Clinical clues for differential diagnosis between verruca plana and verruca plana‐like seborrheic keratosis

Sometimes the clinical differentiation between verruca plana (VP) and VP‐like seborrheic keratosis (SK) could be challenged. However, there have been no studies on this issue to date. The aim of this study was to elucidate clinical and dermoscopic differences between these two diseases, and also to suggest a diagnostic algorithm of VP and VP‐like SK without skin biopsy. The patients who had lesions clinically considered as VP or VP‐like SK were the target of our study. We took clinical and dermoscopic photos with informed consent and conducted a questionnaire. All patients had their diagnoses confirmed by biopsy. Thirty‐three patients were enrolled in our study. Seventeen patients were finally diagnosed with VP (51.5%) and 16 patients with VP‐like SK (48.5%). In clinical findings, VP‐like SK showed significantly more scattered distribution than VP (P = 0.039), which exhibited more clustered or grouped distribution (P = 0.039). In dermoscopic findings, brain‐like appearance was more commonly observed in VP‐like SK (P = 0.003) whereas VP showed more red dots or globular vessels (P = 0.017) and even‐colored light brown to yellow patch (P < 0.001). Sex, onset age, the size of each lesion, location, color and shape showed no significant differences between them (P > 0.05). Based on our results, we suggest a diagnostic algorithm using Koebner's phenomenon, dermoscopic findings, distribution of each lesion and biopsy for multiple VP‐like lesions in adults, and we think it will be a very useful diagnostic tool in daily clinical dermatological practice.     

Conjunctival flap advancement with or without scleral graft for hypotony maculopathy after trabeculectomy

AIM: To introduce a novel technique for transscleral fixation of the PC-IOL that requires no sutures on the IOL haptics. METHODS: Instead of suturing polypropylene onto the IOL haptics, the method simply winds the thread on the haptics. Fifteen eyes of 15 patients underwent this technique and were followed up for more than 18 months. Surgical outcomes and post-operative complications were evaluated and compared with those of the conventional transscleral fixation method. RESULTS: Postoperative cylinder was significantly lower in the thread winding group than in the conventional transscleral fixation method group (-1.02±0.46 diopters vs -1.57±0.77 diopters; P=0.01). Further, no postoperative complications, such as optic capture, IOL dislocation, and hyphema, were detected in the thread winding group. CONCLUSION: We believe that our thread winding technique is better than previously reported methods because it is simple, mechanically stable, and free from suture-related complications.     

玻璃体切除术联合睫状体平部切口摘除球内异物

报道玻璃体切除术联合睫状体平部切口摘除球内异物的联合手术，治疗眼球后段异物８例８眼。其中，３眼为非磁性异物，５眼为磁性异物，均一次手术成功取出异物。介绍了此联合手术的方法，并对其意义、适应证以及手术前的准备进行了较为详细的讨论，对其并发症的处理和预防也作了叙述。     

Scleral buckling combined with internal cyclopexy for severe traumatic cyclodialysis cleft in open globe injuries

This study aimed to evaluate the effect of scleral buckling combined with internal cyclopexy on the treatment of severe traumatic cyclodialysis cleft in open globe injuries (OGIS). This retrospective study recruited 10 patients of 10 eyes. With our surgical intervention, all the 10 eyes achieved retinal and ciliary body anatomic re-attachment. The choroidal ruptures in nine eyes were closed with complete choroidal reattachment. Postoperative best-corrected visual acuity of nine eyes had various improvements. The mean intraocular pressure was increased from 8.9±2.6 mm Hg to 13.4±4.4 mm Hg. Eventually, six eyes underwent silicone oil (SO) removal without complications, two eyes still had SO tamponade and two eyes became SO-dependent eyes. The result shows that internal direct cyclopexy combined with scleral buckling is an effective treatment for severe traumatic cyclodialysis cleft in OGIS.     

Various tumors in the nasal vestibule

Various types of diseases can involve the nasal vestibule. Diagnosis and treatment of a nasal vestibular mass is often challenging due to the anatomical features of the nasal vestibule. Here, we present four cases with nasal vestibular masses. Two cases were diagnosed as squamous papillomas. The others were a trichofolliculoma and pseudoepitheliomatous hyperplasia with hyperkeratosis. Our aim was to discuss the characteristics of each disease and the considerations thought to be necessary for diagnosis and treatment of nasal vestibular tumors from these cases and the related literature.     

Wart with Depigmented Halo and Generalized Vitiligo

Depigmented haloes sometimes appear around melanocytic tumors or non-melanocytic tumors, but coexistence of warts and depigmented haloes is extremely rare. We report here an unusual case of warts accompanied by depigmented haloes and subsequently-triggered generalized vitiligo. A 55-year-old Japanese man presented with a 3-year history of brown nodules on the back, upper eyelid and dorsum of the left hand. Depigmented haloes appeared around the noldules and then gradually spread over a wide area, resulting in the development of generalized vitiligo. He had no history of antecedent treatment for these lesions before consultation. Histopathologically, the lesion showed papillomatosis and hyperkeratosis with lymphocytic exocytosis into the epidermis, which compatible to warts. Based on these clinical and histopathologic findings, a diagnosis of warts with depigmented halo and subsequently-triggered generalized vitiligo was made. None of the warts had resolved spontaneously after the appearance of haloes, and the depigmented haloes and generalized vitiligo remain unchanged.     

高度近视性黄斑裂孔玻璃体切割术后早期高眼压的药物治疗

目的：通过观察高度近视性黄斑裂孔不伴视网膜脱离患者行玻璃体切割术后早期发生高眼压应用降压药物的疗效,以明确单独或联合应用拉坦前列素滴眼液的降压效果。

方法：于我院行23G玻切联合C₃F₈注入的高度近视性黄斑裂孔不伴视网膜脱离患者188例205眼; 监测术后1wk内的眼压。当眼压介于22～29mmHg时设为A组,随机加用盐酸卡替洛尔滴眼液(A1组)或拉坦前列素滴眼液(A2组); 当介于30～39mmHg时设为B组,随机加用盐酸卡替洛尔滴眼液+酒石酸溴莫尼定滴眼液(B1组)或盐酸卡替洛尔滴眼液+拉坦前列腺素滴眼液(B2组); 当高及40mmHg及以上时,设为C组,20%甘露醇快速静脉滴注1次,并随机加用盐酸卡替洛尔滴眼液+酒石酸溴莫尼定滴眼液+布林佐胺滴眼液(C1组)或盐酸卡替洛尔滴眼液+酒石酸溴莫尼定滴眼液+拉坦前列腺素滴眼液(C2组)。连续观察3d,眼压降至21mmHg及以下时则视为有效,比较不同用药3d内的降压有效率、降压幅度及平均有效作用时间。

结果：符合研究标准的术后高眼压共89眼,发生于前3d共70眼(78.6%)。A组共31眼,A1组14眼,A2组17眼; 有效例数分别为5例(35.7%)、13例(76.5%),差异有统计学意义(χ²=5.24,P=0.03); 降压幅度分别为4.21±1.22mmHg(24%)、8.76±3.03mmHg(29.6%),差异有统计学意义(t=5.73,P<0.05); 平均有效作用时间分别为2.80±0.45、2.08±0.49d,差异有统计学意义(t=2.85,P=0.012)。B组共32眼,B1组17眼,B2组15眼,有效例数分别为9例(52.9%)、11例(73.3%),差异无统计学意义(χ²=1.40,P=0.30); 降压幅度分别为10.59±2.72mmHg(36.9%)、16.53±2.67mmHg(43.8%),差异有统计学意义(t=6.27,P<0.05); 平均有效作用时间分别为2.56±0.53、1.63±0.67d,差异有统计学意义(t=3.34,P=0.004)。C组共26眼,C1组14眼,C2组12眼,有效例数分别为9例(64.3%)、8例(66. 7%),差异无统计学意义(P=0.70); 降压幅度分别为22.00mmHg(51.0%)、31.45mmHg(59.3%),差异有统计学意义(t=18.35,P<0.05); 平均有效作用时间分别为2.63±0.52、1.80±0.63d,差异有统计学意义(t=2.97,P=0.009)。

结论：高度近视性黄斑裂孔玻璃体切割术后伴发高眼压的比率较高,一般发生在术后3d内,单独或联合应用拉坦前列素滴眼液可以有效降低眼压。