PURPOSE: To report a case series of patients experiencing side effects of 0.25% alcaftadine eye drops and to analyze the possible reasons for the side effects. CASE SUMMARY: Medical records of 90 patients who had a history of alcaftadine eye drop use were retrospectively analyzed. Eight out of the 90 patients (8.9%) showed ocular side effects that required discontinuation of the alcaftadine eye drops. All eight cases of alcaftadine side effects showed palpebral and bulbar conjunctival injection, watery discharge, and lid swelling. During additional history collection, all patients with alcaftadine side effects confessed of overuse (more than twice/day) of the eye drops. Anticipation for fast symptom relief was the main reason for the alcaftadine overuse. In all side effect cases, patients were asked to stop alcaftadine eye drops and use preservative-free artificial tears and steroid eye drops. After discontinuation of 0.25% alcaftadine eye drops, regression of palpebral and bulbar conjunctival injection and lid swelling was observed. CONCLUSIONS: Overuse of 0.25% alcaftadine eye drops can induce ocular surface toxicity possibly due to toxicity of drug itself. The possible side effects of overuse of 0.25% alcaftadine eye drops should be fully explained to all patients before use.
Conjunctivitis ; Humans ; Hypersensitivity ; Lubricant Eye Drops ; Medical Records ; Ophthalmic Solutions ; Retrospective Studies

PURPOSE: We report a case in which eyelid mass was the initial presentation of breast cancer. The diagnosis of breast cancer was made after lid biopsy. CASE SUMMARY: A 41-year-old female patient presented with a painful mass on the left lower lid after 1 month. There was a pinkish mass in the lateral portion of the tarsal conjunctiva, and computed tomography revealed a mass with an irregular margin on the lower lid connected to the left lacrimal gland. Biopsy was performed at the tarsal conjunctiva of the left eye, and histopathologic examination was suggestive of malignant epithelial cell neoplasm, especially metastatic carcinoma in the breast. The patient was diagnosed as having invasive ductal cancer, for which she is currently receiving chemotherapy. CONCLUSIONS: Metastases to the eyelid are very rare, accounting for less than 1% of all malignant eyelid lesions. We report a patient who presented with an eyelid mass as the initial presentation of breast cancer, which was diagnosed with metastatic breast cancer.
Adult ; Biopsy ; Breast Neoplasms* ; Breast* ; Conjunctiva ; Diagnosis ; Drug Therapy ; Epithelial Cells ; Eyelids* ; Female ; Humans ; Lacrimal Apparatus ; Neoplasm Metastasis

PURPOSE: To evaluate the efficacy of endonasal revision using triamcinolone-soaked nasal packing in patients exhibiting recurrence of epiphora after endoscopic dacryocystorhinostomy. CASE SUMMARY: Four patients (4 eyes) who presented with the chief complaint of recurrence of epiphora after endoscopic dacryocystorhinostomy underwent endonasal revision under local anesthesia. On nasal endoscopy, granulation tissue and membranous tissue around the osseous foramen was removed during endonasal revision. According to the operator's judgement, the osseous foramen was additionally expanded. Following insertion of a silicone tube, triamcinolone-soaked nasal packing was used for intra-nasal packing. The silicone tube was removed after follow-up of more than 12 weeks. Immediately after removing the silicone tube, there was free passage of saline on lacrimal syringing as well as complete resolution of epiphora. At over 6 months of follow-up after tube removal, there was no recurrence of epiphora in any of the 4 patients. CONCLUSIONS: Triamcinolone-soaked nasal packing may be considered in patients with failed endoscopic dacryocystorhinostomy.
Anesthesia, Local ; Dacryocystorhinostomy* ; Endoscopy ; Follow-Up Studies ; Granulation Tissue ; Humans ; Lacrimal Apparatus Diseases ; Recurrence ; Silicon ; Silicones ; Triamcinolone

PURPOSE: To compare two combined surgical techniques, endoscopic endonasal surgery with transconjunctival reconstruction and transcaruncular surgery with transconjunctival reconstruction, when used to treat both medial and inferior orbital wall fractures. METHODS: A retrospective review of 63 patients who were followed up from January 2011 to December 2014 at Inha University Hospital for surgical reconstruction of combined medial and inferior orbital wall fractures was undertaken. We compared between the patients the computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-6 months surgery. A total of 29 patients received endoscopic transnasal surgery with trasconjunctival reconstruction, and 34 received transcaruncular surgery with trans-conjunctival reconstruction. RESULTS: There were no significant differences between the two combined methods in terms of the primary and peripheral gaze diplopia or the restriction of EOM movement 6 months after surgery. However, statistically significant differences were observed in exophthalmometer measurements 6 months after surgery. CONCLUSIONS: The two combined surgical methods showed similar results in terms of postoperative primary and peripheral gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic endosnasal surgery with transconjunctival reconstruction showed several advantages over the other method considered in this study. An appropriate surgical method should be selected by comparing the relative advantages and disadvantages.
Diplopia ; Enophthalmos ; Humans ; Methods ; Orbit* ; Retrospective Studies

PURPOSE: The purpose of our study was to evaluate the cause of acquired third, fourth, and sixth nerve palsy while also establishing recovery rates and important factors for recovery. METHODS: A retrospective chart review was performed for 92 patients who visited the ophthalmologic department of Konyang University Hospital with acquired third, fourth, and sixth nerve palsy from March 2015 to February 2016. Recovery rates and factors for recovery were evaluated in only 66 patients who received first ocular exam within 2 weeks of onset and who were followed up for at least 6 months. Complete recovery was defined as both complete recovery of the angle of deviation and the restoration of eye movement in all directions. For the degree of ocular motor restriction, −4 was defined as not crossing the midline and −2 was defined as 50% eye movement. The degree of ocular motor restriction was analyzed from −1/2 to 4. RESULTS: The fourth nerve was affected most frequently (n = 37, 40.2%), followed by the sixth cranial nerve (n = 33, 35.9%), the third cranial nerve (n = 18, 19.6%), and a combination of 2 or more cranial nerves (n = 4, 4.3%). Vasculopathy (n = 44, 47.8%) was the most common etiology, followed by trauma (n = 14, 15.2%), idiopathic (n = 13, 14.1%), inflammation(n = 10, 10.9%), neoplasm (n = 9, 9.8%), and aneurysm (n = 2, 2.2%). Complete recovery rate occurred for 66.7% (n = 44) of patients, and the overall recovery rate (i.e., at least partial recovery) was 86.3% (n = 57). Significant factors for complete recovery were the initial deviation angle and the limitation of extraocular movement (p < 0.001, p = 0.005, respectively, according to univariate analysis). CONCLUSIONS: In this study, paralytic strabismus due to vasculopathy was the most common etiology, and a lower degree of initial deviation resulted in an improved complete recovery rate. In addition, a high overall recovery rate was possible through quick diagnosis and early treatment of cranial nerve palsy.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Cranial Nerve Diseases ; Cranial Nerves ; Diagnosis ; Eye Movements ; Humans ; Oculomotor Nerve ; Retrospective Studies ; Strabismus*

PURPOSE: To evaluate the long-term changes in spherical equivalent (SE) refractive error and astigmatism in patients after spectacle use. METHODS: A total of 103 patients with refractive error without strabismus and amblyopia who received at least 3 years of follow-up after using spectacles were included in this study. Patients were divided into groups according to the age at which spectacles were used (<4 years, ≥4 to <7 years, ≥7 years), the initial degree of SE refractive error (<−0.50 diopter [D], −0.50 to +0.75 D, >+0.75 D), and the initial degree of astigmatism (<1.00 D, 1.00 to 3.00 D, ≥ 3.00 D). Changes in the SE refractive error and astigmatism were compared between these groups using mixed linear models.. RESULTS: Patients were followed up for a mean of 9.1 ± 1.6 years. An overall negative shift in SE refractive error and an increasing tendency in astigmatism during follow-up were noted regardless of the age at which spectacles were used (p < 0.001). The myopic group showed the largest negative shift in SE and the largest increase in astigmatism (p < 0.001, p = 0.02 respectively). The low and moderate astigmatism groups were more likely to have significant increases in astigmatism (p < 0.001). CONCLUSIONS: Patients with refractive error showed a negative shift in SE and an increasing tendency in astigmatism regardless of the age at which spectacles were used. Changes in SE and astigmatism may be influenced by the initial degree of SE, and the initial degree of astigmatism may influence changes in astigmatism.
Amblyopia ; Astigmatism ; Eyeglasses ; Follow-Up Studies ; Humans ; Linear Models ; Refractive Errors* ; Strabismus

PURPOSE: To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography. METHODS: We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed. RESULTS: The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049). CONCLUSIONS: In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate.
Albendazole ; Anterior Chamber ; Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; Granuloma ; Humans ; Immunoglobulin G ; Incidence ; Inflammation ; Medical Records ; Photography* ; Prednisolone ; Recurrence ; Retinaldehyde ; Retrospective Studies ; Serologic Tests ; Tomography, Optical Coherence ; Toxocara canis ; Toxocariasis* ; Uveitis ; Visual Acuity

PURPOSE: To evaluate the long-term efficacy of pars plana vitrectomy (PPV) on refractory or recurrent macular edema due to branch retinal vein occlusion (BRVO) after intravitreal steroid or anti-vascular endothelial growth factor injections. METHODS: We retrospectively reviewed the medical records of patients with macular edema due to BRVO who underwent PPV after intravitreal triamcinolone acetonide or bevacizumab injections and followed-up for at least 12 months. The best corrected visual acuity (BCVA) and subfoveal macular thickness were measured at 1, 3, 6, 12 months postoperatively and were compared with the preoperative values. The patients received additional intravitreal injections if they had recurrence of macular edema after surgery. The frequency of intravitreal injections (per year) were compared pre- and postoperatively. RESULTS: A total of 41 eyes of 41 patients were included and the mean duration of follow up was 58.7 ± 30.0 (15 - 124) months. The BCVA (logMAR) at 1, 3, 6, 12 months postoperatively, and last follow up was 0.52 ± 0.42, 0.46 ± 0.38, 0.41 ± 0.26, 0.50 ± 0.34, and 0.49 ± 0.37, respectively, which was significantly different from the preoperative values (0.90 ± 0.47, p < 0.001). The subfoveal macular thickness at 1, 3, 6, 12 months postoperatively, and last follow up was 342.72 ± 84.10 µm, 365.02 ± 110.73 µm, 359.45 ± 119.28 µm, 360.96 ± 124.33 µm, and 329.34 ± 119.69 µm, respectively, which was also significantly different (p < 0.001) from the preoperative values (484.9 ± 112.8 µm, p < 0.001). The frequency of intravitreal injections was significantly decreased after surgery (3.58 ± 2.05 times/year vs. 0.60 ± 0.83 times/year, p < 0.001). CONCLUSIONS: Pars plana vitrectomy could improve BCVA, decrease subfoveal macular thickness, and decrease recurrence in BRVO patients with refractory or recurrent macular edema after intravitreal injection. PPV could be an effective treatment option for these patients.
Bevacizumab ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Intravitreal Injections* ; Macular Edema* ; Medical Records ; Recurrence ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Triamcinolone Acetonide ; Visual Acuity ; Vitrectomy*

PURPOSE: To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery. METHODS: This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records. RESULTS: The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFit™ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons). CONCLUSIONS: The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFit™ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.
Capsulorhexis ; Cataract* ; Corneal Opacity ; Humans ; Incidence ; Intraoperative Complications ; Lens Subluxation ; Medical Records ; Pupil ; Retrospective Studies ; Risk Factors*

PURPOSE: We compared the ocular aberration and clinical outcome between different aspheric intraocular lenses (IOL) in both eyes. METHODS: This prospective randomized controlled study was comprised of patients with bilateral cataract who received two different aspheric IOLs implanted in both eyes: negatively aspheric Tecnis® ZCB00 and spherically neutral Akreos® MI60. Total and corneal aberrations computed by Wavescan® and Pentacam® were assessed at 6 months to investigate the effects of the IOL's spherical aberration on the eye and to analyze the incidence and degree of posterior capsule opacification. By using spherical aberration of the cornea and the IOLs, values calculated via Ray-tracing software and Wavescan® were compared. Total spherical aberration was analyzed by the MATLAB program and converting the pupil size to 6.0, 4.5, 3.0 mm. RESULTS: A total of 25 patients were included. Regarding pre-operative corneal aberration, ZCB00 group was 0.232 ± 0.119 µm while MI60 group was 0.240 ± 0.117 µm, and there was no difference between the two IOLs. At 6 months after total ocular spherical aberration, MI60 group (pupil size 6.0 mm; 0.296 ± 0.097 µm, 4.5 mm; 0.094 ± 0.032 µm, 3.0 mm; 0.019 ± 0.006 µm) had more positive values than ZCB00 group (pupil size 6.0 mm; 0.051 ± 0.105 µm, 4.5 mm; 0.009 ± 0.034 µm, 3.0 mm; 0.002 ± 0.007 µm) (p < 0.001). When calculated using the ray tracing method, based on the results after surgery, MI60 group's total spherical aberrations were higher than ZCB00 group. However, from 1 month to 6 months after surgery, the uncorrected distance visual acuity, spherical equivalent and posterior capsule opacification showed no differences between the two IOLs. CONCLUSIONS: In eyes with aspheric IOLs with negative spherical aberration, spherical aberration was lower than spherically neutral aspheric IOLs. Regarding postoperative visual acuity, spherical equivalent and posterior capsule opacification, there were no significant differences between the two groups.
Capsule Opacification ; Cataract ; Cornea ; Humans ; Incidence ; Lenses, Intraocular* ; Methods ; Prospective Studies ; Pupil ; Visual Acuity