A Case of Optic Neuropathy Caused by Sphenoid Sinus Mucocele / 대한이비인후과학회지

Sphenoid sinus mucoceles represent 1% of all paranasal sinus mucoceles. Patients with a sphenoid sinus mucocele often experience only ophthalmic symptoms such as visual impairment, diplopia and external ophthalmoplegia. The ophthalmic symptoms seem to be caused mainly by compression or inflammatory changes. CT scan and MRI help in the correct assessment of this lesion. We have experienced a rare case of optic neuropathy caused by sphenoid sinus mucocele which is likely to misdiagnose to optic neuritis. The mucocele was managed successfully by endoscopic marsupialization. We report this case with a review of related literature.

Mesectodermal Leiomyosarcoma :A Case Report

The mesectodermal leiomyosarcoma of the orbit is extremely rare disease. An 81-year-old woman presented with progressive painless proptosis in her right eye of 1 month duration. Computed tomographic scan of the orbit demonstrated 5-cm size lobulating mass of the right orbit which displaces eyeball anteriorly and bulges out to temporalis portion with severe destruction of lateral orbital wall and intracranial extension. For diagnostic pur-pose, incisional biopsy was performed. Light microscopic examination showed the characteristics of neurogenic tumor. Electron microscopic examination disclosed the features of smooth muscle cells as well as neural differentiation of the tumor, leading to the diagnosis of mesectodermal leiomyosarcoma. To the best of our knowledge, this is the first case of mesectodermal leiomyosar-coma of the orbit in Korea

Survival of Cultured Autologous Fibroblast Injected into Subconjunctival Space Treated with Mitomycin C in Rabbit

Although adjunctive use of Mitomycin C(MMC)increased the success rate of trabeculectomy, intractable bleb leakage-related complications increased. As a consequence, demand for MMC related bleb leakage repair is increasing. We attempted to observe whether the cultured autologous fibroblast injected into the subconjunctival space of rabbit may be used as a new treatment modality in the MMC related bleb leakage. Similar situation to extensive bleb leakage after trabeculectomy with MMC was prepared by repeated injections of 0.1cc of 0.05% MMC into subconjunctival space in 30 eyes of 15 New Zealand white rabbits weekly for 3 times and devided them into control, autologous blood injection and autologous fibroblast injection groups. Then, we observed the change of conjunctiva and enucleated it for histopathologic study at 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks, respectively. In control group, the conjunctiva was thin and transparent. Subconjunctival fibroblasts were hardly visible and collagen fibers were arranged coarsely. In contrast, cultured autologous fibroblast injection group showed thickened and less transparent conjunctiva along with packed fibroblasts and collagen fibers. In autologous blood injection group, the transparency of conjunctiva and the density of fibroblast and collagen fiber arrangement were between those of the other two groups. The cultured autologous fibroblast injection may be a feasible and an effective treatment modality in intractable bleb leakage after trabeculectomy with MMC.

Intraocular Lens Power Calculation in Cataract Surgery after Excimer Laser Photorefractive Keratectomy

To evaluate the accuracy of a new IOL power calculation method, the intraocular lens[IOL]power using a new method [refraction corrected method]was compared with the IOL power calculated using refraction derived keratometric values and conventional keratometry values in 4 eyes of 4 patients received cataract surgery after Excimer PRK.We performed phacoemulsifications and implanted intraocular lens, the power of which was calculated using the new method, and checked refractive errors 2 months after cataract surgery.The intraocular lens powers calculated using refraction derived keratometric values were lower than those calculated using the new method in the range of 0.52 diopter to 2.48 diopter.The intraocular lens powers calculated using conventional keratometry values were much lower than those calculated using the new method and refrac-tion derived keratometric value.Conclusively, the conventional method should not be used in IOL power calculation in catarct surgery after Excimer laser PRK, and in that case our new method is more accurate than a method using refraction derived keratometry value.

Pseudophakic/Aphakic Retinal Detachment Surgery Using Scleral Depression Technique

In aphakic/pseudophakic retinal detachments, difficulty in visualizing the peripheral retina and perhaps higher incidence of proliferative vitreoretinopathy result in lower success rate than phakic retinal detachment. We performed pars plana vitrectomy on 20 eyes with aphakic/pseudophakic retinal detachment. In most cases, we combined scleral bucking or encircling procedure. Using scleral depression technique, we found retinal breaks, dissected the vitreous base meticulously, and removed the vitreoretinal tractions. Intraoperatively, we were able to find retinal breaks in 12 eyes in which retinal breaks were not identified preoperatively, and identify additional retinal breaks in 3 of the remaining 8 eyes. We obtained anatomical success in all eyes and favorable visual acuity of better than 0.025 in 16 eyes (80%). These results suggest that finding all retinal breaks and removing vitreoretinal tractions are directly related to the improvernent of the surgical results.

The Effect of Lens on the Contractability of Ciliary Muscle

There are many factors affecting the outflow facility. Structural changes of aqueous outflow channel by ciliary muscle contraction play major role in the control of outflow facility. Although many studies on the physiology of outflow facility have been done by many authors, the lens effect on the ciliary muscle contractability has not been reported. We performed clear corneal phacoemulsification and foldable intraocular lens implantation in 42 cataract patients and measured intraocular pressure(IOP) pre and postoperatively by Goldmann applanation tonometer and determined outflow facility with and without 2% pilocarpine before and after cataract surgery, respectively. We analysed IOP changes after surgery, and assessed ciliary muscle contractability by analysing outflow facility changes. Statistical analysis was done by Wilcoxon`s signed rank test. IOP decreased by 2.4+/-0.4mmHg(mean+/-SEM)(P<0.001): outflow facility with and without pilocarpine increased by 0.080+/-0.012microliter/min/mmHg(P<0.001) and 0.045+/-0.006microliter/min/mmHg(P<0.01), respectively after lens extraction: outflow facility increased 2.8+/-0.4 times by pilocarpine itself after lens extraction(P<0.001). The lens connected to the ciliary muscle muscle by zonnule may have an influence on ciliary muscle contractability.