Evisceration Using Scleral Capping Technique for Severe Phthisis Bulbi

PURPOSE: To introduce a new technique, involving the creation of a circumferential 360 degrees scleral relaxing incision, using an implant as large as 20 mm in diameter, and report on the surgical results in the treatment of severe phthisis bulbi, which are not indicated for classic evisceration. METHODS: The medical records of 20 patients with 20 phthisis bulbi who had undergone evisceration and placement, using the scleral capping technique, of porous polyethylene orbital implants as large as 20 mm in diameter between September 2002 and February 2006 were reviewed. For each patient, after evisceration, a circumferential 360 degrees equatorial scleral relaxing incision was made posterior to insertion of 4-recti muscles, and a porous polyethylene orbital implant was implanted. Each circumferential scleral relaxing incision wound was loosely sutured in the mattress fashion, using 5-0 braided polyester (Ethibond). RESULTS: The average of preoperative axial length, obtained using A scan and orbital computed tomography scan, was 16.8 mm. Orbital implants of 20 mm in diameter were implanted in all patients. The average of postoperative follow-up interval was 29.1 months. Orbital implant showed good motility to the satisfaction of all of patients. And the scleral capping technique could prevent complications, such as exposure of orbital implant, enophthalmos, and superior sulcus deformity. CONCLUSIONS: Scleral capping technique is safe and useful for evisceration in patients with severe phthisis bulbi. This technique can provide adequate space for the placement of and implant as large as 20 mm in diameter without generating any tension on wound. Consequently, this technique provided cosmesis and prosthesis motiliy, even without the use of a Medor coupling peg, with which patients were satisfied.

A Case of Intramuscular Hemangioma Presenting with Large-angle Hypertropia

PURPOSE: To report the case of a patient with large-angle hypertropia of an intramuscular hemangioma of the right superior rectus muscle (SR). METHODS: A 63-year-old man with progressive vertical deviation of the right eye for the past 6 months visited our strabismus department; his condition was not painful. An examination indicated that he had 60PD of right hypertropia at distance and near in primary gaze. Additionally, a significant limitation of his downgaze was noted. The right eye appeared mildly proptotic, and the upper and lower eyelids were slightly edematous. Corrected vision was 20/20 in both eyes. RESULTS: Orbital magnetic resonance imaging (MRI) studies revealed fusiform enlargement of the right superior rectus muscle, with prominent but irregular enhancement following gadolinium administration. Incisional biopsy revealed an intramuscular hemangioma in the superior rectus muscle with cavernous-type vessels. CONCLUSIONS: This case demonstrates that intramuscular hemangioma should be considered in the differential diagnosis of isolated extraocular muscle enlargement and unusual strabismus.