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Igal Leibovitch

Publications and source records attributed to Igal Leibovitch.

At least 19 recordsLinked to original sources
PubMed2006

Sino-orbital fistula: a complication of exenteration.

PURPOSE: To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital exenteration. DESIGN: Retrospective interventional case series. PARTICIPANTS: One hundred ten patients who underwent orbital exenteration at 2 orbital units. METHODS: Retrospective chart review of all cases of orbital exenteration between 1993 and 2005 at one orbital unit and between 1999 and 2005 at a second orbital unit. MAIN OUTCOME MEASURES: Incidence of sino-orbital fistulas. RESULTS: Seventy-three and 37 orbital exenterations were performed at the first and second orbital units, respectively. Five patients developed sino-orbital fistulas, 1 of whom developed 2 fistulas at separate sites. In the first unit, 4 fistulas developed in 3 of 73 (4.1%) patients who underwent orbital exenteration. In the second unit, 2 fistulas developed in 2 of 37 (5.4%) exenterated orbits. The majority (5/6) of fistulas occurred medially to the ethmoid sinus, whereas 1 occurred superiorly to the frontal sinus. Risk factors that may have contributed to fistula formation include radiotherapy (3/6), sinus disease (3/6), intraoperative penetration into a sinus (3/6), and immunocompromise (1/6). Management was tailored to the individual case and ranged from conservative socket hygiene to surgical repair with grafts or flaps. Four of the 6 fistulas recurred after repair. Three of these subsequently were closed successfully. Only 1 fistula persisted until the patient died from malignant disease. CONCLUSIONS: Sino-orbital fistulas are uncommon but not rare complications of orbital exenteration that may be predicted by several risk factors. Bothersome symptoms may necessitate treatment, which can range from conservative management to surgical repair with various grafts or flaps. Despite repair, fistulas may be difficult to eradicate.

Adult↗
PubMed2006

Periocular and orbital amyloidosis: clinical characteristics, management, and outcome.

OBJECTIVE: To present the clinical features and management outcome in a large series of patients with periocular and orbital amyloidosis. DESIGN: Retrospective, noncomparative, interventional case series. PATIENTS: All patients diagnosed with periocular and orbital amyloidosis in 6 oculoplastic and orbital units. METHODS: Clinical records of all patients were reviewed. MAIN OUTCOME MEASURES: Clinical presentation, radiological and histological findings, treatment modalities, and outcome. RESULTS: The study included 24 patients (15 female, 9 male) with a mean age of 57+/-17 years. Nineteen cases were unilateral, and 5 were bilateral. Clinical signs and symptoms included a visible or palpable periocular mass or tissue infiltration (95.8%), ptosis (54.2%), periocular discomfort or pain (25%), proptosis or globe displacement (21%), limitations in ocular motility (16.7%), recurrent periocular subcutaneous hemorrhages (12.5%), and diplopia (8.3%). Seven cases had orbital involvement, and 17 were periocular. Immunohistochemistry in 7 patients showed B cells or plasma cells producing monoclonal immunoglobulin chains that were deposited as amyloid light chains. Only 1 patient was diagnosed with systemic amyloid light chain amyloidosis. Treatment modalities were mainly observation and surgical debulking. During a mean follow-up period of 39 months, 21% showed significant progression after treatment, whereas 79% were stable or showed no recurrence after treatment. CONCLUSION: Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. Complete surgical excision is not feasible in many cases, and the goal of treatment is to preserve function and to prevent sight-threatening complications.

Adult↗
PubMed2006

Orbital invasion by recurrent maxillary ameloblastoma.

PURPOSE: To describe 2 patients with orbital invasion by maxillary ameloblastoma, a rare odontogenic tumor that is not commonly encountered in ophthalmic practice. DESIGN: Retrospective, interventional case report. METHODS: Two patients who were diagnosed with maxillary ameloblastoma several years ago sought treatment for new-onset ocular and orbital signs and symptoms. MAIN OUTCOME MEASURES: Clinical and radiological findings and outcome. RESULTS: In the first patient, tumor recurrence with orbital invasion was diagnosed, and the patient underwent a total orbital exenteration. No recurrence was noted after 18 months of follow-up. The second patient had intracranial involvement with orbital invasion and underwent an extensive resection through an intracranial approach. No recurrence was noted after a 6-month follow-up period. CONCLUSIONS: Although a slow-growing tumor, maxillary ameloblastoma can recur after surgical excision and can be locally aggressive; it can invade the orbit and result in significant ocular morbidity. Ophthalmologists should be aware of this tumor and should monitor these patients closely when orbital invasion is suspected.

Aged↗
PubMed2006

Paranasal sinus inflammation and non-specific orbital inflammatory syndrome: an uncommon association.

OBJECTIVES: The aim of this study is to present a series of patients with orbital inflammatory symptoms associated with significant paranasal sinus inflammation, and to discuss the diagnostic and management modalities. METHODS: A retrospective, non-comparative, interventional case series of all patients diagnosed with orbital inflammatory syndrome and significant sinus inflammation, seen at two Orbital Units between January 1999 and October 2005. The clinical records of all patients were reviewed. RESULTS: Of 91 cases diagnosed with non-specific orbital inflammatory syndrome, six (6.6%, four males, two females mean age 51+/-17 years) had significant sinus inflammation. Symptoms and signs were periorbital swelling and erythema, proptosis, globe displacement and ocular motility restrictions with diplopia. On imaging, there was extraocular muscle enlargement and/or orbital fat haziness, as well as almost complete ipsilateral maxillary sinus opacification with varying degrees of opacification of adjacent sinuses. Sinus biopsy in four cases showed a non-specific inflammatory reaction. Treatment with steroids alone (four cases) or a combination of oral antibiotics and systemic steroids (two cases) resulted in resolution of signs and symptoms within 24-72 h. One case of recurrence was noted during a mean follow-up period of 9 months (range, 3-24 months), and this responded well to oral steroids. CONCLUSION: Although uncommon, paranasal sinusitis can be associated with a non-specific orbital inflammatory syndrome. When an infectious etiology is excluded, systemic steroids may play a major role in the management of these patients and result in prompt resolution of orbital signs and symptoms.

Adult↗
PubMed2006

Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction.

OBJECTIVES: The objectives of this study were to report a series of paediatric patients who underwent endoscopic endonasal dacryocystorhinostomy (DCR) for primary congenital nasolacrimal duct obstruction (NLDO). METHODS: This is a retrospective, noncomparative review of all consecutive cases in two lacrimal clinics between January 1999 and October 2004. The main outcome measures were patients' demographics, previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. RESULTS: Twenty-one patients (15 males) with a mean age of 6+/-3.5 years (range, 2-14 years) underwent 26 endoscopic DCR operations for congenital NLDO. Sixteen cases were unilateral, and five were bilateral. In 13 cases (50.0%), there was a history of epiphora and chronic dacryocystitis with or without a mucocele. Two cases (7.7%) presented with acute dacryocystitis, and 11 (42.3%) had only a history of epiphora. Previous procedures included probing and irrigation in 25 cases (96.2%) and insertion of Crawford tubes in 19 cases 973.1%). During a mean postoperative follow-up period of 18+/-8 months, the anatomical success rate (free flow of fluorescein sodium and patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 92.3%. CONCLUSION: Endoscopic endonasal DCR is an effective treatment modality for congenital NLDO that compares favourably with the reported success rates of external DCR.

Adolescent↗
PubMed2006

Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea.

Floppy eyelid syndrome (FES) is a recently recognized entity, originally described in obese men with easily everted upper eyelids and chronic ocular irritation. Although the eyelids are primarily involved, other ocular structures such as the conjunctiva and cornea are frequently affected and cause much of the morbidity. Recent studies have found an interesting association with obstructive sleep apnea (OSA) and with chronic diseases such as hypertension and diabetes. The association of FES with OSA has both diagnostic and therapeutic implications; FES may be a presenting symptom in patients with undiagnosed OSA, and, in addition, treatment of obesity and OSA may have a favorable effect on the course of FES.

Blepharoptosis↗
PubMed2006

Recurrent staphylococcal conjunctivitis associated with facial impetigo contagiosa.

PURPOSE: To report the uncommon occurrence of impetigo contagiosa in the setting of recurrent staphylococcal conjunctivitis. DESIGN: Interventional case report. METHODS: A 32-year-old patient had a recurrent painful red left eye and facial rash. Clinical examination revealed left bacterial conjunctivitis and facial bullous impetigo. Microbiology cultures were taken from the nose, conjunctiva, and facial lesions. RESULTS: Microbiologic cultures grew Staphylococcus aureus, and hematology findings demonstrated an elevated white cell count with neutrophilia. Complete resolution was achieved with topical chloramphenicol ointment and oral dicloxacillin. CONCLUSIONS: Although uncommon, bullous impetigo may be associated with recurrent staphylococcal conjunctivitis in adults. Recurrent infections may require nasal decolonization, systemic antibiotics, and antiseptic body wash.

Administration, Oral↗
PubMed2006

Recurrent multiple cavernous hemangiomas of the orbit in association with systemic tumors.

PURPOSE: To report the clinical findings and management of multiple, recurrent cavernous hemangiomas of the orbit in a patient with concurrent liver involvement. DESIGN: Interventional case report. METHODS: An analysis of clinical findings, radiology and treatment was conducted with a literature review. RESULTS: A 35-year-old woman with blurry vision and proptosis was found to have multiple cavernous hemangiomas of the orbit. The tumors were excised completely without complication, and the patient subsequently regained her vision. Fifteen years later, the patient had recurrent, multiple cavernous hemangiomas in the same orbit. Further investigations for vague back pain revealed a presumed cavernous hemangioma in the liver and a presumed schwannoma arising from the neural foramen of the spine at the level of T2 through T4. CONCLUSION: Multiple cavernous hemangiomas may recur after complete excision and may exist with concurrent systemic tumors.

Adult↗
PubMed2006

Ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position.

OBJECTIVES: To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. DESIGN: Interventional case report. METHODS: An 80-year-old man underwent a prolonged lumbar decompression laminectomy for spinal stenosis, under general anesthesia in the prone position. Several hours later, the patient complained of left periocular pain and reduced vision. Examination revealed significant facial edema, left proptosis, and a tight orbit, as well as no light perception and elevated intraocular pressure in the left eye, with complete internal and external ophthalmoplegia. MAIN OUTCOME MEASURES: Clinical course, imaging findings, management, and final outcome. RESULTS: Magnetic resonance imaging confirmed the clinical diagnosis of a compartment syndrome with elevated intraorbital tension. A lateral canthotomy and cantholysis were performed, and high-dose IV steroids were started. The proptosis and facial swelling subsided gradually, but no improvement was noted in left visual acuity or left ocular movements. CONCLUSION: It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively and to intervene surgically and medically once the diagnosis of orbital compartment syndrome is established.

Acetazolamide↗
PubMed2006

Hard palate and free tarsal grafts as posterior lamella substitutes in upper lid surgery.

OBJECTIVES: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material. DESIGN: Retrospective, comparative, interventional case series. PATIENTS: Thirty-one consecutive patients who were operated in 2 oculoplastics centers between July 2000 and January 2005. METHODS: All patients' clinical records were reviewed. MAIN OUTCOME MEASURES: Postoperative upper eyelid contour and viability, ocular discomfort, keratopathy, and corneal edema, as well as assessment for donor site complications and final graft dimensions. RESULTS: There were 31 patients who underwent upper lid surgery (15 HPGs, 16 FTGs). The complications in the HPG group included corneal edema or transient keratopathy (13.3%), partial graft dehiscence (13.3%), upper lid retraction (13.3%), and necrosis of the overlying skin flap (6.7%). There were no significant postoperative complications in the FTG group during a mean follow-up period of 13.5+/-5 months. Donor site complications included 2 cases of mild upper lid retraction and central peaking. There were an average of 17% decrease in FTG vertical height and a 24% decrease in HPG vertical height during the follow-up period. CONCLUSION: Hard palate grafts may be associated with a higher rate of complications in upper lid surgery relative to FTGs, although most complications are temporary. Graft contraction could be reduced by oversizing.

Adult↗
PubMed2006

Lessons learned from difficult or unsuccessful cannulations of the superior ophthalmic vein in the treatment of cavernous sinus dural fistulas.

OBJECTIVE: Retrograde cannulation of the superior ophthalmic vein (SOV) is an important route for embolization of cavernous sinus dural fistulas (CDF). We present our experience with technically difficult cases in which it was not possible to isolate or cannulate this vein. DESIGN: Retrospective, noncomparative, interventional case series. PATIENTS: All patients diagnosed with dural CDF at the University of California Los Angeles Medical Center between January, 1993, and July, 2005, and who were treated with embolization via the SOV. METHODS: The clinical records of all patients were reviewed. MAIN OUTCOME MEASURES: Patient demographics, clinical presentation, and surgical findings. RESULTS: Of 91 patients diagnosed with CDF during the study period, 25 patients (16 females, 9 males; mean age, 59 years) were treated with embolization via the SOV. In 6 of them (24%; 4 women and 2 men; mean age, 67 years), there were significant difficulties in cannulation of the SOV or in successful closure of the fistula with this approach. Three patients had a fragile or a very small vein that could not be cannulated, and 1 of the 3 also had a large, posteriorly located varix that bled extensively on attempted cannulation. In 2 other patients, the anterior segment of the SOV was clotted and the catheter could not be threaded. In 1 patient, an inferior location of the supraorbital vein resulted in difficulties in correct identification of the SOV. CONCLUSIONS: Although the SOV is a useful route for CDF embolization, the presence of fragile or clotted veins can preclude successful cannulation. Deeper orbital dissections carry a higher risk of uncontrolled bleeding and should be avoided, especially in older patients with fragile veins and those with recently diagnosed high-flow fistulas.

Aged↗
PubMed2006

Wegener's granulomatosis: ophthalmic manifestations and management.

OBJECTIVES: To provide an up-to-date and comprehensive review of Wegener's granulomatosis (WG) as a disease entity, focusing on the ophthalmic manifestations and management options. METHODS: A search of Medline was undertaken between 1966 and 2005 regarding WG, systemic vasculitis, and the ocular manifestations of WG. Major ophthalmic and medical textbooks also were reviewed for content, as well as original references. RESULTS: Involvement of ocular and orbital structures in patients with WG is common and may be a presenting feature. The ocular manifestations range from mild conjunctivitis and episcleritis to more severe inflammation with keratitis, scleritis, uveitis, and retinal vasculitis. Involvement of the nasolacrimal system and orbital tissues also can occur. Except for some cases of anterior segment inflammation, the ocular involvement will not respond to topical agents, but rather to systemic antiinflammatory and immunosuppressive regimens. Surgical intervention may be of value for obtaining tissue diagnosis, in achieving orbital decompression in cases of significant orbital disease with optic nerve compromise, or in cases of nasolacrimal duct obstruction. CONCLUSION: WG is an important clinical entity that needs to be recognized early and treated appropriately. Ophthalmic manifestations are frequently encountered and can result in significant morbidity and even blindness. The management is challenging and often requires a multidisciplinary approach.

Diagnosis, Differential↗
PubMed2006

Novel technique to control hypersecretion from a transplanted autologous submandibular salivary gland for keratoconjunctivitis sicca.

PURPOSE: To present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca. METHODS: A 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips. RESULTS: Marked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period. CONCLUSION: Partial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.

Aged↗
PubMed2006

Intraepithelial sebaceous carcinoma of the eyelid misdiagnosed as Bowen's disease.

BACKGROUND: Sebaceous carcinoma (SC) is well known for its ability to masquerade clinically and histologically as a variety of periocular conditions resulting in a delayed diagnosis. We present a series of periocular SC cases and discuss the difficulties in histopathological diagnosis when this tumor presents with a Bowenoid pattern of intraepithelial spread. METHODS: A retrospective case study of all patients with SC of the eyelid treated in our Hospital, from 1997 to 2004, was conducted. RESULTS: Eight patients were identified (four females and four males). Seven cases involved the upper eyelid. Initial clinical diagnoses included blepharitis (three cases), blepharoconjunctivitis (one case), cicatrizing conjunctivitis (one case), and lid lesions (two cases). Histopathologically, 87.5% of cases were misdiagnosed as Bowen's disease (BD) on the initial biopsy. Six of these cases showed no invasive disease on the initial biopsy and were eventually found to be invasive SC on subsequent excisions. In one case, the tumor was wholly in situ. Delay in diagnosis ranged from 0 to 56 months. CONCLUSIONS: SC should always be considered in the histological differential diagnosis of any eyelid lesion which resembles BD, particularly if the upper eyelid is involved or if multivacuolated cytoplasmic clear cell changes are seen.

Adenocarcinoma, Sebaceous↗
PubMed2006

The Australian Mohs database: short-term recipient-site complications in full-thickness skin grafts.

BACKGROUND: There are only a few reports on the outcome with full-thickness skin grafts (FTSG) in defect reconstruction after Mohs micrographic surgery (MMS). OBJECTIVES: The objective was to evaluate the complications with FTSG in patients treated with MMS for cutaneous tumors. METHODS: This study is based on a prospective data collection of all patients in Australia treated with MMS and monitored by the Skin and Cancer Foundation, between 1993 and 2002. Primary outcome measures were FTSG recipient-site complications (partial/complete graft failure, graft infection, acute bleeding/hematoma, graft hypertrophy, and graft contracture). RESULTS: The study group included 2,673 patients (50.2% men) with a mean age of 64+/-14 years. Most tumors were basal call carcinoma (90.9%) and were located on the nose (63.8%), periocular area (14.8%), or auricular area (8.1%). A total of 11.7% of cases had recipient-site complications (graft hypertrophy, 42.3%; partial graft failure, 27.2%; graft contraction, 15.3%). Only 45.2% of complicated cases required treatment. CONCLUSION: Short-term recipient-site complications occurred in less than 12% of reconstructions with FTSG. Graft hypertrophy and partial graft failure accounted for most cases of complications. The authors have indicated no significant interest with commercial supporters.

Adolescent↗