Cyst formation associated with porous polyethylene orbital floor implant.

A 28-year-old female presented with hyperglobus and inferior scleral show after the repair of an orbital floor fracture using a porous polyethylene (Medpor) implant. CT revealed a large inferior orbital cystic mass displacing the globe. The cyst was explored and excised and the implant was found to be free from any attachment to surrounding tissues and hence, removed without difficulty. The reason for the cyst development was most likely inadvertent epithelial inclusion at the time of surgery-a recognized risk with insertion of any foreign body via transconjunctival approach. Porous implants when placed in the subperiosteal space might not get incorporated with surrounding tissues and therefore behave like any traditional nonporous alloplastic material.

Treatment of recurrent eyelid margin verruca vulgaris with mitomycin C.

A 62-year-old male presented with multiple bilateral eyelid margin verruca vulgaris. Treatment with surgical excision and cauterization of the bases was done twice, but the lesions recurred rapidly with more extensive involvement of the eyelid margins. Excision and intraoperative application of mitomycin C (0.2 mg/ml) for 3 minutes using Weck-Cel sponges resulted in no recurrence seen at the 8-month follow-up.

Bilateral lower eyelid margin erosion associated with lichen planus.

A 32-year-old woman presented with bilateral lower eyelid margin erosion and erythema of several years' duration. She reported no improvement with the use of topical corticosteroid therapy. A full-thickness excisional biopsy was performed, and the histopathology of the specimens was consistent with lichen planus.

Mucous membrane graft versus Gunderson conjunctival flap for fitting a scleral shell over a sensitive cornea.

PURPOSE: To assess the efficacy of full-thickness mucous membrane grafts in forming a total and permanent corneal cover. METHODS: The records of all patients with a phthisical globe or microphthalmos who underwent a corneal covering procedure to allow comfortable wearing of a cosmetic scleral shell between March 1999 and July 2004 were reviewed. RESULTS: Ten eyes underwent a Gunderson conjunctival flap (group A), and 9 eyes underwent a full-thickness mucous membrane graft (group B). In group A, 3 eyes had total flap retraction and one eye had partial flap retraction. In group B, only one eye had partial graft retraction. The flap retraction in group A occurred in those eyes with a corneal diameter of 9 mm or more. CONCLUSIONS: The results from this small series of patients indicate that a full-thickness mucous membrane graft might be a better alternative for corneal coverage than a Gunderson conjunctival flap, especially in eyes with conjunctival scarring or relatively large corneal diameter.

Intravitreal triamcinolone for the management of macular edema due to nonischemic central retinal vein occlusion.

OBJECTIVE: To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to nonischemic central retinal vein occlusion (CRVO). METHODS: Twenty consecutive patients were selected with a 3- to 4-month history of nonischemic CRVO and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide (40 mg/mL). The follow-up period ranged from 10 to 12 months. The amount of macular edema was assessed by the amount of retinal thickening on clinical examination using the Goldmann contact lens and by the area and intensity of staining on fluorescein angiography. Treated patients were compared with a retrospectively matched group of patients who were managed with observation only. MAIN OUTCOME MEASURES: Changes in visual acuity and amount of macular edema were assessed in the treated patients and compared with the observation group. RESULTS: The mean baseline visual acuity in the treatment group was 20/132 vs 20/123 for the observation group (P =.57). After 1 week, the treated group had a mean visual acuity of 20/51. At final follow-up, the treated group had a mean visual acuity of 20/37 while the observation group had a mean visual acuity of 20/110 (P =.001). Sixty percent of treated patients had a final visual acuity of 20/40 or better vs only 20% in the observation group (P =.01). Forty percent of the untreated patients had a final visual acuity worse than 20/200 while none of the treated patients did (P<.001). At final follow-up, 75% of treated patients had complete resolution of macular edema on clinical examination vs only 20% of the untreated patients (P<.001). Two of the treated patients had recurrence of macular edema at 6 months, and 3 had elevated intraocular pressure. CONCLUSION: This study shows a treatment benefit from intravitreal triamcinolone in terms of visual acuity and macular edema for nonischemic CRVO.

Modified technique for tube fixation in conjunctivodacryocystorhinostomy.

The standard glass tube used with a conjunctivodacryocystorhinostomy is subject to spontaneous displacement or extrusion, especially in the early postoperative period. To anchor the tube in the surrounding tissues, a suture is commonly tied around the collar of the Pyrex tube and externalized to the skin of the medial canthal area where it is fixed. The loop can become loose around the tube, and displacement or extrusion can occur. We describe an alternative method to better secure the tube in place during the early postoperative period and until the time when the tissues around the tube contract.

Upper eyelid retraction after glaucoma filtering surgery and topical application of mitomycin C.

PURPOSE: To describe 3 cases of upper eyelid retraction after glaucoma filtering surgery and topical application of mitomycin C and to highlight possible causes. METHODS: A report of 3 patients, identified over an 8-year interval period, who had development of upper eyelid retraction a few months after undergoing trabeculectomy with mitomycin C in the ipsilateral eye. RESULTS: Testing for Graves disease, including second-generation thyrotropin receptor antibodies (TRAb), was negative in all cases. A complete physical examination was performed by an internist: Orbital and intracranial neuroimaging studies were ordered when necessary, and all were negative. One patient underwent surgical repair of the eyelid retraction and had a satisfactory result. CONCLUSIONS: Upper eyelid retraction after filtering surgery is a rarely reported entity. Müller muscle overaction, independent of Graves disease, is a likely cause and has been pointed out as a possible factor in one previous report. Müller muscle fibrosis, euthyroid Graves disease, and mechanical hindrance to an elevated bleb are other possible factors.

Anterior canthal tendon release for correction of the centurion syndrome.

PURPOSE: To investigate the effectiveness of anterior canthal tendon release in the management of centurion syndrome. METHODS: Four patients diagnosed as having the centurion syndrome were treated over a period of 3 years. They all underwent bilateral anterior canthal tendon release under local anesthesia. RESULTS: None of these patients had adequate apposition of the lower puncta after surgery. One patient had partial relief of epiphora on one side. CONCLUSIONS: Our results indicate that anterior canthal tendon release is insufficient as a sole treatment for patients with centurion syndrome.

The use of viscoelastics during pars plana vitrectomy in eyes with an anterior chamber intraocular lens.

Pars plana vitrectomy in eyes with an anterior chamber intraocular lens poses several challenges. This becomes more obvious during fluid-air exchange. The use of viscoelastics during the surgery to overcome these problems is described. This technique allows better visibility intraoperatively, provides a stable anterior chamber, and maintains corneal clarity.

Orbital osteoma arising adjacent to a foreign body.

A 27-year-old man sustained a blast injury to the face in April 1996, with a resultant foreign body at the right medial orbital wall. He refused to undergo surgical removal of the foreign body at that time and was discharged on oral antibiotics. Five years later, he presented because of recurrent attacks of swelling, redness, and pain at the right medial canthal area. A repeat computed tomography (CT) scan revealed fragmentation of the original orbital foreign body and an adjacent radiodense lesion that appeared to blend smoothly with the orbital bone from which it arose. This lesion was not present on the initial CT scan done 5 years earlier immediately following the blast. The patient was started on oral antibiotics and surgical exploration was carried out. Three fragments of the foreign body were removed in addition to the adjacent orbital lesion, which proved to be an ivory-type osteoma on histopathology. We briefly review previously suggested factors in the pathogenesis of osteoma and present further evidence in favor of both traumatic and infectious factors.

Mitomycin C as adjunct therapy in correcting punctal stenosis.

PURPOSE: To assess the efficacy of intraoperative mitomycin C in improving the success rate of the posterior punctectomy procedure. METHODS: The charts of all patients who underwent posterior punctectomy between the years 1997 and 2000 were reviewed. The procedure was done without mitomycin C (n = 26 eyes, group A) until the end of 1998 and with mitomycin C (n = 25 eyes, group B) starting in 1999. The Kaplan-Meier curve was used for statistical evaluation. RESULTS: In group A, 5 of 26 (19.2%) eyes had complete anatomic obstruction and scarring of their puncta after surgery, compared with 0 of 25 (0.0%) eyes in group B. The difference was statistically significant (P<0.02). No significant complications were observed. CONCLUSIONS: Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.