Long-Term Results of Reconstruction of Orbital Wall Fracture With Resorbable Copolymer Mesh

PURPOSE: This study examined the postoperative long-term results of the reconstruction of orbital wall fracture using Macropore(R). METHODS: The long-term results for 10 patients who were diagnosed with orbital wall fracture and received the repair of orbital wall fracture using Macropore(R), were examined postoperatively after an average of 23.5 months. RESULTS: The mean difference in orbital volume between the fractured orbit and the unaffected orbit after an average of 23.5 months postoperatively was 1.01+/-0.70 cm3 (4.75+/-2.92%), which slightly increased compared to 0.70+/-0.52 cm3 (3.26+/-2.10%) immediately after the operation, although the difference was not statistically significant (p-value=0.190). At the last follow-up, the shape of Macropore(R) was not observed in 3 out of the 10 patients, and intense ossification was observed at the site of fracture in 6 patients. At the last follow-up, one patient showed 1.5 mm enophthalmos, and the other patients did not show the occurrence of diplopia or the progress of enophthalmos. CONCLUSIONS: According to the long-term results of the reconstruction of orbital wall fracture, Macropore(R) is considered an implant that produces a safe and satisfactory effect without notable complications.

A Case of Acute Orbital Abscess following Repair of Orbital wall Fracture with Alloplastic Implant

PURPOSE: To report a case of acute orbital abscess after Medpor(R) implantation for orbital floor fracture repair. CASE SUMMARY: A 15-year-old boy who was punched in the right orbit visited our clinic because of diplopia. An orbital CT scan demonstrated a fracture of the right orbital floor. At surgery, a Medpor sheet was placed over the orbital floor defect. Over the first three days, clinical improvement was gradual, but at four days postoperatively, depression of the right eye was restricted, and lower lid edema and proptosis was present in the right eye. At eight days postoperatively, the orbital CT scan showed a large cystic mass surrounding the Medpor sheet and fine needle aspiration cytology showed a number of inflammatory cells. Because systemic antibiotics were ineffective, the Medpo(R) sheet and the cystic mass were removed through a transconjunctival approach to the orbit. A culture of the removed Medpor(R) sheet grew Staphylococcus aureus and signs of inflammatory cells in the tissue were present. After removal of the abscess, most clinical symptoms showed improvement except for the remaining depression of the right eye. CONCLUSIONS: Symptoms of eye movement restriction, lower lid edema, and proptosis may be uncommon after orbital floor fracture repair but can occur. We should also consider the possibility of abscess formation due to infection of the implant and emphasize the importance of prompt diagnosis and treatment of such a case.

Clinical Investigation of Therapeutic Effect and Extrusion Rate of Punctal Plug for Dry Eye Syndrome

PURPOSE: To investigte the extrusion rate of punctal plugs and to evaluate their long-term effectiveness related to punctal occlusion. METHODS: The subjects were 120 eyes of 60 patients with tear-deficient dry eye who underwent punctal occlusion using a silicone punctal plug from May 2003 to Jun 2004. They were followed up for 382.3+/-164.3 days. We studied the extrusion rate and the period of extrusion for each plug and examined the differences between the objective and subjective indicators of dry eye syndrome before and after plug insertion and between extruded and non-extruded punctal plugs. RESULTS: In this study, 25.8% of all plugs were extruded during the follow-up period. The majority of plugs (41.9%) were extruded within 100 days after plug insertion. As objective indicators, results of Schirmer test and BUT were significantly increased after plug insertion. As subjective indicators, the patients' clinical symptoms significantly improved. Patient use of artificial tear drops significantly decreased and was discontinued by 70.8% after plug insertion. There were however no significant differences between the extrusion group and the non-extrusion group in each case. CONCLUSIONS: Punctal plug occlusion therapy for tear-deficient dry eye is effective, but the extrusion rate is relatively high. Regardless of punctal plug extrusion, patients experienced a symptomatic improvement. Serious consideration of this fact may greatly aid in making therapeutic adaptations and maintaining a good relationship.

A Case of a Traumatic Eyeball Rupture in Terrien's Marginal Degeneration and It's Surgical Repair

PURPOSE: To report a primary surgical repair of a severe corneal laceration, a lens prolapse and a traumatic aniridia by blunt trauma in Terrien's marginal degeneration. METHODS: A 46-year-old female visited our hospital for corneal laceration due to a blunt trauma of the right eye. A primary corneal suture was done and 8 days later, amniotic membrane transplantation was performed. RESULTS: The perforated eyeball regained its integrity with a stabilized cornea. Also, the anterior chamber was reformed and visual acuity improved. CONCLUSIONS: In the first case of Terrien's marginal degeneration in the right eye, which had a 360-degree iridodialysis(aniridia) with aphakia due to blunt traumatic separation of the iris root from the ciliary body. We achived a good operative result with primary corneal suture and amniotic membrane transplantation.

A Case of Lymphocytic Hypophysitis during Pregnancy

PURPOSE: To report a rare case of lymphocytic hypophysitis in a 31-year-old woman who presented with gradually progressive bilateral visual loss during the third trimester of pregnancy. METHODS: Ophthalmologic examination revealed best corrected visual acuity of 0.02 OD and counting fingers at 20 cm OS. Pupil examination revealed no relative afferent pupillary defect in either eye and intraocular pressure was normal in both eyes. A visual field test revealed nearly total visual defect sparing superotemporal area OD and total defect OS. An MRI of the head was performed. RESULTS: At the time of transsphenoidal surgery following the patient's delivery, a frozen biopsy of the lesion revealed diffuse lymphocytic infilteration and fibrosis of the pituitary gland consistent with the diagnosis of lymphocytic hypophysitis. Postoperatively the patient was treated for hypopituitarism. At 5 weeks postoperative, her best corrected visual acuity was 1.0 OU, and visual field defects resolved in both eyes. On follow-up by telephone for postoperative 7 months, the patient remained visually asymptomatic. CONCLUSIONS: The clinical presentation of lymphocytic hypophysitis may mimic pituitary adenoma, lymphoma, germinoma, and histiocytosis. The diagnosis should be suspected in any pregnant or postpartum patient with an intrasellar or suprasellar mass.

Surgical Results of Zygomatico-Orbital Complex Fractures according to the 3-dimensional Classification

PURPOSE: To classify zygomatico-orbital fractures based on Zingg's classification and to evaluate the results of treatment. METHODS: Thirty patients who were diagnosed with zygomatico-orbital fracture between 2000 and 2004 were classified based on Zingg's classification, were treated and followed up for more than 3 months. Of the 30 patients, 28 received surgical treatment, including Gillies reduction or open reduction and rigid fixation with a microplate. RESULTS: The mean follow-up period was 6 months. Most of the patients were satisified with the results of surgery. There were no secondary operations due to facial asymmetry, secondary wound infection, microplate exposure or paresthesia. However, there were 3 re-operations for diplopia, enophthalmos, and lower eyelid retraction, respectively; the conditions had persisted until postoperative 2 weeks. CONCLUSIONS: The use of 3-dimensional Zingg's classification for zygomatico-orbital fractures appeared to be beneficial in making more accurate diagnoses and in determining surgical treatment. Oculoplastic approaches, including subciliary or transconjunctival incision, Gillies reduction and rigid fixation with a microplate, are considered to be good methods for the treatment of zygomatico-orbital fractures, as they are associated with exact anatomical and functional restoration and few complications.

Management of Complications after Conjunctivodacryocystorhinostomy with Jones Tube

PURPOSE: To analyze the surgical outcomes of conjunctivodacryocystorhinostomy(CDCR) with Jones tube on the postoperative management of complications. METHODS: We retrospectively analyzed the medical records of 87 eyes (79 patients) with at least 3 months follow-up who had undergone CDCR with Jones tube between January 1993 and December 2002. The patients were divided into several cases according to the results of postoperative management. RESULTS: Thirty eyes (34%) experienced no complications of Jones tube, over a mean follow-up period of 26.77 +/- 34.41 months. Forty-five eyes (52%) were improved by postoperative management of complications, over a mean follow-up period of 45.00 +/- 42.70 months. In these 45 eyes, the medial migration of the tube was corrected in 7 eyes after repositioning without fixed suture, in 9 eyes after repositioning with fixed suture, in 10 eyes after endonasal endoscopy-assisted repositioning with fixed suture, and in 1 eye after endonasal endoscopy-assisted tube exchange. The lateral migration of the tube was corrected in 1 eye after repositioning with fixed suture, and in 7 eyes after endonasal endoscopy-assisted tube exchange with fixed suture. The extrusion of the tube was corrected in 3 eyes after endonasal endoscopy-assisted tube reinsertion with fixed suture. Consecutive dacryocystitis improved in 1 eye after tube exchange with dacryocystectomy. The conjunctival obstruction of the tube was corrected in 6 eyes after resection of conjunctival tissue. Twelve eyes (14%) were not improved by CDCR or postoperative managements of complications, over follow-up period of 38.50 +/- 35.39 months. CONCLUSIONS: The complications of Jones tube occurred anytime during the postoperative period. If extrusion of the tube occurred reinsertion had to be done as soon as possible. Migration or obstruction of the tube was mostly improved by postoperative managements.

Surgical Results of Lacrimal Surgery with or without Canalicular Stenosis

PURPOSE: To compare the surgical results of lacrimal surgery for nasolacrimal duct obstruction with and without canalicular stenosis. METHODS: We surveyed 175 eyes which underwent external dacryocystorhinostomy with silicone tube intubation from January 1996 through December 2000 retrospectively. Group 1 included 126 eyes in nasolacrimal duct obstruction without canalicular or commoon canalicular stenosis and group 2 included 47 eyes with canalicular or common canalicular stenosis. We checked the statistical significance with Chi-squre Test. RESULTS: Anatomical success rate was 96.0% (121/126) in group 1 and 85.7% (42/49) in group 2; It was statistically significant (p<0.05). And functional success rate was 91.3% (115/126) in group 1 and 73.5% (36/49) in group 2; it had statistic significance (p<0.05). The surgical success rate depending on the size of sac was not statstically significant in goup 1, but it had statstic significance in total group (p<0.05). In site of stenosis, anatomical and functional success rate ware 93.1% (27/29) and 79.37% (23/29) in common canalicular stenosis. It was higer surgical success rate than the other site, but it had no statistic significance. CONCLUSIONS: The canalicular or common canalicular stenosis is important factor in success of lacrimal surgery. Therefore it is recommendable to open the canalicular stenosis by probing prior to performing dacryocystorhinostomy.

Comparison of Surgical Result between External Dacryocystorhinostomy with Mitomycin-C and without Mitomycin-C

PURPOSE: To compare the surgical results of external dacryocystorhinostomy with intraoperative application of mitomycin-C and external dacryocystorhinostomy without application of mitomycin-C. METHODS: In 80 eyes which underwent external dacryocystorhinostomy, group 1 included 40 eyes with intraoperative mitomycin-C, and group 2 (control group) included 40 eyes without mitomycin-C. In group 1, 5 minute application with 0.4 mg/ml mitomycin-C was intraoperatively performed on the osteotom site and the incision site of posterior mucosal flap. Postoperative follow-up was done at 1-week interval for 1 month, at 2-week interval after 2 months and 1-month interval for 3 to 6 months. We determined the surgical success by the irrigation with normal saline and epiphora. By the irrigation with normal saline, no reflux was regarded as the anatomical success, no reflux with no epiphora was regarded as the functional success. We checked the statistical significance with Fisher's Exact Test. RESULTS: After 6 months, anatomical success rate was 95.0% (38/40) in group 1 and 90.0% (36/40) in group 2. It was not statistically significant (p>0.05). And functional success rate was 90.0% (36/40) in group 1 and 85.0% (34/40) in group 2; it had no statistic significance (p> 0.05). CONCLUSIONS: Authors conclude that the intraoperative use of mitomycin-C in repeated dacyo-cystorhinostomy or the poor condition of nasal mucosa is more helpful than the primary use of mitomycin-C in external dacyocystorhinostomy.

Inhibitory Effect of Tranilast on the Proliferation of Human Conjunctival Epithelial Cells and Subconjunctival Fibroblasts

PURPOSE: Tanilast has been clinically used for various allergic diseases. Recently, it has also been found to inhibit excessive scarring in wound healing process. The purpose of this study is to investigate the inhibitory effect of Tranilast on the proliferation of human conjunctival epithelial cells and subconjunctival fibroblasts. METHODS: Human conjunctival epithelial cells and subconjunctival fibroblasts were exposed for 24 hours to Tranilast 0.05, 0.2, 0.4, 0.8, and 1.6 mg/ml. MTT based calorimetric assay was performed to assess the metabolic activity and inhibition of cellular proliferation. RESULTS: As the concentration of Tranilast increased, the absorbance of spectrometer decreased. Inhibitory effect of cellular proliferation was stronger in subconjunctival fibroblasts than in conjunctival epithelial cells. The inhibitory effect of celluar proliferation in conjunctival epithelial cells was 75%, 66%, 64%, 59%, and 39% at 0.05, 0.2, 0.4, 0.8, and 1.6 mg/ml, respectively (LD50 was 0.9 mg/ml). In subconjunctival fibroblasts, the inhibitory effect of celluar proliferation was 66%, 62%, 47%, 33%, and 23% at 0.05, 0.2, 0.4, 0.8, and 1.6 mg/ml, respectively (LD50 was 0.3 mg/ml). CONCLUSION: Tranilast may prevent excessive proliferation of both human conjunctival epithelial cells and subconjunctival fibroblasts. This inhibitory effect on cellular proliferation was higher in subconjunctival fibroblasts than in conjunctival epithelial cells, suggesting the possibility of being used after glaucoma filtering surgery or pterygium excision.