A Case of Acute Dacryocystitis Diagnosed after Surgical Treatment of Orbital Cellulitis and Orbital Abscess

PURPOSE: We report a case of acute dacryocystitis diagnosed with abscess and rupture of lacrimal sac and fistula to posterior orbit during the operation. CASE SUMMARY: A 71-year-old woman visited our clinic with edema and pain in the eyelid from three days ago. For past four months, there was viscous of the left eye and tears. The patient had severe conjunctival chemosis and hyperemia, compared with the left eyelid edema and redness. Orbital CT scan showed orbital cellulitis, which was followed by systemic antibiotics and steroid therapy. On the 4th day of therapy, orbital abscess formation was observed in orbit MRI and surgical drainage was planned. During surgery, we found rupture of the posterior part of lacrimal sac and fistula to posterior orbit. Pseudomonas aeruginosa was identified in the bacterial cultures, and after the administration of appropriate antibiotics, the disease showed improved progress, and then additional dacryocystorhinostomy was performed. CONCLUSIONS: In our case, acute dacryocystitis rarely spread in orbit, which may lead to delayed diagnosis, orbital cellulitis and abscess, resulting in serious complications of vision threat. So, we think that it is necessary to consider surgical treatment more actively in the stage of chronic dacryocysitis.

A Case of Intraocular Thelasia Callipaeda Infestation

PURPOSE: We report a case of intraocular Thelazia callipaeda infestation in a patient with panuveitis who had a successful recovery after pars plana vitrectomy. METHODS: A 73-year-old female patients complained of a floating sensation and gradually decreasing visual acuity in her right eye. On slit lamp examination, severe intraocular inflammatory reaction was observed. Fundus examination revealed severe vitreous haze with mobile linear structure. Three-port pars plana vitrectomy was performed and then the worm was removed. RESULTS: The worm was confirmed to be Thelazia callipaeda. At postoperative 2 months, the patient's visual acuity was 0.6 and intraocular pressure 14 mmHg. There was no evidence of intraocular inflammatory reaction. CONCLUSIONS: Thelazia callipaeda usually lie in the conjunctival sac or lacrimal apparatus, causing ocular surface disease, but intraocular infestation rarely occurs. If intraocular infestation does occur, early surgical removal should be performed.

Residual Diplopia and Enophthalmos after Reconstruction of Orbital Wall Fractures

PURPOSE: We evaluated the risk factors and related results of residual diplopia and enophthalmos in patients who had orbital wall fracture repair. METHODS: 50 patients with orbital wall fracture who were followed up for at least 6 months postoperatively were included in this study. We analyzed effects of the patient age, timing of surgery, size and location of fracture on development of postoperative diplopia and enophthalmos. RESULTS: 32 patients had diplopia and 16 patients had enophthalmos greater than 2 mm. Among 32 patients with preoperative diplopia, 9 patients experienced postoperative diplopia. Among 16 patients with preoperative enophthalmos, 5 patients experienced postoperative enophthalmos. Delayed timing of surgery was a significant factor for development of postoperative diplopia and enophthalmos. Age of the patients and fracture size were not significant factors for development of postoperative diplopia and enophthalmos. CONCLUSIONS: Early surgical repair of orbital wall fractures decreases the incidence of residual diplopia and enophthalmos. Preoperative assessment of multiple variables could help to achieve cosmetical and functional better results.

Systematic, Combined Treatment Approach to Nasolacrimal Duct Obstruction in Different Age Groups

PURPOSE: we studied the clinical outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). METHODS: we analyzed 186 patients (222 eyes) who had been treated for CNDO between January 1996 and December 2000. According to age, conservative treatment, nasolacrimal duct probing and silicone intubation were applied systematically until a successful outcome was achieved. Patients were grouped according to their age at the time of first visit.: Group 1 (0~6 months), Group 2 (7~12 months), Gruop 3 (13~24 months), Group 4 (25~72 months). Treatment efficacy was determined according to age and success rate was compared. RESULTS: Conservative treatment was applied only in children less than 1 year of age and was successful in 75.9% of Group 1 and 47.3% of Group 2. The difference between these two success rates was significant (p=0.0001). The overall success rate for first probing in all groups was 65.2% with a range 75.8% in Group 1, 62.1% in Group 2, 65.0% in Group 3, and 40.0% in Group 4. After second probing, the overall cure rates for the entire cohort were 82.6% with a range 87.9% in Group 1, 89.7% in Group 2, 80.0% in Group 3, and 50.0% in Group 4. There was no real difference in first probing cure rate relative to age (p=0.208). But after second probing, overall cure rate was significantly decreased when the age of the patients was over 12 months (p=0.027). Silicone intubation was performed in 4 of Group 1, 3 of Group 2, 4 of Group 3, and 5 of Group 4 and was successful in all cases. CONCLUSIONS: Systematic treatment approach to CNDO including conservative treatment, nasolacrimal duct probing, and silicone intubation, was highly successful. In this study, the cure rate for this combined approach was 100% in 186 patients (222 eyes).

The Effect of Mitomycin C on the Success Rate of Endoscopic Dacryo cystorhinostomy

To evaluate the effect of adjunctive use of mitomycin C on endoscopic endonasal dacryocystorhinostomy(DCR), a total of 75 eyes of 66 patients diagnosed with naso-lacrimal duct obstruction were assigned randomly to either a mitomycin C group or a control group.The surgical procedures in both groups were exactly the same, except in the patients of mitomycin C group, a topical 0.2 mg/ml solution of mitomycin was applied to the osteotomy site intraoperatively for 5 minutes. Mean follow-up period was 6.8 months in the mitomycin C group and 7.2 months in the control group. The success rate of endoscopic DCR with intraoperative mitomycin C was 89% whereas the success rate of endoscopic DCR without mitomycin C was 79%. Membranous obstruction, causing failure of surgery occurred in five eyes in the control group while it occurred in two eyes in the mitomyicn C group. Synechia with middle turbinate was found in one eye in the control group, but there was no such synechia found in the patients in the mitomycin C group. Granulation tissue formation also occurred in two eyes in the mitomycin C group as well as in two eyes in the control group. During follow-up period, no complications such as mucosal necrosis, or infection were noted in any patients of mitomycin C group. Adjunctive use of mitomycin C as a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR.

The electroretinogram sensitivity in patients with diabetes

Electroretinograms (ERGs) were measured in 65 patients with diabetes and 10 control subjects. The single flash ERGs were recorded as a function of the stimulus intensity. A Naka-Rushton-type function was fit to b-wave amplitudes, measured as a function of stimulus intensity, to evaluate changes in ERG amplitude and sensitivity. We also measured the temporal aspects of the ERG b-waves. The ERG sensitivity tended to decrease as the retinopathy progressed. An average sensitivity loss in eyes with diabetic retinopathy was statistically significant. However, the eyes of diabetic patients without visible retinopathy did not show significant ERG sensitivity loss. There was less variability in temporal compared with amplitude measurements of ERG components, and significantly prolonged b-wave implicit times were found in all stages of retinopathy and in eyes of diabetic patients without retinopathy.