Primary Cutaneous Adenoid Cystic Carcinoma on Lower Lid

PURPOSE: Primary cutaneous adenoid cystic carcinoma(PCACC) is a very rare malignant tumor originating from the eccrine glands of skin and 39 cases have been reported in the world literature. We report PCACC on the lower lid with metastasis to the lung and brain. METHOD: 56 years old man visited because of hard mass on left lower lid which developed 18 months ago. On punch biopsy the mass showed malignant nature and it was removed by wedge resection method with clear margin. RESULT: Adenoid cystic carcinoma was diagnosed by histologic exam of removed mass and it was diagnosed PCACC because salivary gland region is normal and systemic exam shows no abnormality. After 2 years 10 months recurrent tumor developed on medial lower lid and zygomatic area. We tried to remove mass totally but it failed. Metastases to lung and brain developed.

Change of Visual Acuity and Astigmatism after Operation in Epiblepharon Children

To study the relationship between the corneal erosion by inverted eyelash and the degree of astigmatism and visual acuity, we reviewed the surgical recorders of epiblepharon children. We classified 106 eyes of 53 children as 3 groups according to the area of corneal erosion(grade I:confined below pupil, grade II:involving pupil partially, grade III:involving pupil totally). We examined uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and noncycloplegic auto-refraction test before and 1 month after surgery. Mean UCVA was increased from 0.61 before surgery to 0.71 after surgery and mean BCVA was increased from 0.82 to 0.89 and the differences were stastically significant(p0.05). The degree of visual improvement and astigmatic decrease was similar in 3 groups. In conclusion in epiblepharon children the visual acuity was poor more likely due to corneal erosion itself than due to refractive error like astigmatism. In epiblepharon children with-the-rule astigmatism was more prevalent than in normal children before and after the surgery.

The Relation between Nasal Cavity Size and Success Rate in Endonasal Dacryocystorhinostomy

We studied whether the structure and size of nasal cavity around osteotomy site had an influence on the success rate of endoscopic endonasal dacryocystorhinostomy [DCR]. Endoscopic endonasal DCR was performed on 80 eyes of 72 patients who had obstruction of nasolacrimal system.We graded nasal cavity around osteotomy site according to the diameter of drill which could pass[grade I:7 mmdrill can pass, grade II:5 mmdrill can pass, grade III:3 mmdrill can pass, grade IV:3 mmdrill cannot pass].The primary success rate is 70%[56 eyes] and final success rate is 81.3%[65 eyes]after secondary operation was perfomed on 14 eyes of 24 failed eyes in primary operation.Primary success rate was 78.8%[41/52 eyes]and 53.6%[15/28 eyes]in grade I-II and grade III-IV, respectively.Final success rate was 86.5%[45/52 eyes]and 71.4%[20/28 eyes]in grade I-II and grade III-IV, respectively.The difference of success rates according to nasal cavity size is stastically significant[P<0.05] and the relation of nasal septum deviation to small nasal cavity is stastically significant[P<0.05].We found canalicular obstruciton in 5 of 14 eyes during secondary operation which was not found in primary speration, and it was suspected to have been caused by mechanical trauma to canalicular system during operation.

The Study of Intraocular Vascular Endothelial Growth Factor Concentration in Diabetic Retinopathy after Panretinal Photocoagulation

Vascular endothelial growth factor[VEGF] might play important roles in angiogenesis of diabetic retinopathy. Aim of this study is to determine the effect of panretinal photocoagulation[PRP] on the level of VEGF in intraocular fluid of proliferative diabetic retinopathy[PDR]. Aqueous humor was obtained during cataract surgery from 35 eyes of 35 patients with PDR and VEGF concentration was measured using enzyme-linked immunosorbent assay[ELISA]. Patients were classified into 4 groups according to total amount of panretinal photocoagulation[PRP][group A:no PRP, group B: less than 1000 spots, group C: 1000~1500 spots, group D: more than 1500 spots] and VEGF level was analyzed in each group using Spearman's correlation coefficient by rank. Mean concentration of VEGF is 615pg/mlin group A, 307pg/mlin group B, 234 pg/mlin group C, and 136pg/mlin group D. The level of VEGF was significantly lower as total amount of PRP increased[p<0.05]. These findings suggest that therapeutic effect of PRP on PDR can be explained by the reduction of VEGF concentration in intraocular fluid.