Showing papers in "Ophthalmic Plastic and Reconstructive Surgery in 2003"
TL;DR: The measurement of orbital volume in patients with BOF can be used to predict the degree ofLate enophthalmos and use of the orbital volume increment to determine the amount of implant material can improve the therapeutic outcome in the correction of late enphthalmos caused by BOF.
Abstract: PurposeTo evaluate the use of computer-assisted volumetric measurement for the prediction of late enophthalmos and for volume estimation of implant material in the correction of late enophthalmos secondary to orbital blowout fractures (BOF).MethodsThis is a prospective observational study of 16 pati
153 citations
TL;DR: After levator advancement for acquired good-function blepharoptosis, 77% of patients had ideal results and 8.7% underwent reoperation, whereas levator function and Herring dependence were not and no differences were seen between desired and overcorrected groups.
Abstract: Purpose: To evaluate, in patients with acquired good-function blepharoptosis, levator advancement success and surgical failure risk factors. Methods: This retrospective, case-cohort study was university based. An estimated 828 patients underwent levator advancement for acquired good-function blepharoptosis between January 1, 1990, and December 31, 1999. Seventy-two patients underwent reoperation during the first postoperative year. Of 125 randomly selected patients not undergoing reoperation, 106 met the desired outcome criteria: postoperative margin reflex distance (MRD) ≥2.0 mm and ≤4.5 mm in operated eyes and ≤1.0 mm asymmetry between eyelids. Mean MRD, levator function, and Hering dependence (ipsilateral eyelid elevation exacerbating contralateral blepharoptosis) prevalence were determined for reoperated and desired-outcome groups and compared by using 2-sample t test and the Fisher exact test, respectively. Multivariate analysis was also performed. Results: Reoperative rates were 8.7% overall, 5.2% of unilateral, and 13% of bilateral cases. Fourteen percent of patients had results outside the desired range but declined reoperation. Univariate analysis revealed significant differences in preoperative characteristics between desired and undercorrected groups: MRD, 1.0 versus 0.32 mm (p=0.001); levator function, 15.4 versus 14.7 mm (p=0.013); and Hering dependence, 50% versus 79% (p=0.005). With multivariate analysis, bilateral blepharoptosis was statistically significant (p=0.014), whereas levator function and Herring dependence were not. No differences were seen between desired and overcorrected groups. Conclusions: After levator advancement for acquired good-function blepharoptosis, 77% of patients had ideal results and 8.7% underwent reoperation. Patients with bilateral or severe blepharoptosis have increased risk of undercorrection.
124 citations
TL;DR: Nongranulomatous inflammation consistent with chronic dacryocystitis is the most common diagnosis in lacrimal sac specimens obtained at DCR, and pathologic examination of DCR specimens are recommended.
Abstract: PurposeTo retrospectively review the pathologic diagnoses and clinical characteristics of patients undergoing dacryocystorhinostomy (DCR).MethodsSpecimens accessioned between 1991 and 2001 in a single ophthalmic pathology laboratory were reviewed. All of the specimens included a lacrimal sac biopsy
123 citations
TL;DR: A retrospective, interventional, noncomparative case series of consecutive cases of PP implant placement after anophthalmic socket surgery performed by three surgeons revealed no significant difference in exposure rate between wrapped and unwrapped PP sphere implants, nor was the exposure rate affected by whether an eye was eviscerated or enucleated.
Abstract: PurposeTo evaluate complications and risk factors associated with the placement of wrapped and unwrapped porous polyethylene (PP) spherical implants after evisceration, enucleation, or secondary implantation.MethodsA retrospective, interventional, noncomparative case series of consecutive cases of P
116 citations
TL;DR: Balanced medial and lateral wall decompression combined with orbital fat removal provides an effective reduction in proptosis and reduces the incidence of postoperative permanent diplopia when compared with 3-wall decompression.
Abstract: PurposeTo compare the reduction of proptosis and the incidence of new-onset diplopia after 3-wall (medial, lateral, and inferior) orbital decompression versus balanced medial and lateral wall decompression combined with orbital fat excision in patients with Graves ophthalmopathy.MethodsThree-wall or
109 citations
TL;DR: In this article, the authors compared graft contraction rates of acellular dermis versus hard palate mucosa when used as free spacer grafts in lower eyelid surgery and provided clinical outcome data.
Abstract: PurposeTo compare graft contraction rates of acellular dermis versus hard palate mucosa when used as free spacer grafts in lower eyelid surgery and to provide clinical outcome data.MethodsA prospective, nonrandomized clinical trial involving the placement of 19 spacer grafts in the lower eyelids of
100 citations
TL;DR: The Bioceramic orbital implant represents an alternative porous orbital implant that is biocompatible with orbital tissues, easy to manufacture, structurally strong, and less expensive than other commercially available porous orbital implants (e.g., Bio-Eye hydroxyapatite implant).
Abstract: PurposeTo assess the problems associated with the Bioceramic (Aluminum oxide, Al2O3) orbital implant.MethodsA consecutive case series of 107 patients receiving a Bioceramic orbital implant by two surgeons over a 3-year period were reviewed. The authors analyzed patient age, type of surgery, size of
81 citations
TL;DR: The surgical planning for orbital exenteration should take into account the location, extent, and biological behavior of the orbital disease process and the reconstructive and prosthetic options for the exenterated socket.
Abstract: Purpose The authors report and evaluate their experience with an individualized approach to orbital exenteration. Methods Retrospective chart review was performed on a consecutive series of 25 orbital exenteration patients at a tertiary care center. The cases were classified into two groups for the retrospective analysis: Total exenteration procedures involved the removal of the entire orbital contents including the periorbita (13 cases), and subtotal procedures preserved at least a quadrant of the orbit or the orbital tissues posterior to the globe (12 cases). Results The total exenteration group had a lower rate of clear surgical margins and a higher rate of systemic metastasis, whereas patients in the subtotal exenteration group had fewer surgical complications and better functional and aesthetic results. Conclusions The surgical planning for orbital exenteration should take into account the location, extent, and biological behavior of the orbital disease process and the reconstructive and prosthetic options for the exenterated socket. When an individualized approach to orbital exenteration is used, subtotal procedures can offer improved functional and aesthetic results while still maximizing the chances for a surgical cure.
80 citations
TL;DR: Based on preliminary observations, plaque radiotherapy appears to be a reasonable alternative to exenteration and external irradiation for selected orbital malignancies.
Abstract: PurposeTo describe the principles and preliminary results of plaque brachytherapy for selected orbital malignancies.MethodsA custom-designed Iodine-125 plaque, designed to deliver a target dose of 50 Gray, was placed surgically in the region from which an orbital malignancy was partially resected. T
69 citations
TL;DR: Orbital XG is a proliferative lesion of the non-Langerhans histiocytes, which may present as a solitary orbital lesion or may be associated with a systemic condition known as E-Cd with very poor prognosis.
Abstract: PurposeTo describe the clinical and morphologic features of patients with orbital xanthogranuloma (XG) with or without Erdheim-Chester disease (E-Cd).MethodsRetrospective, noncomparative case series. A review of 8 consecutive histopathologically proven cases of orbital XG from 3 medical centers. Fou
61 citations
TL;DR: Objective assessment of prosthetic motility shows a significant increase in horizontal gaze after motility peg placement, which is similar to that shown in pegged versus unpegged orbital implants.
Abstract: PurposeTo objectively measure and compare prosthetic motility in pegged versus unpegged orbital implants and to determine subjective patient assessment of motility after the pegging procedure.MethodsA prospective case series of 10 patients with integrated porous orbital implants, who had secondary m
TL;DR: Medial rectus muscle injury as a complication of FESS can vary markedly and proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment.
Abstract: Objective: To characterize and evaluate treatment options for medial rectus muscle (MR) injury associated with functional endoscopic sinus surgery (FESS). Design: Retrospective interventional case series Participants: A total of 30 cases were gathered from 10 centers. Methods: Cases of orbital MR injury associated with FESS surgery were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) through an e-mail discussion group. Main Outcome Measures: Variables assessed included patient demographics, computerized tomography and operative findings, extent of MR injury and entrapment, secondary orbital/ocular injuries, initial and final ocular alignment and ductions, and interventions. Results: A spectrum of MR injury ranging from simple contusion to complete MR transection, with and without entrapment, was observed. Four general patterns of presentation and corresponding injury were categorized. Conclusions: Medial rectus muscle injury as a complication of FESS can vary markedly. Proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment. Patients with severe MR disruption can benefit from intervention but continue to show persistent limitation of ocular motility and functional impairment. Prevention and early recognition and treatment of these injuries are emphasized.
TL;DR: Polyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants because it is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials.
Abstract: PurposeTo report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.)MethodsWe retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh–wrap
TL;DR: Nasolacrimal duct obstruction secondary to treatment with docetaxel may be in part due to stromal fibrosis in the mucosal lining of the lacrimal drainage apparatus.
Abstract: PurposeTo identify histopathologic changes in the lacrimal sac and the nasal mucosa caused by docetaxel in 3 patients with canalicular narrowing and nasolacrimal duct obstruction.MethodsSmall case series. Lacrimal sac and nasal mucosal specimens were obtained at the time of dacryocystorhinostomy or
TL;DR: Spontaneous infection or hemorrhage may occur within the capsules of Supramid orbital implants, even many years after surgery, and the insertion of larger implants in the late repair of extensive bony orbital defects may predispose patients to these complications.
Abstract: PurposeTo determine the incidence and risk factors of complications associated with Supramid orbital implants.MethodsA retrospective chart review was performed to document complications in a series of 41 patients receiving Supramid implants during orbital reconstruction or fracture repair. Implant s
TL;DR: Ninety-three percent of the patients who had an ocular abnormality had tearing as one of the complications of the systemic use of 5-Fluorouracil, and patients who are receiving systemic 5-FU and begin to tear should have a ocular examination, looking for ocular surface, ocular adnexal, and lacrimal complications.
Abstract: PurposeTo determine the prevalence rates and associated characteristics of patients who have ocular surface, ocular adnexal, and lacrimal complications associated with the systemic use of the cancer chemotherapeutic agent 5-Fluorouracil (5-FU).MethodsAn exposure-based cohort study was designed. Adul
TL;DR: Transcaruncular approach orbital apex decompression effectively treats dysthyroid optic neuropathy, and new-onset diplopia developed in 2 of 10 patients without preexisting diPLopia.
Abstract: Purpose To determine the efficacy of transcaruncular approach orbital apex decompression for treatment of dysthyroid optic neuropathy. Methods In this retrospective noncomparative interventional case series, charts for all patients undergoing orbital decompression surgery for dysthyroid optic neuropathy performed by one author between October 1999 and September 2001 were included in the study. Primary outcome measures included visual acuity, static perimetry, pupillary testing, and color plate testing before and after surgery. Records were also reviewed for changes in extraocular motility and proptosis after surgery and for surgical complications. Results Sixteen consecutive patients (6 unilateral, 10 bilateral, for a total of 26 cases) underwent orbital apex decompression for dysthyroid optic neuropathy through a transcaruncular approach. In each orbit, the optic neuropathy was refractory to oral corticosteroid therapy. Preoperative visual acuity remained stable or improved in each case. Preoperative Humphrey visual field testing revealed an average mean deviation of −10.3 ± 6.5 (range, +0.76 to −25.45). Average postoperative mean deviation was −2.79 ± 2.4 (range, +0.94 to −9.82). Before surgery, 7 of 23 eyes (30%) had full color plates. After surgery, 22 of 23 eyes (96%) had full color plates. Follow-up ranged from 2 to 26 months (mean, 10 months). New-onset diplopia developed in 2 of 10 (20%) patients without preexisting diplopia. Conclusions Transcaruncular approach orbital apex decompression effectively treats dysthyroid optic neuropathy.
TL;DR: Preoperative lymphoscintigraphy successfully identifies SLNs in most patients with conjunctival and periocular skin malignancies and smaller injection volumes appear to be adequate for identification of the sentinel nodes and lead to less spread to surrounding tissues.
Abstract: Purpose To determine the feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes (SLNs) in patients with conjunctival and periocular skin tumors and to determine the patterns of lymphatic drainage from such tumors. Methods We retrospectively reviewed the records of all patients with biopsy-confirmed conjunctival and periocular skin malignancies who underwent lymphoscintigraphy with or without SLN biopsy between January 1999 and June 2000. Patients underwent lymphoscintigraphy with 0.3 to 1 mCi of technetium Tc-99m sulfur colloid in a volume of either 0.2 mL or 1 mL. Images were taken as soon as the first SLNs were detected through the camera and every 15 minutes thereafter. Intraoperative mapping and SLN biopsy was performed 1 to 2 days after lymphoscintigraphy unless the patient refused or there were medical contraindications to the procedure. Results The study included 7 patients with malignant melanoma of the conjunctiva or periocular skin and 1 patient with Merkel cell carcinoma of the eyelid. On lymphoscintigraphy, at least 1 SLN was identified in 7 of the 8 patients. Although all lesions located in the lateral half of the ocular adnexa drained to at least one SLN in the parotid (preauricular) area, there was some variability in the drainage patterns of lesions located in the medial half of the ocular adnexa. A smaller injection volume (0.2 mL) was adequate for detecting the nodes draining the area of injection and led to less spread of technetium to the surrounding areas. Six patients underwent SLN biopsy. In all but one, the nodes identified during surgery corresponded with those visualized on lymphoscintigraphy. Conclusions Preoperative lymphoscintigraphy successfully identifies SLNs in most patients with conjunctival and periocular skin malignancies. Smaller injection volumes (0.2 mL) appear to be adequate for identification of the sentinel nodes and lead to less spread to surrounding tissues.
TL;DR: Transient immune dysfunction may provoke the cytokine-mediated proliferation of pathologic Langerhans cells within the hematopoietic marrow of the anterolateral frontal bone and cause osteolysis through elaboration of interleukin-1 and prostaglandin E2.
Abstract: Purpose To describe the findings and outcomes in eosinophilic granuloma (unifocal Langerhans-cell histiocytosis [LCH]) of the orbit and to explain the paradox of aggressive bone destruction responsive to minimal intervention. Methods Retrospective, consecutive, interventional case series of patients treated from 1985 to 2001. Minimum inclusion criteria were demonstration of CD1a positivity or Birbeck granules, treatment by a single surgeon, systemic evaluation by a pediatric oncologist, and follow-up of 12 months. A pathogenetic construct was assembled from general LCH concepts and the specific orbital findings. Results Seven patients met study criteria. All were male, 2 to 16 years of age. All had eyelid or forehead swelling and osteolytic defects, with symptoms of 2 to 6 weeks’ duration. All underwent incisional biopsy, with frozen-section examination suggestive of LCH in 6 of 7 cases. The 2 earliest patients received low-dose irradiation after simple biopsy. The 5 most recent patients had subtotal curettage at the time of biopsy; 4 of 5 received simultaneous intralesional corticosteroid injection. In all cases, systemic evaluation showed no other focus of LCH, reossification was timely, and no local recurrence or additional focus was noted in follow-up of 1 to 17 years. Conclusions Transient immune dysfunction may provoke the cytokine-mediated proliferation of pathologic Langerhans cells within the hematopoietic marrow of the anterolateral frontal bone. These cells cause osteolysis through elaboration of interleukin-1 and prostaglandin E2. Corticosteroids can inhibit the mediators. We recommend incisional biopsy, frozen-section provisional diagnosis, subtotal curettage, intralesional corticosteroid instillation, postoperative systemic evaluation, and long-term surveillance.
TL;DR: In patients with evidence of distant perineural spread, radiotherapy volumes inclusive of potential antegrade and retrograde spread are recommended and three-dimensional conformal planning or intensity-modulated radiation therapy assists in minimizing damage to adjacent structures.
Abstract: Purpose: To analyze a series of patients with periorbital perineural spread of squamous cell carcinoma and propose treatment guidelines. Methods: Retrospective, noncomparative, interventional case series of 17 patients with clinical, radiologic, or histologic evidence of distant perineural spread. Treatment, recurrence, progression, and mortality rates were recorded. Results: Numbness and pain were the most common symptoms, whereas ophthalmoplegia, ptosis, and facial palsy were the most frequent signs. All cases received wide-field radiotherapy to at least 50 Gy. Chemotherapy and surgery (biopsy, debulking, exenteration) were used in selected cases. Disease progression occurred in 6 patients, 4 of whom died. Median disease-free survival in the remainder was 37.5 months. Conclusions: The diagnosis of perineural spread is largely clinical and may be confirmed with imaging findings in the majority of cases. The role of biopsy is usually complementary but may be essential in some cases. In patients with evidence of distant perineural spread, radiotherapy volumes inclusive of potential antegrade and retrograde spread are recommended. Three-dimensional conformal planning or intensity-modulated radiation therapy assists in minimizing damage to adjacent structures. Synchronous chemotherapy should be considered to potentiate the effectiveness of radiation. The place of surgery in the treatment of perineural spread is palliative.
TL;DR: Breslow thickness is an important prognostic indicator for eyelid skin melanomas and may be adequate for thin melanomas of the periocular skin, but because of the small number of patients who had >5-mm margins, a definitive comparison of outcome with larger margins of excision cannot be made.
Abstract: Purpose To evaluate the practice patterns among surgeons who treat melanomas of the eyelid skin with respect to margins of excision and to look for possible correlation between margins of excision and the incidence of local and regional recurrence and distant metastasis. Methods A retrospective survey of the members of the American Society of Ophthalmic Plastic & Reconstructive Surgery and the European Society of Ophthalmic Plastic & Reconstructive Surgery yielded 44 cases. The patients’ age, sex, date of diagnosis, histologic classification of melanoma, Breslow thickness, Clark level, location of melanoma, size of margins of excision, and findings of local or regional recurrence or distant metastasis were recorded in each case. Patients were stratified on the basis of margins of excision: ≤5 mm; >5 mm but Results The majority of patients for whom reliable information was available had excision margins of ≤5 mm. The Breslow thickness of most of the tumors was ≤1 mm. Eleven patients (25%) had local recurrence. Five patients (11%) had regional lymph node metastasis. All patients with regional nodal metastasis were men. Distant metastasis developed in 3 patients (7%)—2 men and 1 woman. The follow-up times ranged from 10 to 108 months (mean, 34 months; median, 21 months). The incidence of local recurrence was higher among patients with melanomas at least 2 mm thick and margins of excision ≤5 mm than among patients with melanomas at least 2 mm thick but with margins ≥10 mm, but this difference was not statistically significant because very few patients had melanomas at least 2 mm thick. Breslow thickness was the only statistically significant predictor of local, regional, and distant metastasis. Margins of excision did not have a statistically significant effect on local, regional, or distant recurrence. Conclusions Breslow thickness is an important prognostic indicator for eyelid skin melanomas. A 5-mm margin of excision may be adequate for thin melanomas of the periocular skin, but because of the small number of patients in this series who had >5-mm margins, a definitive comparison of outcome with larger margins of excision cannot be made. For melanomas ≥2 mm, wider margins of excision may be prudent, and careful surveillance for local and regional recurrence is indicated.
TL;DR: Delayed infection with erythematous nodules, particularly when a foreign body is implanted weeks after periocular surgery, should arouse suspicion of an atypical mycobacterial infection.
Abstract: PurposeTo delineate the clinicopathologic features of patients who have atypical mycobacterial infections of the periorbital region after periocular and facial surgery and to define the sequelae after treatment and their management.MethodsA case series of patients from 7 practices of ophthalmic plas
TL;DR: In this article, the authors attempted to survey all board certified ocularists in the United States regarding their experience with evisceration versus enucleation in terms of final function, cosmesis, and complications.
Abstract: Evisceration involves removal of the intraocular contents (lens, uvea, retina, vitreous, and sometimes cornea), leaving the sclera and extraocular orbital anatomy intact. The technique is more than 180 years old, having been introduced by Bear in 1817. Although evisceration has many potential advantages over enucleation, ophthalmologists still perform many more enucleations than eviscerations. A 1996 survey by Levine of members of ASOPRS found that enucleations outnumbered eviscerations by 72.3% (2194 cases) to 27.7% (841 cases). Several reasons have been offered for this bias, including the risk of an occult intraocular malignancy, sympathetic ophthalmia, and the quality of the specimen sent to pathology. From the patient’s perspective, the cosmetic and functional outcome are very important, but objective outcome data on these issues are limited. The opinion of board-certified ocularists is rarely mentioned, even though they are responsible for the long-term care of most anophthalmic patients. We attempted to survey all board-certified ocularists in the United States regarding their experience with evisceration versus enucleation in terms of final function, cosmesis, and complications.
TL;DR: It is demonstrated that 131I therapy for thyroid carcinoma can be associated with nasolacrimal duct obstruction and may indeed be due to pooling of 131I in the lacrimal sac due to nasolacan duct blockage.
Abstract: A 50-year-old woman presented with a 5-year history of unilateral epiphora that began shortly after 131I therapy for thyroid carcinoma. A recent recombinant human thyroid-stimulating hormone (Thyrogen) scan had shown a focus of uptake adjacent to the right eye that was initially thought to be a possible metastasis. Probing and irrigation revealed complete blockage of the right nasolacrimal duct. The patient underwent a right dacryocystorhinostomy (DCR) and biopsy of the lacrimal sac. Histopathologic examination of the lacrimal sac and nasal mucosa revealed foreign-body reaction and fibrosis with no malignant cells. A repeat Thyrogen scan after DCR showed no residual focus of activity in the nose or near the lacrimal sac and confirmed reestablishment of lacrimal drainage on the right side. This case demonstrates that 131I therapy for thyroid carcinoma can be associated with nasolacrimal duct obstruction. The appearance of a focus of uptake near the lacrimal sac on Thyrogen scanning in a patient with a history of thyroid carcinoma may not be due to a new focus of metastasis and may indeed be due to pooling of 131I in the lacrimal sac due to nasolacrimal duct blockage.
TL;DR: A multidisciplinary approach to management is required because facial and cerebral injuries are also common and orbital and ocular injuries are common in association with orbital roof fractures.
Abstract: Purpose: To review the clinical features and management of patients with orbital roof fractures. Methods: Non-comparative, retrospective case review of 21 patients presenting with orbital roof fractures. Results: The orbital roof fractures in our series resulted from motor vehicle accidents, blunt trauma, head injuries, and penetrating orbital injuries. Associated orbital and ocular injuries included other ipsilateral orbital fractures (16 cases), traumatic optic neuropathy (3 cases), ptosis (2 cases), perforating eye injuries (2 cases), intraorbital foreign bodies (2 cases), and oculomotor nerve palsy (1 case). Six patients required surgical intervention for ophthalmic sequelae, which included motility problems (4 cases), lagophthalmos (1 case), and a retained intraorbital foreign body with a cerebrospinal fluid leak (one case). The outcome of surgery was favorable in all cases, with complete resolution of symptoms in five of six patients. Conclusions: Orbital and ocular injuries are common in association with orbital roof fractures. A multidisciplinary approach to management is required because facial and cerebral injuries are also common. Most patients can be managed conservatively. The specific ophthalmic indications for surgical intervention are limited, but the outcome in these cases is gratifying.
TL;DR: The results of this study support the principle of performing orbital implant drilling and peg placement at least 5 to 6 months after HA implant insertion and should be performed after central vascularization of the spherical implant has occurred.
Abstract: PurposeTo report hydroxyapatite (HA) implant enhancement patterns on magnetic resonance (MR) images at varying time intervals after implantation.MethodsWe retrospectively reviewed the records of 45 consecutive patients(from one author's practice) who underwent an MR imaging study 2 to 157 monthsafte
TL;DR: Upper eyelid ptosis repair by Müller muscle–conjunctival resection had no significant effect on tear production as measured by Schirmer testing.
Abstract: Purpose To study the effect of upper eyelid ptosis repair by Müller muscle–conjunctival resection on tear production. Methods The authors retrospectively reviewed the charts of 174 patients who underwent ptosis repair by Müller muscle–conjunctival resection at the Casey Eye Institute between October 1996 and August 2001. After exclusions for insufficient data and confounding ocular morbidities, the charts of 38 patients, consisting of 71 ptosis repair surgeries, were analyzed. A single surgeon performed the same procedure on all patients. All subjects underwent Schirmer testing before ptosis repair and again during the period between 6 weeks to 18 months after surgery. Patients responded to questions pertaining to dry eye symptoms during preoperative and postoperative visits. Results No statistically significant change in tear production (as measured by Schirmer strip testing) associated with ptosis correction by Müller muscle–conjunctival resection was observed. Before surgery, 34% (24 of 71) of eyes measured dry before ptosis repair. This ratio remained unchanged on long-term follow-up. A transient increase in dry-eye symptoms was reported in at least one eye of 29% (11 of 38) of patients in the immediate postoperative period (<2 weeks). On long-term follow-up, a persistent increase in dry-eye symptoms or new diagnosis of dry eye was observed in at least one eye of 16% (6/38) of patients, whereas 13% (5/38) of patients noticed diminution of their presurgical dry eye symptoms. Conclusions Upper eyelid ptosis repair by Müller muscle–conjunctival resection had no significant effect on tear production as measured by Schirmer testing. Subjective dry-eye symptoms transiently increased in the immediate postoperative period but resolved frequently by the late follow-up period.
TL;DR: It is shown that both the incidence and the overall severity of orbital fractures decreases considerably with exposure to airbag deployment, which is accomplished because the airbag minimizes occupant contact with the windshield and steering wheel, which are the two leading sources of orbital fracture for occupants not exposed to air bag deployment.
Abstract: Purpose To investigate orbital fractures that occurred in frontal automobile crashes and to determine the effects of frontal airbags on injury incidence and severity. Methods The National Automotive Sampling System database files from 1993 to 2000 were examined. Frontal crashes were selected that included drivers and front-seat passengers only and excluded ejected occupants and rollover crashes. Orbital fractures could be closed, open, displaced, or any combination of these and were identified by using the Abbreviated Injury Scale codes. Results The analysis included 12,429,580 front-seat occupants from 25,464 cases. Of all occupants who were exposed to an airbag deployment, 0.09% sustained an orbital fracture. In contrast, occupants who were not exposed to an airbag deployment were more than twice as likely to sustain an orbital fracture (0.22%). In addition to reduction in incidence, airbags were also shown to decrease the severity of orbital fractures that occupants sustained. Occupants exposed to airbag deployment mostly sustained closed, less severe fractures (61.9%), whereas occupants not exposed to airbag deployment sustained the majority as more severe, open, displaced, or comminuted fractures (61.3%). Conclusions This article presents the most comprehensive study of orbital fractures in automobile crashes to date. It is shown that both the incidence and the overall severity of orbital fractures decreases considerably with exposure to airbag deployment. This is accomplished because the airbag minimizes occupant contact with the windshield and steering wheel, which are the two leading sources of orbital fractures for occupants not exposed to airbag deployment.
TL;DR: Anchored cheek flaps extend recognition of the continuity of the lower eyelid and midface to the primary reconstruction of tumor-free defects, and they address the relation by restoring deep attachments that minimize eyelids and canthal dystopia.
Abstract: Purpose To describe a system of post-Mohs reconstruction that addresses lower eyelid susceptibility to unopposed tractional, cicatricial, and gravitational forces. Large flaps are anchored to fixed tissue to avoid transmitting flap tension to the eyelids. Methods This is a retrospective, cohort study drawn from approximately 40 patients with post-Mohs defects of the nonmarginal lower eyelid, cheek, and lateral canthus. Surgical intervention involved horizontally oriented, relaxed skin tension line-designed advancement flaps, usually with eyelid margin stabilization. The use of anchoring sutures and any requirement for flap-graft combinations were based on defect size and the elasticity of adjacent tissues. Results Anchoring eyelid and cheek flaps to underlying periosteum permitted broad flap dissection and advancement without distortion, as the semimobile eyelid and canthi were protected from the resulting flap tension. Anticipated defect size limits for flap reconstruction often were exceeded. Defects too broad for flap reconstruction alone could be downsized, leaving a relatively small area for graft resurfacing. Conclusions Anchored cheek flaps extend recognition of the continuity of the lower eyelid and midface to the primary reconstruction of tumor-free defects, and they address the relation by restoring deep attachments that minimize eyelid and canthal dystopia.
TL;DR: Use of bovine pericardium as a wrapping material for orbital implants should be avoided unless some future modifications of the technique can be developed to prevent such complications.
Abstract: Purpose To report our experience with bovine pericardium as a wrapping material for hydroxyapatite orbital implants after enucleation and to compare the exposure rates of the implants wrapped with bovine pericardium versus donor sclera. Methods We retrospectively reviewed the records of all patients who received bovine pericardium-wrapped or donor sclera-wrapped hydroxyapatite implant after primary enucleation between March 1995 and December 2001. Results Of the 26 patients who received donor sclera-wrapped implants after enucleation, 1 (3.8%) had implant exposure. Of the 26 patients who received bovine pericardium-wrapped implants after enucleation, 6 (23%) had implant exposure. The incidence of implant exposure with the use bovine pericardium wrapping material was found to be significantly higher than with sclera (P = 0.05). Six of the 7 implant exposures were noted in the first 6 months after placement of the orbital implant. Five of the 6 exposed bovine pericardium-wrapped hydroxyapatite implants were associated with socket infection. The case of exposure of the sclera-wrapped implant was treated conservatively by observation. Six patients who had exposure of bovine pericardium-wrapped implants required multiple repairs because of recurrent exposures. Four of these patients eventually required removal of the implant. Conclusions Despite the advantages of using bovine pericardium as a wrapping material for hydroxyapatite orbital implants, we observed a significantly higher incidence of exposure with bovine pericardium compared with donor sclera in the early postoperative period. Use of bovine pericardium as a wrapping material for orbital implants should be avoided unless some future modifications of the technique can be developed to prevent such complications.