Correction of superior sulcus deformity and enophthalmos with porous high-density polyethylene sheet in anophthalmic patients.

PURPOSE: Superior sulcus deformity is the main cosmetic problem in anophthalmic patients. Many methods of correcting enophthalmos have been reported, especially in patients with orbital wall fracture. The purpose of this study is to review the long term results of effectiveness in superior sulcus deformity correction by subperiosteal Medpor sheet implantation in anophthalmic patients. METHODS: Subperiosteal Medpor sheets were used in 11 eyes of 11 anophthalmic patients. To estimate the effectiveness, photographs were taken and exophthalmometric value with their own prosthesis using Hertel exophthalmometer was measured in all patients before and after surgery. RESULTS: The overall cosmetic results in superior sulcus deformity were 'excellent' in 3 (27.3%), 'good' in 6 (54.5%), 'fair' in 2 (18.2%). The overall results in enophthalmos were 'excellent' in 3 (27.2%), 'markedly improved' in 4 (36.4%), 'slightly improved' in 4 (36.4%). Most patients had a marked increase in orbital volume, except two patients. They received irradiation treatment in early childhood so showed unsatisfactory results in both superior sulcus deformity and enophthalmos. CONCLUSIONS: Subperiosteal Medpor sheet implantation is considered to be a reliable and safe procedure without serious complication and with an excellent cosmetic result.

Fibrovascularization of intraorbital hydroxyapatite-coated alumina sphere in rabbits.

We investigated the fibrovascular ingrowth and fibrovascular tissue maturation of hydroxyapatite-coated, porous alumina sphere (Alumina sphere) in comparison with the hydroxyapatite sphere (HAp sphere) in rabbits. Alumina spheres and HAp spheres were implanted in the left orbits of 42 New Zealand white rabbits after enucleation. Fibrovascular ingrowth and maturation were graded from 1 to 5 at postoperative 1, 2, 3, 4, 8, 12 and 24 weeks. We defined 4 phases: postoperative 1-2 weeks as phase I, 3-4 weeks as phase II, 8-12 weeks as phase III, and 24 weeks as phase IV. The grade was analyzed at each phases. There was no significant difference in fibrovascular ingrowth and maturation between the two groups at all 4 phases, except phase II at which the Alumina sphere showed significantly lower maturation grade (p<0.05). We concluded that the Alumina sphere is an ideal orbital implant material and an ideal substitute for the HAp sphere in clinical practice.

Choroidal schwannoma.

PURPOSE: Schwannoma is rarely encountered as an intraocular tumor arising from uveal tract. We describe a case of choroidal schwannoma. METHODS: A 74-year-old woman presented with rapidly decreasing visual acuity and proptosis for 2 months. To further delineate the tumor, she underwent enucleation of the eyeball. The tumor was examined by light microscopy, electron microscopy and immunohistochemical study. RESULTS: Microscopically, the tumor was composed of a mixture of cellular solid component (Antoni A) and loose myxoid component (Antoni B). Immunohistochemical study revealed a positive reaction for S-100 protein. Ultrastructurally, the tumor cells showed prominent, continuous basal lamina. CONCLUSIONS: We enucleated the eyeball with a clinical diagnosis of choroidal amelanotic melanoma, but the tumor was finally diagnosed as schwannoma. We think that currently available ancillary studies are still little value in definitely differentiating schwannoma from other choroidal tumors.