Inferior oblique weakening surgery on ocular torsion in congenital superior oblique palsy

AIM: To investigate changes in fundus excyclotorsion after inferior oblique myectomy or myotomy. METHODS: The records of 21 patients undergoing strabismus surgery by a single surgeon between 2009 and 2012 were examined. Only patients who had undergone an inferior oblique myectomy or myotomy,with or without horizontal rectus muscle surgery, were evaluated. Digital fundus photographs were obtained,and the angle formed by a horizontal line passing through the optic disc center and a reference line connecting the foveola and optic disc center was measured. Associated clinical factors examined include age at the time of surgery, presence or absence of a head tilt, degree of preoperative vertical deviation,torsional angle, inferior oblique muscle overaction/superior oblique muscle underaction, and surgery laterality. Whether the procedure was performed alone or in combination with a horizontal rectus muscle surgery was also examined. RESULTS: Mean preoperative torsional angle was12. 0 ± 6. 4 °, which decreased to 6. 9 ± 5. 7 ° after surgery(P 【0.001, paired t-test). Torsional angle also decreased from 15. 1 ± 7. 0 ° to 6. 2 ± 4. 3 ° in the myectomy group(P 【0.001, paired t-test) but there were no significant changes in the myotomy group(P =0.093, Wilcoxon signed rank test). Multivariable linear regression analysis showed that preoperative torsional angle, degree ofinferior oblique overaction, and age at surgery independently and significantly affected postoperative torsional angle.CONCLUSION: Mean torsional angle decreased after inferior oblique myectomy. Degree of preoperative torsional angle, inferior oblique overaction, and age at surgery influence postoperative torsional angle.

Intraocular medulloepithelioma in children: clinicopathologic features itself hardly differentiate it from retinoblastoma

Dear Editor,Iam Di: Jinho Lee from the Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. I am writing to present five case series of intraocular medulloepithelioma. Medulloepitheliomas are the second most common type of pediatric intraocular tumors. They display clinical characteristics similar to retinoblastomas, such as leukocorias and intraocular endophytic masses, and are extremely difficult to clinically differentiate from retinoblastomas.

CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease: multi-institutional case series

AIM:To report CT and MR imaging findings of ocular adnexal mucosa-associated lymphoid tissue lymphoma associated with IgG4-related disease(IgG4-MALT lymphoma),a rare but clinically important complication of ocular adnexal IgG4-related disease.METHODS:We retrospectively reviewed all cases of histologically confirmed ocular adnexal IgG4-related disease at three ter tiary and one secondary referral centers,between February 2003 and December 2016.Seven cases of histopathologically diagnosed IgG4-MALT lymphoma were identified.CT and MR images were analyzed by consensus of two experienced head and neck radiologists.RESULTS:Lacrimal glands were the main site of involvement in all seven patients.The lesions typically showed well-demarcated margins,iso-to hyperattenuation on precontrast CT,T2 hypo-to isointensity,T1 isointensity,and homogenous internal architecture with homogenous enhancement pattern.Lesions were mostly hyperdense and isointense to normal extraocular muscles on postcontrast CT and MR images,respectively.CONCLUSION:Unlike in typical ocular adnexal IgG4-related disease,T2 isointensity and hyperattenuation on precontrast CT images were noted in some IgG4-MALT lymphoma cases.Although the findings may be nonspecific,the possibility of accompanying MALT lymphoma may need to be considered,when ocular adnexal lesions in patients clinically suspected of having IgG4-related disease are refractory to glucocorticoids and show T2 isointensity and hyperattenuation on precontrast CT for the optimal management of the patients.However,this is a case series of a very rare complication of ocular adnexal IgG4-related disease,and thus caution is warranted to generalize the conclusion.