Orbital Rosai-Dorfman disease in a fifty-eight years old woman

Rosai-Dorfman disease [RDD] is rare and characterized by histiocytic proliferation and massive cervical lymphadenopathy. About 40% of patients have extra-nodal involvement. Ophthalmic involvement is seen in 10% of cases. A case of orbital Rosai Dorfman disease in a 58 years old woman is presented here, who was misdiagnosed as orbital inflammatory disease initially. The patient did not respond to a course of oral prednisolone. Then complete surgical excision of the mass was performed and the histopathological examination was consistent with a diagnosis of RDD

Effects and complications of placement of motility coupling post in porous polyethylene orbital implants / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To investigate the effects and complications of primary and secondary placements of motility coupling post (MCP) in the unwrapped porous polyethylene orbital implant (PPOI) following enucleation.</p><p><b>METHODS</b>We investigated 198 patients who received PPOI implantation following the standard enucleation procedure in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, from 2002 to 2004. These patients were subgrouped into PPOI-only patients (112 cases, received PPOI following enucleation), primary MCP patients (46 cases, received primary placement of MCP during PPOI operation), and secondary MCP patients (40 cases, received secondary placement of MCP 6 months after the initial surgery). Effects and complications among these three groups were compared.</p><p><b>RESULTS</b>The PPOI-only patients took shorter treatment course when compared with other two MCP groups (P<0.001), without significant difference noted between the two MCP groups. However, the two MCP groups had better prosthetic motility than PPOI-only group (P<0.001), without significant difference between the two MCP groups. In the early stage, 2 eyes in the PPOI-only group and 1 eye in the primary MCP group had PPOI infection. In PPOI-only group, 3 (2.68%) eyes had PPOI exposure, which occurred after fitting the prostheses; 4 eyes (8.70%) in primary MCP group and 1 eye (2.50%) in secondary MCP had PPOI exposure, which occurred before fitting the prostheses. After prosthesis was fit successfully, the excessive discharge and granuloma were 33.9% and 1.79% in PPOI group-only, 53.3% and 8.9% in primary MCP group, and 52.5% and 7.5% in secondary MCP group, respectively.</p><p><b>CONCLUSION</b>Both primary and secondary placements of MCP into the PPOI following enucleation can help patients to obtain desirable prosthetic motility, but may be associated with more complications. The primary placement of MCP with skilled operation in selected patients is more recommendable than secondary placement.</p>

Amniotic membrane transplantation for porous sphere orbital implant exposure / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>This study is aimed at describing the clinical outcome of amniotic membrane transplantation for exposure of porous sphere implants.</p><p><b>METHODS</b>A retrospective review of consecutive cases of porous sphere orbital implant exposure was carried out. Eight cases were presented between May 2004 and Oct. 2006 (5 males, 3 females; mean age 44.5 years). Six had enucleation and two had evisceration. Exposure occurred in two primary and six secondary. Orbital implant diameter was 22 mm in seven cases and 20 mm in one case. Six patients are with hydroxyapatite and two with high-density porous polyethylene (Medpor) orbital implants. The mean time from implantation to exposure was 1.1 months (range 0.8-2 months). All patients required surgical intervention.</p><p><b>RESULTS</b>The time of follow-up ranged from 3.0 to 28.0 months (mean 16.5 months). Amniotic membrane grafting successfully closed the defect without re-exposure in all of these patients. The grafts were left bare with a mean time to conjunctiva of about 1 month (range 0.8-1.5 months).</p><p><b>CONCLUSION</b>Exposed porous sphere implants were treated successfully with amniotic membrane graft in all of patients. The graft is easy to harvest. This technique is useful, dose not lead to prolonged socket inflammation and infection, and it is valuable application extensively.</p>

Effect of basic fibroblast growth factor (bFGF) on the treatment of exposure of the orbital implants / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To evaluate the efficacy and the indication of basic fibroblast growth factor (bFGF) in the treatment of exposure of orbital implants.</p><p><b>DESIGN</b>Retrospective and observational case series.</p><p><b>METHODS</b>We reviewed 41 patients (41 eyes) suffering exposure of orbital implants from Jan. 2000 to June 2006. The study group patients with mild exposure received combined treatment with bFGF and antibiotic drops, and while the control group patients with mild exposure were treated with antibiotic drops only. The study group patients with moderate and severe exposure received combined treatment with bFGF and antibiotic drops, and after 2 months they were subjected to amniotic membrane transplantation, while the control group patients with moderate and severe exposure underwent amniotic membrane transplantation after using antibiotic drops. Observation of the growth of conjunctival epithelium and comparison of the healing rate of the two groups.</p><p><b>RESULTS</b>The healing rates of the mild, moderate and severe exposure study group were 100% and 92.3%. The healing rates of the mild, moderate and severe exposure control group were 55.6% and 66.7% respectively. The difference of the healing rates of the mild exposure study group and the control group was significant (P=0.033). And the difference of the healing rates of the moderate and severe exposure study group and the control group was not significant (P=0.167).</p><p><b>CONCLUSION</b>bFGF may promote obviously the healing of orbital implant exposure, particularly it can be the first choice for the treatment of mild degree exposure. For the moderate and severe cases, it can be administered before surgical repair to enhance neovascularization and will tend to increase the success rate of surgical repair.</p>

High density porous polyethylene material (Medpor) as an unwrapped orbital implant / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To introduce the clinical effect among patients who received an unwrapped orbital implant with high density porous polyethylene material (Medpor) after enucleation or evisceration.</p><p><b>METHODS</b>Retrospective analysis of a series of 302 patients with anophthalmia who underwent placement of an unwrapped high density porous polyethylene orbital implant. We compared the patients (n=180) who accepted primary implant placement with those (n=122) who accepted secondary implant placement. Parameters evaluated included: age at time of surgery, date of surgery, sex, implant type and size, surgery type, the surgical procedure and technique performed, and complications.</p><p><b>RESULTS</b>The time of follow-up ranged from 2.0 to 58.0 months (mean 32.5 months). A total of 5 of 302 (1.66%) cases had documented postoperative complications. The following problems were noted after surgery: implant exposure, 3 patients (0.99%); implant removed due to orbital infection, 1 patient (0.34%); ptosis, 1 patient (0.34%). There were no significant complications observed in other 297 cases and all implants showed good orbital motility. The clinical effect of primary implant placement is better than that of secondary placement.</p><p><b>CONCLUSION</b>High density porous polyethylene material can be used successfully as an unwrapped orbital implant in anopthalmic socket surgery with minimal complications. The material is well tolerated, nonantigenic and has low rate of infection and migration.</p>

Analysis of high density porous polyethylene (Medpor) orbital implant in 266 cases / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the postoperative complications, the appearance and motility in patients who underwent placement of Medpor orbital implant after enucleation, or secondary implantion.</p><p><b>METHODS</b>A retrospective study was carried out on the 266 cases in whom a Medpor orbital implant was implanted from 2001 to 2004.</p><p><b>RESULTS</b>All the cases were followed up from 3 to 26 months. A total of 23 in 266 (8.6%) cases had documented postoperative complications: inflammatory granuloma in 2 cases (0.8%), and moderate or severe ptosis in 4 cases (1.5%), and remained upper eyelid notch with mild ptosis in 8 cases (3.0%), and lower eyelid laxity in 2 cases (0.8%). In 5 cases (1.9%), implant exposure developed: 3 cases were resolved with conservative therapy, and 2 cases with surgical revision of the socket. 2 cases experienced persistent pyogenic discharge in conjunctival sac, and the implant was took out because the discharge couldn't control with local and systemic antibiotic therapy. The motility is excellent in 148 cases and good in 11 cases after the primary obital implant, and excellent in 36 cases and good in 68 cases and bad in 3 case after the secondary implant. The difference between the primary and the secondary obital implant is obvious.</p><p><b>CONCLUSIONS</b>It is considered that Medpor orbital implant is a good method of ocular plasty. Although there are some mild postoperative complications, but those can be resolved with conservative therapy or surgical revision. Medpor orbital implant has good histocompatibility, and the operative processes are convenient. Patients are satisfied with appearance and motility. So the Medpor orbital implant is one of the best selection in ocular socket plasty.</p>