Nam Ju Kim

Free orbital fat graft to prevent porous polyethylene orbital implant exposure in patients with retinoblastoma.

Purpose: To determine if porous polyethylene orbital implant (Medpor®) exposure can be prevented in retinoblastoma patients when the implant is placed in combination with a free orbital fat graft over the anterior surface of the implant. Methods: Free orbital fat grafts were performed after enucleation and Medpor® implantation, and results were compared with patients who underwent conventional enucleation and Medpor® implantation without an orbital fat graft. Results: Although implant exposure occurred in 13 of 39 eyes (33.3%) that had conventional enucleation and Medpor® implantation, exposure did not develop in any of the 38 eyes that had the combined procedure with a free orbital fat graft. Conclusions: These findings suggest that a free orbital fat graft is a simple, effective way to prevent orbital implant exposure in patients requiring enucleation and Medpor® implantation.

Conjunctival cytologic features in anophthalmic patients wearing an ocular prosthesis.

Purpose: To evaluate the cytologic features of conjunctival epithelium in anophthalmic sockets with an ocular prosthesis, using an impression cytology technique and to determine the clinical factors associated with these changes. Methods: In a prospective case-controlled study, 40 consecutive unilateral anophthalmic patients who wore an ocular prosthesis were recruited. A questionnaire on the care of the prosthesis included total wearing period, frequency of cleaning, frequency of polishing, cleaning solution, and eye drop use. The degree of inflammation of the anophthalmic conjunctival socket was evaluated. Impression cytology specimens were taken from the upper tarsal conjunctiva, the bulbar conjunctiva, and the lower tarsal conjunctiva of each socket, and from the contralateral eye (to serve as an internal matched control). The goblet cell density and the nucleus-to-cytoplasm ratio of the epithelial cells were measured. The relevance of these conjunctival cytologic features to the various factors of prosthesis care or conjunctival inflammation was analyzed. Results: In the anophthalmic sockets, the conjunctiva showed squamous metaplasia at all 3 areas sampled. The goblet cell density was significantly decreased and the nucleus-to-cytoplasm ratio of the epithelial cells was significantly increased compared with the control eyes (p < 0.05, on all 3 areas sampled, Wilcoxon signed rank test). These conjunctival cytologic changes were not significantly associated with total wearing time, frequency of polishing, cleaning solution, or eye drops use (p > 0.05, Spearman’s correlation test). Conclusions: Squamous metaplasia with decreased goblet cell density and increased nucleus-to-cytoplasm ratio occurred in anophthalmic conjunctival sockets but was not associated with particular aspects of prosthesis care.

Frontalis sling operation using silicone rod for the correction of ptosis in chronic progressive external ophthalmoplegia.

Aims: The aim of the study was to evaluate the results of the frontalis sling operation using silicone rod for the correction of ptosis in chronic progressive external ophthalmoplegia patients. Methods: Chronic progressive external ophthalmoplegia patients who received the frontalis sling operation using silicone rods from 1999 to 2006 were included in this study. The medical records were retrospectively reviewed and the clinical characteristics and postoperative surgical results of these patients were analysed. This study was a retrospective, non-randomised, interventional case series and the main outcome measures were margin reflex distance, eyelid contour and corneal status. Results: Seven patients were recruited (one male and six female). The mean age at the time of operation was 29.6 (range 15–62) years. Two patients had unilateral ptosis and five patients had bilateral ptosis. The mean follow-up period was 22.7 (range 1–61) months. Satisfactory lid height was achieved in all patients. Although corneal erosions were detected in five patients 1 month after surgery, these findings eventually resolved in three patients 2 months later, after the use of artificial tear eyedrops and ointments. Conclusion: The frontalis sling operation using silicone rod can safely and effectively correct ptosis in chronic progressive external ophthalmoplegia patients without serious corneal complications.

Steatocystoma simplex of the caruncle.

CASE REPORTnThe authors present a rare case of steatocystoma simplex occuring in the caruncle. A 42-year-old male presented with an asymptomatic, yellow soft mass in the medial canthal area of the left eye. An excisional biopsy was performed, and the mass lesion was diagnosed as steatocystoma by histological examination.nnnCOMMENTSnSteatocystoma simplex should be considered one of the differential diagnoses for patients with an asymptomatic mass lesion in the caruncle.

Eyelid mass secondary to injection of calcium hydroxylapatite facial filler.

A 37-year-old woman presented with a 2-month history of fullness and ptosis of the left upper eyelid. Examination revealed a 6-cm x 2-cm mass in the left brow and upper eyelid, and a diffuse mass in the lower eyelid. Marked ptosis of the left upper eyelid and elevation of the left lower eyelid were noted. CT showed masses with a bone-like density in the left eyelid and periorbital soft tissue. A through history revealed that the patient had received calcium hydroxylapatite filler injection for nose augmentation 3 days prior to the development of the eyelid masses. The eyelid masses were excised and pathologically confirmed as calcium hydroxylapatite microspherules surrounded by collagen and histiocytes. Two months after surgery, the eyelid masses and ptosis of the left upper eyelid were completely resolved. To our knowledge, this is the first reported case of eyelid mass after injection of calcium hydroxylapatite facial filler for nose augmentation.

Effect of an acrylic posterior chamber intraocular lens on posterior capsule opacification in cataract patients with associated risk factors

Purpose: To evaluate the effect of an acrylic foldable posterior chamber intraocular lens (PC IOL) on the rate of posterior capsule opacification (PCO) in patients with associated risk factors. Setting: Department of Ophthalmology, Seoul National University, Seoul, Korea. Methods: The medical records of 570 patients who had phacoemulsification and foldable PC IOL implantation by the same surgeon from January 1, 1998, to December 31, 1999, were reviewed. Patients with risk factors for PCO (ie, young age, diabetes mellitus) received an acrylic PC IOL to decrease the opacification rate. Their rate was compared to that in patients without associated risk factors who received a foldable silicone PC IOL. Results: In the patients without diabetes mellitus, the PCO rate in patients younger than 60 years with an acrylic PC IOL and in patients older than 60 years with a silicone PC IOL were similar. In patients older than 60 years, the rate of PCO was significantly lower in patients with diabetes mellitus and an acrylic PC IOL than in patients without diabetes mellitus with a silicone foldable PC IOL. Conclusions: The rate of PCO in patients with risk factors for PCO with an acrylic PC IOL was similar to or lower than that in patients without risk factors with a foldable silicone PC IOL. Therefore, acrylic PC IOLs are preferable, particularly in patients with risk factors for PCO.

Evaluation of lacrimal tear drainage mechanism using dynamic fluoroscopic dacryocystography.

Purpose: To evaluate the dynamic change of the canaliculus and the lacrimal sac during blinking using fluoroscopic dacryocystography. Methods: Sixteen patients presenting with unilateral epiphora were enrolled in the study. Fluoroscopic dacryocystography was performed in both eyes, and sequential images of the lacrimal drainage system were acquired during blinking. On examination of the contralateral asymptomatic side, the length of the lower canaliculus and the width of the superior and inferior portions of the lacrimal sac were measured and compared between eyelid closure and opening. Results: The length of the lower canaliculus decreased with eyelid closure in 13 of 16 patients, and the change was statistically significant (p = 0.006, Wilcoxon signed rank test). The width of the superior portion of the lacrimal sac increased with eyelid closure (p = 0.033), but the width of the inferior part did not change significantly (p = 0.679). Conclusions: With eyelid closure, the canalicular system contracts, and the superior portion of the lacrimal sac dilates; these may be important parts of the active lacrimal pump mechanism. These findings suggested that the canalicular system and the superior portion of the lacrimal sac play key roles in active tear drainage pump.

Management of dermoid tumor in the medial canthal area.

Dermoid tumors in the medial canthal area are rare, but when present they commonly adhere to the lacrimal canaliculi. Three patients presented with a mass in the medial canthal area. The authors performed excisional biopsies, and the masses were diagnosed as dermoid tumors. In two patients, canalicular lacerations were found after mass excision, which suggested that the masses had been firmly adherent to the lacrimal canaliculi. The lacerated canaliculi were repaired after bicanalicular silicone intubation. In the remaining patient, lacrimal silicone intubation was performed at the beginning of surgery, and the mass was successfully dissected from the canaliculi, leaving them intact. Excision of dermoid tumors in the medial canthal area requires careful dissection to avoid canalicular laceration. Bicanalicular silicone intubation at the beginning of surgery is helpful for the identification of the canaliculi and for the prevention of canalicular laceration during dermoid tumor excision.

A Phacovitrectomy with a Clear Corneal Incision for a Full-Thickness Macular Hole

Purpose To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. Methods This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. Results All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Students t-test, p<0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808±0.761) two months after surgery. Conclusions Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.

Decrease in Levator Function in the Anophthalmic Orbit

Background/Aims: It has been argued that levator function in anophthalmic patients is reduced, but no detailed report on this topic has been issued. This study was undertaken to investigate measured levator function in anophthalmic patients, and to determine how measured values are related to prosthesis size. Methods: Unilateral anophthalmic patients with no significant ptosis, and no history of trauma or surgery to orbit or eyelid were recruited. Levator function was measured with patients wearing their prosthesis, test prosthesis of different heights, and no prosthesis. Results: Thirty-two patients were recruited. Levator function was found to be lower in anophthalmic orbits (10.43 ± 1.48 mm) than in contralateral normal orbits (12.74 ± 1.81 mm). Levator function was lower in anophthalmic orbits with any height or type of prosthesis than in contralateral normal orbits (paired t-test, p < 0.05). In the anophthalmic orbits, the levator functions were highest when patients wore a prosthesis of the proper height, and these functions reduced as the prostheses height reduced (linear regression, p < 0.05). Conclusion: Diminished levator function in an anophthalmic orbit doesn’t necessarily mean that levator muscle function is abnormal. When levator function is measured in an anophthalmic orbit, the fact that it is often underestimated should be taken into account.