2007/05/24

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Items 1 - 36 of 36
1: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):256-7.

Iatrogenic giant fornix syndrome of the lower eyelid.

PMID: 17519686 [PubMed - in process]

2: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):255.

Quantifying upper eyelid laxity in symptomatic floppy eyelid syndrome by measurement of anterior eyelid distraction.

PMID: 17519685 [PubMed - in process]

3: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):255-6.

Misdiagnosis in chronic canaliculitis.

PMID: 17519684 [PubMed - in process]

4: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):254.

Reply re: "Minimally Invasive Conjunctivodacryocystorhinostomy With Jones Tube".

PMID: 17519683 [PubMed - in process]

5: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):254-5.

Defining the tear trough.

PMID: 17519682 [PubMed - in process]

6: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):253.

Re: "congenitally enlarged extraocular muscles: can congenital thyroid eye disease exist in a euthyroid infant?".

PMID: 17519681 [PubMed - in process]

7: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):253.

Reply re: "Congenitally Enlarged Extraocular Muscles: Can Congenital Thyroid Eye Disease Exist in a Euthyroid Infant?".

PMID: 17519680 [PubMed - in process]

8: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):253-4.

Re: "minimally invasive conjunctivodacryocystorhinostomy with jones tube".

PMID: 17519679 [PubMed - in process]

9: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):252.

Laterality of Periocular Basal Cell Carcinomas in Relation to Driving Practices in Philadelphia, PA, U.S.A.

PMID: 17519678 [PubMed - in process]

10: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):252-3.

Re: "Laterality of Periocular Basal Cell Carcinomas in Relation to Driving Practices in Philadelphia, PA, U.S.A.".

PMID: 17519677 [PubMed - in process]

11: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):250-1.

Metastatic endometrial carcinoma resulting in orbital apex compression.

A 63-year-old woman presented subacutely with signs of orbital apex and cavernous sinus disease in the setting of widespread, untreated metastatic carcinoma of the uterus. MRI revealed a destructive lesion of the left sphenoid wing with compression of the orbital apex and with possible extension in the cavernous sinus. The underlying diagnosis was confirmed with repeat endometrial biopsy, revealing well-differentiated endometrial adenocarcinoma. Given the supporting clinical evidence for metastatic disease and the radiologic characteristics of the lesion, the decision was made to not perform a confirming orbital biopsy.

PMID: 17519676 [PubMed - in process]

12: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):249-50.

Epibulbar conjunctival fibroma.

Department of Ophthalmology, New York University Medical Center, New York, New York, U.S.A.

A nodular, epibulbar mass appearing in an adult woman without antecedent inflammation or injury prompted concern for possible malignancy. Excision was performed, and pathologic examination demonstrated a conjunctival fibroma. The rarity of the fibroma and its clinical similarity to other benign or malignant tumors render its clinical diagnosis elusive.

PMID: 17519675 [PubMed - in process]

13: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):246-248.

Orbital Chordoid Meningioma: a Rare Subtype of Meningioma.

*Department of Ophthalmology and daggerDepartment of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea.

A 34-year-old woman presented with progressive proptosis of the right eye for 2 years. MRI revealed a well-demarcated mass in the right intraconal space, which was isointense on T1- and hyperintense on T2-weighted images with bright uniform enhancement. The mass was resected through a lateral orbitotomy. Histopathologic examination revealed cords and clusters of spindle and epithelioid cells embedded in a myxoid matrix, with vacuolated eosinophilic cytoplasm and round nuclei. The tumor cells were diffusely positive for epithelial membrane antigen and vimentin. These findings helped confirm the diagnosis of chordoid meningioma, a rare variant of meningioma with a greater risk of recurrence and aggressive growth. Many of the clinical manifestations and imaging findings were indistinguishable from those of cavernous hemangiomas, solitary fibrous tumors, neurofibromas, and other variants of meningiomas. Given the prognostic significance of chordoid meningioma, extra care and attention should be given during surgery, histopathologic assessment, and follow-up.

PMID: 17519674 [PubMed - as supplied by publisher]

14: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):244-246.

Ectopic Brain in the Orbit With Congenital Adduction Deficit and Simultaneous Abduction.

*Departments of Ophthalmology and daggerRadiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

An 11-month-old girl was referred to us with enophthalmos and restriction of ocular movement in the right eye. There was restriction of supraduction and adduction with synergistic divergence on left gaze. MRI revealed a multiloculated cystic mass in the right inferior orbit. There was an atrophic and misinserted inferior rectus muscle and only a vestigial right medial rectus muscle. Excisional biopsy of the orbital cystic mass was performed. Microscopic examination disclosed that the mass was brain tissue composed of arachnoid tissue, brain parenchyma, choroid plexus, and dura mater. Our report describes a rare case of ectopic brain in the orbit that was combined with anomalies of the extraocular muscles.

PMID: 17519673 [PubMed - as supplied by publisher]

15: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):243-4.

Ophthalmologic presentation of nasal chondromesenchymal hamartoma in an infant.

California Pacific Medical Center, San Francisco, California, U.S.A.

A 7-month-old infant was examined for severe right ptosis, strabismus, and noisy breathing. CT revealed a right intranasal mass with areas of calcification, erosion, and extension to the cribriform plate. Surgical resection was performed. Pathologic examination confirmed the diagnosis of nasal chondromesenchymal hamartoma. Ophthalmologists may be among the first medical practitioners to encounter nasal chondromesenchymal hamartoma, a rare, benign neoplasm of the nasal and paranasal sinuses.

PMID: 17519672 [PubMed - in process]

16: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):242-3.

Reactive lymphoid hyperplasia of the nasolacrimal duct presenting as bloody epiphora.

The Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A.

A 90-year-old man reported a 1-year history of tearing and irritation in the left eye. Ophthalmic examination was significant for bloody mucopurulent material expressed from the left nasolacrimal duct. The patient underwent external dacryocystorhinostomy with excision of a soft-tissue mass. Initial histopathologic examination of the specimen revealed an atypical lymphoid infiltrate. Subsequent immunohistochemistry suggested that the mass was reactive lymphoid hyperplasia. Lymphoid hyperplasia should be considered in the differential diagnosis of bloody epiphora, in addition to primary malignancy of the nasolacrimal duct, hematologic abnormalities, coagulopathies, vascular tumors, and giant papillary conjunctivitis.

PMID: 17519671 [PubMed - in process]

17: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):240-241.

Nasolacrimal Duct Obstruction With Urbach-Wiethe Syndrome.

*Albany Medical College, Albany, New York, U.S.A.; daggerOphthalmic Plastic Surgery, Lions Eye Institute and double daggerDepartments of Ophthalmology and Pathology, Albany Medical Center, Albany, New York, U.S.A.

An 80-year-old woman presented with signs and symptoms consistent with bilateral nasolacrimal duct obstruction. She also was noted to have multiple eyelid margin lesions. She underwent bilateral dacryocystorhinostomy with biopsy of the nasolacrimal ducts and eyelid lesions. Her tearing resolved. Histopathology of the eyelid lesions was consistent with lipoid proteinosis. Nasolacrimal duct obstruction may occur in patients with lipoid proteinosis (Urbach-Wiethe syndrome).

PMID: 17519670 [PubMed - as supplied by publisher]

18: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):238-40.

Retrobulbar orbital abscess secondary to dacryocystitis in a neonate.

Sankara Nethralaya, Medical and Vision Research Foundation, Chennai, India.

A retrobulbar orbital abscess secondary to congenital dacryocystitis is extremely rare. External abscess drainage, probing, and syringing with broad spectrum intravenous antibiotics was performed in a 22-day-old neonate who was examined for congenital dacryocystitis complicated by retrobulbar orbital abscess formation.

PMID: 17519669 [PubMed - in process]

19: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):236-238.

Benign Fibrous Histiocytoma Associated With a Frontoethmoidal Mucopyocele and Orbital Abscess.

*Department of Ophthalmology, Taoyuan Veterans Hospital, Taiwan; daggerSchool of Medicine and double daggerInstitute of Clinical Medicine, National Yang-Ming University, Taiwan; section signDepartment of Pathology, parallelDepartment of Ophthalmology, and paragraph signDepartment of Radiology, Taipei Veterans General Hospital, Taiwan.

A 74-year-old man sought treatment for painful swelling in the right upper eyelid. CT demonstrated a frontoethmoidal mucocele extending in the right orbit with abscess formation. Following functional endoscopic sinus surgery, the inflammatory symptoms in the right eye nearly resolved. However, a firm mass was still noted in the same location. Histopathologic examination proved it to be a benign fibrous histiocytoma. Benign fibrous histiocytoma may occur in association with an orbital abscess secondary to mucocele.

PMID: 17519668 [PubMed - as supplied by publisher]

20: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):234-5.

Lacrimal Gland Pleomorphic Adenomas With Low-density Zones Resembling Cystic Change on Computed Tomography.

Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.

We report 2 cases of pleomorphic adenoma with unusual radiologic findings. CT showed lacrimal gland masses dominated by low-density areas resembling cysts. Pathology revealed the lesions to be pleomorphic adenomas with myxomatous and/or cartilaginous features.

PMID: 17519667 [PubMed - in process]

21: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):232-234.

Resection of an Orbital Rim Intraosseous Cavernous Hemangioma and Reconstruction by Chin Graft and Resorbable Fixation Plate.

*Cellular and Molecular Pathology Research Unit, Oral Pathology and Oral Medicine, University of Sydney, Westmead Centre for Oral Health, Westmead Hospital, Westmead, Australia; daggerDepartment of Surgery, Central Coast Campus, University of Newcastle, Newcastle, Australia.

Intraosseous hemangiomas are uncommon in the orbital rim and pose difficulties for removal and reconstruction. Here we report an excellent cosmetic and functional outcome following en bloc resection and reconstruction, using a corticocancellous bone graft from the chin and LactoSorb perforated tray plate. The lesion treated is characterized by both computed axial tomography and histology, while the postsurgical bony contour also is revealed by CT.

PMID: 17519666 [PubMed - as supplied by publisher]

22: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):231-232.

Simple Alternative to the Wright Needle in Frontalis Sling Surgery.

*Sisli Etfal Research Hospital, Department of Ophthalmology, Istanbul, Turkey; daggerAbant Izzet Baysal University, Izzet Baysal Medical Faculty, Department of Ophthalmology, Bolu, Turkey.

The Wright needle is a widely used instrument for insertion of fascia lata or a synthetic material during frontalis suspension surgery; however, difficulties in handling this instrument are frequently encountered by many surgeons. We describe an 18-gauge needle with a 4/0 monofilament polypropylene suture as an alternative to the Wright needle for placement of the sling material in frontalis suspension surgery. Less slippage and easier control of the needle's direction and depth of tissue penetration result in more accurate placement of the material and a reduction in damage to the surrounding tissues.

PMID: 17519665 [PubMed - as supplied by publisher]

23: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):228-31.

Free tarsal graft combined with skin transposition flap for full-thickness lower eyelid reconstruction.

Department of Ophthalmology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.

We present the surgical outcome in a series of 4 patients with large full-thickness eyelid defects after basal cell carcinoma excision. The patients underwent reconstructive eyelid surgery using autogenous free tarsal grafts combined with a skin transposition flap from the upper eyelid. Two female and 2 male patients ranging in age from 44 years to 85 years were treated. In all 4 cases, posterior lamellae were reconstructed using a free tarsal graft, and the outer lamella was developed with a transposition skin flap from the upper eyelid. The skin flap provided adequate vascular support in all cases. Follow up of 10 months to 20 months showed a good outcome in all patients. Reconstruction of full thickness eyelid defects after extensive tumor excision requires reforming of the anterior and posterior lamella. Whereas the Hughes or Cutler Beard techniques for eyelid reconstruction require a 2-step approach with occlusion of the eye for at least 1 week, reconstruction with a free tarsal graft is a 1-stage procedure and does not entail eye occlusion. Autogenous tarsus as a free graft proves to be a simple procedure for posterior lamella substitution in lower eyelid surgery, especially in combination with a skin transposition flap from the upper eyelid.

PMID: 17519664 [PubMed - in process]

24: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):227-8.

A novel approach to the management of severe facial disfigurement in neurofibromatosis type 1.

Manchester Royal Eye Hospital, Manchester, United Kingdom.

A 12-year-old girl with neurofibromatosis type 1 underwent subtotal anterior exenteration of a blind, unsightly, buphthalmic eye and orbital/eyelid plexiform neurofibroma. Simultaneously, a channeled Medpor orbital implant was positioned to reduce a meningoencephalocele resulting from severe sphenoid wing dysgenesis. Two-stage osseointegration was subsequently performed to permit secure fitting of an orbital prosthesis. This patient's cosmesis and social interaction were improved markedly with this surgical approach for disfiguring ocular, eyelid, and orbital disease due to neurofibromatosis type 1.

PMID: 17519663 [PubMed - in process]

25: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):225-226.

Rapamycin for Treatment of Refractory Dysthyroid Compressive Optic Neuropathy.

*Cole Eye Institute and daggerDepartment of Nephrology and Hypertension, The Cleveland Clinic Foundation, Cleveland, OH, U.S.A.

We report a patient with dysthyroid optic neuropathy refractory to steroids and orbital decompression treated with rapamycin, a fibroblast and T cell inhibitor. Symptoms, visual acuity, color plate testing, and visual fields improved. Aside from hypercholesterolemia, no complication related to this therapy was observed. By addressing the pathogenesis of thyroid eye disease, rapamycin may represent an alternative when standard treatments fail. Further investigation of rapamycin for treatment of dysthyroid orbitopathy is warranted.

PMID: 17519662 [PubMed - as supplied by publisher]

26: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):222-4.

Comparison of the outcomes of internal-fixation versus bolster-suture tarsorrhaphy.

Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.

PURPOSE:: To compare the outcomes of 2 techniques of permanent tarsorrhaphy. METHODS:: The clinical records of 30 patients who underwent tarsorrhaphy at a single university-based hospital clinic were reviewed. Patients underwent permanent tarsorrhaphy because they had a nonresolving facial palsy, neurotrophic keratopathy unresponsive to medical treatment, or both. Permanent tarsorrhaphies were carried out by either internal fixation tarsorrhaphy or rubber bolster suture tarsorrhaphy. RESULTS:: The overall success (100%) of internal fixation tarsorrhaphy on 12 patients (ages, 42.0 +/- 17.6 years) was significantly better than that of rubber bolster suture tarsorrhaphy (44.4%) on 18 patients (ages, 40.6 +/- 25.5 years) (Mann-Whitney U test, p = 0.01). Of the 10 patients who had unsuccessful outcomes, 8 (80%) had their eyelids separated within the first 3 postoperative weeks. Patients whose surgical outcomes were deemed successful were followed for a period of 21.4 +/- 10.7 weeks (range, 11-52 weeks). CONCLUSIONS:: Internal fixation tarsorrhaphy is associated with a more favorable outcome than rubber bolster suture tarsorrhaphy in patients who require permanent eyelid closure.

PMID: 17519661 [PubMed - in process]

27: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):217-21.

A randomized clinical trial of two methods of fascia lata suspension in congenital ptosis.

Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.

PURPOSE:: To compare the results of 2 methods of upper eyelid sling placement with autogenous fascia lata in the treatment of congenital ptosis. METHODS:: In a randomized clinical trial, patients with congenital upper eyelid ptosis and poor levator function (<4 mm) were randomly assigned to either of 2 methods of upper eyelid sling placement: group A, bitriangular fascia sling (modified Crawford method), and group B, monotriangular fascia sling (modified Fox method). RESULTS:: This study included 30 upper eyelids (15 eyelids in each surgical group) of 19 patients (8 unilateral and 11 bilateral cases) with congenital ptosis. Mean increase in eyelid fissure height was 2.7 +/- 2.3 mm in group A and 3.4 +/- 2.2 mm in group B. Change in eyelid fissure in both groups was significant (p < 0.001, paired t test) but the intergroup difference was not (p = 0.4, independent sample t test). Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the 2 groups. No patient experienced recurrent ptosis requiring reoperation in either group. CONCLUSIONS:: The monotriangular method of upper eyelid fascia sling placement can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation, and a shorter period of anesthesia.

PMID: 17519660 [PubMed - in process]

28: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):211-216.

Eyelid Mucous Membrane Grafts: A Histologic Study of Hard Palate, Nasal Turbinate, and Buccal Mucosal Grafts.

*Ophthalmic Plastic Surgery Service, Division of Ophthalmology, Department of Surgery and the daggerDivision of Dermatopathology, double daggerDepartment of Pathology, University of Vermont College of Medicine, Burlington, VT, U.S.A., and the divisions of section signOrbital and Ophthalmic Plastic Surgery and || ||Ophthalmic Pathology, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA, U.S.A.

PURPOSE:: To histologically evaluate the outcome of mucous membrane grafts to the eyelid. METHODS:: Case series of 31 eyes from 24 patients who underwent transplantation of hard palate (25 eyes), buccal (1 eye), or nasal turbinate (5 eyes) mucosa to the posterior eyelid surface. These grafts were biopsied at 0.5 months to 84 months (mean, 20 months) postoperatively. They were examined with light microscopy and compared with either the donor mucosa from the same patient (2 patients) or the typical donor site histology (22 patients). RESULTS:: Graft biopsies revealed general epithelial morphology that was quite similar to the respective donor sites in virtually all cases. Six (25%) of 24 hard palate graft biopsies, which were obtained at 8 months to 49 months (mean, 22 months) postoperatively, displayed orthokeratosis alternating with parakeratosis, while 12 (50%) demonstrated parakeratosis alone, and another 6 (25%) showed adjacent regions of parakeratotic and nonkeratinized epithelium. No hard palate grafts showed complete absence of keratinization after transplantation. Other significant findings included loss of goblet cells in nasal turbinate grafts and few submucosal glands remaining in any specimen. CONCLUSIONS:: Full-thickness mucosal grafts typically maintain their native epithelial morphology following transplantation to the ocular surface. Submucosal glands usually do not survive transplantation, which could be the result of intentional thinning of the graft at the time of transplantation. Contrary to the opinion that hard palate graft epithelium usually undergoes metaplasia from keratinized to nonkeratinized within 6 months following transplantation to the eye, all hard palate grafts in this study remained orthokeratotic and/or parakeratotic.

PMID: 17519659 [PubMed - as supplied by publisher]

29: Ophthal Plast Reconstr Surg. 2007 May-Jun;23(3):206-10.

Complications of pegged and non-pegged hydroxyapatite orbital implants.

W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Health System, Ann Arbor, MI, U.S.A.

PURPOSE:: The purpose of this study is twofold: to assess the incidence and implications of complications unique to placing a freestanding polycarbonate peg in patients with hydroxyapatite implants and to compare the incidence of complications in these patients with the incidence in patients with non-pegged hydroxyapatite implants. METHODS:: This is a retrospective clinical case series of 103 patients who underwent hydroxyapatite implant insertion at our institution. The incidence of postoperative complications in patients who underwent freestanding polycarbonate pegging procedures (n = 21) and those who had not (n = 82) were compared. RESULTS:: One postoperative complication-infection-occurred in a significantly higher percentage of patients in the pegged group (42.9%, 9/21) compared with the non-pegged group (19.5%, 16/82), (p = 0.037). Fifteen of the 21 patients (71.4%) in the pegged group experienced complications unique to freestanding polycarbonate pegging. Overall, 95.2% (20/21) of patients in the pegged group experienced a complication compared with 58.5% (48/82) of patients in the non-pegged group, (p = 0.001). In addition, there was an average of 3.1 (66/21) complications per patient in the pegged group compared with an average of 1.9 (106/82) complications per patient in the non-pegged group (p = 0.010). CONCLUSIONS:: Patients who received a freestanding polycarbonate pegged implant had a high risk of experiencing complications unique to pegging, and therefore a significantly higher rate of complications overall when compared with patients whose implant was not pegged. In addition, patients who received a pegged implant had a higher incidence of infection. However, most patients retained their pegs despite complications.

PMID: 17519658 [PubMed - in process]

30: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):202-205.

Orbital Lipoma: 2 Cases and Review of Literature.

*Aravind Eye Hospital, Madurai, India; Departments of daggerOphthalmology and Visual Sciences, double daggerPathology, and section signRadiology, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.

PURPOSE:: Lipomas are rare benign tumors of the orbit that can resemble a variety of other orbital masses. We present 2 patients with orbital lipomas and review the literature. METHOD:: Retrospective review of clinical charts, imaging studies, and pathology specimens. RESULTS:: We encountered 2 patients with lipomas, both presenting with orbital swelling and a mass noted on clinical examination. A well-circumscribed lesion was seen on CT, which on excision was composed of mature fat cells arranged in lobules and surrounded by a diaphanous capsule. CONCLUSIONS:: Lipomas arising in the orbit may evoke a range of clinicoradiologic differential diagnoses.

PMID: 17519657 [PubMed - as supplied by publisher]

31: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):197-201.

Errors of Single-Mirror or Prism Hertel Exophthalmometers and Recommendations for Minimizing the Errors.

*Department of Geosciences, Oregon State University, Corvallis, Oregon, U.S.A.; daggerDepartment of Ophthalmology, University of Michigan, Ann Arbor, Michigan, U.S.A.

PURPOSE:: Analysis is performed of the geometry of a Hertel exophthalmometer to determine the intrinsic error of reading that results from using the instrument in the manner that the manufacturer intended. Recommendations for improvement of the design and/or use of the instrument are made based on the findings. METHODS:: A schematic drawing of the manufacturer-recommended use of an exophthalmometer is created. The geometry is analyzed to reveal the sources of error in the exophthalmometer reading and an equation for the magnitude of the error is derived. RESULTS:: The exophthalmometer reading error is directly proportional to the difference between the reading obtained and the reading at the no-parallax-alignment position used to make the reading (commonly 18 mm), with the reading being low when the reading is greater than the no-parallax-alignment position and high when the reading is less. The error is increased by the observer's eye being closer to the reflecting surface and by widening the base or separation of the 2 reflecting surfaces of the instrument. The exophthalmometer reading may be 1.7 mm less than actual when it reads as 35 mm, which is 17 mm from the no-parallax-alignment position. CONCLUSIONS:: To minimize error in exophthalmometer readings, the reading should be as close to the no-parallax-alignment-position as possible. Exophthalmometers should therefore be modified to have multiple sets of no-parallax-alignment lines, each pair of a different color. The instrument should be used with the narrowest feasible base and the examiner should be consistently positioned as far from the reflecting surface of the instrument as possible.

PMID: 17519656 [PubMed - as supplied by publisher]

32: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):192-196.

Beveled Osteotomy With Lateral Wall Advancement and Interpositional Bone Grafting for Severe Thyroid Orbitopathy.

Department of Ophthalmology, Baylor University Medical Center, *Dallas and daggerPlano, TX, U.S.A.

PURPOSE:: To present a new technique for orbital decompressions for patients with severe thyroid orbitopathy that minimizes complications while maximizing the amount of decompression. This method involves advancing the lateral orbital wall in such a way as to promote osseous union and minimize cosmetic deformities. METHODS:: This paper represents a case series (42 eyes from 26 patients) of orbital decompressions for severe thyroid related orbitopathy. All patients were treated via a graded balanced orbital decompression with advancement of the lateral orbital wall with interpositional bone grafts. Preoperative and postoperative measurements were tabulated and statistically analyzed. RESULTS:: All patients demonstrated significant improvement in proptosis with an average Hertel exophthalmometry reduction of 8 mm. In addition, 22 patient orbits with preoperative elevation of intraocular pressure demonstrated an average 7 mm Hg improvement in postoperative intraocular pressure. Seven patients required strabismus surgery postoperatively and no patient developed new onset strabismus after surgery. Of all patients, 54% demonstrated improvement of visual acuity of greater than 1 line and no patient experienced a decrease in visual acuity. Postoperative computed tomography scan demonstrated osseous union of the lateral wall after advancement with this new technique. No patient complained of a palpable deformity of the lateral orbital wall. CONCLUSIONS:: The graded balanced orbital decompression with interpositional bone grafts effectively decompressed the orbit with significant improvement in final visual acuity, exophthalmometry measurements, and final intraocular pressure. In addition, this technique promotes osseous union with minimal cosmetic deformities.

PMID: 17519655 [PubMed - as supplied by publisher]

33: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):187-191.

Papillary Thyroid Carcinoma With Thyroid-associated Orbitopathy in a Euthyroid State.

*Department of Ophthalmology, Yonsei University Medical College, Institute of Vision Research, Seoul, Korea; daggerDepartment of Ophthalmology, Pochun CHA University College of Medicine, Pundang CHA Hospital, Sungnam, Korea; and double daggerDepartment of General Surgery, Yonsei University Medical College, Seoul, Korea.

PURPOSE:: Thyroid cancers with concurrent thyroid-associated orbitopathy (TAO) are extremely rare. The present study reports 5 unusual cases of papillary thyroid microcarcinoma in patients presenting with TAO in an euthyroid state. METHODS:: We retrospectively reviewed the records of 5 patients (4 female, 1 male) with no known history of thyroid disease, who initially presented with TAO and were subsequently found to have thyroid cancer. TAO was diagnosed by a combination of computed tomography and clinical symptoms and signs. All patients underwent routine serologic assessment of thyroid hormones and thyroid-related autoantibodies including thyrotropin-receptor antibodies, as well as imaging studies such as neck ultrasonography or thyroid scintiscan with I. RESULTS:: Patients presented with asymmetric proptosis (cases 1-3), ocular motility restriction (cases 1-3), and eyelid retraction (cases 1-5). None of the patients showed clinical signs of hyperthyroidism, and all returned normal thyroid function test data. Thyroid nodules were detected by neck imaging; subsequent fine-needle aspiration biopsies were performed with the cytologic result of papillary carcinoma. In no cases did ophthalmic symptoms resolve following cancer treatment (e.g., thyroidectomy and radioactive iodine therapy). All patients were positive for thyroid-binding inhibiting immunoglobulin in low titers. CONCLUSIONS:: Although coincident occurrence is rare, patients presenting with TAO should be carefully evaluated for the possible presence of papillary microcarcinoma, which can develop in a setting of systemic autoimmunity without inducing hyperthyroidism.

PMID: 17519654 [PubMed - as supplied by publisher]

34: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):183-186.

Effect of Timing of External Dacryocystorhinostomy on Surgical Outcome.

*The Alberto Moscona Department of Ophthalmology, Rambam Medical Center, Haifa, Israel; daggerClalit Heathcare Services, Primary Care Practice, Zur Shalom, Israel; double daggerThe Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.

PURPOSE:: To present our experience with external dacryocystorhinostomy (DCR) outcome and to compare cases of early and late DCR. METHODS:: Retrospective data review of all patients who had external DCR with silicone intubation in a 7-year period. Data were collected and analyzed concerning patients' preoperative and postoperative symptoms, and the lacrimal drainage system examination before, during, and after surgery. RESULTS:: In all, 162 patients underwent 195 DCR surgeries for nasolacrimal duct obstruction. Success was achieved in 81% of surgeries. Success rates were higher in patients who had early DCR (tearing only or early inflammatory signs of the lacrimal sac, 84% success) than in cases that had late DCR (more than 6 months after inflammation started, 77% success). These differences were statistically insignificant. Failure of DCR was much higher in posttraumatic DCR than in DCR for other etiologies. Complications (in 9% of surgeries) were generally mild and infrequent, except 1 case of meningitis. CONCLUSIONS:: In experienced hands, external DCR has good postoperative success with a low complication rate. Early DCR does not have a substantial advantage over late surgery with regard to surgical outcome.

PMID: 17519653 [PubMed - as supplied by publisher]

35: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):179-182.

Transcanalicular Dacryocystorhinostomy With Diode Laser: Long-term Results.

Departments of *Otolaryngology and double daggerOphthalmology, Hospital de Fuenlabrada, Madrid, Spain; daggerOphthalmology Department, Fundacion Hospital Alcorcon, Madrid, Spain.

PURPOSE:: To evaluate the effectiveness of transcanalicular dacryocystorhinostomy with diode laser in treatment of epiphora in adults. METHODS:: A prospective, noncomparative, interventional case series of transcanalicular dacryocystorhinostomy in 25 patients presenting with epiphora due to nasolacrimal obstruction. Patient age ranged from 32 to 72 years. Patients were evaluated postoperatively at 12, 24, and 36 months. Patients were evaluated for symptom improvement through a visual analog scale, and patency of osteotomy by lacrimal system irrigation with fluorescein and direct visualization by nasal endoscopy. Success was defined as resolution of epiphora. RESULTS:: Transcanalicular dacryocystorhinostomy was able to re-establish patency of the lacrimal system in 88% of cases after 36 months of surgery. No differences were found between patients older than 65 years and younger patients (chi-square, p > 0.05). Early (12 months) and late (36 months) results were similar (chi-square, p > 0.05). CONCLUSIONS:: In this prospective series, transcanalicular dacryocystorhinostomy was effective in treatment of epiphora in adults with little morbidity.

PMID: 17519652 [PubMed - as supplied by publisher]

36: Ophthal Plast Reconstr Surg. 2007 May/June;23(3):173-178.

Assessing Patients With Epiphora Who Are Patent to Syringing: Clinical Predictors of Response to Dacryocystorhinostomy.

*Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia; daggerDepartment of Ophthalmology, St. Vincent's Hospital, Sydney, New South Wales, Australia.

PURPOSE:: To assess the value of an abnormal fluorescein dye disappearance test (FDDT), lacrimal syringing, and Jones test for patients with epiphora who are clinically patent to syringing. METHODS:: Prospective cohort study of 68 consecutive patients with epiphora who were clinically patent to syringing and otherwise normal to examination. Patients were assessed using FDDT and lacrimal syringing, as well as the Jones test comparing either single- or multiple-drop technique. FDDT and canalicular reflux on lacrimal syringing were subjectively graded. RESULTS:: Success was defined as nil or only mild epiphora after surgery. Surgery was performed on 68 patients with a successful result in 64 (94%). The majority of these patients had severely delayed FDDT (90%), >/=50% reflux on lacrimal syringing (78%), or were Jones I negative (81%). There was no significant difference between outcomes of the single- and multiple-drop tests. In patients examined with the single-drop Jones test, patients with a Jones I negative result had a statistically significant better surgical outcome (p = 0.04). This comparison was highly significant when the subgroup of patients with severely delayed/nonclearing FDDT and >/=50% reflux was examined (p = 0.005). The results were not significant for the multiple-drop group. CONCLUSIONS:: These findings show that a negative single-drop Jones I test is predictive of symptomatic improvement after dacryocystorhinostomy surgery in patients with epiphora who are clinically patent to syringing. Lacrimal syringing and the FDDT, on their own, were not predictive of surgical outcome. Jones testing was of significant value in patients, but only when the traditional single-drop test was used.

PMID: 17519651 [PubMed - as supplied by publisher]

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