Lens subluxation: 10-years' experience at Chang Gung Memorial Hospital, Kaohsiung

BACKGROUND

This study aimed to describe the clinical manifestations and surgical outcomes of subluxated lens.

METHODS

Reviewing charts from January 1991 to June 2000, we studied 110 patients (123 eyes) who had lens subluxation at Chang Gung Memorial Hospital, Kaohsiung. For 21 eyes, patients accepted conservative treatment, and 102 eyes underwent surgery (8 eyes had Marfan syndrome; 18 eyes had idiopathic dislocation; and 76 eyes had experienced trauma). Indications of surgery included reduction in visual acuity, uncorrectable refractive error, and secondary glaucoma.

RESULTS

There were 81 male and 29 female patients. Their mean age was 47.6 years (range, 2-76 years). The mean post-operative follow-up period was 22.24 months (range, 2-118 months). In spite of the different lens statuses, similar visual results were found between the surgical treatment group and the nonsurgery group. In the surgery group, 47 eyes (46.1%) achieved best corrected visual acuity (BCVA) of 20/40 or better. A total of 80 eyes (78.4%) achieved an improvement (log MAR change >0.3) in BCVA. The major postoperative complications included glaucoma (11 eyes), retinal detachment (9 eyes) and intraocular lens dislocation into the vitreous cavity (3 eyes).

CONCLUSIONS

Results indicate that the presence of a subluxated lens alone is not an absolute indication for surgical removal. The lens status had no significant influence on surgical outcome. Most cases can achieve an improvement in BCVA after appropriate management.

Orbital epithelial cyst derived from the lacrimal sac

We describe a 32-year-old female who presented with a painless, moderately hard mass in the left inferior medial canthal region which had been present for about 6 years. She suffered from epiphora in the left eye in that time. The nasolacrimal system was completely patent on irrigation. Computed tomography showed a nodular mass with a diameter measuring about 25 mm located over the upper portion of the left lacrimal sac. The lesion was found to be a cyst located separately with close proximity to the lacrimal sac via anterior orbitotomy. Histopathologic examination revealed a cystic cavity lined by columnar to cuboidal epithelium consistent with a cyst derived from lacrimal sac epithelium. The patient has remained free of symptoms with a patent lacrimal system during the follow-up period of 1 year, without recurrence of the lesion. Orbital cysts of lacrimal sac derivation should be considered in the diagnosis of medial orbital tumors. Careful evaluation clinically with imaging studies and planning surgery constituted adequate therapy in this case.

Management of choroidal melanomas with linear accelerator-based stereotactic radiosurgery

PURPOSE

To discuss the technical aspect, dose prescription, clinical results, and biological responsiveness of linear accelerator-based stereotactic radiosurgery for choroidal melanoma.

METHODS

From March 1995 to December 1995, three choroidal melanoma patients were treated with Linac-based radiosurgery in our department. Two patients underwent one dose of radiosurgery with 18 and 20 Gy in single fraction, respectively. The third patient received two doses of radiosurgery with a total dose of 35 Gy.

RESULTS

Follow-up time ranged from 19 to 25 months (median: 24 months). One patient had near-total regression, while the other two patients had partial response on the last MR images. Visual acuity was deteriorated in all patients. One patient developed a radiation-induced cataract in the treated eye.

CONCLUSION

Linac-based radiosurgery is technically feasible for management of choroidal melanoma. Although visual acuity was not improved in these patients, they appreciated the preserving of the eyeball without affecting their general appearance.