Changes in Eyelid Height with Time after Levator Resection under Local Anesthesia

PURPOSE: To evaluate the factors that affect the eyelid height changes during the postoperative period in patients who underwent levator resection under local anesthesia. METHODS: Among the 242 patients that underwent levator resection under local anesthesia by the same surgeon between January on 1995 and December 2003, marginal reflex distance 1 (MRD1) measurements were performed using a caliper in 91 patients who were followed for more than 3 months. RESULTS: There were 36 males and 55 females, aged between 12 and 78 years (average of 33.6 years). The average follow-up period of the patients was 8.7 months (3 months ~ 58 months). During this period, 86 patients (94.5%) experienced satisfactory results. The average change in the MRD1 of the eyelids preoperatively, during the operation, and 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively were 0.8 mm, 3.9 mm, 3.0 mm, 2.7 mm, 2.5 mm, 2.4 mm, and 2.2 mm, respectively. The MRD1 decreased 1.2 mm after 1 month and stabilized. When the levator function was greater than 8 mm, the height of the eyelids stabilized within 1 week. The worse the function of the levator palpebrae, such as in the case of congenital ptosis, the greater the correction was needed. CONCLUSIONS: Levator resection under local anesthesia is a preferable method in adjusting the height of the eyelids. In a patient with poor levator function, a greater amount of correction is needed to achieve a satisfactory eyelid height.

The Effect of Topical Interferon alpha-2b in the Treatment of Conjunctival Squamous Papilloma

PURPOSE: To study the effectiveness of Interferon alfa-2b (IFN alpha 2b) for treating squamous papilloma of the conjunctiva. METHODS: One million units/cc of IFN alpha 2b was applied 4 times a day after identifying squamous papilloma by excisional biopsy. The IFN alpha 2b was used continuously 2 to 6 months after the tumor became undetectable with the unaided eye. The dose was then tapered. RESULTS: Three of the 4 patients had a history of recurrences (1-4 times). In one patient, the tumor was difficult to remove surgically due to the location of the tumor (around the upper punctum). The tumor disappeared with no complications or recurrences during the follow-up period. CONCLUSIONS: In patients with conjunctival squamous papilloma with frequent relapses or difficulty in excision, applying IFN alpha 2b as an eye drop appears to be an effective form of therapy and can be used safely without complications.

A Case of Encephalocraniocutaneous Lipomatosis (ECCL)

PURPOSE: Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous syndromes characterized by unilateral scalp and facial lesions and multiple anomalies involving the eye and central nervous system. To our knowledge, this is the first case reported in Korea. METHODS: A 19-month-old girl was referred to our clinic for evaluation of right-sided multiple facial masses and ocular disorders. RESULTS: Physical examination showed large lipomatous masses on the scalp with overlying alopecia. There were also multiple skin tags in the right periocular area and defects of the right lid margin and lateral canthus. Other ocular anomalies included epibulbar lipodermoid, corneal opacity, iris coloboma and localized hypopigmentation of the retinal pigment epithelium. Brain MRI demonstrated multiple abnormalities that were consistent with lipomas and leptomeningeal angiomatosis. We removed the scalp lipoma and the epibulbar lipodermoid and reconstructed the lateral canthus. CONCLUSIONS: In the case of suspected ECCL, it is essential to differentiate from other syndromes which present with epibulbar choristoma. Neuroimaging such as CT or MRI and pathologic study may be helpful.

The Effect of Botulinum Toxin A Injection in the Upper Eyelid Retraction

PURPOSE: To investigate the effectiveness of botulinum toxin injections in the management of upper eyelid retraction associated with thyroid eye disease and developed after levator resection. METHODS: Under topical anesthesia, 2.5 to 7.5 units of botulinum toxin type A were administered medially and laterally at the superior margin of the tarsal plate after everting the upper eyelid. The level of the upper eyelid was evaluated by MRD1 obtained from photographs taken during the follow-up period. RESULTS: Of 9 patients treated, 5(55.6%) experienced some improvement in the amount of lid retraction after injections and 3(33.3%) showed good results with a difference in height between the two eyelids of less than 1mm. Ptosis was developed in two patients, but was transient and improved in one month. There were no other complications such as strabismus. CONCLUSIONS: This subconjunctival method of botulinum toxin injection is easy to administer and can be used safely and repeatedly, without significant side effects, for patients who do not wish to undergo a surgical procedure or as a temporary purpose before surgery.

Primary Localized Amyloidosis of the Lacrimal Gland

PURPOSE: Primary localized amyloidosis of the lacrimal gland is rarely encountered in the lacrimal gland. The authors report a patient with orbital amyloidosis isolated to the lacrimal gland. METHODS: A 52-year-old woman presented with the superotemporal orbital mass for one year. The patient underwent surgical biopsy. RESULTS: A representative tissue section, stained with hematoxylin and eosin, showed pink amorphous hyaline deposits diffusely infiltrating tissue. The hyaline deposits stained positively with Congo red and demonstrated birefringence under polarized light. Immunohistochemical stains against immunoglobulin light chain were positive against kappa and lambda chain. No systemic involvement was noted from systemic work-up. Primary localized amyloidosis of the lacrimal gland was diagnosed. CONCLUSIONS: As far as we know this is the first case of primary localized amyloidosis of the lacrimal gland in Korea. Amyloidosis should be considered in differential diagnosis of a mass in the lacrimal gland.

Frontalis Suspension Using Autogenous Fascia Lata

PURPOSE: To investigate the effect of frontalis sling operation with autogenous fascia lata. METHODS: We reviewed the medical records of 83 ptosis patients who had undergone frontalis sling with autogenous fascia lata from December 1997 to April 2003, and who were followed up for six months or more. We retrospectively evaluated the clinical features and the surgery outcomes. RESULTS: There were 55 males and 28 females with age ranging from 3 to 42 years (mean, 10.8 years). The ptosis was unilateral in 29 patients and bilateral in 54. With a mean follow-up of 23.3 months (range 6-70 months), 74 patients (89.1%) showed good results and 9 (10.8%) showed fair results. The summation of these two results indicated an overall satisfactory result of 100%. Superficial punctate keratopathy was the most common complication (38.5%), but most of them were transient and improved with time. Other complications were entropion (8.4%) and peripheral corneal opacity (2.4%). CONCLUSIONS: We conclude that frontalis sling using autogenous fascia lata may be the best method for ptosis management in patients who have a severe ptosis with poor levator function.

The Effect of Vitrectomy on the Complication of Branch Retinal Vein Occlusion

PURPOSE: This study was designed to evaluate the effect of vitrectomy on the recovery of impaired visual acuity from complication of branch retinal vein occlusion (BRVO). METHODS: The medical records were obtained from all patients who underwent vitreoretinal surgery for complication of BRVO and were followed up at least for 6 months postoperatively. RESULTS: The Surgical indications included vitreous hemorrhage (29 patients), epiretinal membrane (7), and retinal detachment (4). Mean follow-up was 13 months. Preoperatively, best corrected visual acuity was greater than or equal to 0.1 in 14 eyes (35.0%). Six months postoperatively, best corrected visual acuity was greater than or equal to 0.1 in 36 eyes (90.0%). Clinical features associated with better visual outcome included better preoperative visual acuity (P<0.01) and absence of preoperative macular edema (P<0.02). CONCLUSIONS: Vitrectomy is a good procedure for the recovery on the visual impairment due to BRVO complication.

A Case of Fungal Sphenoidal Sinusitis Involving Optic Nerve

Few have reported fungal sinusitis confined in only sphenoidal sinus which caused orbital complication. Reportedly, early surgical treatment can lead to visual recovery especially in its involvement of optic nerve. We report a patients who was hospitalized due to sudden decrease in visual acuity and headache, and was histopathologically diagnosed as having aspergillosis confined in sphenoid sinus, but failed to show restoration of visual acuity after the operation using nasal endoscope.

Pars Plana Vitrectomy Combined with Anterior Phacoemulsification

Phacoemulsification combined with pars plana vitrectomy was performed on seventeen eyes with both cataract and vitreoretinal disease. Postoperative visual acuity improved in ten of seventeen cases. There was no serious perioperative complication. In those eyes with both cataract and vitreoretinal disease, the small incision used in phacoemulsification allows better control of the anterior chamber during vitrectomy. In addition, this procedure allows endocapsular fixation of the intraocular lens.