Pythium insidiosum: A Rare Necrotizing Orbital and Facial Infection.

Pythium insidiosum, also known as "swamp cancer," has been long known for its destructive effects on plants and animals. Infections with this fungus-like organism typically occur in temperate, tropical, and subtropical regions [ 1]. Human infection with P insidiosum, although exceedingly rare, is characterized by invasion of the cornea, cutaneous, subcutaneous, and orbital tissues with eosinophilic, tumor-like masses demonstrating arterial tropism [ 1, 2]. In most cases, patients have a history of recent exposure to wet environments [ 1]. If left untreated, P insidiosum is fatal, because it is an angioinvasive organism that leads to thrombosis and tissue ischemia. Reports of most human cases are from Thailand, with only 4 well documented orbital cases to date in the United States and Australia [ 1, 3, 4].

Superior conjunctivoplasty-mullerectomy for correction of chronic discharge and concurrent ptosis in the anophthalmic socket with enlarged superior fornix.

PURPOSE: Many anophthlamic patients with ocular prostheses experience chronic discharge. A subset of these patients is found to have concurrent ptosis and an enlarged superior conjunctival fornix. Examination reveals an enlarged superior fornix with copious mucopurulent discharge. The subset of patients meeting these criteria is very small, and estimated incidence cannot be determined. The authors propose that using a modification of the conjunctivomullerectomy to decrease the potential space in the enlarged fornix while at the same time correcting the ptosis will help alleviate this chronic discharge. METHODS: A retrospective review of 5 anophthalmic patients who underwent a modified superior conjunctivoplasty- mullerectomy was performed. All patients had chronic discharge and an enlarged superior conjunctival fornix, with mucous collection noted in the cul-de-sac. All patients had a concomitant ptosis and superior sulcus deformity on the affected side. Postoperative outcomes regarding correction of discharge, ptosis, and enlarged superior fornix were obtained. RESULTS: All patients had improvement in their chronic discharge. Palpebral fissure measurements improved from a median of 6.5 mm (range 6-8 mm) at baseline to 9.25 mm (range 8-10 mm) at last follow-up. The enlarged superior fornix was corrected in all patients. CONCLUSIONS: A modified superior conjunctivoplasty- mullerectomy is an effective method for correcting chronic discharge and ptosis in anophthalmic patients who have an enlarged superior conjunctival fornix.

Recurrent Rhodococcus gordoniae eyelid infection after combined septoplasty and blepharoplasty.

Rhodococcus species are rare human pathogens. Most cases of human infection have involved Rhodococcus equi, a natural zoonotic pathogen causing pneumonia in young foals. The human population at risk mainly includes immunocompromised patients. Infection of immunocompetent hosts has been rare, with less than 30 reported cases in the literature. The authors report a first case of recurrent Rhodococcus gordoniae granulomatous lower eyelid infection that occurred after an immunocompetent 44-year-old woman underwent a combined intranasal and lower blepharoplasty procedure. A literature search revealed only 10 reported cases of non-R. equi rhodococcal infections, most involving traumatic inoculation; 5 of these cases involved the eye and ocular adnexa. To the author's knowledge, this is the first case report of a non-R. equi rhodococcal infection of the eyelids. Identification of Rhodococcus by most laboratories is difficult, and in this case, 2 of 3 cultures were misidentified prior to definitive testing at a specialized laboratory. Multidrug resistance is also a concern, and the treatment course could be long and difficult.

Comparison of orbital volumes in enucleated patients with unilateral retinoblastoma: hydroxyapatite implants versus silicone implants.

PURPOSE: To compare the difference in volume between enucleated and contralateral, uninvolved orbits in patients with unilateral retinoblastoma treated with primary enucleation who received either hydroxyapatite or solid silicone implants. METHODS: In this retrospective, comparative interventional case series, data were reviewed for all patients (N = 33) with retinoblastoma at St. Jude Children's Research Hospital who underwent unilateral enucleation and received either hydroxyapatite or solid silicone implant from 1969 to 1999. Patients who received external beam radiation or systemic chemotherapy were excluded. CT and/or MRI were used to compare the difference in orbital volumes between the enucleated orbit and the contralateral orbit in 13 patients who underwent enucleation with hydroxyapatite implants vs. 20 patients who underwent enucleation with silicone implants. The main outcome measure was the difference in volume between enucleated and contralateral, uninvolved orbits correlated to implant material, which we determined using the Wilcoxon rank sum test. RESULTS: The median difference in orbital volumes between enucleated and contralateral, uninvolved orbits was 0.9 cm (range, -3.78 to 3.09 cm; quartiles, -0.37, 2.72 cm; mean +/- standard error [SE], 0.76 +/- 0.64 cm; 95% confidence interval [CI], -0.49 to 2.01 cm) for patients treated with hydroxyapatite implants vs. 0.63 cm (range, -4.43 to 3.91 cm; quartiles, 0, 2.13 cm; mean +/- SE, 0.8 +/- 0.41 cm; 95% CI, -0.004 to 1.6 cm) in patients treated with silicone sphere implants. The median differences did not differ between the 2 types of implant (p = .74). The median follow-up time was 137 months (range, 10-244 months; quartiles, 37, 179 months; mean +/- SE = 118.31 +/- 22.83 months; 95% CI, 73.56-163.06 months) and 144 months (range, 57-251 months; quartiles, 98, 154 months; mean +/- SE, 136.1 +/- 10.78 months; 95% CI, 114.97-157.23 months), respectively. CONCLUSIONS: In unilateral retinoblastoma patients treated with primary enucleation, hydroxyapatite-integrated orbital implants provide no better symmetry of orbital volume than do more traditional silicone implants.