Radiotherapy for Malignant Lymphoma of Orbit and Ocular Adnexa

PURPOSE: To investigate the clinical features of orbital and ocular adnexal malignant lymphoma and the effectiveness of radiotherapy for its treatment. METHODS: We retrospectively reviewed the medical records of 54 eyes in 44 patients who were diagnosed with orbital and ocular adnexal malignant lymphoma and who underwent radiotherapy. RESULTS: The main symptoms of malignant lymphoma patients were conjunctival mass, lid mass, lid swelling, and exophthalmos. Histopathologically, MALT-lymphoma was the most common in 39 patients (88.6%). In all 54 eyes of the 44 patients, the mass either decreased or disappeared completely after radiotherapy. The mean follow-up period was 31 months, ranging from 4 to 68 months. There was no recurrence of malignant lymphoma in the orbit or ocular adnexa during this period. However, there were three cases where the tumor recurred in other systemic organs. Complications of radiotherapy included mild punctate epithelial erosion, xerophthalmia, cataract, and retinopathy. CONCLUSIONS: Localized radiotherapy is an effective and safe way to treat malignant lymphoma of the orbit and the ocular adnexa. In order to decrease complications, the use of lens shielding and optimized radiation amount should be considered.

Acellular Dermal Allograft for the Correction of Eyelid Retraction

PURPOSE: To evaluate the efficacy and safety of acellular human dermis (AlloDerm) as a spacer graft in the correction of eyelid retraction. METHODS: We used acellular human dermis (AlloDerm) as a spacer in 8 patients with eyelid retraction. Two patients had upper eyelid retraction and 6 had lower eyelid retraction. The causes of the former were congenital (1) and ptosis operation (1), and of the latter were strabismus surgery (1), necrotizing blepharitis (1), blow-out fracture (1), anophthalmic socket contracture (1), cicatricial entropion (1), and lower lid blepharoplasty (1). The follow-up period ranged from 5 to 14 months (mean 9 months). RESULTS: Surgical results in 7 eyelids were satisfactory. There was mild overcorrection in one eyelid with congenital upper eyelid retraction. There were no other complications such as exposure, infection, or rejection. CONCLUSIONS: AlloDerm was easy to manipulate, closely approximated the eyelid tarsus in contour and thickness, and appeared to be nontoxic and nonallergenic. We suggest AlloDerm as the spacer material of choice for the treatment of eyelid retraction.

Two Cases of Burkitt's Lymphoma in the Orbit

PURPOSE: We report two cases of Burkitt's lymphoma involving the orbit. METHODS: A seven-month male presented with the chief complaint of a 15-day history of left upper lid swelling. Ocular examinations revealed left ptosis, inferior displacement of the left eyeball due to upper lid mass. Orbital MRI scan showed diffusely enhancing homogenous mass of the left orbit. Another twelve-month male visited our clinic with sudden onset of left proptosis, and his conjunctiva was exposed due to severe proptosis. Orbital MRI showed a mass on the medial portion of the contralateral eye, ipsilateral temporal bone and extradural space. In both cases, incisional biopsy was done. RESULTS: Histopathologically, the lesions were characterized by a uniform background of large round or oval lymphocytes with multiple prominent nucleoli. Large, pale staining, benign phagocytic histiocytes or macrophages were interspersed within the collection of neoplastic lymphocytes. They showed a "starry sky appearance" and were positive for immunohistochemical stain against Ki-67 antigens. CONCLUSIONS: Burkitt's lymphoma should be suspected and considered in the differential diagnosis for children with acutely progressing orbital mass.

A Case of Simultaneous Injury to Ipsilateral Superior Rectus and Superior Oblique Muscle

PURPOSE: Because the ipsilateral superior rectus (SR) and superior oblique (SO) muscles are innervated by two different nerves, it is very rare for these two muscles to be paralyzed while all other extraocular muscles function normally. The authors experienced a case where the patient had a loss of intorsion (action of both SR and SO muscles) and also loss of SO muscle's infraduction and adduction, and SR muscle's supraduction and abduction. The authors studied how such loss of function affects extraocular movement. METHODS: A 63-year-old male patient who had his SR and SO muscles severed by a saw was admitted to the hospital after getting rid of the two exposed muscle which were attached to the eyeball due to failure of reconstruction of two muscle. The patient was followed up for 8 months, and at the end of the follow-up period, the angle of deviation was measured while double Maddox test and fundus examination were also performed. RESULTS: At primary position there was extorsion of 7 degrees as well as esodeviation of 6 PD and hypodeviation of 6 PD on the left eye, and we hereby report the case.

Factors Affecting the Anterior Displacement of Posterior Corneal Surface after Laser In Situ Keratomileusis

PURPOSE: To determine factors which influence forward displacement of the posterior surface of conea after performing LASIK with residual corneal thickness greater than 250 micro meter. METHODS: We studied 100 eyes of 50 myopic patients with an expected residual corneal thickness of greater than 250 micro meter after underwent LASIK. Residual corneal thickness, amount of laser ablation, intraocular pressure, spherical equivalent of cornea (keratometer), corneal diameter, corneal thickness, and anterior chamber depth were obtained at the preoperative stage, the postoperative one week, one month. Computed topography of cornea was performed between before and after LASIK. We evaluated the influence the forward displacement of posterior surface of conea by LASIK procedure. RESULTS: Average forward displacement of posterior surface of the cornea was 38+/-12 micro meter, and among preoperative factors, preoperative corneal thickness showed relatively high correlation with r=0.462 (P<0.001), having influence on the forward displacement. The displacement measured 1 month after LASIK was shown to decrease slightly (31+/-8 micro meter) compared that the displacement measured at 1 week after LASIK. CONCLUSIONS: Despite performing LASIK with residual corneal thickness of greater than 250 micro meter, if pre- operative corneal thickness is thin, one should be careful about anterior displacement of corneal posterior surface, and this change usually occurs within 1 week.

A case of erosive vitreoretinopathy

Hereditary vitreoretinopathies are potentially blinding inherited disorders characterized by an abnormal-appearing vitreous gel and associated retinal changes. Four of these disorders, Stickler's syndrome, Wagner's disease, erosive vitreoretinopathy, and Goldmann-Favre syndrome, exhibit marked syneresis of the vitreous gel. Erosive vitreoretinopathy has associated retinal pigment epithelial changes, poor night vision, visual field defects, and abnormal electroretinographic findings; symptoms not found in Stickler's syndrome. A 36-year-old man with progressive visual loss and a visual field defect had no systemic disease. His vitreous cavity was liquefied. Vitreous strands and a cataract were found in both eyes. Pronounced RPE degeneration was found superotemporally in both eyes and a bullous rhegmatogenous retinal detachment in the left eye accompanied two retinal tears. His visual field showed a ring scotoma in both eyes and the ERG finding was abnormal. We report one case of erosive vitreoretinopathy with retinal pigment epithelial changes, rhegmatogenous retinal detachment, visual field defects, abnormal electroretinographic findings, marked vitreous syneresis and cataract. These symptoms are distinct from previously described entities.

Assessment and Significance of RBC-Sorbitol Level on Diabetic Retinopathy

The intracellular accumulation of sorbitol, a product, which arises from polyol pathway: one of glucose metabolic pathways, has been said to be one of the pathogens for diabetic retinopathy. So, to obtain fundamental data regarding the time of administratin as well as the dosage of aldose reductase inhibitor(ARI) which inhibits the formation of sorbitol, we examined the interrelationship between RBC-sorbitol and glucose, HbAlc, and the association of RBC-Sorbitol with the severity of diabetic retinopathy in fifty NIDDM patients(20 No diabetic retinopathy, 10 mild NPDR, 10 sever NPDR, 10 PDR). In results, there was no association between RBC-sorbitol and glucose(r=0.172), between RBC-sorbitol and HbAlC(r=0.262), also there was no discernible RBC-Sorbitol level in each degree of diabetic retinopathic severity (F`=0.67, p>0.05), and wide variation of RBC-sorbitol level in each diabetic patients. Thus, for the progression of diabetic retinopathy, the duration time of high sorbitol level was predicted to be of more important value than the sorbitol level at the time of diagnosis. Therefore, we have shown through the research that ARI needs to be administered early on when RBC-Sorbitol level is higher than normal and in terms of ARI dosage, administering differenct ARI dosage according to different sorbitol level of each patient will be more effective for prevention and treatment of diabetic retinopathy.

A Case of Bilateral Tuberous Sclerosis

Tuberous sclerosis is a rare multisystem syndrome characterized by hamartomatous tumors of the brain, skin, viscera, and eye. The diagnostic triad for this disease, proposed by Vogt, included epilepsy, mental retardation, and adenoma sebaceum. In eyes, retinal hamartomas and optic nerve phacoma are observed over 50% and hypopigmented areas of peripheral retina and iris are often found. We introduce an 18-year old girl with adenoma sebaceum of the face, history of epilepsy and insignificant mental retardation status. She also had a retinal hamartoma in her right eye, optic nerve phacoma in her left eye, shagreen patch on lumbosacral area, angiomyolipoma of both kidneys, periventricular subependymal nodules and calcified cortical nodule of occipital lobe of brain.