Helen Lew

CHA Bundang Medical Center

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Tear production and drainage after botulinum toxin A injection in patients with essential blepharospasm

Acta Ophthalmologica (2013)

Dae Il Park Hyun Min Shin Sang Yeul Lee Helen Lew

To evaluate the clinical manifestations of tear production, distribution and drainage in the essential blepharospasm patients, and to analyse the changes after botulinum toxin A injection in these patients.This prospective study was performed in 23 patients with essential blepharospasm treated with Botulinum neurotoxin A (BoNT-A; Dysport, Ipsen Biopharm, UK) from November 2010 to February 2011. Ocular examinations, including frequency and severity of blepharospasm, tear break up time (BUT), Schirmer's test, lower lid tear meniscus height (TMH) measured by optical coherence tomography (OCT, rtvue software version 3.5; Optovue Inc., Fremont, CA, USA), and dacryoscintigraphy using 99m technetium pertechnetate, were performed before and 2 weeks after BoNT-A injection. We asked all patients about changes in the dry eye symptom score, before and after treatment. Results were analysed with independent t-test using spss software version 12.0 for Windows XP, (SPSS Inc., Chicago, IL, USA).Botulinum neurotoxin A treatment relieved blepharospasm in all patients. Mean injection dose was 38 ± 5.6 units. After injection, mean tear BUT was significantly increased from 4.7 ± 4.9 to 6.6 ± 1.6 seconds (p = 0.001) Lower TMH increased in all three points and most notably at the lateral point (p = 0.05). On dacryoscintigraphy, tear drainage velocity was not affected by BoNT-A treatment. But Tc-99m 50% clearance time in interpalpebral fissure significantly increased from 1564 to 2220 seconds on the time activity curve (p = 0.027). Subjective dry eye symptoms also improved in 16 patients (70%) after injection.Tear film stability and TMH increased, but tear drainage velocity was not affected by BoNT-A treatment. Overall Tc-99m 50% clearance time in interpalpebral fissure significantly increased, and tear storage from mild lateral lower eyelid laxity increased after BoNT-A injection. Botulinum neurotoxin A injection was also effective for combined dry eye symptom in the essential blepharospasm patients.

Blepharospasm

Neurotoxin

10.1111/aos.12002

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Citations (52)

Clinical characteristics and cytological changes in mucinous obstruction diagnosed by dacryoendoscopy

Scientific Reports (2024)

Doah Kim Helen Lew

Abstract To analyze the clinical characteristics of mucinous obstruction diagnosed by dacryoendoscopy and compared the cytological changes with membranous obstruction using a modified liquid-based thin prep cytology method. A retrospective chart review was conducted on 53 eyes of 51 patients with mucus obstruction based on dacryoendoscopic findings from January 2022 to October 2022. Liquid-based thin-prep cytology was performed by irrigating the inside of the nasolacrimal drainage system with saline during dacryoendoscopy-guided silicone tube intubation. Pathological findings were analyzed through a comparison of mucinous obstruction with membranous obstruction as determined by dacryoendoscopic findings. The modified liquid-based thin prep cytology technique had a higher cytology detection rate across all cases. Mucinous obstruction exhibited a significantly higher number of successful canalicular irrigation test cases compared to membranous obstruction. In mucinous obstruction, epithelial squamous cells were more frequently detected in pre-sac obstruction, whereas columnar epithelial cells were predominant in post-sac obstruction. Inflammatory cells showed a stronger correlation with primary change and post-sac obstruction. Bacterial colonies were observed exclusively in cases of mucinous obstruction. The use of a modified liquid-based thin prep cytology method enables the examination of histopathological changes in the lacrimal passage in primary acquired nasolacrimal duct obstruction (PANDO), particularly in cases of mucinous obstruction, without the need for invasive biopsies. These findings enhance the understanding of the etiopathogenesis of mucinous obstruction, complementing knowledge of membranous obstruction in PANDO.

10.1038/s41598-024-59580-9

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Comparison of Outcomes of Silicone Tube Intubation with or without Dacryoendoscopy for the Treatment of Congenital Nasolacrimal Duct Obstruction

Research Square (Research Square) (2023)

Helen Lew Doah Kim

Abstract In this retrospective study, we compared and analyzed two groups of patients undergoing silicone tube intubation (STI) for congenital nasolacrimal duct obstruction (CNDO), one with dacryoendoscopy and one without. A total of 87 eyes from 70 patients were included, with 52 eyes from 41 patients in the group without dacryoendoscopy and 35 eyes from 29 patients in the group with dacryoendoscopy. The total success rate of STI was 90.8%, with a higher success rate of 94.3% in patients treated with dacryoendoscopy compared to 88.5% in patients without. In patients under 36 months of age, the success rate was 100% (23 eyes). Among patients with membranous obstruction at Hasner's valve, all were younger than 36 months old and presented with structural obstruction in the lacrimal drainage system (LDS) (p = 0.024). However, in patients without membrane obstruction at Hasner's valve, both secretory obstruction (46.4%) and structural obstruction (53.6%) in the LDS were observed at similar rates, regardless of age. Combined obstructions were also observed in the LDS in CNDO, and the type of obstruction at Hasner's valve varied in every patient.

Nasolacrimal Duct Obstruction

Nasolacrimal duct

10.21203/rs.3.rs-2781968/v1

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Changes in Lower Eyelid Positions after Individualized Lower Blepharoplasty

Journal of the Korean Ophthalmological Society (2015)

Young Je Sung Jong Seo Park Helen Lew

Purpose: Various forms and degrees of morphological changes in the lower eyelid are presented in this study.A comprehensive, individualized clinical approach based on sound anatomical principles and lower lid stability is needed.We evaluated morphological outcomes of lower blepharoplasty by measuring lower eyelid position.Methods: One hundred sixty-eight eyes underwent lower blepharoplasty between August 2009 and August 2014.The mean patient age was 62.1 ± 13 years and mean follow-up period was 6.0 ± 10.2 months.Lower eyelid position of 84 consecutive primary lower blepharoplasty patients (52 females and 32 males) was analyzed using digital images and measured with standardized data points using the Image J Program.Results: Of the 168 individualized lower eyelid blepharoplasties analyzed, margin reflex distance 2 (MRD2) decreased from 5.4 ± 1.1 mm to 4.9 ± 0.8 mm (p = 0.005) and marginal nose distance (MND) increased from 59.2 ± 18.3 mm to 61.9 ± 17.6 mm (p < 0.001).Complications after lower blepharoplasty were not observed.Conclusions: The position of the lower eyelid improved after individualized lower blepharoplasty that addressed all the anatomical lower eyelid findings was performed.

Blepharoplasty

10.3341/jkos.2015.56.12.1831

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Classification of Nasolacrimal Duct Obstruction According to Dacryocystographic Finding and Its Clinical Ssignificance

Journal of the Korean Ophthalmological Society (2003)

Ho‐Sun Lee Helen Lew Young Soo Yun

Purpose: The purpose of this study is to analyze the various forms of nasolacrimal duct obstruction in patients after they took dacryocystography and to find out the relations between the dacryocystographic finding and the results of the treatment. Methods: From March 2001 to April 2002, 48 patients out of 53 cases who suffered from epipora were diagnosed to have nasolacrimal duct obstruction. The nasolacrimal duct obstruction was classified complete obstruction and partial obstruction that was divided into regular inner surface, irregular inner surface and secondary dilatation. Dacryocystorhinostomy was performed on the patients with complete obstruction and the others with partial obstruction got silicone tube intubation according to the dacryocystography. Success rate that was estimated as patient's satisfaction(0-3) was compared, and success was defined as score 1 or more. Results: The Numbers of complete obstruction and partial obstruction were 25 and 28 respectively. As for the patients with partial obstruction, patients with regular inner surface(2.430.93) showed better statistical(P=0.00) results than those who had irregular inner surface(1.751.28) or secondary dilatation(1.000.89). However, the location of the obstruction was insignificant in the course of treatment. Conclusions: Dacryocystorhinostomy is preferred to silicone tube intubation in nasolacrimal duct obstruction patients. It is more appropriate to conduct dacryocrystorhinostomy on patients who have secondary nasolacrimal duct dilatation due to nasolacrimal duct obstruction on dacryocystography.

Nasolacrimal Duct Obstruction

Nasolacrimal duct

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Cytologic Study of Removed Silicone Tube in Nasolacrimal Duct Obstruction Patients with the Liquid-based Thin Layer Preparation Technique

Journal of the Korean Ophthalmological Society (2004)

Hyun Min Shin Helen Lew Jun Mo Lee

Purpose: This study investigated the cytological findings of the nasolacrimal duct by using the removed silicone tube in patients of nasolacrimal duct obstruction according to the surgical technique. Methods: Cytologic study was performed in 49 eyes of 41 patients who underwent silicone tube intubation or dacryocystorhinostomy from May 2002 to April 2003. By using Thin Prep 2000 (CYTYC. USA), the cells around the removed silicone tube inserted in the operation were observed by light microscope. The patients were classified into the silicone tube intubation group and the dacryocystorhinostomy group. Differences of observed cytological results were analyzed by the Pearson Chi-Square test. Results: From the cytological results by the type of operation, there was no statistical difference between the silicone tube intubation group and the dacryocystorhinostomy group, and the frequency of hyphae detection was higher in the dacryocystorhinostomy group than in the silicone tube intubation group (p

Nasolacrimal Duct Obstruction

Nasolacrimal duct

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Eyelid Contour Analysis Following Müller's Muscle-conjunctival Resection and Levator Aponeurosis Advancement in Mild to Moderate Belpharoptosis

Journal of the Korean Ophthalmological Society (2017)

Sang Min Lee Helen Lew

Aponeurosis

10.3341/jkos.2017.58.6.627

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Effect of Botulinum Toxin A Chemodenervation in Sensory Strabismus

Journal of Pediatric Ophthalmology & Strabismus (2001)

Sueng‐Han Han Helen Lew C W Jeong Jung‐Bum Lee

To study the effect of botulinum toxin type A chemodenervation in sensory strabismus.Twelve patients with sensory strabismus were treated with an injection of botulinum toxin type A (Botox; Allergan, Irvine, Calif). Botulinum toxin type A was diluted with 0.9% sodium chloride without preservative at a dose that ranged from 1.25-5 U. A Teflon-coated needle electrode was inserted into the medial rectus muscle in cases of esotropia and into the lateral rectus muscle in cases of exotropia. Four patients were treated with > or =2 injections of botulinum toxin type A. Changes in the angle of strabismus and related complications were followed for >6 months postinjection.The mean deviation before injection was 33.8 prism diopters (delta) and the mean corrective effect on the deviation was 72.8% after injection in patients with sensory strabismus. The final deviation in 9 patients was <10 delta. Complications were hypertropia in 3 (25%) patients and conjunctival hemorrhage in 1 (8.3%) patient.Botulinum toxin type A is likely to prevent muscle contracture and affect muscle and neuronal tissues. This study on the effects of sensory strabismus with botulinum toxin type A injection suggests it has the potential to replace surgery or be used as an adjuvant therapy.

Hypertropia

Medial rectus muscle

Lateral rectus muscle

Esotropia

Superior rectus muscle

10.3928/0191-3913-20010301-06

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Citations (19)

Dissociated Vertical Deviation with Microtia showing Familial Tendency.

Journal of the Korean Ophthalmological Society (2006)

Hyun Min Shin Helen Lew Young Soo Yun

Purpose: We report two brothers having dissociated vertical deviation with microtia and familial history of the condition. Methods: The subjects of this report are a 7-year-old patient with bilateral dissociated vertical deviation, exotropia, bilateral inferior oblique muscle overaction, and microtia, and his brother, a 6-year-old with bilateral dissociated vertical deviation, right dissociated horizontal deviation and microtia. Results: The first patient underwent asymmetric bilateral lateral rectus muscle recession and bilateral inferior oblique muscle myotomy, while the second patient had asymmetric bilateral lateral rectus muscle recession. In the first patient, the exotropia was corrected, but the bilateral dissociated vertical deviation and left dissociated horizontal deviation remained. The right dissociated horizontal deviation improved in the second patient. Their father, two aunts and paternal grandmother also had strabismus and microtia. Conclusions: Physicians must investigate familial history in examining the strabismus patient with microtia. Additionally, genetic investigation is in need in more subjects of this study.

Microtia

Inferior oblique muscle

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Functionally enhanced placenta-derived mesenchymal stem cells inhibit adipogenesis in orbital fibroblasts with Graves’ ophthalmopathy

Research Square (Research Square) (2020)

Jae Yeon Kim Sohae Park Hyunjung Lee Helen Lew Gi Jin Kim

Abstract Background: Placenta-derived mesenchymal stem cells (PD-MSCs) have unique immunomodulatory properties. Phosphatase of regenerating liver-1 (PRL-1) regulates the self-renewal ability of stem cells and promotes proliferation. Graves’ ophthalmopathy (GO) is an autoimmune inflammatory disease of the orbit and is characterized by increased orbital levels of adipose tissue. Here, we evaluated the therapeutic mechanism for regulation of adipogenesis by PRL-1-overexpressing PD-MSCs (PD-MSCs PRL-1 , PRL-1+) in orbital fibroblast (OF) with GO patients. Methods: Primary OFs were isolated from orbital adipose tissue specimens from GO patients. After maturation as adipogenic differentiation, normal and GO-derived OFs were cocultured with naïve and PD-MSCs PRL-1 . We analyzed the protein levels of adipogenesis markers and their signaling pathways in OF from GO patients. Results: The characteristics of PD-MSCs PRL-1 were similar to those of naïve cells. OFs from GO patients induced adipocyte differentiation and had significantly decreased a lipid accumulation after coculture with PD-MSCs PRL-1 compared to naïve. The mRNA and protein expression of adipogenic markers was decreased in PD-MSCs PRL-1 . Insulin-like growth factor-binding proteins (IGFBPs) secreting PD-MSCs PRL-1 downregulated the phosphorylated PI3K/AKT/mTOR expression in OFs from GO patients. Interestingly, IGFBP2, -4, and -7 expression in PD-MSCs PRL-1 , which was mediated by integrin alpha 4 (ITGA4) and beta 7 (ITGB7), was higher than that in naïve cells and upregulated phosphorylated FAK downstream factors. Conclusion: In summary, IGFBPs secreting PD-MSC PRL-1 inhibit adipogenesis in OFs from GO patients by upregulating phosphorylated FAK, providing a novel therapeutic strategy using functionally enhanced MSCs to treat degenerative diseases.

10.21203/rs.2.23922/v3

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