A Case of Isolated Orbital Sarcoidosis

PURPOSE: The authors report a case of orbital sarcoidosis without evidence of systemic involvement. CASE SUMMARY: A 33-year-old female had a 1 month history of erythematous eyelid swelling. On physical examination, a firm and non-tender mass was observed diffusely along the upper, lower and medial canthal areas. A computed tomography (CT) scan showed a diffuse mass in the anterior orbit. We performed an incisional biopsy and histopathological examination revealed non-caseating granulomas and no evidence of a foreign body. Acid-fast-bacilli (AFB), methenamine silver and periodic-acid-schiff (PAS) stain showed no evidence of infection and chest radiograph was normal. Polymerase chain reaction (PCR) and interferon gamma secretion test showed no evidence of tuberculosis. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative and angiotensin converting enzyme (ACE) was within the normal range. Further systemic evaluations were compatible with a diagnosis of orbital sarcoidosis and oral prednisone was prescribed. Six weeks later, the erythematous eyelid swelling had disappeared and there was no evidence of recurrence to date.

A Case of Acute Idiopathic Bilateral Lower lid Ectropion

Introduction: Ectropion is an eversion of the eyelid due to various causes, and it mainly develops in the lower lid. Usually it shows a slow progression, and it is classified as involutional, cicatricial, paralytic and congenital. Acute idiopathic bilateral lower lid ectropion is very rare; few cases have been reported worldwide, and none have been seen in Korea. CASE SUMMARY: A 79-year-old male patient visited our department with a six-day history of epiphora and lower lid eversion in both eyes. On slit-lamp examination, lower lid ectropion was present in both eyes, and mild corneal punctate epithelial erosion was also observed. Two weeks after conservative treatment, the lower lid eversion disappeared and the lower lid returned to its original position. No changes were observed three months after treatment. We report a case of acute idiopathic bilateral lower lid ectropion with a literature review.

Reconstruction of Isolated Medial Orbital Wall Fracture Using a Transcaruncular Approach

PURPOSE: We present our results in the reconstruction of medial orbital wall fractures using a transcaruncular approach. METHODS: Forty-five patients with isolated medial orbital wall fractures underwent reconstruction by transcaruncular approach in our clinic between May 2003 and October 2007, and were followed up for 6 months or more. RESULTS: Thirty-three males and 12 females were included in this study, with a mean age of 34.9 years. The most common indication for reconstruction were large sized fractures more than 50%. Operations were performed at a mean 11.9 days after trauma. Among 18 patients who had diplopia before the operation, 16 (89%) patients had symptom relief or improvement, and in the 2 patients where diplopia persisted, it did not in primary and down gaze and offered no difficulties in daily activities. Among 34 patients who had enophthalmos before the operation, most (n=30) of the patients had minimal enophthalmos not more than 2 mm, 4 patients had enophthalmos that exceeded 2 mm. CONCLUSIONS: Transcaruncular approach in reconstruction of isolated medial orbital wall fracture shows more satisfying functional and cosmetic results and can be preferred to isolated medial orbital wall fracture.

Clinical Application of Nutrigenomics

Nutritional genomics (nutrigenomics) is the application of high-throughput functional genomics technologies to nutritional science lying in the interface between the nutritional environment and genetic process. It seeks to provide a molecular genetic understanding of how common dietary nutrition affects health by altering the expression or structure of an individual's genetic makeup. On the other hand, nutrigenetics is significantly different from nutrigenomics since nutrigenetics has been used for decades in certain rare monogenic diseases such as phenylketonuria, and has the potential to provide a basis for personalized dietary recommendation based on the individual's specific genetic background in order to prevent common multifactorial disorders decades before their clinical manifestation. The human genome maps and SNP databases, together with the rapid development of tools suitable for investigating genetic and epigenetic changes in small tissue biopsies provide the means to begin the test hypothesis about the mechanisms by which diet influences disease risk including cancer directly in human subjects, could be inevitable flatforms for clinical application to achieve targeted therapy in near future.

Clinical Experience of Orbital wall Reconstruction using Medpor(R) Barrier Sheet Implant

PURPOSE: To evaluate surgical effect of Medpor(R) Barrier Sheet, by comparing with postoperative outcomes using Medpor(R) Barrier Sheet and Medpor(R) in orbital wall reconstruction. METHOD: We have retrospectively analyzed clinical features and postoperative outcomes in two groups. One group is 29 patients who had undergone orbital wall reconstruction using Medpor(R) Barrier Sheet, the other group is 26 patients who had undergone orbital wall reconstruction using Medpor(R). RESULTS: The violence was the most common cause of the orbital wall fractures, the most common fracture site was inferior wall in the two groups. There were no significant differences between the two groups in improvement of diplopia and limitation of extraocular movement(p>0.05). The mean amount of enophthalmic correction were 1.15 mm in Medpor(R) Barrier Sheet group and 1.39 mm in Medpor(R) group. Three cases of Medpor(R) Barrier Sheet group and two cases of Medpor(R) group caused the infraorbital hypoesthesia, but prolapse or dislocation of implant was not found in the two groups. CONCLUSIONS: In this study, Medpor(R) Barrier Sheet had similar surgical effect to regular Medpor(R); its advantages over regular Medpor(R) were easy intraoperative manipulation and less adherence of extraocular muscle in reconstruction of orbital wall fractures. But when cost- effectiveness is considered, Medpor(R) Barrier Sheet may be a good available implant in orbital wall reconstruction for the selective cases with extraocular muscle exposed.

Three Cases of Congenital Aniridia in One Family

Aniridia is a relatively rare congenital anomaly and its incidence is about 1:100, 000.Main features of aniridia include congenitally partial or nearly complete absence of the iris and hypoplasia of optic disc and fovea. It is almost bilateral and occurred as an autosomal dominant trait.However, some patients develop both sporadic nonfamilial aniridia and Wilms 'tumor, and another group of patients is transmitted as an autosomal recessive trait. We observed aniridia in two generations, as mother and two daughters. They had cataract, nystagmus, neovascularization of corneal margin and pannus formation, as well as aniridia.We also found hypoplasia of optic disc and fovea in mother. We have operated on mother with phacoemulsified lens aspiration and posterior chamber IOL implantation in both eyes consecutively.The postoperative visual acuity following lens extraction improved, but was not corrected. In addition, intraocular pressure decreased.

Case Report of Retained Intraorbital Metallic Foreign Body Removal

Retained intraorbital foreign body after penetrating orbital injury may affect adjacent tissue and lead to many ophthalmological sequeles such as visual disturbance, EOM limitation, diplopia, strabismus, orbital cellulitis and orbital abscess. If intraorbital foreign body intrudes into adjacent CNS system, it may lead to fatal complications such as meningitis and brain abscess. We should diagnose and treat intraorbital foreign body early and accurately to prevent complications, and rehabilitate damaged tissue anatomically and functionally. A patient with retained intraorbital foreign body after penetrating lower lid injury was transferred to our hospital for lid swelling and periocular pain. We diagnosed and confirmed intraorbital foreign body with use of plain X ray and orbital CT, and removed it with lateral orbitotomy surgical approach.

Case Report of Retained Intraorbital Metallic Foreign Body Removal

Retained intraorbital foreign body after penetrating orbital injury may affect adjacent tissue and lead to many ophthalmological sequeles such as visual disturbance, EOM limitation, diplopia, strabismus, orbital cellulitis and orbital abscess. If intraorbital foreign body intrudes into adjacent CNS system, it may lead to fatal complications such as meningitis and brain abscess. We should diagnose and treat intraorbital foreign body early and accurately to prevent complications, and rehabilitate damaged tissue anatomically and functionally. A patient with retained intraorbital foreign body after penetrating lower lid injury was transferred to our hospital for lid swelling and periocular pain. We diagnosed and confirmed intraorbital foreign body with use of plain X ray and orbital CT, and removed it with lateral orbitotomy surgical approach.

Clinical Experience of Lacrimal Surgery

The success rate of endonasal lacrimal surgery have been reported inferior to that of external lacrimal surgery. But nowadays, owing to developement of surgical instrument, such as endoscope, and improvement of surgical skill, better success rates have been reported. We have performed endonasal lacrimal surgery in 36 eyes of 34 patients and external lacrimal surgery in 41 eyes of 36 patients who have had lacriaml pathway obstruction confirmed by dacryocystography. Endonasal lacrimal surgery has been performed with endoscope, fiberoptic light pipe, and conventional lacrimal surgery instruments. Primary success rates are 84.0% in endonasal dacryocystorhinostomy (DCR), 89.5% in external DCR, 81.8% in endonasal conjunctivodacryocystorhinostomy(CDCR), and 90.9% in external CDCR. The rate of postoperative complications are 32.0% in endonasal DCR, 47.4%, in external DCR, 27.3% in endonasal CDCR, and 40.9% in external CDCR. Therefore, in order to increase the success rate of endonasal lacrimal surgery, improvement of surgical technique, use of adequate surgical instrument and careful followup examination for proper management of postoperative complicaitons are considered essential.