Refractive errors in high myopic eyes after phacovitrectomy for macular hole

AIM: To examine the refractive prediction error in high myopic eyes after phacovitrectomy.METHODS: This retrospective comparative case series included 91 eyes(18 high myopic eyes and 73 non-high myopic eyes) of 91 patients who underwent successful phacovitrectomy(phacoemulsification, intraocular lens implantation, and pars plana vitrectomy). The high myopic eyes were defined as the eye with more than 26.0mm of axial length. The postoperative prediction error of mean error and mean absolute error were evaluated at4 mo postoperatively. Axial length and keratometry measurement were performed preoperatively and 4mo postoperatively using the IOL Master.RESULTS: The refractive outcome after phacovitrectomy showed significantly greater myopic shift in the high myopic eyes [-1.08 ±0.87 diopters(D)] than that in the non-high myopic eyes(-0.43 ±0.63 D, P =0.004). Axial length and keratometric value in the high myopic eyes were significantly increased(P =0.043, 0.037 respectively),whereas those in the non-high myopic group were not significantly increased(P =0.135, 0.347 respectively). The change of the axial length in the myopic eye(0.46±0.28 mm)was greater than that in the non- high myopic eye(0.11 ± 0.34 mm; P <0.001).CONCLUSION: High myopic eyes showed more myopic shift than non-high myopic eyes after phacovitrectomy.The cause of myopic shift in high myopic eyes seems tobe attributed to actual elongation of the axial length in high myopia.

Treatment of intractable orbital implant exposure with a large conjunctival defect by secondary insertion of the implant after preceding dermis fat graft

AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis. METHODS: A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated.RESULTS: The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion. CONCLUSION: The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.

Effect of trapping vascular endothelial growth factor-A in a murine model of dry eye with inflammatory neovascularization

·AIM: To evaluate whether trapping vascular endothelial growth factor-A(VEGF-A) would suppress angiogenesis and inflammation in dry eye corneas in a murine corneal suture model.·METHODS: We established two groups of animals, one with non-dry eyes and the other with induced dry eyes.In both groups, a corneal suture model was used to induce inflammation and neovascularization. Each of two groups was again divided into three subgroups according to the treatment; subgroup I(aflibercept),subgroup II(dexamethasone) and subgroup III(phosphate buffered saline, PBS). Corneas were harvested and immunohistochemical staining was performed to compare the extents of neovascularization and CD11b+ cell infiltration. Real-time polymerase chain reaction was performed to quantify the expression of inflammatory cytokines and VEGF-A in the corneas.·RESULTS: Trapping VEGF-A with aflibercept resulted in significantly decreased angiogenesis and inflammation compared with the dexamethasone and PBS treatments in the dry eye corneas(all P <0.05), but with no such effects in non-dry eyes. The anti-inflammatory and antiangiogenic effects of VEGF-A trapping were stronger than those of dexamethasone in both dry eye and non-dry eye corneas(all P <0.05). The levels of RNA expression of VEGF-A, TNF-alpha, and IL-6 in the aflibercept subgroup were significantly decreasedcompared with those in the PBS subgroup in the dry eye group.·CONCLUSION: Compared with non-dry eye corneas,dry eye corneas have greater amounts of inflammation and neovascularization and also have a more robust response to anti-inflammatory and anti-angiogenic agents after ocular surface surgery. Trapping VEGF-A is effective in decreasing both angiogenesis and inflammation in dry eye corneas after ocular surface surgery.

Concurrence of iridocorneal endothelial syndrome in a patient with glaucomatocyclitic crisis

Dear Sir,Iam Jin A Choi,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.I write to present a case report of a young female treated with the diagnosis of Posner-Schlossman syndrome for several years,in which she was ultimately proved to have iridocorneal endothelial(ICE)syndrome.Posner-Schlossman syndrome(PS syndrome)is characterized by recurrent attacks of mild anterior uveitis with marked elevation of intraocular pressure(IOP)[1].The exact etiology of this syndrome is not fully established yet.However,the possible role of herpes simplex virus(HSV)is suggested by a study that revealed DNA evidence of the virus in all aqueous specimens of patients during acute attacks in PS syndrome[1,2].ICE is a spectrum of disease

Recurrent basal cell carcinoma of lower lid invading the orbit and whole hemiface reconstructed by rectus abdominis free flap

Dear Sir, I am Dong Hyun Ji, from the Department of Ophthalmology of St. Vincent’s Hospital, Suwon, Korea. I write to present a very severely recurrent basal cell carcinoma (BCC) in lower lid invading left orbit and whole hemiface,

Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model

AIM: To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration,neovascularization(NV) and lymphangiogenesis(LY)between the dry eye and non-dry eye in murine cataract surgery models.·METHODS: We established two groups of animals, one with normal eyes(non-dry eye) and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture.After harvesting of corneas on the 9th postoperative day and immunohistochemical staining, we compared NV, LY and CD11b+ cell infiltration in the corneas.· RESULTS: Dry eye group had significantly more inflammatory infiltration(21.75%±7.17% vs 3.65%±1.49%;P =0.049). The dry eye group showed significantly more NV(48.21% ±4.02% vs 26.24% ±6.01%; P =0.016) and greater levels of LY(9.27%±0.48% vs 4.84%±1.15%; P =0.007). In corneas on which no surgery was performed,there was no induction of NV in both the dry and non-dry group, but dry eye group demonstrated more CD11b+cells infiltration than the non-dry eye group(0.360% ±0.160% vs 0.023% ±0.006%; P =0.068). Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection(P =0.020 and 0.000, respectively).·CONCLUSION: In a murine cataract surgery model,preexisting dry eye can induce more postoperative NV,LY, and inflammation in corneal tissue.

A case of unsuspected trans-orbital-cranial penetrating injury by a wooden chopstick in a one-year-old infant

Dear Editor,Transorbital penetrating injury is one emergency faced by ophthalmologists during primary care that requires special attention because it can lead to serious ophthalmic and neurological sequela.Of all head injuries, intracranial penetrating injuries occur at a low rate of 0.4%[1], and transorbital-cranial penetrating injuries are even more rare, but do occur more frequently in young children than in adults[2-3].

Temporary severe oculomotor nerve palsy after reconstruction of orbital medial wall fracture: a case report of nonfamiliar complication

Dear Editor, Commonly known complications following reconstruction of an orbital fracture include diplopia, hemorrhage, and displacement or infection of the orbital implant, and some studies have reported ptosis caused by temporary or permanent oculomotor nerve palsy after operation.