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Objective@#: The blood-brain barrier (BBB) is an obstacle for molecules to pass through from blood to the brain. Focused ultrasound is a new method which temporarily opens the BBB, which makes pharmaceutical delivery or removal of neurodegenerative proteins possible. This study was demonstrated to review our BBB opening procedure with magnetic resonance guided images and find specific patterns in the BBB opening. @*Methods@#: In this study, we reviewed the procedures and results of two clinical studies on BBB opening using focused ultrasound regarding its safety and clinical efficacy. Magnetic resonance images were also reviewed to discover any specific findings. @*Results@#: Two clinical trials showed clinical benefits. All clinical trials demonstrated safe BBB opening, with no specific side effects. Magnetic resonance imaging showed temporary T1 contrast enhancement in the sonication area, verifying the BBB opening. Several low-signal intensity spots were observed in the T2 susceptibility-weighted angiography images, which were also reversible and temporary. Although these spots can be considered as microbleeding, evidence suggests these are not ordinary microbleeding but an indicator for adequate BBB opening. @*Conclusion@#: Magnetic resonance images proved safe and efficient BBB opening in humans, using focused ultrasound.
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Background and Objectives@#It can be troublesome to repair tympanic membrane (TM) perforation extending to anterosuperior quadrant (ASQ). Underlay technique may cause re-perforation at ASQ, whereas overlay technique may result in anterior blunting or lateral healing of TM, causing conductive hearing loss. Anterior scutum-anchoring tympanoplasty (ASAT) can be a good alternative to repair TM perforation involving ASQ. ASAT is a variant of classic underlay tympanoplasty during which a graft is overlayed only at anterosuperior aspect by way of inserting a graft between the bony and fibrous annulus and anchoring the anterosuperior end of graft on the anterior scutum. This study was performed to assess the outcome of ASAT.Subjects and Method The medical records of patients with chronic otitis media who received type 1 tympanoplasty between April 2014 and August 2019 were reviewed. Depending on the size of the TM perforation, patients were classified into four groups. The tympanic graft success rate, complication rate, and hearing improvement were evaluated by group. @*Results@#The 82 ears of 78 patients were included for the study. At the most recent examination after 6 months of surgery, the graft success rate was 100% in all four groups. There were no postoperative complications. The mean hearing threshold was improved at 17.2 dB HL in air-conduction pure tone audiometry after surgery. @*Conclusion@#ASAT is a reliable and easily performable technique to repair TM perforation extending to ASQ with a high graft success rate and good postoperative hearing.
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Purpose@#To investigate clinical factors affecting subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) after cataract surgery. @*Methods@#A retrospective medical record review was performed of 62 patients (95 eyes) who underwent cataract surgery. The SFCT and CVI were calculated based on cross-section measurements obtained from enhanced depth imaging-optical coherence tomography preoperatively and postoperatively at 1 week, 1 month, and 2 months. The changes in SFCT and CVI were analyzed with respect to anesthesia, diabetes mellitus (DM), hypertension (HTN), and phaco power/time. @*Results@#Regardless of anesthesia, DM, or HTN, SFCT had increased at 1 week postoperatively and continued to decrease up to 2 months postoperatively. In the case of topical anesthesia and patients without DM or HTN, the CVI was significantly higher at 1 month postoperatively, but was followed by a steady reduction up to the 2-month follow-up. In the case of retrobulbar anesthesia and patients with DM or HTN, the CVI increased up to 2 months postoperatively. @*Conclusions@#In this study, clinical factors had a significant impact on the change in CVI after surgery, but not on the SFCT. This suggests that the presence of DM affects the change in the choroidal vessels after cataract surgery.
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Purpose@#To investigate clinical factors affecting subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) after cataract surgery. @*Methods@#A retrospective medical record review was performed of 62 patients (95 eyes) who underwent cataract surgery. The SFCT and CVI were calculated based on cross-section measurements obtained from enhanced depth imaging-optical coherence tomography preoperatively and postoperatively at 1 week, 1 month, and 2 months. The changes in SFCT and CVI were analyzed with respect to anesthesia, diabetes mellitus (DM), hypertension (HTN), and phaco power/time. @*Results@#Regardless of anesthesia, DM, or HTN, SFCT had increased at 1 week postoperatively and continued to decrease up to 2 months postoperatively. In the case of topical anesthesia and patients without DM or HTN, the CVI was significantly higher at 1 month postoperatively, but was followed by a steady reduction up to the 2-month follow-up. In the case of retrobulbar anesthesia and patients with DM or HTN, the CVI increased up to 2 months postoperatively. @*Conclusions@#In this study, clinical factors had a significant impact on the change in CVI after surgery, but not on the SFCT. This suggests that the presence of DM affects the change in the choroidal vessels after cataract surgery.
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Tracheostomy is considered as a first treatment, when oral intubation seems to be difficult in patient who present severe upper airway obstruction. Generally, tracheostomy is performed in supine position. But if airway obstruction is severe enough to cause dyspnea, low oxygen saturation and inability to maintain supine position, tracheostomy should be performed in sitting position. The authors report a case of successful tracheostomy using high flow nasal cannula which help to maintain stable oxygen saturation and respiration in patients with laryngeal cancer.
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Purpose@#To explore the clinical characteristics and profiles of newly diagnosed glaucoma subtypes in urban Korea. @*Methods@#All newly diagnosed glaucoma patients enrolled in the participating ophthalmology outpatient clinics were in-cluded. A review of medical history including family history of glaucoma was conducted. The patients underwent complete ophthalmologic examinations including visual field test. The diagnosis of glaucoma was based on the International Society of Geographical and Epidemiological Ophthalmology criteria developed by glaucoma specialists. @*Results@#A total of 198,671 patients visited the participating ophthalmology outpatient clinics during the study period (from January 1, 2001 to June 30, 2016), of which 5,530 (2.8%) were diagnosed with glaucoma. The mean age of the newly diag-nosed glaucoma patients was 52.0 ± 17.3 years (range, 6 to 89) and 2,830 patients were male (51.2%). The mean untreated in-traocular pressure and vertical cup-to-disc ratio of the optic nerve head of newly diagnosed glaucoma eyes were 22.1 ± 10.6 mmHg and 0.66 ± 0.22, respectively. The most frequently observed subtypes of glaucoma were: normal tension glaucoma (33.0%) primary open-angle glaucoma (28.4%), ocular hypertension (11.1%), chronic angle-closure glaucoma (6.8%), neovas-cular glaucoma (5.2%), glaucoma associated with inflammation (3.8%), acute angle-closure glaucoma (3.3%), and glaucoma associated with aphakia or pseudophakia (2.2%). @*Conclusions@#Normal tension glaucoma was the most frequently observed glaucoma subtype in urban ophthalmology outpa-tient clinics in Korea.
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Congenital aural atresia (CAA) is usually accompanied by an anomalous course of facial nerves, which may run over the round window niche toward the promontory in some cases of CAA. Very rarely, cochlear malformation might coexist at the same ear which has CAA, in which case cochlear implantation can be difficult due to anomalous facial nerve. Herein we present a case of cochlear implantation performed in a child who had CAA along with cochlear hypoplasia and cochlear nerve aplasia. The mastoid segment of facial nerve was displaced anteriorly, running over the round window niche. The surgery was done successfully using the round window approach without facial nerve injury.
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PURPOSE: To quantify the size of commotio retinae and investigate its spontaneous resolution over time using ultra-wide field (UWF) color fundus photography.METHODS: We analyzed serial UWF color fundus photographs of 33 eyes of 33 ocular trauma patients with commotio retinae. Total visible retinal areas and the areas of commotio retinae were measured at baseline, 3 days, 1 week, and 4 weeks from the initial traumatic event.RESULTS: The median time of observation was 10.8 ± 12.1 (4-44) weeks. Spontaneous resolution of commotio retinae was observed in all patients, and no patients experienced any complications during the follow-up period. The mean percentage of commotio retinae at 3 days significantly decreased compared to the baseline (8.51 ± 9.66% versus 12.23 ± 10.39%; p < 0.001), and more decreased at 1 week (1.04 ± 2.75%; p < 0.001), but no significant differences were observed between 1 week and 4 weeks (0.00 ± 0.00%; p = 0.219). The spontaneous resolution percentages during the first 3 days, between 3 days and 1 week, and during the next 4 weeks were 12.97 ± 13.44%/day, 19.62 ± 9.22%/day, and 0.87 ± 1.87%/day, respectively (p = 0.192 and p < 0.001, respectively). The resolution rate was higher during the first 1 week.CONCLUSIONS: We quantified the size of commotio retinae using UWF color fundus photography. Most patients with commotio retinae resolved spontaneously during the first 1 week following trauma, and all cases completely resolved at 1 month without any complications.
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PURPOSE: We sought to elucidate the influence of acetazolamide on choroidal structure changes during the treatment of central serous chorioretinopathy (CSC).METHODS: This was a retrospective study of 45 eyes from 45 patients with acute CSC who were divided into an acetazolamide group (group 1, n = 20) and an observation group (group 2, n = 25). The main outcome measures were the changes in best-corrected visual acuity, subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) at one week, one month, two months, and three months, respectively.RESULTS: Although statistical significance was not reached, best-corrected visual acuity improved in both groups at month 3 (from 0.06 ± 0.07 to 0.01 ± 0.03 in group 1 and 0.17 ± 0.24 to 0.09 ± 0.18 in group 2; p = 0.083 and 0.183, respectively). Separately, SRF height and CVI showed a significant decrease at three months in both groups (all p < 0.05), while a significant SRF height decrease was also noted in group 1 at one month (p = 0.038). In group 1, a significant decrease in the SFCT and CVI started at one week and one month (p = 0.021 and 0.008), respectively. However, in group 2, a significant decrease in the SFCT and CVI started at one month and two months (p = 0.005 and 0.015), respectively.CONCLUSIONS: Acetazolamide has no effect on final functional or anatomical status at three months in eyes with CSC but does shorten the time for SRF absorption and accompanying choroidal structural changes.
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Humans , Absorption , Acetazolamide , Central Serous Chorioretinopathy , Choroid , Outcome Assessment, Health Care , Retrospective Studies , Subretinal Fluid , Visual AcuityABSTRACT
PURPOSE: The effects of desensitizing agent are often for a short duration. One of the reasons is believed to be wear of desensitizing agent by tooth brushing. To reduce the wear and make the duration longer, dental bonding resin was applied and the changes of dentin permeability after toothbrushing were measured. MATERIALS AND METHODS: Extracted teeth free from caries were chosen. Coronal dentin discs with thickness of 1 mm were prepared. Using the split chamber device developed by Pashely, hydraulic conductance and scanning electron microscope images (SEM) were compared and contrasted before and immediately after the application of desensitizing agent and bonding resin and then after equivalent tooth brushing of 1 week, 2 weeks, and 6 weeks. Four commercially available desensitizing agents were used in this study; they were All-Bond 2, Seal & Protect, Gluma, and MS Coat. And Dentin/Enamel Bonding resin (Bisco Inc.) was used. The results of this study are as follows. RESULTS: On all specimens, the hydraulic conductance decreased after the application of tooth desensitizing agent and bonding resin. Compared with the specimens treated only with desensitizer, the specimens treated with All-Bond 2, Gluma, MS Coat and plus D/E bonding resin had a little increase in hydraulic conductance after 1, 2 and 6-week tooth brushing. In case of Seal & Protect, the specimens showed the same result only after 6-week tooth brushing. On examination of SEM, the dentinal tubule diameter had decreased after treatment of desensitizing agents and bonding resin. And the specimens treated with All-Bond2, Seal&Protect, Gluma, MS Coat and plus D/E bonding resin had an significant decrease in diameter of dentinal tubule after 6-week tooth brushing. CONCLUSION: According to the results of this study, it is effective to use bonding resin after application of desensitizer in reducing the wear by tooth brushing and making the duration longer. In this study, just 6-week tooth brushing was performed, and it is not enough to regard it as a long-term data. So further study is needed and more perfect method for treating dentin hypersensitivity should be developed.
Subject(s)
Dental Bonding , Dentin , Dentin Permeability , Dentin Sensitivity , Dentin-Bonding Agents , Tooth , ToothbrushingABSTRACT
PURPOSE: To evaluate the changes of refractive astigmatism after horizontal rectus muscle surgery in intermittent exotropic children. METHODS: Sixty-nine exotropic patients were retrospectively reviewed. Of those, 35 patients received unilateral lateral rectus recession (BLR group, 35 eyes) and 34 patients received unilateral lateral rectus recession and medial rectus resection (R&R group, 34 eyes). Non-cycloplegic refractions were measured until 6 months postoperatively. Spherical equivalent (SE), J0 and J45 using power vectors were calculated to determine and compare the changes of refractive astigmatism and axis in both groups. RESULTS: SE significantly decreased after surgery for the first week and did not changed thereafter in both groups (p = 0.000 and p = 0.018, respectively). In BLR group, J0 showed significant changes at the first week and 1 month after surgery (p = 0.005 and p = 0.016, respectively), but in R&R group, J0 changed significantly between 1 week and 3 months postoperatively (p = 0.023 and p = 0.016, respectively). J45 did not change significantly as time passed in both groups (all p > 0.05). There was no statistically significant difference in the magnitude of changes in SE, J0 and J45 between the two groups after the 6-month follow-up (p = 0.500, p = 0.244 and p = 0.202, respectively). CONCLUSIONS: Horizontal rectus muscle surgery in intermittent exotropic children tends to induce a statistically significant change in astigmatism in the with-the-rule direction and myopic shift in SE. This astigmatism change seems to occur within the first 3 months after surgery. Thus, astigmatism induced by surgery should be checked and corrected at least 3 months after horizontal strabismus surgery.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Astigmatism/etiology , Exotropia/complications , Eye Movements , Follow-Up Studies , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures/methods , Retrospective Studies , Treatment Outcome , Vision, Binocular/physiologyABSTRACT
Cyberknife with small field size is more difficult and complex for dosimetry compared with conventional radiotherapy due to electronic disequilibrium, steep dose gradients and spectrum change of photons and electrons. The purpose of this study demonstrate the usefulness of Geant4 as verification tool of measurement dose for delivering accurate dose by comparing measurement data using the diode detector with results by Geant4 simulation. The development of Monte Carlo Model for Cyberknife was done through the two-step process. In the first step, the treatment head was simulated and Bremsstrahlung spectrum was calculated. Secondly, percent depth dose (PDD) was calculated for six cones with different size, i.e., 5 mm, 10 mm, 20 mm, 30 mm, 50 mm and 60 mm in the model of water phantom. The relative output factor was calculated about 12 fields from 5 mm to 60 mm and then it compared with measurement data by the diode detector. The beam profiles and depth profiles were calculated about different six cones and about each depth of 1.5 cm, 10 cm and 20 cm, respectively. The results about PDD were shown the error the less than 2% which means acceptable in clinical setting. For comparison of relative output factors, the difference was less than 3% in the cones lager than 7.5 mm. However, there was the difference of 6.91% in the 5 mm cone. Although beam profiles were shown the difference less than 2% in the cones larger than 20 mm, there was the error less than 3.5% in the cones smaller than 20 mm. From results, we could demonstrate the usefulness of Geant4 as dose verification tool.
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Electronics , Electrons , Head , Photons , Radiosurgery , Resin Cements , WaterABSTRACT
PURPOSE: To evaluate the results of arthroscopic contouring surgery and posterolateral meniscal repair for pediatrics with snapping discoid lateral meniscus without tear. MATERIALS AND METHODS: Nine children below 10 years, with snapping discoid lateral meniscus without tear were evaluated in this study. 3 cases had a morphologic deformity of lateral meniscus in MRI and arthroscopic findings, but there was no meniscal tear. Only contouring surgery was performed in 6 cases, and in 3 cases, because of the instability of meniscus over 5mm in traction due to the relaxation of the menisco-capsular junction after contouring surgery, posterolateral repair was performed. The average duration of follow up was 39 months(range, 25 to 72 months). RESULTS: Additional posterolateral repair was done due to remaining snapping, in three cases of six contouring surgery cases. In all cases, snapping was disappeared. The average Lysholm score was improved from 71 in preoperative status to 97 in postoperative status(p=0.008) CONCLUSION: In case of the increased instability of the posterolateral corner of lateral meniscus after contouring surgery in the treatment of snapping discoid lateral meniscus, posterolateral repair is effective to improve the snapping symptom from meniscal subluxation.
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Child , Humans , Congenital Abnormalities , Follow-Up Studies , Magnetic Resonance Imaging , Menisci, Tibial , Pediatrics , Relaxation , TractionABSTRACT
PURPOSE: There is ongoing demand to deliver better procedural training to medical students in the emergency department. Thus, we studied the efficacy of a cadaver-based training model for teaching simple suture techniques to medical students. METHODS: We investigated ten fourth-year medical students, who were rounding and being trained in the Emergency Department of Chungnam National University Hospital. They were educated with slides about a simple suture technique for 30 minutes to evaluate the efficacy of the cadaver-based training model. We prospectively measured their skill by administering a test on the cadaver-based simple suture technique in 3cm sized linar wound separately to each of them. RESULTS: A total of ten fourth-year medical students completed the investigation. The tension, the direction of suture, the degree of cleanness, the number of sutures, the adequacy of the cutting thread length, and the suturing time in the first attempt were compared with those in the second one. The second results were compared with those in the third one, and the third results were compared with those in the fourth one. All the results had statistical significance. CONCLUSION: These findings support the value of the cadaver-based simple suture technique training model as a medical student teaching model. The cadaver-based simple suture technique teaching model is a good way of teaching several medical skills to medical students.
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Humans , Cadaver , Emergency Service, Hospital , Prospective Studies , Students, Medical , Suture Techniques , Sutures , Wounds and InjuriesABSTRACT
PURPOSE: There is ongoing demand to deliver better procedural training to medical students in the emergency department. Thus, we studied the efficacy of a cadaver-based training model for teaching simple suture techniques to medical students. METHODS: We investigated ten fourth-year medical students, who were rounding and being trained in the Emergency Department of Chungnam National University Hospital. They were educated with slides about a simple suture technique for 30 minutes to evaluate the efficacy of the cadaver-based training model. We prospectively measured their skill by administering a test on the cadaver-based simple suture technique in 3cm sized linar wound separately to each of them. RESULTS: A total of ten fourth-year medical students completed the investigation. The tension, the direction of suture, the degree of cleanness, the number of sutures, the adequacy of the cutting thread length, and the suturing time in the first attempt were compared with those in the second one. The second results were compared with those in the third one, and the third results were compared with those in the fourth one. All the results had statistical significance. CONCLUSION: These findings support the value of the cadaver-based simple suture technique training model as a medical student teaching model. The cadaver-based simple suture technique teaching model is a good way of teaching several medical skills to medical students.
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Humans , Cadaver , Emergency Service, Hospital , Prospective Studies , Students, Medical , Suture Techniques , Sutures , Wounds and InjuriesABSTRACT
PURPOSE: Urine alkalinization is commonly used to treat rhabdomyolysis and to prevent the rapid progression of rhabdomyolysis into acute renal failure. However, there are no prospective studies on the beneficial effect of urine alkalinization on rhabdomyolysis. We prospectively examined whether fluid hydration with urine alkalinization treatment would be more effective than single hydration treatment in treating rhabdomyolysis and preventing acute renal failure in the emergency department. METHODS: We performed a prospective randomized trial with fifty-eight patients who were diagnosed with rhabdomyolysis. Thirty-five patients were treated with crystalloid alone, while the others were treated with crystalloid mixed with sodium bicarbonates. Creatine phosphokinase (CPK) and creatinine levels were checked every 4 hours for the first 24 hours and then checked every 8 hours thereafter. Data collected included "peak CPK time"(time from the start of treatment to achievement of the maximal CPK value), increasing and decreasing rate of CPK, and whether acute renal failure developed. RESULTS: Patient's age, sex, initial CPK concentrations, and initial creatinine concentrations were not statistically different between the single hydration treatment group and the hydration with urine alkalinization group. Mean time to peak CPK was 10.2+/-13.7 hours in the single hydration group and 8.1+/-10.2 hours in the hydration with urine alkalinization group. Neither the time to peak CPK nor the CPK change rates was statistically different between the two groups (p=0.547, p=0.176, p=0.696). CONCLUSION: Hydration with urine alkalinization as a treatment for rhabdomyolysis and prevention of acute renal failure did not improve patient results over single hydration treatment.
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Humans , Acute Kidney Injury , Bicarbonates , Creatine Kinase , Creatinine , Emergency Service, Hospital , Prospective Studies , Rhabdomyolysis , SodiumABSTRACT
Ophthalmoplegia following snake bite is a rare but not serious neurotoxic complication. However, symptoms like diplopia, blurred vision, and ocular discomfort can be emotionally devastating for a patient. We experienced one case f ophthalmoplegia following a snake bite. The patient complained of diplopia and ptosis that had developed several hours after the snake bite. The symptoms were completely resolved after pyridostigmine medication with antivenin treatment.
Subject(s)
Humans , Cholinesterase Inhibitors , Diplopia , Ophthalmoplegia , Pyridostigmine Bromide , Snake Bites , SnakesABSTRACT
PURPOSE: To compare the sedation quality of oral chloral hydrate against intramuscular ketamine in children requiring primary repair in the emergency department. METHODS: Patients needing primary repair of lacerations (range 1.6 years of age) were blindly randomized to either chloral hydrate or ketamine groups. One group received intramuscular ketamine at 4 mg/kg and the other group received oral chloral hydrate at 50 mg/kg. Both groups received lidocaine for local anesthesia. Physiologic parameters (heart rate, blood pressure and respiratory rate), the time from sedation to recovery, and the degree of sedation as measured by the Ramsay sedation score and the Modified Aldrete recovery score were recorded during the treatment. Overall behavior and complication were assessed both at baseline and at the end of the treatment. RESULTS: Data are mean+/-SD. We enrolled 80 consecutive patients into the study; 39 received intramuscular ketamine and 41 were administered oral chloral hydrate. The two groups were similar with regard to age, sex, and body weights. No patient had a clinically significant change in vital signs and the time from sedation to recovery. Changes in the Modified Aldrete recovery score after sedation were not statistically significant. However, statistically significant differences were observed for the Ramsay sedation score at 15 minutes after sedation (4.89+/-0.32 versus 4.23+/-0.48; p=0.024). No differences at other time points achieved statistical significance in the Ramsay sedation score. CONCLUSION: Both oral chloral hydrate and intramuscular ketamine are safe and effective for the sedation of children requiring laceration repair in the emergency department.
Subject(s)
Child , Humans , Anesthesia, Local , Blood Pressure , Body Weight , Chloral Hydrate , Emergencies , Emergency Service, Hospital , Ketamine , Lacerations , Lidocaine , Vital SignsABSTRACT
PURPOSE: This study was performed to investigate the value of corrected QT interval (QTc), corrected QT dispersion (cQTd), cardiac enzyme (Creatinine kinase; CK, CKMB) as a short-term prognosis and severity evaluation in CO poisoning. METHODS: This study reviewed 55 cases of CO poisoning that occurred form January 1, 2000, to June 31, 2005. We have analyzed the admission ECGs of patients with CO poisoning for QTc, QTd (QT dispersion), cQTd and measure CK, CK-MB, too. QTd was defined as the difference between the longest and the least QT intervals in any of the 12 leads. We evaluate short-term outcome with consciousness on discharge from ED and severity with receiving hyperbaric oxygen therapy (HBO). RESULTS: Eighteen of 55 patients received HBO and seven patients received two or more. On admission, cQTd intervals of the intoxicated patients were increased compared to normal (63.2+/-38 ms), but not the QTc, QT, QTd. QTc interval and CK of patients who received HBO were significantly increased compared to patients who not receive(472.0+/-4 7 ms VS 437.2+/-730 ms, p=0.006 158 3.1+/-43174 u/L 138.8+/-2363 u/L p=0.009). Whether or not consciousness on discharge was associated only CK (p= 0.02). CONCLUSION: The QTc interval and CK were prolonged at patients who received HBO. That means that the QTc interval and CK reflected the severity of CO poisoning. CK of Patients who not recover consciousness after HBO were increased significantly. To say, as CK were increase, the short-term prognosis of CO poisoning is the poorer.
Subject(s)
Humans , Carbon Monoxide Poisoning , Carbon Monoxide , Carbon , Consciousness , Electrocardiography , Hyperbaric Oxygenation , Phosphotransferases , Poisoning , PrognosisABSTRACT
PURPOSE: We present a case of orbital abscess following porous orbital implant infection in a 73-year-old woman with rheumatoid arthritis. METHODS: Just one month after a seemingly uncomplicated enucleation and porous polyethylene (Medpor(R)) orbital implant surgery, implant exposure developed with profuse pus discharge. The patient was unresponsive to implant removal and MRI confirmed the presence of an orbital pus pocket. Despite extirpation of the four rectus muscles, inflammatory granulation debridement and abscess drainage, another new pus pocket developed. RESULTS: After partial orbital exenteration, the wound finally healed well without any additional abscess formation. CONCLUSIONS: A patient who has risk factors for delayed wound healing must be examined thoroughly and extreme care such as exenteration must be taken if there is persistent infection.