Search

Purpose: This study investigated the surgical outcomes of canalicular trephination combined with endoscopic dacryocystorhinostomy (DCR) in patients with a distal or common canalicular obstruction. It also identified the factors affecting surgical success rates associated with this technique. Methods: We retrospectively reviewed the medical records of 57 patients (59 eyes) in whom a canalicular obstruction was encountered during endoscopic DCR. All patients were treated with endoscopic DCR, followed by canalicular trephination and silicone tube placement. The surgical outcome was categorized as a functional success according to the patient’s subjective assessment of symptoms, including epiphora, and as an anatomical success according to a postoperative nasolacrimal duct irrigation test. Surgical success rates were compared based on age, sex, location of the obstruction, number of silicone tubes, and experience of the surgeon. Results: Functional success was achieved in 55 of 59 eyes (93%) at one month, 50 eyes (84%) at three months, and 46 eyes (78%) at six months. Anatomical success was achieved in 58 of 59 eyes (98%) at one month, 52 eyes (88%) at three months, and 50 eyes (84%) at six months. There was a statistically significant difference in surgical outcome according to the experience of the surgeon. The anatomical success rate at the six-month follow-up exam was 95.4% in the >5 years of experience group, and 53.3% in the

Purpose: To report on the anatomical and functional changes to the macula in nine patients suffering from commotio retinae not accompanied by any other types of traumatic retinopathy. Methods: Nine injured eyes with commotio retinae were evaluated soon after ocular trauma with ophthalmic examination, including Spectral-domain optical coherence tomography (SD-OCT). In 12 eyes of 6 patients, Humphrey visual field (HVF) and multifocal electroretinogram (mfERG) were performed. Re-examinations were periodically performed for a mean of 26 days. Data from 9 injured eyes were collected and compared to data collected from the 9 non-affected eyes of the same patients. Results: SD-OCT revealed no significant differences in the foveal thickness and total macular volume between traumatized and intact eyes in all 9 patients. Only 3 out of the 9 injured eyes showed abnormal findings in SD-OCT images such as discontinuity of the inner/outer segment (IS/OS) junction or abnormal hyper-reflectivity from the IS/OS and retinal pigment epithelium (RPE) lines in the macula. HVF and mfERG results did not show any functional deterioration in the injured eyes compared with intact eyes. During follow-up, the commotio retinae resolved in all 9 eyes. The changes to the outer retinal region detected in 3 patients by SD-OCT were also resolved. Conclusions: Acute retinal changes in commotio retinae, not associated with other retinal pathologies, were resolved without histological and functional sequelae. In a few cases of commotio retinae, SD-OCT revealed transient abnormalities mainly observed at the IS/OS and RPE complexes.

We investigated the case of a young man with blurred vision in his left eye. His visual acuity was slightly decreased, and ophthalmoscopy disclosed a gray-white lesion in the macula. He had no systemic or ocular history. On the visual field test, the threshold sensitivity was decreased in the corresponding region. Spectral domain optical coherence tomography (OCT) demonstrated a disruption in the photoreceptor inner and outer segment (IS/OS) junction and undulation of the retinal pigment epithelium (RPE) with backscattering. We re-examined the patient after two weeks and after three months without any treatment. Visual acuity and visual field results were gradually normalized, and OCT demonstrated the recovery of continuity in the photoreceptor IS/OS junction, as well as decreased RPE irregularity with minimal backscattering. We used spectral domain OCT instead of time domain OCT (OCT3) so that we could provide better image resolution of the acute retinal pigment epitheliitis (ARPE). Finally, we observed recovery of the functional and anatomical changes in the ARPE patient with a resolution of the condition within three months following the initial examination, using OCT and visual field tests.

Graves' orbitopathy (GO) is a component of autoimmune Graves' hyperthyroidism, in which thyroid stimulating hormone (TSH) receptor antibody (TRAb) stimulates orbital and periorbital tissues [1]. The natural history of GO is not well understood. It is generally thought that GO has an inflammatory, active phase that subsides after 1 to 2 years. The average active inflammatory phase duration is approximately 18 months (range, 3 to 36 months) [2]. After the inflammation subsides, patients may suffer permanent structural changes around the eyes that require surgical repair. Currently, there are two established assays to measure TRAb: the competitive TSH-binding inhibition immunoglobulin (TBII) assay and the functional thyroid-stimulating immunoglobulin (TSI) bioassay [3,4]. The TBII assay utilizes the ability of TRAb to inhibit the binding of radiolabeled TSH to TSH-receptors. The newly-developed, third-generation TBII assay measures the inhibition in the binding of a labelled monoclonal antibody clone M22 to the TSH-receptor rather than the traditional radiolabeled TSH-TSH receptor binding [4,5]. This assay enhanced the sensitivity and specificity of earlier assays using radiolabeled TSH [6,7,8]. The TSI bioassay measures cyclic adenosine monophosphate production after TRAb binds to the TSH-receptor, thus enabling identification of functional TRAb [9,10]. The development of the Mc4-CHO cell line simplified the cell culture protocols for the TRAb bioassays. The Mc4-CHO TSI bioassay has superior diagnostic potential for differentiating Graves' disease (GD) from painless thyroiditis [11]. Recently, several reports have focused on the relevance of TRAb, especially TSI, in untreated early stage GO [12]. Ponto et al. [13] reported that TSI levels correlated with disease activity (R = 0.89) and severity (R = 0.81) in untreated GO. Lytton et al. [12] showed a similar correlation between TSI and GO activity/severity. In previous studies we investigated whether serum TRAb in newly-diagnosed, untreated GO patients were predictive of the disease course beyond the first year after the initial diagnosis [14]. The results showed that patients with higher initial TRAb levels had a greater risk of severe disease outcomes. Likewise, we hypothesized that serum TRAb levels could provide important prognostic information to clinicians regarding early stage GO patients [14]. To the best of our knowledge, no prior reports of TRAb levels in chronic stage GO patients have been published. Chronic stage GO frequently imposes severe psychological, social, and economic burdens on patients because patients often experience substantial facial disfigurement including proptosis, puffy eyelids, and strabismus [1,15,16]. Although GO usually spontaneously resolves, patients often show heterogeneous clinical courses with complications such as restrictive strabismus and severe proptosis. We observed that patients who were current heavy smokers or of old age often exhibited high serum TSI levels even after prolonged anti-thyroid drug (ATD) treatment. TRAb level, TSI and TBII was usually high during the early disease period, and decreased gradually during ATD treatment. TBII typically decreased after a few months of ATD treatment, however, TSI levels generally remained high, especially in patients with complicated GO. In the present study, we investigated the associations between serum TRAb levels and GO activity/severity in chronic-stage GO and compared the performance of two newly-developed TRAb assays: the third-generation TBII assay and the Mc4-TSI bioassay.

Purpose To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery. Methods Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 µg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed. Results The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups). Conclusions Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.