Lamellar tarsoplasty--a new technique for correction of horizontal tarsal kink.

A case of a congenital upper lid entropion with corneal ulceration is reported. The surgical repair by means of a lamellar tarsoplasty is presented as a simple technique to correct the congenital anomaly of a tarsal kink.

The cornered incision--a precision cataract wound.

One hundred fifty-four patients underwent cataract extraction by using a new cornered incision. Closure with 10-0 nylon under keratometric control with the Terry surgical keratometer allowed 79% of patients to have 1.50 or less diopters of residual corneal astigmatism at two months without suture cutting. The cornered incision allowed for precision suture placement and wound closure, allowing for rapid patient visual rehabilitation.

Norepinephrine therapy of ischemic optic neuropathy.

Two monocular normotensive patients with nonarteritic ischemic optic neuropathy and retinal ischemia unresponsive to steroid therapy were treated with intravenous norepinephrine. In both patients, improvement in vision began within minutes after moderate hypertension was produced. A third patient showed no response to this therapy in one eye with established ischemic optic neuropathy, but had prompt recovery of vision in the second eye early in the course of ischemic optic neuropathy. This patient returned with recurrent ischemic optic neuropathy more than 1 year later. At that time she was found to have essential hypertension. One patient could not be weaned from the norepinephrine infusion without recurrent visual loss. In the second patient, controlled hypertensive therapy restored visual acuity to 20/30 during two separate recurrences of ischemic optic neuropathy. Therapy of a later episode of ischemic optic neuropathy was delayed for 2 days, and vision did not improve with norepinephrine infusion. This eye subsequently became painful and required enucleation. Histopathological evaluation showed combined arterial and venous occlusions within the optic nerve and evidence of previous peripapillary choroidal vascular occlusion. Selected normotensive patients with ischemic optic neuropathy and retinal ischemia may benefit from controlled hypertensive therapy induced by norepinephrine infusion.

Conjunctival cysts of the orbit following enucleation.

Four patients developed orbital conjunctival cysts following enucleation. The cysts were demonstrated by ultrasonography and computerized tomography and confirmed by histopathology. They were lined by a non-keratinizing stratified squamous epithelium without goblet cells and contained fluid with mucinous strands. They were excised at eight, seven, and seven, and 25 years post-enucleation, respectively, the latter being the longest interval yet recorded. A simple classification of conjunctival cysts of the orbit is proposed and the mechanisms of the development of cysts in anophthalmic sockets are discussed. The effects of secretory rate and cyst growth are reviewed and surgical management in prevention and treatment of these lesions is outlined.

Clinical anophthalmia associated with congenital cytomegalovirus infection.

Three cases of congenital clinical anophthalmia associated with congenital cytomegalovirus infection were diagnosed by positive viral cultures and immunologic studies. Ultrasonography in one infant with clinically detected anophthalmia showed the presence of severe microphthalmia with cyst. These findings suggest that maternal infection occurred within the first trimester of gestation.

Autogenous scleral graft in implant extrusion.

The first case report of the use of an autogenous scleral patch graft is presented in the repair of an extruding implant. Its use eliminates the possibility of viral transmission by heterogenous grafts. Suitable material may be available if a primary evisceration was carried out, or if sclera is preserved at the time of enucleation of a severely ruptured globe.

Baggy lids:a classification and newer aspects of treatment to avoid complications.

A clinical classification of baggy lids is presented to allow for categorization of existing deformities and their subsequent surgical correction. Standard photographic documentation is suggested for impartial evaluation of the selected surgical procedure. A technique in the placement of skin incisions and their modifications, based on position and degree of skin excess, is outlined and recommendations directed toward avoidance of complications are proposed.

A 'black cornea' secondary to topical epinephrine.

We report a case of 'black cornea" secondary to topical epinephrine therapy and present the biochemical analysis of the lesion. The formed pigment is a melanin and not the intermediate substance, adrenochrome, as has been previously reported. The pathogenesis of melanin deposition is reviewed and a hypothesis of epinephrine-melanin binding is suggested.