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Biomedical subjects

A M Putterman

Publications and source records attributed to A M Putterman.

At least 73 records · Page 4Linked to original sources
PubMed1987

Correction of postoperative eyelid retraction with a simplified levator palpebrae superioris (LPS) muscle recession: analysis of a 10-year experience.

A simplified levator palpebrae superioris (LPS) muscle recession was performed to correct eyelid retraction in 56 eyelids of 48 patients. Improvement of preoperative keratopathy and cosmetically acceptable results were achieved in 93% of the eyelids. Based on preoperative surgical intervention, eyelids were divided into four groups: levator resection, levator aponeurosis advancement, surgery associated with dysthyroid ophthalmopathy, and miscellaneous reconstructive eyelid procedures. For each group the mean preoperative and postoperative eyelid levels, the mean change in eyelid level following surgery, and the mean amount of surgery performed were analyzed statistically with the two-tailed student's t-test. Linear regression was used to analyze the relationship between the change in eyelid level and the amount of levator recession performed. No significant relationship was demonstrated between eyelid retraction and dysthyroid ophthalmopathy or reconstructive eyelid surgery. However, a significant relationship was demonstrated between the amount of recession and the eyelid level change for eyelids retracted following levator resection (P less than .01) and levator aponeurosis surgery (P less than .05). This may indicate that the change in eyelid level following a simplified LPS recession in these two groups is predictable. However, additional prospective studies are required to further assess the clinical applicability and use of this finding.

Adolescent↗
PubMed1986

A clinicopathologic study of hematic cysts of the orbit.

Hematic cyst of the orbit has been described in association with various diseases, but its pathogenetic mechanism remains unclear. We treated two patients (two men, 38 and 35 years old) who had growing cysts suspected of being malignant tumors. Surgical exploration of the orbits disclosed birefringent crystals (hematodin) either in the cyst wall or in the cyst's contents. The crystals imitated foreign bodies in their appearance and in the reactions they induced.

Adult↗
PubMed1986

Conjunctival map biopsy to determine pagetoid spread.

Sebaceous adenocarcinoma (meibomian gland cancer) can be localized at times to one specific area of the eyelid; at other times, it spreads diffusely by pagetoid invasion throughout the conjunctiva. The pagetoid spread is often impossible to visualize. I used a map biopsy of the conjunctiva to determine the extent of involvement of sebaceous adenocarcinoma in 12 patients. Sixteen conjunctival biopsy specimens were taken from various areas of the palpebral and bulbar conjunctiva. An analysis of these specimens helped to delineate the area of tumor involvement, which aided in determining whether to treat these cases by full-thickness eyelid resection or orbital exenteration.

Adenocarcinoma↗
PubMed1986

Orbital exenteration with spontaneous granulation.

Excision of the orbital contents by orbital exenteration is required in the treatment of some eyelid and orbital carcinomas. Allowing the orbit to heal spontaneously with granulation tissue has several advantages over the popular technique of lining the orbital walls with a split-thickness skin graft. The use of granulation tissue is simpler, since it avoids the needs for obtaining a skin graft, and the final result is cosmetically more acceptable, because a shallower cavity occurs compared with the skin graft technique. The main disadvantages are that it takes longer for the orbit to heal and dressing changes are required more frequently. The spontaneous granulation technique has provided excellent results in 12 patients with exenterated orbits.

Adenocarcinoma↗
PubMed1986

Primary localized amyloidosis presenting as an eyelid margin tumor.

A 40-year-old man had slow-growing, nodular, amyloid tumors of the eyelid margin associated with recurrent intradermal hemorrhages for 18 years. Medical evaluation revealed no evidence of primary systemic amyloidosis. We suggest that amyloidosis be included in the differential diagnosis of painless, slow-growing, nodular tumors of the eyelid margin.

Adult↗
PubMed1986

Conjunctiva-Müller's muscle excision to correct anophthalmic ptosis.

We treated 35 eyelids with ptosis and anophthalmos by resecting conjunctiva and Müller's muscle. Before surgical intervention all patients were evaluated by an experienced ocularist who, if necessary, modified or refit the prosthesis. All eyelids had a positive response to 10% phenylephrine hydrochloride. Preoperatively, the margin reflex distance-one (MRD-1) of the ptotic eyelids ranged from -2.0 to +3.5 mm. The amount of conjunctiva-Müller's muscle excision ranged from 7.25 to 9.25 mm. Following surgery, the average change in MRD-1 was 3.33 mm. Thirty-one eyelids (88.6%) achieved a post-operative level within 1 mm of the opposite eyelid. There were two overcorrections and two undercorrections. Postoperatively, no patients had any compromise of the superior fornix, socket dryness, or inability to retain their prosthesis. Resection of conjunctiva and Müller's muscle is a simple and effective method to treat ptosis associated with anophthalmos.

Adolescent↗
PubMed1986

Evaluation of lubricants for the prosthetic eye wearer.

We evaluated the need for additional lubrication in 200 consecutive patients using an ocular prosthesis. Of these patients, 154 (77%) required no additional lubrication, while 46 patients (23%) required supplemental lubrication. Enuclene, the only product manufactured specifically for the patient with an ocular prosthesis, has been reported by the majority of our patients to be inadequate for comfort and wearability. Other solutions for contact lens use were compared with Enuclene and found to be far superior by patients using an ocular prosthesis.

Adolescent↗
PubMed1986

Müller's muscle in the treatment of upper eyelid ptosis: a ten-year study.

Müller's muscle is a sympathetically innervated muscle that can be resected to treat upper eyelid ptosis. Candidates for the ptosis procedure are those whose upper lids elevate to a normal level following instillation of phenylephrine hydrochloride drops into their upper ocular fornix. A specially designed clamp is applied to 6.5 to 9.5 mm of conjunctiva and Müller's muscle above the superior tarsal border. A suture is run distal to the clamp, connecting conjunctiva and Müller's muscle to the superior tarsal border; then, the tissues held in the clamp are resected. In a ten-year study of this procedure, 90% of the lids with acquired ptosis and 100% of those with congenital ptosis were within 1.5 mm of the level of the opposite lid postoperatively. Only two of 232 treated lids required additional surgery.

Adult↗
PubMed1986

Müller's muscle in the treatment of upper eyelid retraction: a 12-year study.

Müller's muscle is a sympathetically innervated muscle that can be excised to relieve upper eyelid retraction. A graded, controlled excision of Müller's muscle, with or without recession of the levator aponeurosis, using sensory without motor anesthesia is an excellent technique for releasing thyroid-related upper eyelid retraction. The procedure is simple, based on anatomic and physiologic principles, tailored to the individual patient intraoperatively, and yields consistently good results. In a 12-year study of this procedure, 96% of the treated lids attained lid levels within 1.5 mm of the opposite side. Only seven of 156 treated eyelids required additional surgery.

Eyelid Diseases↗
PubMed1985

Internal vertical shortening for the correction of diffuse or segmental postoperative blepharoptosis.

In a series of 18 patients operated on because of postoperative eyelid contour abnormalities or small to moderate amounts of diffuse blepharoptosis, a technique of internal vertical shortening produced consistently reliable results. A cosmetically acceptable result was achieved in 17 of 18 patients (95%); only one of 18 (5%) showed no improvement. In cases of overcorrected upper eyelid retraction secondary to thyroid ophthalmopathy, 11 of 11 patients had cosmetically acceptable results. In those with blepharoptosis or eyelid contour abnormalities secondary to other causes, six of seven patients (84%) had cosmetically acceptable results. In our technique of internal vertical shortening, a predetermined amount of conjunctiva and overlying scar tissue or levator aponeurosis is removed. The resection uses a posterior approach to remove tissue from the superior tarsal border upward.

Adolescent↗
PubMed1985

Margin limbal distance to determine amount of levator resection.

In 68 consecutive patients with congenital blepharoptosis undergoing levator muscle resection, a formula derived from the preoperative margin limbal distance (MLD) was used to determine the amount of levator resection. Excellent results were achieved in 86% of 43 patients with unilateral blepharoptosis when this formula was followed. Of 25 patients with bilateral blepharoptosis, excellent results were achieved in 76% of eyelids. When compared with Berke's method, the MLD formula was superior in unilateral cases and almost equal in bilateral cases. The MLD formula gave the surgeon an excellent preoperative prediction of the amount of levator to resect and aided in the placement of the initial tarsal-levator suture. In unilateral cases, little if any tarsal-levator adjustment was necessary. In bilateral cases, Berke's intraoperative values enabled the surgeon to refine the MLD determination.

Adolescent↗
PubMed1985

A modified glass tube for conjunctivodacryocystorhinostomy.

The standard glass tube used with a conjunctivodacryocystorhinostomy is subject to spontaneous displacement. Either internal displacement into the surgically created passageway or external displacement and loss are possible. We have modified the tube by adding a flange 4 to 6 mm from the tube's top. This anchors the tube and significantly reduces postoperative tube mobility. Many procedures that would otherwise fail can be salvaged by using this new tube.

Evaluation Studies as Topic↗
PubMed1985

The mysterious second temporal fat pad.

Temporal eyelid fullness due to residual herniation of orbital fat is a complication of cosmetic oculoplastic surgery. It frequently occurs despite the surgeon's excision of temporal herniated orbital fat and requires a second surgical procedure to remove. Anatomists have demonstrated three lower eyelid fat pads, temporally, centrally, and nasally. I have found a second temporal fat pad that was not evident until the first had been removed. Searching for and excising the second temporal fat pad have eliminated the complication of residual temporal lower, eyelid fat herniation following cosmetic eyelid surgery.

Adipose Tissue↗
PubMed1985

Reconstruction of the contracted ocular socket.

Totally contracted ocular sockets are difficult to reconstruct and many patients resort to wearing a black patch. One reason for surgical failure is that many popular techniques attach a mucous membrane or a skin-lined vertical stent to the superior or inferior orbital rim. This produces a vertical space that commonly shrinks and becomes too small to retain an artificial eye. The normal anatomy of the ocular cul-de-sac is C-shaped rather than vertical. It passes under the orbital roof superiorly and over the floor inferiorly. A technique has been devised in which the mid-aspect of a custom-made C-shaped mucous membrane-lined conformer is secured to the superior and inferior orbital rims. This attachment forces the posterior periphery of the conformer deep into the socket to form a space that stimulates the normal anatomy of the ocular cul-de-sac. The described technique has been successful in producing a spacious cul-de-sac in 36 patients with total socket contractures. A modification of the technique has been successful in treating 12 patients with partial contractures. All patients have easily retained an artificial eye after operation.

Contracture↗
PubMed1985

Müllers muscle-conjunctival resection ptosis procedure.

The Müllers muscle-conjunctival resection procedure is a relatively simple means of relieving upper eyelid ptosis. Candidates for the operation are chosen by placing several drops of 10% phenylephrine hydrochloride into the upper ocular fornix. If the upper lid elevates close to a normal level after five minutes, the patient is selected for the operation. A specially designed clamp is applied to 6.5 to 9.5 mm of conjunctiva and Müllers muscle above the superior tarsal border. A suture is run distal to the clamp, connecting conjunctiva and Müllers muscle to the superior tarsal border, and then the tissues held in the clamp are resected. The Müllers muscle-conjunctival resection has advantages over the Fasanella procedure, because tarsus is preserved, and over the levator aponeurosis advancement and tuck procedures, because the results are much more predictable.

Blepharoptosis↗