Nam Yeo Kang

Comparison of Fibrin Glue and Sutures for Conjunctival Wound Closure in Strabismus Surgery

Purpose To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery. Methods In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated. Results One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed. Conclusions Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.

Astigmatic Changes after Horizontal Rectus Muscle Surgery in Intermittent Exotropia

Purpose To evaluate the changes of refractive astigmatism after horizontal rectus muscle surgery in intermittent exotropic children. Methods Sixty-nine exotropic patients were retrospectively reviewed. Of those, 35 patients received unilateral lateral rectus recession (BLR group, 35 eyes) and 34 patients received unilateral lateral rectus recession and medial rectus resection (R&R group, 34 eyes). Non-cycloplegic refractions were measured until 6 months postoperatively. Spherical equivalent (SE), J0 and J45 using power vectors were calculated to determine and compare the changes of refractive astigmatism and axis in both groups. Results SE significantly decreased after surgery for the first week and did not changed thereafter in both groups (p = 0.000 and p = 0.018, respectively). In BLR group, J0 showed significant changes at the first week and 1 month after surgery (p = 0.005 and p = 0.016, respectively), but in R&R group, J0 changed significantly between 1 week and 3 months postoperatively (p = 0.023 and p = 0.016, respectively). J45 did not change significantly as time passed in both groups (all p > 0.05). There was no statistically significant difference in the magnitude of changes in SE, J0 and J45 between the two groups after the 6-month follow-up (p = 0.500, p = 0.244 and p = 0.202, respectively). Conclusions Horizontal rectus muscle surgery in intermittent exotropic children tends to induce a statistically significant change in astigmatism in the with-the-rule direction and myopic shift in SE. This astigmatism change seems to occur within the first 3 months after surgery. Thus, astigmatism induced by surgery should be checked and corrected at least 3 months after horizontal strabismus surgery.

Excision with corneoscleral lamellar keratoplasty and amniotic membrane transplantation of a corneal displaced recurrent conjunctival melanoma.

An 81-year-old woman with a raised pigmented nodule over her left cornea for 7 months duration was examined. Dark conjunctival pigmentation was observed in the upper bulbar fornix conjunctiva. She had previously undergone primary surgical excision of a malignant conjunctival melanoma four years earlier. The tumor separated easily from the corneal surface, but remained slightly attached to the corneoscleral surface. A corneoscleral lamellar dissection of 3 mm in width and 2 mm in depth as well as a corneoscleral lamellar keratoplasty for the reconstruction of the corneoscleral defect were performed. The wide upper bulbar and fornix conjunctiva were excised, and an amniotic membrane transplantation was performed. Biopsy revealed an invasive melanoma with a depth of 1 mm. Left, right, and inferior tumor margins of the corneoscleral lesion and the pigmentary lesion in the conjunctiva were free of the tumor. After surgery, 0.04% mitomycin was administered topically 4 times daily for 4 weeks. There was no recurrence 2 years after surgery, and systemic evaluation revealed no metastasis.

A Case of Nodular Fasciitis in the Upper Eyelid

history. An enhancing, well-circumscribed 5 mm × 5 mm mass in the lateral aspect of the left upper eyelid was found on computed tomography (CT) 3 months before the surgery. The lesion infi ltrated the orbicularis muscle but was separated from the overlying skin. Bone involvements or calcifi cations were not found (Fig. 1A). Excision by skin incision above the lesion revealed a 15 mm × 12 mm mass in the subcutaneous and preseptal area. The tumor abutted the periosteum at its superotemporal aspect but was excised en bloc (Fig. 1B). On gross examination, the excised tumor was a soft, pale brown mass measuring 15 mm × 12 mm (Fig. 1C). After sectioning, histological analysis showed a 5 mm × 5 mm solid, gray component, presenting as a demarcated, nonencapsulated, oval nodule (Fig. 1D). Under light microscopy, spindle-shaped fi broblasts with a tissue-cultured appearance were arranged in small fascicles, and small capillaries were abundant and associated with extravasated red blood cells (Fig. 2A). The tumor cells varied little in size and shape and had oval, pale-staining nuclei. Atypical mitotic fi gures or cellular atypia were not seen (Fig. 2B). Immunohisto-

Fungal Corneal Ulcer and Bacterial Orbital Cellulitis Occur as Complications of Bacterial Endophthalmitis after Cataract Surgery in an Immunocompetent Patient

ABSTRACT Purpose: To report a case of fungal corneal ulcer and bacterial orbital cellulitis as complications of bacterial endophthalmitis following cataract surgery. Methods: A 51-year-old man underwent anterior chamber irrigation and aspiration in the left eye one day after cataract surgery because of bacterial endophthalmitis. Marked lid swelling with purulent discharge was developed after 5 days. Slit lamp examination showed generalized corneal ulcer and pus in the total anterior chamber. A computerized tomography scan showed left retrobulbar fat stranding with thickened optic disc. Streptococcus pneumonia was cultured from corneal scraping, vireous, and subconjunctival pus. Results: The patient improved gradually with antibiotics treatments, but the corneal ulcer did not fully recover 2 months after cataract surgery. Candida albicans was detected in repetitive corneal culture. After antifungal and antibacterial therapy, the corneal epithelium had healed, but phthisis bulbi had developed. Conclusion: Fungal corneal ulcer and bacterial orbital cellulitis can occur as complications of endophthalmitis in an immunocompetent patient.

Relationship between Age and Retinal Nerve Fiber Layer Thickness in Normal Children.

ABSTRACT Purpose: To evaluate the effect of age and ocular factors on peripapillary retinal nerve fiber layer (RNFL) thickness in children. Method: A total of 198 normal subjects aged <19 years received a comprehensive ophthalmologic examination, including measurement of visual acuity, axial length, and cycloplegic refraction. Fast optical coherence tomography RNFL scans were obtained and average RNFL thickness was adjusted for ocular magnification. One eye of each subject was randomly selected as the study eye. The correlations between age and other ocular variables were examined. Results: Mean subject age was 8.61 ± 3.12 years. Average RNFL thickness and ocular magnification-corrected average RNFL thickness were 107.71 ± 11.83 and 103.03 ± 12.53 μm, respectively. There was no significant correlation between observed RNFL thickness and spherical equivalent of the refractive error (SE), axial length, or age (all P >0.05). Corrected RNFL thickness was positively correlated with age and axial length and negatively correlated with SE (P <0.01). Age was negatively correlated with the percent difference between observed and corrected RNFL thickness (P <0.001). Multivariate linear regression analysis showed that both axial length and age were correlated with corrected RNFL thickness in subjects <15 years old (P <0.05). Conclusion: The RNFL thickness is likely to be overestimated in children <15 years old. Additionally, an RNFL thickness increase was observed in children <15 years old. Thus, ocular magnification and RNFL thickness increase should be considered when assessing RNFL thickness in patients <15 years old.

Effect of small head tilt on ocular fundus image: Consideration of proper head positioning for ocular fundus scanning.

AbstractHead tilt and resultant ocular cyclotorsion can influence the results of ophthalmologic examinations. Thus, proper head positioning during fundus scanning has been emphasized. However, there is no perfect method to control the head tilt and little is known about the effect of small head tilts. In this study, we investigated the effect of minimal head tilt on the ocular cyclotorsion which we cannot easily detect.Forty-seven participants without ophthalmologic or vestibular abnormalities were recruited as normal subjects. Their faces were positioned at the desired head tilt using a customized adjustable head tilter and facial and fundus photographs of both the left and right eyes were taken in the upright neutral position; as well as at rightward and leftward head tilts of 2°, 4°, and 6°. The actual head tilt was determined using the facial photographs by measuring the slope of a line that intersected the corneal reflexes of both eyes. Rotational changes in the fundus images were recorded and the correlation of these changes with the degree of head tilt was determined.The degree of head tilt was significantly correlated with rotational changes in the fundus images from both the right and left eyes (P < 0.001; right eye: R2 = 0.897, left eye: R2 = 0.899). The mean relative compensations for head tilt, mediated by the ocular counterrolling reflex, were 0.376 ± 0.255 in the right eye (range: −0.02 to 1.0), and 0.350 ± 0.263 in the left eye (range: −0.03 to 1.0), and exhibited a significant negative correlation with head tilt (P < 0.05). The mean relative compensation of the right eye did not differ significantly from that of the left eye (P = 0.380), but the value did vary widely among individuals and within individuals.Even very small head tilt was partially and variably compensated for, and caused significant rotation in the fundus image. We concluded that proper head positioning does not guarantee the minimal ocular cyclotorsion change of the eyes and image-adjusting technique would be a better solution for minimizing errors from ocular cyclotorsion changes.

Retraction Note to: A case of nodular fasciitis in the upper eyelid (Jpn J Ophthalmol. 2009;53:546–8)

Dr Seol Won Jung and Dr Nam Yeo Kang, authors of the article ‘‘A Case of Nodular Fasciitis in the Upper Eyelid,’’ published in the September/October 2009 issue of the Japanese Journal of Ophthalmology [1], have requested that the article be retracted from the literature after it was brought to their attention by the Korean Ophthalmological Society that it is a duplication of their article published in Korean in the Journal of the Korean Ophthalmological Society in 2008 [2]. According to an investigation by the editorial committee of the Japanese Journal of Ophthalmology, the authors sent a signed statement of authorship responsibility with the initial submission of the manuscript stating that it had not been published and was not under consideration for publication elsewhere. The content of the two papers is identical apart from the addition of one figure in the Japanese Journal of Ophthalmology version. A formal investigation by the authors’ institutional authority, conducted at our request, concluded that the authors were not fully aware that a translated version of an article constitutes duplicate publication. Therefore, we retract the article from the literature on the grounds of duplicate publication and have duly informed the authors, their institutional authority, and the Korean Ophthalmological Society.