Effect of Basic Fibroblast Growth Factor on Fibrovascular Ingrowth into Porous Polyethylene Anophthalmic Socket Implants

To investigate the effect of basic Fibroblast Growth Factor (bFGF) on fibrovascular ingrowth into porous polyethylene orbital implants (Medpor (R) ) and to investigate any differences according to the method of administration. For the treated groups, after evisceration and Medpor (R) implantation, bFGF was administered by soaking Medpor (R) in the bFGF solution, and/or by injecting bFGF into the Medpor (R) 1 week after the operation. Implants were removed 4 weeks after the operation and examined for the degrees of fibrovascular ingrowth by light microscopy. The percentages of the cross-sectional area of the implant occupied by fibrovascular ingrowth and the numbers of proliferated vessels were significantly higher in the bFGF-treated groups (Mann Whitney test, p 0.05). bFGF promoted fibrovascular ingrowth into porous polyethylene orbital implants regardless of the route of administration. Therefore, bFGF might be helpful to prevent complications such as implant exposure.

A Case of Malignant Lymphoma of Lid Margin

PURPOSE: Masquerade Syndrome that is often misdiagnosed as a conjunctivoblepharitis in the early discovery; It often later becomes identified as Sebaceous gland carcinoma. After carrying out the histopathology of the patient who had been treated at other hospital for six months, we found she had diffuse large B-cell malignant lymphoma. METHODS: Before the patient was transferred to our hospital due to no progress of the condition, she had been treated for conjunctivoblepharitis at other hospital for six months. Along the Rt. Upper lid, with expanded capillary vessels, the reddish subcutaneous mass was found, and it took 70% of the whole length of the upper lid. Cilia on mass was all vanished and the right eye had 2 mm of ptosis. The conjunctiva remained the same when we turned the eyelid inside out. There was no tumor connected to orbital floor from the lid. We conducted a histopathology. RESULTS: We diagnosed the case as diffuse large B-cell type malignant lymphoma with the results of the histopathology, and the combination chemotherapy remarkably reduced lid mass.

Scleral Eversion Technique for Porous Polyethylene Orbital Implant after Evisceration

PURPOSE: This study is to describe scleral eversion technique as a modification of evisceration to improve its disadvantages for placement of porous orbital implant and to report the results of placement of porous orbital implants with this technique. METHODS: The medical records of 27 patients with 27 eyes who had undergone evisceration and placement of porous polyethylene orbital implant with scleral eversion technique between November 1998 and January 2000 were reviewed. Surgical technique involved the removal of corneal button and the intraocular contents. Optic nerve was severed, scleral shell was everted, and porous polyethylene orbital implant was implanted into the retroscleral and intraconal space. RESULTS: Orbital implants of 20 mm in diameter were implanted in all patients. The average postoperative follow-up interval was 22.4 months. No patient experienced severe complications like exposure of implant. All of patients showed good motility of orbital implant and 19 patients were satisfied with motility of prosthesis. Eight patients (29.6%) got placement of motility coupling post without significant problems to enhance motility. CONCLUSIONS: Scleral eversion technique is safe and useful for evisceration and placement of porous polyethylene orbital implant. This technique can provide adequate space for adequate size of implant without any tension on wound, thick anterior scleral barrier for implant and more vascular source for fibrovascular ingrowth. Therefore, it decrease exposure rate of implant.

A Case of Unilateral Blepharochalasis Associated with Exophthalmos and Aponeurotic Ptosis

PURPOSE: To present a case of unilateral exophthalmos with aponeurotic ptosis caused by blephalochalasis. METHODS: The left upper lid blepharoplasty, levator muscle resection, prolapsed lacrimal gland fixation, and excisional biopsy of lacrimal gland was done on a 16-year-old female who had had repetitive episodes of drooping and swelling of left upper lid for 6 years. RESULTS: Up to 11months after operation, she had no episodes of drooping and swelling. Histologically, the epidermis was atropic and wrinkled, and the dermis showed diffuse edema and vascular ectasia with mild perivascular inflammatory infiltrates. Elastic staining revealed a marked decrease or fragmentation of elastic fiber. Edema and vascular ectasia were also seen in the palpebral lobe of lacrimal gland and adjacent fat tissue.

A Case of Acquired Brown Syndrome Following Scleral Buckling

PURPOSE: To present a case of the acquired Brown syndrome caused by scleral buckling. METHODS: A 58-year-old man presented with floaters in his right eye which had developed 20days before. Rhegmatogenous retinal detachment with a retinal tear at the location of 2 o' clock was diagnosed. Radial scleral buckling was performed. Ten days after surgery, he was unable to elevate his right eye in adduction, and right superior oblique muscle overaction was presented. RESULTS: Acquired Brown syndrome caused by scleral buckling has not been documented in Korea to our knowledge. Therefore, we report this case with review of related literatures.

Effect of the Bone wax for the Maintenance of a Created Fistula between the Maxillary Sinus and the Nasal Cavity in Rabbits

PURPOSE: To investigate whether the bone wax could maintain the created fistula between the maxillary sinus and the nasal cavity in a rabbit model of dacryocystorhinostomy. METHODS: After creating a fistula between the maxillary sinus and the nasal cavity at both sides in 20 rabbits, the one on the right side was plugged with bone wax (treated side) and the one on the left side was used as a control. Five rabbits were sacrificed each time at 1, 2, 4 weeks after surgery. Bone wax was removed at 4weeks after surgery in 5 rabbits and they were sacrificed 2 weeks later. The state of the fistulas and the histopathology were observed. RESULTS: Among controls, only one of the rabbits sacrificed at 1 and 2 weeks after surgery, showed partially open fistula and all other rabbits showed closure of fistula. The treated fistulas were opened in 4 rabbits at 1 week, in 3 rabbits at 2 weeks, and 4 rabbits at 4weeks after surgery. Two out of 5 treated fistulas which had the removal of the bone wax 4 weeks later showed open fistula. The epithelial lining of the opened treated fistula was observed at 4 weeks after surgery. There was no significant difference in the amount of discharge within the maxillary sinus or the degree of inflammation around the fistula between the treated and the control sides. CONCLUSIONS: The bone wax may be used as a new stent in maintaining a created fistula during dacryocystorhinostomy.

Persistent Diplopia after Local Anesthesia

PURPOSE: To determine causative factors of persistent diplopia after local anesthesia for ophthalmic surgery. METHODS: Prism and alternate cover test in the diagnostic positions of gaze and ductions/versions testing were performed in 26 patients with persistent diplopia six months after local anesthesia. Lancaster test, Bielshowsky head tilt test, double Maddox rod test, funduscopic examination for torsion, forced duction test, force generation test, tensilon test, thyroid function test, and/or orbit CT were done when necessary. RESULTS: Most of the patients (24 patients, 92%) did not have diplopia before local anesthesia. Of the thirteen patients with strabismus resulting from trauma to extraocular muscles, eleven patients showed vertical rectus overaction (10 superior recti, 1 inferior rectus) and two patients, mild vertical rectus underaction. Eight patients were presumed to have sensory deviation. In the remaining patients, one patient had childhood esotropia and another, old superior oblique palsy. Three patients showed a small vertical deviation without any specific cause. CONCLUSIONS: Fifty percent of diplopia was related with the surgical trauma to extraocular muscles, in which overactions (42%) were more common than underactions (8%). Thirty-five percent of the patients were presumed to have sensory deviation, which suggested the importance of preoperative examination for strabismus as well as the explanation about the risk of postoperative diplopia before surgery.

A Case of Eccrine Poroma on the Eyelid

PURPOSE: To present an eccrine poroma that occurred on the sweat gland of upper eyelid. METHODS: A 54-year-old female developed a non-tender palpable mass on her left upper eyelid 2 months ago. She removed the same lesion 6 months ago. We performed excisional biopsy. RESULTS: Histopathologic examination revealed an eccrine poroma. The mass was completely removed and there was no evidence of recurrence 6 months postoperatively.

Atypical Inflammatory Orbital Pseudotumor with Acute Pneumonic Infiltrates

PURPOSE: Orbital pseudotumor is a nonspecific benign orbital inflammation without evidence of specific local or systemic cause. Orbital pseudotumor rarely displays predominant tissue eosinophilia without vasculitis. We report this rare case of eosinophilic orbital pseudotumor associated with acute pneumonic infiltrates. METHODS: A 27-year-old man visited our clinic because of painless swelling of the upper and lower lid and proptosis which developed 10 days ago. Subconjunctival mass showed severe eosinophilic infiltration, mild proliferation of capillaries, and non-necrotic vasculitis. We started steroid treatement under the diagnosis of atypical orbital pseudotumor with acute pneumonic infiltrates. RESULTS: At four days after starting steroid treatment, swelling of lids, proptosis and pulmonary infiltration disappeared. At four months there was no evidence of recurrence with the cessation of steroid.

Long-term Results of Diode Laser Trans-scleral Cyclophotocoagulation in Neovascular Glaucoma

To determine the long-term efficacy of diode laser trans-scleral cyclophotocoagulation in neovascular glaucoma, a retrospective analysis was done in 30 patients(32 eyes) with intractable neovascular glaucoma treated with diode laser trans-scleral cyclophotocoagulation between March 1996 and June 1997, by reviewing the treatment parameters, complications, and preand postoperative intraocular perssure(IOP). The IOP was compared using a Wilcoxon signed rank test, and the success rate was evaluated by a Kaplan-Meier life-table analysis. Success was defined as an IOP of 21mmHg or lower in the absence of phthisis without any additional surgical procedure. The mean follow-up was 54.6+/-13.3 weeks. The mean preoperative IOP was 46.2+/-9.6mmHg. The mean postoperative IOP was 10.5+/-8.7mmHg(p=0.000). The mean number of preoperative medications was 2.2+/-0.6. The mean number of postoperative medications was 0.5+/-0.9(p=0.000). Kaplan-Meier survival analysis showed a probability of continued success at 44 weeks and 60 weeks to be 80.2% and 44.5%, each, without any antiglaucoma medications and 86.4% and 66.1%, each, with some antiglaucoma medications. Complications included phthisis(12.5%), hypotony(9.0%), and hyphema(25%). This study suggests that diode laser trans-scleral cyclophotocoagualtion provides a significant long-term reduction of intraocular pressure in eyes with intractable neovascular glaucoma.

Clinical Study of Cataract Surgery in Patients Over 80 Years of Age

To analyze the preoperative and postoperative characteristics of the patients over 80 years of age who had undergone cataract extraction, we reviewed the clinical records of 120 patients(167 eyes) over 80 years of age. The preoperative visual acuity was worse than 2/20 in 139 eyes(84%) and the preoperative visual acuity of 76 eyes(45%) were hand motion or worse. One hundred and twelve eyes(67%) had cataract more dense than nucleosclerosis of grade III and 54 eyes had total cataract. Seven patients were not cooperative enough to check the postoperative visual acuity. Among the 113 patients(156 eyes) with the measured postoperative visual acuity, 73 eyes(47%) resulted in the visual acuity of 20/40 or better. Among 83 patients with the postoperative visual acuity less than 20/40, the ocular 28 eyes. In conclusion, 25%(39 eyes among 156 eyes) of the patients older than 80 years could not see better than 20/40 after cataract surgery without any ocular organic pathologies. Age factor can have the predictive value of visual outcome after cataract extraction.