A Case of Rhino-orbital Mucormycosis, Treated with Intraconal Amphotericin B Irriation and Abscess Drainage

Mucormycosis is a relatively uncommon opportunistic fungal infection that occurs more commonly in patients with immunosuppression and diabets mellitus, particularly those with ketoacidosis. Successful therapy for rhinoorbital mucormycosis requires early diagnosis, correction of predisposing conditions, prompt use of amphotericin B, and aggressive surgical debridement. We experienced a 56-years-old poorly controlled diabetic woman with rhinoorbital mucormycosis that was successfully treated with intraconal amphotericin B irrigation and packing without exenteration.

The Effect of Topical Antiglaucomatous Medication on the Outcome of Trabeculectomy

The purpose of this study was to determine whether preoperative topical antiglaucomatous therapy influences the outcome of subsequent trabeculectomy. We investigated 50 eyes of 36 patients with primary open anlge glaucoma(POAG)and 86 eyes of 77 patients with primary angle closure glaucoma (PACG), who had undergone trabeculectomy. All the patients had received topical antiglaucomatous therapy preoperatively and had been followed up for at least 6 months postoperatively. Both groups, POAG and PACG were divided into two subgroups according to the duration of preoperative antiglaucomatous therapy: (a)for less than 1 month and (b)for more than 6 months. The criterion for success was maintenance of postoperative intraocular pressure(IOP)below 21 mmHg without medication. The rates of success were compared at 1 week, 1 month, 3 months, and 6 months postoperatively. In POAG patients, the overall success rate was clinically significantly higher in subgroup (a)than in subgroup (b)(P<0.05). The success rate in subgroup (a)of POAG patients remained higher irrespective of class of antiglaucomatous medications(P<0.05). In PACG patients, the success rate was also higher in subgroup A, but it failed to reach clinical significance. Postoperative mean IOP was slightly lower in subgroup (a)of all the participants, but it was not clinically significant. Our study suggests that long-term use topical antiglaucoma medications can affect adversely the result of filtering surgery in POAG.

Correction of Involutional Entropion by the Amount of Lower Eyelid Laxity

Authors have analysed a series of involutional entropion placed into two categories, those with and without increased horizontal lid laxity following preoperative assessment. Of the 30 entropion operations on 25 eyes, 14 operations(on 13 eyes) were for the group without horizontal lid laxity and 16 operations(on 12 wyws) with horizontal lid laxity. In patients with tight eyelids, we performed lower retractor tucking and excision of preseptal orbicularis muscle and in patients with increased horizontal lid laxity, we added horizontal eyelid shortening procedure to the above procedures. The success rate was 92.8%(13 eyes/14eyes) in group without eyelid laxity, the total surgical success rate being 96.6%(29 eyes/30 eyes).

Visual Results after Grid Laser Photocoagulation for Diffuse Diabetic Macular Edema

We reviewed 92 eyes(65 patients) of diffuse diabetic macular edema which were treated with grid laser photocoagulation and followed up for more than 4 months from March 1992 to March 1997. There were improvements of visual acuity in 24 eyes(26.1%)and non changes in 50 eyes(54.3%), and 18 eyes(19.6%) showed worsened visual acuity. Initial visual acuity, presence of clinically significant macular edema and severity of retinopathy had not significant effects on visual outcome(P>0.05). Patients with grid photocoahulation without panretinal photocoagulation showed significantly good results than panretinal photocoagulation before or after grid photocoagulation(p<0.05).

Clinical Study on Rhegmatogenous Retinal Detachment Treated with Scleral Buckling

One hundred sixteen eyes with rhegmatogenous retinal detachment were treated with a scleral buckling procedure which consisted of silicone sponge or silicone band explants, cryotherapy, drainage of subretinal fluid, and other procedures. In 100(86.2%) of these eyes, anatomic reattachment was successful after one operation. Reattachment was not initially successful in 16 eyes. These failures generally resulted from proliferative vitreoretinopathy, diffuse and multiple lattice degeneration, and buckle malposition. Final success was achieved in 113(97.4%) of the 116 eyes. Overall, 49(42.2%) of the 116 eyes had a favorable functional visual result, which we defined as a final visual acuity of 0.3 or better. In this study we found no statistical relationship between age and postoperative visual outcome. But there was significant correlation between a favorable functional visual result and the location of retinal hole, the duration of retinal detachment(p<.05).

Management and Surgical Results of Proliferative Vitreoretinopathy C by Scleral Buckling

Scleral buckling used alone to treat retinal detachment with proliferative vitreoretinopathy(PVR) of grade C resulted in an overall anatomic reattachment rate of 86%(39/45); 96%(27/28) in stage C1, 83%(10/12) in stage C2, and 40%(2/5) in stage C3. The success rate declined with increasing severity of PVR. Stage C3 eyes showed a significantly lower rate of retinal reattachment than stage C1 and C2 eyes(p<.05). We currently recommend scleral buckling alone as the surgery of choice for stage C1 and C2 PVR; we reserve vitrectomy with preretinal membrane removal for the more advanced cases.