Clinicopathologic reports, case reports, and small case series: 0.01% becaplermin gel for the treatment of a chronic orbital ulcer after exenteration.
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Anticoagulants↗
Biomedical subjects
J W Karesh
Publications and source records attributed to J W Karesh.
Primary implant placement with evisceration in patients with endophthalmitis.
OBJECTIVE: To evaluate the efficacy of primary orbital implant placement with evisceration in patients with endophthalmitis and blind eyes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Eleven patients with endophthalmitis and blind eyes underwent evisceration by two surgeons between 1994 and 1998. INTERVENTION: Evisceration and primary orbital implant placement. MAIN OUTCOME MEASURES: All patients were evaluated for implant exposure and successful fitting of their prostheses. RESULTS: Ten of 11 patients had uneventful postoperative courses and successful prosthetic fitting. One patient with Pseudomonas aeruginosa endophthalmitis had an implant exposure successfully treated with a fascia lata patch. CONCLUSIONS: Primary orbital implant placement with evisceration in patients with endophthalmitis is an acceptable treatment, eliminating the need for open evisceration and subsequent delayed orbital implant placement.
Aged↗
Giant cell angiofibroma of the orbit and eyelid.
PURPOSE: To report the clinicopathologic features of a newly recognized tumor, giant cell angiofibroma. DESIGN: Observational case series. MAIN OUTCOME MEASURES: Clinical and histopathologic features of giant cell angiofibroma. METHODS: Light and electron microscopy and immunohistochemistry of five cases of giant cell angiofibroma. RESULTS: A total of five patients (4 women and 1 man) are described: two presented with a painless mass in the eyelid, two with a mass in the orbit, and one presented with a conjunctival lesion. All lesions were well demarcated with no capsule and were composed of blood vessels, a patternless spindle-shaped cell proliferation with a solid and pseudovascular appearance, and multinucleated giant cells. Both spindle-shaped and giant tumor cells were intensely positive for CD34 and vimentin. CONCLUSION: Giant cell angiofibroma resembles solitary fibrous tumor and giant cell fibroblastoma and should be considered in the differential diagnosis of spindle-cell tumors in the eyelid, orbit, and conjunctiva.
Aged↗
T-cell and T/natural killer-cell lymphomas involving ocular and ocular adnexal tissues: a clinicopathologic, immunohistochemical, and molecular study of seven cases.
OBJECTIVE: Lymphomas of the eye and its adnexa are frequently of B lineage. This study aims to characterize the clinical and histopathologic features of the rare non-B-cell non-Hodgkin lymphomas (NHL) of these locations. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Seven cases of T- and T/NK-cell lymphomas involving the ocular and ocular adnexal tissues. METHODS: A morphologic, immunohistochemical, and molecular analysis (polymerase chain reaction) of each of the tumors was undertaken. The lesions were classified according to the Revised European-American Lymphoma (REAL) classification. The clinical and follow-up data were collected. RESULTS: The patients included four women and three men ranging in age from 32 to 88 years (mean, 63 years). The presenting ophthalmic symptoms varied from a small nodule on the upper eyelid and conjunctival swellings to dramatic loss of vision associated with gross protrusion of the globe. Five of the cases presented were secondary manifestations of a systemic lymphoma in ocular tissues; two cases represented primary disease. Three cases were "peripheral T-cell lymphomas (PTCL), unspecified" with positivity for CD3, CD8, and betaF1 and negativity for CD56. Two cases were CD3+, CD30+, and CD56- and were classified as "anaplastic large-cell lymphomas of T-cell type" (T-ALCL). The remaining two cases showed an immunophenotype of CD3+, CD56+, and betaF1- and proved to contain Epstein-Barr virus (EBV) by in situ hybridization, consistent with "T/natural killer (NK)-cell lymphoma of nasal type." Clonal T-cell populations were shown in all three of the PTCLs by Southern blot (n = 1) and polymerase chain reaction (n = 2) for the T-cell receptor gamma and beta genes in one case of ALCL but not in the T/NK-cell lymphomas. Five patients died within 2 years; only two patients (one primary PTCL and one cutaneous T-ALCL) were disease free at 4 and 5 years' follow-up, respectively. CONCLUSION: This study shows that a heterogeneous group of T-cell lymphomas can involve the eye and its adnexal tissue. Most T-cell neoplasms are secondary manifestations of systemic disease and carry a poor prognosis. These findings, in conjunction with published data on ocular B-NHL, also indicate that immunophenotypic differentiation between T- and B-NHL in these locations is of clinical importance.
Adult↗
Lacrimal sac diverticula associated with a patent lacrimal system.
PURPOSE: To describe the clinical features of lacrimal sac diverticula. METHODS: Orbital masses were evaluated in 3 patients. One patient had a large tumor extending from the medial orbit associated with upward globe displacement, one had a mass inferior to the medial canthus, and one had an inflamed mass in the right lower lid. Two of the patients had no history of chronic epiphora, sinus disease, or nasal trauma. In all patients, irrigation demonstrated lacrimal drainage system patency. RESULTS: Surgical exploration confirmed the diagnosis of lacrimal sac diverticulum in all patients. Two diverticula were associated with a dacryolith. Each patient was successfully managed with excision of the diverticulum and dacryocystorhinostomy. CONCLUSIONS: Lacrimal sac diverticula should be considered in the diagnosis of medial orbital tumors, and computed tomography is useful in the diagnosis of lacrimal sac diverticula.
Adult↗
Osteosarcoma of the orbit associated with Paget disease.
Osteosarcoma is a common primary bone malignancy most often involving the long bones and occurring in the second decade of life. Orbital involvement in this disease process is rare and is usually due to extension of the tumor from an adjacent sinus cavity. Orbital osteosarcoma arising from preexisting Paget disease is exceedingly rare. We report the case of a 78-year-old female patient with Paget disease of the forehead who presented with rapidly increasing bilateral proptosis and visual loss for several months. Examination showed bilateral aphakia, decreased motility, proptosis with resistance to retropulsion, and tumorous infiltration of the eyelids and periorbital soft tissue. Fundus examination showed marked bilateral scleral indentation without overlying serous retinal detachment. A computed tomographic (CT) evaluation of the orbits demonstrated extensive soft tissue involvement of the paranasal sinuses, nasal cavity, periorbital soft tissue, and orbits, with compression of the optic nerve and globe bilaterally. Biopsy of the periorbital soft tissue demonstrated osteosarcoma. Radiation therapy failed to stem the progression of the disease process, and the patient died approximately 4 months later. Although osteosarcoma of the orbit associated with Paget disease is unusual, it should be considered in the differential diagnosis of older patients with a rapidly progressive orbital mass.
Aged↗
Streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy.
Necrotizing fasciitis is a rare infection of the deep and subcutaneous tissue layers most commonly caused by group A beta-hemolytic Streptococcus. The disease begins as a typical cellulitis. Necrosis of the deeper tissues progresses rapidly, accompanied by a dusky, gray-blue skin discoloration with erythematous margins. Even with appropriate treatment, mortality rates remain as high as 36%. Most cases of necrotizing fasciitis have been reported in the general surgical literature, associated with trauma or as a postoperative wound infection after abdominal and gynecologic procedures. Of the 50 cases involving the eyelids reported in the literature, only three were reported to have occurred as a "postoperative" complication. This report is of the first known case of streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy.
Aged↗
Masters of ophthalmic plastic and reconstructive surgery: Rocko Michael Fasanella, a reminiscence. The Archives Committee of the American Society of Ophthalmic Plastic and Reconstructive Surgery.
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History, 20th Century↗
Biomaterials in ophthalmic plastic and reconstructive surgery.
Over the past several years, new biomaterials have been developed or modified for use in ophthalmic plastic and reconstructive surgery. Hydroxyapatite and high-density porous polyethylene are extensively utilized in enucleation and evisceration surgery as well as in orbit reconstruction. Absorbable plates and screws as well as cyanoacrylate glue are at the forefront of fracture repair. Silicone and polytetrafluoroethylene eyelid implants are important adjuncts for adult and congenital ptosis repair. As technology advances, new materials will be developed and new applications identified. An understanding of biomaterials and their use is essential for every oculoplastic surgeon.
Animals↗
Blepharoplasty: an overview.
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Blepharoplasty↗
Household objects as a cause of self-inflicted orbital apex syndrome.
This report describes two cases of self-inflicted penetrating nonprojectile orbitointracranial injury. Suicide attempts caused by these types of injuries are very rare. An understanding of the orbital and intracranial anatomy and the avoidance head turn help to predict potential injury sites. Computed tomography and cerebral angiography were helpful in the treatment of these two cases.
Adult↗
Correction of late enophthalmos with polyethylene implant.
High density porous polyethylene (HDPP) has been used extensively for craniofacial reconstructive procedures. The authors recently reviewed the records of 21 patients who had undergone correction of late (more than 6 months) posttraumatic enophthalmos utilizing HDPP implants to restore orbital integrity and volume. Follow-up after implant placement was 6 months to 54 months (mean 20 months). Twenty of 21 patients demonstrated a clinically significant reduction in enophthalmos to within 2 mm of the opposite globe, as demonstrated by Hertel and/or Naugle exophthalmometry and by clinical observation. There were no cases of worsened visual acuity, lid position or ocular mobility, and no HDPP implant became infected or was extruded. The authors' experience supports the safety and efficacy of HDPP implants for correction of mild to moderate posttraumatic enophthalmos.
Adolescent↗
Diagnosis and management of acquired blepharoptosis and dermatochalasis.
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Aged↗
High-density porous polyethylene (Medpor) as a successful anophthalmic socket implant.
BACKGROUND: High-density porous polyethylene (Medpor) has been used successfully as an implant in orbital fracture repair and in the management of both cosmetic and post-traumatic facial deformities. The material is well tolerated, resists infection, is nonantigenic, and promotes tissue ingrowth. Additionally, sutures can be passed through it. These characteristics led to its use as an implant in anophthalmic socket surgery. METHODS: Twenty-one patients with anophthalmia underwent implantation of spherically shaped high-density porous polyethylene implants. The implant was used in six primary enucleations with direct extraocular muscle attachment, ten secondary implant insertions, one repeat secondary implant insertion, and five eviscerations. RESULTS: Postoperative follow-up averaged 19 months. During this period, there were no extrusions, infections, significant inflammatory responses, or implant exposures. One implant was removed 4 months after insertion due to inadequate initial placement secondary to a severe post-traumatic orbital deformity. Successful re-implantation was performed without complication. Postoperatively, all sockets showed good to excellent motility. Results of histologic examination of the removed implant demonstrated minimal inflammatory response and extensive fibrovascular ingrowth involving 60% of the implant substance. CONCLUSIONS: This initial report indicates that high-density porous polyethylene can be used successfully as an implant in anophthalmic socket surgery. Its advantages over other similar implants include a significantly lower material cost and the ability to suture the extraocular muscles directly to it without the need for a covering material such as fascia or sclera. Experimental studies are in progress to determine if this implant can be integrated with an ocular prosthesis to promote improved motility and cosmesis.
Adolescent↗
Transconjunctival entropion repair.
Involutional lower-eyelid entropion has three underlying correctable causes: eyelid laxity, overriding of the orbicularis oculi muscle, and attenuation of the lower-eyelid retractors. We describe a new technique for correcting this problem. A transconjunctival approach is used to advance or fortify the lower-eyelid retractors. The orbicularis oculi muscle can also be addressed through this approach. Combining this technique with lateral canthal resuspension anatomically corrects the entropion by addressing all three correctable causes. Transconjunctival blepharoplasty can also be performed in conjunction with this technique. Twenty-three eyelids of 18 patients successfully underwent this procedure. Six patients underwent simultaneous transconjunctival blepharoplasty. Follow-up ranged between 9 and 18 months. There were no postoperative recurrences, overcorrections, or lower-eyelid retraction. This approach yields a stable and definitive repair of involutional entropion with excellent postoperative cosmesis.
Aged↗
Dacryocystitis associated with malignant lymphoma of the lacrimal sac.
BACKGROUND: Tumors of the lacrimal sac are unusual, and lymphomas of the lacrimal sac are quite rare. Four patients with a history of well-differentiated, small cell lymphoma or chronic lymphocytic leukemia presented with either acute or chronic dacryocystitis and epiphora due to lymphomatous infiltration of the lacrimal sac. METHODS: All four patients underwent dacryocystorhinostomy with lacrimal sac biopsy. All tissues underwent complete histopathologic evaluation including immunohistochemical studies for cell surface markers and, in addition, were compared with previous biopsies performed for the initial diagnosis of lymphoma. FINDINGS: All biopsies demonstrated small cell well-differentiated lymphoma on histologic and immunofluorescent examination. No patient demonstrated orbital involvement on computed tomography. One patient had previously diagnosed chronic lymphocytic leukemia and one patient demonstrated diffuse lymph node involvement on postoperative systemic evaluation. All four patients underwent additional chemotherapy. No recurrence of dacryocystitis or epiphora occurred. CONCLUSION: Four patients presented with dacryocystitis secondary to lacrimal sac lymphoma. Lymphomatous lacrimal sac infiltration is an unusual cause of dacryocystitis. Biopsy of the lacrimal sac plays a diagnostically important role in dacryocystorhinostomy even in the absence of obvious tumorous involvement of the lacrimal sac mucosa.
Acute Disease↗
Eyelid imbrication. An unrecognized cause of chronic ocular irritation.
BACKGROUND: Eighteen patients with chronic ocular irritation were examined over a 3-year period. All patients demonstrated papillary conjunctivitis and, occasionally, tarsal ulcers. Six also had floppy eyelid syndrome. Underlying every patient's symptoms was the overriding or imbrication of a lax upper eyelid on an often equally lax lower eyelid, allowing lower eyelid lashes to chronically rub the upper eyelid tarsal conjunctiva. METHODS: Chronic ocular irritation in five patients was managed with ocular lubricants. Two of these patients had floppy eyelid syndrome and required nightime shielding for nocturnal eyelid eversion. Thirteen patients underwent eyelid surgery to correct the overriding upper eyelid. Surgical procedures included full-thickness upper eyelid wedge resection, lateral canthal tendon plication, and lower eyelid horizontal shortening, using a tarsal strip procedure. RESULTS: Follow-up averaged 2.5 years. Symptomatology was adequately controlled in all patients. In addition to the five patients who received medical treatment for their symptoms, two with complicated ocular problems required continued ocular lubrication after surgery. Seven patients were successfully treated with eyelid shortening procedures and lateral canthal tendon plication. The remaining six patients underwent a variety of additional eyelid surgeries. All patients undergoing surgery had complete resolution of eyelid imbrication. CONCLUSIONS: Eyelid imbrication is a previously unrecognized cause of chronic ocular irritation. In this condition, eyelid laxity causes the upper eyelid to override the lower eyelid, allowing the lower eyelid to chronically rub and chafe the upper eyelid tarsal conjunctiva. In some cases, symptoms can be managed medically. More often, surgical intervention is required to correct eyelid laxity and prevent overriding of the upper eyelid.
Aged↗
Orbital cellulitis caused by Eikenella corrodens.
Eikenella corrodens is a gram-negative, facultative anaerobic bacillus with specific culture and growth requirements and unusual antibacterial susceptibilities. It has only recently been recognized as a human pathogen. Ocular and adnexal infections with this organism are rare especially in children. We treated two children with orbital cellulitis caused by E. corrodens. One was an 8-year-old boy; the other was an 11-year-old girl. Orbital cellulitis in both patients occurred after an upper respiratory tract infection. Sinusitis and a subperiosteal abscess were present in both patients. Eikenella corrodens and Streptococcus viridans were isolated from the boy; E. corrodens was the sole isolate in the girl. Intravenous ampicillin, prolonged hospitalization, and surgical drainage of the orbit were required to control the infection in both patients. Eikenella corrodens must be considered in the differential diagnosis of orbital cellulitis in children, and ophthalmologists must become familiar with the characteristics of this peculiar organism.
Ampicillin↗