ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine the clinical characteristics and outcomes of patients with leukemic or lymphomatous involvement of the lacrimal drainage system (LDS).MethodsA computerized retrieval system was used to identify patients with histologically proven leukemic or lymphomatous involvement of the LDS. Medical records were reviewed.ResultsBiopsies of the lacrimal sac or nasolacrimal duct obtained during dacryocystorhinostomies (DCR) performed at the Mayo Clinic (Rochester, Minnesota) between January 19, 1989, and August 26, 1997, were positive for leukemia or lymphoma in 11 patients (15 LDS). Ten patients had previously diagnosed leukemia or lymphoma; the interval between the diagnosis of systemic disease and DCR averaged 5.8 years (range, 7 months to 13 years; median, 5 years). The median age at the time of LDS involvement was 72 years (range, 49 to 85 years). Seven patients (64%) were women, and all were white. The median postoperative follow-up after DCR was 38 months (range, 10 to 65 months). Eight patients had leukemic infiltration of the LDS, 2 patients had B-cell lymphoma, and 1 patient had cutaneous T-cell lymphoma. Four patients had bilateral LDS involvement, and the remainder had unilateral disease (right eye, 1 patient; left eye, 6 patients). The most common initial presentation, in 9 patients (82%), was epiphora. Lacrimal irrigation of 2 LDS was deferred because of acute dacryocystitis. Of the remaining 13 systems, 8 were completely obstructed. The blockage was low (in the lower sac or in the nasolacrimal duct) in 6 systems and high (in the upper sac or common internal punctum) in 2 systems. Four LDS were anatomically patent to irrigation but were functionally obstructed. Chemotherapy was the primary treatment in 7 patients, whereas 4 patients underwent radiation therapy. Nine patients responded well to treatment, with alleviation of signs and symptoms, and none of these patients had local recurrence during the follow-up interval.ConclusionsLeukemic or lymphomatous involvement of the LDS is an unusual cause of tearing in elderly patients, but it should be suspected in patients with known systemic disease. Treatment comprising multiple interventions improves the signs and symptoms of this complication of lymphoproliferative disorders in most patients.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo describe the clinical features and histologic classification of orbital lymphoma secondary to systemic non-Hodgkin lymphoma, to evaluate the efficacy of various treatment modalities for controlling the orbital component of disease, and to analyze vision-related outcomes.MethodsIn this retrospective case series, the clinical records of patients diagnosed with orbital lymphoma who were treated between January 1999 and May 2001 at the University of Texas M.D. Anderson Cancer Center were reviewed. Demographic data, histologic classification of lymphoma, immunophenotype, stage of disease, treatment outcomes, vision-related outcomes, and duration of follow-up after the diagnosis of orbital lymphoma were recorded in each case.ResultsAt the time of diagnosis, all 15 patients identified either had a previous history of non-Hodgkin lymphoma or had simultaneous involvement of lymph node or other sites. Ten patients (67%) had intermediate-grade or high-grade lymphoma. All 15 patients had a B-cell phenotype. Systemic chemotherapy or immunotherapy was the initial treatment modality in 13 patients; the other 2 patients were treated with radiation as the initial mode of therapy. Eleven patients (73%) achieved complete regression of the orbital tumor; one patient had partial regression of the orbital lymphoma. Loss of vision secondary to compressive optic neuropathy was seen in 5 patients (33%); in 3 of these patients, the orbital lymphoma was diagnosed early and treatment was successful in reversing the loss of vision. One patient had irreversible vision loss secondary to compressive optic neuropathy; in this case, therapy had not been initiated until several months after onset of symptoms. Another patient died of lymphoma before the orbital disease could have responded to therapy.ConclusionsBecause of often widespread systemic involvement and a usually more aggressive histologic classification than primary orbital lymphomas, secondary orbital lymphomas warrant treatment with systemic chemotherapy or systemic immunotherapy. In some cases, combining such systemic therapy with local radiation treatment is beneficial. Loss of vision as the result of compressive optic neuropathy in this setting can be reversed if systemic therapy is initiated soon after the onset of progressive signs and symptoms of orbital disease.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo investigate variability in measurements of axial globe position taken with different exophthalmometers of the same style and manufacturer by the same observer.MethodsIn this small clinical study, 10 Hertel-type mirror exophthalmometers were used to measure the degree of exophthalmos of a plastic head. The deepest points on the lateral orbital margins were marked to ensure accurate placement of the instrument. A single observer, masked to previous measurements, recorded multiple measurements with each instrument over several days.ResultsVariation was seen between instruments from different manufacturers and more interestingly, between the same design of instruments from the same company. The measurement of axial globe position varied by up to 2.9 mm between instruments of the same make. There was also variation in the measurement of the relative axial globe position of the model. This measurement varied from 0.6 to 2.4 mm. The mean variation of readings taken with the same instrument was 0.5 mm.ConclusionsIt is already considered good practice to minimize interobserver error by recording the make of exophthalmometer used. This small study also suggests that the same instrument should be used for each examination to minimize error caused by variation between instruments of the same make. Variation of 1.5 to 2.0 mm could affect patient treatment when a difference in measurement of 2 mm is regarded as significant during serial or relative exophthalmometry.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine whether postoperative pain and nausea after evisceration surgery is better controlled with intraoperative retrobulbar ethanol or bupivacaine.MethodsProspective, randomized, clinical trial. Eleven patients undergoing evisceration surgery by two surgeons over a 6-month period for blind, chronically painful eyes were randomly allocated in two groups. One group (5 patients) received prophylactic retrobulbar 95% ethanol injections; the control group (6 patients) received retrobulbar 0.75% bupivacaine with 1:100,000 epinephrine. Postoperative pain and nausea were recorded by the patients with the use of a 10-point analog scale. Patients also documented the quantity of analgesics required.ResultsThe mean and median postoperative pain and nausea scores were significantly lower for patients given intraoperative retrobulbar ethanol (pairedttest,P<0.01). These patients also required significantly less analgesic medicine. Complications from the retrobulbar ethanol injections included forehead numbness and ptosis, both of which had resolved by the time of prosthesis fitting 6 weeks later.ConclusionsSurgeons should consider the use of intraoperative retrobulbar ethanol injections to help relieve postoperative pain and nausea.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo report the clinical and pathologic findings in 3 cases of traumatic evulsion of the globe, during which the optic nerve and its sheath were disrupted at different locations and to varying extents.MethodsCase series (3 patients).ResultsWe describe the clinical,gross, and microscopic pathologic findings in 3 globes that were traumatically evulsed from their orbits. The optic nerves and sheaths were disrupted at 2 different locations and in 2 distinct combinations. Two of these variations in discontinuity of the nerve and/or its sheath were unique. In 1 case, the eye and optic nerve sheath were evulsed without the nerve; in another case, the nerve and sheath were pulled from the posterior sclera at the lamina cribrosa.ConclusionsTraumatic evulsion of the globe may cause the optic nerve and its sheath to be disrupted at varying distances from the eye and may involve the optic nerve and its sheath together or separately. To the best of our knowledge, no cases have been reported in which orbital trauma caused the globe and optic nerve sheath to be removed together, leaving the nerve behind, or in which disruption of the optic nerve at the lamina cribrosa resulted in a complete posterior scleral defect. Three theories are proposed to explain possible mechanisms leading to optic nerve disruption during traumatic evulsion of the globe.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine the safety and efficacy of bovine hydroxyapatite as an orbital implant material.MethodsProspective, consecutive case series of patients undergoing enucleation, evisceration, or secondary orbital implantation. A motility peg was placed in all consenting candidates. Patients were followed 1 week, 1 month, and several months after surgery for signs of inflammation, infection, extrusion, or other complication.ResultsTwenty-seven patients received a bovine hydroxyapatite orbital implant. Magnetic resonance imaging was obtained in 3 patients (3 orbits) approximately 4 weeks after surgery and showed signs of peripheral fibrovascular ingrowth in all three cases. Magnetic resonance imaging was obtained in 9 patients (9 orbits) 4 to 12 months after surgery and showed signs of incomplete fibrovascular ingrowth in 1 of 9 (11%) cases, subtotal fibrovascular ingrowth in 2 of 9 (22%) cases, and complete fibrovascular ingrowth in 6 of 9 (67%) of cases. Complications included postoperative chemosis in 3 cases (11%) and exposure requiring reoperation in 2 cases (7%). Motility peg placement was performed successfully in 5 patients (5 orbits).ConclusionsBovine hydroxyapatite appears to be a safe and effective orbital implant material. The material appears to be biocompatible and nonallergenic. Bovine hydroxyapatite allows for fibrovascular integration and motility peg placement.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo compare the rate of fibrovascularization of wrapped versus unwrapped hydroxyapatite (HA) spheres in an animal model and to investigate how drilling small-diameter access holes at the time of implantation affects the rate of fibrovascular ingrowth in wrapped implants.MethodsThe right eyes of 20 New Zealand White rabbits were removed and a 12-mm HA sphere was implanted in each socket. The spheres were left bare in 8 of the animals. In the other 12, the implant was wrapped in an autologous sclera shell. In 4 animals from each group, a 1-mm diameter access hole was drilled into the spherical center of the implant at the sites of extraocular muscle insertion and at the posterior pole before implantation. All implants were explanted after 1 week.ResultsThe mean depth of fibrovascularization in the bare group without access holes (n=4) was 100% (SD=0). The mean depth of fibrovascularization in the wrapped group without access holes (n=8) was 30.1% (SD=11.0). The difference between these two groups was statistically significant (P<0.001). The mean depth of fibrovascularization in the wrapped group with access holes (n=4) was 91.5% (SD=9.8). Compared with the wrapped group without access holes, the difference was statistically significant (P<0.001). The difference in the mean depth of fibrovascularization between the bare group without access holes and the wrapped group with access holes failed to reach statistical significance (P=0.18).ConclusionsOn the basis of this preliminary study, we conclude that whereas scleral wrapping does significantly slow the rate of fibrovascular ingrowth, the concomitant placement of access holes greatly improves the rate of fibrovascularization.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine the relation between the fluorescein transit test time and postoperative relief of epiphora in patent dacryocystorhinostomies.MethodsA retrospective study of 40 patients who underwent 42 external dacryocystorhinostomies between January 1994 and January 2000 was performed. Postoperative symptomatic success was assessed by a questionnaire. Intranasal rigid endoscopy was performed to measure the fluorescein transit test time, defined as the time from instillation of fluorescein to its free flow from the osteotomy site. The main outcome measures were symptomatic success, fluorescein transit test time, and anatomic patency to irrigation. Statistical analysis was performed with the use of the Fisher exact test.ResultsOf the 42 dacryocystorhinostomies studied, 92.8% were patent to irrigation. There was a statistically significant association between a fluorescein transit test time of ≤45 seconds and subjective success (P<0.001), with 96% of patients reporting a successful postoperative outcome. A slow fluorescein transit test, with an average time of 138.9 seconds, was associated with symptomatic failure (P<0.001), with 56.2% of this group reporting significant postoperative epiphora.ConclusionsThe fluorescein transit test provides a quantitative measure of lacrimal drainage function after dacryocystorhinostomy, with a fluorescein transit test time of ≤45 seconds being the relevant parameter to characterize symptomatic success. Postoperative failure in external dacryocystorhinostomy, as evidenced by slow transit times, may result from surgical interference with the lacrimal pump.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo assess the efficacy of intraoperative mitomycin C in improving the success rate of the posterior punctectomy procedure.MethodsThe charts of all patients who underwent posterior punctectomy between the years 1997 and 2000 were reviewed. The procedure was done without mitomycin C (n = 26 eyes, group A) until the end of 1998 and with mitomycin C (n = 25 eyes, group B) starting in 1999. The Kaplan-Meier curve was used for statistical evaluation.ResultsIn group A, 5 of 26 (19.2%) eyes had complete anatomic obstruction and scarring of their puncta after surgery, compared with 0 of 25 (0.0%) eyes in group B. The difference was statistically significant (P<0.02). No significant complications were observed.ConclusionsMitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID