Management of Exposed Porous Orbital Implants

PURPOSE: With its increasing popularity, several complications, such as infection, exposure, and extrusion have been reported in the use of the porous orbital implants. Exposure of the implants is one of the most difficult complications to treat. We evaluate the effect of treatment in exposed porous orbital implants with various techniques. METHODS: From January 1995 to December 2000, 15 patients visited our clinic with exposure of implant after porous orbital implantation. The following procedures were used to cover the implants: observation with delayed prosthesis fitting and posterior vaulting of the prosthesis, burring away the anterior surface of the hydroxyapatite implant and placing dermis fat graft, removing infected implants and dermis fat graft, and removal and 180degrees rotation and replacement of porous implants according to the degree of exposure. RESULTS: Porous implants exposures occurred 1 to 12 weeks after implantations (mean, 5.2 weeks). Small areas of exposure (<3mm) closed spontaneously (2 cases), remained stationary (2 cases), and increased the exposure area requiring dermis fat graft (1 case). During the follow-up period (mean, 19 months), no porous orbital implant was exposed again except 1 case who received previous orbital irradiation therapy. CONCLUSIONS: Small exposure of porous orbital implants less than 3 mm in diameter may be closed with nonsurgical methods. In the case of exposure larger than 4 mm, dermis fat graft or removal and 180degrees rotation and replacement of porous implants were effective in the treatment of exposure.

Radiation Therapy for Thyroid Orbitopathy

PURPOSE: The aim of this study is to evaluate the effect of radiotherapy for the patients with Graves' orbitopathy who were intolerable to corticosteroid therapy. METHODS: From December 1995 to June 2000, We reviewed medical records of thirteen patients who had received orbital radiation delivering 2000 cGy in 10 fractions over 2 weeks. RESULTS: Compressive optic neuropathy was improved in 3 of 4 patients (75%), and soft tissue swelling was improved in eight of 9 patients (88%). Proptosis was reduced in 3 of 13 (30%) patients. However, diplopia and ocular motility responded poorly and was improved only in 2 of 10 (20%) patients. No adverse effects of radiotherapy occurred in any patient. Specifically there was no sign of radiation-induced injury to optic nerve, retina, or lens. CONCLUSIONS: Radiotherapy was successful in patients with acute Graves' orbitopathy especially who had compressive optic neuropathy or soft tissue swelling. This modality was useful for those who showed intolerable side effects from the use of corticosteroid or the recurrence with corticosteroid treatment.

Frontalis Suspension Using Preserved Fascia Lata for Severe Congenital Ptosis Under 2 years of Age

PURPOSE: To investigate the effect of frontalis sling operation with preserved fascia lata before 2 years of age when amblyopia has existed or is suspiscious. METHODS: We reviewed the medical charts of ptosis patients who undergone frontalis sling with preserved fascia lata before 2 years of age from December 1994 through February 2000. Thirty four patients was included. RESULTS: There were 21 men and 13 women with ages ranging from 5 to 23 months(mean, 13.4 months). With a mean follow-up of 22 months(range 6-60months), 30 patients(88%) achieved normal or near normal eyelid position. Four slings eventually failed, requiring repeat procedure with autogenous fascia lata(2 cases) or preserved fascia lata(1 case). Three patients achieved good results. CONCLUSIONS: Our findings suggest that the frontalis sling using preserved fasica lata has good potential for ptosis management in children before 2 years of age

Clinical Characteristics of Sclerosing Pseudotumor of the Orbit

Sclerosing pseudotumor of the orbit is a unique clinico-pathological entity which is characterized by an insidious, chronic and progressive fibrosing process damaging orbital structures.As this entity forms immunologically mediated fibrosis even in early phase and frequently involves orbital apex and adjacent intracranial structures, it can cause severe ocular symptoms, visual impairments and even can threaten the life. We report clinical characteristics of nine biopsy-proven cases of sclerosing pseudotumor of the orbit.Five cases out of them have shown clinical improvement with combined therapeutic approach of surgical debulking, systemic steroids therapy, radiation therapy, and immunosuppressive therapy. We believe that prompt diagnosis through biopsy, early introduction of radiation therapy and immunosuppressive therapy are the most rational, currently available treatment for sclerosing pseudotumor of the orbit.

Effects of Platelet-derived Growth Factor and Laminin on Retinal Pigment Epithelial Cells

To investigate the effects of platelet-derived growth factor(PDGF)and laminin on the proliferation and morphological change of retinal pigment epithelial(RPE)cells, RPE cells(5 10(3))were cultured on either plastic or laminin-coated 24-well-plates for 6 days. One percent fetal calf serum and PDGF(0, 10, 20 ng/ml)were added in the culture media. Morphological change and the numbers of attached RPE cells were assessed at the end of the culture, using image analyzer and MTT assay. In image analysis, as the PDGF concentration were increased, area(A), perimeter(P), normalized perimeter(NP), diameter(D), minimum size(MinS), maximum size(MaxS), and eccentricity of binary object(EF)were increased while circle filling(Cfil)was decreased. Compared with the cells cultured on plastic, the cells on the laminin showed increase in all the parameters except EF. The proliferative effect on RPE cells were increased on both plastic and laminin as PDGF concentration were increased(P<0.05). These results suggest that proliferation and morphologic change of RPE cells might be influenced by PDGF and laminin.

A Case of Neuromyelitis Optica in Children

Neuromyelitis optica (Devic`s syndrome) is a rare demyelinating disorder of unknown etiology in which unilateral or bilateral optic neuritis and transverse myelitis occur within an 8-week time interval. It is 8 disorder that occurs more common in children than in adults. The prognosis is better in children than in adults. The authors experienced 8 case of neuromyelitis optica in a 5-year-old female who developed acute visual loss of the left eye, sensory loss below the 4th thoracic derinatoine, paraplegia, fever and nuchal ridigity ; all following viral prodromes. We diagnosed this case through neurologic features, magnetic resonance imaging, and cerebrospinal fluid findings. She has irnproved without any specific treatment.

Evaluation of Retinal Circulation Times in Rhegmatogeneous Retinal Detachment with SLO

This study was designed to evaluate the association between rhegmatogenous retinal detachment and retinal circulation times. We observed retinal circulation times in 30 patients with rhegmatogeneous retinal detachment before and after operation using the scanning laser ophthalmoscope. We measured arm to retina time(ART) and arteriovenous passage time(AVT) before the operations and after(average 2.5 weeks) successful reattachment of detached retina. Preoperative ART and AVP were 13.83 +/- 3.08 see and 2.91 +/- 0.69 see respectively, whereas postoperative ART and AVP were 13.60 +/- 2.99 see and 2.90 +/- 0.63 see in detached areas. There was no statistically significant difference between pre- and post-operative ART and AVP in detached retina(P>0.05). Preoperative ART and AVP in flat retinal area were 13.82 +/- 3.08 and 2.91 +/- 0.69 see respectively. There was no statistically significant difference between flat and detached area preoperatively (P>0.05). No significant correlation was noted between retinal circulation times and rhegmatogeneous retinal detachments by scanning laser ophthalmoscope.

Measurement of Blood Retina Barrier in Branch Retinal Vein Occlusion (BRVO)

Vitreous fluorophotometry was used to measure blood retinal barrier permeability to fluorescein in 15 patients with branch retinal vein occlusion(BRVO). Mean posterior vitreous fluorescein concentration(3mm) was 20.0 +/- 11.3(ng/ml) in affected eyes, and 2.99 +/- 1.22(ng/ml) in unaffected eyes. There was a statistically significant difference between the affected eye and unaffected eye(p<0.05). Also there was a correlation between the hemorrhage area and the posterior vitreous fluorescein concentration(r2=0.819). This study revealed that the permeability of blood retinal barrier was increased in BRVO as compared to the contralateral eye, and the higher permeability values were associated with the extent of area involved.

The Incidence of Retinal Detachment after Cataract Surgery according to Surgical Methods

We reviewed our medical records to evaluate the incidenee of and risk factors for retinal detachment after cataract surgery according to the surgical methods. Group 1 included 605 eyes operated on with corneoscleral incision, extracapsular cataract extraction(ECCE) and posterior chamber intraocular lens(PCL) implantation, and Group 2 included 600 eyes with scleral tunneling incision, phacoemulsification and PCL implantation. 8 eyes(1.3 %) developed retinal detachment in group 1, whereas 1 eyes(0.2%) in group 2. The difference in incid ence between the two groups was statistically significant(P<0.05). Axial length is longer than 25mm, intraoperative posterior capsule rupture, and scleral fixation were identified as risk factors for retinal detachment after cataract surgery. From the above results, suggest that phacoemulsification with scleral tunnel incision is preferable to extracapsular cataract extraction(ECCE) with cornea-scleral incision, in cataract surgery, to lower the post operative complication of retinal detachment.