Biomedical subjects

D R Meyer

Publications and source records attributed to D R Meyer.

At least 19 recordsLinked to original sources

PubMed2001

Lacrimal sac dacryoliths: predictive factors and clinical characteristics.

OBJECTIVE: Lacrimal sac dacryoliths are often diagnosed during dacryocystorhinostomy (DCR), although their cause is unclear. Several factors have been suggested to predispose to dacryolith formation. The clinical presentation of nasolacrimal duct obstruction (NLDO) may differ if associated with a dacryolith. Our study evaluated specific risk factors related to dacryolith formation and how the clinical presentation of patients with dacryoliths differs from patients with primary acquired NLDO who undergo DCR. DESIGN: Retrospective, comparative, interventional case series. PARTICIPANTS/INTERVENTION: One hundred thirty-eight consecutive patients with NLDO who underwent DCR (163 total DCR cases) between 1993 and 1998. MAIN OUTCOME MEASURES: We evaluated the frequency of dacryolith formation for all DCR cases. For 115 patients with primary acquired NLDO, we statistically compared the patients with dacryoliths (n = 12) to those without (n = 103) for several variables related to clinical history and presentation. RESULTS: The overall frequency of dacryoliths was 12 of 163 (7.4%) for all DCR cases and 12 of 138 (8.7%) for all patients. All patients with dacryoliths were in the subgroup of 115 patients with primary acquired NLDO, and the frequency in that subgroup was 12 of 115 (10.4%). There was no statistical difference between the group of patients with dacryoliths and those without dacryoliths for age, duration of epiphora, history of acute dacryocystitis, or previous use of antiglaucomatous topical medications. Male gender was more likely to be associated with dacryoliths (P = 0.004), as was initial presentation with lacrimal sac distension (P < 0.001). Partial nasolacrimal obstruction on lacrimal irrigation approached statistical significance for dacryolith formation (P = 0.08), as did a history of cigarette smoking (P = 0.09). CONCLUSIONS: In patients with primary acquired NLDO who require DCR, male gender and presence of sac distension are more frequently associated with dacryoliths. Partial NLDO and history of cigarette smoking may also be relative risk factors for dacryolith formation. These observations may be helpful in the evaluation and surgical planning for patients with lacrimal obstruction.

Dacryocystorhinostomy↗

PubMed2001

Management and prognosis of Merkel cell carcinoma of the eyelid.

OBJECTIVE: To evaluate the clinical presentation, treatment, and long-term follow-up of eyelid Merkel cell carcinoma. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Fourteen patients with primary eyelid Merkel cell carcinoma. METHODS: Cases of Merkel cell carcinoma for which long-term follow-up was available were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery through an on-line e-mail/news group. MAIN OUTCOME MEASURES: Follow-up period, treatment history, presence and type of recurrence, and mortality. RESULTS: Average follow-up was 33.4 months. Of the 14 cases identified, only 2 patients (14%) received prophylactic therapy beyond wide surgical excision. Three patients (21%) had recurrences, none of whom initially received prophylactic therapy (i.e., radiation therapy, lymph node dissection, and/or chemotherapy) beyond wide surgical excision. One patient (7%) died of metastatic Merkel cell carcinoma. CONCLUSIONS: Merkel cell carcinoma is a rare skin malignancy that occasionally affects the eyelid, with the potential for regional and distant metastasis. Consideration should be given to the use of prophylactic adjunctive therapies beyond wide surgical excision while simultaneously considering the morbidity of these therapies.

Aged↗

PubMed2001

Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology.

OBJECTIVE: This document describes endonasal dacryocystorhinostomy (DCR) and examines the evidence to answer key questions about the effectiveness of the procedure compared with external DCR; the relative indications, contraindications, advantages, and limitations of the procedure; and patient selection, surgical technique, postoperative care, and complications. METHODS: A literature search conducted for the years 1968 to 2000 retrieved 93 citations. The panel members reviewed 71 of these articles and selected 64 for the panel methodologist to review and rate according to the strength of evidence. A level I rating is assigned to properly conducted, well-designed, randomized clinical trials; a level II rating is assigned to well-designed cohort and case-control studies; and a level III rating is assigned to case series and poorly designed prospective and retrospective studies, including case-control studies. RESULTS: The published literature includes two reports that describe clinical trials comparing endonasal with external DCR with a 1-year follow-up. The success rate was 91% for the external DCR group in both reports and 63% and 75% for the endonasal DCR groups, defined by patency to irrigation. A longitudinal cohort study included a control group of age-matched external DCR patients who were compared with a study group of endonasal DCR patients. The reported success rate at 9 months following surgery for the endonasal cohort was 90% and was not statistically significantly different from the 94% success rate noted in the external DCR control group. Remaining data on reported success rates of primary and revision endonasal DCR were obtained from a collection of uncontrolled observational case studies with varying periods of follow-up and success rates ranging from 59% to 100%. CONCLUSIONS: It is difficult to make definite evidence-based determinations about the relative efficacy of endonasal and external DCR because of the deficiencies in the reported literature. Based on level III evidence, the available data suggest that endonasal DCR may be a viable option for the correction of acquired nasolacrimal duct obstruction and complex forms of congenital dacryostenosis in selected patients. This procedure may be indicated on a primary basis or as revisional surgery following failed external or endonasal DCR. Some studies comparing endonasal DCR with external DCR suggested lower success rates in the endonasal group; other studies yielded success rates comparable with or exceeding those of external surgery. Reported complications of endonasal DCR do not generally appear to be greater in frequency or magnitude than those associated with external DCR. Disadvantages of endonasal DCR include the preferred use of general anesthesia by many surgeons, the high cost of expensive equipment and instrumentation, and the relatively steep learning curve for this procedure. Depending on the preference of the surgeon, more postoperative care may be required for patients undergoing endonasal DCR than external DCR. Both the advantages and the limitations of endonasal DCR relative to external DCR should be carefully discussed with patients who are contemplating endonasal surgery.

Academies and Institutes↗

PubMed2001

Giant cell angiofibroma of the nasolacrimal duct.

PURPOSE: To describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman. METHODS: Interventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34. RESULTS: The lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up. CONCLUSIONS: Originally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.

Adult↗

PubMed2001

[Segmental variants of the inferior vena cava--manifestations with embryological correlation in differentiation from secondary vena cava occlusion].

The vast variability of the overall rare congenital anomalies of the inferior vena cava (IVC) are mostly detected by accident through different imaging modalities. These cannot be classed as pathological findings, and should not be confused with lymphomas and has to differ from secondary collateral venous pathways. Based on 656 CT examinations 10.5% known forms of IVC anomalies were found. According to the embryological development three main groups of IVC variants could be nosologically classified: agenesis of the suprarenal IVC, anomalies of the pars renalis and anomalies of the infrarenal IVC. Additionally three unusual anomaly complexes were found. For the understanding details of the embryology based on a simplified depiction are presented.

Adolescent↗

PubMed2000

Internal orbital fractures in the pediatric age group: characterization and management.

OBJECTIVE: To evaluate the specific characteristics and management of internal orbital fractures in the pediatric population. DESIGN: Retrospective observational case series. PARTICIPANTS: Thirty-four pediatric patients between the ages of 1 and 18 years with internal orbital ("blowout") fractures. METHODS: Records of pediatric patients presenting with internal orbital fractures over a 5-year period were reviewed, including detailed preoperative and postoperative evaluations, surgical management, and medical management. MAIN OUTCOME MEASURES: Ocular motility restriction, enophthalmos, nausea and vomiting, and postoperative complications. RESULTS: Floor fractures were by far the most common fracture type (71%). Eleven of 34 patients required surgical intervention for ocular motility restriction. Eight were trapdoor-type fractures with soft-tissue incarceration; five had nausea and vomiting. Early surgical intervention (<2 weeks) resulted in a more complete return of ocular motility compared with the late intervention group. CONCLUSIONS: Trapdoor-type fractures, usually involving the orbital floor, are common in the pediatric age group. These fractures may be small with minimal soft-tissue incarceration, making the findings on computed tomography scans quite subtle at times. Marked motility restriction and nausea/vomiting should alert the physician to the possibility of a trapdoor-type fracture and the need for prompt surgical intervention.

Adolescent↗

PubMed2000

Endoscopic conjunctivodacryocystorhinostomy with Jones tube placement.

OBJECTIVE: Conjunctivodacryocystorhinostomy (CDCR) with Jones tube placement as described by Jones has traditionally been performed as an "open" or external procedure by means of medial canthal incision. Application of endoscopic technique for CDCR with Jones tube placement has not been well described in the peer-reviewed literature. DESIGN: Retrospective nonrandomized comparative trial. PARTICIPANTS: Ten patients with epiphora secondary to canalicular stenosis. METHODS: A total of 13 consecutive CDCR with Jones tube procedures were reviewed. Five procedures (performed predominantly in the early study period) were done by means of a traditional external approach with a medial canthal incision. Eight procedures were performed with an intranasal endoscopic approach and instrumentation with Jones tube placement under direct endoscopic visualization. MAIN OUTCOME MEASURES: Total operative time, estimated blood lost, intraoperative, and postoperative complications and need for secondary surgery were evaluated. RESULTS: All procedures were successfully completed with no intraoperative complications. Average operative time was 59 minutes in the endoscopic group and 74 minutes in the external group. Average blood loss was 3.5 ml and 4.4 ml in the endoscopic and external groups, respectively. Postoperative adjustment of tube size or position (performed as an office procedure with topical/local anesthesia) was common: five of eight endoscopic and three of five external approach. Two patients in the endoscopic group required secondary surgery for anatomic reasons. Ultimately, all cases in both groups demonstrated patent, retained Jones tubes and relief of epiphora. CONCLUSION: Endoscopic technique appears to be a reasonable approach for CDCR with Jones tube placement. Operative time and blood loss were comparable in the two groups, with the endoscopic group being slightly lower for each variable. Endoscopic Jones tube placement can be accomplished with readily available instrumentation. In this series, we did not find it necessary to use laser, radiofrequency, or monopolar devices for intranasal hemostasis.

Aged↗

PubMed2000

Nasolacrimal duct obstruction and dacryocystocele associated with a concha bullosa mucocele.

PURPOSE: To describe the rare occurrence of a concha bullosa mucocele producing secondary nasolacrimal duct obstruction and dacryocystocele. DESIGN: Case report. PARTICIPANT: Forty-two-year-old man with 6-month history of left medial canthal mass. INTERVENTION: Clinical evaluation with lacrimal testing, computed tomography and surgical exploration, including biopsy, dacryocystorhinostomy, and excision/marsupialization of the middle turbinate concha bullosa mucocele were performed. RESULTS: The medial canthal mass was confirmed to be a dacryocystocele associated with nasolacrimal duct obstruction and bone destruction caused by concha bullosa mucocele. CONCLUSIONS: Concha bullosa mucoceles are uncommon and even more rarely can produce secondary nasolacrimal duct obstruction and dacryocystocele formation. The clinical and radiologic features may mimic a lacrimal sac malignancy.

Adult↗

PubMed2000

Treatment of subtotal medial rectus myectomy complicating functional endoscopic sinus surgery.

During the past 2 decades, the introduction of functional endoscopic sinus surgery (FESS) has dramatically improved the treatment of sinus disorders. However, a variety of orbital complications have been reported, including optic nerve damage, hemorrhage, infection, compromise of the lacrimal drainage apparatus, and strabismus. At least 10 cases have reported damage to the medial rectus muscle. (1-8) Treatment options for such patients have been limited, especially because most are adults at risk for anterior segment ischemia after transposition of vertical rectus muscles. We describe 2 patients whose medial rectus myectomies were repaired by using nonabsorbable "hang-back" sutures in combination with a botulinum toxin (Botox) injection of the antagonist lateral rectus muscle. Good primary position alignment was achieved in both patients, and one patient was able to regain binocular function. We recommend this surgical approach, especially in patients at increased risk for anterior segment ischemia.

Adult↗

PubMed2000

Comparison of oxymetazoline and lidocaine versus cocaine for outpatient dacryocystorhinostomy.

PURPOSE: To evaluate the effectiveness of oxymetazoline combined with lidocaine versus cocaine for outpatient dacryocystorhinostomy (DCR). METHODS: Twenty-seven patients underwent DCR with a combination of oxymetazoline 0.05% nasal spray and lidocaine 4% spray/pledgetts (oxy/lido) and were compared with 28 patients who underwent DCR with cocaine 4% pledgetts for nasal anesthesia and vasoconstriction. Most of the patients underwent standard external approach DCR: five patients in the oxy/lido group and four patients in the cocaine group underwent endoscopic DCR. RESULTS: Patients in both groups reported being comfortable during and immediately after surgery. Visualization of the operative field was adequate, and surgery was successfully completed in all cases. Mean blood loss was 6.3 ml (+/-6.0) in the oxy/lido group and 7.3 ml (+/-6.4) in the cocaine group (p = 0.541). There were no cases of postoperative epistaxis requiring nasal packing or hospital admission in the oxy/lido group, whereas one patient in the cocaine group developed epistaxis 8 days after surgery, which required treatment. Success rate was similar in the two groups. CONCLUSIONS: The combination of oxymetazoline and lidocaine is effective for outpatient dacryocystorhinostomy. Patient comfort was adequate and blood loss not significantly different in comparison to cocaine. This combination provides effective nasal anesthesia and vasoconstriction, while avoiding the "hassle" and potentially greater risks associated with cocaine.

Ambulatory Surgical Procedures↗

PubMed2000

Outpatient ophthalmic plastic surgery: outcomes and patient satisfaction using initial postoperative telephone call follow-up.

PURPOSE: To evaluate the safety and efficacy of using a telephone call within 24 hours as the initial follow-up after outpatient ophthalmic plastic surgery, deferring the first postoperative visit 4 to 7 days. METHODS: We prospectively evaluated clinical outcomes, including complications and patient satisfaction, after 469 outpatient eyelid, lacrimal and anterior orbital procedures. Patient satisfaction was assessed with a 13-item questionnaire. RESULTS: Response to the questionnaire was 282 of 469 (60%) patients. Essentially, all patients responding to the questionnaire who received a telephone call believed that it was helpful and their questions and concerned were adequately addressed. Only 4 of 274 (1%) patients without a planned 24-hour visit indicated that they would have preferred being seen in the office. Complications of a minor nature were noted in 12 of 469 (3%) patients, none of which adversely affected clinical outcomes. CONCLUSION: We conclude that a telephone call on the initial postoperative day, deferring the first visit 4 to 7 days, is a safe, cost-effective strategy with high patient acceptance for most types of eyelid and lacrimal surgery, as well as some types of orbital surgery.

Ambulatory Surgical Procedures↗

PubMed1999

Primary temporal fossa dermoid cysts. Characterization and surgical management.

OBJECTIVE: To detail the characteristics and management of rarely reported and incompletely described dermoid cysts originating in the temporal fossa. DESIGN: Retrospective case series. PARTICIPANTS: Five patients ranging from 2 to 38 years of age with a mass in the temporal region (posterior to the lateral orbital rim) participated. INTERVENTION: Computed tomography (CT) and excisional biopsy were performed. MAIN OUTCOME MEASURES: Clinical and CT characteristics and surgical outcomes were measured. RESULTS: Computed tomography showed cystic lesions, originating from the region anterior to the confluence of the greater wing of the sphenoid, frontal, and zygomatic bones. Displacement of the anteriormost portion of the temporalis muscle was common. Three cysts were isolated to the temporalis fossa, while two showed more extensive bony erosion and extension into the cranial and orbit cavities. At surgical excision, gross rupture of the cysts was noted in two cases, and two were completely liquefied. Histopathology showed variable inflammation surrounding all of the dermoid cysts. All patients did well after surgery. CONCLUSIONS: Dermoid cysts may infrequently occur "primarily" in the temporal fossa. Bone involvement and anterior temporalis muscle displacement are common. An origin from the area anterior to the confluence of the greater wing of the sphenoid, frontal, and zygomatic bones is seen. A coronal approach facilitates wide exposure and excision. When dural extension is suggested on CT, neurosurgical assistance may be required.

Adolescent↗

PubMed1999

Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery.

OBJECTIVE: To assess the effect of blepharoptosis on patients' visual function and health-related quality of life and to determine what measures are associated with postsurgical change in functional status. DESIGN: Prospective, observational case series. PARTICIPANTS: One hundred patients with unilateral or bilateral blepharoptosis. INTERVENTION/MAIN OUTCOME MEASURES: Preoperative and postoperative upper eyelid position (i.e., margin reflex distance [MRD]) and superior visual field (SVF) height, as well as subjective visual function and health-related quality-of-life functional status before and after ptosis surgery. RESULTS: There was a mean 30-point increase in functional index score after ptosis repair (P < 0.001). Lower (more ptotic) preoperative upper eyelid position and SVF (combined eye) were associated with greater change in functional index after surgery (r = -0.290, P = 0.007 and r = -0.39, P = 0.003, respectively). Preoperative visual field testing with manual lid elevation was not significantly correlated to the postoperative change in functional index (P > 0.100). The strongest correlation of postoperative functional index change was with the preoperative functional status (r = -0.79, P < 0.001). CONCLUSIONS: Patients' functional status is reduced by blepharoptosis, and surgical repair results in measurable increase in health-related quality of life. Patients' self-reported preoperative functional impairment is most strongly associated with the degree of postsurgical functional improvement.

Adult↗

PubMed1999

Pronounced cystic transformation of the Rete testis. MRI appearance.

BACKGROUND: Cystic transformation of the rete testis is a little-known partial or complete obstruction of the spermatozoa-containing secretion of the head of the epididymis. Depending on its severity, either ectasia or a cystic transformation occurs, which spreads to the network of convoluted seminiferous tubules in the mediastinum testis. Findings in contrast-enhanced MRI examinations are characteristic and may help to differentiate this benign entity from malignant neoplasia. The authors present two pronounced cases in different stages, documenting the broad spectrum of possible involvement.

Aged↗

PubMed1999

Surgical management of Graves orbitopathy.

The surgical management of Graves ophthalmopathy includes treatment of globe malposition (exophthalmos), strabismus, and eyelid abnormalities. The various techniques used continue to be refined and are detailed in this review.

Exophthalmos↗

PubMed1998

Enlargement of the nasolacrimal canal in the absence of neoplasia.

BACKGROUND: Asymmetrical enlargement of the nasolacrimal canal and nasolacrimal duct in the absence of associated neoplasm in uncommon. A dilemma in proper management in encountered because the subject is not well discussed in the medical literature. DESIGN: Case series. PARTICIPANTS: Three patients with abnormal enlargement of the nasolacrimal canal on computed tomography (CT) are analyzed. Two patients had a history of intermittent acquired dacryocystocele, whereas one had no associated lacrimal disorder. INTERVENTION: To relieve their obstructive symptoms, one patient was treated with lacrimal probing and silicone intubation, and the other patient was treated with dacryocystorhinostomy. The third patient, who was asymptomatic, elected observation alone. MAIN OUTCOME MEASURES: Anteroposterior diameters of the nasolacrimal canal were measured from the CT scans of these cases and compared with normative data derived from radiologic and anatomic studies. RESULTS: The maximal anteroposterior diameters of the nasolacrimal canals from these patients were 12.5, 15.4, and 15.1 mm, all well above the upper range of normal (8-10 mm). These enlarged nasolacrimal canals were not associated with any neoplastic process. Follow-up CT scans showed no change in size of the nasolacrimal canal. CONCLUSION: Nasolacrimal canal enlargement may occur without neoplasia of the lacrimal sac or nasolacrimal duct. In the absence of other features suggestive of neoplasia, appropriate management is aimed at treatment of lacrimal obstructive symptoms, if present, and serial CT scans. Open biopsy of the nasolacrimal duct is not necessary in asymptomatic patients with stable CT findings.

Adult↗

PubMed1998

Silicon granulomas and dermatomyositis-like changes associated with chronic eyelid edema after silicone breast implant.

Silicone medical products may be associated with various complications. Recent attention has focused particularly on health risks associated with silicone breast implants. The authors present the clinical and histopathological findings in a 71-year-old woman who had previously undergone breast reconstruction with a silicone gel-filled elastomer envelope-type breast implant and who developed severe chronic eyelid edema and inflammation. Extensive systemic evaluation and serologic studies were unrevealing, prompting biopsy of the eyelids. Histopathologic evaluation of the upper eyelids revealed scattered noncaseating granulomas throughout the dermis, an atrophying interface dermatitis with a sparse perivascular lymphocytic infiltrate, and focal perivascular and interstitial lymphocytic infiltrates of the muscles. Scanning electron microscopy demonstrated particles of material within the granulomas, which were revealed by electron probe x-ray microanalysis to contain silicon. The presence of silicon-containing material within areas of eyelid inflammation supports a role for silicon in the pathogenesis of this patient's condition. In the absence of other predisposing conditions, migration of silicone breast implant material must be considered.

Aged↗

PubMed1998

Ophthalmic manifestations of ectrodactyly-ectodermal dysplasia-clefting syndrome.

Ophthalmic manifestations are a common component of the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome; however, few ophthalmic publications have specifically addressed these features. The authors describe a 38-year-old patient with EEC syndrome who demonstrated several associated ocular signs and symptoms. The ophthalmic findings in this patient included bilateral entropion with secondary trichiasis, and shallow inferior fornices with symblepharon. Interestingly, the patient also had vertically deficient tarsi and absence of the meibomian glands. Ophthalmologists should be aware of the ocular signs and symptoms associated with EEC because some manifestations can potentially be sight threatening.

Adult↗