Application of acellular diurnal allografts.
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Blepharoplasty↗
Biomedical subjects
C N Soparkar
Publications and source records attributed to C N Soparkar.
Porous polyethylene implant fibrovascularization rate is affected by tissue wrapping, agarose coating, and insertion site.
PURPOSE: Often used in facial and ocular reconstruction, biointegratable materials, such as hydroxyapatite and high density porous polyethylene, can be associated with migration, exposure, and infection. Complications are less likely after implants become fibrovascularly integrated. A model was sought to study the influence of multiple factors on the rate of fibrovascular ingrowth into porous implants. METHODS: High density porous polyethylene cubes were implanted into paraspinous skeletal muscles in rabbits. The cubes were explanted at weekly intervals using survival surgery. The number of fibroblasts at the center of each cube was counted, generating a time-dependent standard curve of cell accumulation. Porous polyethylene cubes uncoated, coated with agarose (a plant-derived carbohydrate), or coated with nonperforated sclera (human or rabbit) were implanted into suprascapular adipose and paraspinous skeletal muscle in other rabbits. RESULTS: Fibrovascular ingrowth occurred more rapidly with cube implantation into skeletal muscle versus adipose, with increased surface area contact between implants and muscle, and with removal of muscle capsules. While the rate of fibroblast accumulation decreased in cubes coated with sclera, coating the cubes with agarose increased the fibrous capsule formation without altering the rate of biointegration. CONCLUSIONS: This study provides a novel approach for the study of fibrovascular ingrowth into implants treated under a variety of conditions. Modification of current surgical techniques may increase the rate of porous polyethylene implant biointegration.
Adipose Tissue↗
Epidermal and fibroblast growth factors enhance fibrovascular integration of porous polyethylene implants.
PURPOSE: Porous implants used in functional and aesthetic reconstruction of the orbit, face, and cranium are less likely to develop complications after they become biointegrated. We investigated whether the administration of exogenous growth factors could increase the rate of implant integration. METHODS: High-density porous polyethylene cubes were placed in dorsal paraspinal muscles of rabbits, and daily transcutaneous injections of saline, epidermal growth factor, or basic fibroblast growth factor were administered directly over the cubes for 10 days. At serial time points up to 10 weeks, cubes were explanted and the fibroblasts present at the center of the cubes were counted. RESULTS: Injections of epidermal growth factor and basic fibroblast growth factor increased the rate at which fibroblasts accumulated in porous polyethylene implants and decreased the time required to achieve a maximal rate of cellular accumulation within the cubes. At 4 weeks, when all cell populations had attained a linear rate of accumulation, cubes previously injected with saline, epidermal growth factor, or basic fibroblast growth factor contained an average of 10, 40, and 80 cells per 0.0156 mm2, at their centers, respectively. CONCLUSIONS: Enhancement of the rate of biointegration of porous polyethylene cubes in rabbits is achievable by repeated, transcutaneous administration of exogenous growth factors.
Animals↗
Growth factors embedded in an agarose matrix enhance the rate of porous polyethylene implant biointegration.
PURPOSE: Repeated injections of epidermal and basic fibroblastic growth factors have been shown to enhance the biointegration rate of implanted porous polyethylene. A study was done to determine whether agarose, introduced at the time of implant placement, might serve as an adequate "single dose" delivery system for endogenous and exogenous growth factors. METHODS: Polyethylene cubes coated with agarose-containing growth factors were implanted into fat and muscle in rabbits. Factors studied included autogenous whole blood, autogenous serum, ascorbic acid, epidermal growth factor, basic fibroblast growth factor, transforming growth factor alpha, and transforming growth factor beta. The rate and character of the fibrovascular ingrowth into implants and surrounding capsule thickness were assessed. RESULTS: Fibroblast infiltration enhanced two- to sixfold with the use of autogenous or allogenic factors introduced in an agarose matrix at the time of cube implantation. CONCLUSIONS: Growth factors studied altered the thickness of the capsule surrounding implants as well as both the vascularity and stromal density within implants.
Adipose Tissue↗
Total upper eyelid reconstruction with mucosalized tarsal graft and overlying bipedicle flap.
Total or near-total upper eyelid reconstruction with a mucosalized tarsal graft and overlying bipedicled myocutaneous flap was performed on 12 patients. This technique offers several advantages over other reconstructive methods: (1) the opportunity for immediate visual rehabilitation through a single-staged procedure without obscuration of the visual axis, (2) preservation of eyelid blinking and closure by relocation of functional orbicularis muscle, (3) excellent eyelid contour, and (4) use of tissue physiologically similar to that removed. The technique and clinical results are presented herein.
Aged↗
Tarsoconjunctival pedicle flap.
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Conjunctiva↗
The ocular complications of periocular laser surgery.
Laser periocular surgery has achieved an increased popularity, especially since recent technical developments in the carbon dioxide and erbium:yttrium-aluminum-garnet lasers. Despite the relative safety of these procedures in experienced hands, postoperative complications affecting the periocular region, and the eye itself, may follow laser surgery. Common complications include persistent erythema, hyper- and hypopigmentation, and hypertrophic scarring. Skin infection (viral, bacterial, or fungal) may also jeopardize the postoperative period after periocular laser treatment. Severe burns, transitory or permanent, lower lid ectropion, and even corneal injuries or ocular perforation are among the most severe hazards. A thorough preoperative evaluation, appropriate training, and a cautious and conservative approach are reinforced to minimize such problems.
Eyelid Diseases↗
Ocular melanoma.
The eye is the second most common site for primary melanoma after the skin. An ophthalmologic evaluation should be an integral aspect of melanoma screening that is often not even considered by nonophthalmologists. Delays or failures to make an accurate and early diagnosis can have grave consequences. Early recognition and diagnosis, before the tumor has progressed into an advanced process with a poor prognosis, can often result in complete cures through early interventional treatments. It is imperative that physicians adequately understand and appropriately examine or refer patients for appropriate screening for ocular melanoma as a routine practice in screening for melanoma. This article is intended to raise the clinical awareness of the practicing physician regarding this disease.
Eye↗
Negative sinus pressure and normal predisease imaging in silent sinus syndrome.
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Adult↗
Conjunctival cysts of the orbit.
OBJECTIVE: This study reviews functionally and anatomically disruptive features of simple conjunctival orbital cysts. DESIGN: A case series review from four oculoplastic practices over 6 years. PARTICIPANTS: Eleven patients with simple conjunctival cysts of the orbit were identified. INTERVENTION: All cysts were excised and evaluated histopathologically. MAIN OUTCOME MEASURES: Assessment was made of the length of time from inciting event to presentation, preoperative and postoperative refractive state and ocular motility, the presence or absence of discomfort, and radiographic or clinical evidence of bone remodeling. RESULTS: Six of 11 cysts were presumed to be primary, unrelated to antecedent surgery or trauma. Four of 11 cysts were associated with pain or tenderness, 5 cysts induced ocular motility disturbance, 6 cysts caused observable globe distortion or refractive error change, and 6 cysts remodeled bone. CONCLUSIONS: Simple conjunctival cysts of the orbit, traditionally regarded as low-pressure lesions with minimal structural impact, may induce considerable anatomic and functional disruption.
Adult↗
Tarsal patch-flap for orbital implant exposure.
The authors determine the efficacy of a new technique, the tarsal patch-flap, in the management of postenucleation and postevisceration porous orbital implant exposures that are recalcitrant to other surgical approaches. All patients treated during a 30-month period with recurrent orbital implant exposures who failed at least one surgical attempt at defect closure were treated using a tarsal patch-flap, a fornix-based tarsoconjunctival flap from the upper eyelid. Eight patients, six after enucleation and two after evisceration, were treated with a tarsal patch-flap. Five implants were porous polyethylene and three were hydroxyapatite. The defect size ranged from 4 mm to 12 mm (largest dimension). All eight patients have maintained closure of their defects for a mean follow-up of 13.8 months (range, 4-30 months). The vascularized tarsal patch-flap provides an excellent alternative surgical approach to the management of recurrent orbital implant exposures recalcitrant to Tenon-conjunctival advancement and autologous fascia grafting.
Biocompatible Materials↗
Eyelid cancers.
Eyelid cancers, like most malignancies, are on the rise, creating an ever-enlarging population of patients with these diseases. Trends in eyelid cancer diagnosis, prognostic evaluation, prevention, and management are reviewed. Special emphasis is placed upon understanding perineural invasion by squamous cell carcinoma, the role of genetic mutations in eyelid cancer development and prognosis, and new techniques for total upper eyelid reconstruction.
Biopsy↗
Surgery of the eyelids.
This article reviews the most common pediatric oculoplastic conditions and addresses clinical evaluation as well as medical and surgical management. The complex issues of amblyopia and special considerations for eyelid surgery in children are discussed. A step-by-step approach is used in the treatment of many common pediatric oculoplastic conditions, including congenital blepharoptosis and lid margin defects. Surgical options are explored and clinical examples are provided.
Amblyopia↗
Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants.
OBJECTIVE: To describe patterns of conjunctivitis caused by ophthalmic decongestants. DESIGN: Case series. SETTING: Outpatient eye clinic. PATIENTS: We selected patients with conjunctival inflammation who were using nonprescription decongestant eyedrops, who had no other cause for conjunctivitis, and whose conditions improved after discontinuing the incriminated preparations. MAIN OUTCOME MEASURES: Clinical characteristics of conjunctival inflammation and time to resolution of symptoms and signs after discontinuing the use of eyedrops. RESULTS: Seventy patients (137 eyes) were identified. Preparations containing the vasoconstrictors naphazoline, tetrahydrozoline, or phenylephrine were associated with 3 clinical patterns of conjunctivitis: conjunctival hyperemia (50 cases), follicular conjunctivitis (17 cases), and eczematoid blepharoconjunctivitis (3 cases). Decongestants were used daily for a median of 3 years (range, 8 hours to 20 years) prior to presentation. The median time to resolution of symptoms and signs was 4 weeks (range, 1-24 weeks), and patients remained asymptomatic for a median follow-up of 6 months (range, 0-12 years). CONCLUSION: Nonprescription decongestant eyedrops can produce acute and chronic forms of conjunctivitis by pharmacological, toxic, and allergic mechanisms. Once recognized, conjunctival inflammation often takes several weeks to resolve.
Acute Disease↗
The perils of permanent punctal plugs.
PURPOSE: To describe previously unreported complications associated with permanent lacrimal punctal plugs. METHOD: Five oculoplastic practices reviewed patients referred to them over the preceding 2 years for permanent lacrimal punctal plug complications. RESULTS: In 12 patients, 14 lacrimal punctal plugs migrated distally within the lacrimal drainage system, causing symptoms and necessitating surgical removal. CONCLUSION: Luxation of permanent punctal plugs into the distal lacrimal drainage system can occur, sometimes requiring complex surgical intervention.
Foreign-Body Migration↗
Abscessed hydroxyapatite orbital implants.
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Abscess↗
Ascorbate stimulates type I and type III collagen in human Tenon's fibroblasts.
PURPOSE: To better understand wound healing after glaucoma filtration surgery by measuring the production of type I and type III collagen in cultured Tenon's fibroblasts and determine the effect of ascorbic acid on collagen subtype production. METHODS: An ELISA-type dot blot assay was used to directly measure the production of types I and III collagen by subconfluent cultures of fibroblasts from human Tenon's capsule. Because ascorbic acid is both high in aqueous humor and necessary for the production of collagen, we measured the dose response of type I and type III collagen production to ascorbic acid. RESULTS: Ascorbic acid stimulated an increase in collagen production that reached a maximum level at 100 micrograms/ml. This is approximately half of the ascorbic acid concentration found in human aqueous humor. Unlike previous reports, we found no toxic effects from ascorbic acid at concentrations as high as 250 micrograms/ml over a 24-hour period. The lack of toxicity may result from the use of serum-free media in the assay. CONCLUSIONS: This culture system will be useful for exploring factors that may alter collagen production and could potentially affect wound healing.
Ascorbic Acid↗