Su Kyung Jung

Lacrimal gland fistula after cosmetic lateral canthoplasty.

BackgroundWe report a case of lacrimal gland fistula formation after cosmetic lateral canthoplasty in a young Asian woman. PatientA 34-year-old woman, who twice underwent lateral canthoplasties of both eyes with additional upper eyelid blepharoplasty, developed clear fluid discharge from a small draining tract near the lateral canthus after being operated on with cosmetic lateral canthoplasty. Assuming that lacrimal gland fistula has developed, we differentiated the tract from the lacrimal gland using a Bowman probe and performed lacrimal gland fistulectomy, which resolved the discharge, leaving no complications. ConclusionsTo our knowledge, this is the first case of lacrimal gland fistula after cosmetic lateral canthoplasty, and surgeons performing this procedure should be aware of lacrimal gland herniation and fistula tract formation, especially in patients who have undergone multiple eyelid surgeries.

Effect of Orbital Decompression on Corneal Topography in Patients with Thyroid Ophthalmopathy

Objective To evaluate changes in corneal astigmatism in patients undergoing orbital decompression surgery. Methods This retrospective, non randomized comparative study involved 42 eyes from 21 patients with thyroid ophthalmopathy who underwent orbital decompression surgery between September 2011 and September 2014. The 42 eyes were divided into three groups: control (9 eyes), two-wall decompression (25 eyes), and three-wall decompression (8 eyes). The control group was defined as the contralateral eyes of nine patients who underwent orbital decompression surgery in only one eye. Corneal topography (Orbscan II), Hertel exophthalmometry, and intraocular pressure were measured at 1 month before and 3 months after surgery. Corneal topographic parameters analyzed were total astigmatism (TA), steepest axis (SA), central corneal thickness (CCT), and anterior chamber depth (ACD). Results Exophthalmometry values and intraocular pressure decreased significantly after the decompression surgery. The change (absolute value (|x|) of the difference) in astigmatism at the 3 mm zone was significantly different between the decompression group and the controls (p = 0.025). There was also a significant change in the steepest axis at the 3 mm zone between the decompression group and the controls (p = 0.033). An analysis of relevant changes in astigmatism showed that there was a dominant tendency for incyclotorsion of the steepest axis in eyes that underwent decompression surgery. Using Astig PLOT, the mean surgically induced astigmatism (SIA) was 0.21±0.88 D with an axis of 46±22°, suggesting that decompression surgery did change the corneal shape and induced incyclotorsion of the steepest axis. Conclusions There was a significant change in corneal astigmatism after orbital decompression surgery and this change was sufficient to affect the optical function of the cornea. Surgeons and patients should be aware of these changes.

CD34 + tumours of the orbit including solitary fibrous tumours: a six-case series

BackgroundTo report six cases of CD34+ fibroblastic mesenchymal tumours, which are uncommon neoplasms in the orbit.Case presentationSix patients presenting with proptosis and palpable mass who were later diagnosed with fibrous solitary tumours, fibrous histocytoma or haemangiopericytoma in the orbit were included. All patients received radiologic examinations and surgical excision for histopathology and immunohistochemistry examinations. Five patients had no recurrence after a minimum follow-up of 12 months. One patient (case 6) experienced recurrence twice, and had debulking surgeries each time. At present, the patient still has remnant tumour in the orbit, but no growth has been detected during the past two years. The tumour size will be closely monitored.ConclusionsEven though fibroblastic tumours are rarely found in the orbit, they can present as a palpable mass with proptosis. Complete surgical excision is important for long-term prognosis, and immunohistochemical study is helpful for confirming pathologic diagnosis.

Corneal stromal damage through the eyelid after tightening using intense focused ultrasound.

entity is usually subtle rather than gross, as in our patient. Furthermore, whiplash maculopathy has been associated with OCT appearances of a hyperreflective lesion at the vitreoretinal interface, rather than the macular edema we observed. A case report by Parsons et al. described an association between a severe whiplash injury and serous retinal pigment epithelial detachments and retinoschisis most likely attributable to a shearing mechanism, although in this case the patient’s injuries were so extensive they led to death. Previous cases of traumatic retinal angiopathy have also been described, although these were invariably unilateral and less significant visual deterioration was manifest. Macular edema has been reported in cases after minor head trauma (with normal Glasgow Coma Score) and after blunt ocular trauma, as in commotio retinae; however, our patient had no evidence of head or systemic trauma, and commotio retinae is characterized by retinal pallor, which our patient did not display. Cases bearing resemblance to our patient have been described; however, the pattern of macular thickening was different in these cases and 1 case did suffer minor ocular trauma and concussion. Airbag deployment in road traffic accidents has also been associated with retinal findings such as cotton wool spots, subretinal fluid, and impending macular hole, along with persistent central visual disturbance, which again were not seen in our case presentation. In summary, the clinical presentation and ocular findings noted in our case appear distinct from other such ophthalmic manifestations of trauma, making this a unique and instructive report. A discussion of the potential pathophysiology of the bilateral macular edema in this case is difficult given the absence of fundus fluorescein angiography. However, given the rapidity of resolution of the edema and lack of recurrence over 1 year of follow-up, it was believed to be unethical to undertake fundus fluorescein angiography. In other cases of retinal trauma, the manifestations are postulated to be a combination of localized microcirculatory insufficiency caused by localized endothelial damage, coagulation, and