摘要:

Summary:A 36-year-old woman was experiencing discomfort and discharge after placement of an orbital implant 1 year previously. Her ocular history included iridocorneal endothelial syndrome, requiring two trabeculectomies, the last of which included the use of 5-fluorouracil (5-FU). After enucleation, a hydroxyapatite orbital implant was placed. Shortly thereafter, an implant exposure developed and continued to enlarge to 11 mm even after her ocularist had elevated the prosthesis off the exposed area and surrounding conjunctiva. Magnetic resonance imaging with gadolinium enhancement was not obtained because of the prohibitive cost. Fourteen months later, a vascularized Müller muscle pedicle flap was devised and tunneled underneath the existing conjunctiva to cover the defect. The overlying levator was undisturbed; however, transient ptosis occurred that returned to baseline after 2 weeks. This is a new and novel approach to restore orbital implant exposure and may be most helpful after antimetabolite treatment to the conjunctiva or radiation to the orbit.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Circumscribed conjunctival melanoma usually arises in the bulbar conjunctiva and less often in the forniceal or palpebral conjunctiva. After simple superficial removal, employed by many ophthalmologists, these tumors have an increased tendency toward local recurrence and distant metastasis. A surgical procedure designed to remove the tumors completely and minimize the chances of recurrence would be desirable. The authors employed a surgical approach to conjunctival melanoma excision, which they believe insures more complete tumor removal and decreases the chances of recurrence and metastasis. The surgical management of melanoma in the limbal region of the bulbar conjunctiva consists of localized alcohol epitheliectomy, removal of the mass by a partial lamellar scleroconjunctivectomy, and supplemental double freeze-thaw cryotherapy to the adjacent remaining conjunctiva by a specific technique. For tumors located in the forniceal or palpebral conjunctiva, wide surgical resection with alcohol treatment to the scleral base and cryotherapy to the surrounding conjunctiva is performed. A “no touch” technique is employed and direct manipulation of the tumor is strictly avoided in an effort to prevent tumor cell seeding into a new area. The technique currently employed has evolved from experience with circumscribed conjunctival melanoma excision during a 20-year period. About 80 patients had circumscribed conjunctival melanoma unassociated with appreciable primary acquired melanosis. Although it is not the purpose of this article on surgical technique to provided a detailed statistical analysis of the results, the authors currently believe that this technique should be employed in all cases of circumscribed lesions in which conjunctival melanoma is a diagnostic consideration. Incisional biopsy and frozen sections are generally not advisable. Preliminary observations suggest that this method decreases the chances of local recurrence.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:A retrospective histopathologic review of 97 patients with basal cell carcinoma of the eyelid was performed to determine the prevalence and behavior of tumors with a mixed pattern of growth. A mixed type basal cell carcinoma was defined as a tumor having a significant nodular or ulcerative component combined with an infiltrative component. Histologic classification of the 97 tumors yielded four (4.1%) that were multicentric, 67 (69.1%) that were nodular, one (1%) that was ulcerative, 13 (13.4%) that were infiltrative, and 12 (12.4%) that were the mixed variant. Follow-up was obtained on 8 of the 12 patients with mixed basal cell carcinoma. Three tumors recurred, but there were no tumor-related deaths. One of these patients underwent numerous eyelid resections over a 2-year period and then underwent an orbital exenteration. The authors conclude that mixed type basal cell carcinomas are not infrequent and behave as aggressively as basal cell carcinomas of the morphea type. A greater awareness and recognition of mixed type basal cell carcinomas by ophthalmologists and pathologists should result in fewer recurrences and better patient management.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Lower-lid defects can arise from many sources, but they are often the result of excision of lower-lid tumors. The excision of the lesion is often performed by means of a pentagonal wedge resection. After repair of the tarsus and reapproximation of the lid margin, the skin and orbicularis are usually closed in a vertical fashion, which is perpendicular to relaxed skin tension lines and may extend further down the lid than is optimal as a result of a dog-ear excision.The authors propose a new method for closure of skin and orbicularis muscle in repair of lower eyelid marginal defects. This method is simple and has several advantages over vertical closure: it follows relaxed skin tension lines, allows closure of the anterior lamella in the opposite direction from the posterior lamella, and leaves an infraciliary scar rather than a vertical scar extending down the cheek. This method has been used in over 100 patients during the past 8 years, and no significant complications have occurred. Potential disadvantages of the technique include increased vertical tension and a tendency for the lid to be pulled downward. For these reasons, the arrowhead flap would not be the best choice in patients with preexisting lower eyelid retraction, cicatricial ectropion, or vertically tight lower-lid skin.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID