Bülent Yazici

Treatment of nasolacrimal duct obstruction in adults with polyurethane stent

PURPOSE To evaluate the efficacy of polyurethane nasolacrimal duct stents in the treatment of epiphora resulting from primary acquired nasolacrimal duct obstruction in adults. MATERIALS AND METHODS In 25 patients (21 women and four men with mean age of 44 years, range 20 to 74 years) with nasolacrimal duct obstruction, 28 hollow polyurethane stents designed by Song and associates were placed under fluoroscopic guidance. The obstruction was complete in 20 lacrimal drainage systems and partial in eight. The lacrimal sac size was normal or large on dacryocystogram in all lacrimal drainage systems. A Ritleng probe was introduced through the upper punctum and advanced past the obstruction. A guide wire with a flexible tip was then introduced through the probe, over which the stent was advanced in retrograde fashion and placed into the lacrimal sac and nasolacrimal duct. Clinical success was defined by the demonstration of a completely patent lacrimal drainage pathway through saline irrigation and no or minimal complaint of epiphora. RESULTS Stent placement was technically successful in 26 of 28 lacrimal drainage systems (93%). The mean time of fluoroscopy screening was 3.2 minutes (range, 1.4 to 5.8 minutes). The overall success rate was 82% (23 of 28 lacrimal drainage systems). Two stents were completely occluded. In one lacrimal drainage system with minimal epiphora, the stented drainage pathway was partially occluded. The patients were followed up from 4 to 22 months (mean, 7.2 months). CONCLUSIONS Retrograde placement of a hollow polyurethane nasolacrimal duct stent is a technique that is simple and well tolerated by patients. This method achieves a high success rate and may be suggested as a nonsurgical procedure for adults with primary nasolacrimal duct obstruction and proper lacrimal sac size. The Ritleng probe facilitates the procedure.

Treatment of obstructive epiphora in adults by balloon dacryocystoplasty

AIMS To determine the efficacy of dacryocystoplasty with balloon dilatation in the treatment of complete and partial obstruction of the lacrimal drainage system. METHODS The procedure was performed on 26 patients with epiphora due to complete (n=16) or partial (n=10) obstruction of the lacrimal drainage system. A flexible tipped guide wire was introduced through the superior canaliculus into the inferior meatus and manipulated out of the nasal cavity. A 3 mm balloon was then introduced in a retrograde direction over the guide wire and dilated at the obstruction site. RESULTS The procedure was technically successful in all patients with partial obstruction, but unsuccessful in four of 16 cases with complete obstruction. Reobstruction occurred in eight of 12 patients with complete obstruction, and in five of 10 patients with partial obstruction. The overall success rate was 25% for complete and 50% for partial obstructions. The mean follow up was 14 months (8–37 months). CONCLUSION Although the balloon dacryocystoplasty is a simple and minimally invasive technique, the outcome from our study indicates that it is not advisable for treatment of complete obstruction of the lacrimal drainage system. Balloon dilatation may prove suitable for the treatment of patients with partial obstruction below the level of the lacrimal sac, especially in those who are poor candidates for surgery, or who do not wish to undertake dacryocystorhinostomy. Even in the partial obstruction group the success rate was only 50%, so that further modification to the technique and controlled studies are likely to be required before it could be recommended for general use.

Posttraumatic subperiosteal hematomas of the orbit in children.

Purpose: To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature. Methods: Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature. Results: Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage. Conclusions: In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.

Cavernous hemangioma of the conjunctiva: case report.

Cavernous hemangioma of the conjunctiva is rare and has been reported previously in only a few cases. In this report, the authors describe a 17-year-old boy with an isolated conjunctival cavernous hemangioma. The tumor was located in the caruncular region over the bulbar conjunctiva. The lesion had appeared as a red mark in early childhood, grown in the last 2 years, and was causing bloody tears occasionally. No associated vascular lesion was noted within the eye and orbit. After removal of the tumor, no recurrence or complication developed during the follow-up period.

Oculomotor palsy with cyclic spasms: a case report

Oculomotor palsy with cyclic spasms is a rare, non-progressive disorder in which the muscles innervated by the third cranial nerve undergo alternating rhythmic spasm and paralysis. An 18-year-old male was referred with left upper eyelid ptosis present since birth. On examination we noted cyclic movements of the left eyelid and pupil. The cycle consisted of periods of ptosis and mydriasis alternating with eyelid retraction with miosis. The interpalpebral fissure measured 2 mm in the paralytic phase and 11 mm in the spastic phase. The pupil diameter varied from 3 mm to 6 mm. Six cycles were observed in 5 minutes. The patient had no voluntary control over his left eyelid, nor over the other muscles innervated by the third nerve. The affected eye was deeply amblyopic and exotropic. Systemic evaluation and cranial MRI gave normal results. A therapeutic trial with oral baclofen (30 mg/day), a central muscle relaxant drug, was ineffective in suppressing the cyclic movements.

Sino-orbital osteoma with osteoblastoma-like features: case reports.

Most of the orbital osteomas arise from the adjacent paranasal sinuses. Some of them may contain osteoblastoma-like areas and may be misdiagnosed as osteoblastoma, both radiologically as well as histopathologically. Sino-orbital osteomas with osteoblastoma-like features show a typical radiological appearance. They have a distinct zonal pattern, in which less dense osteoblastoma-like areas are located at the base of the lesion and dense mature bone is located at the periphery. These broad-based bone lesions also have a tendency for extracavitary polypoid growths from the paranasal sinus into the adjacent orbit. We report here the CT and MR imaging findings of three cases with sino-orbital osteoma with osteoblastoma-like features.

Radiation therapy in exudative age-related macular degeneration.

It has been suggested that ionizing radiation at doses relatively safe to the optic nerve and retina exert an inhibitory and occlusive effect on the endothelial proliferation of choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). The encouraging results of early studies in preservation or improvement of visual acuity and regression of the CNV gave rise to many clinical trials in different centers. Disparate radiation doses, dose fractions, type and rate of radiation administration have been used to determine the efficacy of radiotherapy in AMD. Conflicting treatment responses have been reported by different centers. Some studies provided evidence of beneficial treatment outcome in AMD, and others could not show any efficacy of ionizing radiation in the visual and morphological evolution of the disease. Data from the literature and our experience indicate that radiotherapy can be effective in regressing the leakage of the CNV in AMD. However, despite treatment visual deterioration continues and new CNV lesions develop. The observation of morphological progression in the disease process might be related to an unfavorable effect of radiation on the pathogenesis of AMD.

Neonatal Orbital Abscess Secondary to Pseudomonas Aeruginosa Conjunctivitis.

Pseudomonas aeruginosa conjunctivitis, although rare in healthy infants, may cause serious ocular and systemic complications. A 30-day-old, otherwise healthy male infant was referred with the diagnosis of right orbital abscess. The patient had been diagnosed as having Pseudomonas conjunctivitis 9 days previously at the referring center. Despite antibiotic treatment, his ocular findings had worsened and marked proptosis had developed. Other examination findings were ptosis, restriction of eye movements, periorbital erythema, and chemosis. Radiologic studies showed a large, homogenous mass with a thick capsule in the lateral retrobulbar orbit. The abscess was drained through a lateral orbitotomy. A culture of the abscess yielded P. aeruginosa. After surgery, the ocular findings improved rapidly without any complication. No other focus of infection or immune system abnormality was found. The patient did not experience any other significant disease during a follow up of 23 months.

Choroidal ganglioneuroma in a patient with orbitopalpebral neurofibromatosis.

Ganglioneuroma is a rare, benign tumor originating from the sympathetic ganglion cells. Choroidal ganglioneuroma in association with neurofibromatosis type 1 (NF-1) has been reported in a few cases. This study describes a 21-year-old woman with orbitopalpebral NF, who underwent evisceration for pseudophakic bullous keratopathy, intractable glaucoma, and absolute painful eyes and who was found to have choroidal ganglioneuroma and retrobulbar plexiform neurofibroma on histologic examination. This case, together with the previously described cases, suggests that eyes with choroidal ganglioneuromas may have some common clinical and prognostic characteristics, although this condition cannot be diagnosed preoperatively. In patients with NF-1 who may undergo eye removal surgery, the possibility of choroidal tumors should be kept in mind.

Co-occurrence of choroidal pigmented ganglioneuroma and plexiform neurofibroma in a patient with neurofibromatosis 1

Neurofibromatosis 1 (NF1) is an autosomal dominant disorder characterized by a wide variety of lesions. Ganglioneuromas are well-differentiated benign tumors originating from the ganglion cells of the sympathetic and parasympathetic nervous system. A 21-year-old woman presented to the eye clinic of our institution with severe pain in her congenitally blind left eye for 6 months. She had asymmetry of the face and had undergone an operation for an asymmetrical left upper eyelid, the pathologic diagnosis of which was plexiform neurofibroma. She had multiple facial café au lait spots. An evisceration procedure for the painful blind eye using an implant was considered. At surgery, the surgeon noted no evident intraocular tissue.