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Biomedical subjects

J B Holds

Publications and source records attributed to J B Holds.

At least 19 recordsLinked to original sources
PubMed2001

Evisceration with scleral modification.

PURPOSE: To describe an evisceration technique that combines scleral modification with optic nerve release for coverage of any sized orbital implant. METHODS: The medical records of 70 patients who underwent the described evisceration procedure were reviewed. RESULTS: The average implant was 20 mm in diameter, with 50 patients (71%) receiving a solid polymethylmethacrylate sphere. Fifty-eight patients (83%) had a history of at least one previous ocular surgery, and 12 patients (17%) had phthisical eyes preoperatively with moderate to severe scleral cicatrization. Postoperatively, there were two cases of new or worsened ptosis, no cases of worsened motility, and no cases of implant extrusion. CONCLUSION: Evisceration with scleral modification is a simple and effective procedure that allows placement of any size orbital implant. Surgical results are excellent with few complications.

Adolescent↗
PubMed2001

Systemic corticosteroid use in orbital lymphangioma.

PURPOSE: To describe the clinical results of systemic corticosteroid use in a series of patients with orbital lymphangioma. METHODS: Four patients (two adults and two children) were treated with corticosteroids using intravenous, oral, or both routes for 2 days to a month. Corticosteroids were used with and without other therapies for symptomatic exacerbations. RESULTS: The adults showed more improvement with pain than with swelling, whereas the children had improvement with both the signs and symptoms. There were no complications in any patient. CONCLUSIONS: Systemic corticosteroids are a useful therapeutic option for patients with orbital lymphangioma and can be used as an adjuvant treatment to surgery and other modalities. Resolution of symptoms with corticosteroids was expedited compared with the natural history of the disease in the patients studied.

Administration, Oral↗
PubMed1999

Frontal periosteum as an exposed orbital implant cover.

PURPOSE: To describe the surgical technique of harvesting frontal bone periosteum, through an eyelid-crease incision, for coverage of orbital implants. METHODS: A retrospective review of the medical records of 15 patients who underwent the procedure. RESULTS: Eleven patients had surgery to cover exposed orbital implants, whereas in 4 patients the periosteal graft was used as an implant cover during enucleation. Periosteal grafts as large as 25 mm in diameter can be harvested. Recurrent exposure developed in 2 patients who had complicated histories of local trauma. One of these patients required a secondary dermis-fat graft, and the other experienced spontaneous granulation. The remaining 13 patients had excellent results without complications. CONCLUSION: Harvesting frontal bone periosteum, through an eyelid-crease incision, for orbital implant coverage is a relatively straightforward surgical technique. The procedure can be performed in the office under local anesthesia and yields excellent results. Recurrent exposure occurred only in 2 patients with histories of significant local trauma.

Adult↗
PubMed1999

Tarsal switch procedure for the surgical rehabilitation of the eyelid and socket deficiencies of the anophthalmic socket.

PURPOSE: To describe a tarsal transfer procedure, which we have named the "tarsal switch," to correct the eyelid malpositions and camouflage the socket defects of acquired anophthalmos. METHODS: The technique consists of an upper eyelid tarsectomy, with transfer of the autologous tarsoconjunctival graft to the posterior lamella of the lower eyelid. RESULTS: The operation was performed in 21 anophthalmic patients. In 16 patients with eyelid malpositions, excellent results (within 1 mm of the fellow eye) were attained in 100% of the patients with ptosis, and in 88% of patients with lower eyelid retraction. In the remaining 5 patients, orbital volume loss with secondary implant migration, inferior prosthetic displacement and eyelid asymmetry predominated. In these patients the anophthalmic orbital defects and eyelid asymmetry were masked well. Patient satisfaction was high and complications were few during an average follow-up interval of 16 months. CONCLUSION: The tarsal switch procedure is useful in managing the eyelid malpositions and masking the orbital deficiencies of the anophthalmic socket.

Adult↗
PubMed1998

The missing muscle syndrome in blowout fractures: an indication for urgent surgery.

The purpose to this study was to determine whether early surgical repair is indicated for a severely entrapped inferior rectus muscle following orbital blowout fracture. We report two patients with small blowout fractures, severe entrapment of the inferior rectus muscle, and an absence of the inferior rectus muscle in multiple contiguous coronal computed tomography cuts. At surgery, we released the severely entrapped inferior rectus muscles with resolution of diplopia. We concluded that patients with the "missing muscle syndrome" require urgent surgical intervention and that clinician review of radiologic studies is always prudent.

Adolescent↗
PubMed1998

Postimplantation density changes in coralline hydroxyapatite orbital implants.

The purpose of our study was to determine serial mineral density changes in coralline hydroxyapatite orbital implants after implantation into the human socket. Prospective analysis by quantitative computed tomography determined the mineral density of hydroxyapatite orbital implants in five patients before and at two time intervals after implantation. Mineral density of the spheres increased an average of 135% after implantation (3-8 months) from preoperative measurements. The density continued to rise an average of 5% (range, -9%-16%) at the second postoperative period (22-39 months). Average follow-up was 30 months. The increased density in the nonevisceration patients was noted in the regions of the scleral windows and the exposed posterior implant where the cornea had been removed from the scleral wrap. The mineral density of hydroxyapatite spheres markedly increases after implantation. Approximately 2 to 3 years later, the densities continue to increase slightly in enucleation and secondary implant cases. An evisceration implant was the only implant to lose density. This study shows no decrease in the mineral density of orbital coralline hydroxyapatite enucleation implants, suggesting a lack of implant mineral resorption.

Adult↗
PubMed1998

Blepharospasm: past, present, and future.

To investigate causes, associations, and results of treatment with blepharospasm, 1,653 patients were evaluated by extensive questionnaires to study blepharospasm and long-term results of treatment with the full myectomy operation, botulinum-A toxin, drug therapy, and help from the Benign Essential Blepharospasm Research Foundation (BEBRF). The percent of patients improved by the BEBRF was 90%, full myectomy 88%, botulinum-A toxin 86%, and drug therapy 43%. The patient acceptance rate for the BEBRF was 96%, full myectomy 82%, botulinum-A toxin 95%, and drug therapy 57%. Blepharospasm is multifactorial in origin and manifestation. A vicious cycle and defective circuit theory to explain in origin and direct treatment rather than a defective specific locus is presented. All four forms of therapy evaluated are useful and must be tailored to the patient's needs. Mattie Lou Koster and the BEBRF have helped blepharospasm sufferers more than any other modality, and all patients should be informed of this support group. The full myectomy is reserved for botulinum-A toxin failures, and the limited myectomy is an excellent adjunct to botulinum-A toxin.

Blepharospasm↗
PubMed1997

Ocular neuromyotonia in Graves dysthyroid orbitopathy.

OBJECTIVES: To describe 2 patients with ocular neuromyotonia in association with Graves orbitopathy and to consider the possible underlying mechanisms. DESIGN: Description of the clinical findings in 2 patients with these conditions. SETTING: Neuro-ophthalmology referral centers. PATIENTS: Two patients, aged 55 and 52 years, had episodic, involuntary periods of vertical diplopia and dysthyroid orbitopathy. INTERVENTION: Treatment with carbamazepine in one patient and external beam radiation therapy in the second patient. MAIN OUTCOME MEASURES: Frequency and duration of episodic spasms of the extraocular muscles. RESULTS: Although radiation therapy is the most common association with ocular neuromyotonia, it cannot explain the involuntary contractions of extraocular muscles in all affected patients. Other mechanisms must be involved, such as those discussed in this article. CONCLUSION: Ocular neuromyotonia is described in 2 patients with dysthyroid orbitopathy, confirming previous findings. Possible mechanisms are given.

Analgesics, Non-Narcotic↗
PubMed1997

Complications of the transconjunctival approach. A review of 400 cases.

OBJECTIVE: To review the intraoperative and postoperative complications of the transconjunctival approach, as well as their prevention, management, and outcomes. DESIGN: A retrospective study of the complications in 400 patients who underwent the transconjunctival approach to the lower eyelid or orbit for treatment of orbital trauma or the aging face. SETTING: Academic tertiary referral medical center. RESULTS: There were 8 cases of conjunctival granuloma, 2 cases of entropion, and 1 case each of hematoma, ectropion, prolonged chemosis, conjunctival inclusion cyst, lower eyelid laceration, and avulsion with lacrimal system injury. CONCLUSIONS: Complications of the transconjunctival approach are uncommon. When they do occur, proper management results in a successful outcome.

Adult↗
PubMed1997

Osteogenin-enhanced bone-specific differentiation in hydroxyapatite orbital implants.

Hydroxyapatite orbital implants undergo early ingrowth of fibrovascular tissue after enucleation. This animal study determined whether control and osteogenin-impregnated hydroxyapatite orbital implants vary in their osteogenic response at 6 and 52 weeks. Rabbits underwent enucleation with implantation of control or osteogenin-impregnated hydroxyapatite spheres. Light microscopy determined fibrovascular ingrowth, and histomorphometry quantitated the amount of bone produced. Osteogenin implants vascularized at a faster rate and contained bony foci by 6 weeks that became confluent at 1 year. Spontaneous osteogenesis was not seen in control animals at 6 weeks. After 1 year they contained bone, although less than in the osteogenin implants. Mixed cell inflammation was observed at the hydroxyapatite-tissue interface in both groups. No inflammation was noted at the interface of hydroxyapatite and bone. These are the first controlled observations that bone-specific differentiation occurs in the pores of spherical hydroxyapatite implants within the soft tissues of the socket. This vascularized process can be enhanced with osteogenin to occur earlier and more uniformly in the implants at one year.

Animals↗
PubMed1997

Difficulties with hydroxyapatite orbital implants in two patients with dysfunctional levator/superior rectus muscle complex.

Hydroxyapatite orbital implants are recognized for their excellent results in anophthalmos. Few complications are reported in the literature. We implanted hydroxyapatite spheres in two patients with acquired anophthalmos and denervated or nonfunctional levator palpebrae superioris and superior rectus muscles. In both patients, the implant rotated anteriorly, obliterating the superior fornix and causing proptosis. Prosthetic fitting was impeded, necessitating surgical revision in both patients. A hydroxyapatite implant may rotate and migrate anteriorly in the presence of a nonfunctional superior rectus muscle, distorting the conjunctival fornices and causing proptosis. This complication calls into question whether muscle-attached orbital implants should be used in patients with significant rectus muscle weakness.

Adolescent↗
PubMed1997

Combined transconjunctival/intranasal endoscopic approach to the optic canal in traumatic optic neuropathy.

Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.

Adolescent↗
PubMed1997

Basal cell carcinoma involving the lacrimal canaliculus. A documented mechanism of tumor spread.

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignant tumor of the eyelid and periocular tissues but rarely involves the lacrimal system. In addition, BCC in this location frequently recur due to inadequate margin control. A further understanding of the pathophysiology of periocular BCC was addressed. OBJECTIVE: To report two rare cases of BCC involving the lacrimal system and to account for subtle clinical features yet extensive tissue spread of periocular BCC. METHODS: Using the Mohs micrographic surgical technique, we describe two patients with a BCC involving the lacrimal system that histologically tracked beyond clinically apparent margins. RESULTS: Spread of BCC along mucosal surfaces is documented. CONCLUSION: Rare involvement of the lacrimal system by a BCC is reported in two patients. Superficial histologic involvement can explain the ability of BCC to extend locally and escape adequate treatment.

Adult↗
PubMed1996

Periocular autografts in socket reconstruction.

BACKGROUND: Current enucleation and socket reconstruction techniques often require reinforcement of an orbital implant or wound by the use of a tissue graft. Commonly, allograft tissue (cadaveric sclera, fascia, etc.) is used. Disadvantages of allografts include possible inflammatory reaction, unpredictable vascularization rate, variable resorption, antigenicity, and cost. Another alternative to implant reinforcement is autogenous tissue which usually is harvested from a remote site (fascia lata, split dermis, temporalis fascia, pericranium, etc.). An overlooked source of readily available autogenous grafts is the connective tissue in the periorbital region and the enucleated eye itself. These sources include autogenous lamellar sclera, the corneoscleral button, capsular tissue from a migrated implant, and orbital rim periosteum. METHODS: The authors used periocular autografts in primary and secondary socket reconstructions in 24 patients, with excellent success over a 2-year period. Seven autogenous corneoscleral buttons and two autogenous scleral grafts were used to cover biointegrated implant spheres. Ten implant capsules from migrated nonintegrated spheres were used to cover and reinforce secondary implants. In five patients, an autogenous periosteal graft was taken from the supraorbital rim and used to cover an exposed implant. RESULTS: Complications included one pyogenic granuloma, one conjunctival inclusion cyst, and one recurrent exposure after a periosteal graft, which necessitated explanation and a dermis fat graft. Postoperative motility was judged to be good to excellent in 21 patients. CONCLUSIONS: These techniques are presented as a new alternative to using human bank tissue or remote incision autografts for reconstruction of the anophthalmic socket.

Adolescent↗
PubMed1996

Visual outcome in bilateral nonarteritic anterior ischemic optic neuropathy.

BACKGROUND: Nonarteritic anterior ischemic optic neuropathy (NAION) is a common cause of visual loss in the older population. Bilateral NAION is a well-documented entity; however, no study to date has compared the visual outcome between affected eyes. METHODS: The authors retrospectively reviewed the charts of 99 patients with diagnoses of NAION over 3 1/2 years. In the 23 patients with bilateral involvement, 16 were included in the study for analysis of final visual outcome between affected eyes. Snellen acuity, Ishihara color plates, and Humphrey automated perimetry were evaluated as the parameters of visual function. Descriptive analysis of the outcome between affected eyes for each parameter is presented as a frequency distribution of pre-defined groups. Statistical significance is established using nonparametric tests. RESULTS: Bilateral NAION was found in 23% (23/99) of the patients studied. The authors identified a high percent agreement between eyes with regard to visual acuity (81% within 3 Snellen lines), color vision (69% within 3 plates), and Humphrey visual field (75% within 5 decibels of mean deviation). Additionally, there was a statistically significant correlation between affected eyes for all three visual parameters: visual acuity (P = 0.043), color vision (P = 0.001), and Humphrey visual field (P = 0.039). CONCLUSION: The authors found a high percent agreement and statistically significant correlation in final outcome between affected eyes of patients with bilateral NAION for visual acuity, color vision, and visual field loss. With a larger series, it may be possible to predict the visual outcome of the second affected eye based on the parameters of the first eye.

Adult↗
PubMed1996

Benign orbital fibrous histiocytoma simulating a lacrimal gland tumor.

The case of a patient with a lacrimal fossa mass that was believed to be a primary lacrimal gland tumor is reported. However, at lateral orbitotomy the tumor was found within the lacrimal fossa, but distinct from the lacrimal gland. Histopathology revealed a benign fibrous histiocytoma. The tumor was totally excised, has not recurred over a 3-year follow-up period. This mesenchymal tumor should be included in the differential diagnosis of lacrimal fossa mass in adults.

Adult↗