Biomedical subjects
Publications and source records attributed to A Putterman.
Lymphomas and leukemias account for a large portion of orbital tumors. Orbital lymphoma accounts for 55% of malignant orbital tumors in adults. Idiopathic orbital inflammatory pseudotumors are pathologic entities that often challenge ophthalmologists and radiologists. This article describes the MR and CT features of orbital lymphoma, leukemia, and some other lymphoproliferative disorders.
A series of arms and retractors that attach to the operating table to aid the surgeon during orbitotomy and dacryocystorhinostomy is described. This enables the surgeon to consistently retract and expose orbital structures without assistance.
OBJECTIVE: To determine criteria to diagnose and document functional visual impairment from upper eyelid ptosis in the downgaze position of reading. DESIGN: Prospective clinical study. PATIENTS: From September 1991 to June 1992, 47 consecutive patients with adult-onset acquired ptosis were enrolled in the study. Downgaze eyelid and relative brow position were evaluated in 88 eyelids of these patients. INTERVENTIONS: Surgical repair of blepharoptosis by the Müller muscle conjunctival resection ptosis procedure, levator aponeurosis advancement and/or resection, or levator muscle resection. MAIN OUTCOME MEASURE: Postoperative change in the eyelid and brow position in downgaze. RESULTS: Of all ptotic eyelids, 43% had zero vertical palpebral fissure height in downgaze when the brows were relaxed and therefore were functionally blind in the downgaze position. After ptosis repair, there was a significant widening of the vertical palpebral fissure height in downgaze (P < .001), a significant decrease in frontalis muscle use (P < .001), and return of the patients' ability to sustain downgaze function. CONCLUSIONS: Measurement of palpebral fissure height in downgaze and frontalis muscle use in patients with acquired ptosis identifies patients with a functional visual deficit in the downgaze reading position. These measurements can be easily performed in the office and may be added to criteria for documenting functional impairment from blepharoptosis.
Three patients who had orbital decompression for compressive optic neuropathy secondary to Graves' ophthalmopathy are presented. Despite initial improvement in their visual acuity, all of the patients experienced subsequent relapse due to progressive enlargement of the extraocular muscles, resulting in recurrent compressive optic neuropathy. Management consisted of reoperation, systemic prednisone, and retrobulbar radiation. Enlargement of the extraocular muscles is felt to be caused by continuation of the autoimmune process and/or expansion of the extraocular muscles after slitting of the periorbita and bony removal of the orbital walls.
CT and MRI of the orbit have significantly enhanced the diagnosis of orbital lesions. Because of these techniques, disorders of the globe, structures within the bony orbit, surrounding structures of the eye, and optic pathways can now be diagnosed with much more certainty than before.
Ten patients with non-Hodgkin's lymphoma primarily affecting the orbital region were evaluated at Michael Reese Hospital and Medical Center, Chicago, between 1976 and 1983. Diagnoses were based on the histopathologic classification systems of the Working Formulation of the Non-Hodgkin's Lymphomas and Rappoport. Sequential staging procedures performed at the time of diagnosis included liver-spleen scans, Technecium-99 bone scans, gallium 67 scans, computerized axial tomograms of the orbit and abdomen, bone marrow examination and cerebral spinal fluid analyses. Adverse prognostic factors included the following: orbital bone erosions, Stage IV disease, and large cell or mixed cell, diffuse histologic features. The type of histopathologic findings combined with the results of sequential staging procedures is useful in identifying those patients who would benefit most from systemic chemotherapy.
We used the retinal cryoprobe in the surgical management (biopsy and excision) of orbital and ocular adnexal tumors in four patients. The strong bond between the cryoprobe tip and the tumor allowed application of moderate traction to the tumors, facilitating their removal. The amount of traction on the tumor or cyst appeared to be much greater than that caused by forceps or clamps. In one case, however, marked traction with the cryoprobe caused rupture of the tumor capsule. In another case, in which a cyst wall was entered during dissection, we applied the cryoprobe to the opening, sealing the hole with an ice ball, to keep the cyst from collapsing. Histopathologic structure was not altered by cryoprobe applications.
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