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Background and Objectives: To find the differences in ocular axial length, keratometric measurements, and intraocular lens (IOL) power in patients with Graves’ disease (GD) after treatment with a thionamide antithyroid drug (ATD), methimazole. Materials and Methods: The medical charts of 28 patients (4 males and 24 females, mean age: 47.2 ± 21.2 years) were studied. Each patient was examined twice using an IOL Master Device and keratometry at the first visit (before ATD treatment) and after 1 month of ATD treatment. The IOL power was calculated for each patient using the Hoffer Q, SRK-2, and SRK/T formulas according to axial length. Results: After 1 month, the axial length increased (right and left eyes: p &lt, 0.001 and p = 0.05, respectively). Based on keratometry, changes in the horizontal and vertical optical power [in diopters (D)] were not statistically significant. However, the IOL power changed after 1 month of ATD treatment in 64.3% of the patients. In 14 patients (50%), there was a 0.5–1.0 D IOL power decrease in single eyes, in two patients (7.1%), an IOL power decrease of 0.5–1.0 D in both eyes, and in two patients (7.1%), a 0.5 D IOL power increase in single eyes. The calculated IOL power values were lower after ATD treatment (right and left eyes, p = 0.010 and p = 0.018, respectively). Conclusions: The IOL power changed in 64.3% of GD patients after ATD treatment. Therefore, avoiding cataract surgery at the early stage of ATD treatment would be appropriate for selecting a more accurate IOL power.

Colony stimulating factor-1 receptor (CSF-1R or FMS) and it ligand, CSF-1, signaling regulates the differentiation and function of tumor-associated macrophages (TAMs) that play an important role in tumor progression. Derivatives of thieno[3,2-d]pyrimidine were synthesized and evaluated as kinase inhibitors of FMS. The most representative compound 21 showed strong activity (IC50 = 2 nM) against FMS kinase and served as candidate for proof of concept. Anti-tumor activity alone and/or in combination with paclitaxel was examined via a tumor cell growth inhibition assay and via an in vitro tumor invasion assay using human breast adenocarcinoma cells.

Purpose The role of fibroblast growth factor (FGF) in orbital fibroblasts (OFs) is rarely known. In this study, we investigated the effect of FGF10 on fibrosis and the inflammation mechanism of Graves′ orbitopathy (GO). Methods Orbital tissue from GO (n = 15) and non-GO (n = 15) was obtained for this study. The mRNA and protein expression levels of FGF10 and FGF receptor 2b (FGFR2b) in orbital tissue were determined by real-time polymerase chain reaction, western blot analysis, and confocal microscopy. The effects of FGF10 on transforming growth factor (TGF)-β1 induced fibrotic proteins and interleukin (IL)-1β- or tumor necrosis factor (TNF)-α- induced inflammatory proteins were investigated using recombinant human (rh) FGF10 and small interfering (si) RNA transfection against FGF10. Results FGF10 and FGFR2b mRNA expression levels were significantly lower in GO orbital tissues than in non-GO orbital tissues (p = 0.009 and 0.005, respectively). Immunostaining of FGF10 in orbital adipose tissues showed differences in FGF10 expression between GO and control samples. Immunostaining of FGF10 was very weak in the orbital tissues of GO patients. TGF-β1-induced fibronectin, collagen Iα, α-smooth muscle actin protein expression in GO OFs was attenuated by rhFGF10 treatment and increased by knockdown of FGF10 via siFGF10 transfection. Similarly, IL-1β- or TNF-α-induced IL-6, IL-8, and cyclooxygenase-2 protein production in GO OFs was either blocked by rhFGF10 treatment or further upregulated by inhibition of FGF10 via siFGF10 transfection. Conclusions Our data demonstrate that FGF10 has beneficial effects on the inflammatory and fibrotic mechanisms of GO in primary cultured OFs, providing new insights into GO pathology and the discovery of FGF10 as a promising novel therapeutic application for the treatment of GO.

Background We developed a novel surgical technique to treat punctal stenosis involving the placement of three interrupted sutures after rectangular three-snip punctoplasty (TSP). Methods Retrospective chart review of forty-eight eyes of 44 patients who underwent rectangular TSP with three interrupted sutures was performed. We investigated whether anatomical recurrences (re-stenosis) occurred during the follow-up period. The subjective symptoms of patients were surveyed. Results The mean patient age was 64.1 years, and the mean follow-up time was 17.4 months. The placement of three interrupted sutures after rectangular TSP afforded satisfactory outcomes. Regarding subjective symptoms, 91.7% of the eyes (44/48) were reported as improved. Among 4 eyes determined as symptomatic failure, anatomical recurrence (re-stenosis of the punctum) was observed in only one eye. The other three (6.25%, 3/48 eyes) showed functional nasolacrimal obstruction, namely epiphora with patent tear duct. Conclusions Placement of three interrupted sutures after rectangular TSP to treat punctal stenosis showed promising results. Notably anatomical success rate was about 98%. Further comparisons between the novel surgical technique and conventional techniques are required.

To compare preoperative incision design markings between both eyelids in upper blepharoplasty.This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. The authors measured medial canthal excision angle, maximal lid excision height, maximal lid excision width, peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software.The mean medial canthal excision angle, maximal lid excision height, and maximal lid excision width for the right side (30.68° ± 10.16°, 1.17 ± 0.24 cm, and 0.72 ± 0.19 cm) were significantly different from those for the left side (35.39° ± 13.82°; Plt; 0.001, 1.24 ± 0.25 cm; P = 0.002, and 0.77 ± 0.21 cm; P = 0.011). The mean peak point angle and peak point distance for the right side (15.67° ± 5.09°, 2.41° ± 0.31°) were significantly different from those for the left side (18.11° ± 5.49°; P = 0.001, 2.22 ± 0.28 cm; P = 0.001).In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximized by including the asymmetries in the preoperative design.

Purpose A mixture of 2% lidocaine with epinephrine and bupivacaine was developed to achieve the fast-onset anesthetic effect of lidocaine and the long-lasting effect of bupivacaine. The authors compared pain scores between 2% lidocaine, 2% lidocaine with epinephrine, and 2% lidocaine with epinephrine-bupivicaine mixture during local anesthesia for eyelid surgeries. Methods This was a double-blind, randomized, prospective, comparative study. In total, 120 consecutive patients (43 males, 77 females, mean age = 47.2 ± 21.2) who underwent bilateral eyelid surgery under subcutaneous anesthesia were asked to report pain scores for each eye during the first injection of anesthesia. Each patient was randomly assigned to receive 1 of the 3 anesthetic agents in 1 eyelid, and 1 of the remaining 2 agents in the other. Results The pH values of the 2% lidocaine, 2% lidocaine with epinephrine, and 2% lidocaine with epinephrine-bupivicaine mixture were 6.23 ± 0.21, 4.21 ± 0.37, and 3.87 ± 0.19, respectively. The pain scores of each were 4.3 ± 1.8, 5.1 ± 1.8, and 5.7 ± 1.9, respectively. The 2% lidocaine with epinephrine produced a statistically significantly higher pain score than 2% lidocaine (p = 0.044, generalized estimating equation method). The mixture also showed a significantly higher pain score than 2% lidocaine (p = 0.003, generalized estimating equation method). Conclusions Epinephrine seemed to increase subjective pain scores. Compared with 2% lidocaine with epinephrine, 2% lidocaine with epinephrine-bupivicaine mixture was not significantly different in terms of subjective symptoms or pH.

Purpose To investigate whether transconjunctival approach surgery caused meibomian gland dysfunction in patients with inferior orbital wall fractures. Methods Twenty consecutive patients who underwent reconstruction surgery for unilateral inferior orbital wall fracture via a transconjunctival approach were enrolled in this study. All patients were asked to complete the Ocular Surface Disease Index questionnaire for each separate eyelid. Both eyelids of each patient underwent slit lamp examination to determine the lid margin abnormality scores. The structure of the meibomian gland was assessed using meibography. Intraindividual comparison of outcome measurements between both eyelids was performed using the Wilcoxon signed-rank test. The contralateral eyelid of each patient was used as a normal control. Results The mean Ocular Surface Disease Index score of the operated eyelid was 46.5 ± 8.9, which was significantly higher than that of the contralateral normal eyelid (23.4 ± 7.3; P = 0.02). The lid margin abnormality score of the operated eyelid (1.2 ± 0.7) was higher than that of the normal eyelid (0.5 ± 0.7; P = 0.033). The meibography score of the eyelid on the operated side (1.8 ± 0.8) was greater than that of the contralateral eyelid (1.0 ± 1.0; P = 0.015). Conclusions Compared to paired normal eyelids, eyelids that underwent transconjunctival approach surgery exhibited significant signs of meibomian gland dysfunction. Clinicians should be aware of such ocular symptoms in patients after transconjunctival approach surgery.

PurposeTo investigate the characteristics of human orbital fibroblasts (OFs) cultivated from intraconal, nasal and central adipose tissues.MethodsIntraconal adipose tissues were obtained during orbital decompression surgery for severe proptosis in nine patients with Graves’ orbitopathy (GO). Nasal and central adipose tissues were obtained during upper eyelid blepharoplasty in nine patients with no history of GO. Human OFs were separately cultured from GO intraconal, non-GO nasal, non-GO central orbital adipose deposits. Human dermal fibroblasts were also cultured from redundant resected skin tissue obtained during upper eyelid blepharoplasty in normal controls. Expression of insulin-like growth factor 1 (IGF-1) and thyroid-stimulating hormone (TSH) receptors were investigated using real-time quantitative reverse transcription PCR. Protein levels of interleukin-1β (IL-1β)-induced inflammatory cytokines and generated intracellular reactive oxygen species (ROS) were determined.ResultsIGF-1 and TSH receptor RNA expressions of GO intraconal OFs and non-GO nasal OFs were higher than non-GO central OFs and dermal fibroblasts. The expression of IL-1β induced the IL-6, IL-8, intercellular adhesion molecule-1 and cyclooxygenase-2 of GO intraconal OFs, and non-GO nasal OFs were higher than non-GO central OFs and dermal fibroblasts. Intracellular ROS generation in GO intraconal OFs and non-GO nasal OFs were higher than in non-GO central OFs and dermal fibroblasts, although the differences were not statistically significant.ConclusionsNon-GO nasal OFs had similar characteristics to GO intraconal OFs. We recommend the use of nasal adipose tissue in order to culture OFs as a normal control involving in vitro experiments.

PURPOSE To analyze corneal curvature changes (eg, central corneal power and corneal astigmatism) after upper eyelid surgery, and to compare the effects of different upper eyelid procedures on corneal curvature. METHODS Fifty eyes of 34 patients with various degrees of dermatochalasis or ptosis underwent corneal topography before surgery, and at 6 weeks after blepharoplasty or levator resection. Patients were divided into groups according to the method of surgery. Preoperative and postoperative changes in corneal curvature of each operated eye were compared within each group. RESULTS At 6 weeks after levator resection, 50% of the eyes showed an increase in corneal power, 34.6% showed a decrease, and 15.4% showed no change. The corneal astigmatism in 50% of eyes with levator resection decreased, increased in 19.2% of eyes, and showed no change in 30.8% of eyes. At 6 weeks after blepharoplasty, 12.5% of the eyes showed an increase in corneal power, 37.5% showed a decrease, and 66.7% showed no change. Regarding corneal astigmatism in patients who underwent blepharoplasty, 16.7% of the eyes decreased, 16.7% increased, and 66.6% showed no change. Comparing eyes treated with the 2 surgical techniques, there was a statistical difference in the percentage eye which showed corneal diopter and astigmatism change using these 2 techniques (P

PURPOSE To determine the relationship between the distribution of adrenergic receptors in the human eyelid and the eyelid elevation after topically instilling 0.5% apraclonidine in blepharoptosis patients. METHODS A total of 26 blepharoptotic patients (30 eyelids) were included in the experimental study. Marginal reflex distance 1 was measured before and after topical instillation of 0.5% apraclonidine. Eyelids were divided into 2 groups according to the responses to topical 0.5% apraclonidine. Patients who positively responded to apraclonidine were classified as group A and those that negatively responded to it were classified as group B. Muller's muscle was obtained during the blepharoptotic surgery, followed by immunohistochemical staining and scoring. This study was approved by the Institutional Review Board of Kim's Eye Hospital and the study protocol adhered to the tenets of the Declaration of Helsinki. RESULTS α-1D staining intensity was significantly higher in group A than in B (p < 0.001) and α-2C and β-1 staining intensities were significantly higher in group B than in A (p < 0.001 and p < 0.05, respectively). The difference in β-2 staining intensity between groups A and B was not statistically significant. CONCLUSIONS α-1D adrenoceptor was predominant in patients showing a positive response to topical 0.5% apraclonidine. Because apraclonidine has an α-1 agonistic effect, α-1D adrenoceptor may contribute to apraclonidine's elevating effect in patients with blepharoptosis.

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

To compare the functional and cosmetic outcomes of two- and three-point sutures for advancing the levator aponeurosis in blepharoptosis surgery on Asians. This retrospective study examined 60 Asian patients with blepharoptosis who had undergone advancement of the levator aponeurosis: 34 patients (46 eyelids) had ptosis correction using the two-point suture technique and 26 patients (41 eyelids) had ptosis correction using the three-point suture technique. The postoperative marginal reflex distance (MRD1), lid height difference, and eyelid contour were evaluated. Twenty-seven (79.4%) of the 34 patients in the two-point group and 19 (73.1%) of 26 patients in the three-point group had a postoperative MRD1 of 2–4 mm, lids within 0.5 mm of each other, and a satisfactory eyelid contour; this difference was not significant. The rate of reoperation did not differ significantly between the two groups. Two- and three-point sutures for advancing the levator aponeurosis were equally effective for correcting blepharoptosis in Asians.

Purpose To investigate leptin expression and distribution in the tissue of lacrimal gland epithelial tumours, and leptin concentration in the tears secreted by these tumours. Methods Clinical records and microscopic slides of six pleomorphic adenoma (PA), three adenoid cystic carcinoma (ACC), and one chronic sclerosing dacryoadenitis (CSD) cases were reviewed. Normal-appearing gland tissue adjacent to tumours from patients with PA served as controls. Tissue leptin expression and distribution were assessed using leptin immunohistochemistry staining. Preoperative and postoperative leptin concentrations in tears were measured in the tumour-affected eye in two patients with PA, two with ACC and one with CSD, and in the contralateral eye in one patient with ACC and one with CSD. Results Moderate cytoplasmic staining was observed in all tumour-adjacent morphologically normal tissue, PA, ACC and CSD tissues. ACC tissues revealed moderate nuclear staining in tumour cells, whereas other tissues did not reveal leptin nuclear staining (p=0.012). Leptin in tears was not detected in the eyes of patients with PA preoperatively and postoperatively. However, leptin was detected in tears of patients with ACC and CSD preoperatively, and its concentration markedly decreased at 1 month postoperatively. Leptin was not detected in any sample from the contralateral eyes of patients for which such samples were available. Conclusions The leptin concentration in tears was greater in patients with ACC than in those with PA. Leptin nuclear staining was only observed in the ACC tissue. Further investigations should be conducted to identify the cause and significance of these findings.

Purpose The objective of this study was to compare the surgical outcomes between interrupted and continuous buried suture methods in double eyelid blepharoplasty in Koreans. Methods Medical records of 204 patients (392 eyes) who underwent double eyelid operation by buried suture method and who were followed up for at least more than 3 months were reviewed. Patients were divided into 2 groups according to the buried suture method; an interrupted group (88 patients) and a continuous group (116 patients). Results The rate of loss of formed double eyelid is 19.3 % (17 of 88 patients) in interrupted buried method and 8.6 % (10 of 116 patients) in continuous group (P = 0.026). One patient experienced an exposure of suture knot in a continuous group, whereas 5 patients experienced an exposure of suture knot and 1 patient suffered from granuloma in an interrupted group (P = 0.021). Conclusions The continuous buried suture method has a lower rate of the loss of double folds and less complication than the interrupted buried suture method for double fold formation in Koreans.

Background Systemic lupus erythematosus (SLE) is associated with B cell hyperactivity, and lupus nephritis (LN), in particular, is promoted by the production of autoantibodies and immune complex deposition. Bruton’s tyrosine kinase (BTK) plays critical roles in B cell receptor-related and Fc receptor-related signaling. We aimed to investigate the impact of therapeutic intervention with HM71224 (LY3337641), a selective BTK inhibitor, on the development of murine SLE-like disease features. Methods We examined the therapeutic effects of HM71224 on SLE-like disease features in MRL/lpr and NZB/W F1 mice. The disease-related skin lesion was macroscopically observed in MRL/lpr mice, and the impact on splenomegaly and lymphadenopathy was determined by the weight of the spleen and cervical lymph node. The renal function was evaluated by measuring blood urea nitrogen, serum creatinine, and urine protein, and the renal damage was assessed by histopathological grading. Survival rate was observed during the administration period. The impact of B cell inhibition was investigated in splenocytes from both mice using flow cytometry. Autoantibody was measured in serum by ELISA. Results HM71224 effectively suppressed splenic B220+GL7+, B220+CD138+, and B220+CD69+ B cell counts, and anti-dsDNA IgG and reduced splenomegaly and lymph node enlargement. The compound also prevented skin lesions caused by lupus development, ameliorated renal inflammation and damage with increased blood urea nitrogen and creatinine, and decreased proteinuria. Furthermore, HM71224 also decreased mortality from lupus development in both mouse models. Conclusion Our results indicate that inhibition of BTK by HM71224 effectively reduced B cell hyperactivity and significantly attenuated the development of SLE and LN in rodent SLE models.

BackgroundTo investigate the role of microRNA (miR)-27a and miR-27b in adipogenesis in an in vitro model of Graves' orbitopathy (GO).MethodsOrbital fat tissues were harvested from GO and non-GO participants for primary orbital fibroblast cultures. The expression levels of miR-27a and miR-27b between GO and non-GO orbital fat tissues were compared. During adipogenesis of GO orbital fibroblasts, the expression levels of miR-27a and miR-27b were determined, and the effects of mimics of miR-27a and miR-27b transfection on adipogenesis of GO orbital fibroblast were investigated.ResultsReal time-polymerase chain reaction showed significantly more decreases in miR-27a and miR-27b levels in orbital fat tissues in GO participants than in non-GO participants (p < 0.05). The expression of both miR-27a and miR-27b was highest in orbital fibroblasts at day 0 and declined gradually after the induction of adipogenic differentiation. The expression levels of PPARγ, CCAAT/enhancer binding protein (C/EBP)α and C/EBPβ were decreased and Oil Red O-stained lipid droplets were lower in GO orbital fibroblasts transfected with miR-27a and miR-27b mimics than in negative controls.ConclusionsOur results indicated that miR-27a and miR-27b inhibited adipogenesis in orbital fibroblasts from GO patients. Further studies are required to examine the potential of miR-27a and miR-27b as targets for therapeutic strategies.

Purpose To determine the correlation between the degree of enophthalmos and interpalpebral fissure (IPF) measurements in a group of patients with unilateral orbital wall fractures. Materials and methods The medical charts of 45 patients diagnosed with unilateral enophthalmos resulting from an orbital wall fracture were reviewed. Demographic characteristics were investigated, including patient age, sex, medical history, and type of orbital wall fracture. The correlation between the degree of enophthalmos and IPF was determined, adjusting for confounding demographic factors. Results In the group with orbital wall fractures, the correlation between the degree of enophthalmos and the IPF measurements was positive and significant (R = 0.299, p = 0.046, Pearson's correlation). The correlation coefficient increased after adjusting for age, sex, medical history, and type of orbital wall fracture (R = 0.316, p = 0.044). Conclusion The patient group with more severe enophthalmos tended to have lower IPF values.

Purpose: To evaluate the surgical outcome between Quickert suture and Quickert suture with modified lateral tarsal strip in involutional lower eyelid entropion. Methods: A retrospective study was performed on 76 patients (94 eyes) who had undergone Quickert suture (Group 1) and on 38 patients (44 eyes) who had undergone Quickert suture with modified lateral tarsal strip (Group 2) for correction of involutional lower eyelid entropion from January 2011 to December 2013. Results: In Group 1, recurrence rate is 25.5% (24 eyes) and mean duration to recurrence is 11.9 months in Group 1. For correction of recurrence, Quickert suture is performed in 50% (12 eyes), Quickert suture with lateral tarsal strip is performed in 37.5% (9 eyes), and lateral tarsal strip is performed in 12.5% (3 eyes). In Group 2, recurrence rate is 9.1% (4 eyes). For correction of recurrence, lower eyelid retractor reinsertion is performed in 50% (2 eyes), Quickert suture with lateral tarsal strip is performed in 25% (1 eye), and Quickert suture is performed in 25% (1 eye). Conclusions: Recurrence rate is lower in patients who had undergone Quickert suture with modified lateral tarsal strip than in a patient who had undergone Quickert suture for correction of involutional lower eyelid entropion.

The aim of this study was to investigate whether the hominis placenta hydrolysates (HPhs) have a protective effect against radiation-induced enteropathies. HPh (1-10 mg kg⁻¹, i.p.) was treated to C57BL/6 mice, once daily for 5 days. Mice were irradiated (10 Gy) 1 h after the last injection. Cell damage was investigated at 24 and 72 h by haematoxylin-eosin staining, and the apoptotic index was determined at 24 h by deoxynucleotidyl transferase-mediated dUTP nick end labelling staining. The results showed that the HPh alleviated radiation-induced damage of crypts and suppressed apoptosis dose dependently. In conclusion, hominis placenta might be a beneficial agent against radiation-induced intestinal complications.

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.

Paralytic ectropion caused by facial nerve palsy often requires surgical intervention for cornea protection. In this study, the authors intended to investigate the long-term surgical outcome of their surgical technique of correcting paralytic ectropion, which is a combined lateral tarsal strip and minimal temporal permanent tarsorrhaphy. The authors performed a retrospective chart review of patients who underwent paralytic ectropion repair by combined lateral tarsal strip with minimal temporal permanent tarsorrhaphy (5 mm) from January 2010 to December 2012. Patients with at least 1 year of follow-up were included. An analysis of preoperative and postoperative measurements included the extent of lagophthalmos, grade of superficial punctate keratopathy (SPK), and tear break-up time (tBUT). The study included 22 patients and a total of 22 eyes. The lagophthalmos, grade of SPK, and tBUT at both 1 month and 1 year of postoperative follow-up were all significantly improved compared with preoperatively (all P

To examine morphologic changes in the meibomian glands associated with patients with Graves' orbitopathy (GO) using a novel meibography imaging system, and to evaluate its correlation with GO clinical manifestations.Retrospective, observational case series.Fifty-one GO patients and 31 normal control participants.This retrospective study examined 51 GO patients and 31 normal control participants. The structure of the meibomian gland was assessed using the meibography imaging system. All of the participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The tear film break-up time (BUT) was measured. The palpebral fissure height, exophthalmos, and eyelid retraction were also assessed.The meibography score, tear film BUT, and OSDI indicated statistically significant differences between the GO and normal groups: The tear film BUT was shorter and the OSDI and meibography score were higher in the GO patient group. There was a significant negative correlation between the meibography score and the tear film BUT in GO patients (r = -.503 and p.001). In the multivariable linear regression analysis, the meibography score of the GO patients had a positive association with exophthalmos and palpebral fissure height.Compared with the normal control participants, GO patients had more unstable tear films and severe symptoms of dry eye. Using the meibography system, the authors found that GO patients had a higher prevalence of obstructive type meibomian gland dysfunction and changes in meibomian glands increased, with proptosis and lid fissure widening.

Aims To investigate the effect of silicone stent intubation (SI) on the quality of life of patients diagnosed with nasolacrimal duct stenosis and dry eye syndrome. Methods This study is a prospective, interventional case series. Consecutive 30 patients diagnosed with nasolacrimal duct stenosis and reflex tearing due to dry eye syndrome were included. Eligible subjects underwent SI and were asked to complete the Glasgow Benefit Inventory (GBI) questionnaire. Surgical outcomes and GBI scores were investigated 6 months postoperatively. Results The surgical success rate determined by the patients’ subjective symptoms was 76.7% (23/30). Mean total GBI score was +17.19 (95% CI 8.34 to 26.03). The general subscale score was +20.36 (95% CI 10.19 to 30.54), the social support scale score was +21.54 (95% CI 11.37 to 31.71) and the physical health score was −0.56 (95% CI −8.92 to 7.80). Conclusions SI could be an effective treatment option for reflex tearing in patients diagnosed with dry eye syndrome and nasolacrimal duct stenosis.

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 report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. Materials and Methods Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. Results Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. Conclusion TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.

Background We describe four cases of primary lacrimal adenoid cystic carcinoma (ACC) treated with neoadjuvant intra-arterial chemotherapy (NAIC). Methods The outcomes and complications of NAIC were reviewed. Several treatment-related local and/or systemic complications were noted. Results One patient experienced ipsilateral eyelid and eyeball necrosis and permanent facial palsy; the second patient developed ipsilateral facial swelling and jaw claudication; and the third patient had febrile neutropenia, cellulitis, and phlebitis. These three patients underwent total exenteration. The fourth patient experienced neutropenia and thrombocytopenia and underwent tumour removal without exenteration. All patients were followed for more than 4 years and were alive at the last follow-up. Conclusion Neoadjuvant intra-arterial chemotherapy may be an alternative treatment that will improve the survival rate of ACC. However, careful and close observation is needed to minimise the risk of side effects. Further investigations are needed to justify the use of chemotherapy-related treatments and the associated costs.

Background Few reports have described the ophthalmic complications that occur after maxillary orthognathic surgery. Since cases of decreased reflex tearing after maxillary orthognathic surgery are extremely rare, we describe 2 cases of loss of reflex tearing after maxillary orthognathic surgery. Case presentation Two Asian women, an 18-year-old and a 32-year-old, suffered from unilateral dryness and irritation caused by maxillary orthognathic surgery. In both patients, Schirmer test (II) showed reduced reflex tearing in 1 eye. Computed tomography showed that the pterygoid plate had been fractured in both patients. Conclusions The pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa may be injured during Le Fort osteotomy.

The purpose of this study was to evaluate the efficacy of simultaneous correction of a postenucleation sunken socket syndrome and deficient inferior fornix with a porous polyethylene wedge and oral mucosa graft.In this study, the authors retrospectively reviewed 24 patients who underwent simultaneous correction of postenucleation sunken socket syndrome by wedge implants and deficient inferior fornix by oral mucosa graft from January of 2009 until December of 2011. Upper and lower fornix depths were measured and exophthalmometry was performed before and 6 months after surgery. A paired t-test analysis was used to compare preoperative and postoperative results of fornix depth and exophthalmos.Of the 24 patients, 15 were women and nine were men. The mean age of the patients was 44.1 years and the mean follow-up period was 11.2 months. Enophthalmos significantly decreased in all cases, with a mean change of 3.3 ± 1.26 mm (p0.001). Inferior fornix depth increased significantly, with a mean difference of 5.0 ± 0.86 mm (p0.001). There were no significant complications after surgery.A simultaneous correction of postenucleation sunken socket syndrome and deficient inferior fornix using porous polyethylene wedge implants and oral mucosa graft can be effective for cosmetic improvements in anophthalmic patients.Therapeutic, IV.

Background The purpose of this study was to report 10 years of experience with unilateral conjunctival mullerectomy in the Asian eyelid. Methods Medical records of patients with unilateral ptosis who underwent conjunctival mullerectomy performed by a single surgeon from January of 2001 to December of 2011 were reviewed. The following factors were investigated: preoperative marginal reflex distance-1 of the ptotic and contralateral normal eyelids, levator function, and preoperative marginal reflex distance-1 after instillation of 2.5% phenylephrine of the ptotic eye. Main outcome measures were the surgical success rate of conjunctival mullerectomy, comparison of preoperative factors according to surgical results, and the results of univariate and multiple logistic regression analyses to identify the factors associated with undercorrection of conjunctival mullerectomy. Results Of a total of 64 eyes (64 patients), 53 eyes (82.8 percent) showed surgical success, two eyes (3.1 percent) showed overcorrection, and nine eyes (14.1 percent) showed undercorrection. The mean preoperative marginal reflex distance-1 difference between both eyes was 2.20 mm in the undercorrection group and 1.40 mm in the surgical success group (p = 0.001). The percentage of patients in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid was 88.9 percent (eight of nine eyes) in the undercorrection group, and 28.3 percent (15 of 53 eyes) and 0 percent (zero of two eyes) in the surgical success and overcorrection groups, respectively (p = 0.001). Multiple logistic regression analysis showed that patients in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid were associated with an increased risk of undercorrection after conjunctival mullerectomy (OR, 10.740; 95 percent confidence interval, 1.098 to 15.431; p = 0.041). We observed 0.18 ± 0.08-mm lid elevation per 1 mm of conjunctival mullerectomy. Conclusions Conjunctival mullerectomy can be successfully performed to correct unilateral ptosis in the Asian eyelid in 82.8 percent of patients. Patients with greater degrees of preoperative ptosis and those in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid have a higher possibility of undercorrection. Clinical question/level of evidence Therapeutic, IV.

Objectives To determine the long-term surgical outcomes associated with the use of Quickert sutures (Q-sutures) for involutional entropion and elucidate the risk factors for postoperative recurrences. Methods This is a retrospective, interventional case series. We recruited patients suffering from involutional entropion who were treated with Q-sutures during the period from January 2008 to August 2010. Preoperative clinical characteristics and surgical outcomes including recurrence at 1, 6, 12, and 24 months were investigated by reviewing the medical charts. Results Of 85 patients, 69 attended each follow-up visit and were included in the analysis. Thirty-four patients (49.3%) experienced recurrences within 2 years. The recurrence rate was 5 of 69 (7.2%) at 1 month, 15 of 64 (21.6%) at 6 months, 9 of 49 (13%) at 12 months, and 5 of 40 (7.2%) at 2 years. Multiple logistic regression analysis showed that men and patients with lower-lid laxity (OR = 2.852 [95% CI: 1.005–8.092] and OR = 3.780 [95% CI: 1.231–11.614], respectively) were susceptible to postoperative recurrences. Conclusions The recurrence rate among patients treated with Q-sutures was highest at the 6-month follow-up visit. Alternative surgical options should be considered in males and those with lower-lid laxity in order to prevent recurrences.

Objective To investigate clinical characteristics of patients with Graves' orbitopathy (GO) who showed discrepancies between levels of thyroid-stimulating immunoglobulin (TSI) and thyrotropin-binding inhibitory immunoglobulin (TBII). Design Comparative case series. Patients A total of 317 patients with GO in whom Mc4-TSI and M22-TRAb (third-generation TBII) were measured simultaneously. Patients were divided into four groups according to TRAb levels as followings: Group 1, TBII and TSI

To determine whether meibomian gland dysfunction (MGD) is a possible cause of ocular discomfort in patients wearing an ocular prosthesis, with the paired normal eye used as a control.Thirty consecutive patients with a unilateral ocular prosthesis completed a questionnaire designed to identify MGD-related ocular symptoms. Both eyelids of each patient underwent slit lamp examination, meibography imaging, and Fourier-domain (FD) optical coherence tomography (OCT) scanning. Intra-individual comparison of main outcome measures between the eyelids of a prosthetic eye and paired normal eyelids was performed using Wilcoxon signed-rank test. A linear mixed model was used to investigate an association between ocular symptoms and condition of meibomian gland/tear parameters.The eyelids with an ocular prosthesis exhibited significantly higher scores for ocular symptoms, lid margin abnormality, meibomian gland expression, and meibography compared to the normal eyelids (p0.01 for all scores). Tear parameters in the eyelid of a prosthetic eye, assessed with FD OCT, were significantly lower than those of the normal eyelid (p0.01 for all scores except tear meniscus angle). The ocular symptom score was significantly positively correlated with the meibography score and negatively correlated with tear parameters (p0.01 for all parameters, linear mixed model).Compared to paired normal eyelids, the eyelids with an ocular prosthesis exhibited significant signs of MGD. These results indicate that clinical assessment and management recommendations for MGD may benefit patients with prosthetic eyes, especially those with ocular discomfort.

This study reports the surgical technique of modified medial tarsorrhaphy using tarsoconjunctival advancement flap for treatment of exposure keratitis secondary to incomplete lid closure combined with ocular dysmotility or decreased corneal sensation. Three patients suffered from intractable exposure keratitis due to incomplete lid closure with ocular motility limitation or decreased corneal sensation, even after the lateral tightening procedure. Because they did not want a cosmetically unacceptable appearance by permanent tarsorrhaphy, modified medial tarsorrhaphy using tarsoconjunctival advancement flap was performed. Clinical manifestation and surgical outcome were investigated through retrospective chart review. The minimum follow-up period was 10 months. All patients showed successful surgical results. Ocular symptoms were satisfactorily treated, corneal re-epithelialization was achieved and maintained during the follow-up period, lagophthalmos improved, and all patients were satisfied with their appearance. We describe modified medial tarsorrhaphy with tarsoconjunctival advancement flap which was effective in treatment of severe exposure keratitis with incomplete lid closure in patients who elected not to have cosmetically problematic, permanent corrective surgery.

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.

Purpose To report cases of nasolacrimal duct obstruction (NLDO) after maxillary orthognathic surgery. Materials and Methods The authors reviewed the clinical manifestations, dacryocystographic images, and orbital computed tomographic scans of 10 patients who were diagnosed with NLDO after undergoing maxillary orthognathic surgery. Results Six of the 10 patients (60%) complained of epiphora immediately after the surgery. Bilateral (n = 2, 20%) or unilateral (n = 8, 80%) NLDO occurred in all patients involved in the study. Twelve eyes of 10 patients were examined, and dacryocystography showed that the obstruction was present in the distal ostium in 7 eyes (58.3%), the junction between the sac and duct in 3 eyes (25%), and the common canaliculus in 2 eyes (16.7%). Computed tomographic scans of all subjects showed that mucosal swelling and congestion around the distal NLD opening narrowed the space between the lateral nasal wall and the inferior turbinate of the affected side. Dacryocystorhinostomy was performed in 9 eyes (8 patients), with a success rate of 100%. Conclusions The distal to proximal portion of the NLD can become obstructed after maxillary orthognathic surgery. This obstruction seems to be caused by secondary inflammatory changes associated with an indirect injury of the NLD. Therefore, clinicians should be aware of the possibility of NLDO after orthognathic surgery, which can be treated successfully with dacryocystorhinostomy.

Purpose We investigated the effects of quercetin on fibrotic markers and matrix metalloproteinases (MMPs) in primary cells and whole orbital tissues from Graves' orbitopathy (GO). Methods Orbital fat tissues were harvested from GO for primary cell and tissue cultures during orbital fat decompression. To determine noncytotoxic dose and time of quercetin treatment, 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and LDH release assay were performed. The effects of quercetin on fibrosis were evaluated according to a scratch wound closure assay, and Western blotting for expression of fibronectin, collagen Iα, α-smooth muscle actin with or without TGF-β stimulation, and MMP-2, -7, -9, and tissue inhibitor of metalloproteinase-1 with or without IL-1β stimulation. The gelatinolytic activities of MMP-2 and MMP-9 were measured using gelatin zymography. In tissue cultures, MMP secretion and MMP and collagen Iα mRNA levels were determined by enzyme-linked immunosorbent assays and reverse transcription-polymerase chain reaction (RT-PCR), respectively. Results Quercetin significantly inhibited cell migration at nontoxic concentrations. In primary cells, quercetin dose-dependently downregulated expression of TGF-β-stimulated fibronectin and collagen Iα, and IL-1β-enhanced MMP-2 and MMP-9. However, without IL-1β stimulation, 10-50 μM of quercetin increased MMP-2 expression and activity, but dose-dependently suppressed MMP-9 expression and activity. In tissue cultures, quercetin dose-dependently inhibited MMP-2 and -9 activity and secretion, but 30 and 50 μM of quercetin increased tissue MMP-2 mRNA. MMP-9 and collagen Iα mRNA levels were dose-dependently suppressed. Conclusions Quercetin inhibited fibrotic markers and affected MMP-2 and MMP-9 activities in primary cell and orbital fat tissue cultures from GO at nontoxic concentrations. Our results support the potential use of quercetin for active inflammation and treatment or prevention of chronic fibrosis in GO.

To compare clinical characteristics and thyroid-stimulating hormone receptor antibodies (TRAbs) in thyroid-associated ophthalmopathy (TAO) in euthyroid Korean patients with those in hyperthyroid patients. Clinical activity scores (CASs), modified NOSPECS scores, exophthalmometry values, prevalence of optic neuropathy, restrictive myopathy and lid retraction, and the positivity and levels of TRAb (thyrotropin-binding inhibitor immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSI)) were compared in 24 euthyroid (group A) and 139 clinical/subclinical hyperthyroid TAO patients (group B). Group A presented more clinically unilateral involvement than group B (79.2% vs 27.3%, P

To evaluate the efficacy of subconjunctival triamcinolone injection for treating upper eyelid retraction caused by thyroid-associated ophthalmopathy (TAO). Prospective single blind randomized clinical trial. Patients diagnosed with TAO-associated eyelid retraction and/or swelling

We describe the surgical technique of using an illuminated infusion chandelier for cataract extraction in patients with absent red reflex due to vitreous hemorrhage. A 23-gauge illuminated infusion chandelier was used for cataract extraction in 6 consecutive patients (6 eyes) who underwent combined surgery: phacoemulsification and 23-gauge sutureless vitrectomy. During surgery, the light from the illuminated infusion chandelier was used to enhance the red reflex and to better visualize the lens structure and capsule. Continuous curvilinear capsulorhexis and phacoemulsification were successfully performed. Capsular polishing was also performed safely and easily. The posterior capsule remained intact and the intraocular lens was inserted into the bag in all cases. Thus, the use of the 23-gauge illuminated infusion chandelier can improve visualization of the lens structure and capsule, thereby facilitating successful cataract extraction in select patients with vitreous hemorrhage.

Purpose To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. Methods This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. Results Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 ± 2.8 mm) was reduced significantly at six months postoperatively (16.1 ± 2.3 mm). Proptosis significantly decreased with a mean of 4.3 ± 1.7 mm, and the reduction was greatest (5.1 ± 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. Conclusions Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.

Purpose To investigate an association between the levels of serum thyroid-stimulating hormone (TSH)-receptor autoantibodies (TRAbs) and Graves' orbitopathy (GO) activity/severity scores, and compare the performance of three different TRAb assays in assessing the clinical manifestations of GO. Materials and Methods Cross-sectional study. Medical records of 155 patients diagnosed with GO between January 2008 and December 2010 were reviewed. GO activity was assessed by clinical activity score (CAS) and severity graded with the modified NOSPECS score by a single observer. Serum TRAb was measured by three different methods: 1st generation thyrotropin-binding inhibitor immunoglobulin (TBII) assay (TRAb1st); 3rd generation TBII assay (TRAb3rd); and biological quantitative assay of thyroid-stimulating immunoglobulin (TSI) using Mc4-CHO cells (Mc4-CHO TSI assay). Results were correlated with scores of activity/severity of thyroid eye disease. Results All three assays (TRAb1st, TRAb3rd, and Mc4-CHO TSI) yielded results that were significantly positively correlated with CAS (β=0.21, 0.21, and 0.46, respectively; p

Purpose To investigate the effect of yellow-tinted intraocular lenses (IOLs) on short-wavelength automated perimetry (SWAP). Design Cross-sectional observation study. Methods Twenty-two patients who had implantation of yellow-tinted IOLs (AcrySof SN60AT or SN60WF; Alcon Laboratories) in 1 eye and nontinted IOLs (AcrySof SA60AT) in the other eye were included in the study. Standard automated perimetry (SAP) and SWAP were performed. The results for the mean deviation (MD), pattern standard deviation (PSD), and glaucoma hemifield test results were compared intra-individually. Results There was no statistically significant difference between the IOLs on the SAP (MD, PSD; P = .851, P = .388, respectively). However, a significant difference was observed between the IOLs on the SWAP (MD, PSD; P = .033, P = .033, respectively). The glaucoma hemifield test did not show significant differences in the SAP (P = .083). However, the SWAP showed significant differences (P = .003). Conclusions The yellow-tinted IOLs may affect the results of the SWAP; therefore, caution is needed in interpreting the results of the SWAP in eyes with implanted yellow-tinted IOLs.