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Shin K, Choung H, Lee MJ, Kim J, Lee GM, Kim S, Kim JH, Oh R, Park J, Lee SM, Park J, Kim N, Moon JH. A preliminary evaluation of the diagnostic performance of a smartphone-based machine learning-assisted system for evaluation of clinical activity score in digital images of thyroid-associated orbitopathy. Thyroid 2024. [PMID: 38623815 DOI: 10.1089/thy.2023.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND We previously developed a machine learning (ML)-assisted system for predicting the clinical activity score (CAS) in thyroid-associated orbitopathy (TAO) using digital facial images taken by a DSLR camera in a studio setting. In this study, we aimed to apply this system to smartphones and detect active TAO (CAS ≥ 3) using facial images captured by smartphone cameras. We evaluated the performance of our system on various smartphone models and compared it with the performance of ophthalmologists with varying clinical experience. METHODS We applied the pre-existing ML architecture to classify photos taken with smartphones (Galaxy S21 Ultra, iPhone 12 pro, iPhone 11, iPhone SE 2020, Galaxy M20, and Galaxy A21S). The performance was evaluated with smartphone-captured images from 100 patients with TAO. Three ophthalmology residents, 3 general ophthalmologists with < 5 years of clinical experience, and 3 oculoplastic specialists independently interpreted the same set of images taken under a studio environment and compared their results with those generated by the smartphone-based ML-assisted system. Reference CAS was determined by a consensus of three oculoplastic specialists. RESULTS Active TAO (CAS ≥3) was identified in 28 patients. Smartphone model used in capturing facial images influenced active TAO detection performance (f1 score 0.59 to 0.72). The smartphone-based system showed 74.5% sensitivity, 84.8% specificity, and f1 score 0.70 on top three smartphones. On images from all six smartphones, average sensitivity, specificity, and f1 score were 71.4%, 81.6%, and 0.66, respectively. Ophthalmology residents' values were 69.1%, 55.1%, and 0.46. General ophthalmologists' values were 61.9%, 79.6%, 0.55. Oculoplastic specialists' values were 73.8%, 90.7%, 0.75. This smartphone-based ML-assisted system predicted CAS within 1 point of reference CAS in 90.7% using facial images from smartphones. CONCLUSIONS Our smartphone-based ML-assisted system shows reasonable accuracy in detecting active TAO, comparable to oculoplastic specialists and outperforming residents and general ophthalmologists. It may enable reliable self-monitoring for disease activity, but confirmatory research is needed for clinical application. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT05731154.
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Affiliation(s)
- Kyubo Shin
- THYROSCOPE INC., R&D Div., 607, BLG 114, 50, UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan, Ulsan, Korea (the Republic of), 44919;
| | - Hokyung Choung
- Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, Korea (the Republic of);
| | - Min Joung Lee
- Hallym University Sacred Heart Hospital and Hallym University College of Medicine, Anyang, Korea (the Republic of);
| | | | - Gyeong Min Lee
- Dongguk University Ilsan Medical Center, Goyang, Korea (the Republic of);
| | - Seongmi Kim
- Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Korea (the Republic of);
| | - Jae Hyuk Kim
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (the Republic of);
| | - Richul Oh
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (the Republic of);
| | - Jisun Park
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (the Republic of);
| | - Sang Muk Lee
- Hallym University Sacred Heart Hospital and Hallym University College of Medicine, Anyang, Korea (the Republic of);
| | - Jaemin Park
- THYROSCOPE INC., Ulsan, Korea (the Republic of);
| | - Namju Kim
- Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Korea (the Republic of);
| | - Jae Hoon Moon
- Seoul National University Bundang Hospital, 65462, Department of Internal Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, Seongnam, Korea (the Republic of), 13620;
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Yang MK, Kim N, Choung H, Kim JE, Khwarg SI. Prevalence of human papillomavirus in eyelid carcinoma among Koreans: a clinicopathological study. BMC Ophthalmol 2023; 23:390. [PMID: 37752463 PMCID: PMC10521399 DOI: 10.1186/s12886-023-03131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has been detected in eyelid sebaceous gland carcinoma (SGC) and squamous cell carcinoma (SCC), and detection rates greatly varied across studies. This study aimed to investigate the presence of HPV in eyelid SGC and SCC among Koreans and its correlation with clinicopathological characteristics. METHODS Surgically resected eyelid samples diagnosed as SGC or SCC from January 1999 to June 2011 were identified from the pathology database of three referral centres in Korea. Clinicopathological information including origin (skin vs. tarsal conjunctiva) and treatment outcomes were retrospectively reviewed. Immunohistochemistry (IHC) for p16, HPV DNA in situ hybridisation (ISH), and polymerase chain reaction-based DNA microarray were performed in paraffin-embedded tissue sections. RESULTS Our cohort included 34 SGC and 12 SCC cases with Asian ethnicity. HPV was detected in 4 SGC and 6 SCC by DNA microarray, while 2 SCC (16.7%) showed positivity in ISH. SCC of tarsal conjunctival origin was significantly more common in HPV-positive SCC than in HPV-negative SCC (5 of 6 vs. 0 of 6, P = 0.015, Fisher's exact test). Among samples showing positive staining in p16 IHC, HPV positivity rates were 0.0% (0/19) in SGC and 100% (3/3) in SCC. There was no significant difference in overall and local recurrence rate in eyelid SGC and SCC according to the HPV status (P > 0.99). CONCLUSIONS HPV was found in a subset of eyelid SGC and SCC among Koreans and might be aetiologically related to SCC of tarsal conjunctival origin. Overexpression of p16 is considered to be inappropriate as an indicator of HPV infection in eyelid SGC. Further investigation is required to elucidate the transmission route and pathogenic roles of HPV.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Republic of Korea.
| | - Ji Eun Kim
- Department of Pathology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Republic of Korea.
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Kim DH, Jung JH, Choi MY, Hwang JM, Kim SJ, Lee YH, Han SH, Choi DG, Choi HY, Choi DG, Kim DH, Lee DC, Lee SY, Lim HW, Lim HT, Lim KH, Ryu WY, Yang HK, Choi HY, Lim HT, Jung JH, Baek SH, Choi MY, Hwang JM, Kim SJ, Lee YH, Han SH, Park SH, Lee HJ, Kim SY, Lee SY, Gye HJ, Kim SY, Shin SY, Park J, Ryu WY, Park HS, Kim DH, Paik HJ, Choi DG, Lee JY, Yang HK, Oh SY, Lee SJ, Chung SA, Choi J, Oh SY, Kim M, Suh YW, Kang NY, Yum HR, Kim SA, Kim H, Han J, Cho YA, Kim H, Lew H, Lee DC, Rah SH, Yoo YJ, Lim KH, Ahn H, Kim US, Lee JH, Choung H, Kim SJ, Jeon H, Shin HJ, Han SY, Heo H, Park S, Park S, Kyung SE, Kim C, Park KA, Jung EH, Hong EH, Lim HW, Choi D, Choi YJ, Moon NJ, Lyu IJ, Cho SY. A cross-sectional study of ophthalmologic examination findings in 5385 Koreans presenting with intermittent exotropia. Sci Rep 2023; 13:1329. [PMID: 36693891 PMCID: PMC9873724 DOI: 10.1038/s41598-023-28015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
The Korean Intermittent Exotropia Multicenter Study (KIEMS) was a retrospective, cross-sectional and multicenter study for the investigation of intermittent exotropia involved 65 strabismus specialists from 53 institutions in Korea. Purpose of this study was to present ophthalmologic findings of intermittent exotropia from the KIEMS. Consecutive patients with intermittent exotropia of ≥ 8 prism diopters (PD) at distance or near fixation were included. Best-corrected visual acuity, cycloplegic refraction data, angles of deviation at several cardinal positions, ocular dominance, fusion control, oblique muscle function, and binocular sensory outcomes were collected. A total of 5385 participants (2793 females; age 8.2 years) were included. Non-dominant eye was more myopic than the dominant eye (- 0.60 vs. - 0.47 diopters, P < 0.001). Mean exodeviation angles were 23.5 PD at distance and 25.0 PD at near fixation. Basic type (86.2%) was the most, followed by convergence insufficiency (9.4%) and divergence excess (4.4%) types. Alternating ocular dominance and good fusion control were more common at near than at distance fixation. Good stereopsis at 40 cm was observed in 49.3% in Titmus stereo test (≤ 60 arcsec) and in 71.0% in Randot stereo test (≤ 63 arcsec). Intermittent exotropia was mostly diagnosed in childhood and patients with the condition showed relatively good binocular functions. This study may provide objective findings of intermittent exotropia in a most reliable way, given that the study included a large study population and investigated comprehensive ophthalmology examinations.
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Affiliation(s)
- Dae Hee Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Jin Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Yangsan, Korea
| | - Yeon-Hee Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sueng-Han Han
- Department of Ophthalmology, Yonsei University College of Medicine, Severance Eye Hospital, Seoul, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 1, Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea.
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Kim N, Choung H, Kim YJ, Woo SE, Yang MK, Khwarg SI, Lee MJ. Serum microRNA as a potential biomarker for the activity of thyroid eye disease. Sci Rep 2023; 13:234. [PMID: 36604580 PMCID: PMC9816116 DOI: 10.1038/s41598-023-27483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
The aim of this study is to characterize the microRNA (miRNA) expression signatures in patients with thyroid eye disease (TED) and identify miRNA biomarkers of disease activity. Total RNA was isolated from the sera of patients with TED (n = 10) and healthy controls (HCs, n = 5) using the miRNeasy Serum/Plasma Kit. The NanoString assay was used for the comprehensive analysis of 798 miRNA expression profiles. Analysis of specific miRNA signatures, mRNA target pathway analysis, and network analysis were performed. Patients with TED were divided into two groups according to disease activity: active and inactive TED groups. Differentially expressed circulating miRNAs were identified and tested using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) tests in the validation cohort. Among the 798 miRNAs analyzed, 173 differentially downregulated miRNAs were identified in TED patients compared to those in the HCs. Ten circulating miRNAs were differentially expressed between the active and inactive TED groups and regarded as candidate biomarkers for TED activity (one upregulated miRNA: miR-29c-3p; nine downregulated miRNAs: miR-4286, miR-941, miR-571, miR-129-2-3p, miR-484, miR-192-5p, miR-502-3p, miR-597-5p, and miR-296-3p). In the validation cohort, miR-484 and miR-192-5p showed significantly lower expression in the active TED group than in the inactive TED group. In conclusion, the expression levels of miR-484 and miR-192-5p differed significantly between the active and inactive TED groups, suggesting that these miRNAs could serve as circulating biomarkers of TED activity, however, these findings need to be validated in further studies.
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Affiliation(s)
- Namju Kim
- grid.412480.b0000 0004 0647 3378Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hokyung Choung
- grid.412479.dDepartment of Ophthalmology, Seoul Metropolitan Government-Seoul National University, Boramae Medical Center, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Yu Jeong Kim
- grid.412484.f0000 0001 0302 820XDepartment of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Sang Earn Woo
- grid.412479.dDepartment of Ophthalmology, Seoul Metropolitan Government-Seoul National University, Boramae Medical Center, Seoul, Korea
| | - Min Kyu Yang
- grid.413967.e0000 0001 0842 2126Department of Ophthalmology, Asan Medical Center, Seoul, Korea
| | - Sang In Khwarg
- grid.31501.360000 0004 0470 5905Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea ,grid.412484.f0000 0001 0302 820XDepartment of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-Ro 170 Beon-Gil, Dongan-Gu, Anyang-Si, Gyeonggi-Do, 14068, Republic of Korea.
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Choi SR, Shin JY, Shin A, Choung H, Woo SJ, Park SJ, Ha YJ, Lee YJ, Lee EB, Park JK, Kang EH. Comparative risk of blindness and vision-threatening ocular comorbidities in patients with Behcet’s disease versus the general population. Rheumatology (Oxford) 2022; 62:1895-1902. [PMID: 36102793 DOI: 10.1093/rheumatology/keac531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To compare the risk of blindness and vision-threatening ocular comorbidities in patients with Behçet’s disease (BD) vs the general population.
Methods
Using 2002–2017 Korea National Health Insurance Service database, we did a population-based cohort study comparing newly-diagnosed BD patients and age- and sex-matched non-BD controls at a 1:5 ratio. The primary outcome was blindness defined as a best-corrected visual acuity of ≤ 20/500 in the better-seeing eye. Secondary outcomes were vision-threatening ocular comorbidities (cataract, glaucoma, and retinal disorders) that require surgical interventions and incident uveitis. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). We performed subgroup analyses by sex and BD diagnosis age.
Results
We included 31 228 BD patients and 156 140 controls. During a follow-up of 9.39 years, the incidence rate of blindness per 1000 person-years was 0.24 in BD and 0.02 in controls with the HR [95% CI] of 10.73 [7.10–16.22]. The HR [95% CI] for secondary outcomes was 2.06 [1.98–2.15] for cataract surgery, 5.43 [4.57–6.45] for glaucoma surgery, and 2.71 [2.39–3.07] for retinal surgery. The HR [95% CI] of incident uveitis was 6.19 [5.83–6.58]. Males suffered a disproportionately higher risk of blindness than females due to greater severity than lower incidence of uveitis. The risk of uveitis and blindness decreased as BD diagnosis ages increased.
Conclusion
In this large population-based cohort study, BD patients compared with the general population have a 10.73-fold risk of blindness in 10-years and also a substantially higher risk of diverse ocular comorbidities that pose potential threats to vision.
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Affiliation(s)
- Se Rim Choi
- Seoul National University Bundang Hospital Division of Rheumatology, Department of Internal Medicine, , Seongnam, Korea
| | - Joo Young Shin
- Seoul National University College of Medicine, SMG-SNU Boramae Medical Center Department of Ophthalmology, , Seoul, Korea
| | - Anna Shin
- Seoul National University Bundang Hospital Division of Rheumatology, Department of Internal Medicine, , Seongnam, Korea
| | - Hokyung Choung
- Seoul National University College of Medicine, SMG-SNU Boramae Medical Center Department of Ophthalmology, , Seoul, Korea
| | - Se Joon Woo
- Seoul National University Bundang Hospital Department of Ophthalmology, , Seongnam, Korea
| | - Sang Jun Park
- Seoul National University Bundang Hospital Department of Ophthalmology, , Seongnam, Korea
| | - You-Jung Ha
- Seoul National University Bundang Hospital Division of Rheumatology, Department of Internal Medicine, , Seongnam, Korea
| | - Yun Jong Lee
- Seoul National University Bundang Hospital Division of Rheumatology, Department of Internal Medicine, , Seongnam, Korea
- Seoul National University College of Medicine Department of Internal Medicine, , Seoul, Korea
| | - Eun Bong Lee
- Seoul National University College of Medicine Department of Internal Medicine, , Seoul, Korea
- Seoul National University Hospital Division of Rheumatology, Department of Internal Medicine, , Seoul, Korea
| | - Jin Kyun Park
- Seoul National University College of Medicine Department of Internal Medicine, , Seoul, Korea
- Seoul National University Hospital Division of Rheumatology, Department of Internal Medicine, , Seoul, Korea
| | - Eun Ha Kang
- Seoul National University Bundang Hospital Division of Rheumatology, Department of Internal Medicine, , Seongnam, Korea
- Seoul National University College of Medicine Department of Internal Medicine, , Seoul, Korea
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Yang MK, Sa HS, Kim N, Jeon HS, Hyon JY, Choung H, Khwarg SI. Quantitative analysis of morphological and functional alterations of the meibomian glands in eyes with marginal entropion. PLoS One 2022; 17:e0267118. [PMID: 35421204 PMCID: PMC9009701 DOI: 10.1371/journal.pone.0267118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To quantitatively analyze morphological and functional alterations of the meibomian glands in eyes with marginal entropion and their changes after surgery.
Methods
Sixty eyes of 52 patients with marginal entropion and underwent meibography and interferometer were included. One-hundred and seventeen age- and sex-matched eyes with minimal to mild meibomian gland dysfunction (MGD) were recruited as control eyes. Meibomian gland loss (MGL) and lipid layer thickness (LLT) were compared between eyes with marginal entropion and control eyes. Subgroup analysis was performed according to the extent of entropion. MGL and average LLT at 1 and 5 months after surgery were compared with those of 20 eyes with marginal entropion followed without surgery.
Results
In eyes with marginal entropion, MGL was higher (27.7% vs. 12.8%, P = 0.014), and average LLT was thinner (64 nm vs. 86 nm, P = 0.005) than those in control eyes. MGL was higher in eyes with more extensive entropion (> 2/3 eyelid width) than in eyes with less extensive entropion (≤ 1/3 eyelid width) (40.5% vs. 13.2%, P = 0.001). Average LLT increased after surgery (97 nm at 1 month, P = 0.003; 75 nm at 5 months, P = 0.319), and thicker than that of eyes followed without surgery (97 nm vs. 66 nm, P = 0.046). MGLs after surgery remained unchanged from the preoperative MGL (all P > 0.7).
Conclusion
Marginal entropion is associated with morphological and functional alterations of the meibomian glands. Functional improvement after entropion repair suggests that marginal entropion could cause or exacerbate MGD. Further studies are required to establish the role of entropion repair in managing MGD.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Yang MK, Sa HS, Kim N, Kim JH, Choung H, Khwarg SI. Bony nasolacrimal duct size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction. PLoS One 2022; 17:e0266040. [PMID: 35344555 PMCID: PMC8959155 DOI: 10.1371/journal.pone.0266040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the association between the bony nasolacrimal duct (NLD) size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction (PANDO). Methods Patients who underwent silicone intubation for incomplete PANDO and had undergone facial computed tomography (CT) were included. Surgical success was judged by both epiphora improvement and normalized tear meniscus height (TMH; < 300 μm) on anterior segment optical coherence tomography at 3 months after tube removal. The area, major axis diameter, and minor axis diameter of the elliptic bony NLD sections were measured in 1.0 mm-thick axial CT images. These bony NLD sizes were analyzed for associations with surgical success and TMH normalization. Results Eighty-one eyes of 48 patients were investigated. The smallest area and the smallest minor axis diameter were significantly larger in the success group (49 eyes), compared with those in the failure group (median smallest minor axis diameter: 4.7 mm vs. 3.8 mm, P = 0.008, Mann–Whitney U test). There was also a tendency for the TMH normalization rate to significantly increase as the smallest area and the smallest minor axis diameter increased (P = 0.028 and 0.037, respectively, Fisher’s 2 × 4 tests). Under multivariable logistic regression analysis using generalized estimating equation, a larger smallest minor axis diameter was associated with success of the nasolacrimal silicone intubation (odds ratio: 2.481, 95% confidence interval: 1.143–5.384). Conclusion Surgical success of the nasolacrimal silicone intubation in incomplete PANDO is associated with a larger smallest minor axis diameter of the bony NLD. This finding will help understand the pathophysiology of surgical failure after nasolacrimal silicone intubation.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- * E-mail:
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Yang MK, Lee MJ, Kim N, Choung H, Khwarg SI. Outcomes of enucleation and porous polyethylene orbital implant insertion in patients with paediatric retinoblastoma: a long-term follow-up study. Br J Ophthalmol 2020; 106:502-509. [PMID: 33293268 DOI: 10.1136/bjophthalmol-2020-317934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To report the long-term outcomes of enucleation and insertion of porous polyethylene (PP) orbital implant according to the evolving surgical techniques and implant in patients with paediatric retinoblastoma . METHODS Patients with paediatric retinoblastoma who underwent enucleation and PP implant insertion from December 1998 to December 2014 were retrospectively reviewed and divided into four groups: group A, classic enucleation +PP implant; group B, enucleation +PP implant +anterior closure of the posterior Tenon's (ACPT) capsule; group C, enucleation +PP implant +free orbital fat graft +ACPT and group D, enucleation +smooth surface tunnel PP implant +ACPT. Survival analysis of implant exposure and eyelid malpositions was performed. RESULTS One hundred and ninety-eight eyes of 196 patients were included. The median follow-up period was 13.0 years (range, 5.0-21.1). A 20 mm implant was inserted for 149 eyes (75.3%). The 10-year exposure-free survival probabilities were 44.6% in group A, 96.4% in group B, 97.4% in group C and 97.7% in group D. ACPT was associated with significant reduction in implant exposure (p<0.001). The most common eyelid malposition was upper eyelid ptosis (24.2%). The eyelid malposition-free survival probability did not differ among the four groups. However, the insertion of a 20 mm implant was associated with significant reduction in upper eyelid ptosis and lower eyelid entropion (p=0.004 and 0.038, respectively). CONCLUSIONS The long-term postenucleation implant exposure was rare after PP implant insertion and ACPT, even with a 20 mm-diameter implant. A larger implant can be beneficial in long-term prevention of eyelid malposition.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
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Choung H, Reshef ER, Tanking T, Freitag SK. A conjunctival-sparing surgical technique for lower eyelid cicatricial entropion repair in ocular cicatricial pemphigoid. Orbit 2019; 39:23-30. [PMID: 30732510 DOI: 10.1080/01676830.2019.1573434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To present five cases of lower eyelid cicatricial entropion secondary to ocular cicatricial pemphigoid (OCP) successfully repaired with a conjunctival-sparing surgical technique.Methods: The records of one surgeon (SKF) were reviewed to identify patients with lower eyelid cicatricial entropion secondary to OCP who underwent repair with a conjunctival-sparing technique between September 1, 2016 and October 18, 2017. The medical records were reviewed and extracted data included: age, gender, past medical history, current medical and OCP status, clinical examination, details of entropion repair surgery, and outcome.Results: Five patients (three female, two male) were included with ages ranging from 44 to 93 years. All had biopsy proven OCP, which was in remission at the time of surgery, and all were currently receiving immunomodulatory medications. All patients were symptomatic from cicatricial entropion secondary to OCP and underwent successful lower eyelid entropion repair with a conjunctival-sparing technique described herein, involving infraciliary rotation with suture fixation of the orbicularis muscle to the tarsus. Other contributing mechanisms of eyelid malposition including horizontal eyelid laxity and orbicularis oculi override were addressed simultaneously with lateral tarsal plication or orbicularis muscle debulking, resulting in 100% anatomic success and relief of symptoms with no cases of OCP reactivation, and with good durability with an average 13.9 months follow up (range 6.5-22 months).Conclusions: Successful repair of lower eyelid cicatricial entropion in immunomodulated patients with OCP can be achieved without disease reactivation using a surgical technique that spares the conjunctiva and lower eyelid retractors.
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Affiliation(s)
- Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Edith R Reshef
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Thidarat Tanking
- Ocular Plastic and Reconstructive Service, Department of Ophthalmology, Somdech Phra Pinklao Royal Navy Hospital, Bangkok, Thailand
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Choi YJ, Kim TW, Kim S, Choung H, Lee MJ, Kim N, Khwarg SI, Yu YS. Effects on Periocular Tissues after Proton Beam Radiation Therapy for Intraocular Tumors. J Korean Med Sci 2018; 33:e120. [PMID: 29651818 PMCID: PMC5897156 DOI: 10.3346/jkms.2018.33.e120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To present our experience on orbital and periorbital tissue changes after proton beam radiation therapy (PBRT) in patients with intraocular tumors, apart from treatment outcomes and disease control. METHODS Medical records of 6 patients with intraocular tumors who had been treated with PBRT and referred to oculoplasty clinics of two medical centers (Seoul National University Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center) from October 2007 to September 2014 were retrospectively reviewed. The types of adverse effects associated with PBRT, their management, and progression were analyzed. In anophthalmic patients who eventually underwent enucleation after PBRT due to disease progression, orbital volume (OV) was assessed from magnetic resonance (MR) images using the Pinnacle3 program. RESULTS Among the six patients with PBRT history, three had uveal melanoma, and three children had retinoblastoma. Two eyes were treated with PBRT only, while the other four eyes ultimately underwent enucleation. Two eyes with PBRT only suffered from radiation dermatitis and intractable epiphora due to canaliculitis or punctal obstruction. All four anophthalmic patients showed severe enophthalmic features with periorbital hollowness. OV analysis showed that the difference between both orbits was less than 0.1 cm before enucleation, but increased to more than 2 cm³ after enucleation. CONCLUSION PBRT for intraocular tumors can induce various orbital and periorbital tissue changes. More specifically, when enucleation is performed after PBRT due to disease progression, significant enophthalmos and OV decrease can develop and can cause poor facial cosmesis as treatment sequelae.
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Affiliation(s)
- Youn Joo Choi
- Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tae Wan Kim
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Namju Kim
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Kim YJ, Kim J, Choung H, Kim MK, Wee WR. Conjunctival granuloma with necrosis associated with exposed suture in upper double lid masquerading as ocular surface squamous neoplasia: a case report. BMC Ophthalmol 2017; 17:55. [PMID: 28446156 PMCID: PMC5405542 DOI: 10.1186/s12886-017-0457-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background This study reports two cases of conjunctival granuloma with necrosis caused by an exposed suture in the upper palpebral conjunctiva masquerading as ocular surface squamous neoplasia. Case presentation Two patients presented with chronic conjunctival ulcerative and granulomatous lesions on the superior bulbar conjunctiva that repeatedly recurred after the mass was removed. The pathologic findings revealed the absence of malignant cells and presence of many lymphocytes, plasma cells, and histiocytes. There was no evidence of acid-fast bacilli or fungal organisms. When a past history of blepharoplasty was established, microscopic examination revealed occult exposed suture tips. After the sutures were removed, the granuloma with necrosis was resolved within a month. Conclusion For all conjunctival lesions in the superior bulbar conjunctiva, a thorough examination of the ocular adnexae which includes eyelid eversion should be performed. There should be a suspicion of foreign body or exposed suture material especially when there is a non-healing ulcer.
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Affiliation(s)
- Yu Jeong Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jaeyoung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Hospital, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. .,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. .,Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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Choung H, Kim YA, Kim N, Lee MJ, Khwarg SI. Clinicopathologic Study of Chromosomal Aberrations in Ocular Adnexal Lymphomas of Korean Patients. Korean J Ophthalmol 2015; 29:285-93. [PMID: 26457033 PMCID: PMC4595253 DOI: 10.3341/kjo.2015.29.5.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/13/2015] [Indexed: 01/20/2023] Open
Abstract
Purpose The incidence and clinical correlation of MALT1 translocation and chromosomal numerical aberrations in Korean patients with ocular adnexal mucosa associated lymphoid tissue (MALT) lymphoma have not yet been reported. We investigated the incidence and clinicopathologic relationship of these chromosomal aberrations in ocular adnexal MALT lymphomas in a Korean population. Methods Thirty ocular adnexal MALT lymphomas were investigated for the t(11;18) API2-MALT1, t(14;18) IgH-MALT1 translocations and chromosomes 3 and 18 aneuploidies using fluorescence in situ hybridization. Patient medical records were reviewed retrospectively for information on demographics and clinical characteristics, including treatment response. Results The MALT1 gene rearrangement was found in one out of 30 cases. The t(14;18) IgH-MALT1 translocation was demonstrated in only one case (3.3%), and the t(11;18) API2-MALT1 translocation was not found in any of the cases. Trisomy 3 was observed in three ocular adnexal MALT lymphomas (10.0%), and five cases showed trisomy 18 (16.7%). Translocation positive cases also showed trisomy 18. One case of tumor relapse showed trisomy 18 only in the recurrent biopsies. There were no statistically significant correlations between chromosomal aberrations and clinical characteristics and treatment responses. Conclusions Translocations involving the MALT1 gene are not common in Korean ocular adnexal MALT lymphomas. The t(14;18) translocation was detected in only one out of 30 cases, and the t(11;18) translocation was not found at all. Furthermore, the chromosomal aberrations found in this study had no prognostic implications.
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Affiliation(s)
- Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young A Kim
- Department of Pathology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kim N, Park C, Park DJ, Kim HH, Kim S, Kim YJ, Kim JH, Lee JS, Bang YJ, Khwarg SI, Choung H, Lee MJ, Lee KW. Lacrimal drainage obstruction in gastric cancer patients receiving S-1 chemotherapy. Ann Oncol 2012; 23:2065-2071. [PMID: 22589332 DOI: 10.1093/annonc/mds106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study was conducted to determine the incidence and clinical characteristics of lacrimal drainage obstruction (LDO) in patients receiving S-1 chemotherapy. PATIENTS AND METHODS Consecutive 170 patients with gastric cancer who underwent curative surgery and received adjuvant S-1 chemotherapy were enrolled. S-1 was administered orally (40 mg/m2 b.i.d. on days 1-28 every 6 weeks) for 1 year. Ophthalmologic examinations were carried out on patients complaining of epiphora. RESULTS Thirty-one patients (18%) developed epiphora. Among 31 patients, 25 underwent ophthalmologic examinations and 22 (88%) were diagnosed with LDO. The median time to the onset of LDO was 2.9 months. The most common site of obstruction was the nasolacrimal duct [86% (19/22)]; punctal [23% (5/22)] and canalicular obstruction [14% (3/22)] were also noted. In multivariate analysis, total gastrectomy [versus partial gastrectomy: hazard ratio (HR), 2.9; P=0.014] and creatinine clearance<50 ml/min (versus ≥50 ml/min: HR, 2.9; P=0.038) were independent risk factors for the development of LDO. CONCLUSION Considering the high incidence of LDO in patients receiving S-1 chemotherapy, oncologists should be alert to epiphora and cooperate with ophthalmologists in the early stages to improve the quality of life of patients and avoid more complicated ophthalmologic procedures.
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Affiliation(s)
- N Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - C Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | | | | | - S Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Y J Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - J H Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - J S Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Y-J Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - S I Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - H Choung
- Department of Ophthalmology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul
| | - M J Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - K-W Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam.
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Affiliation(s)
- Changho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Joung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Min Seop Pahn
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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