PURPOSE: To report a case of an orbital mass diagnosed as metastasis from small cell lung cancer and to provide a review of the literature. CASE SUMMARY: A 66-year-old male with a history of diabetes mellitus and hypertension presented with decreased visual acuity and exophthalmos in his left eye. He had been diagnosed with age-related macular degeneration 13 years prior and had a history of pneumonia that was treated for one month. The best corrected visual acuity was hand-motion in the right eye and 0.04 in the left eye. Optic disc swelling and splint hemorrhage of the left eye was observed on fundus examination. The left eye was protruded and eye movement was limited. On orbital magnetic resonance imaging, an irregular mass in the left intraconal space was found. Incisional biopsy was performed, and histopathologic examination revealed a small round tumor. According to the results of immunohistochemical staining, metastatic tumors were suspected. After systemic evaluation, the patient was diagnosed with primary small cell lung cancer with multiple metastases. After 2 months, the visual acuity was hand-motion and proptosis was not resolved. CONCLUSIONS: In patients with orbital masses, the possibility of metastatic tumors should be considered during differential diagnosis and early biopsy should be performed.
Aged ; Biopsy* ; Diabetes Mellitus ; Diagnosis, Differential ; Exophthalmos ; Eye Movements ; Hemorrhage ; Humans ; Hypertension ; Macular Degeneration ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Orbit* ; Pneumonia ; Small Cell Lung Carcinoma* ; Splints ; Visual Acuity

Dengue fever is an acute febrile disease that is caused by a mosquito-borne flavivirus. It has become a major infectious disease threat in tropical and subtropical areas. In Korea, travel-associated dengue fever is increasing. Thirty-five Koreans went to Sri Lanka to do volunteer activities. Eight of the volunteers developed fever, myalgia, and rash; they were diagnosed with dengue fever. Two patients had macular hemorrhages and edema with no ophthalmic symptoms. The maculopathy caused by the dengue fever improved without specific treatment.
Communicable Diseases ; Dengue* ; Edema ; Exanthema ; Eye Manifestations ; Fever ; Flavivirus ; Hemorrhage ; Humans ; Korea ; Myalgia ; Sri Lanka* ; Volunteers*

Acupuncture Therapy ; adverse effects ; Adolescent ; Adult ; Eye ; blood supply ; Eye Diseases ; therapy ; Hemorrhage ; etiology ; Humans ; Male

PURPOSE: To present easily measurable 2D orbit computed tomography (CT) reference data that can be used in a preoperative study for orbital decompression and classification of individual orbital morphologies. METHODS: The study sample was composed of 77 patients with orbital contusion (42 Asian males + 35 Asian females = 154 orbits) who visited the emergency room of the Korea University Guro Hospital from September 2012 to June 2013. Patients with orbital wall fracture, retrobulbar hemorrhage, or eyeball rupture were excluded. Medical records including 2D orbit or facial bone CT were retrospectively reviewed and 4 orbital parameters (orbital length, OL; globe length, GL; GL/OL ratio and 2D cone angle) were measured. RESULTS: The average OL was 42.53 +/- 2.46 mm (35.63-49.09 mm) and average GL was 24.83 +/- 1.09 mm (22.75-28.13 mm). The average GL/OL ratio using these 2 parameters was 0.59 +/- 0.04 (0.50-0.68). The posterior cone angle was on average, 45.96 +/- 5.91degrees (29.35-60.04degrees). CONCLUSIONS: Simple measurement of 4 parameters using 2D orbit CT and classification of Asian individual orbital morphology may help in the choice of the most effective surgical technique for decompression surgery in thyroid eye disease patients.
Asian Continental Ancestry Group ; Classification ; Contusions ; Decompression* ; Emergency Service, Hospital ; Eye Diseases* ; Facial Bones ; Female ; Humans ; Korea ; Male ; Medical Records ; Orbit* ; Retrobulbar Hemorrhage ; Retrospective Studies ; Rupture ; Thyroid Gland*

PURPOSE: Solitary fibrous tumor (SFT) is a rare tumor of the pleura, mediastinum, pericardium and other organs affecting predominantly middle-aged patients. SFT arising in the orbit is extremely rare, and its malignant form is even rarer. The authors herein describe a case of malignant solitary fibrous tumor of the orbit. CASE SUMMARY: A 67-year-old male presented with a 4-month history of right proptosis. On ophthalmologic examination, 9-mm proptosis was observed in the right eye, and extraocular movements were limited in all directions of gaze. CT scan and MR imaging showed a lobulated, well-enhancing mass adjacent to the lateral rectus muscle in the superolateral retrobulbar space. Excisional biopsy through a lateral orbitotomy was performed. Histopathological examination showed proliferation of spindle cells with a fascicular pattern interspersed with bands of collagen, increased cellularity, cellular pleomorphism, hemorrhage, necrosis and high mitotic activity. Immunohistochemical staining revealed diffuse positivity for CD34, CD99, Ki67 and p53, and malignant SFT was diagnosed. CONCLUSIONS: Malignant SFT should be considered in the differential diagnosis of acutely progressing unilateral proptosis.
Aged ; Biopsy ; Collagen ; Diagnosis, Differential ; Exophthalmos ; Eye ; Hemorrhage ; Humans ; Male ; Mediastinum ; Muscles ; Necrosis ; Orbit* ; Pericardium ; Pleura ; Solitary Fibrous Tumors*

PURPOSE: To report a case of a full-thickness macular hole after a single intravitreal injection of ranibizumab in a patient with choroidal neovascularization associated with age-related macular degeneration. CASE SUMMARY: A 63-year-old woman presented to our department with gradually decreasing vision in her right eye. Best corrected visual acuity (BCVA) was measured as 0.7 in the right eye and 1.0 in the left eye. Examination of the macula showed a choroidal neovascularization associated with subretinal hemorrhage in the right eye. Optical coherence tomography (OCT) confirmed incomplete posterior vitreous detachment, subretinal hemorrhage and serous elevation. The patient subsequently received an intravitreal ranibizumab injection. After 1 month, the best corrected visual acuity in the right eye was decreased to 0.4, and fundus examination revealed posterior vitreous detachment and a macular hole. The patient underwent pars plana vitrectomy with internal limiting membrane peeling and fluid-air exchange, SF6 gas injection, phacoemulsification and posterior chamber intraocular lens implantation. Three months later, the macular hole had closed completely and best visual acuity was 1.0. CONCLUSIONS: Although the occurrence of a full-thickness macular hole after intravitreal ranibizumab injection is uncommon, physicians should be well acquainted with this complication.
Antibodies, Monoclonal, Humanized ; Choroidal Neovascularization ; Eye ; Female ; Hemorrhage ; Humans ; Intravitreal Injections ; Lens Implantation, Intraocular ; Macular Degeneration ; Membranes ; Phacoemulsification ; Retinal Perforations ; Tomography, Optical Coherence ; Vision, Ocular ; Visual Acuity ; Vitrectomy ; Vitreous Detachment ; Ranibizumab

PURPOSE: To report a case of ischemic retinopathy due to suspicious gentamicin retinal toxicity after primary repair of a scleral laceration. CASE SUMMARY: A 45-year-old man presented to our department with decreasing vision in his right eye after ocular trauma. Best corrected visual acuity (BCVA) was 0.02 in the right eye and slit lamp examination revealed scleral laceration. Both intravenous and topical antibiotics (10% cefazolin and 2% gentamicin) were immediately administered. On intraoperative examination, a scleral laceration located 5 mm to 11 mm from nasal limbus, prolapsed vitreous body and partial division of medial rectus muscle were observed. After irrigation with gentamincin 0.2% around the wound, primary repair was performed. On postoperative day 3, fundus examination revealed a retinal break, barrier laser was performed. On postoperative day 4, diffuse retinal edema with intraretinal hemorrhage was observed as well as, superonasal ghost vessels. Subsequently, fluorescein angiography showed diffuse leakage of retinal vessels and a nonperfusion area at the periphery, especially on the nasal side. As vitreous opacity became worse, the patient underwent pars plana vitrectomy with endolaser. One month later, vitreous cavity was clearer and best visual acuity was 0.2. CONCLUSIONS: Large doses of intraocular gentamicin ccan cause retinal toxicity. Increased gentamicin application through a scleral laceration may lead to toxic antibiotic levels. When a scleral laceration wound irrigation is performed, precautions are necessary to prevent retinal ischemia associated with gentamicin toxicity.
Anti-Bacterial Agents ; Cefazolin ; Eye ; Fluorescein Angiography ; Gentamicins ; Hemorrhage ; Humans ; Ischemia ; Lacerations ; Muscles ; Papilledema ; Retinal Perforations ; Retinal Vessels ; Retinaldehyde ; Vision, Ocular ; Visual Acuity ; Vitrectomy ; Vitreous Body

PURPOSE: To report 2 cases of cytomegalovirus retinitis treated with intravitreal ganciclovir. CASE SUMMARY: A 29-year-old female (Case 1) who received immunosuppressive therapy with tacrolimus and mycophenolate mofetil for 3 months after pancreatic transplantation, was given an intravitreal Bevacizumab injection 4 times in each eye under the suspicion of bilateral central retinal vein occlusion. During follow-up, a new lesion with white opacification and multiple snowballs appeared in the left eye. Suspecting cytomegalovirus retinitis, we administered an intravitreal ganciclovir injection resulting in a decrease of white opacification and improvement of visual acuity. A 66-year-old male (Case 2) who was receiving treatment for general weakness and heart failure, presented with visual disturbance in both eyes. Fundoscopic examination revealed white opacification, multiple snowballs and retinal hemorrhage in the left eye; diagnostic vitrectomy was performed. Macular edema and subretinal fluid continued after the vitrectomy and the serologic testing revealed an IgG titer positive for cytomegalovirus, therefore, an intravitreal injection of ganciclovir was given. Macular edema and subretinal fluid decreased and visual acuity improved. CONCLUSIONS: Intravitreal ganciclovir can be an effective treatment option for the management of CMV retinitis.
Antibodies, Monoclonal, Humanized ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Eye ; Female ; Follow-Up Studies ; Ganciclovir ; Heart Failure ; Humans ; Immunoglobulin G ; Intravitreal Injections ; Macular Edema ; Male ; Mycophenolic Acid ; Retinal Hemorrhage ; Retinal Vein ; Retinitis ; Serologic Tests ; Subretinal Fluid ; Tacrolimus ; Transplants ; Visual Acuity ; Vitrectomy ; Bevacizumab

PURPOSE: To investigate the effects of Nasopore(R) as a nasal packing material on the surgical success rate and prevalence of postoperative complications after endonasal dacryocystorhinostomy (DCR). METHODS: The present study included a total of 558 patients (699 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal DCR; 227 eyes were packed with Nasopore(R) and 472 eyes were packed with Merocel(R). The surgical success rate and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelialization), postoperative bleeding, infection, and revision rate were compared between the packing materials. RESULTS: The surgical success rate of the Nasopore(R) group (99.1%, 98.6%) showed significantly better results than the Merocel(R) group (97.2%, 95.1%) at postoperative 1 and 3 months (p = 0.04, 0.03 Pearson chi-square test), whereas there was no statistically significant difference between the 2 groups in postoperative surgical success rate at 1 week and 6 months. In comparison of postoperative complications, the Nasopore(R) group (0%) showed a lower incidence of delayed wound healing (delayed epithelialization of osteal mucosal epithelium) than the Merocel(R) group (2.3%; p = 0.013), whereas there was no difference in granulation, synechiae, postoperative bleeding, infection and revision rate (p > 0.05). CONCLUSIONS: The Nasopore(R) group showed a lower proportion of delayed wound healing and improvement of the surgical success rate at an early postoperative period after endonasal DCR compared to non-absorbable nasal packing material.
Dacryocystorhinostomy ; Epithelium ; Eye ; Hemorrhage ; Humans ; Incidence ; Nasolacrimal Duct ; Postoperative Complications ; Postoperative Period ; Prevalence ; Wound Healing

PURPOSE: To report a case of severe vaso-occlusive retinopathy with significant decrease of bilateral visual acuity as the first manifestation associated with systemic lupus erythematosus (SLE). CASE SUMMARY: A 23-year-old man was referred to our clinic with bilateral visual impairment of hand motion (HH). Fundus examination revealed severe retinal hemorrhage, cotton-wool patch, occlusive retinal vasculitis with vascular engorgement, and diffuse retinal edema in both eyes. Because of a malar rash on both cheeks, generalized edema was observed on initial examination with hypertension, azotemia, anemia, and thrombocytopenia, The patient was diagnosed with SLE, strongly positive to antinuclear antibody (ANA), and received an intravitreal injection of Bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) in the left eye in addition to hemodialysis, transfusion, systemic corticosteroid and immunosuppressant treatment due to lupus nephritis. Eighteen months later, the retinal edema, cotton-wool patch and hemorrhage resolved, leaving epiretinal membrane without traction in his left eye and diffuse degeneration of the right eye. Final visual acuity was HM in the right eye and 20/100 in the left eye. CONCLUSIONS: Vaso-occlusive retinopathy in SLE can result in permanent visual impairment. In a patient with a high possibility of SLE retinopathy, a periodic fundus examination and intensive management of systemic disease should be considered.
Anemia ; Antibodies, Antinuclear ; Antibodies, Monoclonal, Humanized ; Azotemia ; Cheek ; Edema ; Epiretinal Membrane ; Exanthema ; Eye ; Hand ; Hemorrhage ; Humans ; Hypertension ; Intravitreal Injections ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Papilledema ; Renal Dialysis ; Retinal Hemorrhage ; Retinal Vasculitis ; San Francisco ; Thrombocytopenia ; Traction ; Vision Disorders ; Visual Acuity ; Bevacizumab