Su-Ho Lim

Extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type of the ocular adnexa: Retrospective single institution review of 95 patients

Context: There are few reports on the management of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT), which are based on the experience of a single institution, as opposed to large multicenter randomized trials. Aim: The aim of this study was to report on the clinical experience of a single institution. Materials and Methods: A retrospective review was undertaken of records of 95 patients with MALT lymphoma of the ocular adnexa. Histologic diagnosis of MALT lymphoma was made according to established criteria, and clinical staging was carried out to determine treatment modalities. All patients were treated by external beam irradiation (30.6–45.0 Gy) after biopsy. Additional chemotherapy was performed in accordance with the clinical stage of the disease. All the patients were treated by the same hemato-oncologist and radio-oncologist. Results: Almost all patients showed complete response, except for four patients who showed partial response. In two of 95 patients, contralateral eye showed recurrence, and they were salvaged by additional radiotherapy. The 3-year overall survival and event-free survival rates were 100 and 97%, respectively, by Kaplan–Meier survival analysis. Moreover, there were no serious radiation-associated complications. Conclusions: Radiotherapy alone can be an important treatment modality for the local control and survival in patients with localized MALT lymphoma of ocular adnexa. Systemic chemotherapy should be considered in patients with advanced stage disease.

Long-term Outcomes of Mitomycin-c Trabeculectomy in Exfoliative Glaucoma Versus Primary Open-angle Glaucoma.

Purpose: To compare long-term surgical outcomes in exfoliative glaucoma (XFG) versus primary open-angle glaucoma (POAG) after primary trabeculectomy with mitomycin-C. Methods: This retrospective, case-control study included 32 eyes of XFG and 64 eyes of POAG matched by propensity score analysis. Surgical success was defined according to 3 different criteria: (1) intraocular pressure (IOP)<18 mm Hg and IOP reduction ≥20% without medication; (2) IOP<15 mm Hg and IOP reduction ≥25% without medication; and (3) IOP<18 mm Hg and IOP reduction ≥20% with or without medication. Cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors of surgical failure were analyzed. Results: Cumulative success rates were 84.4% at 1 year and 19.9% at 5 years for XFG, and 82.3% and 64.7%, respectively, for POAG by criterion A. Complete success rates were significantly lower for XFG than for POAG by criteria A and B. However, qualified success, as determined by criterion C, did not show a statistically significant difference. Postoperative hyphema was more frequent for XFG. The risk factors associated with surgical failure were a young age (<60 y; hazard ratio=2.58, P=0.047, criterion A) and exfoliation syndrome (hazard ratio=3.01, 2.96, P=0.006, 0.005, criteria A and B). Conclusions: Although trabeculectomy for XFG had success rates similar to POAG at 1 year, XFG showed poorer long-term IOP control from 2 years postoperatively. This study indicates that it is more difficult to achieve long-term low target IOP control in eyes with XFG than in eyes with POAG after trabeculectomy with mitomycin-C.

Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

BackgroundThe relationship between intraocular pressure (IOP) changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery.Case presentationA 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+) in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg) and no painful IOP spikes occurred during hemodialysis over the first postoperative year.ConclusionWe present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.

Incidental frontoparietal parasagittal meningioma in a patient with acute bilateral optic neuritis.

Department of Ophthalmology, Daegu Veterans Health Service Medical Center, Daegu 704-802, Korea Department of Ophthalmology, Yeungnam University College of Medicine, Daegu 705-717, Korea 3Department of Ophthalmology, Inje University Busan Paik Hospital, Busan 614-735, Korea Correspondence to: Su-Ho Lim. Department of Ophthalmology, Daegu Veterans Health Service Medical Center, 60 Wolgok-Ro, Dalseo-Gu, Daegu 704-802, Korea. mdshlim@gmail.com Received: 2014-01-21 Accepted: 2014-04-22

COMPARISON OF THE LAMINA CRIBROSA THICKNESS OF PATIENTS WITH UNILATERAL BRANCH RETINAL VEIN OCCLUSION AND HEALTHY SUBJECTS.

Purpose: To compare the lamina cribrosa (LC) thickness of healthy subjects and patients with unilateral branch retinal vein occlusion (BRVO), and to determine possible correlations between the LC thickness and the BRVO subtypes. Methods: This prospective, cross-sectional study included a total of 46 patients with naive, untreated, unilateral BRVO and 31 healthy control subjects. The occlusion site was divided into two BRVO types: arteriovenous crossing BRVO (AV-BRVO) and optic nerve BRVO (ON-BRVO). The optic nerve head was scanned using enhanced-depth imaging with the Spectralis optical coherence tomography system. Results: The mean LC thickness of both eyes in patients with BRVO was thinner than that of eyes (274.0 &mgr;m) of the healthy subjects (both, P < 0.001). Although the LC thickness of the BRVO-affected eyes was slightly thinner than that of the fellow eyes (237.0 &mgr;m vs. 241.4 &mgr;m, respectively), there was no statistically significant difference. In addition, there were no significant differences in the LC thicknesses of both eyes according to the site of occlusion. Conclusion: A thinner LC was observed in both eyes of unilateral BRVO patients compared with those of healthy subjects. This finding suggests that thin LC may contribute to the pathogenesis of BRVO as a local mechanical factor in addition to systemic factors.

Short-term in vivo morphological changes of amniotic membrane after fibrin glue-assisted pterygium surgery on anterior segment optical coherence tomography: a case presentation

BackgroundThe evaluations of morphological changes of amniotic membrane (AM), even after successful AM transplantation surgery without complications, may be difficult. Moreover, there was no report regarding morphological changes after fibrin glue-assisted AM transplantation with pterygium excision. Here, we highlight and describe the use of spectral domain optical coherence tomography (OCT) for the evaluation of the morphological features of amniotic membrane (AM) and of associated in vivo structural changes after fibrin glue-assisted pterygium surgery.Case presentationAll three patients underwent cryo-preserved AM transplantation using the permanent inlay technique (epithelial side up) with fibrin glue. In vivo morphological changes of AMs were evaluated using a spectral domain OCT equipped with an anterior segment imaging module (RTVue-100, Optovue, Inc., Fremont, CA, USA). Anterior segment OCT examinations demonstrated morphological changes, that is, re-absorption of fibrin glue or subconjunctival hemorrhage, migration of epithelium, and integration of AM into sclera, of AMs over first postoperative months.ConclusionsAnterior segment OCT might provide additional structural information, including quantitative and qualitative data, on AMs after pterygium surgery as compared with conventional slit-lamp examination.

Immunohistopathologic features of surgically excised overhanging filtering bleb: myofibroblasts after filtration surgery--a case report.

Dear Editor,An overhanging filtering bleb is a late, uncommon complica-tion of trabeculectomy. It expands from the limbus onto thecornea and causes a foreign body sensation, tearing, anddecreased visual acuity [1]. However, there are few reportsofhistopathologicalfindingsofanoverhangingbleb[1–3].Inthis paper, histopathological findings and an immunohisto-chemical study of an overhanging bleb are presented, partic-ularly a case in which a dissecting portion of an overhangingbleb was successfully removed.A 58-year-old male underwent uncomplicatedphacotrabeculectomy with mitomycin C. Seven years later,he visited the authors’ glaucoma clinic due to ocular discom-fortinhislefteye.Henotedseeinga“whitishmaterial”onhisleft eye and an increasing foreign body sensation. A slit-lampexamination showed a thin-walled, avascular, multiloculatedcystic bleb in the superior cornea (Fig. 1a).Despitetheuseofatopicallubricant,theoculardiscomfortwas not relieved. Thus, the authors decided to perform a blebrevision surgery. The corneal portion of the overhanging blebwas bluntly dissected and then removed with cyclodialysisspatula, forceps and scissors. The underlying bleb remainednegative for the Seidel test 1 day after the operation. And itwasstillnegativeafterwards.Until6monthsafterthesurgery,the patient was satisfied with the treatment of his oculardiscomfort and showed stable IOP control without leakage(Fig. 1b). The biopsy specimen consisted of the bleb and thesuperior superficial cornea. A histopathological examinationshowed a multiloculated cystic structure with a flattened cor-neal epithelium, and focal myxoid and hyaline degenerationof the stroma (Fig. 2a). Moreover, the stromal spindle cells(myofibroblasts)werepositiveforvimentinandalpha-smoothmuscle actin (ASMA), and negative for CD34 (immunohis-tochemical stain, Fig. 2b–d).Alargeoverhangingblebmaygraduallyextenddownoverthe cornea, possibly because of the eyelid movement [2].Excision of the excessive bleb near the limbus will not causea bleb leak and will generally not require suturing [1, 2].However,thepathogenesisofanoverhangingblebhadnotbeen fully understood. And there are few reports of blebrevisionsurgeryandhistopathologicexaminations.Tothebestof our knowledge, this is the first report on an immunohisto-chemical stain for myofibroblast in an overhanging filteringbleb. A previously published article suggested a subepithelialdissection component of the bleb into the cornea and thedissectionplaneoverlyingBowman’smembrane[1,2].How-ever, the myofibroblast has not been evaluated in previousstudies [1–3]. The crucial role played by the myofibroblast inwound healing and pathological organ remodeling is well-established. The main mechanism of wound healing bymyofibroblasts is known as tension production throughwound contraction and extracellular matrix production [4].Sometimes they don’t get lost by apoptosis after woundhealing and lead to hypertrophic scar. Myofibroblasts gener-ally show altered responses to cytokine and are characterizedby vimentin-positive stromal cells and the presence of intra-cellular microfilament bundles that contain ASMA, the actinisoform expressed by smooth muscle cells.