PubMed Health⌕ Search

Biomedical subjects

Dinesh Selva

Publications and source records attributed to Dinesh Selva.

At least 73 records · Page 4Linked to original sources
PubMed2005

Free tarsus autogenous graft struts for lower eyelid elevation.

PURPOSE: Free tarsus autogenous graft (FTG) has emerged as a useful biological spacer in lower eyelid elevation. However, it has limited use where a spacer of greater than 4 mm height is required, because at least 4 mm of upper tarsal height must be preserved to maintain upper eyelid rigidity. We describe an augmentation of FTG in its use as a spacer, by way of creating 2 parallel-placed vertical FTG struts, in contrast to interpositioning the FTG horizontally. METHODS: This case series describes the technique of harvesting and interpositioning FTG struts. Nine eyelids in 6 patients in whom FTG struts were used for lower eyelid elevation are reported. The patients ranged in age from 41 to 80 years. Underlying diagnoses included thyroid orbitopathy, previous blepharoplasty, and previous facial and eyelid thermal burns. RESULTS: FTG struts achieved an effective spacer height of up to 7 mm, and follow-up of 9 to 20 months revealed a good outcome in all 3 cases, with no complications. CONCLUSIONS: FTG struts provide an effective and lasting lower eyelid elevation when used as a spacer. A spacer graft of up to 7 mm in vertical height may be harvested from a long strip of upper eyelid tarsus that is 4 mm in vertical height. This technique would allow autogenous upper eyelid tarsus to be harvested with maximum conservation of tissue.

Adult↗
PubMed2005

Pericranium grafts for exposed orbital implants.

PURPOSE: To report the use of autologous pericranium grafts to cover exposed orbital implants. METHODS: A two-center consecutive case series of exposed orbital implants covered with autologous pericranium grafts. A patch of pericranium was harvested from the parieto-occipital region and was placed over the implant within a pocket between the implant and the Tenon capsule, followed by layered closure of Tenon and conjunctiva. RESULTS: Four patients (2 women, 2 men) with a mean age of 37 years (range, 26 to 45 years) were included in the study. The mean follow-up period was 9.5 months (range, 7 to 12 months). In all cases, there was no recurrence of exposure and no donor site morbidity. A small pyogenic granuloma, arising from the conjunctival suture line, developed in one case. CONCLUSIONS: Autologous pericranium is a useful covering material for exposed orbital implants and may be used as an alternative to frontal periosteum.

Adult↗
PubMed2005

Orbital invasion by esthesioneuroblastoma.

PURPOSE: Esthesioneuroblastoma is a rare malignancy arising from the olfactory mucosa in the nasal fossa, which can invade the orbit producing ophthalmic symptoms and signs. The purpose of this study was to present a case series and review the literature to assess the characteristics of orbital involvement by esthesioneuroblastoma. METHODS: Retrospective case series of all patients treated for biopsy-proven esthesioneuroblastoma at the Royal Adelaide Hospital between 1992 and 2004. RESULTS: Nine patients (5 male, 4 female) with a mean age of 50 years (range, 20 to 66 years) were reviewed. One case was classified as Kadish stage A, 1 as Kadish stage B, and 7 as Kadish stage C. Mean time from onset of symptoms to diagnosis was 17 months (range, 2 to 24 months). Radiologic orbital invasion was present in 4 cases and was associated with ophthalmic symptoms or signs in 3 of these cases. These included proptosis (2 cases), periorbital pain (1 case), decreased visual acuity (1 case), extraocular muscle restriction (1 case), and chemosis (1 case). One patient with symptoms secondary to orbital invasion was initially referred to and assessed by an ophthalmologist. All patients who had or went on to have development of orbital invasion had advanced disease at diagnosis. Treatment was surgical (9/9), with the addition of radiotherapy (6/9) and chemotherapy (2/9). Mean follow-up was 3.6 years (range, 0.5 to 8.5 years). Six of 9 patients had tumor recurrence. Two had metastasis. Five of 9 patients remained alive. CONCLUSIONS: Orbital invasion by esthesioneuroblastoma is not uncommon. It is important to be aware of this malignancy because a significant proportion of patients will present with ophthalmic signs and symptoms.

Adult↗
PubMed2005

Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma.

An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.

Adenocarcinoma, Sebaceous↗
PubMed2005

Persistent posterior globe flattening after orbital cavernous haemangioma excision.

A 54-year-old man presented with left intraconal cavernous haemangioma resulting in globe compression and hyperopia. The tumour was excised completely via lateral orbitotomy approach. Complete excision of tumour did not result in resolution of globe flattening and hyperopia after 21 months. Persistent globe flattening despite removal of a longstanding orbital tumour may be caused by remodelling of the sclera from long-term compression.

Choroid Diseases↗
PubMed2005

Autoimmune bullous diseases: ocular manifestations and management.

The ocular manifestations of autoimmune bullous diseases are common and potentially sight-threatening. Major ophthalmic involvement is most commonly seen in mucous membrane pemphigoid (cicatricial pemphigoid), epidermolysis bullosa acquisita, linear IgA bullous disease, pemphigus vulgaris and paraneoplastic pemphigus. The main pathological process is related to autoimmune-induced conjunctival inflammation with consequent lid and corneal pathology, which may eventually result in permanent visual loss. Ocular involvement can be asymptomatic. Early detection is aided by careful attention to symptoms and signs of early ophthalmic disease. Ocular disease can be difficult to treat and management usually involves systemic therapy with immunomodulators to control inflammation and prevent progression to irreversible blindness, as well as surgical intervention in advanced disease. Recent advances in treatment, including methotrexate, mycophenolate mofetil, monoclonal antibodies and topical tacrolimus therapies, have led to promising results.

Administration, Topical↗
PubMed2004

Surgical margins for lentigo maligna and lentigo maligna melanoma: the technique of mapped serial excision.

OBJECTIVES: To assess the margins required for excision of lentigo maligna (LM) and lentigo maligna melanoma (LMM) by the technique of mapped serial excision (MSE), and to assess the efficacy of MSE. DESIGN: An interventional, prospective, noncontrolled case series. SETTING: Tertiary referral, dermatologic surgery unit. PATIENTS: Consecutive patients with head and neck LM or LMM who underwent MSE between March 1, 1993, and October 31, 2002. INTERVENTION: The MSE of LM or LMM. MAIN OUTCOME MEASURES: The number of 5-mm levels for excision of LM and LMM and recurrence. RESULTS: One hundred sixty-one LMs or LMMs in 155 patients were treated. Thirty percent (37 of 125) of LMs required more than 5-mm margins. For LMMs less than 1 mm in Breslow thickness, 12% (4/32) required more than 10-mm margins. For primary tumors, 20% of LMs (18 of 91) required more than 5-mm margins, while 10% of LMMs less than 1 mm in Breslow thickness (2 of 21) required more than a 10-mm margin. For recurrent tumors, 56% of LMs (19/34) required more than a 5-mm margin. Mean follow-up of 38 months (range, 5-100 months) showed 4 recurrences (2%) after MSE. The extrapolated recurrence at 5 years was 5.0%. CONCLUSIONS: The current recommendations of 5-mm margins for LM and 10-mm margins for LMM less than 1 mm in Breslow thickness are often insufficient. Our results demonstrate the importance of margin-controlled excision, particularly in recurrent lesions. The use of MSE offers a high cure rate, in conjunction with tissue conservation.

Adult↗
PubMed2004

Donor site morbidity in free tarsal grafts.

PURPOSE: To determine if harvesting free tarsal grafts from the upper eyelids is associated with significant morbidity. DESIGN: Prospective case series. METHODS: Consecutive patients managed with free tarsal grafts by three of the authors (D.S., D.G., R.G.) over a 4-year period. RESULTS: Ninety-one eyelids in 75 patients were operated on using the free tarsal graft for various eyelid pathologies. Mean follow-up period was 14.83 +/- 8.45 months (range, 4 to 42 months). Contour peaking in donor upper eyelid appeared in two eyelids (2.2%), lash ptosis in four eyelids (4.4%) of three patients, and donor site infection in one eyelid (1.1%). Four patients (5.3%) complained of a transient ocular discomfort. There were no cases of postoperative changes on the eyelid height, entropion, or keratopathy in the donor site eye. Most of the donor site complications were mild or transient and required no further surgery. In three patients who underwent subsequent surgery to treat preexisting ptosis or retraction of the donor eyelid, the results were less predictable and further procedures were required. CONCLUSION: Free tarsal grafts harvested from the upper eyelids, with preservation of at least 4 mm of the tarsal plate inferiorly, do not lead to significant donor site morbidity. However, subsequent procedures to alter the position of the donor eyelid may be less predictable.

Adult↗
PubMed2004

The use of a polyglactin suture in the lateral tarsal strip procedure.

PURPOSE: To evaluate the rate of recurrence of horizontal laxity or lid malposition and suture-related complications associated with the use of an absorbable suture in the lateral tarsal strip procedure. DESIGN: Prospective, interventional, consecutive case series. METHODS: A prospective study. SETTING: Institutional. PATIENT POPULATION: One hundred patients with horizontal lid laxity associated with ectropion or entropion. Patients with paralytic ectropion or ocular prostheses were excluded. INTERVENTION: One hundred and five lateral tarsal strip procedures were performed using a 6-0 polyglactin suture. These were combined with full-thickness skin grafts (34), internal (55) or external (23) retractor plications, and inverting sutures (4) as required to correct the lid malposition. MAIN OUTCOME MEASURES: Recurrence of horizontal laxity or lid malposition and suture related complications were the main outcome measures. Suture related wound infection was diagnosed clinically by the presence of pus associated with wound breakdown. RESULTS: One patient failed to reach 3-month follow-up and was excluded. There was one recurrence of horizontal laxity after a mean follow-up period of 9.1 months. Four patients developed lateral canthal wound infections, compared with none at the other operative sites. The 95% confidence intervals for infections in the tarsal strip procedure were 1.1% to 9.6%, which were significantly greater than zero (P < .0001), the infection rate for the other procedures. CONCLUSION: A 6-0 absorbable suture may be used for the lateral tarsal strip and does not lead to a recurrence of horizontal laxity. It does not appear to reduce the wound infection rate associated with this procedure.

Aged↗
PubMed2004

The Australian Mohs database: periocular squamous cell carcinoma.

OBJECTIVE: To present the results of all patients with periocular squamous cell carcinoma (SCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1999. DESIGN: Prospective, noncomparative, multicenter, interventional case series. PARTICIPANTS: Seventy-nine patients undergoing MMS for periocular SCC over a 7-year period (1993-1999). MAIN OUTCOME MEASURES: Recurrence after MMS, site, size, prior recurrence, defect size, histologic subtype, and presence of perineural invasion (PNI). RESULTS: Seventy-nine patients had 54 (68%) lower eyelid, 19 (24%) medial canthus, and 6 (7.6%) upper eyelid SCCs. The most common histologic subtypes were well differentiated (48.7%) and moderately differentiated (35.1%) SCC. Seventy-three percent were primary tumors and 27% were recurrent tumors. Three (4.3%) cases had histologically confirmed PNI. Two of the 3 cases with PNI were recurrent (P = 0.1355), and surgical excision was the most frequent prior treatment (P = 0.0192), with up to 3 prior excisions in 1 case. None of the patients with PNI received adjunctive radiotherapy, and none have recurred with follow-ups to date of 4, 5, and 6 years, respectively. A median follow-up of 73 months (mean, 77.3; range, 42-117) was available in 56 (71%) cases, of which 2 (3.64%; exact 95% confidence interval, 0.44%-12.53%) recurred. Both cases were primary, moderately differentiated SCCs. CONCLUSION: This is the largest reported prospective series of periocular SCC managed by MMS, with a median follow-up of over 5 years. It demonstrates that MMS has the lowest reported recurrence rate (3.64%) of any treatment modality for periocular SCC. That there were no recurrences for cases with PNI further emphasizes the importance of margin-controlled excision for periocular SCC.

Adult↗
PubMed2004

The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up.

OBJECTIVE: To report the outcome with 5-year strict follow-up (only cases where 5-year follow-up is available) of all patients with periocular basal cell carcinoma (BCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1996. DESIGN: Prospective, noncomparative, multicenter, interventional case series. METHODS: A prospective series of 819 patients, undergoing MMS for periocular BCC over a 3-year period (1993-1996). INCLUSION CRITERIA: Periocular BCC referred for MMS. MAIN OUTCOME MEASURES: Recurrence, site, size, prior occurrence, defect size, histologic subtype, and presence of perineural invasion. RESULTS: Eight hundred nineteen patients had 257 (54%) lower eyelid, 195 (41%) medial canthus, and 22 (5%) upper eyelid BCCs. The most common histologic subtypes were nodulocystic (43%) and infiltrating (30%) (P = 0.0003). Sixty-eight percent were primary and 32% were recurrent tumors. Five-year follow-ups for cases between 1993 and 1996 were available in 347 (42%) cases. There were 7 recurrences (2.0%; exact 95% confidence interval [CI]: 0.82%-4.1%), 5 of which were at the medial canthus and all of which were previously recurrent, with up to 3 recurrences before MMS. Previous recurrence (P<0.0001), infiltrating (5) or superficial (2) histologic subtype (P = 0.0882), and medial canthal site were the main predictors of recurrence after MMS. There were no recurrences for primary BCC, and the 5-year recurrence for previously recurrent BCC was 7.8% (exact 95% CI: 3.2%-15.4%). CONCLUSION: The Australian MMS database is the largest prospective nationwide series of periocular BCC managed by MMS. The strict 5-year recurrence rates of 0% and 7.8% for primary and recurrent tumors, respectively, confirm MMS as the treatment of choice for periocular BCC.

Adolescent↗
PubMed2004

The Australian Mohs database, part I: periocular basal cell carcinoma experience over 7 years.

OBJECTIVE: To present the findings of all patients with periocular basal cell carcinoma (BCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1999. DESIGN: Prospective, noncomparative, multicenter, interventional case series. METHODS: Prospective series of 1295 patients undergoing MMS for periocular BCC over a 7-year period (1993-1999). INCLUSION CRITERIA: Periocular BCC referred for MMS. MAIN OUTCOME MEASURES: Site, tumor size, prior occurrence, defect size, histologic subtype, and presence of perineural invasion. RESULTS: Twelve hundred ninety-five patients had 615 (47.5%) lower eyelid, 626 (48.3%) medial canthus, and 51 (3.9%) upper eyelid BCCs. The most common histologic subtypes were nodulocystic (39.5%) and infiltrating (34.8%) (P = 0.0008). Sixty-eight percent were primary and 32% were recurrent tumors. Previously recurrent BCCs were larger (P<0.0001), with larger defects (P<0.0001) than primary BCCs, and had more subclinical extension (P<0.0001) requiring more levels for complete excision (P<0.0001). Furthermore, superficial BCCs were more likely to have a prior occurrence (P<0.0001). In this series, perineural invasion was found in 1% of cases, with greater subclinical tumor extension in such cases (P = 0.0657). CONCLUSION: The Australian MMS database is the largest prospective, nationwide series of high-risk periocular BCC managed by MMS. Almost 50% of tumors were at the medial canthus, with nodulocystic and infiltrating being the most common histologic subtypes. Recurrent BCCs comprised a third of tumors and were larger, with larger defects and more subclinical extension than primary BCCs. Perineural invasion was found in 1% of cases and also had greater subclinical extension.

Adolescent↗
PubMed2004

The Australian Mohs database: periocular squamous intraepidermal carcinoma.

OBJECTIVE: To present the findings and report the outcomes of all patients with periocular squamous intraepidermal carcinoma (IEC) treated with Mohs micrographic surgery (MMS) in Australia between 1993 and 1999. DESIGN: Prospective, noncomparative, multicenter, interventional case series. METHODS: A prospective series of 53 patients undergoing MMS for periocular IEC over a 7-year period (1993-1999). MAIN OUTCOME MEASURES: Recurrence, site, size of IEC, prior recurrence, and size of final defect. RESULTS: Fifty-three patients had 27 (51%) lower eyelid, 17 (32%) medial canthus, and 9 (17%) upper eyelid IEC. Most (85%) of the IECs were present for less than 5 years. Fifty-eight percent were primary IECs, and 42% were recurrent IECs. There were no differences in the clinical features of primary and recurrent IECs. Significant subclinical tumor extension was found, whereby the defect exceeded tumor size by at least 2 size groups (> or =2 cm) in 25% of cases. Follow-up to date was available in 68% (36 of 53) of cases (19 primary and 17 recurrent IECs). With a mean follow-up of 77.4 months (median, 75; range, 44-120 months), 3 (8.3%; exact 95% confidence interval 1.8%-23.1%) cases recurred. Hence, the recurrence rate was 5.3% (1 of 19) for primary periocular IEC and 11.8% (2 of 17) for recurrent periocular IEC. CONCLUSIONS: The Australian MMS database provides data for the first prospective series of periocular IEC managed by MMS. Periocular IEC demonstrates significant subclinical tumor extension, with no significant differences in the clinical features of primary and recurrent lesions. Compared with other published studies, the recurrence rate of 5% and 12% for primary and recurrent lesions, respectively, with more than 5-years of follow-up for most cases emphasizes the importance of margin-controlled excision for periocular IEC.

Adult↗
PubMed2004

Modified Hughes flap: division at 7 days.

PURPOSE: To report the outcome of early division of the tarsoconjunctival pedicle of a modified Hughes flap at 1 week after the primary operation. DESIGN: Noncomparative, interventional, prospective case series. PARTICIPANTS: Twenty-nine eyelids of 29 consecutive patients operated using the modified Hughes flap and full-thickness skin graft for lower eyelid reconstruction after Mohs micrographic surgery, over a 4-year period. INTERVENTION: In all patients, the pedicle of the Hughes flap was divided 1 week after the primary operation. MAIN OUTCOME MEASURES: Postoperative lower eyelid flap viability and lower eyelid contour complications. RESULTS: Twenty-nine eyelids of 29 patients (mean age: 69+/-11 years) were operated using the modified Hughes flap. The mean follow-up period was 14+/-6 months (range: 6-23). There were no cases of lower eyelid retraction, flap ischemia, or necrosis after division. Postoperative complications included lower eyelid margin erythema in 2 patients (6.9%), upper eyelid lash ptosis in 3 patients (10.3%), and upper eyelid lateral retraction in 1 patient (3.4%). CONCLUSION: Early division of the tarsoconjunctival pedicle of a modified Hughes flap at 1 week does not compromise the viability of the reconstructed lower eyelid and results in a good functional and cosmetic outcome.

Adult↗
PubMed2004

Late reactivation of thyroid orbitopathy.

BACKGROUND: Thyroid orbitopathy is characterized by spontaneous remissions and exacerbations. Although data on the natural history are scarce, the active phase is usually self-limited, encompassing an average period of 18-36 months. Late reactivation, defined as active orbitopathy occurring after more than 5 years of quiescent disease, appears to be an uncommon and poorly documented event. The aim of the present study was to assess the incidence and characteristics of late reactivation of thyroid orbitopathy within a tertiary referral orbital clinic. METHODS: A retrospective case review was conducted of patients with thyroid orbitopathy seen at the Royal Adelaide Hospital Orbital Clinic between 1996 and 2001. RESULTS: From 193 cases of thyroid orbitopathy, eight cases (5%) of late reactivation were identified. The mean age of patients was 51 years (range 32-76 years) with a female to male ratio of 3:1. All cases presented with proptosis and seven demonstrated increased diplopia and gaze restriction. Signs of soft tissue inflammation were seen in three cases. All were euthyroid at presentation with a past history of thyroid orbitopathy and hyperthyroidism. One patient had an association of smoking with reactivation but the remainder had no discernible precipitants. The average interval between the initial orbitopathy and reactivation was 12 years (range 6-30 years). Computed tomography revealed enlarged extraocular muscles in seven cases and two showed partial response to treatment with low dose radiotherapy and steroids. The average length of disease activity was 14 months (range 9-18 months). CONCLUSION: Late reactivation of thyroid orbitopathy appears to be an uncommon phenomenon. It may occur under euthyroid conditions with no obvious precipitants and often presents as a reactivation of myopathy.

Adult↗