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Biomedical subjects

J W Shore

Publications and source records attributed to J W Shore.

At least 19 recordsLinked to original sources
PubMed1995

Choroidal and retinal detachment in antineutrophil cytoplasmic antibody-positive scleritis.

PURPOSE/METHODS: A 72-year-old woman with antineutrophil cytoplasmic antibody-positive vasculitis had a combined detachment of the choroid and retina. This unique initial manifestation was also associated with systemic and orbital manifestations, including brow ptosis, dacryoadenitis, and pneumonitis. RESULTS/CONCLUSIONS: This patient underwent vitrectomy for removal of a dense vitreitis and responded well to systemic cyclophosphamide. This case demonstrates that antineutrophil cytoplasmic antibody testing is useful for the diagnosis and treatment of Wegener's granulomatosis and microscopic polyarteritis-associated scleritis. The distinction between these two entities is often difficult to make.

Aged↗
PubMed1995

Simplified method of sizing implants for orbital fracture repair.

PURPOSE/METHODS: Over the past six years, we have used ordinary radiographic film as a template for sizing alloplastic implants for orbital fracture repair in over 60 patients. The implants are made of such materials as titanium, Vitallium, and porous high-density polyethylene. Autoclaved 9.5 x 4.5-cm rectangles of radiographic film are easily trimmed, held by nontoothed forceps, inserted, and removed from the orbital cavity. RESULTS/CONCLUSIONS: We have found this simple and inexpensive technique to be superior to using aluminum templates that are supplied in commercially available plating sets.

Humans↗
PubMed1995

Complications of porous spherical orbital implants.

PURPOSE: To determine the complications observed with using porous spherical orbital implants (hydroxyapatite and porous polyethylene) and the factors leading to their occurrence. METHODS: A total of 101 cases of porous spherical orbital implantation by five ophthalmic surgeons were reviewed retrospectively. The demographic data, diagnosis, prior surgery, type and technique of surgery, implant characteristics and prosthesis fitting were described in patients with complications. RESULTS: Eleven of the 101 patients had implant exposure. There were six male (1 with bilateral involvement) and four female patients, ranging in age from 2 to 71 years. Preoperative diagnosis included trauma in five patients, nontrauma in five, and tumor in one. Seven had prior eye surgeries. Three patients underwent evisceration, whereas eight underwent enucleation. Eight hydroxyapatite and three porous polyethylene implants were used with diameters of 16 to 20 mm. Three were unwrapped, six were wrapped in sclera, and two were wrapped in preserved fascia. Exposures, which generally occurred within 1 year, were grouped into small (1-5 mm), medium (6-10 mm), and large (> 10 mm). One delayed case occurred after drilling. Small stable exposures were managed conservatively. Larger exposures were managed either by implant revision or replacement. All patients were fit ultimately with a prosthesis. Histopathologic findings of explanted spheres showed fibrovascularization limited to the periphery with moderate inflammatory reaction. CONCLUSION: Complications were significantly higher in cases of eviscerations than enucleations. Complications occurred in implants either unwrapped or wrapped in homologous grafts. None of the autologous wrapping had exposure. Secondary procedures may initiate exposure when fibrovascular status of implant is inadequate.

Adolescent↗
PubMed1995

Results of Müllerotomy and levator aponeurosis transposition for the correction of upper eyelid retraction in Graves disease.

BACKGROUND: Upper eyelid retraction in Graves disease may cause functional morbidity and aesthetic deformity. Surgery to correct thyroid-related upper eyelid retraction may result in temporal undercorrection with failure to eliminate lateral eyelid retraction, leading in turn to a poor eyelid contour postoperatively. METHODS: In 1984, one of the authors developed a new procedure for correcting moderate to severe upper eyelid retraction associated with Graves disease. The surgical technique consists of a Müllerotomy and recession of the levator aponeurosis combined with medial transposition of the lateral horn of the levator aponeurosis. The procedure was performed on 37 patients (72 eyelids). Müller's muscle was used as the spacer to set the eyelid height. Transposition of the levator aponeurosis allowed adjustment of eyelid contour. RESULTS: Thirty patients (58 eyelids) had excellent results, six (13 eyelids) had good results, and one (1 eyelid) had a poor result. No patient required re-operation for asymmetry, unacceptable contour, or malposition. Only one eyelid had significant overcorrection, and only one eyelid had significant undercorrection, requiring further surgery. The most frequent unwanted effects were high eyelid crease (24 eyelids) and residual temporal flare (6 eyelids); however, most of these were seen early in the series before the lateral levator transposition modification was added. CONCLUSION: This procedure allows successful and simultaneous correction of both eyelid position and contour in patients with moderate to severe thyroid-related upper eyelid retraction.

Adult↗
PubMed1995

Endoscopic orbital decompression under local anesthesia.

Orbital decompression for Graves' disease has traditionally been performed with the patient under general anesthesia. Endoscopic instrumentation allows for removal of the medial orbital wall and floor through an intranasal approach with local anesthetic techniques. Twelve endoscopic orbital decompressions were performed on awake patients with uncovered eyes so that vision could be monitored throughout the procedure. Simultaneous lateral decompressions were performed in 11 cases. No intraoperative or postoperative complications occurred. Visual acuity remained stable or improved in all cases. Proptosis was reduced an average of 5.5 +/- 1.6 mm. In a comparable series of 29 endoscopic decompressions performed with patients under general anesthesia, proptosis was reduced an average of 4.8 +/- 2.0 mm. Endoscopic orbital decompression with patients under local anesthesia appears to be an effective technique that may provide an additional margin of safety in prevention of injury to the optic nerve.

Adult↗
PubMed1995

Aneurysmal bone cyst of the orbit associated with fibrous dysplasia.

Aneurysmal bone cyst is a rare but recognized osseous lesion of the orbit. We report the presentation, treatment, and postoperative course of an orbital aneurysmal bone cyst in a patient with McCune-Albright syndrome. To our knowledge, this report represents the first description of aneurysmal bone cyst of the orbit in a patient with fibrous dysplasia. Although visual loss in patients with fibrous dysplasia is most commonly due to narrowing of the optic canal, aneurysmal bone cyst should be considered in a patient with fibrous dysplasia who presents with decreasing vision in the face of a rapidly expanding orbital mass. The treatment in this case was drainage and debridement with prompt resolution. Although not necessary in this case, an alternative treatment includes packing with bone chips. Radiation is usually avoided because of the risk of iatrogenically induced sarcoma.

Adult↗
PubMed1994

Orbital reconstruction using porous polyethylene sheets.

BACKGROUND: There has been growing interest in using porous alloplastic implants for reconstructive orbital surgery because of their perceived increased biocompatibility. One commercially available porous implant is high-density porous polyethylene (Medpor). It is made of pure particles of polyethylene that form interconnecting pores and have excellent handling characteristics. METHODS: The authors performed 37 orbital reconstructions using 0.85-, 1.5-, or 3-mm porous polyethylene sheets to reconstruct internal orbital defects. Mean postoperative follow-up was 18.5 months. Four patients were treated for anophthalmic enophthalmos; there was one patient with spontaneous enophthalmos. In selected patients, other implants also were used, including miniplates or microplates, silastic sheets, autologous bone, or nasal septal cartilage. In patients with enophthalmos, the implants were stacked to reverse the malposition evident at surgery. RESULTS: Preoperatively, 27 patients had symptomatic diplopia. Postoperatively, the diplopia resolved in 15 patients and decreased in 7. No patients had induced diplopia or exacerbation of preoperative diplopia. Enophthalmos resolved in 9 of 18 patients. Hypoglobus was normalized in nine of nine patients. There was one major complication of orbital infection requiring explantation 1 week postoperatively. Minor complications included undercorrection, a symptomatically palpable implant, and transient postoperative chemosis. CONCLUSION: Porous polyethylene sheets offer several distinct advantages when used for orbital reconstruction. They are easy to handle, shape, contour, position, fixate, and use with other autogenous and alloplastic implants. In this series, these sheets permitted predictable, stable results with few complications.

Adolescent↗
PubMed1994

Magnetic resonance imaging of the lacrimal drainage system.

BACKGROUND: Magnetic resonance imaging (MRI) has excellent spatial and soft tissue resolution in the periocular and orbital region, especially when combined with surface coil techniques. Other methods, including computed tomography, dacryocystography, and dacryoscintigraphy provide limited information in the area of the lacrimal drainage system. Magnetic resonance imaging was used in conjunction with other imaging modalities to compare the anatomic detail and clinically relevant information obtained about various pathologic processes in the lacrimal drainage area. METHODS: Patients with a variety of lacrimal drainage disorders underwent MRI with either head or surface coils. Contrast agents also were used in selected cases. Seven case reports are presented. RESULTS: Magnetic resonance imaging provided detailed information about local anatomy, extent of pathology, and, in some cases, etiology of the pathology. CONCLUSIONS: Magnetic resonance imaging with surface coils provides detailed soft tissue information when compared with dacryocystography and computed tomography in the area of the lacrimal drainage system. In selected cases of lacrimal drainage system pathology, MRI may provide data that affect patient management.

Abscess↗
PubMed1994

Histopathologic features of the floppy eyelid syndrome. Involvement of tarsal elastin.

PURPOSE: Patients with the floppy eyelid syndrome have chronic papillary conjunctivitis with easily everted upper eyelids and a soft, pliant upper tarsus. The purpose of this study is to describe the clinical features and the histopathologic correlate in a group of patients with floppy eyelid syndrome. METHODS: The authors examined eight patients with floppy eyelid syndrome, four of whom underwent surgical management with horizontal eyelid shortening. Eyelid tissue from these patients was examined using light microscopy, electron microscopy, and immunohistochemistry and compared with controls with unrelated eyelid or orbital disorders. RESULTS: Clinical findings included obesity or eye rubbing, lash ptosis, and, less commonly, blepharoptosis. Two patients had documented sleep apnea with abnormal sleep electroencephalogram. Light microscopy of the surgical specimens showed chronic conjunctival inflammation, papillary conjunctivitis, and meibomian gland abnormalities, including granuloma formation. Verhoeff's modified elastin stain demonstrated a marked decrease in the amount of elastin fibers in tarsus from patients with floppy eyelid syndrome compared with controls. Immunohistochemical staining for elastin also showed a marked decrease of tarsal elastin in floppy eyelid patients compared with controls. In contrast, immunohistochemical stains showed that the distribution of collagen types I and III was similar between patients with floppy eyelid syndrome and controls. Electron microscopy demonstrated that tarsal collagen was comparable in patients and controls, and that there was a reduced amount of tarsal elastin in floppy eyelid syndrome compared with controls. CONCLUSIONS: These findings demonstrate that tarsal elastin is decreased in the floppy eyelid syndrome, which may contribute to the laxity of the tarsus in this disorder.

Adult↗
PubMed1994

Comparison of fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants.

Two porous orbital implants available for clinical use in the anophthalmic socket are hydroxyapatite (HA) and porous polyethylene (PP). We examined the rate and the extent of fibrovascular ingrowth into these implants using histopathologic criteria in a rabbit model. Thirty-two New Zealand white rabbits underwent a unilateral enucleation with placement of a 14-mm spherical orbital implant. Twelve rabbits received HA, 12 small-pore PP, and 8 large-pore PP. The implants inserted were wrapped either in autologous sclera with and without anterior fenestrations or as unwrapped spheres. The implants were harvested at 6 and 12 weeks. The extent of fibrovascular ingrowth was assessed by determining the percentage of the cross-sectional area penetrated by fibrovascular tissue. On gross inspection, 12 implants (37.5%) were found to be exposed at harvesting; however, only two were grossly infected. The highest rate of exposure was found among the unwrapped implants. Wrapped versus unwrapped and fenestrated versus unfenestrated implants did not result in significant differences in the extent of vascularization. Hydroxyapatite implants were vascularized most rapidly. The small-pore PP implants did not become fully vascularized during the study, and yet complete vascularization was found in the large-pore PP at 12 weeks. The most intense areas of microscopic fibrovascular ingrowth were in the region where the extraocular muscles were in direct contact with the implant and at the posterior opening. Exposure of the implant was accompanied by chronic and acute inflammation. Both HA and large-pore PP spherical implants are capable of complete vascularization in this animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Endoscopic orbital decompression.

Exophthalmos from Graves' disease can result in visual disability and cosmetic deformity. Surgical treatment of this disorder is now possible through an intranasal endoscopic approach that allows removal of the medial orbital wall and floor without an external incision. Endoscopic orbital decompression was performed on 22 orbits in 14 patients for treatment of progressive exophthalmos. Local anesthesia was used in five cases. Sixteen procedures involved a concurrent lateral orbital decompression performed through an external approach. There were no intraoperative or postoperative complications. Visual acuity remained stable or improved in all cases. Proptosis was reduced an average of 3.2 +/- 1.1 mm (range 2 to 4.5 mm) by endoscopic decompression alone. When a lateral decompression was also performed, proptosis was reduced by an additional 2.4 mm, for an average improvement of 5.6 +/- 1.7 mm (range 2 to 8 mm). Endoscopic orbital decompression appears to be a safe technique for the treatment of exophthalmos that can be performed effectively with the patient under general or local anesthesia.

Adult↗
PubMed1993

Long-term results of mucous membrane grafting in ocular cicatricial pemphigoid. Implications for patient selection and surgical considerations.

BACKGROUND: Buccal mucous membrane grafting was performed in 26 eyes of 20 patients with advanced ocular cicatricial pemphigoid. The disease causes abnormalities of the eyelid margin and conjunctiva, which results in mechanical damage to the cornea. The authors' short-term results showed that mucous membrane grafting was effective in reversing these abnormalities if the disease was first medically controlled by chemotherapy or was in remission. METHODS: At the end of 2 years of follow-up, the authors reviewed all records and photographs of these patients. RESULTS: Serious postoperative corneal complications developed in 16 eyes (61.5%), causing worsened visual acuity in 8. The postoperative complications were associated with severe keratoconjunctivitis sicca in 14 eyes (87.5%), progression of subepithelial conjunctival fibrosis and postoperative exacerbation of ocular cicatricial pemphigoid inflammatory activity in 8 eyes, and advanced ankyloblepharon in 7 eyes. The condition of one eye was unchanged. The beneficial effect of grafting was maintained in nine eyes. CONCLUSIONS: The authors' observations indicate that mucous membrane grafting should not be performed when patients have severe keratoconjunctivitis sicca, very advanced ocular cicatricial pemphigoid, or active conjunctival inflammation uncontrolled by immunosuppression. The authors suggest complete control of inflammation before surgery and perioperative treatment with systemic prednisone while maintaining any ongoing immunosuppressive chemotherapy. The selection of alternative surgical approaches is discussed.

Aged↗
PubMed1992

'Black cornea' after long-term epinephrine use.

Fifteen years after a partial maxillectomy and radiation therapy for left antral carcinoma, a 53-year-old woman presented to the Eye Plastics and Orbit Service of the Massachusetts Eye and Ear Infirmary, Boston, with phthisis and a large, black corneal lesion in the left eye. She had been treated for unilateral glaucoma in the left eye for more than 10 years with topically administered epinephrine borate, timolol maleate, and pilocarpine hydrochloride. Clinically, the lesion was smooth, black, and homogeneous, and was thought to represent uveal prolapse covered by a thin layer of epithelium. An eyelid-sparing anterior exenteration was performed. Histopathologic examination revealed an acellular, homogeneous substance that stained positively with the Fontana Masson stain for melanin and bleached with potassium permanganate, findings consistent with corneal adrenochrome deposition. Since adrenochrome can be easily dissected free from the cornea, this case illustrates that misdiagnosing adrenochrome deposition may lead to unnecessary surgery.

Cornea↗
PubMed1992

Orbital prosthesis following temporal muscle or forehead flap reconstruction: use of optics and illusions.

Temporalis myocutaneous flap reconstruction of orbital defects may cause difficulty with fabrication of esthetic orbital prostheses because of limited space. Two patient treatments are presented to show the wide variation in defect size that may be encountered after surgical reconstruction. Methods for using optics and illusions to enhance the esthetic result are also presented.

Adult↗
PubMed1992

Miniplate reconstruction of the lateral orbital rim after orbital decompression for Graves disease.

BACKGROUND: Removal of lateral orbital bone with or without simultaneous removal of the lateral orbital rim is an accepted method of orbital decompression for Graves disease. Once removed, the bone is no longer available for reconstruction and secondary complications such as rounding of the canthal angle, canthal dystopia, and globe dystopia may result. METHODS: The authors replaced the excised bone with a titanium miniplate to protect the globe and fixate the lateral canthal tendon in 18 patients (33 orbits). The orbital rim and lateral orbital wall were completely removed, and the inner aspect of the orbit was enlarged with a cutting burr. A standard titanium miniplate was then anchored to remaining bone, and soft tissue was secured to the miniplate to reconstruct the lateral canthus. RESULTS: The results, as manifest by appearance of the lateral canthus and position of the eyelid in apposition to the globe, were graded as excellent in all patients and orbits. There were no early or late complications. CONCLUSION: Miniplate reconstruction of the lateral orbital rim after decompression for Graves disease allows the beneficial affect of lateral decompression and preserves the functional aspect of the lateral orbital wall.

Adult↗
PubMed1992

Repair of telecanthus by anterior fixation of cantilevered miniplates.

BACKGROUND: The accepted surgical method for telecanthus repair is transnasal wiring. This procedure requires a stable posterior lacrimal crest on the affected side and surgical manipulation of the wires as they exit the contralateral side. A method for repairing telecanthus that obviates these prerequisites is presented. Indications for use of this technique and comparison to transnasal wiring is discussed. METHODS: A Y-shaped titanium rigid orbital plating system ("miniplate") was used to surgically correct traumatic telecanthus in five patients, two in the acute setting and three in late reconstruction. The miniplate was cantilevered from the lateral aspect of the nose and directed posteriorly into the orbit. This provided a stable fixation point for the medial canthal tendon. RESULTS: Marked resolution of the telecanthus was noted in four patients. No post-operative complications have been encountered to date. CONCLUSIONS: Miniplate fixation was used successfully to repair unilateral traumatic telecanthus. Miniplate fixation of the medial canthal tendon should be considered in unilateral cases of traumatic telecanthus and in cases where poor bony support for transnasal wires is evident.

Adult↗