Endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor.

The indications for and timing of surgical treatment of blowout fractures of the orbital floor remain controversial. We report good results with the endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor in the early stage after trauma in a consecutive series of 29 patients treated over the last 3 years, based on the following criteria: 1) diplopia observed by ophthalmological examination, 2) entrapment of intraorbital tissue at the fracture site on diagnostic imaging, mainly using CT scans, and 3) no improvement of diplopia during the acute phase (within one week of injury). Even in the presence of eyelid swelling, this method allows reduction and fixation of the fracture and impacted tissues simply and in a short time. Disappearance of diplopia was reported by 27 patients (93 %) within three months after surgery, and all 20 patients with enophthalmos were cured. There were only 4 cases with transient minor operative complications. Re-entrapment at the fracture site or relapse of symptoms was not seen during follow-up for 5 to 39 months (mean: 23.4 months). The combination of endoscopic transmaxillary reduction and the balloon technique for blowout fractures of the orbital floor is an effective and minimally invasive treatment with a high rate of improvement, not just for disturbances of ocular movement, but also for enophthalmos, which is often a problem in the long term.

[The postoperative change of depth of anterior chamber, refraction and anterior capsulorhexis size after intraocular lens implantation].

We evaluated postoperative shrinkage of anterior capsule, depth of anterior chamber, and refraction in 161 eyes, on which we performed continuous curvilinear capsulorhexis and phacoemulsification, and then implanted an intraocular lens in the capsular bag. We measured the depth of anterior chamber, anterior capsulorhexis size, contact surface with intraocular lens, and quantity and rate of anterior capsular shrinkage on the basis of anterior segment photographs before the operation, and 1 week, 1 month, and 3 months after the operation. After operation the depth of the anterior chamber deepened gradually, anterior capsulorhexis size narrowed, and refraction tended to hyperopia. There was a correlation in anterior chamber depth and anterior capsulorhexis size between preoperative and postoperative values but no correlation in refraction. The depth of the anterior chamber was dependent on the degree of anterior capsular shrinkage. There was a correlation between the depth of anterior chamber and the degree of anterior capsular shrinkage.

Retinal detachment associated with atopic dermatitis.

BACKGROUND: Retinal detachment associated with atopic dermatitis, one of the most common forms of dermatitis in Japan, has markedly increased in Japan in the past 10 years. To clarify pathogenic mechanisms of retinal detachment in such cases, we retrospectively studied clinical characteristics of retinal detachment associated with atopic dermatitis. METHODS: We examined the records of 80 patients (89 eyes) who had retinal detachment associated with atopic dermatitis. The patients were classified into three groups according to lens status: group A, eyes with clear lenses (40 eyes); group B, eyes with cataract (38 eyes), and group C, aphakic or pseudophakic eyes (11 eyes). RESULTS: No significant differences were noted in the ratio of males to females, age distribution, refractive error, or characteristic of retinal detachment among the three groups. The types of retinal breaks, however, were different in eyes with and without lens changes. While atrophic holes were dominant in group A, retinal dialysis was mainly seen in groups B and C. CONCLUSION: These findings suggested that anterior vitreoretinal traction may play an important role in the pathogenesis of retinal breaks in eyes with atopic cataract and that the same pathological process may affect the formation of cataract and tractional retinal breaks in patients with atopic dermatitis.