PURPOSE: This study is to describe scleral eversion technique as a modification of evisceration to improve its disadvantages for placement of porous orbital implant and to report the results of placement of porous orbital implants with this technique. METHODS: The medical records of 27 patients with 27 eyes who had undergone evisceration and placement of porous polyethylene orbital implant with scleral eversion technique between November 1998 and January 2000 were reviewed. Surgical technique involved the removal of corneal button and the intraocular contents. Optic nerve was severed, scleral shell was everted, and porous polyethylene orbital implant was implanted into the retroscleral and intraconal space. RESULTS: Orbital implants of 20 mm in diameter were implanted in all patients. The average postoperative follow-up interval was 22.4 months. No patient experienced severe complications like exposure of implant. All of patients showed good motility of orbital implant and 19 patients were satisfied with motility of prosthesis. Eight patients (29.6%) got placement of motility coupling post without significant problems to enhance motility. CONCLUSIONS: Scleral eversion technique is safe and useful for evisceration and placement of porous polyethylene orbital implant. This technique can provide adequate space for adequate size of implant without any tension on wound, thick anterior scleral barrier for implant and more vascular source for fibrovascular ingrowth. Therefore, it decrease exposure rate of implant.
Follow-Up Studies ; Humans ; Medical Records ; Optic Nerve ; Orbit* ; Orbital Implants* ; Polyethylene* ; Prostheses and Implants ; Wounds and Injuries

PURPOSE: To investigate whether the bone wax could maintain the created fistula between the maxillary sinus and the nasal cavity in a rabbit model of dacryocystorhinostomy. METHODS: After creating a fistula between the maxillary sinus and the nasal cavity at both sides in 20 rabbits, the one on the right side was plugged with bone wax (treated side) and the one on the left side was used as a control. Five rabbits were sacrificed each time at 1, 2, 4 weeks after surgery. Bone wax was removed at 4weeks after surgery in 5 rabbits and they were sacrificed 2 weeks later. The state of the fistulas and the histopathology were observed. RESULTS: Among controls, only one of the rabbits sacrificed at 1 and 2 weeks after surgery, showed partially open fistula and all other rabbits showed closure of fistula. The treated fistulas were opened in 4 rabbits at 1 week, in 3 rabbits at 2 weeks, and 4 rabbits at 4weeks after surgery. Two out of 5 treated fistulas which had the removal of the bone wax 4 weeks later showed open fistula. The epithelial lining of the opened treated fistula was observed at 4 weeks after surgery. There was no significant difference in the amount of discharge within the maxillary sinus or the degree of inflammation around the fistula between the treated and the control sides. CONCLUSIONS: The bone wax may be used as a new stent in maintaining a created fistula during dacryocystorhinostomy.
Dacryocystorhinostomy ; Fistula* ; Inflammation ; Maxillary Sinus* ; Nasal Cavity* ; Rabbits* ; Stents

PURPOSE: Benign mixed tumor of the accessory lacrimal gland is a very rare neoplasm, with only one case with presumed origin of Wolfring's gland in domestic literature. We report our experience with a case of a nodular lesion of the lateral lower eyelid which is completely excised and histologically diagnosed as benign mixed tumor from Krause's gland. METHODS: A 68 year-old woman presented with 1 cm-sized subcutaneous mass in right lateral lower eyelid. A hard non-tender movable mass was palpated. After 6 months of observation, the mass was excised through subciliary skin incision. RESULTS: The mass was located deep to the subcutaneous tissue, inferior to lower border of tarsal plate, and was adherent to inferior forniceal conjunctiva. Round 1.2 cm-sized yellow-pink mass was completely excised. Histologic examination showed many glandular elements embedded in a myxoid ground substance, and glandular structures were composed of two layers of inner cuboidal and outer polygonal cell. It was diagnosed as benign mixed tumor from accessory lacrimal gland of Krause. CONCLUSIONS: In any case presenting lower eyelid mass lesion, benign mixed tumor of accessory lacrimal gland should be considered as one of the differential diagnosis.
Aged ; Conjunctiva* ; Diagnosis, Differential ; Eyelids ; Female ; Humans ; Lacrimal Apparatus* ; Skin ; Subcutaneous Tissue

PURPOSE: To investigate the long term survival of orbital fat grafted on a Medpor(R) implant as a method of preventing porous polyethylene orbital implant (Medpor(R)) exposure in anophthalmic sockets. METHODS: In one orbit in each of 8 rabbits, a small amount of retrobulbar orbital fat was grafted between the anterior surface of the Medpor(R) implant and overlying conjunctiva, during the enucleation and Medpor(R) implantation procedure. Two rabbits were sacrificed at 2, 4, 8 and 12 weeks postoperatively and grafted orbital fats were examined by light microscopy. RESULTS: Grafted orbital fat was well-maintained at 2 and 4 weeks, postoperatively. However, fat amounts were significantly reduced at 8 weeks, and viable fat was barely visible at 12 weeks. CONCLUSIONS: In rabbits, orbital fat grafted on Medpor(R) implants was gradually resorbed, and the fat-occupied volume was not maintained.
Time Factors ; Rabbits ; Porosity ; *Polyethylene ; *Orbital Implants ; *Graft Survival ; Follow-Up Studies ; *Biocompatible Materials ; Animals ; Adipose Tissue/cytology/*transplantation

PURPOSE: To investigate the surgical results of an ear cartilage graft and supplemental procedures for correcting lower lid retraction combined with entropion in anophthalmic patients. METHODS: We reviewed retrospectively the medical records of 7 anophthalmic patients with lower lid retraction and entropion, who received a posterior lamellar ear cartilage graft and one or both of lateral tarsal strip or eyelash-everting procedure between March 1998 and March 2003. Preoperative and postoperative lid and socket statuses were also investigated. RESULTS: Ear cartilage grafts were performed in all 7 patients, lateral tarsal strips in 6, and eyelash-everting procedures in 5. Postoperative follow-up durations ranged from 4 to 28 months (average 12.6 months). Retractions were corrected during follow-up in all patients. There were no cases of entropion immediately after surgery. However, the eyelashes of the lower lid returned to an upright position in 4 patients, but not so severe as to touch the ocular prosthesis, and thus did not require surgical correction during follow up. CONCLUSIONS: Lower lid retraction combined with entropion in anophthalmic patients can be corrected effectively using an ear cartilage graft with selective, supplemental procedures.
Retrospective Studies ; Male ; Humans ; Female ; Eyelid Diseases/*etiology/*surgery ; Entropion/*etiology/*surgery ; Ear Cartilages/*transplantation ; Child, Preschool ; Child ; Anophthalmos/*complications ; Adult

PURPOSE: To report the clinical results of implantation of porous polyethylene orbital implant (Medpor(R))after enucleation of eyes in patients with retinoblastoma. METHODS: The medical records of 33 children who had undergone Medpor(R) implantation after enucleation of eyes in patients with retinoblastoma were reviewed retrospectively. RESULTS: Surgery was performed in 33 eyes of 33 patients. The mean age at the time of operation was 24 months (ranged from 2 to 85 months). The mean follow-up period was 20 months (ranged from 12 to 31months). The diameters of the orbital implant used were 18 mm in 20 patients, and 20 mm in 13 patients. All parents were satisfied with the motility and cosmesis of the prosthesis. Exposure of the porous polyethylene orbital implant was found in 11 eyes (33.3%) at the mean postoperative time of 15 months (ranged from 7 to 29 months). The implant exposures in 10 eyes were not responsive to supportive therapy and underwent subconjunctival scleral patch grafts and direct conjunctival closure with success. The small exposure of the remaining eye was spontaneously healed under a careful observation with supportive therapy. CONCLUSIONS: Medpor(R) implantation in children with retinoblastoma showed good surgical results. However, careful follow-up examination is needed due to potential conjunctival pressure erosion and implant exposure. If exposure of the implant does occur, active surgical management is suggested instead of supportive management.
Child ; Follow-Up Studies ; Humans ; Medical Records ; Orbit* ; Orbital Implants* ; Parents ; Polyethylene* ; Prostheses and Implants ; Retinoblastoma* ; Retrospective Studies ; Transplants

PURPOSE: To report the clinical characteristics and treatment outcomes of dural carotid-cavernous sinus fistula (CCF). METHODS: Fifteen cases of dural CCF confirmed with cerebral angiography were retrospectively analyzed. RESULTS: The mean age of onset was 57.2 years. The cases had 12 female patients and 2 bilateral cases. There were 3 diabetes mellitus, 2 hypertension patients and 3 patients with history of trauma. The most common chief complaints were conjunctival injection and exophthalmos. Elevated intraocular pressure (IOP) and corkscrew vessel were the most common ophthalmic findings. On orbital CT, 13 cases other than 2 cases showed dilatation of superior ophthalmic vein. On cerebral angiography, there were 10 Barrow Type D cases, in which the superior ophthalmic vein was the main drainage. Eleven patients were treated with embolization 2.0 (1-5) times per patient on the average. During the follow-up period, 5 cases were complicated with central retinal vein occlusion (CRVO). At the last follow-up, all cases except 1 neovascular glaucoma showed normalized IOP but 1 case had conjunctival injection, 3 had residual exophthalmos, and 1 had cerebral nerve palsy. CONCLUSIONS: The diagnosis of dural CCF should be suspected at a middle-aged woman with conjunctival hyperemia or exophthalmos, and the clinician should be careful about the IOP and CRVO. The embolization, though the success rate of 1 first treatment is not so high, is thought to be the best treatment modality because it is less invasive and it brings the improvement of clinical symptom nearly in all cases.
Age of Onset ; Carotid-Cavernous Sinus Fistula* ; Cerebral Angiography ; Diabetes Mellitus ; Diagnosis ; Dilatation ; Drainage ; Exophthalmos ; Female ; Fistula ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Hyperemia ; Hypertension ; Intraocular Pressure ; Orbit ; Paralysis ; Retinal Vein ; Retrospective Studies ; Veins

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.
Adolescent ; Adult ; Dermoid Cyst/pathology/*surgery ; Female ; Humans ; Intubation ; Lacrimal Apparatus Diseases/pathology/*surgery ; Male ; Middle Aged ; Orbital Neoplasms/pathology/*surgery ; Postoperative Care ; Preoperative Care ; Silicones

PURPOSE: Orbital hematic pseudocyst is the localized accumulation of organized blood-breakdown products within a fibrous capsule, and is known to be typically located subperiosteally. We report a case of orbital hematic pseudocyst in the intraconal space. METHODS: A 51-year-old man visited our clinic, complaining of injection and bruise of his right eye one month before. On the orbit MRI, a mass assumed to be benign was detected in the intraconal space of his right orbit. After several months of follow-up, a decrease of visual acuity and visual field defect were detected in his right eye. Excision of the mass was done through lateral and medial orbitotomy. RESULTS: Histologic examination showed the accumulation of blood-breakdown products within a fibrous capsule, and the mass was diagnosed as a hematic pseudocyst. CONCLUSIONS: When a well-demarcated and slowly growing mass is detected in the intraconal space of the orbit, the possibility of hematic pseudocyst should be considered.
Contusions ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Orbit ; Visual Acuity ; Visual Fields

PURPOSE: To investigate the efficacy of lacrimal silicone intubation for the management of epiphora in patients who have previously undergone anatomically successful dacryocystorhinostomy (DCR). METHODS: The authors recruited 13 patients (4 male, 9 female) who had persistent epiphora after an anatomically successful primary external DCR and conducted lacrimal silicone intubation through the dacryocystorhinostomy site. RESULTS: Mean patient age was 54.2 years (range 42-80) and mean follow-up was 13.8 months (range 6-30). Epiphora was resolved in all 13 patients following silicone intubation. Spontaneous tube extrusion occurred in three patients, but a new one was easily reintubated. CONCLUSIONS: Lacrimal silicone intubation is a simple safe and effective procedure for patients with epiphora even after anatomically successful DCR.
Adult ; Aged ; Aged, 80 and over ; *Dacryocystorhinostomy ; Female ; Follow-Up Studies ; Humans ; Intubation/*instrumentation ; *Lacrimal Apparatus ; Lacrimal Apparatus Diseases/*therapy ; Male ; Middle Aged ; Retrospective Studies ; *Silicone Elastomers ; Time Factors ; Treatment Failure