Comparison of Ocular Adnexal Mantle Cell Lymphoma and MALT Lymphoma

PURPOSE: Mantle cell lymphoma (MCL) is known to have systemic dissemination with poor prognosis, but very few cases have been reported in Korea. Therefore, we analyzed clinical features and prognosis of MCL by comparing 3 cases of ocular adnexal MCL and mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: The medical records of patients with ocular adnexal MALT lymphoma and MCL from Chungnam National University Hospital and Pusan National University Hospital from January 1999 to April 2014 were retrospectively reviewed. Immunohistochemical examination was selectively used to diagnose lymphoma subtypes. Systemic dissemination, treatment response, and recurrence were identified using radiological testing and bone marrow aspiration. RESULTS: This study included 39 patients with ocular and ocular adnexal MALT lymphoma and 1 patient with MCL from Chungnam National University Hospital and 53 patients with MALT lymphoma and 2 patients with MCL from Pusan National University Hospital. All 3 (100%) patients diagnosed with ocular adnexal MCL were over 60 years of age. However, 28 of 92 (30.4%) patients diagnosed with MALT lymphoma were over 60 years of age. In MALT lymphoma, 3 of 92 patients presented with systemic dissemination and most patients recovered with radiotherapy. Conversely, all 3 patients with MCL showed systemic dissemination and recurrence after radiotherapy or chemotherapy, therefore, additional chemotherapy was required. CONCLUSIONS: Contrary to MALT lymphoma, ocular and ocular adnexal MCL usually presented with systemic dissemination and complete remission was difficult even though many regimens of chemotherapy were attempted. Because MCL can be misdiagnosed as MALT lymphoma, careful evaluation should be performed.

Comparison of Frontalis Sling and Levator Resection for Recurrence after Frontalis Sling in Congenital Ptosis

PURPOSE: To compare the success rate of two procedures frontalis sling operation and maximal levator resection for recurred congenital ptosis. METHODS: In the 44 eyes in 30 patients who had recurrence after frontalis sling using banked fascia lata, 21 eyes received frontalis sling operation using autogenous fascia lata (Group I), and the other 23 eyes received maximal levator resection with aponeurotic approach (Group II). Follow up was made at one month, three months, six months and one year after the operation. RESULTS: Six months after the operation, Group I showed 81.0% while Group II showed 78.3% in success rate. One year after the operation, Group I had 76.2%, while Group II had 73.9% in success rate. There were no significant statistical difference between the two groups (p=0.744, 0.707). CONCLUSIONS: In cases of recurrence after frontalis sling using banked fascia lata in treating congenital ptosis patients, we found the frontalis sling using autogenous fascia lata to be effective. The maximal levator resection may be used as an alternative procedure.

The Effects of Placement of Silicone Tube and e-PTFE Stent in External Dacryocystorhinostomy

PURPOSE: To determine the surgical results of bicanalicular silicone tube and e-PTFE (expanded polytetrafluoroethylene) stent in external dacryocystorhinostomy without flap. METHODS: Sixteen patients had been placed with bicanalicular silicone tube and e-PTFE stent and 17 patients with silicone tube only in external dacryocystorhinostomy without flap. We examined the presence of epiphora symptom, passage of dye, and inflammatory change or granuloma formation of nasal mucosa at postoperative 1 day, 1 week, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. RESULTS: Success rate was higher in double stent group (81.3%) than that in control group (76.5%). But there was no statistically significant (difference between two groups. p=0.085). At nasal endoscopic examination, one case (6.3%) of granuloma was noted in double stent group, and two cases (11.8%) in control group. Membraneous obstruction was not observed in double stent group but one case (5.9%) in control group. CONCLUSIONS: In case of structural deteriolation of midface including nasolacrimal duct, placement of bicanalicular silicone tube with e-PTFE stent may be an useful method in external dacryocystorhinostomy without flap.

MALT (mucosa associated lymphoid tissue) type Lymphoma of the Ocular Adnexa

PURPOSE: To report MALT (mucosa associated lymphoid tissue) type lymphoma in ocular adnexa. METHODS: This retrospective study included 11 patients (13 cases) of MALT type lymphoma between August 1995 and July 2000. We identified 11 lymphoma cases with MALT characteristics by conventional examination and immunohistochemical staining. Twelve cases were treated with partial excision and radiotherapy, one case with partial excision and chemotherapy. RESULTS: The patients consisted of 4 females and 7 males with an age range of 29~88 (average 48) years old. Mean follow up period was 24.8 (6~60) months following treatment. Eleven patients had ocular adnexal involvement at presentation; 7 eyes in conjunctiva, 5 eyes in orbit and one in eyelid. All cases represented extranodal marginal zone B-cell lymphoma by REAL classification. Control of lymphomas was achieved in all but 4 cases which developed recurrence after irradiation and chemotherapy, and were salvaged with further radiotherapy. Complications such as cataract, radiation retinopathy, ptosis and alopecia developed later in 4 eyes. CONCLUSIONS: Surgical excision and radiotherapy seemed to be effective for the treatment of primary ocular adnexal MALT lymphoma. Long-term follow up should be warranted.

Effect of High dose Corticosteroid and Optic Canal Decompression on Traumatic Optic Nerve Injury

PURPOSE: To evaluate the effect of high dose corticosteroid and optic canal decompression on the traumatic optic nerve injury. METHODS: Twenty six patients who were diagnosed to have traumatic optic nerve injury, were divided into two groups in which one group received corticosteroid therapy while the other group underwent optic canal decompression combined with corticosteroid therapy. RESULTS: Visual acuity increased by > OR =3 lines of LogMAR scale in 47% of the corticosteroid group, in 28% of operation and steroid group, and in 42% of overall cases. But the degree of visual acuity improvement had no difference between two groups(p=0.72). As the patients were divided into two groups based on initial visual acuity such as no light perception and light perception or better, the initial visual acuity did not have influence on the final visual outcome in both corticosteroid group and operation and steroid group(p=0.78, p=0.33). CONCLUSIONS: This result suggest that effect of high dose corticosteroid and optic canal decompression on traumatic optic nerve injury is not different.

Relationship between Preoperative Clinical Features and Postoperative Recovery of Ocular Motility Restriction in Blow-out Fractures

PURPOSE: Diplopia and ocular motility restriction after blow-out fracture repair may often be permanent. We attempted to analyze various factors associated with preoperative and postoperative ocular motility restriction after blow-out fracture. METHODS: We assessed retrospectively the recovery of ocular movement in 60 eyes of 60 patients with blow-out fractures, which were repaired by orbital reconstruction from April 1997 to October 1999. We analyzed the relationship between patient age, fracture size, severity of ocular motility restriction before and after surgery, and CT evidence of muscle entrapment. RESULTS: Fracture size was smaller in the patients aged 18 years or younger than those 19 years or older, and ocular motility restriction before surgery was greater in the patients with small-sized fractures. Postoperatively, ocular motility restriction was remained more frequently in the patients with severe ocular motility restriction before surgery. CONCLUSIONS: In pediatric patients who have severe motility restriction, CT evidence of small-sized fracture and some tissue entrapment, immediate surgical repair would be helpful for recovery of extraocular movement.

Traumatic Optic Neuropathy: The Comparison of Visual Outcome by Treatment Modalities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traumatic optic neuropathy (TON) is a rare but potentially devastating complication of blunt head trauma. However, the optimal management for the TON is still an open question. In this report, we compared the visual outcome of TON treated with corticosteroids and optic nerve decompression (OND) with those treated with corticosteroids alone. PATIENTS AND METHODS: A total of 32 cases with TON due to blunt head trauma was followed over 6 months at the Chungnam National University Hospital. Twenty-two cases were treated with megadose corticosteroids and eleven cases were treated by surgical decompression of the optic canal combined with corticosteroids. For the purpose of analysis, visual acuity was converted into logMAR (logarithm of the minimum angle of resolution) units. Improvement was measured as the difference in visual acuity between the initial and final visual-acuity units (improvement in logMAR=post-treatment logMAR-initial logMAR). This value was then used to determine the percentage of improvement as the proportion of the visual acuity lost, using 20/13 (logMAR=0.18) as perfect vision (Improvement %=Improvement/{0.18-initial logMAR}). RESULTS: Patients whose initial vision was better than no light perception (NLP) showed better improvement rate (64%) compared with patients whose initial vision was NLP (17%). Vision improved in eight of the steroid-treated groups (38%) and in four of the steroid-OND groups (36%). There were also no significant differences in the improvement or the percentage of improvement in the visual acuity between two groups. CONCLUSION: As might have been expected, patients with initial NLP in both groups attained significantly lower final visual acuities than those who initially had some vision. However, there were no significant differences in the improvement or the percentage of improvement in the visual acuity between two groups. That is, no clear benefit was found for optic canal decompression surgery. But the limitation of this study was that it was difficult to conclude that surgical decompression is not necessary in the treatment of TON. A prospective randomized controlled clinical trial will be needed.

Orbital Cyst after Repair of Blow-out Fracture

When blow-out fracture repair is performed, many implants including Silastic, Supramid, Porous polyethylene and others have been used to pervent reherniation of orbital tissue. Complications associated with implants include implant extrusion, orbital infection, fistula formation, implant migration, extraocular muscle entrapment, globe elevation, protosis and orbital cyst formation. The latter was known as a rare late complication of blow-out fracture repair. We report two cases of orbital cyst which developed after blow-out fracture repair with alloplastic implants. These patients developed diplopia and unliateral proptosis 7 and 10 years after repair of blow-out fracture, respectively. In these cases, orbital CT scan revealed retrobulbar cyst-like structures surrounding the orbital implant. At sufgery, a fibrous capsule surrounded the previously inserted orbital implants and was filled with dark brown mucoid material in both cases. These cysts were lined by squamous epithelium with cholesterol cleft and hemosiderin laden macrophage collection. Proptosis and diplopia were resolved after surgical removal of the cyst. These cases illustrate that it is important for us to be aware of the complication of late cyst formation around alloplastic implants after repair of blow-out fracture.

A Case of The Modified Jensen Procedure Saving Anterior Ciliary Arteries

For the 6th nerve paralysis, we use the procedure described by Jensen combined with a 6-7mm recession of the madial rectus muscle. But, anterior segment ischemia(ASI) is an occasional complication of this surgery in which over three rectus muscles are partially or completely detached, ligated. The authors performed this modified Jensen procedure to the patient of 6th nerve paralysis, in which anterior ciliary arteries of vertical rectus muscles were separated from the muscles under the operating microscope and then ligated muscles only. So, this modified procedure preserve the integrity of the anterior ciliary arteries in those portions of the vertical muscles not involved in the muscle union to avoid the danger of anterior segment ischemia.

Sutureless Strabismus Surgery with Tissue Adhesive in Rabbit Models

Inadvertent perforation of the globe, granuloma and hypersensitivity reaction were recognized complications of the strabismus surgery. We performed sutureless surgery with Beriplast in rabbit model to determine whether this technique can replace the classic suture technique and decrease it's complications. The authors measured maximum adhesion power and observed histopathologic findings at 1st, 2nd, 4th and 8th week following recession of the rectus muscle with Beriplast. Maximum adhesoin power were increased with time such as 210, 300, 480 and 650gm at each week. Pathologically inflammatory and foreign body reactions were decreased with time, and collagen fibers were proliferated at muscle scleral contact area.