A clinical analysis of bilateral orbital fracture.

Although bilateral orbital fracture can cause serious eyeball and facial skeletal problems, few reports have been issued on the topic. We analyzed the clinical features of bilateral orbital fracture by reviewing the medical records of 147 patients and compared bilateral and unilateral fractures by reviewing the literature.Bilateral orbital fracture was most common in men aged between 50 and 59 years. A traffic accident was the leading cause of trauma, and average time between trauma and surgery was 12.2 days. Bilateral medial fracture accompanied by nasal fracture accounted for the overwhelming majority, and impure blowout fracture in at least 1 eye occurred in 69.4% of the 147 patients. Associated ocular injuries seemed to be similar for bilateral and unilateral fracture. Thirty-five patients (23.8%) had other multiple traumas affecting other than the eyes, and this significantly increased the need for surgery (P < 0.05). Of the 48 patients who underwent surgery, including 4 cases of bilateral surgery, 21 patients who had ocular motility restriction with central diplopia within 30 degrees almost completely recovered. No significant relation between the timing of surgery and improvement was found. Although unilateral surgery was performed in most cases, facial asymmetry related to enophthalmos was unclear at 6 months postoperatively.In summary, bilateral orbital fracture was found to be clinically distinguishable from unilateral fracture in several aspects. We hope these findings provide a reference guide to the approach and management of bilateral orbital fracture.

Metastatic renal cell carcinoma to the orbit and the ethmoid sinus.

The orbit is an unusual site for metastatic renal cell carcinoma (RCC), and concurrent metastases of RCC to the ethmoid sinus and the orbit occur very rarely. The treatment goal of orbital and paranasal metastatic RCC is total exenteration. We report a rare case of metastatic RCC to the orbit and the ethmoid sinus. The patient underwent total exenteration, craniotomy, and total maxillectomy. Six years after surgery, the patient showed no sign of metastasis and had successful cosmetic result by using orbital prosthesis.

Temporary unilateral neurogenic blepharoptosis after orbital medial wall reconstruction: 3 cases.

PURPOSE: We report 3 cases of unilateral blepharoptosis after orbital medial wall reconstruction and describe the cause and clinical outcome. METHODS: Observational case series. RESULTS: Three previously healthy patients underwent reconstruction for orbital medial wall fracture. All 3 patients had complete unilateral upper eyelid ptosis with no levator palpebrae superioris muscle function immediately after their recovery from anesthesia. Additional findings included minimal eyelid ecchymosis, eyelid edema and subconjunctival hemorrhage, which all presented preoperatively. All 3 patients had full conjugated ocular motility in the entire field of gaze and no anisocoria. With oral steroid therapy, all 3 patients recovered completely with normal symmetric lid height and levator function within 1 month. CONCLUSION: Isolated neurogenic blepharoptosis after medial orbital wall reconstruction is a rare but favorable disease that may result from ischemic damage at the end portion of the superior branch of the oculomotor nerve in the orbit. High-dose steroid therapy early in the course of the disease was effective, and complete resolution was achieved within 1 month.

Choroidal ischemia and serous macular detachment associated with severe postoperative pain.

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

Cataract and refractive surgery in ; a survey of KSCRS members from 1995~2006.

PURPOSE: This purpose of this report was to study trends in cataract and refractive surgeries conducted during the past twelve years and to compare results to previous reports from the ASCRS and New Zealand (NZ) in order to forecast future medical services. METHODS: We surveyed members of the Korean Society of Cataract and Refractive Surgery (KSCRS) every year from 1995 to 2006, and studied changes in cataract and refractive surgeries (RS). RESULTS: The duration of hospitalization has been gradually decreasing to the point that a one day hospitalization following surgery has become common. The rate of topical anesthesia use has significantly increased since 1998. Sutureless incision methods are now commonly practiced. The use of acryl IOL as an optic material has been gradually increasing for cataract surgeries. KSCRS members showed an interest in the special intraocular lenses as multifocal IOL. While Excimer laser PRK was the most popular refractive surgery during the first stage, KSCRS members increasingly prefer LASIK to the Excimer laser PRK. Regression of the corrected visual acuity, dry eye, night halo, and flashes were the most common complications following refractive surgeries. Medical disputes related to PRK and LASIK have been gradually increasing throughout the study period. CONCLUSIONS: We confirm that the KSCRS practice styles for cataract and RS are similar to those of the ASCRS and NZ. We infer a world-wide trend from the comparison of these three societies.