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Orbit*

The anatomic and physiologic changes of the anopthalmic orbit affect cosmetic appearance of the patient and function of the socket and the prosthesis. During the past three years, the authors studied 13 cases of dermis-fat graft and 27 cases of posterior Tenon's capsule suturing with a plastic implant, and compared the post'operative effects of the two procedures. Dermis-fat graft produced good fornix formation with no remarkable fat atrophy after both primary and secondary proceddure. Posterior Tenon's capsule suture technique showes good effect to keep implant from migration or extrusion. Size of the plastic implant and fixation of the extraocular muscles were important factors also for good cosmesis and implant motility. There revealed no significant difference between the two procedures in EOM motility, enophthalmos, deep superior sulcus deformity, implant migration or prolapse etc.

Fifty-four marginal rotation procedures for cicatrical entropion and marginal entropion were performed in twenty-eight patients (8 males, 20 females). The age ranged from 4 to 74 years old (meant 51.1 years old). After the follow up periods of 6 to 48 months, excellent correction of the eyelid margin and good cosmetic appearance were noticed in most cases, but nine cases combined with severe trichiasis showed recurred trichiasis requiring reoperation.
Entropion ; Eyelids ; Follow-Up Studies ; Humans ; Male ; Reoperation ; Trichiasis

Experimental parotid duct-conjunctivoplasty was carried out using great saphenous vein graft in six dogs. After the operation, the tear meniscus level in the operated eye was higher than that of the control eye. The parotid secretion was noticed through the conjunctival opening of the vein graft in the lower lateral fornix. Profuse tearing was not detected during the time of having meal, which was supposed due to a good lacrimal drainage. In Schirmer test of the operated eye, the preoperative mean value was similar to the postoperative value. But, the intraprandial mean value of Schirmer test was measured as slightly higher than the preprandial value. In paired t-test, no significant difference could be detected. On scintigraphic study with 99mTc-O4, three cases of the four dogs revealed the parotid flow with good patency of the grafted vein. These results suggest that the parotid duct-conjunctivoplasty will be an effective surgery for dry eye syndrome, if the grafted vein could be kept from an obstruction for a prolonged period.
Animals ; Dogs ; Drainage ; Dry Eye Syndromes ; Meals ; Saphenous Vein* ; Transplants* ; Veins

PURPOSE: The preoperative axial length measured by ultrasonography in the phthisis bulbi and the postoperative surgical outcome was evaluated in order to determine the surgical procedure of an evisceration or enucleation. METHODS: The preoperative axial length was measured by ultrasonography in 30 eyes of 30 patients with phthisis bulbi from January 2000 to October 2002. Enucleation was performed on 20 eyes with a relatively short preoperative axial length. The axial length of the enucleated globe was measured and compared with the preoperative axial length. Evisceration was performed in 10 eyes with a relatively long preoperative axial length. The size of the implant, the thickness of prosthesis, and the complications were evaluated postoperatively. RESULTS: In the 20 eyes that underwent enucleation, the preoperative axial length was 6.8~16.6 mm (mean 12.4 mm) and the axial length of the enucleated globes was 9.0~20.0 mm (mean 15.3 mm). The size of implants was 16.5~20.0 mm (mean 19.5 mm). In the 10 eyes that underwent evisceration, the preoperative axial length was 13.5~22.7 mm (mean 19.1 mm). The size of the implants was 18.5~20.0 mm (mean 19.4 mm). During a follow-up period of 6-30 months (mean 16.0 months), none of the eyes showed any complications such as conjunctival dehiscence or implant exposure or extrusion. CONCLUSIONS: The preoperative axial length measurement was helpful in deciding if enucleation or evisceration of the phthisis bulbi should be performed. Evisceration was performed sufficiently in cases of a preoperative axial length of 16 mm or more.
Follow-Up Studies ; Humans ; Prostheses and Implants ; Ultrasonography*

Sixty-five levator aponeurotic surgeries were carried out to treat acquired and congenital blepharoptosis including those with very poor levator function. Margin reflex distance(MRD) was measured and postoperative drooping of the upperlid was observed carefully during the follow-up period of 6 months to 1 year. Most of these cases had a stationary level of MRD or less than 1 mm change of MRD but three cases resulted in more than 1.5 mm postoperative fall of the upperlid. This procedure also proved the excellent surgical efficacy in severe congenital ptosis with very poor levator function. In our experience, about 1 mm overcorrection at surgery provided a more satisfactory result.
Blepharoptosis ; Follow-Up Studies ; Reflex

BACKGROUND: Tandem duplication of chromosome 17p11.2-p12 including peripheral myelin protein 22 (PMP22) gene is the most frequent cause of Charcot-Marie-Tooth 1A (CMT1A). Patients carrying one extra copy of PMP22 develop CMT1A, whereas the deletion of the 17p11.2-p12 region causes hereditary neuropathy with the liability to pressure palsies (HNPP). In the present study, we established the genotyping methods of 6 microsatellite markers (D17S921, D17S9B, D17S9A, D17S4A, D17S918 and D17S122) within the 17p11.2-p12 regions by the hexaplex PCR for the genetic diagnosis of CMT1A duplication and HNPP deletion. METHODS: We established polymorphic behavior and genotyping methods of 6 microsatellite markers (D17S921, D17S9B, D17S9A, D17S4A, D17S918 and D17S122) within the duplication region. The 6 markers were amplified by hexaplex PCR reaction and analyzed by an automatic sequencing analyzer and genotyper program. RESULTS: The genotype distributions of all markers were not significantly deviated from the Hardy-Weinberg equilibrium (P>or=0.05). When comparing the control group and CMT1A, HNPP patients group by the distribution of allele, there is no significant difference in the 5 locus except in the 1 locus (D17S921) among HNPP patients. The specificity was more than 99.9%. The sensitivity of each CMT1 and HNPP was 56.3% (40/71 pedigrees) and 72.1% (31/43 HNPP pedigrees), respectively. CONCLUSIONS: The error rate for the system may be less than 0.001. According to this study, it is possible to have rapid and exact genetic diagnosis of both CMT1A and HNPP, which may be helpful for the development of personalized therapy according to genetic defects.
Alleles ; Charcot-Marie-Tooth Disease ; Diagnosis* ; Genotype ; Humans ; Microsatellite Repeats* ; Multiplex Polymerase Chain Reaction* ; Myelin Sheath ; Paralysis ; Polymerase Chain Reaction ; Sensitivity and Specificity

PURPOSE: To evaluate the effect of mitomycin C (MMC) on osteotomy site as an adjunctive therapeutic agent during dacryocystorhinostomy, the effect of MMC on cultured rabbit osteoblasts was tested. METHODS: Cultured osteoblasts which was obtained from the iliac crest of rabbits, were treated with MMC (0.2 mg/ml) for 5 or 30 minutes, washed and changed with fresh osteogenic media (Opti-MEM), and then cultured for 24 hours. To observe the effect of MMC dose dependency on cultured osteoblasts, four different concentrations of MMC (0.2 mg/ml, 0.02 mg/ml, 0.002 mg/ml, 0.0002 mg/ml) were applied into the cells and cultured for 24 hours. The effect of fibroblast growth factor (FGF) and transforming growth factor-beta(TGF-beta) on the MMC-treated cells was evaluated. In control group, osteoblasts were cultured in osteogenic media without exposure of MMC for 24 hours. Cell viability was measured using trypan blue staining method. RESULTS: As compared with control group, the growth of osteoblasts was inhibited by MMC (0.2 mg/ml) treatment, 30-minute treatment group demonstrated marked suppression twice as much as 5-minute treatment group. Growth rate of 0.2 mg/ml MMC-treated cells was highly suppressed to 7.7% of control and 0.02 mg/ml MMC-treated cells was inhibited to 15.4% in number. Growth rate of 0.002 mg/ml, 0.0002 mg/ml MMC-treated cells was diminished to 53.8%, 84.6% in number, respectively. Both growth factors had promotive effect on the growth of osteoblasts in 0.002 mg/ml MMC-treated cells, especially in TGF-beta. CONCLUSION: Osteoblasts which were treated for longer time and with higher concentration of MMC showed more severe suppression in growth rate. These results suggest that MMC could have some therapeutic effect on osteotomy site of dacryocystorhinostomy.
Cell Survival ; Dacryocystorhinostomy ; Fibroblast Growth Factors ; Intercellular Signaling Peptides and Proteins ; Mitomycin* ; Osteoblasts* ; Osteotomy ; Rabbits ; Transforming Growth Factor beta ; Trypan Blue

Sixteen canaliculoplasties using Mini-Monoka(R) were performed for repair of monocanalicalar lacerations. Mini-Monoka(R) was introduced into the dilated punctum and the proximal canaliculus, and passed through the distal end of the canaliculus. End-to-end anastomosis was done with 9-0 Ethylone(spatula needle) or 6-0 Vicryl(round needle). Fixation suture was placed with 6-0 black silk to secure the head portion of Mini-Monoka(R). Removal of the tube was performed 4 months after surgery. After the follow-up period of 6-14 months(mean 9.3 months), fifteen eyes were successful. One eye had intermittent epiphora with canalicular obstruction due to early loss of the tube. Postoperative complications were one case each of punctal slit, punctal granuloma and corneal erosion. The authors suggest that canaliculoplasty using Mini-Monoka(R) is an ideal procedure for repair of monocanalicular laceration. The advantages of this procedure include 1) no damage of the another intact canaliculus, 2) no passage through the nasal cavity, 3) easy technique, 4) short operation time, 5) less discomf ort and 6) cosmetically well acceptable.
Follow-Up Studies ; Granuloma ; Head ; Lacerations ; Lacrimal Apparatus Diseases ; Nasal Cavity ; Postoperative Complications ; Silk ; Sutures

PURPOSE: To evaluate the effect of intraoperative 0.2 mg/ml mitomycin C application on the success of endonasal dacryocystorhinostomy. METHODS: One hundred patients (121 eyes) were randomly divided into two groups. Group A (50 patients, 59 eyes) was treated with 0.2 mg/ml mitomycin C application during endonasal dacryocystorhinostomy and group B (50 patients, 62 eyes) was operated without application of mitomycin C. In group A, mitomycin C soaked cotton swabs were applied to the osteotomy site for five minutes. The surgical success was defined as either symptom free from epiphora or good passage of syringing. RESULTS: After the follow-up period of 6~24 months (mean 10.2 months), average diameter of mucosal osteum measured 1.17+/-0.52 mm in group A and 1.00+/-0.61 mm in group B. Granuloma around mucosal osteum was noted in 20 eyes of group A and in 31 eyes of group B. Primary success rate was 93.2% in group A and 82.3% in group B. There was no significant difference in mucosal osteum size or success rate between the two groups. CONCLUSIONS: Adjunctive use of intraoperative mitomycin C may be useful to maintain larger osteotomy size and provide better success rate of endonasal dacryocystorhinostomy.
Dacryocystorhinostomy* ; Follow-Up Studies ; Granuloma ; Humans ; Lacrimal Apparatus Diseases ; Mitomycin* ; Osteotomy