摘要:

Primary adenocarcinomas of the lacrimal gland rarely display sebaceous differentiation. An anaplastic lacrimal gland neoplasm manifesting this feature was excised from a 64-year-old man who initially appeared with recurrent painless subconjunctival hemorrhages. Globe displacement and tumor-induced hyperopia were later findings. Electron microscopic studies performed on the widely excised tumor documented prominent lipid vacuoles, desmosomes. scattered cytoplasmic filaments, and linear segments of basement membrane material. The patient refused radical surgery and instead opted for 6,000 rads of adjuvant radiotherapy. Eleven months postoperatively liver and bone metastases developed, but he was free of local orbital recurrence. Twenty-two months postoperatively he died from complications of his metastatic disease. This most unusual lacrimal neoplasm is discussed in terms of its initial signs and symptoms and its histopathology. When the current case is analyzed in combination with three earlier reports, there is evidence that primary lacrimal gland sebaceous carcinoma is probably among the most malignant orbital tumors due to its uniform early fatality.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Among 2, 135 consecutive patients with posterior uveal melanoma who were evaluated clinically in the Ocular Oncology Service of Wills Eye Hospital between February 1974 and December 1986, 123 (5.8%) were found to have some degree of extrascleral extension of the tumor. Ten of the 2.135 patients (0.5%) had massive orbital extension we defined as extrascleral tumor having an estimated volume exceeding 1,000 mm3. Three of these patients were characterized by orbital recurrence sometime after enucleation, whereas seven had massive orbital extension as the initial manifestation of the neoplasm with no prior history of enucleation. These cases of advanced orbital extension are presented in detail with emphasis on clinical features, diagnostic problems, pathologic findings, and follow-up observation. Based on our observations, suggestions are made regarding the diagnosis and management of advanced orbital extension of posterior uveal melanoma.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A 64-year-old woman presented with periorhital induration of 6 months' duration. Computed tomography (CT) revealed enlargement of extraocular muscles. A biopsy specimen of the orbicularis muscle and indurated preaponeurotic fat demonstrated an infiltrating carcinoma, and immunoperoxidase studies for surface antigens suggested a metastatic adenocarcinoma. Extensive evaluation revealed a 1-cm subareolar breast mass, with histopathological features identical to those of the orbital lesion. Orbital metastasis presenting before the diagnosis of a primary breast cancer is unusual, particularly in the absence of other disseminated disease.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Vision loss in orbital hypertension secondary to sudden space-occupying lesions is usually attributed to one of three causes: central retinal artery occlusion, direct compressive optic neuropathy, or compression of optic nerve vasculature. Accepted modes of decompressive therapy include lateral canthotomy and cantholysis; drainage of localized orbital air, hematoma, or abscess; and bony wall decompression. Five cases are presented in which orbital hypertension caused severe proptosis with traction on the optic nerve and tenting of the posterior globe. Another mechanism contributing to visual loss is proposed in these cases: ischemie optic neuropathy due to stretching of nutrient vessels. In these cases, rapid posterior decompression should theoretically be favored to reduce orbital pressure and relieve traction on the optic nerve vasculature.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The control of perioperative hemorrhage is a concern in dacryocystorhinostomy, which has traditionally been done as an inpatient procedure, often with general anesthesia. The trend now is toward outpatient surgery under local anesthesia. With proper patient selection and education, adequate anesthesia, and a meticulous surgical technique aimed at preventing blood loss, complications related to outpatient dacryocystorhinostomy can be minimal and associated with a high degree of patient acceptance. This article reviews my technique and experience in preventing blood loss in 434 procedures over 3 years.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Hematic, or “chocolate,” cysts are accumulations of blood and its breakdown products within cystic spaces. They have been reported as being associated with lesions having cystic spaces (lymphangiomas, hemangiomas), spontaneously and immediately following trauma. We report a patient who had a blow-out fracture repair 21 years before the discovery of her chocolate cyst. She had been free of symptoms for the first 10 years after her orbital floor repair. She then developed signs of recurrent myositis with increasing symptoms, which finally led to surgical intervention. At surgery the migration of the silicone implant produced the chocolate cyst.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The surgical management of 95 cases of involutional entropion were reviewed to form this retrospective study. The 66 cases treated with the Wies procedure alone had a recurrence rate of 11%. The 29 cases treated with a combined procedure consisting of a Wies procedure with a lateral canthal horizontal shortening had no recurrences. All patients had a minimum of 6 months postoperative follow-up. The etiologic factors as they relate to the appropriate surgical procedures are discussed.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Polytetrafluoroethylene (PTFE) is a synthetic, woven, nonabsorbable, nonantigenic. Teflon-related material that has been shown to be useful in correcting eyelid retraction and as an implant enveloping material in primary and secondary surgery to correct anophthalmos. Implanted PTFE will extrude if not entirely covered with a layer of conjunctival epithelium. In vitro studies demonstrated that coating PTFE with collagen, fibronectin, gelatin, or laminin promotes epithelial cell and fibroblast migration over and adherence to PTFE. In vivo studies showed that a coating of type 1 collagen is most successful in preventing graft extrusion by promoting conjunctival epithelial attachment and growth over exposed PTFE. Further studies are needed to determine the optimum PTFE coating and pore size needed to ensure the consistent retention of uncovered implanted PTFE grafts.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Concern over the transmission of communicable diseases through donor tissue has recently increased. Nine hundred and fifty-nine pieces of banked homologous irradiated fascia lata have been distributed to ophthalmic plastic surgeons nationwide over the past 3 years since the establishment of the Wills Eye Hospital Fascia Lata Bank. Safeguards taken against the transmission of disease include strict donor selection; negative antibody testing for human immunodeficiency virus (HIV), rapid plasma reagin (RPR), and hepatitis B surface antigen (HbsAg); heat treatment; and radiation sterilization with 4 million rads of cobalt-60 gamma radiation. To date, no cases have been reported of the transmission of HIV through surgical implantation of banked irradiated homologous fascia lata.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We have devised a frontalis suspension technique originally described in an article entitled, “Transconjunctival frontalis suspension for blepharoptosis” (Trans Am Acad Ophthal Otolaryngol83:684–92), by Swan and Tongue in 1977. This modified transconjunctival frontalis suspension (TCFS) procedure is described. It has been used at the Oregon Health Sciences University in its original or modified form since 1970. To better understand how this procedure successfully corrects blepharoptosis in patients with poor levator function, a study was undertaken to discern the anatomic relationship of the suspension material to important ocular adnexal structures. The findings are based on gross anatomic dissection and histologie examination of a cadaver eyelid after postmortem transconjunctival fascia lata frontalis suspension. The distal, horizontal limb of the fascia suspends the central portion of the levator aponeurosis in a hammock-type fashion. The two vertical limbs pierce the aponeurosis at the level of Whitnall's ligament and incorporate this ligament. The fascia then exits the orbit through the orbital septum near the arcus marginalis and is incorporated into the frontalis muscle near the junction of the medial one-third and lateral two-thirds of the brow, temporal to the supraorbital neurovascular bundle. This anatomic location is not only relatively easily and safely attained, but also maximizes the principles of more traditional frontalis suspensions while minimizing the effort and surgical manipulation.

ISSN:0740-9303    

出版商:OVID    

年代:1991

数据来源: OVID