PURPOSE: To investigate the effects of commodified growth factor products used clinically on fibrovascular ingrowth into porous polyethylene orbital implants. METHODS: Porous polyethylene orbital implant sheets (Medpor(R)) soaked with Nepidermin (Easyef(R)), Trafermin (Fiblast(R)), and normal saline were implanted into the backs of 18 Sprague-Dawley rats. The degree of fibrovascular ingrowth as observed using a light microscope was compared 1 and 2 weeks after implantation and was calculated as a percentage of the fibrovascular ingrowth length. RESULTS: One week after implantation, the percentage of fibrovascular ingrowth length was 25.33 +/- 5.43%, 22.56 +/- 5.30%, and 21.78 +/- 4.66% in the Easyef(R)-, Fiblast(R)- and normal saline-soaked groups. The degree of fibrovascularization was higher in the Easyef(R)-soaked group than in the other groups (p = 0.020, 0.012). Two weeks after implantation, the degree of fibrovascularization was 98.33 +/- 5.00%, 100.00 +/- 0.00%, and 95.89 +/- 4.57%, which was significantly higher in the Easyef(R)-, and Fiblast(R)-soaked groups than in normal saline-soaked group (p = 0.019, <0.001). CONCLUSIONS: Commodified growth factor products used in other areas selectively enhanced fibrovascular ingrowth to a greater degree and earlier in ophthalmic plastic and reconstructive surgery.
Epidermal Growth Factor ; Fibroblast Growth Factor 2 ; Orbital Implants* ; Plastics ; Polyethylene* ; Rats, Sprague-Dawley

PURPOSE: To report a case of treating a patient with intralesional cidofovir injection who had frequently recurring lacrimal sac squamous papilloma after several excision surgeries. CASE SUMMARY: A 59-year-old man who had mass excision surgery at a different clinic nine months previously, visited our clinic to treat a recurring erythematous protruding mass near his left medial canthus that developed two months prior. Orbit CT showed a 15 x 25 mm-sized large mass located on the lacrimal sac adherent to medial orbital wall. An excision biopsy was performed and the histopathologic examination showed typical findings of squamous papilloma. Because the tumor recurred six months after the second surgery, we decided to perform adjuvant therapy using the antiviral agent cidofovir. The patient was treated with a 5 mg/mL intralesional cidofovir injection every three weeks. A transient recurrence presented on the upper lid at the third intralesional cidofovir injection site two months after the surgery, but the recurrent lesion improved after repeated injections. During the 12 months of follow-up, there were no complications and no evidence of recurrence. CONCLUSIONS: Intralesional cidofovir injections can be a safe and effective treatment for the management of recurrent squamous papilloma of the orbit, especially after total excision.
Biopsy ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Middle Aged ; Orbit ; Papilloma* ; Recurrence

PURPOSE: To report a case of multiple eyelid trichilemmomas associated with Cowden syndrome. CASE SUMMARY: A 27-year-old woman presented with multiple upper and lower eyelid skin masses that developed over several years. The masses were as large as whitish millet, and were around the upper and lower eyelid margin and the face. The patient had previously undergone subtotal thyroidectomy for a thyroid mass and a mass excision for extremity hemangioma. Excisional biopsy was performed for the diagnosis, and trichilemmoma was diagnosed based on histopathologic examination. Consequently, multiple trichilemmoma associated with Cowden syndrome was diagnosed, and breast evaluations for existence of further masses were recommended. On breast examinations, intraductal papilloma and fibroadenoma were detected. CONCLUSIONS: The trichilemmoma was a hair-follicle benign tumor that also appeared on the skin around the eyelid. If multiple trichilemmoma is diagnosed, an association with Cowden syndrome should be considered as well as presence of masses in other organs.
Biopsy ; Breast ; Extremities ; Eyelids ; Female ; Fibroadenoma ; Hamartoma Syndrome, Multiple ; Hemangioma ; Humans ; Panicum ; Papilloma, Intraductal ; Skin ; Thyroid Gland ; Thyroidectomy

PURPOSE: This survey was performed to gather information about the guardians of pediatric oculoplastic patients undergoing certain medical care services in order to recommend improvements in these services. METHODS: Questionnaires were distributed to guardians of pediatric oculoplastic patients who were admitted for operations to correct epiblepharon and ptosis. Completed questionnaires, which numberd 100, were then analyzed. RESULTS: The results of this survey show that most guardians were the parents of the patient; most had a level of education higher than or equal to junior college graduation; and most were middle-class. The parents themselves had discovered their children's disease and had a great influence on the decision to operate. Most parents took an optimistic view of the results of the operation. The higher the guardians' economic status, the more likely he or she believed that both an ophthalmic and a plastic surgeon could perform oculoplastic operations. Many guardians chose an ophthalmic clinic over a plastic surgery clinic because the likelihood of a satisfactory result is higher and because these diseases are related to visual acuity. Half of the guardians knew that there is an oculoplastic clinic at the department of ophthalmology, and many of them gathered information about oculoplastic surgery from the internet. CONCLUSIONS: Better explanations about oculoplastic diseases and more education about these diseases should be available to the guardians of patients with these diseases. Systematic publicity for the field of oculoplastic surgery is needed urgently, and the availability of accurate information and specialized medical counseling about these diseases on the internet should be increased.
Counseling ; Education ; Humans ; Internet ; Ophthalmology ; Parents ; Surveys and Questionnaires ; Surgery, Plastic ; Visual Acuity

BACKGROUND: The safety and efficacy of trabeculectomy with Mitomycin C (MMC) for surgical treatment in aphakic and pseudophaic eyes were retrospectively evaluated. MATERIALS AND METHODS: The authors reviewed 51 eyes of 45 patients who had been followed up for at least 6 months after trabeculectomy using MMC for aphakic and pseudophakic eyes. The success rate and complications were analyzed. The success criteria included intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as a postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: The average follow up period was 27.7 months and the intraocular pressure was controlled under 21 mmHg in 36 eyes of 51 (70.6%) after the procedure with or without medication for glaucoma. Using the Kaplan-Meier survival analysis, the cumulative success rate at the 3-, 6-, 12-, 24- and 36-month intervals were 98.0%, 94.1%, 91.9%, 83.4% and 75.5%, respectively. The complications observed were hyphema (4 eyes), serous choroidal detachment (4 eyes), hypotony (3 eyes), and endophthalmitis (1 eye). CONCLUSION: Trabeculectomy using Mitomycin C for the treatment of aphakic and pseudophaic eyes was safe and effective.
Aphakia ; Choroid ; Endophthalmitis ; Follow-Up Studies ; Glaucoma ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin* ; Pseudophakia ; Retrospective Studies ; Trabeculectomy*

PURPOSE: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position. METHODS: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia. RESULTS: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up. CONCLUSIONS: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.
Visual Acuity ; Severity of Illness Index ; Retinal Artery Occlusion/*complications/diagnosis ; Postoperative Complications ; Ophthalmoplegia/*complications/diagnosis ; Neck Injuries/diagnosis/*surgery ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Laminectomy/*adverse effects ; Humans ; Fundus Oculi ; Follow-Up Studies ; Fluorescein Angiography ; Diagnosis, Differential ; Cervical Vertebrae/injuries/*surgery ; Blindness/*etiology

PURPOSE: To evaluate the surgical result of lacrimal surgery with total removal of the nasal mucosal flap. METHODS: Lacrimal surgery was performed in 30 eyes of 26 patients, by external approach without the nasal mucosal flap from February 2001 to August 2002. The surgical method was similar to conventional dacryocystorhinostomy, but the nasal mucosa of the osteotomy site was removed with a No.11 Bard-Parker blade and Westcott scissors. After insertion of a silicone tube, the anterior flap of the lacrimal sac was sutured to the soft tissues around the osteotomy site. Surgical efficacy was evaluated after a follow-up period of 7 22 months (average, 11.5 months). RESULTS: The primary success rate was 96.7% (29/30 eyes). We performed revision of mucosa ostium in the one failed eye, thereby raising the final success rate to 100%. The size of mucosa ostium was 0.7 3.0 mm (average 1.17 mm). CONCLUSIONS: Satisfactory surgical results were obtained without anastomosis of the lacrimal sac or the nasal mucosa during external approach, lacrimal surgery. We suggest that this method is a good surgical procedure in external approach, lacrimal surgery.
Dacryocystorhinostomy ; Follow-Up Studies ; Humans ; Mucous Membrane ; Nasal Mucosa ; Osteotomy ; Silicones

PURPOSE: To evaluate the effectiveness of intralesional triamcinolone acetonide injection for chalazia in pediatric patients. METHODS: We performed a retrospective chart review of 58 patients (70 lesions) under fifteen years of age and 40 patients (50 lesions) aged fifteen and over, who underwent intralesional triamcinolone acetonide injections and performed follow-ups for at least three months between January 2007 and October 2008. Data regarding age, sex, lesion size, location, number of injections, treatment success, surgery, and complications were evaluated. RESULTS: Cumulative treatment success of TA was 64.3% with the first injection, 82.9% with a second injection, and 88.6% with a third injection in patients under fifteen years of age. The average number of TA injections was 1.67+/-1.03 in primary chalazia and 1.48+/-0.87 in recurrent chalazia, while the cumulative treatment success until third TA injection was 89.8% in primary chalazia and 85.7% in recurrent chalazia inpatients under fifteen years old. The average number of TA injections was 1.95+/-1.18 in primary chalazia and 1.80+/-1.14 in recurrent chalazia, while the cumulative treatment success until the third TA injection was 82.5% in primary chalazia and 70.0% in recurrent chalazia in patients aged fifteen and over. No complications were noted with TA injections. CONCLUSIONS: Intralesional triamcinolone acetonide injection in chalazia is an effective and safe treatment in pediatric patients.
Aged ; Chalazion ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Inpatients ; Retrospective Studies ; Triamcinolone Acetonide

PURPOSE: While the principles of eyelid reconstruction are well established, the rapid choice of a method of upper and lower eyelid defect reconstruction is difficult. The authors present a successful case of simultaneous reconstruction of upper and lower eyelid defects with a modified paramedian forehead flap resulting from a dog bite. CASE SUMMARY: The authors report a case of a 77-year-old woman with total hyphema and extensive skin defects involving the forehead, cheek, and upper and lower eyelid resulting from a dog bite. The wound on the left periorbital area was treated with microimplantation and skin grafts from the left thigh and groin. In the weeks following, sequential failure of the flap and skin graft was observed, and exposed keratitis worsened, resulting in corneal perforation. Evisceration with hydroxyapatite implantation and paramedian forehead flap was performed. After 3 weeks, division of the pedicle, transverse division of the flap, and socket reconstruction were performed. CONCLUSIONS: Reconstruction of large, full thickness defects of both upper and lower eyelids with a paramedian forehead flap is associated with a good cosmetic outcome. Paramedian forehead flap should be considered as an effective choice for simultaneous upper and lower eyelid reconstruction.
Aged ; Animals ; Bites and Stings ; Cheek ; Corneal Perforation ; Cosmetics ; Dogs ; Durapatite ; Eyelids ; Female ; Forehead ; Groin ; Humans ; Hyphema ; Keratitis ; Skin ; Thigh ; Transplants

PURPOSE: To report 2 cases of skin necrosis over the medial canthus following canaliculodacryocystorhinostomy in young women diagnosed with canalicular obstruction. CASE SUMMARY: (Case 1) A 31-year-old female presented to our clinic with epiphora in the right eye that had developed 2 years prior. On examination, a right upper and lower canalicular obstruction was noted and the patient underwent canaliculodacryocystorhinostomy with silicone tube intubation. Topical 0.04% mitomycin-C eyedrops were applied twice a day from postoperative day 1 for 7 days. The patient revisited our emergency center with swelling, redness, and tenderness in the medial canthal region that developed 3 days after the initial surgery. Furthermore, a skin ulceration had developed followed by an exudative oozing with crust. (Case 2) A 23-years-old female visited our clinic with epiphora in the right eye that had developed 3 months prior. Ophthalmic examinations revealed a common canalicular obstruction in the right eye and canaliculodacryocystorhinostomy with silicone tube intubation was performed. Seven days postoperatively, the patient developed mild pain and tenderness over the right lacrimal sac and medial canthal erythema with purulent discharge was noted. Furthermore, a localized skin necrosis had developed. CONCLUSIONS: Localized skin necrosis may rarely develop after canaliculodacryocystorhinostomy in young women. If localized skin symptoms develop postoperatively, the patient should be closely monitored.
Adult ; Emergencies ; Erythema ; Female ; Humans ; Intubation ; Lacrimal Apparatus Diseases ; Mitomycin ; Necrosis* ; Ophthalmic Solutions ; Silicones ; Skin Ulcer ; Skin*