Effect of Epinephrine in Reconstruction of an Orbital Wall Fracture

PURPOSE: To evaluate the effect of epinephrine on pupil size in reconstruction of an orbital wall fracture. METHODS: The authors of the present study describe 27 patients (27 eyes) who had reconstruction of an orbital wall fracture from January to July of 2009. Patients were divided into two groups according to the use of epinephrine during surgery. Preoperative and postoperative pupil sizes, operation times, and epinephrine dosages were collected. RESULTS: Preoperative pupil sizes were 1.80 +/- 0.37 mm, 1.74 +/- 0.36 mm and postoperative pupil sizes were 1.97 +/- 0.43 mm (p = 0.042), 2.18 +/- 0.52 mm (p = 0.003) in the group with of epinephrine and the group without epinephrine, respectively. Postoperative pupil size significantly increased in all groups. However, no significant difference was found regarding change in pupil size after surgery (p = 0.258). In the group with epinephrine, change in pupil size did not show a significant association with operation time (p = 0.228), nor did change in pupil size and epinephrine dosage (p = 0.922). CONCLUSIONS: The use of epinephrine is an effective modality for bleeding control and securing a clear view in orbital wall fracture reconstruction.

Autophagy of Human Tenon's Capsule Fibroblasts Induced by Mitomycin-C

PURPOSE: The present study investigated whether an autophagic process is involved in the apoptotic death of human tenon's capsule fibroblasts (HTCFs) caused by mitomycin-C. METHODS: An autophagic phenotype was tested using fluorescence microscopy and flow cytometry with specific biological staining dyes including monodansylcadaverine and acridine orange and microtubule-associated protein 1 light chain 3 (LC3). RESULTS: Treatment with mitomycin-C (0.4 mg/ml) increased the acidic vesicular organelles of tenon's capsule fibroblasts in a time dependent manner. Mitomycin-C induced both LC3-II cleavage and beclin-1 expression. 3-MA, a pharmacological inhibitor of autophagy, inhibited the mitomycin-C induced increase of acidic vesicular organelleS. CONCLUSIONS: Autophagy was induced with 0.4 mg/ml mitomycin-C in tenon's capsule fibroblasts. And, autophagic mechanisms may be involved in the early stage of apoptosis of fibroblasts.

Postoperative Neurogenic Blepharoptosis after Repair of a Medial Orbital Wall Fracture Using the Transcaruncular Approach

PURPOSE: We report a case of neurogenic blepharoptosis after reconstruction of a medial orbital wall fracture using the transcaruncular approach. CASE SUMMARY: A 13-year-old girl presented with left eyeball pain and binocular diplopia caused by trauma from falling. Orbital computerized tomography showed a blowout fracture of the left medial orbital wall, herniation of the orbital soft tissue into the ethmoid sinus, and a portion of the medial rectus muscle trapped in the fracture. The patient underwent successful reconstruction of the medial orbital wall using the transcaruncular approach. However, moderate blepharoptosis with functional loss of the levator palpebrae superioris muscle developed immediately after awaking from the anesthesia. The blepharoptosis was presumed to have developed due to postoperative edema; therefore, oral corticosteroid was prescribed. However, the blepharoptosis did not improve. No other ocular signs or symptoms were detected. Because neither the margin reflex distance (MRD1) nor the function of the levator palpebrae superioris muscle recovered after eight weeks of conservative treatment, surgical correction of blepharoptosis was performed under local anesthesia. The preaponeurotic fat, soft tissue, tarsal plate, and aponeurosis of the levator palpebrae superioris all appeared normal. The patient underwent maximal resection of the levator palpebrae superioris muscle and the blepharoptosis was alleviated two weeks after the operation.