An unusual cause of acquired horizontal diplopia in a young adult.
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Adult↗
Biomedical subjects
C T Choo
Publications and source records attributed to C T Choo.
Integrated hydroxyapatite implant and non-integrated implants in enucleated Asian patients.
INTRODUCTION: This study compares the outcome and complications of integrated hydroxyapatite implant and non-integrated orbital implants following enucleation in Asian patients. MATERIALS AND METHODS: This is a retrospective study of enucleated patients with coralline hydroxyapatite implants versus non-integrated implants (acrylic, glass and silicone) at the Singapore National Eye Centre from January 1991 to December 2000. The outcomes measured were implant migration, extrusion, socket infection, conjunctival dehiscence and implant exposure. Statistical analysis was done using the 2-sample t-test. RESULTS: Twenty-one patients had the hydroxyapatite implant and 38 non-integrated implants (27 acrylic, 9 glass and 2 silicone). The mean duration of follow-up was 2.7 years and 4 years for the hydroxyapatite implant and non-integrated implants respectively. Three patients with pre-existing severe socket contracture before enucleation surgeries were excluded from the study. Four cases of implant migration, 4 cases of implant extrusion and 3 cases of socket infection were encountered; all were sockets fitted with non-integrated implants. There was a higher rate of conjunctival dehiscence for sockets with hydroxyapatite implants (6 out of 21) compared to sockets with non-integrated implants (3 out of 35). This was statistically significant (P = 0.048). CONCLUSIONS: Implant complications of migration, extrusion and socket infection were found in non-integrated implants and none in coralline hydroxyapatite implants, which had a significantly higher rate of conjunctival dehiscence. Most of these were easily managed with only a small number progressing to implant exposure.
Adult↗
Congenital upper lid colobomas: management and visual outcome.
PURPOSE: Congenital upper lid colobomas may be associated with ocular and systemic anomalies. The ophthalmologist's role involves both the diagnosis and management of their various ocular structural defects and management of the visual development. METHODS: All cases of congenital eyelid colobomas referred to the Singapore National Eye Centre between July 1992 and July 1995 were assessed for the extent of the eyelid defect, associated ocular anomalies, status of the cornea, and any systemic anomalies. RESULTS: Four infants were tested during this period. The mean follow-up was 25 months (range, 16 to 30 months). All required surgical correction of their eyelid defects before 2 years of age. The patients also had refractive errors requiring amblyopia management. Three of the babies also needed other surgical procedures. CONCLUSIONS: Congenital upper eyelid colobomas are a potential threat to vision at an early age and a significant cosmetic blemish later in life. Early surgical intervention is usually required when the defect is larger than one third of the eyelid margin. Close monitoring of the visual development of patients with congenital upper eyelid colobomas is also essential since the risk of amblyopia in these patients is high.
Coloboma↗
Lacrimal sac tumour presenting with blood-stained ocular discharge.
Malignant epithelial tumours of the lacrimal sac are uncommon. They can mimic chronic dacryocystitis or dacryostenosis to cause a delay in diagnosis. The presence of a medial canthal lump with blood-stained ocular discharge should arouse the suspicion of this diagnosis. The prognosis of lacrimal sac tumour is often guarded especially following tumour recurrence after incomplete resection. We report a patient with squamous cell carcinoma of the lacrimal sac to highlight its presentation and clinical course.
Adult↗
An unusual orbital bone lesion.
A case of Langerhans cell histiocytosis involving the left orbital ridge in an 11-year-old girl is reported. The clinical presentation, radiologic findings and histopathological features as well as diagnostic criteria for Langerhans cell histiocytosis are reviewed.
Child↗
Graves' ophthalmopathy in the absence of elevated free thyroxine and triiodothyronine levels: prevalence, natural history, and thyrotropin receptor antibody levels.
The aims of this study were to (a) determine the prevalence of patients without elevated thyroid hormone levels in Graves' ophthalmopathy (GO) using current generation free thyroid hormone assays, (b) measure the prevalence of thyrotropin receptor antibodies (TRAb) in these cases, and (c) identify possible predictors of hyperthyroidism. Over a 30-month period, 1020 cases of thyroid eye disease were evaluated, of which only 19 (1.9%) met the diagnostic criteria. Ten (1%) had subclinical thyrotoxicosis, 7 (0.7%) were euthyroid, and 2 (0.2%) were hypothyroid as determined by a third-generation thyrotropin (TSH) assay. TRAb levels were measured in 16 of these 19 patients. The prevalence of TRAb varied according to the assay used. Polyethylene glycol-extracted thyroid-stimulating immunoglobulin (PEG-TSI), unfractionated thyroid-stimulating immunoglobulin (uTSI), first-generation porcine TSH-binding inhibitory immunoglobulin (pTBII), and second-generation human TSH-binding inhibitory immunoglobulin (hTBII) assays were positive in 93.8%, 50%, 18.8%, and 81.3% of patients, respectively. TRAb was detected by at least one method in all patients. Patients were followed up for 15 to 45 months. Hyperthyroidism developed in 4 patients (25%). Suppressed TSH levels and elevated TBII were predictors of hyperthyroidism. When sensitive assays are used, the prevalence of GO patients without elevated thyroid hormone levels is extremely low. The sensitivities of assays for TRAb detection differ substantially in these cases. PEG extraction improves the detection rate of TSI (p = 0.02), and hTBII assays improve the detection of TBII in these patients (p = 0.002). The high prevalence of TRAb in such cases supports a role for these antibodies in the pathogenesis of thyroid-associated eye disease.
Adolescent↗
The correction of oriental lower lid involutional entropion using the combined procedure.
INTRODUCTION: Involutional entropion is a common lid malposition problem in the Chinese geriatric population. The major contributing factors of involutional entropion include disinsertion of the lower lid retractors and horizontal lid laxity. The combined procedure (lower lid retractor repair and lateral tarsal strip procedure) is a useful technique that tackles both the horizontal and vertical aetiologic components of this condition. The surgical technique of this procedure is described and the results and complications presented. MATERIALS AND METHODS: A retrospective non-randomised study on 41 lower eyelids of 38 Chinese patients. The combined procedure was performed by a single surgeon over a 2 years 11 months period. Nine patients had bilateral lid surgeries. The clinical charts and operative notes were reviewed by an observer. RESULTS: The mean age of the patients was 74.7 years (range 51 to 92 years). There were 14 males (36.8%) and 24 females (63.2%). The cases were followed up postoperatively for a mean duration of 13 months (range 3 to 48 months). Twelve lids had early postoperative overcorrection but the majority (8 lids) resolved spontaneously with good lid-globe apposition. Of the remaining 4 eyelids, 3 lids had persistent mild asymptomatic ectropion that did not require surgical treatment and only one required re-operation. CONCLUSION: The combined procedure is an effective means of repair for oriental lower lid entropion with low complication rates.
Age Factors↗
High-pressure paint gun injury to the orbit and ocular adnexa.
High-pressure injection injury to the orbit and adnexa is a rare but potentially blinding type of trauma. Few cases of such injury have been reported in the literature. A 27-year-old Indian man accidentally injected paint material from a high-pressure nozzle gun into his left eye. Radiological investigation revealed the presence of paint material in the orbital tissues and the ethmoidal sinuses. The patient underwent two orbital surgeries to remove the paint material. He later developed signs suggestive of limbal stem cell failure and was treated with limbal stem cell autografting. He also has ophthalmoplegia with a compensatory anomalous head posture that was managed conservatively. We report the clinical course and outcome of this unfortunate patient to highlight the complexity of such an injury and the need for a multidisciplinary approach in its management.
Adult↗
Surgical management of upper lid epiblepharon.
BACKGROUND: Upper lid epiblepharon refers to a developmental anomaly characterised by the presence of an exaggerated skin fold running horizontally across the upper lid below the lid margin, which in severe cases is associated with lash-cornea touch or even corneal punctate epithelial erosions. METHOD: This retrospective study looked at 14 patients who underwent bilateral upper lid pretarsal orbicularis debulking and skin excision to correct lash-globe contact from the upper lid. RESULTS: Surgery was successful in 25 of 28 lids, with one recurrence being successfully re-operated. The remaining 2 recurrences did not undergo further surgery as the patients were asymptomatic. CONCLUSION: This surgical procedure appears to be an effective treatment of lash inversion in upper lid epiblepharon with good aesthetic results.
Adolescent↗
Using the phacoemulsification crescent knife in dacryocystorhinostomy.
Dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Most techniques employ a conventional blade or knife in making the incision of the nasal mucosa and lacrimal sac. The authors describe the use of a phacoemulsification crescent knife for this purpose. This technique can be effective and at the same time safer and easier to perform.
Dacryocystorhinostomy↗
The use of sodium hyaluronate as a lubricant in brow suspension ptosis surgery using polyester fiber mesh.
Polyester fiber is used as an alternative to autologous fascia lata for brow suspension ptosis surgery. The authors found it difficult to pass the polyester compound through the submuscular plane during brow suspension surgery. They used sodium hyaluronate as a lubricant to aid the passage of polyester fiber mesh. In 14 cases of brow suspension surgery with polyester fiber mesh, the authors found sodium hyaluronate to be useful in reducing tissue resistance and without untoward effect.
Blepharoptosis↗
Burkitt lymphoma manifesting as acute proptosis.
PURPOSE: To describe an unusual case of Burkitt lymphoma manifesting as acute proptosis and simulating orbital inflammatory disease. METHODS: Case report. RESULTS: A 24-year-old Chinese man developed painful severe nonaxial proptosis in his left eye during 1 day. Computed tomographic scan disclosed an orbital mass that was shown to be Burkitt lymphoma when biopsy was performed. The disease progressed rapidly despite chemotherapy. CONCLUSIONS: Our case supports the fact that Burkitt lymphoma can manifest as acute proptosis and expands the spectrum of clinical presentation of Burkitt lymphoma.
Acute Disease↗
Orbital metastasis from carcinoma of cervix.
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Carcinoma, Squamous Cell↗
Hydroxyapatite orbital implants--our local experience.
Hydroxyapatite orbital implants were first introduced by Arthur Perry in 1985 and approved by the Food and Drug Administration for general use in 1989. Since its inception, it has become a popular orbital implant as it combines biocompatibility with improved motility. At the Singapore National Eye Centre, twenty consecutive patients underwent hydroxyapatite implantation from June 1993 to June 1996. Seventeen patients who had a follow-up time of more than 6 months were analysed retrospectively. Sixteen had enucleation while one had evisceration performed. The implant size used was either 18 or 20 mm. Seven primary and 10 secondary hydroxyapatite implants were performed in 17 patients ranging in age from 20 to 65 years. Six consisted of coralline hydroxyapatite while the remaining 11 were made of artificial hydroxyapatite. In the follow-up time of 6 to 16 months (mean 10.2 months), there have been no cases of infection, extrusion or migration. Two patients who had implant exposure were managed surgically with fascia lata grafts and have healed well. It appears that hydroxyapatite is the implant of choice for an anophthalmic socket. It becomes incorporated by the patients own tissues and once vascularised, it is less likely to migrate or extrude. The complication rate is low and implant exposure, if it occurs, can be easily managed.
Adult↗
Lacrimal gland amyloidosis.
Primary localized lacrimal gland amyloidosis is an extremely rare occurrence. The typical clinical and radiologic appearances have been suggested but not clearly established. This report describes two patients with amyloid tumor of the lacrimal gland. Both patients were middle-aged women of Asian origin, one a Chinese with unilateral lacrimal gland swelling and the other, a Malay with bilateral lacrimal gland swelling. Neither patient had associated systemic disease. They were otherwise asymptomatic except for prominence over the lacrimal gland region. Neither visual impairment nor evidence of optic nerve dysfunction was noted in either patient. CT findings mimic that of an inflammatory or lymphoproliferative disorder of the lacrimal gland. The diagnosis of amyloidosis was only proved on histology. Further investigations revealed that the disease process was truly localized and not part of a systemic process. Subsequent observation proved no recurrence.
Adult↗