Upper and lower eyelid defects of 40-60% can be reconstructed by the Tenzel semicircular flap technique. Lower eyelid defects of 75-80% can be successfully corrected if the lower eyelid retractors and inferior orbital septum are severed from their attachment. This technique provides several distinct advantages. It is useful for reconstruction of both the upper and lower eyelids. It can be accomplished without borrowing tissues from other sites. It provides a length about 1.5 times greater than would be available along the straight line diameter. The indications for the use of this procedure included basal cell carcinoma(4 cases), compound nevus(1 case), post-traumatic eyelid deformity(2 cases). We obtained cosmetically good results in all cases without any senous postoperative complications.

We repaired posttraumatic enophthalmos in three patients by inserting a large silastic block through a transconjunctival approach to the orbit. These blocks were hand carved at the time of surgery to match the bony defects. Satisfying cosmetic and functional results were achieved in all case with good improvement of enophthalmos and hypo-ophthalmos. No significant complications were found. The improvements were stable over a mean follow-up of 8.6 months.
Enophthalmos* ; Follow-Up Studies ; Hand ; Humans ; Orbit

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by the infiltration of the gastrointestinal tract by mature eosinophils, and increased peripheral eosinophil count and associated with various food allergies. Clinical manifestations were related to the site of histologic infiltration in the wall and the segment of the involved gastrointestinal tract. Recently, the authors experienced one case of eosinophilic gastroenteritis of the small bowel with spontaneous rupture that was managed by segmental resection of ileum and end to end anastomosis. Four years previous, he has undergone segmental resection of the ileum due to ileum perforation of unknown etiology. The peripheral blood eosinophil count of this case was normal but the IgE level was elevated. Microscopically, there was a dense infiltration of eosinophils throughout the entire thickness of the ileal wall, particularly in the muscle layer. The patient recovered well, but had one episode of abdominal pain with diarrhea and those symptoms were improved following the administration of corticosteroids. A brief review of the etiology, pathology, clinical features, diagnosis and management of this disease is presented.
Abdominal Pain ; Adrenal Cortex Hormones ; Diagnosis ; Diarrhea ; Eosinophils* ; Food Hypersensitivity ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Ileum ; Immunoglobulin E ; Pathology, Clinical ; Rare Diseases ; Rupture* ; Rupture, Spontaneous

No abstract available.
Anesthesia, Epidural*

Purpose: We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. Methods: We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. Results: The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. Conclusions Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.

Purpose: We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. Conclusions Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

Purpose: We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. Methods: We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. Results: The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. Conclusions Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.

Purpose: We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. Conclusions Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

It is important to understand the acute and chronic complications of prolonged contact lens use; treatment of acute problems is more effective than treatment of chronic reactions because it is difficult to restore corneal tissue. Contact lens-induced acute red eye (CLARE) is an acute inflammatory reaction of the cornea and conjunctiva triggered by contact lenses. CLARE recurrence is common; differential diagnosis from serious eye diseases that can compromise visual acuity is important. CLARE must be appropriately treated and patients must be educated in terms of safe contact lens wearing and storage.

Purpose: We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment. Conclusions Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.