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Purpose@#To describe the clinical outcome of retrobulbar injection of synthetic fillers to correct enophthalmos associated with phthisis bulbi or anophthalmos. @*Methods@#We retrospectively reviewed the medical records of patients who underwent enophthalmos correction using retrobulbar filler injections at Asan Medical Center between January 2015 and October 2019, and who were followed for at least 6 months. We evaluated the number of injections and amount of filler injected, improvement in enophthalmos, interval between injections, and adverse effects of filler injection. @*Results@#The study enrolled five patients (four females and one male). Two patients had anophthalmos after evisceration and three had phthisis bulbi. Two patients received hyaluronic acid (HA) filler only, one had collagen-polymethylmethacrylate (PMMA) filler only, and two had both fillers. The HA and collagen-PMMA filler volumes per injection were 1.0–1.4 and 0.75–1.0 mL, respectively. The average degree of enophthalmos, compared to the contralateral eye, was 1.8 mm; the amount of enophthalmos correction per 1 mL of filler injection was 1.5 mm for HA filler and 1.4 mm for collagen-PMMA filler. The longest duration of enophthalmos correction was 15 months for HA filler and 25 months for collagen-PMMA filler. There were no significant adverse effects, but anterior migration of HA filler was observed in one case that resolved with hyaluronidase injection. @*Conclusions@#Retrobulbar filler injection is a safe, effective, minimally invasive procedure for correcting enophthalmos in patients with anophthalmos or phthisis bulbi. If HA filler injection shows good outcomes without adverse effects, semi-permanent fillers can be used for long-term maintenance of enophthalmos correction. Further studies with more patients and long-term follow-up are needed to compare the effectiveness of various fillers.
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Purpose@#We report a case of primary small cell neuroendocrine carcinoma arising from the lacrimal sac. Case summary: A 54-year-old man presented with epiphora that had been present for 1 month. He underwent lacrimal syringe analysis of the lower punctum in the right eye, which demonstrated fluid regurgitation from the upper punctum. Computed tomography revealed a 3.0 × 3.4 × 3.0 cm mass with an ill-defined margin in the right lacrimal sac, which demonstrated invasion of the lacrimal duct and bony destruction of the inferior and medial orbital walls. Incisional biopsy and histologic examination showed that the tumor was composed of small round tumor cells. On the basis of histopathological and immunohistochemical evaluations, a diagnosis of small cell neuroendocrine carcinoma was made. The patient received chemotherapy. @*Conclusions@#To the best of our knowledge, this is the first case of primary small cell neuroendocrine carcinoma arising from the lacrimal sac in Korea. Small cell neuroendocrine carcinoma in the lacrimal sac should be regarded as a differential diagnosis for patients with a nasolacrimal duct obstruction.
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Purpose@#We report a case of primary small cell neuroendocrine carcinoma arising from the lacrimal sac. Case summary: A 54-year-old man presented with epiphora that had been present for 1 month. He underwent lacrimal syringe analysis of the lower punctum in the right eye, which demonstrated fluid regurgitation from the upper punctum. Computed tomography revealed a 3.0 × 3.4 × 3.0 cm mass with an ill-defined margin in the right lacrimal sac, which demonstrated invasion of the lacrimal duct and bony destruction of the inferior and medial orbital walls. Incisional biopsy and histologic examination showed that the tumor was composed of small round tumor cells. On the basis of histopathological and immunohistochemical evaluations, a diagnosis of small cell neuroendocrine carcinoma was made. The patient received chemotherapy. @*Conclusions@#To the best of our knowledge, this is the first case of primary small cell neuroendocrine carcinoma arising from the lacrimal sac in Korea. Small cell neuroendocrine carcinoma in the lacrimal sac should be regarded as a differential diagnosis for patients with a nasolacrimal duct obstruction.
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Purpose@#To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy. @*Methods@#Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded. @*Results@#The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade. @*Conclusions@#When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.