The Effect of Chemical Myectomy using Doxorubicin Delivered by Osmotic Pump on Eyelid Skin Necrosis

PURPOSE: Direct injection of doxorubicin into the eyelids results in permanent loss of muscle fiber and it is considered an attractive nonsurgical method in essential blepharospasm therapy. However, necrosis of skin overlying orbicularis oculi muscle is the most serious side effect of this therapy. The purpose of this study is to determine the effect of doxorubicin delivered by osmotic pump which release doxorubicin slowly, and to evaluate the degree of overlying skin injury following chemical myectomy. METHODS: Thirty three rabbits were assigned to three groups according to the doxorubicin concentration. The first group received direct injections of 0.5 mg doxorubicin diluted in 0.1 ml of saline in the right lower eyelid. and osmotic pump was inserted into the left lower eyelid which contained 0.5 mg doxorubicin in 0.1 ml of saline. The second group received 1 mg doxorubicin and the third group received 2 mg doxorubicin. Eight weeks after injection, the eyelids were assessed for the degree of muscle fiber loss microscopically. For the evaluation of functional change of muscle, an EMG study was carried out. RESULTS: Skin necrosis developed in all rabbits except for one which received injection of 0.5 mg doxorubicin. Skin necrosis appeared earlier in the direct injection group. The duration of skin necrosis was shortened at lower concentrations(0.5 mg, 1.0 mg) with a pump delivery(P<0.05). But there was no statistical differences in the 2.0 mg concentration. The size of necrosis was much smaller in rabbits using pump delivery than those of direct injection group in high doxorubicn concentrations(1.0 mg, 2.0 mg)(P<0.05). The total size of muscle fiber was decreased after a doxorubicin injection. There was no statistical difference between the direct injection group and the pump group(P<0.05). The similar effect on the muscle was noted regardless of the slow release of the doxorubicin into the muscle. Light microscopic study demonstrated destructive change of muscle and it was replaced by connective tissues. Electron microscopic study showed destruction of micro-architecture of muscle fibers. Functionally, in EMG study, there was no motor activity in the injection area. But some motor unit potentials appeared in the periphery of skin necrosis site. CONCLUSIONS: These results suggest that the osmotic pump may be used as an effective adjuvant in preventing skin necrosis in blepharospasm treatment.

Effect of Endonasal DCR on Acute Dacryocystits as a Primary Treatment

In the past, the principles of treatment for acute dacryocystits were exclusively conservative treatment. Especially external DCR has been contraindicated. The purpose of this study is to investigate surgical results of endonasal DCR for acute dacryocystitis. The author performed standard endonasal laser-drill assisted DCR on 15 patients with acute dacryocystitis and followed up at least 2 months postoperatively. Anatomically surgical success were accomplished in 11 of 15 patients without epiphora in the primary operation. Swelling and redness disappeared within 10 days postoperatively in all cases. In short, when considering side effects of long-standing use of systemic antibiotics and secondary DCR, endonasal DCR should be considered the primary choice of treatment regimen for acute dacryocystitis.

The effects of Modified Transnasal Wiring on the Teleeanthus

We report 10 cases of the patients with telecanthus undergone modified transnasal wiring procedure between May, 1986 and December, 1990. The procedure of this operation is characterized as follow: Each wire is traversed through 2 holes in nasal bone to the medial canthal ligament. After piercing through the ligament, the wire is returned to the opposite medial canthal ligament over the nasal bone. Ultimately 2 ends of each wire are tied together on one side without silicone sheath. We believe that this modified procedure is more effective and simple for the correction of telecanthus with less recurrence rates than conventional method.

A Case of Squamous Cell Papilloma of the Lacrimal Sac

Squamous cell papilloma is one of epitheial tumors. Squamous cell papilloma of the lacrimal sac is so rare that the indrvidual clinician rarely acquires substantial experience in their management. The patients with benign squamous cell papilloma present with epiphora, palpable mass and bloody discharge that can be mistaken clinically as evidence of chronic dacryocystitis. The choice of treatment is simple excision and recurrence rate is approximately 20-30%. Most of the papilloma does not reveal any malignant change. We experienced a 40-year-old woman who had a soft, irregular surfaced palpable mass and unilateral epiphora for one year in the lower lid and inner canthus of the left eye. We treated with dacryocystectomy including tumor mass. The histopathologic evaluation revealed the tumor to be a benign squamous cell papilloma. The general conditions of the patient and operation sites are good so, we present our case with a brief review of the literature.