Sang In Khwarg

Ocular adnexal IgG4-related disease: comparative analysis with mucosa-associated lymphoid tissue lymphoma and other chronic inflammatory conditions

Go H, Kim J E, Kim Y A, Chung H K, Khwarg S I, Kim C‐W & Jeon Y K u2028(2012) Histopathology 60, 296–312 u2028Ocular adnexal IgG4‐related disease: comparative analysis with mucosa‐associated lymphoid tissue lymphoma and other chronic inflammatory conditions

Frontalis Sling Operation Using Silicone Rod Compared with Preserved Fascia Lata for Congenital Ptosis : A Three-Year Follow-up Study

PURPOSEnTo evaluate the 3-year results of frontalis sling operation using a silicone rod compared with preserved fascia lata for congenital ptosis.nnnDESIGNnRetrospective, nonrandomized, comparative, interventional case series.nnnPARTICIPANTSnOne hundred twenty-three patients with congenital ptosis.nnnMETHODSnThe medical records of 123 patients who underwent a frontalis sling operation for congenital ptosis were retrospectively reviewed. Patients were divided into 2 groups according to the sling material used; a preserved fascia lata group (n = 63) and a silicone rod group (n = 60). Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the habitual upper lid heights and symmetry, and bilateral cases and unilateral cases were compared separately. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category.nnnMAIN OUTCOME MEASURESnPostoperative cosmetic results and recurrence rate.nnnRESULTSnAt the 3- and 6-month follow-ups, the cosmetic results were not significantly different between the 2 groups (P = 0.17 and P = 0.25 for bilateral cases and P = 0.14 and P = 0.35 for unilateral cases, respectively, by Armitages test of trend in proportions). However, the silicone rod group showed significantly better cosmetic results than the preserved fascia lata group at 1, 2, and 3 years after surgery in both bilateral and unilateral cases (all P < 0.05, by Armitages test of trend in proportions). At 3 years after surgery, the recurrence rates were 29.2% (7/24 bilateral cases) and 11.1% (3/27 unilateral cases) for the silicone rod group, and 63.2% (12/19 bilateral cases) and 41.4% (12/29 unilateral cases) for the preserved fascia lata group.nnnCONCLUSIONSnGiven the limitations of this retrospective study, the frontalis sling operation using a silicone rod showed better cosmetic results and lower recurrence rate compared to the procedure using preserved fascia lata up to 3 years after surgery for congenital ptosis. However, only prospective randomized studies can give a more accurate conclusion in that regard.nnnFINANCIAL DISCLOSURE(S)nThe authors have no proprietary or commercial interest in any of the materials discussed in this article.

First-line therapy with doxycycline in ocular adnexal mucosa-associated lymphoid tissue lymphoma: a retrospective analysis of clinical predictors.

This retrospective study was launched to evaluate the efficacy of doxycycline and to find independent predictors of a clinical response in patients with ocular adnexal lymphoma of mucosa‐associated lymphoid tissue (OAML). Thirty‐eight patients with newly diagnosed, localized OAML received doxycycline for 3u2003weeks (12 patients) or 6u2003weeks (26 patients). Clinical factors including absolute lymphocyte count (ALC) and neutrophil count (ANC) were compared between responders and non‐responders. After a median follow‐up of 26.4u2003months, doxycycline resulted in an overall response rate of 47% and a 3‐year time‐to‐treatment failure (TTF) rate of 84%. Patients treated with doxycycline for 6u2003weeks versus 3u2003weeks tended to have a higher response rate (54%vs 33%). Absolute lymphocytosis (ALCu2003>u20033.01u2003×u2003109/L) and absolute neutrophilia (ANCu2003>u20031.92u2003×u2003109/L) were defined based on the median value of each count. Patients with (19 patients) versus without absolute lymphocytosis had significantly shorter 2‐year TTF (70%vs 100%, Pu2003=u20030.021) and a lower response rate (32%vs 63%, Pu2003=u20030.051). Absolute lymphocytosis (odds ratio [OR]u2003=u20034.7; 95% confidence interval [CI], 1.1–20.8; Pu2003=u20030.043) and non‐conjunctival tumor (ORu2003=u200311.8; 95% CI, 1.1–122.5; Pu2003=u20030.038) were negative predictors for response by multivariate analysis. Front‐line doxycycline is effective particularly in localized OAML patients without absolute lymphocytosis but with conjunctival involvement.

Hydroxyapatite Implantation With Scleral Quadrisection After Evisceration

BACKGROUND AND OBJECTIVESnIn contrast to the literature on enucleation, reports of hydroxyapatite (HA) implantation during evisceration are limited; however, those that have been published mention the high HA exposure rate. The authors examined the scleral quadrisection procedure to evaluate its effect on cosmetic appearance and the prevention of HA exposure after evisceration.nnnPATIENTS AND METHODSnThe authors analyzed the surgical outcomes of 17 patients who had undergone an HA implantation with scleral quadrisection after evisceration between November 1994 and November 1995.nnnRESULTSnIn each case, the authors were able to use HA implants of 18 mm or more. During follow-up (average 10.7 months), there were no cases of conjunctival erosion, HA exposure, implant migration, significant enophthalmos, or superior sulcus deformity. All of the patients, 7 of whom had a ball- and-socket prosthesis, were satisfied with their cosmetic appearance and prosthetic motility. More than 11 weeks after evisceration, all 10 studied patients had complete, round uptakes with orbital bone SPECT (single photon emission computed tomography).nnnCONCLUSIONnFor good cosmetic appearance and for the prevention of implant exposure, scleral quadrisection is a safe and effective procedure for HA implantation after evisceration.

Mesenchymal stem/stromal cells protect the ocular surface by suppressing inflammation in an experimental dry eye.

Dry eye syndrome (DES) is one of the most common ocular diseases affecting nearly 10% of the US population. Most of the currently available treatments are palliative, and few therapeutic agents target biological pathway of DES. Although DES is a multifactorial disease, it is well-known that inflammation in the ocular surface plays an important role in the pathogenesis of DES. Mesenchymal stem/stromal cells (MSCs) have been shown to repair tissues by modulating excessive immune responses in various diseases. Therefore, we here investigated the therapeutic potential of MSCs in a murine model of an inflammation-mediated dry eye that was induced by an intraorbital injection of concanavalin A. We found that a periorbital administration of MSCs reduced the infiltration of CD4(+) T cells and the levels of inflammatory cytokines in the intraorbital gland and ocular surface. Also, MSCs significantly increased aqueous tear production and the number of conjunctival goblet cells. Subsequently, corneal epithelial integrity was well-preserved by MSCs. Together, the results demonstrate that MSCs protect the ocular surface by suppressing inflammation in DES, and suggest that MSCs may offer a therapy for a number of ocular surface diseases where inflammation plays a key role.

One-Snip Punctoplasty and Canalicular Curettage Through the Punctum: A Minimally Invasive Surgical Procedure for Primary Canaliculitis

PURPOSEnTo evaluate treatment results of canalicular curettage through the punctum after 1-snip punctoplasty for primary canaliculitis.nnnDESIGNnRetrospective, interventional case series.nnnPARTICIPANTSnThirty patients with primary canaliculitis who were treated at Seoul National University Hospital between February 2005 and January 2008.nnnMETHODSnAll patients underwent 1-snip punctoplasty and canalicular curettage through the punctum, and granules or concretions were removed. After the procedure, oral and topical antibiotics were used for 3 weeks. Demographic data and clinical presentations of the patients were analyzed. The resolution of symptoms and inflammatory signs and complications were evaluated 3 weeks after the procedure.nnnMAIN OUTCOME MEASURESnResolution rate of the canaliculitis and complications after the procedure.nnnRESULTSnThere was a female predominance in the study group (23:7). Common symptoms of canaliculitis included discharge, tearing, and pus or concretions from the punctum. During the procedure, concretions, granules, or discharges were drained in all patients. In 25 (83.3%) of 30 patients, the symptoms and signs of canaliculitis completely resolved 3 weeks after 1 treatment. Two patients (6.7%) required additional curettage. Symptomatic canalicular strictures developed in 2 patients.nnnCONCLUSIONSnMaterials were removed easily from the canaliculus using a 1-snip punctoplasty and curettage through the punctum. This procedure, combined with systemic and topical antibiotic therapy, can be a highly effective treatment for primary canaliculitis.

Free orbital fat graft to prevent porous polyethylene orbital implant exposure in patients with retinoblastoma.

Purpose: To determine if porous polyethylene orbital implant (Medpor®) exposure can be prevented in retinoblastoma patients when the implant is placed in combination with a free orbital fat graft over the anterior surface of the implant. Methods: Free orbital fat grafts were performed after enucleation and Medpor® implantation, and results were compared with patients who underwent conventional enucleation and Medpor® implantation without an orbital fat graft. Results: Although implant exposure occurred in 13 of 39 eyes (33.3%) that had conventional enucleation and Medpor® implantation, exposure did not develop in any of the 38 eyes that had the combined procedure with a free orbital fat graft. Conclusions: These findings suggest that a free orbital fat graft is a simple, effective way to prevent orbital implant exposure in patients requiring enucleation and Medpor® implantation.

Epiblepharon of the lower eyelid: technique of surgical repair and quantification of excision according to the skin fold height.

BACKGROUND AND OBJECTIVEnTo describe our excisional technique for lower eyelid epiblepharon to reduce a medial undercorrection and to provide a guide for the excision amount using a classification system of epiblepharon according to the skin fold height.nnnPATIENTS AND METHODSnAfter classification, an elliptical excision of skin and orbicularis muscle, including that below the lower canaliculus after tarsal suturing of the upper edge of the incised skin, was consecutively performed for 111 eyelids of 58 patients. The widest width of the excisional ellipse was measured.nnnRESULTSnThe results were successful in 108 eyelids. The mean widest width of the excisional ellipse was 1.1, 1.7, 2.5, and 3.0 mm in Class I, II, III, and IV epiblepharons, respectively.nnnCONCLUSIONnThis surgical technique is effective for the correction of epiblepharon, and it is easy to determine the amount of excision. Using this technique, a 1 mm to 3 mm width of excision is sufficient.

Long-term outcomes of first-line treatment with doxycycline in patients with previously untreated ocular adnexal marginal zone B cell lymphoma.

Ocular adnexal lymphoma (OAL) has been associated with Chlamydophila psittaci infection, for which doxycycline has been suggested as a treatment option. We conducted this study to evaluate the long-term results of first-line doxycycline treatment in patients with OAL. Ninety patients with histologically confirmed OAL with marginal zone B cell lymphoma were enrolled. Each patient received one or two cycles of doxycycline (100xa0mg bid) for 3xa0weeks. After a median follow-up period of 40.5xa0months (8–85), the 5-year progression-free survival (PFS) rate was 60.9xa0%. All patients were alive at the last follow-up date. Thirty-one patients (34xa0%) showed local treatment failure without systemic spread. However, PFS rate in these patients was 100xa0% after salvage chemotherapy and/or radiotherapy. PFS was independently predicted in multivariate analysis by the tumor-node-metastasis (TNM) staging (hazard ratio [HR], 4.35; 95xa0% confidence interval [CI], 2.03–9.32; Pu2009<u20090.001) and number of cycles of doxycycline (HR, 0.31; 95xa0% CI, 0.14–0.69; Pu2009=u20090.004). No serious adverse event was reported during doxycycline therapy. In conclusion, first-line doxycycline therapy was effective and safe. Patients who failed to respond to doxycycline therapy were successfully salvaged with chemotherapy and/or radiotherapy without compromising long-term outcomes. Patients with T1N0M0 disease could be considered good candidates for first-line doxycycline.

Dermis-Fat Graft for Treatment of Exposed Porous Polyethylene Implants in Pediatric Postenucleation Retinoblastoma Patients

PURPOSEnTo demonstrate the use of the autogenous dermis-fat graft for the treatment of porous polyethylene implant exposure and volume augmentation in postenucleation retinoblastoma children.nnnDESIGNnRetrospective, interventional case series.nnnMETHODSnTen children who received a dermis-fat graft at Seoul National University Hospital between July 1, 2005 and January 31, 2010 were included in this study. The patients had undergone unilateral enucleation for retinoblastoma, and received a subconjunctival dermis-fat graft to repair implant exposure and simultaneously correct enophthalmos. The clinical characteristics of the patients, rate of graft survival, and complications were analyzed. The cosmetic outcome was assessed using a grading system.nnnRESULTSnAll patients had enucleation using porous polyethylene implant as a primary orbital implant. The average time to exposure was 89.1 ± 22.4 months and the median size of defect was 2 × 3 mm. With a mean follow-up of 28 months, 9 of 10 patients showed well-survived graft without re-exposure. One patient who experienced a graft failure managed with implant rotation and a scleral graft. Seven patients showed significant improvement of enophthalmos.nnnCONCLUSIONSnImplantation of an autogenous dermis-fat graft is a procedure that can be effectively used to treat porous polyethylene implant exposure and simultaneously correct enophthalmos. Use of this procedure can be particularly advantageous for pediatric postenucleation patients.