow-up period in this study was 27.3 ± 2.8 (range, 24–30) months. Visual acuity was stable during the follow-up period. Resolution of patient discomfort and wound epithelialization was achieved in 1 week. Cosmetic outcomes improved in view of corneal opacity and conjunctival vascularization. All patients were satisfied with the cosmetic results with no complications. Conclusions: Corneal tattooing and a sutureless limboconjunctival autograft after simple excision of limbal dermoids can lead to a satisfactory cosmetic outcome, better compliance, and early postoperative recovery without complications for grade 1 limbal dermoids in pediatric patients.

Corneal tattooing method using dye injection into the anterior stroma infiltrated with small air bubbles

Editor, C orneal tattooing is classifiable into two categories according to the dye delivery method: the dye is inoculated directly and repeatedly in the conventional anterior stromal puncture technique, and in the other method, the dye is injected in a lamellar channel. The conventional tattooing method of dye injection with anterior stromal puncture is limited by the staining homogeneity; further, the repeated manipulation is timeconsuming and sometimes causes recurrent corneal erosion and the phagocytosis of tattoo pigment by keratocytes (Sekundo et al. 1999; Fogla et al. 2010). The manual lamellar pocket method had some risk of uneven tissue dissection or perforation (Kim et al. 2009; Kymionis et al. 2009). Here, we describe a novel technique for corneal tattooing by anterior stromal air bubble infiltration. Corneal tattooing following anterior stromal air bubble infiltration method was applied for six eyes of six patients who wanted cosmetic improvement of chronic total leukoma without visual potentials. Average age of the patient was 64 years. We began the surgery by applying 0.5% proparacaine hydrochloride for topical anaesthesia. By using a 20-gauge microvitreoretinal blade, we made slit entrance at the superior limbus and reached the paracentral anterior stroma of the cornea. Thereafter, we inserted a 25-gauge bent cannula attached to a 3-ml airfilled syringe through the entrance and, with the cannula tip secured, injected air in the syringe, which infiltrated the anterior stroma with small air bubbles. After we visualized the air bubble spread over entire cornea as a whitish opaque delineation, the cannula was attached with a commercially available tissue-marking dye (Davidson Marking System, Bradley Products, Inc., Bloomington, MN, USA). The dye injection stained the anterior stromal layer, replacing the preformed space made by the small air bubbles. If some part of the peripheral cornea was not stained, the same procedure was repeated 1–3 times in the unstained area. We prescribed topical administration of levofloxacin and 1% prednisolone acetate 4 times per day for 2 weeks. There was no intraoperative complication during the corneal tattooing procedure using small air bubble infiltration. Postoperative intraocular pressure was within normal range. In slit lamp examination, it could be identified that the dye had spread uniformly, and there was no complaint for pain. The average of stromal dye stain depth was 284 lm. All patients were satisfied with the cosmetic effect of corneal tattooing. In actual environment, tattooing discoloration was darker at a distance than discoloration from anterior segment photographs with bright illumination. Most optimal tattooing discoloration could be achieved when the dye was spread at 200–300 lm depth of cornea. Average period of follow-up was 14 months, and no adverse events occurred during the follow-up. This tattooing technique differs from the previous lamellar channel methods. Our technique did not involve mechanical dissection or incision of the corneal stromal layers. Instead, we infiltrated the corneal

Postoperative Hemorrhagic Occlusive Retinal Vasculitis with Intracameral Vancomycin

Dear Editor, Endophthalmitis following cataract surgery is the one of the most serious complications of ocular surgery [1]. To minimize the risk of postoperative endophthalmitis, many ophthalmologists have performed routine use of intracameral antibiotics during cataract surgery [2]. However, recent reports have demonstrated development of hemorrhagic occlusive retinal vasculitis (HORV) following administration of intracameral vancomycin for endophthalmitis prophylaxis after cataract surgery [3-5]. In 2014, Nicholson et al. reported severe bilateral ischemic retinal vasculitis after cataract surgery in two patients (four eyes) for the first time [3]. In 2015, in 11 eyes (six patients) that had undergone uncomplicated cataract surgery with prophylactic injection of intracameral vancomycin, there was a delay of 1 to 14 days before the onset of severe ischemic hemorrhagic retinal vasculitis [4]. The American Society of Retina Specialists formed a task force to define the characteristics of HORV and suggested that it is caused by a delayed hypersensitivity reaction to vancomycin [5]. We present two cases of ischemic retinal vasculitis following uneventful cataract surgery with intracameral vancomycin prophylaxis. To our knowledge, these are the first documented cases of postoperative HORV associated with intracameral vancomycin in Asia. Case 1. An 86-year-old male developed severe visual loss in his left eye 12 days after uneventful phacoemulsification using an infusion bottle (500 mg balanced salt solution) mixed with 10 mg vancomycin (Vancorin; CJ Healthcare, Seoul, Korea). His best-corrected visual acuity (BCVA) was 20 / 200 with mild corneal edema, moderate anterior chamber, and anterior vitreous inflammation. Fundus examination showed multiple retinal hemorrhages following the retinal venules (Fig. 1A). Wide-field fluorescein angiography (FAG) showed perivascular leakage in the periphery and retinal vascular occlusions with capillary non-perfusion Korean J Ophthalmol 2018;32(5):430-431 ht tps: / /doi.org /10.3341/k jo.2018.0043

Prevalence of Pseudoexfoliation Syndrome in an Isolated Island Population of Korea: The Woodo Study

Purpose: To determine the prevalence and clinical characteristics of pseudoexfoliation syndrome (PXS) within Korean population living in Woodo Island. Methods: Among the 625 residents aged 50 years or older, 305 residents (197 women and 108 men) participated in the study; a response rate of 48.8%. Participants filled out questionnaires on life style. Intraocular pressure and corneal endothelial cell function was measured. Both pupils were dilated. Fundus photographs and stereo disc photographs were taken. Vertical cup-to-disc ratio was determined. Pure tone audiometry threshold was measured at 0.5, 1, 2, 4, and 6 kHz of frequencies for each ear. Results: The prevalence rate of PXS among Woodo Island residents older than 50 years significantly increased with age, from 1.0% [95% confidence interval (CI), 0%-2.8%] in participants aged 50 to 59 years to 23.3% (95% CI, 8.2%-38.5%) in those aged over 80 years (P<0.001). The prevalence of PXS showed no significant difference between men and women in all age groups. The age-standardized prevalence rate of PXS was 10.4% (95% CI, 8.0%-12.8%), with a rate of 9.4% (95% CI, 5.8%-13.1%) in men and 14.9% (95% CI, 11.3%-18.4%) in women. PXS did not show significant association with smoking, outdoor activity, and occupation, except alcohol consumption. PXS showed significant decrease in endothelial cell density. Pure tone audiometry test of PXS group revealed statistically significant decrease in 1, 2 kHz. Conclusions: The prevalence of PXS was 10.4% in the 50 years and older age group, and tended to increase with age. Decrease in corneal endothelial function and selective hearing loss was correlated in PXE patients, supporting impairment of systemic endothelial function in PXE syndrome.

Ophthalmologic manifestations in patients with inflammatory bowel disease

Background/Aims Inflammatory bowel disease (IBD), including Crohns disease (CD) and ulcerative colitis (UC), has been reported to have various ophthalmologic manifestations. The aim of this study was to evaluate the prevalence of ophthalmologic manifestations associated with IBD in Korea. Methods Sixty-one patients were examined between May 2013 and October 2014. We performed complete ophthalmologic examinations. Results Findings included 36 patients with CD and 25 with UC. The mean age of the patients was 34±16 years and disease duration was 45.3±23.9 months. Ophthalmologic manifestations were positive in 44 cases. Primary complication was diagnosed in 5 cases, as follows; iritis in 2 cases, episcleritis in one case, iritis with optic neuritis in 1 case, and serous retinal detachment in 1 case, without secondary complications. The most common coincidental complication was dry eye syndrome (DES), in 35 patients (57.4%). The prevalence of DES in the control group was 21.3%. The proportion of DES in patients with IBD was significantly higher than in the control group (P=0.002). Conclusions Ophthalmologic manifestations were high (72.1%) in IBD patients. Clinically significant primary ocular inflammation occurred in 8.2% of patients. The most common complication was DES. There was a higher rate of DES in patients with IBD compared to the control group. Evaluation of the eye should be a routine component in patients with IBD.