ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo describe a novel surgical technique for lower eyelid ectropion repair that avoids canthotomy and cantholysis and can be used in combination with external levator repair and/or in combination with blepharoplasty.MethodsA retrospective analysis of lower eyelid procedures with the use of the canthus-sparing technique between January 1, 1998, and December 31, 1999, was performed. The canthus-sparing approach was used in 198 eyelid procedures for the correction of lower eyelid ectropion. Seventy-four (37.4%) procedures involved the correction of lower eyelid ectropion alone and 25 (12.6%) procedures involved the correction of lower eyelid ectropion during upper eyelid small-incision external levator repair. In these cases, an incision was made lateral to the lateral canthus and a periosteal flap was created at the lateral orbital rim. The inferior crus of the lateral canthal tendon was then attached to this full-thickness elevated periosteum. Twenty (10.1%) procedures involved the correction of ectropion during upper blepharoplasty and 79 (39.9%) procedures involved the correction of ectropion during combined upper eyelid ptosis repair and blepharoplasty. In these cases, the inferior crus of the lateral canthal tendon was attached to a periosteal flap created through the lateral portion of the blepharoplasty incision.ResultsThe mean age of patients undergoing ectropion repair was 74.3 ± 9.3 years (range, 42–93 years). The average duration of symptoms (most commonly tearing and/or ocular irritation) was 20 ± 14 months (range, 3–84 months). Recurrences of lower eyelid ectropion or symptoms occurred in 4 (2%) eyelids. The average follow-up interval was 54 ± 65 days (range, 3–330 days).ConclusionsThe canthus-sparing approach to ectropion repair promotes a secure adhesion to the lateral orbital wall with minimal violation of normal anatomic structures and relations. It is time-efficient and reduces postoperative morbidity.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo describe a technique for stabilizing external eyelid load weights with isobutyl cyanoacrylate tissue adhesive for the temporary treatment of facial palsies.MethodsThis was a nonrandomized, prospective study of six consecutive patients with unilateral facial paralysis treated with external eyelid load weights stabilized with isobutyl cyanoacrylate tissue adhesive instead of adhesive tape. Follow-up assessment included corneal exposure, patient comfort, amount of artificial tear usage, and complications associated with the weights.ResultsOf the six patients studied, five had decreased corneal exposure, decreased artificial tear usage, and increased patient comfort with use of the weights. One patient had no improvement of symptoms. Weights were retained for a mean of 10.7 days. Two patients had difficulty with the weights; one was secondary to dermatochalasis and blepharoptosis obscuring his vision, and the other patient’s weight fell off after 1 day. No weights were lost.ConclusionsThe use of isobutyl cyanoacrylate tissue adhesive is a simple, quick, and inexpensive method for placement of external eyelid weights for temporary treatment of ocular exposure associated with facial paralysis and for determining the correct weight for implantation. Furthermore, isobutyl cyanoacrylate tissue adhesive used to stabilize external eyelid weights is better tolerated and lasts longer than the previously described fixation method with adhesive tape.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo describe the demographics, etiologic factors, clinical presentations, and outcomes of orbital fractures in children.MethodsThis was a retrospective case series of 96 consecutive patients under 18 years of age with orbital fractures presenting to the Massachusetts Eye and Ear Infirmary, including both hospitalized and nonhospitalized patients.ResultsOrbital fractures in children were most frequently the result of sports, assault, or motor vehicle accident. The majority of patients did not require hospitalization and were treated as outpatients. The medial wall and floor of the orbit were the most frequent locations of fracture. Approximately half of the patients in this series required surgery, most often for entrapment. There were no cases of persistent diplopia in patients in whom surgery was performed or was not indicated. Associated ocular injuries were observed in half of the patients.ConclusionsIn this series of hospitalized and nonhospitalized patients, orbital fractures in children had a location pattern similar to that most frequently observed in adult patients (floor and medial wall). Orbital fractures in children frequently require surgery. The high prevalence of ocular injury in children with orbital fractures emphasizes the need for a comprehensive ophthalmic evaluation.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo determine whether endonasal dacryocystorhinostomy may constitute effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation.MethodsThis was a retrospective review of a series of 24 patients with acute dacryocystitis and lacrimal sac abscess who underwent endonasal dacryocystorhinostomy as a primary procedure. Outcome measures included resolution of signs and symptoms of acute dacryocystitis as well as intranasal ostium patency as assessed by lacrimal irrigation.ResultsPain was relieved in all patients within 3 days of surgery, and swelling resolved in all patients by 9 days after surgery. Ostium patency, as defined by the absence of epiphora, and free lacrimal irrigation was achieved in 20 (83%) of 24 patients, with follow-up of 27 to 59 months (mean, 40 months). Recurrent epiphora developed in four patients; recurrent dacryocystitis developed in none.ConclusionsEndonasal dacryocystorhinostomy may be a useful option in the treatment of acute dacryocystitis with abscess formation.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo assess the problems and/or complications associated with the use of a synthetic hydroxyapatite implant (FCI, Cedex, France).MethodsThe authors analyzed all of the problems and/or complications associated with the use of a third-generation synthetic hydroxyapatite implant (FCI3) in 120 patients by one surgeon over 4 years. The following data were recorded: age, type of surgery performed, size of implant used, peg system used, follow-up duration, time of pegging, problems and/or complications encountered, and treatment.ResultsThirteen patients were lost to follow-up after 3 months, leaving 107 patients who were followed up from 4 to 48 months (average, 29 months). Discharge occurred in 21 (19.6%) patients, implant exposure in 3 (2.8%), socket discomfort in 2 (1.9%), trochleitis in 2 (1.9%), conjunctival thinning in 1 (0.93%), and pyogenic granuloma in 1 (0.93%). Peg problems occurred in 24 (35.2%) of 68 patients. Problems encountered with the peg were discharge in 10 (14.7%) patients, pyogenic granuloma in 9 (13.2%), conjunctiva overgrowing the peg in 4 (5.8%), hydroxyapatite exposure around the sleeve in 3 (4.4%), loose sleeve in 3 (4.4%), peg drilled on an angle in 1 (1.5%), implant infection in 1 (1.5%), and peg falling out in 1 (1.5%).ConclusionsThe FCI3synthetic hydroxyapatite is a less costly alternative form of hydroxyapatite currently in use in many parts of the world. Problems and complications encountered with its use are similar to those seen with the Bio-Eye Integrated Orbital Implants, Inc., San Diego, CA, U.S.A. The incidence of exposure associated with the synthetic hydroxyapatite implant is lower than several other reports on the Bio-Eye. The synthetic hydroxyapatite implant is slightly softer than the Bio-Eye and fractured under extreme pressure in one case.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo describe a clinicopathologic correlation of a metastatic renal cell carcinoma to lacrimal gland.MethodsCase report.ResultsA 59-year-old man with a history of renal cell carcinoma had a hemorrhagic mass involving the palpebral lobe of the right lacrimal gland. Fundus examination disclosed two lesions with typical features of choroidal metastasis. The lacrimal gland mass was excised, and histopathologic examination revealed metastatic renal cell carcinoma. The patient was treated for systemic metastasis but required no further ocular treatment.ConclusionsRenal cell carcinoma can metastasize to the lacrimal gland, where it may appear as a hemorrhagic mass.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeWe present a two-generation family with multiple endocrine neoplasia (MEN) type IIb diagnosed by their ophthalmologists based on characteristic ophthalmic findings.MethodsA family consisting of a 33-year-old female proband and her 8-and 7-year-old children had prominent corneal nerves; eyelid, lip, and tongue nodules; and a characteristic facies. A polymerase chain reaction-based genetic assay was obtained to detect the genetic mutation most commonly associated with MEN type IIb. Serum calcitonin and urine catecholamine studies were obtained.ResultsMolecular genetic studies detected in all 3 patients a mutation at codon 918 of the RET proto-oncogene known to be present in 95% of the cases of MEN type IIb. Serum calcitonin was elevated in the proband and her son. Urine catecholamine levels were elevated in the proband. Surgical treatment and histologic analysis confirmed pheochromocytoma and medullary thyroid carcinoma (MTC) in the proband. Surgical exploration revealed the MTC to be metastatic to the liver.ConclusionsThis family demonstrates the characteristic findings of MEN type IIb: prominent corneal nerves in a clear stroma and multiple submucosal neuromas of the conjunctiva, eyelids, lips, and tongue. Ophthalmologists have a critical role to play in recognizing these signs, because the early diagnosis of medullary thyroid carcinoma and pheochromocytoma may be life saving.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PurposeTo describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman.MethodsInterventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34.ResultsThe lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up.ConclusionsOriginally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.

ISSN:0740-9303    

出版商:OVID    

年代:2001

数据来源: OVID