Two Cases of Deepening of the Upper Lid Sulcus from Topical Bimatoprost Therapy

PURPOSE: To report two cases of deepening of the upper lid sulcus following bimatoprost. METHODS: A 54-year-old woman who used bimatoprost for one week and a 70-year-old woman who used bimatoprost for 4 months developed deep lid sulcus. Both were using bimatoprost for glaucoma treatment. RESULTS: Both patients also showed improvement of dermatochalasis and widening of the palpebral fissure. One week after discontinuing bimatoprost, the lid sulcus of the 54-year-old returned to baseline and exophthalmometry was unchanged. The orbital CT of the 70-year-old was normal. She did not complain about deepening of the lid sulcus, and she has not discontinued treatment due to this adverse effect.

Correction of Epiblepharon by Excision of Redundant skin and Pretarsal orbicularis muscle without tarsal fixation

PURPOSE: To evaluate the effect of the excision of redundant skin and pretarsal orbicularis muscle without tarsal fixation on the correction of the congenital epiblepharon. METHODS: We performed the surgery on 115 patients, 220 eyes from January 1996 to December 1999, and evaluated the functional, and cosmetic result. Surgical treatment included excision of redundant skin and pretarsal orbicularis muscle without tarsal fixation and simple skin suture technique. RESULTS: The mean age of the group was 7.2+/-6.8 years. There were 45 males and 70 females. Following the average follow up period of 18.4+/-4.5 months (minimum was 12 months), 212 eyes (96.4%) showed satisfactory result in functional and cosmetic aspect with of 8 eyes (3.6%) showed undercorrection early postoperativey but none underwent reoperation due to recurrences. CONCLUSIONS: This operative technique resulted in a good cosmetic and functional result.

A Case of Endogenous endophthalmitis Caused by Klebsiella Pneumoniae from Emphysematous Pyelonephritis

PURPOSE: To report a case of Klebsiella pneumoniae endogenous endophthalmitis secondary to renal or urinary tract infection such as emphysematous pyelonephritis. METHODS: A-56-year-old woman with diabetes mellitus and emphysematous pyelonephritis was reterred to us in consultation for visual loss in her right eye for 5 days. Ophthalmologic evaluation and intervention were performed. RESULTS: Culture revealed Klebsiella pneumoniae from vitreous tap of the right eye. Systemic antibiotics, intravitreous antibiotics injection and vitrectomy were performed, but the eye showed progressive worsening to phthisis. CONCLUSIONS: A high index of suspicion of Klebsiella pneumoniae endogenous endophthalmitis must be carried in patients with renal or urinary tract infection such as emphysematous pyelonephritis as well as hepatobiliary disease such as pyogenic liver abscess.

A Case of Bilateral Central Retinal Vein Occlusion

Retinal vein occlusion(RVO)is the second most common form of retinal vascular disease next to diabetic retinopathy. Systemic risk factors such as hypertension, diabetes, cardiovascular disease, blood dyscrasia and ocular risk factors such as short axial length, glaucoma, papilledema, thyroid ophthalmopathy have been shown to be associated with RVO. It is usually unilateral disease, and bilateral occurrene of RVO is relatively uncommon. CRVO rarely occurs bilaterally with a short interval between two eyes. Having experienced a case of bilateral CRVO within one month in a 75-year-old female with short axial length, primary open angle glaucoma, hypertension and hypercholesterolemia, we report this case with literature review.

Hyperosmolar Hyperglycemic Nonketotic Coma in Neurosurgery:Report of Six HHNC

In 1957 Sament and Schwartz reported patient with profound coma and hyperglycemia but without ketonemia or acidosis. This syndrome in usually termed hyperosmolar hyperglycemic nonketotic coma(HHNC). Six critically ill patients while on the neurosurgical service were studied to establish the diagnosis of HHNC. Criteria for the diagnosis of HHNC included. 1) Serum glucose over than 220 mg/dl wigh glucosuria. 2) absence of significant acetonuria. 3) serum Na over than 150 mEq/l. 4) serum osmolarity over than 310 mOsM/kg. 5) neurological dysfunction. The production of the characteristic stupor and diminution of mental acuity appears to result from a decrease in intracellular water content within the brain due to the osmotic effects of those predominately extracellular substances. Factors documented to be significant in it's development include nonspecific stress to primary illness, hyperosmolar tube feeding. Dehydration, and mannitol, dilantin and steroid administration. The treatment of HHNC recommended the division of replacement into two stages: 1) rapid repair of water deficits which was calculated by described formula and correct the Na abnormality. 2) insulin replacement according to the degree of glucosuria. During the replacement therapy of water deficit and insulin, it should be necessary to repeat plasma electrolytes and blood glucose at 4 hour intervals until normal levels are approached. One among the 6 cases of HHNC became good recovery and 5 cases were expired on treatment, Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias and cardiopulmonary dysfunction, both cerebral and systemic, were common in these cases.