Spontaneous Rupture of Lacrimal Gland Pleomorphic Adenoma: Pivotal Role in Masquerading Orbital Cellulitis.

The authors aim to report a 68-year-old patient presenting with acute swelling and redness of orbital area diagnosed initially as orbital cellulitis. Surgical excision was decided based on clinical and imaging findings with the diagnosis of pleomorphic adenoma of the lacrimal gland. Lacrimal gland pleomorphic adenoma usually presents with painless gradual swelling of upper eyelid. In an exceptionally rare circumstance, this case showed acute orbital inflammation, and imaging findings of orbital inflammation mostly focused around the cystic space of the lacrimal gland tumor. Histologic evaluation confirmed a ruptured cystic space of pleomorphic adenoma with foreign body-type inflammatory reaction. The authors propose spontaneous rupture of cystic space in the lacrimal gland pleomorphic adenoma as underlying mechanism for acute presentation of this tumor. Imaging and clinical characteristics and also prognostic implication of this phenomenon are discussed.

Comparison of the exposure rate of wrapped hydroxyapatite (Bio-Eye) versus unwrapped porous polyethylene (Medpor) orbital implants in enucleated patients.

PURPOSE: To compare the exposure rate of wrapped hydroxyapatite versus unwrapped porous polyethylene orbital implants in enucleated patients. METHODS: Medical records of the patients who underwent primary placement of hydroxyapatite (Bio-Eye) or porous polyethylene (Medpor) orbital implants after enucleation between 2002 and 2005 in Farabi Eye Hospital were reviewed, and the occurrence of implant exposure during follow-up visits was recorded. The exclusion criteria were secondary implantation, evisceration, or follow up of less than 1 year unless the exposure had occurred in the year after surgery. In the hydroxyapatite group, the implants were wrapped either in Mersilene mesh (65%) or in donor sclera (35%). Wrapping was not performed for any patient in the porous polyethylene group. RESULTS: A total of 198 cases with hydroxyapatite and 53 cases with porous polyethylene implant were identified. The most common causes of enucleation in both groups were globe trauma and painful blind eye. Rate of exposure was significantly higher [odds ratio (OR) = 7.97, p < 0.001] in patients with porous polyethylene (34.0%) than in those with hydroxyapatite implant (6.1%). This association remained significant after adjustment for potential confounders. Mean time of exposure after surgery was significantly (p < 0.001) longer in patients with porous polyethylene implant. Kaplan-Meier plots depicted a significantly (p < 0.001) higher rate of exposure in patients with porous polyethylene implant during the follow-up time. CONCLUSION: Unwrapped porous polyethylene implants demonstrated a higher rate of exposure, and longer time interval to exposure, compared with wrapped hydroxyapatite implants.

Initial nasolacrimal duct probing in children under age 5: cure rate and factors affecting success.

AIMS: To evaluate the success rate of initial probing and the factors affecting the success rate for congenital nasolacrimal duct obstruction (CNLDO)in children under the age of 5 years. METHODS: In a prospective uncontrolled interventional case series, 207 eyes from 161 consecutive patients with CNLDO underwent nasolacrimal duct probing under brief general anesthesia. Based on exclusion criteria, 180 eyes from 139 patients were included in the study. Diagnoses were made according to the patients' histories, clinical examinations, and modified dye disappearance tests. The state of the punctum, the canaliculus, the sac, and the nasolacrimal duct were recorded. The main outcome measure was the complete disappearance of tearing and discharge in the affected eye. The patients were followed at 1 week, 1 month, and 3 months postoperatively. RESULTS: The age range was 5 to 60 months (mean, 19.1 +/- 11.2 months). The cure rates were 92% in the first year, 84.5% in the second year, 65% in the third year, and 63.5 in the fourth and fifth years of age. The patient's age, nonmemberanous CNLDO, and canalicular stenosis were correlated with the success of initial nasolacrimal duct probing (P <.05). CONCLUSIONS: Based on the results, simplicity of probing, and absence of significant complications, initial nasolacrimal duct probing is advised up to the age of 5 years. Increasing age, nonmembranous CNLDO, and canalicular stenosis increase the failure rate (P <.05).

Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants.

PURPOSE: To compare Mersilene mesh versus sclera in wrapping hydroxyapatite orbital implants used in primary enucleation. METHODS: In a prospective, randomized, interventional comparative case series, 60 eyes from 60 consecutive patients were included and randomly allocated for primary enucleation and either Mersilene mesh-wrapped hydroxyapatite (MHA) orbital implant (30 cases, 50%) or sclera-wrapped hydroxyapatite (SHA) orbital implant (30 cases, 50%) under general anesthesia. Complete socket examination was performed at 1 week, 1 month, and then every 3 months after surgery. RESULTS: Mean age was not significantly different (P = 0.08) between patients with MHA (36.43 years) and SHA (28.50 years) orbital implants. The most common cause of enucleation was trauma in both groups (P = 0.09). Patients with MHA had significantly (P = 0.005) longer follow-up time (mean, 11.40 months) than those with SHA (mean, 9.40 months). No exposure was found at last follow-up in the MHA group, but one patient in the SHA group had a small exposure (1 x 1 mm) 1 month after surgery that was conservatively treated. There were no significant postoperative soft tissue complications in either group. CONCLUSIONS: Sclera and Mersilene mesh could be used as a wrapping material for hydroxyapatite orbital implants without significant complications. Absence of disease transmission, low cost, and availability are the main advantages of Mersilene mesh.