ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryThe 1995 RAND studyEstimating Eye Care and Workforce Requirementsanalyzes the United States' supply, demand, and need for eyecare providers. Portions of the RAND study were prepared along traditional ophthalmic specialty lines. This article extracts and further analyzes those portions of the study that are of interest to active subspecialty oculoplastic surgeons. The RAND study results indicate a significant current and very probable future oversupply of oculoplastics workforce personnel. This over-supply is further exacerbated when a RAND study underestimate of the number of new fellowship-trained oculoplastic surgeons is corrected.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryThe use of trichloroacetic acid (TCA) as a periorbital and eyelid peel for skin rejuvenation is gaining significant acceptance among oculoplastic surgeons, dermatologists, and other surgery groups. In spite of the current enthusiasm, there remain potentially serious complications resulting from any periorbital peel. Cases of cicatricial ectropion have been reported in phenol-peeled patients, and lower eyelid ectropion has reportedly occurred in patients undergoing deep eyelid peel in conjunction with a blepharoplasty (1,2). To avoid this complication, it is necessary to better understand the depth of the wound produced by different strengths and combinations of peeling agents applied to living eyelid tissue and, more important, to determine the concentrations of TCA that are likely to lead to cicatricial ectropion when applied in a consistent fashion. We chose upper-eyelid skin because it is easier to obtain for histopathologic study than lower-eyelid skin and, in our experience, is more sensitive to hypertrophic changes after chemical peeling or carbon dioxide laser resurfacing. We applied TCA to the preseptal skin of 10 patients 48 h before standard upper-eyelid blepharoplasty. The acid was applied to produce a “frost,” using varying concentrations of acid, ranging from 20 to 50%. The treated skin removed at the time of blepharoplasty was reviewed in a masked fashion by a dermatopathologist to determine the depth of necrosis. We found that superficial peels with necrosis involving 30% of the epidermis were produced by the lowest-concentration combination of TCA applied (20% followed by 0%). As the strength increased, so did the depth of peel. The combination of 50% followed by a second application of 50% produced the deepest peel, with necrosis into the papillary dermis. This finding would indicate that the chance of developing cicatricial ectropion with any of the tested combinations of TCA should be very remote.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryPurpose. This study was to determine whether age-related decrements in type I collagen synthesis occur in human eyelid skin. Methods. Using an antibody to procollagen I, we investigated collagen synthetic activity in skin removed for cosmetic purposes from 10 white patients between the ages of 4 and 77 years. Eleven masked referees graded the immunostaining on a scale of 1 (most intense) to 10 (least intense). Results. The multiple range test for rank by group demonstrated more intense staining in younger patients compared with older patients. An average correlation coefficient of 0.8432 (p < 0.05) existed between each of the referee's rankings. Conclusion. Type I collagen synthesis diminishes with age in eyelid skin.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryThe purpose to this study was to determine whether early surgical repair is indicated for a severely entrapped inferior rectus muscle following orbital blowout fracture. We report two patients with small blowout fractures, severe entrapment of the inferior rectus muscle, and an absence of the inferior rectus muscle in multiple contiguous coronal computed tomography cuts. At surgery, we released the severely entrapped inferior rectus muscles with resolution of diplopia. We concluded that patients with the “missing muscle syndrome” require urgent surgical intervention and that clinician review of radiologic studies is always prudent.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryThe purpose of this study was to determine whether orbital volume assessment by computerized tomography (CT) could provide additional information for the initial evaluation of orbital blowout fractures and guide optimal treatment. The medical records of 30 patients with orbital blowout fractures, either surgically or conservatively managed, were retrospectively reviewed. Orbital volumetric analysis was then determined from digitized CT scans. Fracture-related volume expansion relative to the unaffected fellow orbit was correlated with motility deficits and location and degree of enophthalmos. Early Hertel's measurements (<4 weeks) were available in 21 patients and did not correlate with the computer volumetric values or with subsequent late enophthalmos. Late Hertel's measurements (>4 weeks) were obtained in 13 of 15 nonrepaired fractures and in 5 of 15 surgically repaired patients (late presentation; 18 patients). When seen at more than 4 weeks, 11 (92%) of 12 patients with ≥13% orbital volume expansion manifested significant enophthalmos (>2 mm) compared with 1 (17%) of 6 patients with <13% orbital expansion (p= 0.004). Fractures presenting with enophthalmos on initial examination had extensive medial wall involvement in addition to the floor fracture (p= 0.003). CT measurements of orbital volume can predict the final degree of late enophthalmos and may facilitate the planning of surgical intervention.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryNumerous approaches to the orbit have been elegantly described in the literature. One area of the orbit that remains difficult to approach with standard techniques is the inferonasal apex. We describe a new surgical procedure we have termed the LeFort I orbitotomy. The technique involves creation of a LeFort I osteotomy to separate the maxilla from the zygoma and nose bilaterally. The posterior inferomedial orbital bone is then removed and the periorbita opened. This approach allows a more direct, less tangential view to this area of the orbit than does a Caldwell-Luc approach. Wider access for tumor manipulation is gained than would be possible with a transnasal endoscopie approach. An illustrative case report is presented.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummarySoft tissue adhesion to the porous polyethylene sheet implant (PPSI) raises the concern of postoperative extraocular motility disturbance after orbital blowout fracture repairs using PPSI. A PPSI with a barrier surface (PPSI-B) has been developed to reduce adhesion between soft tissue and the implant. Six PPSI-B and six conventional PPSI were implanted under the scalps of three New Zealand white rabbits. The implants were harvested at 2-, 4-, and 20-week intervals. Clinical and histologie comparisons were made between PPSI-B and PPSI with regard to adhesion at the soft tissue—implant interface. Clinically, PPSI-B demonstrated less adhesion between soft tissue and implant compared with the conventional PPSI. Both types of implants demonstrated a complete fibrovascular ingrowth by 2 weeks. Because PPSI-B causes less adhesion at the soft tissue-implant interface, consideration should be given to the use of PPSI-B in repairs of orbital blowout fractures in which extraocular muscle is exposed to the implant surface.SUMMARYOur study supports the efficacy of PPSI-B in reducing soft tissue adhesion without compromising the degree of fibrovascular ingrowth into the implant. The PPSI-B may be especially useful in cases in which the extraocular muscle is exposed to the porous polyethylene implant. However, the reduction of adhesiveness to soft tissue and the resultant improvement in handling characteristics support the use of PPSI-B in all orbital reconstructive surgeries.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryHigh-density porous polyethylene allografts are used as orbital implants in reconstruction of anophthalmic sockets. The use of this material for integrated buried implants is rather new, and studies on removed implants from humans are limited. We studied the case of a 6-year-old boy with an extruded porous polyethylene implant due to orbital recurrence of retinoblastoma. The clinical and morphological features are reported. Histopathology revealed fibrovascular downgrowth in the outer two thirds of the sphere. Scanning electron microscopy, however, documented further downgrowth of fibrous tissue into the central core. Transmission electron microscopy depicted a spectrum of collagen fiber orientations to polyethylene material, ranging from perpendicular to concentric. Immunohistochemistry studies were inconclusive.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

SummaryConjunctival squamous cell carcinoma is an infrequent tumor. It has been reported to occur in association with actinic damage and chronic irritation. To the authors' knowledge, however, this tumor has not been reported secondary to poorly fitting ocular prostheses. Two patients were studied in whom conjunctival squamous cell carcinoma had developed. In both instances, the patient had been enucleated and fitted with an ocular prosthesis more than 40 years before tumor development. Histopathologic evaluation of each tumor revealed its squamous cell origin. In one of the patients, the tumor was found to be metastatic to the ipsilateral parotid gland, an uncommon finding. The authors attempted to identify risk factors that may have contributed to the development of these tumors. Aside from the poor fit of the prostheses, neither patient had significant risk factors for the development of conjunctival squamous cell carcinoma. It is concluded that a new, sanguineous conjunctival discharge or focal eyelid swelling after years of prosthetic wear may not be due to mechanical irritation alone. The onset of these symptoms, especially years after the initial fitting of an ocular prosthesis, should prompt a thorough investigation of its cause.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID