The Distribution of the Extraocular Pulley Smooth Muscle in the Rabbit

PURPOSE: We evaluated the structure, innervation of the extraocular pulley smooth muscle in the rabbit. METHODS: A rabbit was transcardially perfused with physiological saline followed by 4% formalin. The rabbit orbit was dissected en bloc, paraffin processed, and serially sectioned for Hematoxylin-Eosin and Masson's trichrome stain. The distribution of the extraocular pulley smooth muscle was confirmed by immunohistochemistry with human smooth muscle(SM) alpha-actin. RESULTS: We found that the pulley structure consisted of focal condensations of eleastin and collagenous connective tissue in relationship to the rectus muscle in the equatorial Tenon's fascia. The pulley smooth muscle in relation to medial rectus muscle was immunostained with TH and nNOS. CONCLUSIONS: The data support the presence of the extraocular pulley smooth muscle in the rabbit orbit having both parasympathetic and sympathetic innervation.

Right Superior Oblique Paralysis associated with Idopathic Hypertropic Cranial Pachymeningitis

PURPOSE: Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare disase, which causes chronic progressive inflammation and thickening of the basal dura mater. We report a case of IHCP associated with superior oblique paralysis and present a review of the literature. METHODS: An 8-year-old boy presented with binocular diplopia and left side head tilting. Suspecting right superior oblique muscle paralysis, an alternating prism test, head tilt test, fundus examinations, neurologic examination, and brain MRI were performed. RESULTS: The brain MRI revealed abnormal enhancement of the right tentorium in the course of the right fourth cranial nerve, leading to a diagnosis of IHCP with paralytic strabismus and the patient was treated with systemic steroid therapy. CONCLUSIONS: We report a case of IHCP with right superior oblique paralysis. Patients with recent onset paralytic strabismus require appropriate neurolgic and neuroimaging examinations.

Coil Embolization Via a Superior Ophthalmic Vein Approach of Carotid Cavernous Sinus Fistula

PURPOSE: The result of embolization via an external superior ophthalmic vein approach of carotid cavernous sinus fistula was first described around 1970s. We report a case of coil embolization of carotid cavernous sinus fistula using a superior ophthalmic vein approach. METHODS: A 70-year-old female had a 3-month history of headache, periocular pain, and diplopia. Diagnostic orbital contrast-enhanced CT, brain MRI and contrast-angiography and cerebral angiography revealed a carotid cavernous sinus fistula. Fistula occlusion via transfemoral endovascular embolization failed, so we then tried coil embolization using an external superior ophthalmic vein approach of carotid cavernous sinus fistula. RESULTS: The coil embolization via an external superior ophthalmic vein approach was difficult because of venous tortuosity and poor exposure of part of orbital roof area. But, X-ray-guided direct puncture of the superior ophthalmic vein was successful. We thus had good results with coil embolization of carotid cavernous fistula. CONCLUSIONS: The coil embolization via superior ophthalmic vein approach is an effective and challengeable treatment when surgical cauterization or conventional endovascular embolization fails. We suggest that there is need to training ophthalmologists to be experienced in external orbital surgery.

Clinical Study on Anterior Chamber Intraocular Lens Implantation in Completely Vitrectomized Eyes

PURPOSE: We studied the result and clinical significance of anterior chamber lens implantation in completely vitrectomized eyes without capsular support. METHODS: We evaluated 15 aphakic eyes of 15 patients. According to the cause of pars plana vitrectomy, there were 6 eyes for lens dislocation, 5 for intraocular foreign body, and 4 for rhegmatogenous retinal detachment. RESULTS: The final available postoperative best-corrected visual acuity was 0.5 or better in 9 eyes (60%). No statistically significant difference was noted in preoperative and postoperative IOP. The average of postoperative astigmatism was 1.14 +/- 0.79D. The most common early complication was temporary increase in IOP, but we could control IOP within normal limit with transient treatment. The postoperative late complications were glaucoma, IOL decentration and cystoid macular edema, but serious postoperative complications such as bullous keratopathy and retinal detachment were not found. CONCLUSIONS: The anterior chamber IOL implantation appears to be well tolerated and represents a simple alternative to transscleral fixation of a posterior chamber IOL in completely vitrectomized aphakic eyes.

The Distribution and Innervation of the Extraocular Pulley Smooth Muscle in the Rat

PURPOSE: We evaluated the structure, distribution and innervation of the extraocular pulley smooth muscle in the rat, a species with a less complex visuomotor repertoire than primates. METHODS: The adult Sprague-Dawley rat was perfused transcardially with physiological saline followed by 4% formalin. The rat orbit was dissected en bloc, then paraffin processed and serially sectioned for hematoxylin-eosin and Masson's trichrome stain. The distribution and innervation of the extraocular pulley smooth muscle was confirmed by immunohistochemistry with human smooth muscle (SM) alpha-actin, tyrosine hydroxylase (TH) and neuronal nitric oxide synthase (nNOS). RESULTS: We found the pulley structure consist of focal condensations of eleastin and collagenous connective tissue in relationship to the rectus muscle in the equatorial Tenon's fascia. Especially, the pulley smooth muscle connected to medial rectus muscle was immunostained to TH and NOS. CONCLUSIONS: The data supports the presence of the extraocular pulley smooth muscle in the rat orbit supposing to have dopaminergic and nitroxidergic innervation.

A Clinical Study on Transscleral Fixation of Posterior Chamber Intraocular Lens in Complete Vitrectomized Eyes

PURPOSE: We studied the result and cilincal significance of transscleral fixation of posterior chamber lens in complete vitrectomized eyes without capsular support. METHODS: We evaluated 30 aphakic eyes of 30 patients and according to the cause of pars plana vitrectomy, there were 9 eyes for intraocular foreign body, 8 eyes for lens dislocation, 8 eyes for retinal detachment, 3 eyes for vitreous hemorrhage, 2 eyes for endophthalmitis. RESULTS: The postoperative best-corrected visual acuity group was intraocular foreign body group and the group of lens dislocation, vitreous hemorrhage, retinal detachment, and endophthalmitis were in the descending order of visual acuity. The most common postoperative early complication was temporary hypotony and the others were hyphema, and temporary increased IOP. The most common postoperative late complication was exposed scleral fixation suture and the others were vitreous hemorrhage, cystoid macular edema, subluxation of intraocular lenses, retinal detachment. CONCLUSIONS: We experienced many postoperative temporary hypotony patients, but all cases were improved in short term period. The complication related to scleral fixation in vitrectomized eyes was imposed to smaller than the scleral fixation in vitreous support. But, in fact the development of retinal detachment or vitreous incarceration complication in the vitrectomized eye was not different from the eyes having vitreous support.

A Case of Bilateral Retinal Homorrhage Associated with Idiopathic Thrombocytopenic Purpura

PURPOSE: Idiopathic thrombocytopenic purpura has bleeding tendency because of severe thrombocytopenia. We report a case of idiopathic thrombocytopenic purpura who showed retinal and preretinal hemorrhage with severe throbocytopenia. METHODS: A 19-year-old girl experienced a sudden onset of metamorphopsia and subconjunctival hemorrhage in both of her eyes two days prior to hospital visit which folowed the neck and lower legs purpura one month ago. We examined slit ramp, fudus and fluorescein angiography. We followed up the patient every week. RESULTS: Her best corrected visual acuity was 0.9, right eye and 0.8, left eye. Fundus exam showed frame-shaped retinal hemorrage around vascular arcade in both eyes. Fluorescein angiography showed blockage of fluorescene caused by retinal hemorrhages. Two weeks later, retinal hemorrhage was nearly absorbed and metamorphopsia was subsided in both eyes.

Results of Combined Chemotherapy and Radiotherapy for Advanced Intraocular Retinoblastoma

PURPOSE: To report the result of combined chemotherapy and radiotherapy for 5 retinoblastoma patients. METHODS: Retrospective study of 5 patients (8 eyes) who were diagnosed with retinoblastoma of group III to V in the Reese-Ellsworth (R-E) classification was done. After 6 cycles of chemotherapy consisting of Vincristine, VP-16 (Etoposide) and Carboplatin, Radiotherapy (4500Gy/5weeks) was done. Neoaedjuvant therapy consisting of Nimustine and Carboplatin was done, and supplementary laser photocoagulation was done in 1 case. Mean follow-up period is 33 months. RESULTS: Significant reduction of tumor size and regression were observed in five eyes of R-E classification group V, and slight reduction of tumor size and regression were observed in three eyes of R-E classification groups III and IV. There was no recurrence and no new mass was detected. CONCLUSIONS: Combined chemotherapy, radiotherapy and supplementary therapy may save eyeballs which were diagnosed with retinoblastoma, even R-E classification group V.