Superficial Subciliary Cheek Lift for Rejuvenating Infraorbital Region and Orbitomalar Groove

PURPOSE: Aging changes of midface include drooping of lower lid, wrinkles of malar area, orbitomalar groove and deepening of nasolabial fold from drooping of malar fat pad. Improvement of lower lid can be achieved through lower blepharoplasty, but improvement of cheek can not be gained. Superficial subciliary cheek lift(by Moelleken, 1996) is a method that lifts malar fat pad through extended subciliary incision. We obtained simultaneous improvement of lower lid, malar wrinkles and orbitomalar groove with modification of this technique. METHODS: From December 2003 to January 2006, we performed this method on 21 patients among volunteers for lower blepharoplasty who wanted to correct orbitomalar groove and malar wrinkles. Under local anesthesia, lateral extension of subciliary incision is done 1cm from the lateral orbital rim. Skin-muscle flap is elevated, and dealing of orbital fat and septum is the same as with ordinary lower blepharoplasty. After downward subcutaneous dissection through extended incision, exposing the upper 1/3 level of malar fat pad, superolateral fixation is done to superior deep temporal fascia. Excision of the upper part of fat pad is performed, if needed. After excision of overlapped skin-muscle flap, skin closure is done. RESULTS: We obtained satisfactory results with this simple method for improvement of orbitomalar groove and malar wrinkles among patients for lower blepharoplasty. During a follow-up period of 5 months on the average, no revision was performed. CONCLUSION: Under local anesthesia, lower blepharoplasty and improvement of orbitomalar groove and malar wrinkles can be achieved at the same time. It is good for patients who do not want conventional midface- lifting. But surgeons should select patients and perform cautiously for it may leave a scar of the extended incision that require over 2 months for maturation and it is insufficient for improvement of nasolabial fold compared to conventional mid face-lifts.

Correction of the Tear Trough Using Orbital Fat Graft from the Lower Lid

Lower palpebral bags and tear trough grooves are the common signs of aging. Weakness of the orbital septum, atrophy of the orbicularis oculi muscle, slackness and laxity of the lower lid skin are the main causes of these aging changes. Tear trough groove with skeletonization of the lower orbital rim can not be corrected easily by the conventional lower blepharoplasty, but the augmentation of the volume, can be an effective method. Lower lids provide a well vascularized recipient site, which is vital for proper grafting of fat to occur. We treated tear trough groove with free fat graft of surgically removed orbital fat. Surgical excision of the fat pad and septal reinforcement with free fat graft below the levator labii superioris alaeque nasi muscle were performed to correct tear trough groove. This technique was performed in 29 consecutive individuals from October, 2001 to January, 2005. Palpebral bags and tear trough groove were corrected concomitantly and obtained a youthful attractive midface with no secondary hollowness of lower lid and irregularity. The overall results obtained were satisfactory without any complications. Recurrence of tear trough deformity due to grafted fat absorption was not noted during the 7 months of the follow-up period. The authors conclude that the procedure is safe and effective in selected patients.

The Clinical Results of 6-mm Iris-Fixated Phakic IOL

PURPOSE: To evaluate the clinical results of 6 mm iris-fixated phakic intraocular lens (Artisan(R) lens) implantation in myopic patients. METHODS: Forty eyes of 23 myopic patients underwent 6-mm Artisan(R) phakic IOL implantation and were followed-up for over 6 months. We prospectively analyzed the efficacy, stability, predictability, change of astigmatism, endothelial cell count, pupil diameter, degree of decentration, subjective satisfaction and complications. RESULTS: The preoperative mean spherical equivalent was -9.46 D, and postoperative spherical equivalent was -0.70D at 1 month, -0.55D at 3 months, -0.54D at 6 months, -0.78D at 12 months and remained stable during the follow-up period. The preoperative mean astigmatism was -1.88D and postoperative astigmatism was -0.87D at 6 months. Postoperative uncorrected visual acuity (UCVA) was more than 0.8 in 85% of the eyes at 1 month, 91% at 3 months, 95% at 6 months, and 89% at 12 months. The spherical equivalent refraction after surgery was within 1.0D of emmetropia in 78% of eyes at 1 month, 80% at 3 months, 88% at 6 months, and 64% at 12 months. There was no significant decrease in the endothelial cell count during the follow-up period. Preoperative scotopic pupil diameters were significantly decreased at 1 month and the mean decentration of the lens was 0.38 mm. Patient satisfaction was generally high. Complications included the transient elevation of intraocular pressure in 1 eye, corneal edema in 4 eyes, iritis in 1 eye, traumatic dislocation in 1 eye and iris atrophy in 2 eyes. CONCLUSIONS: The 6-mm Artisan(R)phakic IOL implantation may be an effective surgical procedure for myopic patients who cannot undergo corneal refractive surgery, as it provided good visual results, predictability, patient satisfaction, and short-term safety.

The Effectiveness of Fibrin Glue Using in Dermal Shaving at Osmidrosis

Axillary osmidrosis is caused by excessive secretion of apocrine gland, which causes an acidic spicy odor and social embarrassment. Recently, many kinds of treatment for osmidrosis are introduced, but one of the conventional surgical method, dermal shaving is still the most effective method for osmidrosis. But it is often accompanied by complications like seroma, hematoma, necrosis, large scar, and long immobilization period. So, to reduce these disadvantages, we used fibrin glue which has the effect of reducing hematoma, encouraging capillary ingrowth by reinforcement of the flap fixation. Then, we compared the dermal shaving with fibrin glue spraying group with only dermal shaving group by retrospective study for clinical effect. From January 2001 to January 2005, a total of 56 patients were underwent dermal shaving operation for treatment of osmidrosis. Fibrin glue using group, the study group was 11 patients, 22 cases and dermal shaving only group without using fibrin glue, the control group was 45 patients, 90 cases. During operation, fibrin glue was sprayed after dermal shaving, just before completing skin closure. We compared the data from the view point of complications, the time for graft take(pressure dressing) and total occlusive dressing period(immobilzation period). Complication rate was lower in study group. There was 1 case of hematoma in the study group (4.5%), and 10 cases of hematoma, 1 case of seroma and 1 case of partial necrosis in the control group(13.3%). In both group, hematoma was the most common complication. The time for graft take were shorter in the study group than the control group(11.6 vs 13.6 days) and total dressing period was shorter in study group, too(14.3 vs 17.7 days). Statistically, significant difference was found in both the time for graft take and total dressing period. Using fibrin glue in dermal shaving was effective for lowering complication rate, reducing the time for graft take and total dressing period.

Analysis of Results in Rehabilitation Surgery of Down Syndrome Children

Down syndrome patients possess multiple facial stigmata; hypotonic macroglossia with small oral cavity, saddle nose, epicanthal fold, telecanthus, and high palpebral fissure inclination, etc. Surgical mitigation for some of these conditions may benefit both patient and family, and may influence the patient's acceptance by general public. We reported the basic study of craniofacial complex and anthropometric study of face in Korean children with Down syndrome. With the benefit of these study, 210 Down syndrome children underwent orthomorphic surgery including augmentation rhinoplasty, epicanthoplasty, lateral canthoplasty, and partial glossectomy and for the relief of respiratory distress tonsilar adenoidectomy were performed in selected cases of Down syndrome children. We evaluated the postoperative change in 105 Down syndrome children through questionnaires about the parent's satisfaction, the change of oral function and sleep pattern. We analysed postoperative change of speech with multi-speech model 3700 program. After these rehabilitation operation, we found out some facts. The parents were happy with the result of partial glossectomy(85.1%) and augmentation rhinoplasty(82.3%). And we found general improvement in oral function and sleep pattern. The results of speech analysis showed improvement in voice quality, patch, resonance and articulation.

Long-term Follow-up Results of Glaucoma Triple Procedures in Patients with Angle-closure Glaucoma

PURPOSE: To evaluate the long-term clinical efficacy for glaucoma triple procedures of angle-closure glaucoma. METHODS: The author reviewed retrospectively 30 eyes (Group A) which had undergone triple procedures for coexisting angle-closure glaucoma and cataract. The results were compared with those of 30 eyes (Group B) which had undergone trabeculectomy for angle-closure glaucoma and 25 eyes (Group C) which had undergone glaucoma triple procedures for open-angle glaucoma. All patients were followed up for more than 3 years after operation at the Department of Ophthalmology in a hospital from November 1990 to December 1999. RESULTS: The mean intraocular pressures at the last follow-up were 16.1mmHg, 20.9mmHg and 19.7mmHg and the surgical success rates were 83.3%, 63.3% and 68.0% in the triple procedure group of angle-closure glaucoma, trabeculectomy-alone group and triple procedure group of open-angle glaucoma respectively. CONCLUSIONS: Triple procedures in angle-closure glaucoma showed good long-term results in IOP control compared with the trabeculectomy-alone group in angle-closure glaucoma.

Preoperative Evaluation of Eyelid Tumor by Ultrasound Biomicroscopy

PURPOSE: To evaluate the extent of lesion by using ultrasound biomicroscopy in eyelid tumor. METHODS: We retrospectively analyzed 17 patients with eyelid tumor, who had undergone preoperative ultrasound biomicroscopy to access the extent of the lesion and the depth of involvement, excision and biopsy. These data were compared to the histopathologic findings. RESULTS: On ultrasound biomicroscopic examination, the eyelid tumor showed greater homogeneous hypoechoic density or heterogenous echo density than that of the surrounding tissue, leading to identifying the lateral margin of the lesion and depth of involvement. The mean maximum thickness of the lesion measured by ultrasound biomicroscopy was 2.26 +/- 0.49 mm and that of the histopathologic depth was 2.22 +/- 0.56 mm. Linear regression demonstrated that lesion depth measured by ultrasound biomicroscopy was correlated with histopathologic depth. CONCLUSIONS: In eyelid tumor, ultrasound biomicroscopy is helpful in assessing the extent of the lesion and the depth of involvement preoperatively, and in obtaining good postoperative results.

Clinical Features and Treatment Results of Conjunctival Lymphoproliferative Lesions

PURPOSE: To investigate the clinical features of conjunctival lymphoproliferative lesions and associated systemic lymphoma, and to determine the recurrence rate and prognosis according to treatment methods. METHODS: Eighteen patients with conjunctival lymphoproliferative lesions were followed up. We retrospectively analyzed data for clinical symptoms, anatomical location, histological type, associated systemic lymphoma, and treatment results. RESULTS: Conjunctival lymphoproliferative lesions were classified according to WHO classification: benign lymphoid hyperplasia in 7 patients, MALT-lymphoma in 7, and small B lymphocytic lymphoma in 4. Systemic lymphoma existed in 2 patients (11.1%). Remission was not achieved in one patients treated by surgical excision and chemotherapy. Complete remission was achieved in 5 patients with conjunctival malignant lymphoma treated by surgical excision, radiotherapy and chemotherapy. CONCLUSIONS: We consider that aggressive treatment using radiotherapy, chemotherapy and surgical excision in conjunctival malignant lymphoma is needful to achieve complete remission and prevent recurrence.

Frosted Branch Angiitis

PURPOSE: Frosted branch angiitis is a rare retinal disease with the characteristic sheathing in the retinal vessels. We report a typical case of this disease. METHODS: A thirty-year-old woman complained of sudden decrease of visual acuity developed in both eyes three days ago. Visual acuity was 0.4 with several inflammatory cells in the anterior chambers of both eyes. There were diffuse vascular sheathing like frosted branch in both retinas. Fluorescein angiogram showed staining and leakage of dye along the vascular sheathing. RESULTS: Visual acuity recovered to 1.0 and retinal findings returned normal 2 weeks after treatment with the low dose of systemic steroid. There was no recurrence during follow-up period. CONCLUSIONS: Typical frosted branch angiitis occurs suddenly in both eyes of the young, and it responds well to treatment with the low dose of systemic steroid.

Toxic Corneal Reaction Induced by Distilled Water Infused during Cataract Operation

PURPOSE: To report a case of toxic corneal reaction induced by accidentally infused distilled water into the anterior chamber during cataract operation. METHODS: 67-year-old female patient was admitted due to corneal edema and opacity which had been developed instantly by distilled water infused into anterior chamber during cataract operation at a private eye clinic. Cataract surgery was performed after 1 week, and the patient was treated with 5% NaCl solution and artificial eyedrop. RESULTS: On the sixth month after operation, the corneal edema and opacity were decreased remarkably. CONCLUSIONS: When acute corneal edema is developed during cataract operation, the surgeon should stop the procedure and examine all intraocular solutions and irrigation fluids. The prognosis must be estimated after use of hypertonic saline solution at least 6 months.

A Clinical Study on the Silicone Oil in the Treatment of Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the surgical results and complications in vitrectomy with silicone oil tamponade for the treatment of proliferative diabetic reitnopathy(PDR). METHODS: Vitreous microsurgery with silicone oil tamponade was performed on 21 patients with advanced proliferative diabetic retinopathy. RESULTS: Anatomic attachment was maintained in 19 eyes(90.5%). Functional success with visual acuity 0.02 or better was found in 17 eyes(81.0%). Functional failures were caused by retinal detachment in 2 eyes and glaucoma in 2 eyes. Complications of silicone oil included cataract in 8 of 14 phakic eyes(57.1%), epiretinal proliferation in 7 of 21 eyes(33.3%), retinal detachment in 6 eyes(28.6%), silicone oil in anterior chamber in 3 eyes(14.3%), secondary glaucoma in 2 eyes(9.5%), and emulsification of silicone oil in 2 eyes(9.5%). CONCLUSION: Vitrectomy with silicone oil was highly effective in advanced proliferative diabetic retinopathy and early removal of silicone oil was recommended to reduce the complications of silicone oil.

The Minimum Concentration and Preservation Time of Ethanol for Sterilization of Donor Sclera: In Vitro Study

PURPOSE: We studied to investigate the minimum concentration and preservation time of ethanol for sterilization of donor sclera. METHODS: Fresh sclera was inoculated with Staphylococcus epidermidis(ATCC 155), Staphylococcus aureus(ATCC 28213), Pseudomonas aeruginosa(ATCC 27843), and transferred to preservative vials containing the concentration of ethanol(10, 30, 50, 70, and 90%) or trypticase soy broth(TSB, control) and stored at room temperature. The sclera was then homogenized, plated on blood agar, and incubated at 37 degreesC for 24 hours. Colonies were counted at 6, 12, 24, 48, and 72 hours. RESULTS: Staphylococcus epidermidis and Staphylococcus aureus were recovered from contaminated sclera plates preserved in 10% ethanol until 72 hours and in 30% ethanol until 12 hours, but no bacteria was recovered from the sclera preserved in more than 50% ethanol(P<0.05). Pseudomonas aeruginosa was recovered in 10% ethanol until 72 hours but not recovered in more than 30% ethanol until 24 hours(P<0.05). However, all three species were recovered from the control sclera preserved in TSB until 72 hours. CONCLUSIONS: From the above results it is concluded that the concentration of more than 50% ethanol for at least 6 hours is recommendable as human sclera disinfectants.

Normative Measurements of Ko rean Orbital Structure

We studied to establish criteria for the diameters of normal extraocular muscles, the width of the optic nerve, and the globe position by CT, and to investigate the effects of age and sex on these structures among Korean populations. Diameters of extraocular muscles, distance from the interzygomatic line to the posterior margin of the globe, width of the optic nervesheath complex, and length of the interzygomatic line were calculated for 428 normal orbit on axial and direct coronal CT images. Normal range for the diameters of extraocular muscles were medial rectus : 2.2~5.4 mm, lateral rectus: 2.1~4.9 mm, inferior rectus: 2.5~5.7 mm, and superior complex group : 2.6~6.4 mm. The mean optic nerve-sheath complex was 4.1 mm ranged from 2.9 mm to 5.3 mm, and the mean length of interzygomatic line was 103.8 mm. The normal position of the globe was 11.2 mm behind the interzygomatic line(range, 6.4~15.3 mm). The mean diameters of extraocular muscles, sum of all muscle, optic nerve-sheath complex, globe position, and the mean length of interzygomatic line were larger in males than females. However, there was no significant difference between male and female patients except interzygomatic line, and there was also no difference among the various age groups(P>0.05). Our results may help to assess enlargement of the extraocular muscles and the optic nerve as well as determining whether exophthalmos is present in a practical quantitative method.

The Effect of Epidural Clonidine on Plasma Catecholamine Response during General Anesthesia / 대한마취과학회지

BACKGROUND: Tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The purpose of this study is to evaluate whether the epidural clonidine pretreatment reduce the sympathetic activity and cardiovascular response. We compared the hemodynamic changes and catecholamine concentration before, during and after general anesthesia with epidural clonidine pretreatment. METHODS: Forty patients undergoing lower abdominal surgery were randomly allocated into the two groups. In Group 1, 10 ml of 0.9% normal saline was administered epidurally 15 minutes before induction of anesthesia as control. In Group 2, 3 microgram/kg clonidine diluted in 10 ml normal saline was administered epidurally 15 minutes before induction of anesthesia. We measured the blood pressure, heart rate and plasma catecholamine concentration at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3), 1 (T4) and 2 (T5) hours after arrival at recovery room and the results were compared between group 1 and group 2. RESULTS: There was statistically significant difference in systolic pressure at T1 and T2 between the two groups. Heart rate was statistically significant difference at T1 and T4 between the two groups. There was statistically significant difference in epinephrine and norepinephrine concentration at T1 and T2 between the two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine concentration accompanying tracheal intubation and skin incision may be reduced by administration of epidural clonidine.