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Biomedical subjects

D T Tse

Publications and source records attributed to D T Tse.

At least 19 recordsLinked to original sources
PubMed1992

Neuroimaging of the optic nerve after fenestration for management of pseudotumor cerebri.

The mechanisms by which optic nerve-sheath fenestration is effective remain speculative. Possibilities include surgical production of a cerebrospinal fluid filtration outlet or scarring in the subarachnoid space around the nerve in the vicinity of the fenestration site, with shifting of the pressure gradient from the nerve head to the retrobulbar portion. Two patients who underwent successful optic nerve-sheath fenestration developed a cystlike structure contiguous to the fenestration site, apparently in direct communication with the optic nerve sheaths. This was shown on magnetic resonance imaging (one patient) and orbital echography (both patients). These previously unreported observations may support the hypothesis that fenestration works by creating a filtration apparatus that controls the intravaginal pressure in the subarachnoid space surrounding the orbital segment of the optic nerve.

Adult↗
PubMed1992

Vertically oriented upper eyelid nerve fibers. A clinical, anatomical and immunohistochemical study.

Vertically oriented suborbicular nerve fibers are frequently encountered during upper eyelid surgery. It has not been well established whether these fibers are terminal motor branches of the facial nerve (VII) or sensory branches of the ophthalmic nerve (V-1). To investigate the origin of these nerve fibers, three different techniques were used: (1) intraoperative nerve stimulation; (2) cadaver dissection; and (3) immunohistochemical analysis. The results of all three investigative methods are in agreement and conclusively demonstrate that these fibers represent sensory branches of the ophthalmic nerve (V-1) and not motor branches of the facial nerve (VII). Anatomical dissection showed that the sensory fibers to the upper eyelid do not travel solely within the suborbicular fascial plane, but also course in the preorbicular plane and within the orbicularis muscle itself. The terminal branches of the facial nerve to the upper eyelid innervate the orbicularis oculi from the undersurface and in a horizontal orientation. Clinical correlation of these findings is discussed.

Choline O-Acetyltransferase↗
PubMed1991

Surgical correction of lower-eyelid tarsal ectropion by reinsertion of the retractors.

Lower-eyelid tarsal ectropion is an unusual form of eyelid malposition in which the entire lid is everted. The cause is most likely the disinsertion of the lower-eyelid retractors. In 12 eyelids of six patients, a transconjunctival approach was used to reunite the retractors with the inferior tarsal border. In eight eyelids, a horizontal tightening procedure was also needed. The looping passage of fornix sutures through the full thickness of the eyelid created a vector force that helped rotate the lid margin inward. The subsequent formation of an inflammatory cicatrix induced by the absorbable sutures also contributed to maintain the lid in an upright posture. During follow-up periods ranging from 8 to 36 months, there were no instances of overinversion, recurrent ectropion, or suture abscess.

Aged↗
PubMed1991

Temporal artery biopsy technique: a clinico-anatomical approach.

A positive temporal artery biopsy is required to conclusively establish the diagnosis of temporal arteritis. The temporal artery biopsy technique we describe is based on the anatomical branching patterns of the superficial temporal artery, the various fascial layers, and the location of the temporal branches of the facial nerve. Special emphasis is placed on avoiding facial nerve trauma during a biopsy of the frontal branch of the superficial temporal artery. Proper surgical technique combined with a working knowledge of the anatomy of the temporalis region enhances the safety of a temporal artery biopsy procedure.

Biopsy↗
PubMed1990

A simple and reliable technique for permanent lateral tarsorrhaphy.

A simple and reliable technique for permanent tarsorrhaphy is described that has many advantages over previously reported techniques. it produces a stable and permanent lid adhesion without the use of nonabsorbable sutures or bolsters that require removal, and it can be opened at any time without lash loss, trichiasis, epidermalization of the lid margin, or scarring of the anterior lamella.

Eyelids↗
PubMed1990

Surgical treatment of chemotic conjunctival prolapse following vitreoretinal surgery.

The development of marked conjunctival chemosis following vitreoretinal surgery may be due to extensive intraoperative cryopexy, prolonged surgical time, removal of edematous corneal epithelium, and postoperative face-down posturing for an intraocular gas bubble. The fine suspensory attachments of the conjunctival fornix may be disrupted by the hydraulic dissection of marked chemosis, leading to prolapse of the conjunctiva through the eyelids. This problem can be successfully managed by a combination of conjunctival fornix sutures to invaginate the prolapsed conjunctiva and temporary suture tarsorrhaphy.

Adolescent↗
PubMed1990

Management of lower-lid retraction with hard-palate mucosa grafting.

Lower eyelid retraction is frequently managed by recession of the lower-lid retractors and interposition of a "spacer graft." We have used hard-palate mucosa as our spacer material in 25 eyelids of 18 patients. A graft twice the height of the measured amount of lid retraction was used and resulted in predictable, satisfactory results. The hard-palate mucosa was easily obtained and the donor site healed well in all patients, with minimal care.

Adult↗
PubMed1990

Ophthalmic complications of sinus surgery.

Seven patients with orbital complications of sinus surgery seen over a 10-year period are reported. Severe intraoperative orbital hemorrhage occurred in three patients while undergoing external or intranasal ethmoidectomy. In one patient, an avulsed anterior ethmoidal artery was identified as the source of bleeding, whereas in two others bleeding was due to snaring of orbital tissues. In two of these three cases, intraoperative recognition and prompt treatment of the expanding hematoma resulted in preservation of vision. Motility disturbances due to extraocular muscle injury occurred in two patients after intranasal ethmoidectomy and in one patient after a Caldwell-Luc procedure. Bilateral blindness resulted from transection of both optic nerves in one patient during bilateral intranasal endoscopic ethmoidectomies. Recommendations for prevention, intraoperative recognition, and management of such ophthalmic complications of sinus surgery are given.

Adult↗
PubMed1990

The pigtail probe, revisited.

Choosing a method for repair of a canalicular laceration can be a challenge for the ophthalmic surgeon. Important principles to consider include direct anastomosis of the severed canalicular ends, endocanalicular support, and avoiding trauma to the uninvolved portions of the nasolacrimal system. The round-tipped, eyed pigtail probe has been found to be a safe, effective instrument in identifying and repairing a canalicular laceration. The authors also found it helpful in reconstructing partially excised canaliculi after tumor removal with Mohs' surgery. A high degree of anatomic and functional success was achieved using this instrument in a careful and meticulous technique.

Anastomosis, Surgical↗
PubMed1990

Optic nerve sheath distention in Leber's optic neuropathy and the significance of the "Wallace mutation".

We recently encountered a 27-year-old man who presented an atypical clinical picture of Leber's hereditary optic neuropathy: His family history was negative, visual loss continued steadily for over 8 months, circumpapillary microangiopathy was equivocal, the optic discs showed large physiologic cups, and both optic nerve sheaths were notably distended with increased subarachnoid fluid. The latter was confirmed by ultrasonography, computed tomography, and magnetic resonance imaging. The patient's asymptomatic brother also showed unimpressive circumpapillary microangiopathy in the fundi. The asymptomatic mother from France was then seen, and she showed classic circumpapillary microangiopathy in the fundi. Studies of mitochondrial DNA showed the classic point mutation at position 11778 as reported by Wallace in all three family members. Another patient previously seen with classic Leber's hereditary optic neuropathy recently had mitochondrial DNA studies along with three other affected family members and five unaffected family members in the maternal lineage. All nine of these individuals were completely normal at the Wallace locus. In fact, sequencing of the entire ND-4 gene from one affected individual revealed it to be perfectly normal at the amino acid level. The importance of obtaining quantitative ultrasonography and the 30 degrees test, and studying mitochondrial DNA in patients suspected of having Leber's optic nerve disease is emphasized.

Adult↗
PubMed1990

Irradiated homologous tarsal plate banking: a new alternative in eyelid reconstruction. Part I. Technique and animal research.

Reconstruction of full thickness eyelid defects requires the correction of both posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Tarsal substitutes including banked sclera, nasal cartilage, ear cartilage, and periosteum can be beneficial for posterior lamellar repair, while anterior lamellar replacement, including skin grafts, pedicle flaps, advancement flaps, etc., is important to cover the posterior reconstructed portion. At times, due to extensive tissue loss, the eyelid reconstruction can be particularly challenging. We have found an alternative posterior lamellar reconstructive technique utilizing irradiated homologous tarsal plate that can be particularly useful in selected cases of severe tissue loss. The experimental surgical procedure in monkeys and the histological fate of the implanted tarsus is described in Part I, and followed in Part II by our experience with this tissue in six human patients.

Animals↗
PubMed1989

A two-layer closure of sino-orbital fistula.

A two-layer closure of sino-orbital fistulae using tension-free local flaps is described. For small fistulae, the opening is first closed with a mucosal turnover flap; this is combined on the orbital surface with a local rotational advancement flap of the orbital skin. For larger fistulae where a mucosal turnover flap cannot be fashioned, a two-stage, delayed, composite mucocutaneous rotational flap is used. The advantages of these techniques are: (1) a mucous membrane to provide nasal or sinus lining, insulating the raw ventral surface of the skin flap; (2) each flap has an independent blood supply; (3) local flaps are used, avoiding the use of a pedicle flap from forehead; (4) excellent cosmesis since tissues outside the orbital rim are not disturbed; and (5) does not require refitting of exenteration prosthesis since the integrity of the orbital rim is maintained. The authors have used these techniques in six patients with chronic sino-orbital fistulae of the exenterated socket. In one patient, a wound dehiscence occurred and a small fistula measuring 3 to 4 mm in diameter persisted. The fistulae of the remaining five patients were successfully closed.

Adult↗
PubMed1988

Elevated corneal epithelial lines in Acanthamoeba keratitis.

Elevated corneal epithelial lines are another clinical sign in Acanthamoeba corneal infection. In this report, one patient wore extended wear soft contact lenses, and another wore daily wear soft contact lenses. Both patients used distilled water and salt tablets in their lens care. Histopathologic examination of these lines revealed trophozoites and cysts. In one of the patients following penetrating keratoplasty, Acanthamoeba castellani and Acanthamoeba polyphaga were cultured by impression cytology of an epithelial line, as well as from the bulbar and tarsal conjunctiva. In the other patient who did not undergo penetrating keratoplasty, these lines appeared in the cornea one month after initial symptoms.

Acanthamoeba↗