Two Cases of Rhino-Orbitocerebral Mucormycosises that Manifested as Noninflammatory Oculomotor Nerve Palsy

PURPOSE: Rhino-orbitocerebral mucormycosis is the disease that cause orbital cellulitis, orbital apex syndrome, and orbital necrosis. We report two cases of mucormycosis that began with only noninflammatory oculomotor nerve palsy. METHODS: 74-year-old man and 53-year-old woman with DM visited our hospital for sudden ptosis, mydriasis, and paralytic strabismus. MRI scan and other neurological examinations were negative except mild sinusitis. Patients were diagnosed as complete third nerve palsy. RESULTS: A few days later, they developed orbital apex syndrome with exophthalmos and abrupt reduction of visual acuity. Emergency biopsy of sinusitis was done, and revealed mucormycosis. CONCLUSIONS: Sudden oculomotor nerve palsy in chronic debilitating patients with DM and sinusitis should be suspected as prodrome of rhino-orbito-cerebral mucormycosis.

The Results of Molteno Implant Surgery

PURPOSE: The author evaluated the outcome of the Molteno implant drainage device in refractory glaucoma. METHODS: A retrospective study was performed on 17 eyes of 17 patients that had undergone Molteno implantation for glaucoma unresponsive to conventional treatment from May 1997 to February 2001 at our hospital. Complete success was defined as a postoperative intraocular pressure of less than 21 mmHg (but over 5 mmHg) at last visit without glaucoma medications, and qualified success was the same pressure as above with glaucoma medications and with no additional glaucoma surgery, phthisis, or removal of Molteno implant. RESULTS: The total success was 70.6% (41.2%, complete; 29.4%, qualified). There was a significant difference in number of antiglaucoma medications between preoperative and postoperative. Postoperative relief of ocular pain or headache was statistically significant. CONCLUSIONS: The Molteno implant surgery offers a reasonable outcome in eyes with intractable glaucoma. The proper management will result in less complications and a better control of intraocular pressure.