Bilateral Pterygium and Corneal Keloid in a 9-Month-Old Child

PURPOSE: To report a case with bilateral corneal keloid after pterygium excision. METHODS: A-9-month-old girl presented with bilateral, fibrovascular pterygium which had been rapidly growing to the corneal center since 3 months of age. Seven months postoperatively, avascular, scar-like lesion recurred and was excised. This lesion recurred again 3 months later and phototherapeutic keratectomy was performed. However the mass grew rapidly and was excised surgically at the last follow up. RESULTS: Histopathologic study revealed the feature of corneal keloid such as epithelial layer with variable thickness, markedly increased thickness of stroma, irregularly arranged numerous collagen fibers, abundant fibroblasts and variable size of vascular proliferation. CONCLUSIONS: Pterygium in childhood and corneal keloid are rare entities. To the best of our knowledge, this is the first report of a corneal keloid in a child with bilateral pterygium.

Frontalis Suspension Using Preserved Fascia Lata for Severe Congenital Ptosis Under 2 years of Age

PURPOSE: To investigate the effect of frontalis sling operation with preserved fascia lata before 2 years of age when amblyopia has existed or is suspiscious. METHODS: We reviewed the medical charts of ptosis patients who undergone frontalis sling with preserved fascia lata before 2 years of age from December 1994 through February 2000. Thirty four patients was included. RESULTS: There were 21 men and 13 women with ages ranging from 5 to 23 months(mean, 13.4 months). With a mean follow-up of 22 months(range 6-60months), 30 patients(88%) achieved normal or near normal eyelid position. Four slings eventually failed, requiring repeat procedure with autogenous fascia lata(2 cases) or preserved fascia lata(1 case). Three patients achieved good results. CONCLUSIONS: Our findings suggest that the frontalis sling using preserved fasica lata has good potential for ptosis management in children before 2 years of age

Porous Polyethylene in the Repair of Late Posttraumatic Enophthalmos

Traumatic enophthalmos has been denonstrated to be the result of enlargement of the bony orbit, loss or displacement of the ligamentous support, posttraumatic fat atrophy, and cicartricial contraction of the retrobulbar tisses. To correct traumatic enophthalmos, freeing of incarcerated orbital contents combined with reduction of bony volume and reconstruction of suspensory support of the globe is necessary. We repaired late posttraumatic enophthalmos in seven patients by inserting porous polyethylene implants. Several sheets of porous polyethylene, 0.85, 1.5, 3.0mm thick in stacks, were used to bridge bony defects and augment orbital volume according to the degree of enophthalmos. Enophthalmos, globe dystopia, and motility disturbances were ameliorated with acceptable appearance in all cases without any severe complications. In conclusion, insertion of porous polyethylene implants is a relativley simple, safe and efficient technique in repairing late posttraumatic enophthalmos.

A Case of Traumatic Cyclodialysis Cleft Diagnosed by Ultrasound Biomicroscopy

Cyclodiaysis is a disinsertion of the longitudinal muscle of ciliary body from its attachment to the sclera at the scleral spur, allowing direct communication between the anterior chamber and ciliochoroidal space. Although the diagnosis can usually be confirmed by gonioscopy, sometimes it may be difficult to detect the cleft in recently traumatized or operated eyes because of corneal edema, hyphema, or very shallow anterior chamber with hypotony. The authors experienced a case of traumatic cyclodialysis cleft which was difficult to detect due to shallow anterior chamber and hypotony. We diagnosed it easily using ultrasound biomicroscopy and treated it successfully by direct cyclopexy. Ultrasound biomicroscopy is a noninvasive method that can accurately diagnose the presence of traumatic cyclodialysis and can aid in surgical management. It is particularly useful in the presence of hazy media, hypotony, and/or abnormal anterior segment anatomy.

Complications of Vitrectomy for Proliferative Diabetic Retinopathy: Incidence and Management

More intraoperative and postoperative complications of diabetic vitrectomy may result in poor visual prognosis. Sixty eye (49 patients) underwent vitrectomy for complications of proliferative diabetic retinopathy. Iatrogenic retinal breaks occurred in 6 (10%) of 60 eyes. Postoperative vitreous emorrhage was complicated in 13 (21%) of 60 eyes. Postoperative vitreous hemorrhage cleared spontaneously in one eye. Fluid-air exchange alone was successful in clearing the vitreous cavity in 4 eyes. Two eyes in which clearing does not occur in the postexchange period underwent repeated vitrectomy. Remaining 6 eyes required repeated vitrectomy. Choroidal effusion occurred in 4 eyes (7%) and resolved spontaneously within one week. Neovascular glaucoma occurred in 4 eyes (7%) and was treated with glaucoma implant surgery in 2 eyes, trabeculectomy with Mitomycin C in 1 ye, and cyclophotocoagulation in 1 eye. Retinal detachment developed postoperatively in 3 eyes (5%) and was treated successfully. Corneal epithelial defect persisting more than one week was present in 2 eyes (3%). Accidental mechanical lens damage occurred in one eye. The anatomical success rate was 98% (59 eyes). Visual acuity of 0.025 or better was obtained in 49 eyes (82%). Minimizing intraoperative complications as well as properly managing postoperative complications produced better surgical results.