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Brett A O'Donnell

Publications and source records attributed to Brett A O'Donnell.

17 recordsLinked to original sources
PubMed2006

Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia.

PURPOSE: To review the treatment and outcomes of malignant melanoma (MM) of the eyelid skin. DESIGN: Retrospective case series review. PARTICIPANTS: All consecutive patients who had MM arising from eyelid skin treated by 2 regional tertiary referral oculoplastic surgeons were included. METHODS: Patient charts were reviewed to collect information on the main outcome measures. MAIN OUTCOME MEASURES: Demographics, clinical and histological features of the lesion, treatment, and outcomes. RESULTS: Twenty-nine patients between 22 and 88 years old (mean, 65) were included. The most common site of MM occurrence was the lower eyelid. Seventeen cases arose in an area of pigmentation, 4 arose de novo, and 8 were of unknown origin. The most common histopathological types were lentigo maligna melanoma (19 cases), followed by superficial spreading MM (8 cases). Fourteen patients had in situ disease and therefore had no Breslow thickness. Another 7 patients had Breslow thickness of <0.76 mm. Thirteen patients had Clark level II or higher. According to the American Joint Committee on Cancer staging system for cutaneous melanoma, 14 patients were clinically stage 0 and 6 patients were stage IA, with thickness < or = 1 mm and no ulceration. Treatment included wide excision in all cases, one of which underwent anterior exenteration. Pathological techniques used included mapped serial excision with standard or overnight paraffin sections or Mohs' micrographic surgery. Most patients had a good outcome, although 2 died of the disease. Five patients had local recurrence, and 4 had distant metastases. Median postoperative follow-up was 3 years (range, 1 month-9 years, 9 months). CONCLUSIONS: Lentigo maligna melanoma compared with other forms of MM was relatively more common in the periocular region than in other body locations. Our pathologists preferred paraffin sections to frozen section for accurate assessment of melanocytic atypia and margin status. Initial wide excision margins of 10 mm from the macroscopic edge of the tumor are suggested, as histological margins may be less than this. Margin control by mapped serial excision or a modified Mohs' micrographic surgery using paraffin sections is a useful technique to ensure complete excision and minimization of local recurrence.

Adult↗
PubMed2006

Idiopathic sclerosing orbital inflammation.

OBJECTIVE: To perform a multicenter review of the clinical features and treatment of 31 patients with idiopathic sclerosing orbital inflammation. METHODS: We included all patients with histologically confirmed idiopathic sclerosing orbital inflammation from 5 regional orbital centers. We reviewed the case notes to determine the clinical presentation, diagnostic features, and response to treatment. The main outcome measures were duration and nature of symptoms, anatomical location of disease, histopathological findings, treatment modalities, treatment efficacy and adverse effects, and final clinical status. RESULTS: We included 13 male and 18 female patients ranging in age from 7 to 83 years. The average duration of symptoms at presentation was 13.4 months. There was a predilection for the lateral and superior quadrants. Thirteen patients had apical disease, and 4 had extraorbital involvement. Histopathological findings invariably showed sclerosis associated with a sparse mixed cellular infiltrate. Twenty-seven patients were treated with oral prednisolone, response to which was good in 9 patients, partial in 11, and poor in 7. Six patients were treated with a second-line immunosuppressive agent, and 6 received radiotherapy. The response to radiotherapy was generally poor. CONCLUSIONS: Idiopathic sclerosing orbital inflammation is a rare condition that can be difficult to diagnose and manage. Early intervention with immunosuppression in the form of corticosteroids combined with second-line agents can result in control and even regression of the disease.

Administration, Oral↗
PubMed2006

Medial canthal tendon release and lower eyelid retractor plication for Centurion syndrome.

Centurion syndrome is an uncommon, idiopathic medial canthal anomaly that causes epiphora due to the forward displacement of the lacrimal punctum out of the tear lake associated with the abnormal anterior insertion of the medial canthal tendon and enophthalmos. A case of Centurion syndrome is presented together with the description of a previously unreported surgical treatment: the combined surgical techniques of medial canthal tendon release and lower eyelid retractor plication.

Adult↗
PubMed2006

Orbital cellulitis as a postoperative complication of sub-Tenon anaesthesia in cataract surgery.

Orbital cellulitis is a rarely reported sight-threatening complication of sub-Tenon anaesthesia. We report a case of orbital cellulitis in a patient who had received sub-Tenon anaesthesia for routine cataract surgery. We discuss the potential under-reporting of complications of sub-Tenon anaesthesia that had a delayed presentation, and the possible association between the use of hyaluronidase in the anaesthetic mixture and orbital cellulitis following sub-Tenon anaesthesia.

Aged↗
PubMed2005

Orbital and periorbital microcystic adnexal carcinoma.

PURPOSE: To review the clinical and histopathologic features of patients with microcystic adnexal carcinoma of the orbital and periorbital tissues. METHODS: This study was designed as a noncomparative interventional case series of three patients seen and treated at two oculoplastic surgical departments and a review of the literature. Clinical presentation, histopathologic findings, outcome of surgery, and clinical recurrence are presented. RESULTS: Three patients underwent surgery for lesions temporal to the lateral canthus. All had initial histopathology diagnosed as squamous cell carcinoma but were subsequently diagnosed as microcystic adnexal carcinoma after clinical recurrence. All patients had multiple recurrences and extensive perineural spread. Two patients required radiotherapy. CONCLUSIONS: Review of the literature shows that microcystic adnexal carcinoma affecting the orbital and periorbital tissues is difficult to differentiate clinically and microscopically from other conditions including squamous cell carcinoma. Eighty-one percent of cases that have histopathology checked in the initial assessment are still misdiagnosed. A high degree of suspicion is necessary if the lesion extends beyond an apparently adequate surgical margin, multiple recurrences occur, or superficial perineural spread is present. Mohs technique is the treatment of choice and may be improved if paraffin sections or immunohistocytochemistry are performed. Wide excision should be carried out once clear margins are obtained. Radiotherapy may be necessary in cases with multiple recurrences.

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PubMed2005

Malignant fibrous histiocytoma of the eyelid: differential diagnosis and management.

PURPOSE: Malignant fibrous histiocytoma (MFH) is a pleomorphic soft tissue sarcoma that occurs rarely in the periocular region. The purpose of this study was to present a case series of periocular MFH and to discuss the differential diagnosis and management. METHODS: This is a retrospective case review of patients diagnosed with periocular MFH from tertiary hospitals and private practices. RESULTS: Four patients, two women and two men with periocular MFH, had a mean age of 81 years (range, 72 to 85 years). All tumors were <5 cm in diameter and of storiform pleomorphic histologic subtype. One was located deep and 3 presented superficially. The initial diagnoses were sarcomatoid carcinoma, atypical fibroxanthoma, and leiomyosarcoma that were subsequently reclassified as MFH. One patient had a frozen section, 1 had fast track paraffin section margin control, and 2 had no frozen section margins at the initial excisions. Histology showed 2 negative margins, 1 close margin, and 1 positive margin that were cleared with wide local excision. Local recurrence occurred in 3 cases, and of these, 1 required orbital exenteration. Adjuvant radiotherapy was given to 3 patients. One had regional node metastases. There were no distant metastases or tumor-related deaths. Mean follow-up period was 36 +/- 35 months (median, 30; range, 1 to 84 months). CONCLUSIONS: This study highlights the difficulties in the clinicopathologic diagnosis of periocular MFH and in particular the distinction of more superficial tumors from atypical fibroxanthoma. The mainstay of treatment is complete surgical excision with wide margins, and consideration should be given to histologic margin control in addition to adjuvant radiotherapy.

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PubMed2005

Enucleation versus evisceration.

The choice of enucleation and evisceration for removal of an eye remains controversial in certain circumstances. An international panel was asked to give their surgical management of two clinical cases that require either enucleation or evisceration. Case one follows multiple vitreoretinal procedures, and the risk of sympathetic ophthalmia is considered in the surgical management. Case two has had postoperative endophthalmitis, and the possibility of implant infection following insertion of an orbital implant with evisceration and enucleation is discussed.

Adult↗
PubMed2004

Medial canthal tendon repair for moderate to severe tendon laxity.

BACKGROUND: Medial canthal tendon laxity is a common cause of epiphora and ocular irritation. It is difficult to treat due to the proximity of the lower canaliculus and punctum to the tendon. METHODS: The results of a prospective series of patients with involutional medial canthal tendon laxity between 1997 and 2002 were reviewed. Symptoms and measured laxity were recorded before and after medial canthal tendon repair. The medial canthal tendon was routinely repaired through a cut along the lid margin extending from the punctum medially. This avoids a vertical cut onto the anterior lamella of the eyelid, which is useful if a skin graft is required. RESULTS: Twenty lower eyelid medial canthal tendon repairs were performed on 17 patients. Preoperatively, the lower punctum in all patients was able to be distracted to the medial limbus or further and in 50% of cases, the lower lid punctum was able to be distracted to the pupil midline or further. Postoperatively all patients had reduction of their medial canthal tendon laxity. Postoperatively in 85% of cases the lower punctum was not able to be distracted beyond the medial limbus; however, 15% of cases still had significant residual laxity. Eighty-five per cent of patients reported improvement in symptoms. CONCLUSIONS: This is an effective procedure in the majority of patients with moderate to severe medial canthal tendon laxity; however, residual lower lid laxity persisted in some patients.

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PubMed2004

External ophthalmic findings in multiple endocrine neoplasia type 2B.

PURPOSE: To identify external ophthalmic abnormalities in multiple endocrine neoplasia type 2B (MEN2B), which may facilitate early detection and prophylactic thyroidectomy to prevent medullary thyroid carcinoma. METHODS: Three patients with MEN2B were examined by an oculoplastic surgeon and external ophthalmic findings were recorded. RESULTS: All patients had prominent corneal nerves, thickened eyelids, mild ptosis and eversion of the upper eyelids. Two patients displayed eyelid nodules and one exhibited lower lid margin eversion. CONCLUSION: Ptosis and lower lid margin eversion are previously unreported findings in patients with MEN2B. Medullary thyroid carcinoma is the most serious consequence of MEN2B and has a high mortality if untreated. Early diagnosis and prophylactic thyroidectomy may be lifesaving. Gene mutations can be identified but the sporadic tendency of the syndrome emphasizes the importance of early clinical detection. MEN2B is one of a number of systemic malignancies with ophthalmic manifestations. Ophthalmologists should be aware of the external features of this rare but lethal malignancy.

Blepharoptosis↗
PubMed2004

'Ancient' schwannoma of the orbit.

A 65-year-old woman presented with a 3 month history of right eye discomfort and protrusion. Examination revealed right proptosis with hypoglobus and diplopia in extremes of upgaze. Computed tomographic scanning revealed a large extraconal mass in the superotemporal orbit. The mass was excised through an extended superior skin crease incision. Histopathology revealed a benign tumour of Schwann cell origin showing advanced cystic degeneration, the so-called 'ancient schwannoma'. The authors could find only two previously reported cases of such tumours arising in the orbit.

Aged↗
PubMed2004

Orbital lymphoid tumour located within an extraocular muscle.

A rare case of an orbital lymphoid tumour within an extraocular muscle is presented. The tumour displayed features of a progressive indolent systemic lymphoma. There was no response to a trial of chemotherapy and so local radiotherapy was instituted. At follow up 2 months later there was no evidence of disease.

Adult↗
PubMed2002

The cutaneomarginal eyelid graft.

PURPOSE: To assess the effectiveness of the cutaneomarginal graft. METHODS: The cutaneomarginal graft consists of eyelid margin tissue with anterior lamella skin. The tarsal plate is resected following harvesting of a wedge of eyelid tissue. The graft is used to repair eyelid defects following excision of neoplasms which spares the posterior lamella. The graft is principally used at the lateral most part of the lower eyelid following Mohs surgery. A case series of five patients are reviewed to assess the effectiveness of the technique. RESULTS: All patients achieved a satisfactory result following grafting and there were no donor site complications. CONCLUSIONS: The cutaneomarginal graft is an effective means of repair, although with limited indications.

Aged↗
PubMed2002

Late orbital haemorrhage around alloplastic orbital floor implants: a case series and review.

BACKGROUND: Alloplastic implants have been used to repair orbital wall fractures and correct anophthalmic enophthalmos (or volume deficiency in an anophthalmic socket). Orbital haemorrhage is a rare complication of these implants. METHOD: A retrospective review of patient files of two consultant oculoplastic surgeons. RESULTS: Four cases of orbital haemorrhage following alloplastic implants were identified. The haemorrhages occurred 5-18 years after surgery, and occurred within the pseudocapsule of the implant. In one case, recurrent haemorrhages were noted. CONCLUSION: Although rare, orbital haemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery.

Aged↗
PubMed2002

Maximal eyelid donor skin harvesting in eyelid repair after tumor excision.

PURPOSE: A primary defect in the eyelid resulting from tumor excision will benefit from better skin match when the defect is repaired with eyelid skin. The amount of skin harvested by blepharoplasty from a single upper eyelid may be inadequate. This report describes and evaluates the effectiveness of two types of procedure in which maximal eyelid skin is harvested to repair defects in the upper or lower eyelids, respectively. The techniques require the resulting secondary defect being partially replaced by a second graft taken from the contralateral upper eyelid. METHODS: The surgical results of a prospective case series are evaluated. Postoperative upper eyelid graft appearance and patient satisfaction were recorded. RESULTS: Ten patients underwent repair of a large skin defect in the upper eyelid (2 patients) or lower eyelid (8 patients), using maximum upper eyelid skin from above the skin crease. The primary donor site upper eyelid defect was closed after partial secondary grafting with skin from the side contralateral to the upper eyelid from which the maximal graft was taken. All patients were satisfied with the appearance of the grafted and donor areas. CONCLUSIONS: Maximal eyelid donor skin harvesting achieved satisfactory results and is a useful technique in eyelid reconstructive surgery.

Adult↗
PubMedDate not supplied

Clinical features and management of tumors affecting the lacrimal drainage apparatus.

PURPOSE: To report the clinical features of a series of patients with lacrimal drainage apparatus tumors and present guidelines for management based on histopathology. METHODS: A non-comparative retrospective chart review of the clinical, imaging, and pathologic findings of 37 patients presenting to four regional orbital surgery departments with tumors affecting the lacrimal drainage apparatus between 1990 and 2004. RESULTS: There were 37 patients, of whom 62% were male. The mean age at referral was 54 years. Epiphora, a palpable mass, and dacryocystitis were the most common presentations. Two thirds of the tumors were epithelial, with carcinomas being the most frequent (38%), followed by papillomas (27%). Lymphomas were the most common nonepithelial malignancy (30%). Epithelial tumors were more common in men (87%), whereas lymphomas were more common in women (57%). Treatment modalities included surgery, in addition to radiotherapy and/or chemotherapy and immunotherapy. Mean follow-up was 38 months. Thirty-three patients (89%) remain alive without evidence of disease and 4 patients died of recurrence and/or metastases. CONCLUSIONS: Lacrimal drainage apparatus tumors require careful initial management to ensure adequate local and systemic disease control. Atypical mucosa encountered during dacryocystorhinostomy should be biopsied and small papillomas or pedunculated tumors excised and analyzed with frozen sections. If a diffuse or infiltrative mass is encountered, it should be biopsied and managed on the basis of histopathology and extent of disease. Lymphomas should be treated according to protocols, whereas noninvasive carcinoma and extensive papillomas require complete excision of the system. Invasive disease requires en bloc excision. Long-term follow-up is essential for early detection of recurrence.

Adult↗
PubMedDate not supplied

Secondary tarsoconjunctival flap after previous lower eyelid Hughes repair.

PURPOSE: To describe a secondary, two-stage eyelid-sharing tarsoconjunctival flap advancement technique for the repair of full-thickness lower eyelid defect, using the remaining upper eyelid marginal tarsus that was spared in a previously performed Hughes procedure. METHODS: A computerized database search was performed on all cases of Hughes repair of the lower eyelid performed over a 10-year period (1995 to 2005) to identify patients who required a secondary tarsoconjunctival flap repair. In two cases of tumour recurrence at the lower eyelid margin, an eyelid-sharing, two-stage tarsoconjunctival flap repair of the lower eyelid using the remaining 4 mm of marginal tarsus that was spared in the original Hughes procedure was performed. Case reports of these 2 patients are presented together with their postoperative results. RESULTS: The incidence rate of the described secondary tarsoconjunctival flap procedure was 2 cases per 240 cases (0.8%) of primary Hughes procedure performed over a 10-year period. The postoperative courses in the 2 patients were uncomplicated with excellent surgical results at 6 months' follow-up. CONCLUSIONS: The secondary tarsoconjunctival flap advancement procedure is an effective reconstructive technique for the repair of the full-thickness lower eyelid defect in an eyelid that has already undergone a previous Hughes repair.

Aged↗