In contrast to the literature on the use of hydroxyapatite orbital implants with enucleation, reports of the use of hydroxyapatite implants with evisceration are limited and those that have been published reported high exposure rates. The authors described modified surgical technique of primary evisceration with hydroxyapatite implant and evaluated its effects on cosmetic appearance and the prevention of implant exposure. All 28 consecutive patients underwent evisceration with hydroxyapatite implant between December 1994 and April 1998. To place an appropriate hydroxyapatite implant into the scleral shell without tension we made a saw-tooth shaped large posterior sclerotomy around the optic nerve sparing 6-o`clock position to minimize the inferior displacement of the implant. In cases with very small globes we made 3 to 4 additional radial posterior sclerotomies. During the mean follow-up of 13.5 months, none of the patients experienced complications such as conjunctival erosion, hydroxyapatite exposure, implant extrusion, significant enophthalmos, or superior sulcus deformity. The authors have had good success without major complications using our modified surgical technique for hydroxyapatite orbital implants with evisceration.
Congenital Abnormalities ; Durapatite* ; Enophthalmos ; Follow-Up Studies ; Humans ; Optic Nerve ; Orbital Implants

In contrast to the literature on the use of hydroxyapatite orbital implants with enucleation, reports of the use of hydroxyapatite implants with evisceration are limited and those that have been published reported high exposure rates. The authors described modified surgical technique of primary evisceration with hydroxyapatite implant and evaluated its effects on cosmetic appearance and the prevention of implant exposure. All 28 consecutive patients underwent evisceration with hydroxyapatite implant between December 1994 and April 1998. To place an appropriate hydroxyapatite implant into the scleral shell without tension we made a saw-tooth shaped large posterior sclerotomy around the optic nerve sparing 6-o`clock position to minimize the inferior displacement of the implant. In cases with very small globes we made 3 to 4 additional radial posterior sclerotomies. During the mean follow-up of 13.5 months, none of the patients experienced complications such as conjunctival erosion, hydroxyapatite exposure, implant extrusion, significant enophthalmos, or superior sulcus deformity. The authors have had good success without major complications using our modified surgical technique for hydroxyapatite orbital implants with evisceration.
Congenital Abnormalities ; Durapatite* ; Enophthalmos ; Follow-Up Studies ; Humans ; Optic Nerve ; Orbital Implants

Miller Fisher syndrome is characterized by acute external ophthalmoplegia, ataxia and areflexia in the abscence of significant motor or sensory deficit in the limbs and usually results in a complete recovery. Most cases have anteceding events like upper respiratory infection or other viral infections. Diagnosis of Miller fisher syndrome can be made with compatible clinical history taking, cardinal symptoms and normal findings of CT or MRI. The prognosis of Miller Fisher syndrome is favorable contrary to other malignant tumors or Guillain-Barre syndrome which sometimes cause a respiratory paralysis. The locations of its anatomic lesion and pathogenesis are nor yet discovered. From 1991 to 1995, we have experienced 11 cases of Miller Fisher syndrome. Thereby we have analyzed anteceding events, cardinal symptoms along with other associated symptoms, electrophysiological studies, cerebrospinal fluid test and its treatment and prognosis. The purpose of this article is that a better understanding of Miller Fisher syndrome can lead us to differenciate with other disorders causing external ophthalmoplegia.
Ataxia ; Cerebrospinal Fluid ; Diagnosis ; Extremities ; Guillain-Barre Syndrome ; Magnetic Resonance Imaging ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Prognosis ; Respiratory Paralysis

If the corneal opacity and the corneal neovascularization are severe and broad, it should be taken the penetrating keratoplasty. But there is a high risk of the persistent epithelial defect, the neovascularization and the rejection. Recently, there were many reports that support the limbal stem cell theory. Based on the stem cell conception of the corneal epithelium, the authors have evaluated the clinical effects of the penetrating keratoplasty combined with the allograftic limbal transplantation or the penetrating keratoplastty combined with the autologousl imbal transplantation in 4 patients (4 eyes) whose corneas were severly opaque and heavily neovasculized. As a result, the visual improvement was achieved in 3 eyes (as a corrected vision, from hand motion to finger count, from hand motion to 0.05, from hand motion to 0.15), the prompt reepithelialization was accomplished in 3 eyes (the mean time: 5.7 days) and even in case of the failed reepithelialization, the epithelial side at which the limbal transplantion was done showed a rapid recovery. Therefore we think that the combined surgery of the panetrating keratoplasty and the limbal transplantation is useful because it can increase the success rate of the penetrating keratoplasty by the rapid and firm reepithelialization and the suppression of the neovascularization. Futhermore the donor cornea can be used effectively (the central portion is used for a penetrating keratoplasty and the limbal portion is used for a limbal transplantation), and we can expect a rapid visual recovery through a simultaneous surgery of the two other operation.
Allografts ; Cell Transplantation* ; Cornea ; Corneal Neovascularization ; Corneal Opacity ; Corneal Transplantation ; Epithelium, Corneal ; Fertilization ; Fingers ; Hand ; Humans ; Keratoplasty, Penetrating* ; Stem Cells ; Tissue Donors ; Transplants*