Shu-Ching Kao

Visual acuity and contrast sensitivity in different types of posterior capsule opacification

Purpose: To compare the visual acuity (VA) and contrast sensitivity in 2 types of posterior capsule opacification (PCO) in pseudophakic eyes before and after neodymium:YAG (Nd:YAG) capsulotomy and to evaluate vision test results after Nd:YAG capsulotomy. Setting: Department of Ophthalmology, Taipei Veterans General Hospital, National Yang‐Ming University, Taipei, Taiwan. Methods: Fourteen eyes with fibrosis‐type PCO and 15 eyes with Elschnig‐pearl‐type PCO were enrolled prospectively. Before and 1 week after Nd:YAG capsulotomy, VA and contrast sensitivity were assessed using the illiterate E version of the Bailey‐Lovie chart and the Vistech VCTS 6000 chart, respectively. Results: Before capsulotomy, the mean logMAR acuity in the group with Elschnig‐pearl‐type PCO was 0.47 ± 0.32 (SD) and in the group with fibrosis‐type PCO, 0.17 ± 0.07. The difference between the 2 groups was significant (P = .002). After capsulotomy, there was no significant between‐group difference (P gt; .05). Before capsulotomy, the contrast sensitivity was significantly worse (P < .01) at all spatial frequencies in the group with pearl‐type PCO, especially at 6 cycles per degree. After capsulotomy, there was no significant between‐group difference (P gt; .05) at any spatial frequency. Conclusions: After cataract surgery, patients with pearl‐type PCO had lower VA and contrast sensitivity than those with fibrosis‐type PCO. An Nd:YAG capsulotomy improved the VA and contrast sensitivity in patients with both types of PCO.

Preseptal and Orbital Cellulitis: A 10-Year Review of Hospitalized Patients

Background: Preseptal and orbital cellulitis range in severity from minor to potentially severe complications. The purpose of this study is to describe the clinical features of patients with preseptal or orbital cellulitis in one medical center in Taiwan, and to assess the effectiveness of treatments and the complications. Methods: Patients admitted between 1996 and 2005 to Taipei Veterans General Hospital under the diagnosis of preseptal or orbital cellulitis were retrospectively reviewed. The demographics, administrative history, past history, clinical presentations, treatments, and complications were analyzed. Results: In total, 94 patients fulfilling the diagnostic criteria for preseptal or orbital cellulitis were identified (67 had pre‐septal cellulitis, 27 had orbital cellulitis). While paranasal sinus disease was the most common predisposing cause in orbital cases, skin lesions in children and dacryocystitis in adults were the most common in preseptal cases. Microbiologic investigations showed variable results, but the most common pathogen isolated was Staphylococcus aureus. Cultures from eye swabs and local abscesses gave the highest positive yield. Blood cultures were taken in some patients, but the positive rate was extremely low. Treatments included intravenous antibiotics alone, or intravenous antibiotics combined with surgical drainage. Only one case had permanent ocular motility impairment after removal of the orbital foreign body. Conclusion: Despite the past history of potential morbidity and even mortality from orbital cellulitis, early diagnosis and prompt treatment with proper antibiotics and/or surgical intervention can achieve a good prognosis.

Clinical characteristics and factors associated the outcome of lacrimal canaliculitis.

Purpose:  To analyze the clinical and microbiological characteristics and factors associated with the outcome of lacrimal canaliculitis.

Localized amyloidosis of the cornea secondary to trichiasis: clinical course and pathogenesis.

Purpose. To present four cases of localized corneal amyloidosis secondary to trichiasis and to discuss its pathogenesis. Methods. Medical and pathologic records of four patients with corneal amyloidosis secondary to trichiasis were reviewed retrospectively. Two patients underwent trichiasis surgery and then lamellar keratectomy. One patient underwent trichiasis surgery only, and one patient received keratectomy only. The excised specimens were examined by light and electron microscopy. In two cases, they were stained with antibodies against &kgr; and &lgr; immunoglobulin light chains. All patients were followed for evidence of progression or recurrence of the lesions. Results. Three cases presented with blurring of vision and a progressively enlarging vascularized unilateral corneal mass. One case had normal vision and a smaller, nonvascularized mass. All four cases had a history of trichiasis. After trichiasis surgery but before corneal surgery, two patients were followed for 24 and 18 months, respectively, and showed no progression of the corneal lesions. The patient who did not undergo trichiasis surgery had a recurrence of the corneal lesion after lamellar keratectomy. Pathologic examination confirmed amyloid deposition in all three excised specimens with almost no inflammatory cells. Immunohistochemical stains were negative. Conclusion. The close correlation between trichiasis surgery and the clinical course of corneal amyloidosis provides further evidence for their association. The pathologic findings in this study do not confirm that the amyloid deposits are light chain proteins (AL).

Insulin-like growth factor binding protein-5 enhances the migration and differentiation of gingival epithelial cells

BACKGROUND AND OBJECTIVE The objective was to define the roles of insulin-like growth factor binding protein-5 (IGFBP-5) in gingival epithelial cells (GEC). Human IGFBP-5 is expressed in many cell types and has diverse biological functions. It stimulates the growth of bone cells and is associated with the impedance of gingival fibroblast apoptosis. In gingival epithelium, IGFBP-5 is expressed in the cells of the differentiated stratum spinosum layer. MATERIAL AND METHODS Recombinant IGFBP-5 protein treatment and knockdown of IGFBP-5 expression using a lentivirus-delivered short hairpin RNA was carried out in human GEC. Proliferation, apoptosis, anoikis, migration, differentiation and gene expression in GEC were analyzed and molecular images were obtained. RESULTS The IGFBP-5 had no effect on proliferation, but it slightly suppressed apoptosis and anoikis of GEC. It also induced GEC migration and upregulated the expression of involucrin, transglutaminase-1, keratin and focal adhesion kinase. The IGFBP-5 induced migration partly via an insulin-like growth factor-independent mechanism. The knockdown of IGFBP-5 downregulated the expression of involucrin, transglutaminase-1 and focal adhesion kinase. CONCLUSION Expression of IGFBP-5 in GEC is associated with anti-apoptosis, migration and differentiation of GEC. These phenotypic effects may be associated with focal adhesion kinase and are advantageous for re-epithelization of GEC and the maintenance of gingival health.

Adjunctive Orbital Radiotherapy for Ocular Adnexal IgG4-related Disease: Preliminary Experience in Patients Refractory or Intolerant to Corticosteroid Therapy

Abstract Purpose: To present the clinical outcomes of combined orbital radiotherapy and systemic corticosteroid for patients with refractory ocular adnexal IgG4-related disease. Methods: We retrospectively reviewed 3 patients with histopathologically confirmed ocular adnexal IgG4-related disease who had been refractory or intolerant to corticosteroid therapy and treated with adjunctive orbital radiotherapy (2000 cGy; 10 fractions). Clinical improvement was assessed by monitoring the patients ability to taper corticosteroid to discontinuation and by follow-up radiologic examination. Results: All 3 patients had a favorable response to adjunctive radiotherapy with improvement of the clinical symptoms and radiologic abnormalities. Systemic corticosteroid was tapered and discontinued in all patients successfully. There were no adverse effects of treatment or recurrence after a mean follow-up of 19 months. Conclusion: Adjunctive radiotherapy can help to achieve stable disease and cessation of systemic corticosteroid in patients with refractory ocular adnexal IgG4-related disease.

Adenoid cystic carcinoma arising in the inferior orbit without evidence of lacrimal gland involvement.

A 60-year-old woman sought treatment for right orbital fullness and intermittent headache. CT revealed an inferior orbital mass along the inferior rectus muscle. Incisional biopsy revealed an adenoid cystic carcinoma. Orbital exenteration followed by concurrent radiotherapy and chemotherapy was performed. The lacrimal gland was uninvolved by tumor microscopically. Although rare, adenoid cystic carcinoma must be considered in the differential diagnosis of an orbital tumor, because the unusual location of an orbital adenoid cystic carcinoma may make its early detection difficult.

Transplantation of the autologous submandibular gland to the lacrimal basin in rats.

Purpose: In this study, we designed an animal experiment in which we transferred a part of the autologous submandibular gland without performing a microvascular anastomosis. We studied histological changes and functional effects in the transfer glands. Method: Thirty male adult Sprague-Dawley rats were divided into three groups. In each animal of the three groups, the right eye was the control eye and the left eye the experimental eye. Surgical removal of the extraorbital lacrimal gland from the control eyes was performed to create a condition simulating keratoconjunctivitis sicca. In the experimental eyes of group 1, in addition to the removal of the extraorbital lacrimal gland, a part of the autologous submandibular gland was transferred to the orbit and fixed to the intraorbital lacrimal gland. In the experimental eyes of group 2, in addition to the removal of the extraorbital lacrimal gland, an aseptic silicon rubber was transferred to the orbit and fixed to the intraorbital lacrimal gland. In the experimental eyes of group 3, there was no removal of the extraorbital lacrimal gland but instead a sham operation was performed. The histological changes and innervation pattern in the transferred submandibular gland of group 1 were observed. Tear secretion of each group was measured to study the functional effect. Results: Three months after the transplantation, the transferred submandibular glands were similar to the unoperated submandibular glands both in histology and innervation pattern. In group 1, the tear secretion in the experimental eyes was significantly greater than that of the control eyes at 2 and 3 months following transfer. In group 2, no significant difference was noted between the experimental eyes and control eyes. In group 3, the difference in tear secretion between the experimental eyes and control eyes was significant. Conclusion: The result of this study revealed that although the procedure did not involve vascular anastomosis, the transfer gland showed a normal histological appearance and good reinnervation, even 3 months after the transfer. These transferred submandibular glands continued to secrete tears. This secretion continued to increase up until the end of the experimental period.

Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis

Aims To compare the clinical features and treatment outcome between lacrimal plug-related canaliculitis and primary canaliculitis. Methods Patients with plug-related canaliculitis and primary canaliculitis between 2007 and 2014 in a medical centre were collected. Charts were reviewed for clinical features, microbiological profiles, time lapse between plug insertion and symptom onset, type of plug and outcomes. Results Of 76 eligible cases collected, 13 were plug-related canaliculitis and 63 were primary canaliculitis. The most common presenting symptom was discharge in both groups (85% and 79%, respectively). The average time interval from plug insertion to symptoms onset was 5.5 years. Most canaliculitis developed in women, especially for plug-related canaliculitis, when compared with primary canaliculitis (100% vs 65.1%; p=0.015). The most common isolated microorganism was Pseudomonas aeruginosa in plug-related canaliculitis (46%) and Streptococcus in primary canaliculitis (28%), respectively. Isolation of Pseudomonas was significantly higher in plug-related canaliculitis than in primary canaliculitis (46% vs 12%; p=0.029). Most plug-related canaliculitis resolved after removal of plugs by canaliculotomy (12 cases, 93%). Most identified plug was SmartPlug (seven cases), followed by EaglePlug (two cases) and Herrick Lacrimal Plug (two cases). There was no recurrence in patients with plug-related canaliculitis, however, recurrence developed in seven patients (11%) with primary canaliculitis. Conclusions In comparison with primary canaliculitis, plug-related canaliculitis appear to be more prevalent in women and show a different microbiological profile. Retrieval of infected plug by canaliculotomy and adequate antibiotics can achieve a good outcome. Long-term follow-up is required because canaliculitis may develop several years after plug insertion.

Comparison of the Clinical Characteristics and Outcome of Benign and Malignant Eyelid Tumors: An Analysis of 4521 Eyelid Tumors in a Tertiary Medical Center

We retrospectively reviewed the clinical features and outcome of benign and malignant eyelid tumors from 1995 to 2015 in a tertiary medical center. Among 4,521 histologically confirmed eyelid tumors, 4,294 (95.0%) were benign tumors and 227 (5.0%) were malignant tumors. The mean age at diagnosis was significantly higher in patients with malignant lid tumors than those with benign lid tumors (72.5 and 55.4 years, resp., p < 0.001). The most common benign eyelid tumors were intradermal nevus (21.1%), followed by seborrheic keratosis (12.6%) and xanthelasma (11.2%). The most common malignant eyelid tumors were basal cell carcinomas (57.8%), followed by sebaceous gland carcinomas (21.1%) and squamous cell carcinomas (10.1%). There was a relative male predominance (63.4% and 49.2%, resp., p < 0.001) and higher recurrence rate (11.9% and 4.4%, resp., p < 0.001) in malignant lid tumors as compared with those of benign lid tumors. Twenty-two patients (9.7%) received orbital exenteration/enucleation. Eight patients (3.5%) with malignant lid tumors died of disease. Patients with eyelid melanoma were associated with a high mortality rate (25.0%). It is important to differentiate between benign and malignant eyelid tumors, because they may cause cosmetic disfigurement and severe morbidity, especially in those with malignant eyelid tumors.