Analysis of Persistent Diplopia and Enophthalmos after Surgical Repair of Blowout Fracture

PURPOSE: To evaluate the incidence of persistent diplopia and enophthalmos and possible risk factors leading to their occurrence in patients who had orbital blowout fracture repair. METHODS: We retrospectively evaluated clinical features in 76 eyes of 76 patients with orbital blowout fracture, who were repaired surgically after its diagnosis from March 1995 to November 2001. We analysed the relationship between persistent diplopia and enophthalmos after reconstruction and timing of surgery, patient age, fracture location, fracture size and alloplast material. RESULTS: Postoperatively, 11 patients (22.9%) expirienced diplopia and enophthalmos persisted in 11 (28.2%) patients. Timing of surgery, patient age, fracture location, fracture size was found to be significant for the development of postoperative diplopia but alloplast material was not significant for the development of postoperative diplopia (p>0.05). Timing of surgery and fracture size was found to be significant for the development of postoperative enophthalmos but patient age, fracture location and alloplast material was not significant for the development of postoperative enophthalmos (p>0.05). CONCLUSIONS: We believe that timing of surgery is important prognostic factor that decreases the incidence of persistent diplopia and enophthalmos after surgical repair of blowout fracture. In addition, this study will provide important prognostic informations that can be of benefit to both patients and surgeon in performing surgical repair of blowout fracture.

Needle Revision on Failed Filtering Blebs Using Mitomycin C

PURPOSE: To determine the success rate and complications of Mitomycin C (MMC) augmented needle revision on failed filtering blebs. METHODS: We retrospectively investigated the records of 30 patients (32 eyes) who had undergone needle revision with MMC on failed filtering blebs. A mixture of 0.02 ml of MMC (0.4 mg/ml) and 0.02 ml of 2% lidocaine (20 mg/ml) was injected subconjunctivally. 5 minutes later, needle revision was done with bented 30 gauge needle. RESULTS: The mean Intraocular pressure(IOP) decreased from 28.1+/-9.4 mm Hg before surgery to 14.7+/-6.2 mmHg at the last follow-up. The mean follow-up period after the last needle revision was 23.5+/-19.4 months. In 27 eyes (84.4%), the last IOP was less than or equal to 18 mmHg. Serious complications were not found. CONCLUSIONS: MMC augmented needle revision appears to be an effective way to revive failed filtration blebs. The incidence of complications compares favorably to that of other glaucoma related surgery.

Outcome of Mini Monoka Silicone Monocanalicular Lacrimal Stents in Canalicular Laceration

PURPOSE: To determine clinical outcomes of mini Monoka silicone monocanalicular lacrimal stent (from now, mini Monoka stent) in canalicular injury. METHODS: From June 1996 to December 2001, mini Monoka stent was used in 70 eyes(77 canaliculi) of superior, inferior and bicanalicular injury. Mini Monoka stent was shortened about 20 mm with round tip and intubated. Punctal fixation suture was not done. RESULTS: The mean follow-up period was 7.9+/-1.0 months (4-12 months). The outcome of our repair was judged by the existence of epiphora, dye disappearance test, probing and irrigation. In 57 eyes (81.4%), there was no epiphora. In 11 eyes (15.7%), epiphora was developed only after certain stimuli. In 2 eyes (2.9%), there was epiphora at all times. Postoperative complications were premature stent loss 6 eyes (8.6%), conjunctival injection 3 eyes (3.9%). CONCLUSIONS: The intubation of mini Monoka stent for the lacerated canaliculus is the simply operative procedure in the outpatient department. The shortening of mini Monoka stent made this procedure easier. Despite no punctal fixation suture, the occurrence rate of the premature stent loss was not higher than that for published reports of mini Monoka stent.

Surgical Outcome and Complications of Preoperative Subconjunctival Injection of Mitomycin C in Filtering Surgery

PURPOSE: We conducted a retrospective study to evaluate preoperative subconjunctival injection of mitomycin C (MMC) for surgical outcome and postoperative complications in trabeculectomy. METHODS: Twenty-eight eyes (22 patients) with glaucoma patients who were followed up for at least 6 months were injected subconjunctivally with 0.02 ml of 0.4mg/ml MMC (0.008 mg) mixed with 0.03 ml of 2% lidocaine before making the conjunctival incision and then trabeculectomy was performed after 5 minutes. RESULTS: Postoperative mean follow-up period was 21.1 months, preoperative mean IOP was 33.9 mmHg. Postoperative mean IOP at 1, 3, 6, 12month, and at the last follow-up were 9.0, 9.3, 9.5, 11.0, and 11.2 mmHg, respectively. There were statistically significant decreases of IOP in postoperation compared preoperation. When postoperative IOP were controlled below 21 mmHg and reduced under 30% compared with preoperative IOP, postoperative success rate at 1, 3, 6, 12 month, and at the last follow-up were 100%, 96%, 89%, 89%, and 86%, respectively. Postoperative complications were avascular cystic bleb in 8 eyes (29%), transient hypotony in 6 eyes (21%), shallow anterior chamber in 5 eyes (18%). Early aqueous leaking from conjunctival wound was in 4 eyes (14%). CONCLUSIONS: It is suggested that the preoperative subconjunctival injection of MMC of high concentration be used in filtering surgery. But the determination of volume and concentration is needed to prevent postoperative complications and long-term IOP lowering effect.

Frontalis Suspension Using Silicone Rod

PURPOSE: To evaluate the surgical results and complications in patients with blepharoptosis who underwent frontalis suspension using a silicone rod. METHODS: A total of 31 lids of 23 patients with blepharoptosis and poor levator function underwent a pentagon-shaped loop silicone sling surgery in which six skin incisions were made. Eighteen patients had congenital ptosis, two blepharophimosis-ptosis syndrome, two blepharoptosis with superior rectus muscle weakness, and one third nerve palsy. RESULTS: With a mean age of 14 years and a mean follow-up of 16 months, good-to-excellent lid height was achieved in 27 lids (87%) of 20 patients and poor results with undercorrection in 4 lids (13%) of 3 patients. Three of the 4 lids with poor results had reoperation and satisfactory results were achieved. Transient exposure keratitis occurred postoperatively in 7 lids (23%) and persistent exposure keratitis in 2 lids (6%). During the follow-up period, extrusion of the sling and infection did not occur; ptosis recurred in 4 lids (13%). CONCLUSIONS: Silicone rod can be adjusted easily after frontalis suspension, but it needs to pay close attention because the string can be broken during the operation or follow-up period. It is considered that additional follow-ups for a long-term recurrence rate of ptosis are necessary and sufficient explanation to the patients and family and their understanding are need.

Clinical Outcomes of Phacoemulsification Technique with Intraocular Lens Implantation in Leprosy Patients

PURPOSE: To evaluate the surgical results and complications in leprosy patients with cataract who underwent phacoemulsification and intraocular lens implantation retrospectively. METHODS: A total of 17 eyes of 13 leprosy patients with cataract underwent a phacoemulsification and posterior chamber intraocular lens implantation. We performed pupillary sphicterectomy or sector iridectomy for miotic pupils. RESULTS: With mean age of 73 years and a mean follow-up of 8.2 months, patients admitted for 3.2 days. The average visual acuity was 0.1 (0.04~0.3) preoperatively, 0.5 (0.04~1.0) at 1 week after operation, and 0.6 (0.1~1.0) at 2 months after operation. Intraoperative complications were posterior capsular rupture (2 eyes) and vitreous loss (1 eye). Common Postoperative complications were after cataract (4 eyes) and hyphema (2eyes). CONCLUSIONS: We thought the phacoemulsification and intraocular lens implantation was useful method for cataract of leprosy patient for increased life quality and satisfaction.