Dose Dependent Effects of Intravitreal Triamcinolone Acetonide on Diffuse Diabetic Macular Edema

PURPOSE: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular edema. METHODS: In a retrospective study, 44 eyes with diffuse diabetic macular edema were treated with an intravitreal injection of 4 mg (n=12 eyes), 8 mg (n=17) or 25 mg (n=15) of triamcinolone acetonide (TA). Optical coherence tomography, best-corrected logMAR visual acuity and Goldmann tonometry were performed at baseline, 1 week, and 1, 3, 6, 9 and 12 months after treatment. Mean follow-up was 9.8 months (standard deviation=2.3) with a range of 5-12 months. RESULTS: The duration of intravitreal TA effects on macular thickness and visual acuity increased with increasing dosage. An observed increase in intraocular pressure induced by TA was not significantly associated with dosage. CONCLUSIONS: In patients with diffuse diabetic macular edema who receive intravitreal TA, effects may last longer after a dosage of 25 mg, than after lower doses of 8 mg or 4 mg.

Comparison of Safety and Efficacy Between Silicone and Polypropylene Ahmed Glaucoma Valves

PURPOSE: To compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs). METHODS: The medical records of 62 consecutive refractory glaucoma patients who had undergone AGV implantion from March 2003 to December 2005 were reviewed retrospectively. Among the 62 patients, 32 patients underwent polypropylene AGV implantation (group P) and the other 30 patients underwent silicone AGV implantation (group S). Postoperative IOP, the complication rate, and the success rate were compared between the two groups. RESULTS: The life-table success rates for the group P were 81.3% at 6 months and 71.2% at 12 months, and the success rates for the group S were 89.9% at 6 months and 78.6% at 12 months, showing no significant difference between the two groups. Complications, including non-tube-related complications, were observed more frequently in the group S, but there was no significant difference between the two groups. CONCLUSIONS: The silicone AGV can reduce IOP effectively but may be associated with non-tube-related complications.

Results of Conjunctiva-Muller Muscle Resection in Mild Eyelid Ptosis

PURPOSE: To assess surgical outcomes after adjusting the amount of resection of the conjunctiva and the Muller muscle according to 10% phenylephrine test results. METHODS: The charts of 32 patients (32 eyes) with mild upper eyelid ptosis were reviewed retrospectively. They all had conjunctiva-Muller muscle resections. A preoperative 10% phenylephrine test was performed to determine the resection amount of the Muller muscle and conjunctiva. An 8 mm resection was performed when phenylephrine raised the ptotic lid to the same level as that of the contralateral lid. A 7 mm resection was performed when the ptotic lid was raised to a level higher than that of the contralateral lid. A 9 mm resection was performed when the ptotic lid was raised to a level not quite to the level of the contralateral lid. RESULTS: Of the 32 patients, 28 were female and 4 were male. The mean age of the patients was 30.8+/-10.2 years. Patients were followed up for an average of 40.2+/-36.8 days, postoperatively. Postoperative upper lid positions were exactly symmetrical in 26 of the 32 patients. Five patients showed undercorrection, and 1 patient showed overcorrection. CONCLUSIONS: Excellent results were obtained by resecting the conjunctiva and Muller muscle according to the phenylephrine reaction of a ptotic eyelid.

Malignant Peripheral Nerve Sheath Tumor of Scalp

PURPOSE: Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from somatic soft tissues or peripheral nerves. Primary MPNST of the scalp is extremely rare. The case is being reported for its rarity. METHODS: A 53-year-old female was presented with a scalp mass on vertex area. The tumor was localized in scalp skin and did not invade underlying periosteum or skull and treated with complete surgical excision followed by adjuvant chemotherapy and radiotherapy. RESULTS: Histologically, the tumor showed malignant spindle cells with focal S-100 positivity on immunohistochemistry and a diagnosis of MPNST was made. CONCLUSION: Authors experienced a rare case of primary scalp MPNST and report the case.

The Usefullness of Hyaluronidase(H-LASE(R)) on Treatment of Nasal Bone Fractures

A nose is the most prominent feature of the face and prone to trauma. The incidence of nasal bone fracture is highest among the facial bone fractures. Any slight displacement of the bones or cartilages is easily noticed, and so a high degree of accuracy is required in the reduction of nasal bone fracture. But swelling and edema of the injured nose prevent earlier and accurate reduction of nasal bone, so that we used hyaluronidase to reduce swelling and edema on treatment of nasal bone fractures. This procedure was performed to 27 patients for last six months. Among these patients, 12 patients wanted early operation, so closed reduction was performed within 1 day after the fracture(group A). And 15 patients were those who still had swelling and edema on operation day after 5 to 7 days after the fracture(group B). Intraoperatively, before closed reduction, we injected hyaluronidase on swollen nose subcutaneously and compressed swollen area gently with fingers. By using hyaluronidase, posttraumatic days for surgery has lessened and more accurate manual palpation of fractured nasal bone was possible due to decreased swelling and edema of nose. A hyaluronidase injection during treatment of nasal bone fracture has benefit on more earlier and accurate reduction by reducing swelling and edema of nose.

Clinical Study for Accurate Injection Site of Botulinum Toxin A in the Correction of Gummy Smil

Gummy smile refers to the excessive exposure of the upper gum when a one smiles, more than 2-3 mm, accompanying the elevation of upper lip. Recently, it is of an increasing concern that the injection of botulinum toxin A to levator labii superioris alaeque nasi muscle and levator labii superioris muscle which are major lip-elevating muscles, has the corrective effect by weakening of these muscles. It is important to understand anatomical marker of the targeted muscle to which safe and effective injection can be performed. This study was performed to investigate the marker to find the targeted muscle easily applicable in practice by reviewing previous literatures. From January 2004 to May 2005, on 5 females that have a gummy smile, we marked injection points to the target muscle, and confirmed their effectivity, accuracy, and safety by EMG. Then we injected botulinum toxin A, and investigate amount of the gum exposure when smiles and occurrence of the side effect serially. 4 weeks after injection, we observed satisfied result without any side effects. Conclusively, as injection points of botulinum toxin A which we presented, are comparatively correct by anatomy, they are easily applicable in practice.

Clinical Characteristics of Thermal Injuries Following Free TRAM Flap Breast Reconstruction

Following a transverse rectus abdominis musculocutaneous(TRAM) flap breast reconstruction, denervated state of the flap causes the flap skin prone to thermal injury, calling for special attention. During the last 5 years, 69 breast reconstruction with 72 free TRAM flaps, were performed. Four out of thesse 69 patients sustained burn injury. Heat sources were a warm bag(n=2), heating pad(n=1) and warming light (n=1). The thermal injuries occured from 2 days to 3 months following the reconstruction. Three patients healed with conservative treatment, but one patient required debridement and skin graft. Initially 3 out of 4 patients with the burn had shown superficial 2nd degree burn with small blebs or bullae. However all 4 patients healed with scars. Mechanism of burn injuries of the denervated flap are known to be resulting from; 1) loss of behavioral protection due to denervation of flap with flap elevation and transfer, 2) loss of autonomic thermoregulatory control with heat dissipation on skin flap vasculature contributing to susceptibility of burn injury. 3) changes of immunologic and normal inflammatory response increasing thromboxane, and a fall in substance P & NGF (nerve growth factor). Including the abdominal flap donor site, sensory recovery of the reconstructed breast varies individually from 6 month even to 5 years postoperatively. During this period, wound healing is delayed, resulting in easier scarring compared to that observed in the sensate skin. Patients should be carefully informed and warned of possible burn injuries and taught to avoid exposure to heat source at least until 3 years postoperatively.

Surgical Experience of the Kasabach-Merritt Syndrome

In 1940, Kasabach and Merritt first described the association of a large vascular tumor and thrombocytopenia and termed this Kasabach-Merritt(KM) syndrome. It is characterized by a rapidly enlarging vascular anomaly and consumptive coagulopathy with thrombocytopenia, prolonged prothrombin time and partial thromboplastin time, hypofibrinogenemia, and the presence of D-dimer and fibrin split product, with or without microangiopathic hemolytic anemia. This is a potentially life-threatening condition with mortality rates from 20 to 30% as a result of severe sepsis, coagulopathy, or invasion of vital organs. Treatment modalities are corticosteroids, interferon alfa-2a or 2b, chemotherapy(vincristine, cyclophosphamide, etc.), aspirin, dipyridamole, com- pression, radiation therapy, embolization of feeding vessels and surgical excision. A standard treatment regimen for KM syndrome has not been established and most reports on definitive management of these complex vascular lesions have been anecdotal, involving small numbers of patients. The authors have successfully treated a patient of KM syndrome with actively bleeding huge hemangioma by surgical excision. They present it with the review of articles.