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Biomedical subjects

E G Kemp

Publications and source records attributed to E G Kemp.

18 recordsLinked to original sources
PubMed2006

Orbital exenteration--a retrospective study over an 11 year period analyzing all cases from a single unit.

PURPOSE: A retrospective analysis of all cases of orbital exenteration performed at the National Scottish Ocular Oncology Center over an 11 year period. METHODS: We sought all exenteration cases (1993-2003) from ocular oncology and oculoplastic databases. Fifteen exenterations were performed. One case record was irretrievable. Clinicopathological features and outcome of 14 patients were analyzed. All operations were performed by the same consultant. RESULTS: The male to female ratio was 1:1 and the average age at surgery was 66 years. There was a left sided predominance of pathology demonstrated (right to left orbit ratio was 1:1.3. The average follow up period postsurgery was 35 months. The most common underlying diagnosis was malignant melanoma (9/14). Ocular/orbital discomfort was the most frequent presenting symptom (7/14); a mass lesion (10/14) was the most common presenting sign. The average duration of symptoms/signs prior to tertiary institution referral was 10.9 months (range: 0.5-60 months). Exenteration was performed on average 39.7 months (range: 0.13-204) after initial tertiary center presentation. This included patients managed from the outset who failed treatment(s) and then required exenteration. The eyelids were sacrificed in ten cases (10/14). Sockets were lined with eyelid skin (4/10), split skin (thigh) (3/10) or healed secondarily (7/10). Thirteen cases (13/14) had clear histological margins. The average post operative stay was 8.3 days. The most common complication was socket fistula formation (7/14). Ethmoid sinuses were always involved. The average time to fistula development was 4.9 months (sockets lined by skin = 2.2 months compared with sockets left to heal secondarily = 6.9 months). The majority of patients wore occlusive shields long term. CONCLUSION: The most common pathology necessitating exenteration was malignant melanoma. Most patients presented with a mass lesion. Histological tumor free margins were obtained in thirteen of fourteen cases. The most common complication was socket fistula formation.

Aged↗
PubMed2004

Screening for ophthalmic involvement in asymptomatic patients with metastatic breast carcinoma.

BACKGROUND: Breast carcinoma metastasises to the eye more frequently than is clinically recognised. The incidence is perhaps not appreciated, either because of the more common involvement and consequences of spread to major organs (such as lung, liver, or bone) or because a number of eye lesions are small and asymptomatic. Over a 6-month period, all patients with locally advanced or metastatic breast cancer were screened for ocular involvement and as a result management recommendations made. MATERIALS AND METHODS: Between January 2001 and June 2001, 68 patients with known locally advanced or metastatic breast carcinoma were referred for a screening ophthalmic examination. The aim of the study was to assess the frequency of asymptomatic ocular metastases by breast carcinoma in visually asymptomatic patients. The recognition and early treatment of both ocular metastases and ocular manifestations of metastatic breast carcinoma are important in maximising the quality of life in this group of palliative patients. These patients were all referred and recruited from the Beatson Oncology Centre and Breast Unit at the Western Infirmary, Glasgow by the oncologist (ANH). Examination included visual acuity assessment, slit-lamp examination, tonometry, and indirect ophthalmoscopy. RESULTS: The median time from diagnosis of breast carcinoma to ophthalmic screening was 5 years (range 6 months-23 years). No patient had any evidence of choroidal metastases on ophthalmic examination. Four patients (5.8%) had ophthalmic manifestations of metastatic breast carcinoma and a further two had ocular complications of treatment. One patient had a restrictive motility problem from a metastatic deposit to her lateral rectus muscle and another had corneal punctate epitheliopathy secondary to a seventh nerve palsy. A further patient had coarse nystagmus from cerebellar metastases and the final patient of the four had a Horner's syndrome from metastases in the neck. In addition, two patients had symptomatic dry eyes whose onset coincided with commencement of chemotherapy. CONCLUSION: Ophthalmic manifestations of metastatic breast carcinoma occurred in 5.8% of asymptomatic patients. Orbital metastases were documented in one patient. No case of choroidal metastases was observed in this group with advanced or metastatic disease. Therefore, patients do not need to be routinely screened particularly for choroidal metastases.

Adult↗
PubMed2002

A review of the outcome of upper lid lowering for eyelid retraction and complications of spacers at a single unit over five years.

AIM: To review the outcome of upper lid lowering for eyelid retraction at a single unit over five years and to report the high complication rate with mersilene mesh as a spacer material. METHODS: We retrospectively reviewed the case records of 48 patients who underwent upper lid lowering for lid retraction between January 1995 and January 2000. RESULTS: The indication for surgery was eyelid retraction secondary to dysthyroid disease in 41 patients, seventh nerve palsy in 3 cases, overcorrection of ptosis elsewhere in 3 cases and previously treated orbital lymphoma in one patient. A good result was achieved in 80% with a single procedure. Undercorrection occurred in 10% and overcorrection occurred in 8%. Spacer material, either mersilene mesh or more recently vicryl, was used in 42% of lids. Late extrusion of mersilene mesh occurred in 20% of lids that had a spacer inserted an average of 18 months postoperatively. CONCLUSIONS: The high extrusion rate with mersilene was unacceptable and the alternative spacer material vicryl is now used. The possibility of revisional surgery because of under- or overcorrection should be explained to patients.

Adult↗
PubMed2002

Preoperative topical and intraoperative local mitomycin C adjuvant therapy in the management of ocular surface neoplasias.

AIMS: To demonstrate the efficacy of mitomycin C as adjuvant therapy preoperatively and intraoperatively in the management of recurrent or diffuse ocular surface neoplasias. METHODS: The case notes of 11 patients receiving mitomycin C adjuvant therapy as 0.04% eye drops four times a day in two weekly courses preoperatively and/or a single intraoperative application of 0.4 mg/ml of mitomycin C were reviewed. The histopathology included conjunctival primary acquired melanosis, conjunctival melanomas, sebaceous cell carcinomas with conjunctival intraepithelial spread, and conjunctival intraepithelial squamous neoplasias. Seven patients had additional limited local excision of the residual tumour mass and one had cryotherapy. RESULTS: All cases showed a favourable response to mitomycin C adjuvant therapy with regression in size or retardation of a rapid growth pattern and no serious sequelae. Postoperative follow up of 6-36 months following excision of the lesion with or without intraoperative mitomycin C showed no clinical recurrence in any of the cases. CONCLUSION: In this series, mitomycin C adjuvant therapy of recurrent or diffuse ocular surface neoplasias was well tolerated and showed favourable clinical results.

Administration, Topical↗
PubMed2001

Mersilene mesh as an alternative to autogenous fascia lata in brow suspension.

PURPOSE: To evaluate the outcome and complications of brow suspension surgery for ptosis repair performed with Mersilene mesh as the suspensory material. METHODS: A retrospective review was undertaken of all patients undergoing Mersilene mesh brow suspension surgery during a 9-year period. All patients had undergone the same surgical procedure performed by the same surgeon. Preoperative and postoperative palpebral aperture heights were recorded, and the results were analyzed to provide a mean change in palpebral aperture height. The case records of patients with a poor response to surgery were examined carefully, and possible risk factors for a poor outcome were identified. RESULTS: The mean (95% confidence interval) increase in palpebral aperture height was 1.8 mm (1.2-2.4 mm). Factors associated with a poorer outcome were previous ptosis surgery and Marcus Gunn jaw-winking syndrome. CONCLUSIONS: Mersilene mesh has advantages over other materials for use as a suspensory material in brow suspension surgery, and is associated with a good outcome and low complication rate.

Adolescent↗
PubMed1999

Metastatic breast cancer presenting as Tolosa-Hunt syndrome.

Choroidal involvement is a well-recognized manifestation of metastatic disease, particularly from breast and lung primaries. However, breast cancer can involve other ocular structures. The two patients presented illustrate diffuse orbital involvement of the extraocular muscles, simulating Tolosa-Hunt syndrome. This association has not been reported previously. Both patients responded well to local radiotherapy.

Adult↗
PubMed1995

Abnormal extracellular material in the levator palpebrae superioris complex in congenital ptosis.

OBJECTIVE: To determine the pathologic abnormalities of the levator palpebrae superioris in congenital ptosis. METHODS: By means of light and electron microscopy and immunohistochemistry, anterior levator tissue specimen from 15 patients with congenital ptosis excised during routine levator resections were examined. RESULTS: All specimens showed lack of muscle fibers with endomysial and perimysial fibrosis and thickening of the aponeurosis. In addition, in four of the 15 patients, an abnormal extracellular material was present. By light microscopy this appeared as an unusual amorphous material arranged in clumps and bands, and electron microscopy showed it to consist of parallel coarse bundles of fibrillogranular material. Collagen type III and fibronectin were identified within this material by immunohistochemistry. There was no detectable collagen types I, II, IV, V, VI, or VII or laminin, and the material did not stain for actin, myosin, myoglobin, amyloid P component, or amyloid A. CONCLUSIONS: In four of 15 samples of levator palpebrae superioris from patients with congenital ptosis, we identified an unusual amorphous extracellular material that stained positively for collagen type III and fibronectin on immunohistochemistry. This novel material, which we call "amorphocollagenoid," may represent a product of dysgenesis of the levator tissues. The source and full composition of this material merit further study.

Adolescent↗
PubMed1993

The routine use of adjustable sutures in adult strabismus surgery.

A review is given of the adjustable suture technique in adult strabismus surgery, and our experience with its use over a 4-year period. Twenty patients underwent adjustable surgery during that time, both for cosmetic reasons and for alleviation of diplopia. Postoperative adjustment in the alert patient enabled the eyes to be aligned in the most favourable position. The stability of alignment was good, and a success rate of 85% was achieved over a mean follow-up period of 17 months. Our results demonstrate the value of the technique, even when undertaken in a non-specialist ophthalmological department of a district general hospital. We now offer adjustable sutures routinely to all adults able to cooperate, to safeguard against the unpredictable nature of standard strabismus surgery.

Adolescent↗
PubMed1986

Surgical management of upper lid entropion.

One hundred and eighty-three surgical procedures were conducted on 107 patients over seven years. 91% of the cases of upper lid entropion were corrected satisfactorily with only one operation. It is postulated that this level of success is achieved by grading the degree of surgical intervention according to the clinical established on systematic examination of upper lid entropion.

Entropion↗
PubMed1986

Brow suspension in the management of ptosis: an analysis of over 100 cases.

This study analyses the management of ptosis associated with minimal levator function in 105 cases over an eight-year period. A 96 per cent success rate has been recorded which parallels previous authors' results. Clinical indications and relevant pathology are detailed with early identification and graded operative intervention postulated as suitable management for most cases. The overall success rate depended on the use of autogenous fascia lata, delaying its use until after the age of four, and adopting a bilateral approach whenever possible. Stored fascia lata was used in infants and in certain acquired unilateral cases.

Blepharoptosis↗
PubMed1984

Measurement of total and specific IgE levels in the management of a family exhibiting a high incidence of keratoconus.

A prospective survey of a family, some of whose members were suffering from keratoconus, has been assisted by estimating serum levels of total and specific immunoglobulin E. In this family of twelve there were initially 2 keratoconus sufferers identifiable clinically, and they both had raised serum levels of total and specific IgE. Of three other younger siblings with high levels of IgE 2 have become, over the course of the study period, patients requiring regular review due to established early keratoconus. The third, as yet, has no clinical evidence of altered corneal stroma. We consider, therefore, estimation of total and specific serum immunoglobulin E to be an objective test with the potential for indicating high risk patients within selected groups. The patients thus identified may have established keratoconus or may progress to develop the condition.

Adolescent↗
PubMed1982

Immunoglobulin patterns in keratoconus with particular reference to total and specific IgE levels.

A selection of sufferers from keratoconus and random controls were assessed in order to substantiate claims that there existed a significant incidence of patients with both keratoconus and a raised serum level of immunoglobulin E. The results appeared to confirm a high incidence of raised total serum IgE levels in patients with keratoconus and also indicated that the additional measurement of serum specific IgE was more sensitive than total IgE. In fact 59% of the patients with keratoconus in our study were identified as having significantly raised level of specific immunoglobulin E, and 52% were identifiable by measuring total immunoglobulin E. This compares favourably with a previous incidence in a keratoconus population of 47% with raised total immunoglobulin E. Our study avoids clinical estimation of known associated systemic manifestations of atopic disease, thereby reaffirming the correlation between raised serum levels of IgE and keratoconus as objectively as possible. This identification pattern may be useful in reviewing high-risk groups and aid in the earlier detection of the condition.

Female↗