Search

PURPOSE To compare refractive error measured by hand-held wavefront aberrometers with postcycloplegic autorefraction (AR) and cycloplegic refraction (CR). METHODS The medical records of patients who received refractive measurements using the wavefront aberrometer, postcycloplegic AR, and CR between January 2014 and January 2016 were retrospectively analyzed. The mean differences, 95% confidence intervals, and limits of agreement (LOA) were calculated for the refractive vector components (M, J₀, and J45 ). RESULTS Fifty-one patients (9.0 ± 5.5 years, male 41.2%) were enrolled in this study, and only the right eye of each was included. Refractive errors ranged from -9.25 to +7.25 diopters (D) for spherical equivalent (median, 0.75 D). The M component was not significantly different among the three methods (p = 0.080). However, the J₀ vector component was significantly different (p < 0.001). After post hoc analysis, the wavefront aberrometer obtained more positive values for J₀ compared to the other methods. The J45 component was not significantly different among the three methods (p = 0.143). The mean difference between the wavefront aberrometer and postcycloplegic AR was -0.115 D (LOA, -1.578 to 1.348 D) for M, 0.239 D (LOA, -0.371 to 0.850 D) for J₀, and -0.015 D (LOA, -0.768 to 0.738 D) for J45 . The mean difference between the wavefront aberrometer and CR was -0.220 D (LOA, -1.790 to 1.350 D) for M, 0.300 D (LOA, -0.526 to 1.127 D) for J₀, and -0.079 D (-0.662 to 0.504 D) for J45 . CONCLUSIONS The wavefront aberrometer showed good agreement with postcycloplegic AR and CR in spherical equivalents, but tended to produce slightly myopic results. The wavefront aberrometer also overestimated with-the-rule astigmatism. Therefore, we recommend that the device be used for estimations of refractive error, which may be useful for patients who have postural difficulties, live in undeveloped countries, or are bedridden.

INTRODUCTION Mucosal vaccines have several advantages over parenteral vaccines. They induce both systemic and mucosal antigen-specific immune responses, allow easy administration, and bypass the need for trained medical personnel. AREAS COVERED Eye mucosa is a novel route of mucosal vaccine administration. Eyedrop vaccination induces systemic and mucosal immune responses similar to other forms of mucosal vaccines such as oral and intranasal vaccines. EXPERT OPINION Eyedrop vaccines are free of serious adverse side effects like the infiltration of CNS by pathogens. Studies over the years have shown promising results for eye drop vaccines against infectious agents like the influenza virus, Salmonella typhi, and Escherichia coli in animal models. Such efficacy and safety of eyedrop vaccination enable the application of eyedrop vaccines against other infectious diseases as well as chronic diseases. In this review of published literature, we examine the mechanism, efficacy, and safety of eyedrop vaccines and contemplate their role in times of a pandemic.

Background Two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) have been increasingly used in various intra-articular fractures including pilon fracture. However, no study has investigated intraobserver and interobserver reliabilities of pilon fracture classification using 3D CT images. Hypothesis (1) Intraobserver and interobserver agreements of fracture classifications and treatment recommendations will improve by using 2D CT images compared to using plain radiographs only; (2) agreements will improve by adding 3D CT images compared to adding 2D CT images; and (3) agreements of orthopedic residents rather than specialists will be influenced more by imaging modality. Materials and methods Ten orthopedic specialists and 10 residents completed a survey to classify the fractures according to the Ruedi-Allgower and AO/OTA classifications and to select treatment options using 25 pilon fracture images. The survey was conducted using plain radiographs, with 2D and 3D CT images introduced 3 and 6 weeks later, respectively. Kappa coefficients were calculated to determine reliabilities. Results Intraobserver reliabilities for fracture classifications in specialists significantly improved by using 2D images compared to using plain radiographs only. Addition of 3D CT did not significantly improve intraobserver reliabilities compared to those with 2D CT. Use of 2D CT images significantly improved overall interobserver agreement of both classifications, with the improvement being greater for residents. Use of 3D CT images did not improve the interobserver reliability of both classifications. Overall interobserver reliabilities for treatment recommendations did not significantly differ according to the imaging modality. However, interobserver agreement among residents significantly improved from slight agreement using radiographs only to fair agreement using 2D CT images. Discussion Intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendations did not improve between using 3D and 2D CT. Using 2D CT images improved the intraobserver and interobserver reliabilities of the fracture classifications in specialists and the interobserver reliabilities of the fracture classifications and the treatment recommendations in residents. Level of evidence IV, case control study.

Visually impaired and blind people due to diabetic retinopathy were 2.6 million in 2015 and estimated to be 3.2 million in 2020 globally. Though the incidence of diabetic retinopathy is expected to decrease for high-income countries, detection and treatment of it in the early stages are crucial for low-income and middle-income countries. Due to the recent advancement of deep learning technologies, researchers showed that automated screening and grading of diabetic retinopathy are efficient in saving time and workforce. However, most automatic systems utilize conventional fundus photography, despite ultra-wide-field fundus photography provides up to 82% of the retinal surface. In this study, we present a diabetic retinopathy detection system based on ultra-wide-field fundus photography and deep learning. In experiments, we show that the use of early treatment diabetic retinopathy study 7-standard field image extracted from ultra-wide-field fundus photography outperforms that of the optic disc and macula centered image in a statistical sense.

Objectives: Rotavirus (RV) genotypes vary geographically, and this can affect vaccine effectiveness (VE). This study investigated the genotype distribution of RV and explored VE before introducing the RV vaccine to the national immunization programme in Vietnam. Methods: This hospital-based surveillance study was conducted at Children’s Hospital 1, Ho Chi Minh City in 2013–2018. Stool samples and relevant data, including vaccination history, were collected from children aged

Background: Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy. Methods: A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen’s Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels. Results: Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on “most people with genital HPV have no visible signs/symptoms” and less than 18% answered correctly on “I can transmit HPV to my partner(s) even if I have no HPV symptoms.” Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p

Introduction: Cervical cancer is the second leading cause of cancer death among Vietnamese females. By detecting precancerous cells, Pap test screening plays a critical role in the fight against cervical cancer. The present study aims to investigate health-related factors associated with receipt of Pap test among Vietnamese females living in rural Vietnam, particularly examining the correlation between awareness level of the Pap test and the receiving of Pap test. Methods: Anderson’s Behavioral Model of Health Services Use was utilized as the present study’s theoretical framework. A self-administrated questionnaire was completed among 193 females residing in Quantri City, Vietnam. Results: Only 15.5% (N=30) of participants in our sample have had a Pap test. Pap test awareness (OR = 18.38, p

Purpose: To report a new surgical procedure using biodegradable collagen matrix (Ologen) implantation with conjunctival flap for reconstruction of scleromalacia after periocular surgery.Methods: A ...

To investigate conditions that cause temporal lens opacity, we tested chemical and physical factors, such as anaesthesia dose, ocular surface dryness, and infrared (IR) light exposure in anaesthetised C57BL/6 N mice. Mice were anaesthetised with a low (80%; tiletamine/zolazepam 32 mg/kg and xylazine 8 mg/kg, intraperitoneal injection) or high (120%; 48 mg/kg and 12 mg/kg) dose of anaesthetic and examined every 5 min from 10 to 30 min after anaesthesia was induced. Lens opacity levels were assessed and graded (1–6) using the standard classification system. Regardless of the anaesthetic dose, lens opacity grade was 1–2 in moisturised eyes with application of 0.5% carboxymethylcellulose, and 5–6 in dry ocular surface conditions. Lens opacity in mice with high-dose anaesthetic in the dry ocular surface condition was not different from that of mice with low-dose anaesthetic. Lens opacity grade 1–2 was noted in eyes in the wet ocular surface condition, regardless of IR light exposure. During IR light exposure in eyes in the dry ocular surface condition, lens opacity (grade 6) in mice with high-dose anaesthetic was not different from that (grade 6) in mice with low-dose anaesthetic. We demonstrated that ocular surface dryness might be a relevant factor for the formation and progression of lens opacity in anesthetized C57BL/6 N mice. Anaesthesia dose and IR light exposure did not strongly influence lens opacity formation. Furthermore, eyes with corneal dryness-induced lens opacity recovered to normal status without additional intervention.

The goal of this study is to examine the trends, policies and issues of impact evaluation, and to draw policy implications for the introduction of impact evaluation in Korea's ODA evaluation system. To achieve this goal, this study first compares and analyzes the policy, evaluation system and various cases of impact evaluation from other donor agencies such as the World Bank, ADB, USAID, MCC, and JICA. Second, we analyze the major issues related to impact evaluation in details. Three issues are raised and analyzed: evaluability assessment, methodology design, and feedback of the result. Third, we conduct an impact evaluation using clustered-RCT to assess the performance of a health project supported by the Korean government in Vietnam. Finally, we analyze the tasks for introducing impact evaluation into Korea's ODA evaluation system at the level of an ODA-integrated evaluation system and implementing agency. This study also proposes a mid- to long-term roadmap to reform Korea’s ODA evaluation system.

Purpose To investigate changes in the pain-suppressing potency of 2 preoperatively applied topical nonsteroidal antiinflammatory drugs (NSAIDs) after photorefractive keratectomy (PRK) using a time-serial pain-scoring system. Setting Saeyan Eye Center, Seoul, South Korea. Design Comparative case series. Methods Ninety-four patients were randomly assigned to 2 groups: ketorolac group (ketorolac 0.5% in 1 eye and ofloxacin 0.3% in the other eye) and diclofenac group (diclofenac 0.1% in 1 eye and ofloxacin 0.3% in the other eye). One drop of each ophthalmic drug was applied 3 times to each eye 30 minutes before PRK. No other NSAID or steroid was prescribed until 4 days after PRK. The patients were asked to score the postoperative pain in each eye with a visual analog scale at 6, 18, 24, 36, 48, 72, and 96 hours. Results The natural peak of pain was located between 24 and 36 hours. Initially, the degree of pain reduction was constant for both NSAIDs; it dropped after 24 hours and 36 hours in the ketorolac group and the diclofenac group, respectively. The postoperative time-serial pattern of the pain score changed in the diclofenac group but not in the ketorolac group compared with the pattern in the ofloxacin-treated eye. The visual outcome was not affected by either NSAID, and significant complications were not noticed for a mean of 7 months. Conclusions The duration and pattern of the action may vary according to types of NSAIDs. Preemptive topical diclofenac 0.1% was a safe and effective method for post-PRK pain control. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

To demonstrate that ultraviolet-A (UV-A) and voriconazole combination therapy is more effective than voriconazole single treatment for fungal keratitis.The in vitro UV-A (375 nm) fungicidal effect was evaluated on Fusarium solani solutions. Each fungal solution was irradiated with different UV-A irradiation doses. Also, a fungal solution containing voriconazole was also irradiated with UV-A. The in vivo therapeutic effect of UV-A and voriconazole treatment was studied in a rabbit keratitis model. Fungi were injected intrastromally into the cornea of 16 rabbits. Each treatment was initiated 3 days after fungal injection and continued up to 8 days for the following groups: Group 1, control; Group 2, treated with UV-A once a day; Group 3, treated with voriconazole 3 times a day; Group 4, treated with voriconazole 3 times a day and UV-A once a day. On the last day, the sclera-cornea buttons were extracted and microbiological and histological evaluations were performed.The colony-forming units (CFUs) of fungal solutions in culture significantly decreased with UV-A irradiation. The CFUs of fungal solutions containing voriconazole also decreased with UV-A irradiation. In vivo, clinical scores of Group 3 (P=0.03) and Group 4 (P=0.02) 5 days after treatment were significantly lower compared to that of Group 1. The clinical score of Group 4 (P=0.03) 5 days after treatment was significantly lower compared to that of Group 3. The histopathological scores 5 days after treatment were significantly lower in Group 4 compared to those of Group 1 (P0.01) and Group 3 (P=0.02). Based on our CFU analysis, only Group 4 showed significantly lower CFUs compared to Group 1 (P=0.04).UV-A and voriconazole combination treatment could be a safe and effective alternative to voriconazole single treatment for fungal keratitis.

Korean Abstract: 본 연구는 국제사회의 영향력평가 논의동향 및 정책, 쟁점을 살펴보고 우리나라 ODA 성과평가체제에 영향력평가 도입을 위한 정책적 시사점을 도출하는 것을 목적으로 한다. 이를 위해 첫째, 국제사회의 영향력평가 관련 정책 및 수행체제, 사례 등을 비교분석한다. 둘째, 영향력평가 방법 관련 주요 쟁점들을 자세히 분석한다. 셋째, 우리나라 ODA 사업에 실제로 실험적 방법에 기반을 둔 영향력평가를 수행하여 사업의 성과를 측정하고 우리나라 ODA 성과평가에 실질적인 정책적 시사점을 도출한다. 마지막으로 우리나라 ODA 성과관리에 영향력평가 도입을 위한 과제를 ODA 통합평가체계 차원과 시행기관 차원에서 분석하고 중장기적 로드맵을 제시한다. English Abstract: The goal of this study is to examine the trends, policies and issues of impact evaluation, and to draw policy implications for the introduction of impact evaluation in Korea's ODA evaluation system. To achieve this goal, this study first compares and analyzes the policy, evaluation system and various cases of impact evaluation from other donor agencies such as the World Bank, ADB, USA, and Japan. Second, we analyze the major issues related to impact evaluation in details. Three issues are raised and analyzed: evaluability assessment, methodology design, and feedback of the result. Third, we conduct an impact evaluation using clustered-RCT to assess the performance of a health project supported by the Korean government in Vietnam. Finally, we analyze the tasks for introducing impact evaluation into Korea's ODA evaluation system at the level of an ODA-integrated evaluation system and implementing agency. This study also proposes a mid- to long-term roadmap to reform Korea's ODA evaluation system.

We investigated eyedrop vaccination (EDV) in pre-clinical development for immunological protection against influenza and for potential side effects involving ocular inflammation and the central nervous system (CNS). Live attenuated influenza EDV, CA07 (H1N1), PZ-4 (H1N2) and Uruguay (H3N2), induced both systemic and mucosal virus-specific antibody responses in ferrets. In addition, EDV resulted in a clinically significant protection against viral challenge, and suppression of viral replication in nasal secretion and lung tissue. Regarding safety, we found that administered EDV flow through the tear duct to reach the base of nasal cavity, and thus do not contact the olfactory bulb. All analyses for potential adverse effects due to EDV, including histological and functional examinations, did not reveal significant side effects. On the basis of these findings, we propose that EDV as effective, while being a safe administration route with minimum local side effects, CNS invasion, or visual function disturbance.

The eye route has been evaluated as an efficient vaccine delivery routes. However, in order to induce sufficient antibody production with inactivated vaccine, testing of the safety and efficacy of the use of inactivated antigen plus adjuvant is needed. Here, we assessed various types of adjuvants in eyedrop as an anti-influenza serum and mucosal Ab production-enhancer in BALB/c mice. Among the adjuvants, poly (I:C) showed as much enhancement in antigen-specific serum IgG and mucosal IgA antibody production as cholera toxin (CT) after vaccinations with trivalent hemagglutinin-subunits or split H1N1 vaccine antigen in mice. Vaccination with split H1N1 eyedrop vaccine antigen plus poly(I:C) showed a similar or slightly lower efficacy in inducing antibody production than intranasal vaccination; the eyedrop vaccine-induced immunity was enough to protect mice from lethal homologous influenza A/California/04/09 (H1N1) virus challenge. Additionally, ocular inoculation with poly(I:C) plus vaccine antigen generated no signs of inflammation within 24 hours: no increases in the mRNA expression levels of inflammatory cytokines nor in the infiltration of mononuclear cells to administration sites. In contrast, CT administration induced increased expression of IL-6 cytokine mRNA and mononuclear cell infiltration in the conjunctiva within 24 hours of vaccination. Moreover, inoculated visualizing materials by eyedrop did not contaminate the surface of the olfactory bulb in mice; meanwhile, intranasally administered materials defiled the surface of the brain. On the basis of these findings, we propose that the use of eyedrop inactivated influenza vaccine plus poly(I:C) is a safe and effective mucosal vaccine strategy for inducing protective anti-influenza immunity.

Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes. Cold medicines including non-steroidal anti-inflammatory drugs and multi-ingredient cold medications are reported to be important inciting drugs. Recently, we reported that cold medicine related SJS/TEN (CM-SJS/TEN) with severe mucosal involvement including severe ocular surface complications (SOC) is associated with HLA-A*02:06 and HLA-B*44:03 in the Japanese. In this study, to determine whether HLA-B*44:03 is a common risk factor for CM-SJS/TEN with SOC in different ethnic groups we used samples from Indian, Brazilian, and Korean patients with CM-SJS/TEN with SOC, and investigated the association between CM-SJS/TEN with SOC and HLA-B*44:03 and/or HLA-A*02:06. We found that HLA-B*44:03 was significantly associated with CM-SJS/TEN with SOC in the Indian and Brazilian but not the Korean population, and that HLA-A*02:06 might be weakly associated in the Korean- but not the Indian and Brazilian population.

To compare the effect of early systemic immunomodulatory treatment and to identify prognostic factors of chronic ocular complications in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients.Retrospective, comparative, multicenter study.Forty-three patients admitted to 1 of 3 University Hospitals (Seoul National University Hospital, Chonnam National University Hospital, and Yonsei University Hospital) with a diagnosis of SJS or TEN who were followed up for at least 6 months in Korea.Patients were divided into 5 groups according to systemic immunomodulatory treatment received: systemic steroids (S), intravenous immunoglobulin (IVIG), combined S plus IVIG, systemic pulse steroids (PS), and supportive care only (C). Best-corrected visual acuity (BCVA) and chronic ocular surface complications score (COCS; range, 0-15) at final follow-up were compared among the 5 groups. Prognostic factors at onset (age, gender, causative drugs, initial visual acuities, acute ocular involvement score [range, 0-3], acute systemic involvement score [range, 0-16], systemic steroid dose, IVIG dose, and amniotic membrane transplantation [AMT]) were analyzed to predict final BCVA or COCS using logistic regression or linear regression analysis.Best-corrected visual acuity and COCS at final follow-up.The mean age and follow-up period of the patients was 30.5±21.0 years and 29.1±30.4 months, respectively. The acute systemic involvement score in the IVIG, S plus IVIG, and PS groups was significantly higher than that in the S and C groups (P0.001). However, final BCVA and COCS were not significantly different between groups, even after statistical adjustment. High COCS (≥8 points) was associated with female gender (P = 0.012) and AMT at the acute stage (P = 0.040). High acute ocular and systemic involvement scores were associated with worse COCS (P0.001), and COCS showed good correlation with final BCVA (R(2) = 0.7101; P0.0001).There were no therapeutic benefits of systemic immunomodulatory treatments in final visual outcome and COCS in SJS and TEN patients. Female gender and acute ocular and systemic involvement scores may be prognostic factors predicting chronic ocular complications.

Purpose To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft-vs-host disease (GVHD) with ocular surface inflammation. Design A retrospective interventional consecutive case series. Method Long-term maintenance treatment (≥6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations. Results Thirteen patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 ( P = .001) within 2–8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects. Conclusion Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD.

To evaluate dry eye and meibomian gland dysfunction after cataract surgery.Prospective observational case series.We studied 58 eyes of 48 patients who underwent phacoemulsification and evaluated them preoperatively and at 1 month and 3 months postoperatively. Ocular symptom scores, lid margin abnormalities, superficial punctate keratopathies (SPKs), tear film break-up time (TBUT), Schirmer test, lower tear meniscus height, depth, and area using Fourier domain optical coherence tomography, meibum expressibility and images of the meibomian glands using meibography were measured.The ocular symptom scores were worse at 1 month and 3 months postoperatively (P0.001 and P0.001, respectively). Lid margin abnormalities were significantly increased (P0.001 and P0.001, respectively) and TBUT decreased postoperatively (P0.001 and P0.001, respectively). Meibum expressibility decreased at 3 months postoperatively (P = 0.016); however, meibography score, SPK, lower tear meniscus height, depth and area and the Schirmer test did not change significantly postoperatively (all P values0.05).Meibomian gland function may be altered without accompanying structural changes after cataract surgery.

목적: 백내장 수술 전후 0.05% 사이클로스포린 점안액 사용이 눈물막 및 각막수차에 미치는 영향에 대하여 알아보고자 하였다. 대상과 방법: 백내장 수술을 시행 받은 47안을 대상으로 수술 전 1주부터 수술 후 3개월까지 0.05% 사이클로스포린 점안액을 사용한I군(23안)과 사용하지 않은 II군(24안)으로 나누어 수술 전, 수술 후 1개월 및 3개월째의 눈물막 파괴시간, 기본 눈물 분비, 각막/결막상피 병증, 안구 표면 질환 지수 증상 설문조사, 각막수차를 측정하였다. 결과: 수술 전과 비교하여 눈물막 파괴시간은 I군에서 수술 후 3개월(p=0.026) 때 호전된 양상을 보인 반면 II군에서는 변화 없었고,건성안 증상은 I군에서 수술 후 1개월(p=0.033), 3개월(p=0.003) 때 호전된 양상을 보인 반면 II군에서는 변화 없었다. 각막수차 중RMS total은 수술 전에 두 군에서 차이가 없었으나 3개월(p=0.015)째 I군이 유의미하게 감소하는 양상을 보였다. 또한 I군에서 Coma7 (Z3-1) (p=0.018), spherical aberration (Z40) (p=0.031)이 유의미하게 감소하였고, II군에서는 Trefoil 6 (Z3-3) (p=0.033)가 유의미하게 증가하는 소견을 보였다. 결론: 백내장 수술 전후 사이클로스포린 점안액 사용이 건성안 증상 및 눈물막의 안정에 도움을 주었으며, 이는 수술 후 각막수차를감소시키는 효과를 보였다.

Purpose To investigate the effect of conjunctival mini-flap operation to treat restrictive strabismus in patients with diplopia caused by conjunctival adhesion and hyperplasia after periocular surgery. Design Case series study. Methods Eleven patients with diplopia and restrictive strabismus attributable to conjunctival dysplasia after periocular surgery underwent a conjunctival mini-flap surgery without a muscle operation and were followed-up at 1, 3, and 6 months after surgery. The Hess screen test, binocular single vision field with Goldmann perimetry, and extraocular muscle movement were analyzed pre- and postoperatively. Patient satisfaction with the cosmetic results of conjunctival mini-flap operation was also investigated. Results The mean preoperative alignment deviation in primary position was 10.4 ± 5.6 prism diopters (PD). Diplopia in the primary position was resolved in 95% of the patients. The mean postoperative deviation was 1.36 ± 2.34 PD at the primary position. No significant complications or recurrences were noted after mean 9.5 ± 4.2 months follow-up. Conclusion Conjunctival mini-flap operation is an effective and safe surgical technique for treating patients with diplopia and restrictive strabismus following periocular surgery.

Purpose To compare concentrations of tear cytokines in 3 groups composed of Sjogren syndrome (SS) dry eye, non–Sjogren syndrome (non-SS) dry eye, and normal subjects. Correlations between ocular surface parameters and tear cytokines were also investigated. Design Prospective cross-sectional study. Methods SS dry eye patients (n = 24; 40 eyes) were diagnosed with primary SS according to the criteria set by the American-European Consensus Group. Non-SS dry eye patients (n = 25; 40 eyes) and normal subjects (n = 21; 35 eyes) were also enrolled. Tear concentrations of interleukin (IL)-17, IL-6, IL-10, IL-4, IL-2, interferon γ (IFN-γ), and tumor necrosis factor α (TNF-α) were measured by a multiplex immunobead assay. Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), Schirmer I test, and fluorescein staining scores were obtained from dry eye patients. Results All cytokine levels except for IL-2 were highest in the SS group, followed by non-SS dry eye group and control subjects. Concentrations of IL-17, TNF-α, and IL-6 were significantly different among the 3 groups (IL-17: SS > control P control P = .042, SS > non-SS P control P = .006, non-SS > control P = .034, SS > non-SS P = .029; IL-6: SS > control P = .002, non-SS > control P = .032, SS > non-SS P = .002). IL-17 was significantly correlated with TBUT (R = −0.22, P = .012) and Schirmer I test (R = −0.36, P = .027) scores in the SS group. IL-6 was significantly correlated only with TBUT (R = −0.38, P = .02) in the non-SS group. Conclusions Differences in tear cytokine levels and correlation patterns between SS dry eye and non-SS dry eye patients suggest the involvement of different inflammatory processes as causes of dry eye syndrome.