Jung Hye Lee

Choroidal Thickness in Polypoidal Choroidal Vasculopathy and Exudative Age-related Macular Degeneration

PURPOSE To compare choroidal thickness between eyes with polypoidal choroidal vasculopathy (PCV) and eyes with age-related macular degeneration (AMD). DESIGN Observational, comparative case series. PARTICIPANTS Twenty-five eyes with PCV, 14 uninvolved fellow eyes with PCV, 30 eyes with exudative AMD, 17 eyes with early AMD, and 20 eyes of age-matched normal subjects. METHODS Choroidal thickness was measured using enhanced-depth imaging optical coherence tomography. Subfoveal choroidal thickness in each eye was analyzed by measurement of the vertical distance from the Bruchs membrane to the innermost scleral layer. Nasal, superior, temporal, and inferior choroidal thicknesses, 1500 μm apart from the foveal center, were also evaluated in all eyes. MAIN OUTCOME MEASURES Choroidal thickness in each group. RESULTS Mean (± standard deviation) subfoveal choroidal thickness in eyes with PCV and in their uninvolved fellow eyes was 438.3±87.8 μm and 372.9±112.0 μm, respectively, which was significantly greater than in eyes of age-matched normal subjects (224.8±52.9 μm) (P<0.001 and P = 0.003, respectively). Subfoveal choroidal thickness of eyes with exudative AMD (171.2±38.5 μm) and eyes with early AMD (177.4±49.7 μm) was thinner than that of age-matched normal subjects (P = 0.004 and P = 0.078, respectively). Choroidal thickness at each of the other 4 points showed a similar tendency. CONCLUSIONS This study demonstrates thickening of choroid in the eyes with PCV, in contrast with choroidal thinning observed in eyes with AMD. These findings suggest involvement of different pathogenic mechanisms in PCV from those in exudative AMD.

A New Method of Medial Epicanthoplasty for Patients with Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome

PURPOSE To describe a medial epicanthoplasty technique using the skin redraping method and review the surgical outcome in patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). DESIGN Retrospective, noncomparative, interventional case series with the description of a new surgical technique. PARTICIPANTS Sixteen consecutive Asian patients with BPES. METHODS The charts of patients with BPES who underwent medial epicanthoplasty using the skin redraping method were reviewed retrospectively. Preoperative and postoperative inner intercanthal distance (IICD), interpupillary distance (IPD), horizontal palpebral fissure length (HPFL), and visibility of the scar were measured. The ratio of the IICD to IPD (IICD ratio) was calculated. MAIN OUTCOME MEASURES Postoperative improvement in IICD ratio and the visibility of the surgical scar. RESULTS The preoperative median IICD ratio was 1.65 (range, 1.49-1.83) and decreased to 1.27 (range, 1.02-1.48) postoperatively. The median reduction in IICD ratio was 21.7% (range, 16.7%-38.2%) (P<0.001, Wilcoxon signed-rank test). Fourteen patients (87.5%) had no visible scarring or scarring only visible under close inspection. Two patients (12.5%) had a more apparent scar, but no patient had severe scarring that required revision. CONCLUSIONS Medial epicanthoplasty using the skin redraping method is an effective technique in the treatment of epicanthus inversus and telecanthus in patients with BPES, with excellent cosmetic outcomes.

Chronic eyelid swelling as an initial manifestation of myeloma-associated amyloidosis.

Orbital amyloidosis is uncommon and difficult to diagnose due to their variable clinical presentations. The authors report a case of a patient who presents with chronic eyelid swelling as an initial manifestation of myeloma-associated amyloidosis. This patient was also found to have retrobulbar infiltration with no visual impairment. The authors also describe the first documentation of the atypical necrotic appearance of amyloidosis in the involved eyelid tissues. Myeloma-associated amyloidosis can present as chronic, nonspecific periorbital swelling, hence a biopsy of the affected tissues is important in preventing a delay in the correct diagnosis.

Inflammatory mass formation secondary to hydroxyapatite orbital implant leakage.

A 28-year-old woman with a history of an hydroxyapatite implantation performed 2 years earlier, presented with complaints of a poorly fitting prosthesis, and fullness of the left upper eyelid accompanied by eyelid erythema. Computed tomography scan showed a mass adjacent to the implant medially. Surgical removal of the implant and mass was performed. Histological examination of the implant revealed degradation on the medial side of the implant while the mass consisted of fibrous tissue with chronic inflammation and lymphoid follicle formation around a foreign material.

Inferior oblique underaction: a transient complication related to inferior orbital wall fracture in childhood.

Purpose:  To evaluate inferior oblique (IO) underaction related to orbital floor fracture and its management.

Huge Cavernous Hemangiomas Enveloping the Optic Nerve Successfully Removed by a Vertical Lid Split Orbitotomy

A 63-year-old woman presented with a 15-year history of gradually increasing proptosis of right eye. Ocular examination revealed proptosis of 9 mm with decreased visual acuity in her right eye. CT scan showed a well-circumscribed and enhancing orbital mass filling almost the entire right orbit. The tumor occupied the superolateral, superomedial, and inferomedial intraconal space, enveloping the optic nerve. Complete excision of two large intraconal tumors was performed successfully via a vertical lid split orbitotomy. Histopathologic examination confirmed the diagnosis of cavernous hemangioma. There were no intraoperative or postoperative complications. The patient achieved a satisfactory cosmetic outcome 1 year after surgery.

Metastatic adenoid cystic carcinoma of the eyelid.

A 48-year-old man presented with an enlarging mass of the right upper eyelid over a 1-month period. Nine years prior, the patient was diagnosed with adenoid cystic carcinoma (ACC) of the right maxillary sinus and underwent a total maxillectomy followed by local radiotherapy. Over the previous year, the patient had been treated with chemotherapy and radiotherapy for multiple organ metastases, including the spine, chest, and oral cavity. Ophthalmic examination revealed a white, round mass on the tarsal conjunctiva of the right upper eyelid, measuring approximately 1 × 1 cm, and 2 palpable subcutaneous masses near the inferior orbital rim. Excisional biopsies of the masses were performed, and the histopathological findings were consistent with ACC with solid and cribriform patterns. Herein, the authors describe a case of metastatic ACC of the eyelid, which has not been described in the literature to their knowledge.

Prepuce mucosal graft for forniceal and conjunctival sac reconstruction in surgically intractable symblepharon.

A 12-year-old boy who had severe burns in the right eye from a firecracker injury 2 years previously was referred to our hospital with severe and recurrent symblepharon. The patient had received conjunctival sac reconstruction with amniotic membrane grafts twice at another hospital. A symblepharon lysis and conjunctival sac reconstruction with a mouth mucosal graft was performed. Eight months after surgery, he could not wear a prosthesis due to the recurrence of symblepharon. A prepuce mucosal graft obtained from circumcision was applied for forniceal and conjunctival sac reconstruction. One year postoperatively, the patient showed no recurrence of symblepharon and could comfortably wear a prosthesis. The prepuce is a useful alternative donor tissue in a male patient with no other available donor sites for conjunctival sac reconstruction.