Transcaruncular approach for the management of frontoethmoid mucoceles.

AIMS: To present transcaruncular medial orbitotomy as the preferred approach to manage frontoethmoid mucoceles. METHODS: 11 patients with frontoethmoid mucoceles received transcaruncular orbitotomy from 2000 to 2002 at the National Taiwan University Hospital. The incision was made through the caruncle to explore the medial wall periosteum. Then the periosteum was opened and extended to provide adequate surgical field exposure. Frontoethmoid mucoceles could be viewed and removed directly. A transnasal drainage tube was inserted before closure of the caruncle wound. RESULTS: The mean follow up period was 12 (SD 9.1) months (range 1-26). Both functional recovery and cosmetic outcome were excellent. There was no recurrence of mucoceles. One patient complained of diplopia, which subsided after 2 months. CONCLUSION: Transcaruncular orbitotomy provides a wide exposure and a safe access to the medial orbital extraperiosteal space. Furthermore, there is less damage to skin and muscle layer and less manipulation of other ocular adnexal structures, such as medial canthal tendon and lacrimal sac. It can be an excellent approach for the management of frontoethmoid mucoceles.

Malignant eyelid tumours in Taiwan.

AIMS: To describe the clinical characteristics of patients with eyelid cancers in Taiwan. METHODS: Between 1980 and 2000, 127 (58 males and 69 females) patients (mean age 62.6; range 10-91 years) with histologically confirmed eyelid cancers were retrospectively evaluated at the National Taiwan University Hospital and Far Eastern Memorial Hospital in Taiwan. Clinical data of all patients were reviewed from medical records. The mean follow-up period was 62.4 months (range 3-240) for 113 patients. RESULTS: The 127 eyelid cancers included 79 basal cell carcinomas (62.2%), 30 sebaceous gland carcinomas (23.6%), 11 squamous cell carcinomas (8.7%), five malignant melanomas (3.9%), one Kaposi's sarcoma (0.8%), and one metastatic cancer (0.8%). Tumours developed more commonly in the lower (37.0%) than the upper eyelid (33.9%). The clinical accuracy in predicting eyelid malignancy was 90.5%. Primary treatment modality was mainly surgical excision. The recurrence, metastasis, and mortality rates at 5 years were 15.2, 11.7, and 7.3%, respectively, for all eyelid malignancies. Rates of sebaceous gland carcinoma recurrence, metastasis, and mortality were significantly higher (P<0.05) than those of basal cell carcinoma. The mean interval of recurrence or metastasis after primary treatment was 26.3 months (range 4-112) for all eyelid cancers. CONCLUSIONS: Although basal cell carcinoma is the most common eyelid cancer in Taiwan, sebaceous gland carcinoma is also common. Of the two, basal cell carcinoma has a better prognosis and sebaceous gland carcinoma has a higher mortality and therefore should be treated much more aggressively. Long-term follow-up is needed after treatment of malignant eyelid tumours.

Complications of motility peg placement for porous hydroxyapatite orbital implants.

AIM: To evaluate the complications associated with pegging of porous hydroxyapatite orbital implants. METHODS: Complications associated with pegging were retrospectively reviewed from the charts of 100 of 133 patients with hydroxyapatite implantation from 1993 to 2000. RESULTS: 48 (48%) of the 100 hydroxyapatite implanted patients who had undergone pegging were found to have problems with their pegs, including discharge (45.8%), peg falling out (20.8%), pyogenic granulomas (16.7%), popping peg (14.6%), hydroxyapatite visible around peg hole (8.3%), part of peg shaft visible (6.2%), peg drilled off centre (6.2%), peg drilled at an angle (4.2%), and excess movement of peg (4.2%). The standard peg fell out statistically more often than the peg and sleeve system (Yates's corrected chi(2), p=0.038). There was a trend towards complications of the peg with use of a standard peg (versus sleeved peg) (p=0.226). CONCLUSIONS: There are several potential complications of pegging. Most complications are minor and can be managed successfully.

Scanning laser polarimetry in evaluation of retinal nerve fiber layer thickness for normal Taiwanese.

Scanning laser polarimetry has been used recently for the measurement of retinal nerve fiber layer (RNFL) thickness, taking advantage of the birefrigence of the RNFL. We observe the RNFL with the instrument and try to find out a set of normal basic values of the RNFL thickness for clinical comparison. One hundred normal volunteers of different age groups were recruited for this study. There are 44 males and 56 females with a mean (1SD) age of 36.17(14.77) years. Three consecutive 15-degree polarimetric maps were acquired for each subject. RNFL thickness measurements were obtained at 1.75 disc diameters ring from the optic nerve. Four 90-degree quadrants were identified. As a result, the average of RNFL thickness is 90.69 (20.20) microns in the superior quadrant, 80.45 (17.4) microns in the inferior quadrant, 59.28 (15.37) microns in the nasal quadrant, and 48.98 (15.72) microns in the temporal quadrant with a mean thickness value of 69.86 (13.97) microns. Superior and inferior quadrants showed a comparatively thicker nerve fiber layer than nasal and temporal quadrants. The temporal quadrant was always the lowest. The axial length does not affect the RNFL thickness and no significant difference between males and females exists. However, an obvious inverse linear correlation between age and the RNFL thickness in all quadrants is found. The average RNFL thickness decreased with age by 0.26 micron per year. (R2 = 0.081, p-value = 0.004). When compared with the normal range, age-match would be necessary.

Primary antiphospholipid syndrome manifested as venous stasis retinopathy.

Primary antiphospholipid syndrome is a condition in which antiphospholipid antibodies may be present without any associated medical disorder. Thrombosis is the hallmark of this syndrome. We report the case of a 22-year-old female with the chief complaint of floating spots in the right eye for two months. No underlying connective tissue disease or systemic disease was noted. Ophthalmic examination revealed retinal hemorrhage, retinal vein engorgement and optic disk swelling in the right eye only, and normal visual acuity in both eyes. Retinal fluorescein angiography showed venous stasis and branch vein leakage in the right eye. An antibody profile revealed the presence of immunoglobulin G anticardiolipin antibodies, which confirmed the diagnosis of primary antiphospholipid syndrome.

Relapse of acute leukemia in childhood presenting as proptosis due to an orbital mass.

Extramedullary relapse of acute leukemia in sites outside the central nervous system or testes is rare. We report two children who developed proptosis due to an orbital mass as the initial presentation of leukemic relapse. The first patient was an 11-year-old girl with acute myelogenous leukemia who had undergone bone marrow transplantation 4 years previously. She had been in remission until 2 months prior to the present admission, when she developed isolated relapse of disease in the left orbit. The second patient, an 11-year-old girl with acute lymphoblastic leukemia, had been off chemotherapy for 2 years and in remission for 5 years. She suffered from concurrent orbital and central nervous system relapse. Both patients were treated with systemic chemotherapy and orbital radiotherapy. More than 1 year after the relapse, the proptosis was completely cured in both patients.

Visual function in recovered ethambutol optic neuropathy.

The visual acuity of the patient with ethambutol optic neuropathy will recover within 3 to 4 months after discontinuing the drug. We studied the extent of the recovery of other visual functions. Thirty-six axial type ethambutol optic neuropathy patients, who visited our neuro-ophthalmology clinic from January, 1990, to December, 1993, were included in this study. Fifteen patients (29 eyes) regained their visual acuity to better than 1.0. The average follow-up period following the recovery is 21.7 months. Pattern reversal VEP, Farnsworth-Munsell 100-Hue color vision test, critical flicker frequency (CFF), visual field perimetry, contrast sensitivity and edge-light pupil cycle time were assessed for every affected eye. Latency (P100) of visually evoked potential was delayed in 34.5% (10/29) of eyes. In color vision, 48.3% (14/29) of eyes had deutan or tritan defect. An abnormality of red CFF with value lower than 31 Hz was revealed 51.7% (15/29) eyes. In the visual field, 58.6% (17/29) of eyes had paracentral scotoma, arcuate scotoma, or enlargement of physiologic blind spot. Contrast sensitivity was depressed in 62.1% (18/29) of eyes, mainly at middle and low spatial frequency. Pupil cycle time was prolonged in 72.4% (21/29) of eyes. Aside from visual acuity, other visual functions of the recovered ethambutol optic neuropathy patients were incomplete. The extent of recovery of the visual function is as follows: visual acuity-VEPs-color sense-CFF-visual field-contrast sensitivity-pupil cycle time.