ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine the incidence and risk factors of hemorrhagic complications associated with selected oculoplastic procedures.MethodsA prospective study was performed to document the severity of intraoperative hemorrhage and postoperative bruising in patients undergoing oculoplastic procedures. The use of anticoagulant or platelet-inhibiting medications, systemic medical conditions, patient age, patient sex, and type of procedure were examined to identify risk factors for hemorrhagic complications.ResultsTroublesome intraoperative bleeding prolonged surgery in 9.2% of cases. Severe bleeding with the potential to affect surgical outcome was encountered in 0.4% of procedures. There was little correlation between severity of bleeding and degree of postoperative bruising. Male sex, a history of heart disease, or age >60 years imparted a slightly greater risk of intraoperative bleeding. Age >60 years, hypertension, or recent cessation of aspirin may increase the risk of postoperative bruising. A history of previous stroke increased the risk of postoperative bleeding. There was no statistical difference in the incidence of hemorrhagic complications among patients currently treated with antiplatelet/anticoagulant agents, those who had stopped these medications before surgery, and those who were not treated with these agents. No patient had permanent sequelae related to hemorrhage. Two patients had postoperative systemic complications possibly attributable to withholding anticoagulant/antiplatelet medications in preparation for surgery.ConclusionsAlthough serious hemorrhagic complications may be associated with oculoplastic procedures, the incidence of these complications is low. The decision to withhold antiplatelet or anticoagulant medications before surgery should be individualized. Selected procedures can be safely performed without stopping these agents.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo report patients who received dog bite injuries to the periocular area and the incidence of repeat attacks by the biting dog and its disposition. To discuss the demographics of bite attacks, occult injuries, steps to avoid medicolegal problems, and the appropriate options for animal disposition.MethodsSingle-practice prospective case series of dog attacks on 18 victims. Patients were followed and questioned about any repeat attacks by the offending dog.ResultsOf 18 individuals who received dog bites to the perio-ocular area, only 2 were >12 years old. Of the 16 cases available for follow-up (4 months to 3 years; mean, 16 months), 7 of the dogs were euthanized and 1 was sent away from the family. Of the 8 remaining animals, 5 (63%) bit again. All the dogs bit family members or family friends.ConclusionsAlthough most dogs make wonderful pets, canine bites pose a significant public health concern, and some simple steps may be taken to protect against personal injury and legal fallout from repeat attacks.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo study the effect of upper eyelid ptosis repair by Müller muscle–conjunctival resection on tear production.MethodsThe 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.ResultsNo 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.ConclusionsUpper 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.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine the predictability of a new algorithm for determining the amount of tissue resection for conjunctival Müllerectomy with or without tarsectomy blepharoptosis repair.MethodsConsecutive case series of all patients undergoing conjunctival Müllerectomy with or without tarsectomy ptosis repair from October 1999 to September 2001. Each patient underwent excision according to a new algorithm for determining the amount of tissue excision. The amount resected was determined by the following formula: 9 mm of conjunctiva and Müller muscle +xmm of tarsus, wherex= distance of undercorrection after phenylephrine testing.ResultsSixty-eight consecutive patients underwent 70 cases of conjunctival Müllerectomy with or without tarsectomy ptosis repair on 117 eyelids, using a new algorithm for tissue excision. Forty-seven cases were bilateral and 23 were unilateral. Postoperative symmetry was found in 58 of 67 patients (87%) after 1 surgery. Patient satisfaction based on symmetry, contour, and height after 1 repair was achieved in 64 of 67 patients. There were no overcorrections. Two patients underwent successful reoperation with a second conjunctival Müllerectomy with or without tarsectomy operation.ConclusionsThis modified algorithm and technique quantifies conjunctival Müllerectomy with or without tarsectomy ptosis surgery and yields predictable results.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine the rate of recurrence of basal cell carcinomas (BCCs) after modified en face frozen section–controlled excision in a high-risk population in Queensland, Australia.MethodsRetrospective, noncomparative interventional case series. A review was conducted of all patients with periocular BCCs examined between 1992 to 2001 in a tertiary oculoplastics practice. Basal cell carcinomas were surgically excised, and the recurrence rates under modified en face frozen section control, Mohs micrographic surgery, and no frozen section control were documented. Epidemiologic aspects of periocular BCC in Queensland, Australia were also studied.ResultsIn patients with primary BCCs, 0.71% (3 of 423 lesions) recurred when excised under frozen section control (mean follow-up, 2.6 years). At 5-year follow-up, the recurrence rate was 2.1% (2 of 97 lesions). Excision without frozen section control yielded a recurrence rate of 1.8% (2 of 113 lesions; mean follow-up, 2.6 years). There were 6 additional lesions, however, that were incompletely excised. At 5 years, the recurrence rate was 5%. Six patients had lesions removed with Mohs micrographic surgery. There were no recurrences after a mean follow-up of 1.7 years. Of 653 total lesions, 361 involved the right eye (55%). Most BCCs were on the lower eyelid (53%) and inner canthus (29%). Solid BCCs were the most common type (54%), followed by the infiltrative type (15%). The majority of complications were minor and caused no ocular damage.ConclusionsCarefully performed, modified en face frozen section controlled excision of periocular BCCs yields cure rates comparable to Mohs micrographic surgery at 5-year follow-up. Close communication with a skilled pathologist is essential to achieve these low recurrence rates. The fact that lesions involved the right periocular region more than the left may reflect greater sun exposure on that side from driving.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeA primary defect in the eyelid resulting from tumor excision will benefit from better skin match when the defect is repaired with eyelid skin. The amount of skin harvested by blepharoplasty from a single upper eyelid may be inadequate. This report describes and evaluates the effectiveness of two types of procedure in which maximal eyelid skin is harvested to repair defects in the upper or lower eyelids, respectively. The techniques require the resulting secondary defect being partially replaced by a second graft taken from the contralateral upper eyelid.MethodsThe surgical results of a prospective case series are evaluated. Postoperative upper eyelid graft appearance and patient satisfaction were recorded.ResultsTen patients underwent repair of a large skin defect in the upper eyelid (2 patients) or lower eyelid (8 patients), using maximum upper eyelid skin from above the skin crease. The primary donor site upper eyelid defect was closed after partial secondary grafting with skin from the side contralateral to the upper eyelid from which the maximal graft was taken. All patients were satisfied with the appearance of the grafted and donor areas.ConclusionsMaximal eyelid donor skin harvesting achieved satisfactory results and is a useful technique in eyelid reconstructive surgery.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo determine if skin cooling decreases the pain associated with periocular botulinum toxin A injections.MethodsIn this prospective study, 14 patients given bilateral periocular injections for blepharospasm or wrinkle reduction were included. Prior to the injections, one side received a skin cooling agent and the other side served as the control. Relative pain scores were recorded to assess the effects of treatment.ResultsThe range of pain scores on the noncooled side was 3 to 10 (average, 6.5); scores for the cooled side ranged from 0.5 to 7 (average, 3.6), which represents a 45% reduction in pain score.ConclusionsIn most patients, skin cooling decreases the pain associated with periocular botulinum toxin A injection.

ISSN:0740-9303    

出版商:OVID    

年代:2002

数据来源: OVID