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Introduction: The purpose of this study was to compare intraoperative intraocular pressure fluctuation using different aspiration systems and 25- and 27-gauge vitreous surgery probes. Methods: Ex vivo, pars plana, 25- and 27-gauge vitreous surgery was performed on 4 porcine eyes, and IOP fluctuations were evaluated. We performed 3-port vitrectomy using the Constellation® Vision or the EVA® Phaco-Vitrectomy system. Each 20-s experiment was conducted 5 times for each set of conditions, each with the same substituted balanced salt solution. Real-time intraoperative intraocular pressure measurement was performed at the distal end of the infusion tube. Intraocular pressure was measured during core vitrectomy, core vitrectomy with fluid aspiration, peripheral vitreous shaving with scleral indentation, and fluid-gas exchange. The Mann-Whitney U test was used to evaluate statistical significance. Results: Mean ± standard deviation intraoperative intraocular pressure fluctuation during 25- and 27-gauge core vitrectomy was 15.9 ± 1.6 and 11.9 ± 1.4 mm Hg, respectively (p < 0.05), using the Constellation system; 23.2 ± 1.4 and 14.1 ± 0.7 mm Hg, respectively (p < 0.001), using the EVA vacuum mode; and 15.0 ± 0.5 and 11.5 ± 1.4 mm Hg, respectively (p < 0.05), using the EVA flow mode. The smallest intraoperative intraocular pressure fluctuations during core vitrectomy with fluid aspiration, peripheral vitreous shaving with scleral indentation, and fluid-gas exchange were all achieved using the 27-gauge EVA flow mode; these values were 14.2 ± 0.4, 35.7 ± 0.9, and 6.4 ± 0.2 mm Hg, respectively. Conclusion: Regardless of the aspiration system, intraoperative intraocular pressure fluctuation was lower during 27-gauge than during 25-gauge vitrectomy. The 27-gauge EVA flow mode produced optimal intraoperative intraocular pressure stability. [ABSTRACT FROM AUTHOR]

Mesectodermal leiomyoma of the ciliary body is a rare benign tumor, showing both neurogenic and myogenic characteristics. This tumor typically shows predilection for women of reproductive age. Because it is almost impossible to clinically distinguish this tumor from malignant melanoma, unnecessary eye enucleations have been unfortunately performed. Herein, we report a case of mesectodermal leiomyoma of the ciliary body in a young Japanese woman. She was referred to our hospital due to a slow-growing mass in her left iris. A malignant tumor could not be clinically ruled out and surgery with intraoperative pathology consultation was performed. Intraoperative frozen section diagnosis was a benign tumor with neurogenic features, and a simple excision of the tumor was performed. Histologically, the tumor was composed of diffuse growth of spindle cells with fibrillary indistinctive cytoplasm. Immunohistochemical examination showed diffuse positive staining of α-smooth muscle actin, h-caldesmon, calponin, and CD56. Scattered tumor cells were weakly positive for desmin. Neither melanocytic markers nor neural markers except for CD56 were positive. We diagnosed this tumor as mesectodermal leiomyoma. Mesectodermal leiomyoma is rare and often misdiagnosed as malignant melanoma. To avoid overtreatment, a correct preoperative diagnosis is essential. [ABSTRACT FROM AUTHOR]

Purpose: The study reports the correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. Methods: This was a retrospective study of 191 patients that underwent surgical repair for unilateral orbital fractures. All patients included in the study had symptomatic diplopia from the fracture. Patients were classified into one of three groups according to the time of surgery after injury: (1) Early (within 14 days of surgery), (2) intermediate (between 15 and 30 days), and (3) late (greater than 30 days). Ocular motility was measured presurgery and at 3 and 6 months postsurgery by Hess chart with calculation of the Hess area ratio (HAR%). Results: Surgery was conducted at a mean of 24.7 ± 45.0 days (range: 1–283 days) postinjury. There were 120 patients in the early surgery group (surgery at 6.8 ± 3.8 days), 38 in the intermediate surgery group (20.7 ± 4.1 days), and 33 in the late surgery group (95.1 ± 75.0 days). Overall the HAR% improved significantly from a mean of 74.2% preoperatively to 90.8% at 6 months postoperatively (p < 0.01). In the early and intermediate groups, the postoperative HAR% improved significantly with all fracture regions (orbital floor, medial wall, and combined orbital medial wall and floor) (p < 0.05). However, in the late groups, the postoperative HAR% only improved significantly with orbital floor fractures. Conclusion: Pre- and postoperative the HAR% give objective evidence of ocular motility improvement with early orbital floor fracture repair surgery. However, observation can be deployed, as a significant improvement in ocular motility can also be achieved with reconstructive surgery conducted 30 days or more after depressed floor-fragment fractures. Early intervention should be prioritized for symptomatic medial wall fractures, as late surgery does not improve motility. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the etiologic factors predicting acute ocular progression in SJS/TEN, and identify patients who require immediate and intensive ophthalmological treatment. We previously conducted two Japanese Surveys of SJS/TEN (i.e., cases arising between 2005–2007 and between 2008–2010), and obtained the medical records, including detailed dermatological and ophthalmological findings, of 230 patients. Acute ocular severity was evaluated as none, mild, severe, and very severe. A multi-state model assuming the Markov process based on the Cox proportional hazards model was used to elucidate the specific factors affecting the acute ocular progression. Our findings revealed that of the total 230 patients, 23 (24%) of 97 cases that were mild at initial presentation worsened to severe/very severe. Acute ocular progression developed within 3 weeks from disease onset. Exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) and younger patient age were found to be statistically significant for the progression of ocular severity from mild to severe/very severe [hazard ratio (HR) 3.83; 95% confidence interval (CI) 1.48 to 9.91] and none to severe/very severe [HR 0.98; 95% CI 0.97 to 0.99], respectively. The acute ocular severity score at worst-condition was found to be significantly correlated with ocular sequelae. Thus, our detailed findings on acute ocular progression revealed that in 24% of SJS/TEN cases with ocular involvement, ocular severity progresses even after initiating intensive treatment, and that in younger-age patients with a history of exposure to NSAIDs, very strict attention must be given to their ophthalmological appearances. [ABSTRACT FROM AUTHOR]