Porous Orbital Implantation using Autogenous Lamella Scleral Graft

PURPOSE: Current enucleation and socket reconstruction techniques often require reinforcement of an orbital implant or wound by use of a tissue graft. Common source is usually allograft tissue(cadaveric sclera, fascia, etc.). Disadvantages of allografts include possible inflammatory reaction, unpredictable vascularization rate, variable resorption, antigenicity, and cost. METHODS: The authors used autogenous lamella sclera obtained from the enucleated eye. Seven autogenous lamella scleral grafts were used to cover biointegrated implant spheres(hydroxyapatite or Medpor(r)). RESULTS: After the follow-up period of 6 to16 months(average 10.8 months), superior sulcus deformity(1 case) and transient exposure of implant(1 case) were developed. Postoperative prosthetic motility was satisfactory in all cases. CONCLUSIONS: These techniques are presented as an alternative to using human bank tissue or remote incision autografts for reconstruction of the anophthalmic socket.

Clinical Evaluation of Medpor(r) Orbital Implant

Recently the high-density porous polyethylene[Medpor(r)]has been used as a new orbital implant for the reconstruction after enucleation or evisceration to reduce the implant exposure and migration, and to increase the prosthesis motility. We performed 16 cases of Medpor(r) orbital implantation combined with enucleation, evisceration or secondary orbital implantation between November 1997 and December 1998. Then, we investigated the postoperative complication, prosthesis motility, fibrovascular ingrowth pattern into the implant and MCP[Medpor(r) Coupling Post]insertion to increase the prosthesis motility for the average of 10 months [range, 6 to 18 months]. We performed a total of 16 cases of implantation :10 cases after evisceration, 5 cases after enucleation and 1 case as secondary implantation. There were 3 cases of conjunctival dehiscence, 1 case of retrobulbar hemorrhage and 1 case of superior sulcus deformity. There were no implant exposure, migration or severe inflammation. Postoperative prosthesis motility was found in 13 cases as good, 2 cases as fair and 1 case as poor. After enucleation or evisceration, Medpor(r) orbital implantation showed no significant difference from the previous porous orbital implants in postoper ative complication, prosthesis motility and fibrovascular ingrowth into the implant. It appears to be a good orbital implant because of the lower material cost, convenience in the operative procedure and other advantages. But long-term follow-up may be necessary for the detection of clinical change, the complication of MCP insertion and for the evaluation of the fibrovascular ingrowth pattern after Medpor(r) implantation.

Effect of Full-thickness Pentagonal Wedge Resection for Treatment of Localized Trichiasis and Distichiasis

We evaluated the efficacy of the full-thickness pentagonal wedge resection for localized trichiasis and distichiasis. Fourteen eyes of eleven patients, who were diagnosed to have trichiasis and distichiasis from October 1995 to October 1997 and had more than 10 aberrant cilia that were clustered together, were included in this study. More than 2 months later, we examined clinical symptoms, recurrent aberrant cilia, and complications. There was no recurrence in 11 lids. In 3 lids there were one to three recurrent aberrant cilia around resection margins, and the patients had mild foreign body sensations. In 2 of 3 cases of symptomatic recurrence, symptoms improved after argon laser treatment. Although one case showed recurrence after argon laser treatment, the patient remained asymptomatic. There were no significant complications including postoperative scarring. Therefore, we suggest that the full-thickness pentagonal wedge resection may be simple and effective for the treatment of trichiasis and distichiasis clustered with many aberrant cilia, especially in high risk patients who have potential for corneoconjunctival complications.

The Change in Palpebral Fissure Height of Bilateral Eyes after Uniateral Cataract Operation

To investigate the change in upper eyelid position after cataract operation, We studied 40 eyes of 40 patients prospectively who underwent phacoemulsification and intraocular lens implantation. Levator function and vertical palpebral lid fissure height were measured preoperatively and at postoperative day 1, 7, 28 and 56 in and the surgical and the fellow eyes. Postoperative mean vertical lid fissure height decreased compared with preoperative mean vertical lid fissure height in both eyes. The postoperative decrease in vertical lid fissure height tended to decrease with times and these trends had statistically significant correlation between both eyes. This suggests that both eyes are affected by factors unassociated with the cataract surgery and it is most apparent in the immediate postoperative period. In conclusion, we recommend not only the surgical eye but the fellow eye should be evaluated preoperatively and postoperatively to understand the eyelid position after cataract operation.

Reproducibility of the Peripapillary and Retinal Perfusion Measurement with Confocal Scanning Laser Flowmetry

Confocal scanning laser flowmetry(HRF: Heidelberg Retina Flowmetry) is a new kind of instrument which enables non-invasive two-dimentional mapping of perfusion of the retina and optic disc and to evaluate the clinically available reproducibility of the peripapillary and retinal perfusion measurement with the confocal scanning laser flowmetry, the authors calculate the coefficient of variation (CV) from the parameters(volume, flow, velocity). The authors indicate two region of interest in the peripapillary region and retina, not overlapping the large vessels and measure the parameters three times consecutively(one session) while visiting three times intervalled(three session), thereafter calculate the mean CV of parameters in ten healthy eyes of ten subject. The CV of parameters obtained with the confocal scanning laser flowmetry was low relatively and therefore reproducibility was high as the CV lower, the reproducibility higher. Comparing the CV between one session and three session measurement to know the clinically available measurement frequency, the CV of three session (volume 13%, flow 16.7%, velocity 16%) was lower than the CV of one session (volume 16.7%, flow 20.7%, velocity 20.1%) in the peripapillary region(Students t test; volume p=0.009, flow p=0.03, velocity p=0.016) and the CV of three session (volume 16.7%, flow 20.7%, velocity 17%) was lower than the CV of one session (volume 18.2%, flow 21.8%, velocity 21.7%) in the retina(Students t test; volume p=0.017, flow p=0.0009, velocity p=0.0004). Above the results, the CV of parameters(13~21.8%) in one and three session had relatively high reproducibility. Also the CV between two measurements had a difference statistically but the difference was not so high, the authors concluded the confocal scanning laser flowmetry which have high resolution measure the peripapillary region and retina reproduciblly with only one time visit, three consecutive measurements.

Incidence of ptosis following trabeculectomy: a comparative study

The occurrence of ptosis after trabeculectomy has been a common postoperative complication. Many factors have been implicated in the development of postoperative ptosis. The purpose of this study was to investigate the incidence of ptosis following trabeculectomy and whether or not it was influenced by combined cataract surgery, type of conjunctival flap, and previous intraocular surgery. We reviewed 386 eyes of 386 patients who underwent either trabeculectomy alone or trabeculectomy combined with cataract surgery, with greater than 6 month follow-up. Ptosis occurred in 10.7% (18 of 150 eyes) after trabeculectomy alone and in 12.7% (30 of 236 eyes) after trabeculectomy with combined cataract surgery (p = 0.96). The incidence of ptosis was 12.3% (10 of 81 eyes) after limbus-based conjunctival flap and 12.5% (38 of 305 eyes) after fornix-based conjunctival flap (p = 0.98). There was no significant difference in the incidence of ptosis between primary surgery eyes (12.5%, 34 of 273 eyes) and secondary surgery eyes (12.4%, 14 of 113 eyes) (p = 0.97). The incidence of ptosis after trabeculectomy was about 12% overall and not significantly influenced by combined cataract surgery, type of conjunctival flap or previous ocular surgery.

A Case of Optic Atrophy following Methanol Poisoning

Methanol poisoning is a rare disease but may cause blindness and, in severe cases, results in death. It may develop lesions in optic nerve and retina, which may be accompanied with permanent visual damage. We report a case of Methanol poisoning in a 20 year-old male patient, which is followed by optic atrophy and loss of vision.

Clinical Study on Glaucomatous Patients

We analysed clinically 354 glaucomatous patients from 1983 to 1987 who visited the clinic of the Department of Ophthalmology of National Medical Center. The results were as follows: 1) The prevalence of glaucoma was 1.56% among the out-patients. 2) The primary open-angle glaucoma(POAG) was the most frequent type. 3) The mean age of the patients with POAG was 47.8 +/- 14.2 years and 60.8 +/- 8.9 years was that of the patients with primary angle-closure glaucoma(PACG). 4) There was no sexual preference in various types of glacoma, except PACG and secondary glaucoma. 5) There was no significant difference in laterality between right and left eyes.