Orbital Cellulitis Following Strabismus Surgery

PURPOSE: To report a case of sudden orbital cellulitis presenting 2 weeks after strabismus surgery in a patient who had previously undergone retinal surgery for rhegmatogenous retinal detachment. CASE SUMMARY: A 45-year-old male visited the ophthalmology clinic with a 3-day history of left eye pain and lid swelling which suddenly developed 2 weeks after left lateral rectus muscle recession surgery for secondary sensory exotropia. The patient had undergone trans pars plana vitrectomy twice, scleral encircling, oil injection and removal for rhegmatogenous retinal detachment 1.3 years prior. His best corrected visual acuity was 0.2 in his left eye and physical examination revealed eyelid edema, chemosis, and subconjunctival hemorrhage of the left eye. The next day, eye movements were moderately restricted. Computed tomography scanning with contrast enhancement demonstrated diffuse periorbital soft tissue swelling and enhanced fat stranding suggesting left orbital cellulitis. The patient was hospitalized with intravenous broad spectrum antibiotics. He was discharged after a 5-day course of intravenous antibiotic treatment, but readmitted for symptom aggravation and purulent discharge from the left conjunctival fornix. Culture of conjunctival fornices revealed penicillin-resistant staphylococcus aureus. Intravenous anitibiotics were maintained for 11 days additionally and left eye swelling, tenderness and ocular movement restrictions were improved. The patient was discharged from the hospital with a best corrected visual acuity of 0.2.

Clinical Follow-up of Conjunctival Malignant Melanoma

PURPOSE: To investigate the clinical features and course of conjunctival malignant melanoma in Korea. METHODS: The medical records of 15 patients, 5 males and 10 females, diagnosed with conjunctival malignant melanoma who had been treated at Severance Hospital from May 1991 to March 2004 were reviewed retrospectively. The clinical parameters of the patients, tumors, and treatment were analyzed for their relation to outcome measures. RESULTS: The mean age at the time of diagnosis was 53.4 years (+/-11.7 years). In all cases, the disease was unilateral and all patients had experienced at least one recurrence. Local lymph node metastasis was found in 3 patients (20%) and the mean time to metastasis was 3.5 years. Systemic metastasis was found in 6 patients (40%) and the mean time to metastasis was 9.3 years. There were 5 cases of tumor-related death (33.3%), 4 of which were attributed to systemic metastasis. The Kaplan-Meier estimates of cumulative survival rate were 90% at 30 months and 56.6% at 70 months. CONCLUSIONS: Although conjunctival malignant melanoma is a rare disease, it is life-threatening and complete tumor excision at an early stage is mandatory, as is additional therapy to prevent local recurrence and systemic metastasis.

Evaluation of the Difference between the Predicted and Actual Refraction Among Different Types of Intraocular Lenses

PURPOSE: To evaluate the difference between the predicted and actual refraction among the intraocular lenses having different materials and shapes of optic and haptic. METHODS: We retrospectively analyzed the cases of 680 eyes with normal range of axial length (21-26mm), which underwent phacoemulsification and posterior chamber IOL implantation, and had at least 2 months follow up period, divided by 4 groups according to the types of IOL used. RESULTS: Mean age of the subjects was 68.9+/-10.8 years with 197 eyes (29%) of male and 483 eyes (71%) of female. The difference between the predicted and 2 month-postoperative refraction was +0.01 (SI40NB), -0.01 (LI61U), -0.45 (C31UB), +0.05 (MA60BM) diopters, respectively. C31UB group represented the myopic shift of -0.45D range and other groups showed no statistically significant difference. CONCLUSIONS: There was no effect of optic materials on the acquisition of goal diopter. MA60BM, SI40NB, LI61U showed high accuracy of predictiveness. The cause of myopic shift represented in C31UB group might be the differences of the haptic material, optic-haptic junction, or overall diameter.

Measurements of Lid Movements During Blinking: Video Measurement Technique

Understanding the kinetics of normal blinking is helpful for assessing ptosis, third and seventh cranial nerve palsy. Many different techniques have been used to measure the kinetics of blinking. These techniques require expensive tools and specific clinical environment. And they are invasive and difficult to apply to children because of lack of cooporation. We videotaped the eyelid movements of normal subject using video camera which can be used in uncooperative children and is noninvasive manner. There was no significant difference in the mean velocity and the time of eye closure and opening according to the age and sex(p>0.05). But the greater the levator palpebra function, the faster the mean velocity of eye opening and the faster the mean velocity of eye closure, the lesser the D ratio. We took standard data of eyelid movement of normal subject. Therefore, we may expect the diagnostic value of eyelid movement measurement using video camera in eyelid movement disorders.

Combined Phacoemulsification, Posterior Chamber Lens Implantation and Trabeculectomy in Advanced Glaucoma Patients

The treatment of the patients with coexisting cataract and glaucoma is various. It is possible that small conjuntival and scleral incisions, minimal conjunctival dissection, and less ocular inflammation could decrease wound healing stimuli.So, we studied the results of combined phacoemulsification, posteior chamber lesn implantation and trabeculectomy with or without mitomycin C (MMC) in advanced glaucoma patients with coexisting cataract. The preoperative, postoperative 1months and last follow-up intraocular pressures (mean+/-standard deviation) were 23.4+/-8.29, 12.8+/-2.95 and 14.1+3.37mmHg, respectively. Mitomycin C was applied to 13 eyes in high risk group offiltering bleb failure during the combined operation. The amount of postoperative intraocular pressure decrease was not significantly different between two groups. The preoperative and postoperative last follow-up visual acuities (mean) wer 20/200 and 20/30 in bot group, respectively. The complications were corneal epithelial defect, hyphema and posterior subcapsular opacity. But there wer no hypotony with symptomatic maculopathy and bleb leakage. Therefore combined phacoemulsification, posterior chamber lens implantation and trabeculectomy with or without mitomycin C appears to be a safe and effective surgical technique for treating advanced glaucoma patients with coexisting cataract.

Observation of Damage to the Blood-Aqueous Barrier after Trabeculectomy with Mitomycin C

We observed the breakdown of the blood-aqueous barrier after trabeculectomy with mitomycin C by using laser flaremeter. There were 20 patients (25 eyes) of which 9 patients(11 eyes) were applied 0.02% MMC for 3minutes during the trabeculectomy and 11 patients (14 eyes) were not applied MMC. All patients were diagnosed as primary open angle glaucoma and underwent trabeculectomy. The preoperative, postoperative 1 day and 3 months aqueous flare intensity were 10.8+/- 5.05, 15.6+/- 5.32, 10.1+/- 4.55(photon count/msec)in group with MMC and 10.6+/-4.04,15.9+/-3.30, 9.2+/-3.94(photon count/msec) in group without MMC Anterior chamber flares were highest on the first postoperative day, declining rapidly in the first week with more gradual recovery to preoperative level by 1 month postoperatively, which shows the breakdown of blood-aqueous barrier by surgery. There was no statistically significant difference between the two groups in postsurgical aqueous flare intensity. 0.02% MMC does not appear.