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Biomedical subjects

Mark J Lucarelli

Publications and source records attributed to Mark J Lucarelli.

At least 19 recordsLinked to original sources
PubMed2006

Multifocal visual evoked potentials in the anesthetized non-human primate.

PURPOSE: To evaluate monkey multifocal visual evoked cortical potentials (mfVEPs) recorded from central and peripheral fields for reliability and isolation from electroretinographic (ERG) activity. METHODS: The mfVEP stimulus consisted of a 7-element hexagonal array that subtended 80 degrees of the central visual field. Recordings were made under intravenous pentobarbital sodium (15 mg/kg) anesthesia. Two monkeys with absent optic nerve and ganglion cell function after combined unilateral optic nerve transection and experimental ocular hypertension (ONT/OHT) were followed longitudinally. In a second study, 16 ophthalmologically normal monkeys were tested once. RESULTS: Testing of the non-transected eye in two transected animals revealed robust first- and second-order kernel, first slice (K1 and K2.1) mfVEPs. Stimulation of the transected eye revealed no contamination of the mfVEP from the concurrently recorded multifocal ERGs. There was complete separation of the root-mean-square (RMS) mfVEP amplitudes from the transected and the fellow eyes tested repeatedly across a 4- to 17- month period. The largest amplitude mfVEP was generated by the central element; however, mfVEPs were recorded from outside the central 20 degrees element. The 16 normal animals showed waveforms similar to the normal eyes of the ONT/OHT animals both in shape and distribution throughout the visual field. A scalar-product measure showed both K1 and K2.1 mfVEPs from central and some peripheral elements were statistically distinct from noise. CONCLUSIONS: mfVEPs can be reliably recorded from non-human primates anesthetized with pentobarbital. Under the recording conditions described, mfVEPs are not contaminated by ERG activity. mfVEPs may be useful in animal models of diseases that differentially affect macular and peripheral visual field responsiveness.

Anesthesia, Intravenous↗
PubMed2005

Tear meniscus level as an indicator of nasolacrimal obstruction.

PURPOSE: To quantitate the normal level of the tear meniscus, and to determine whether it is an accurate diagnostic indicator of nasolacrimal drainage obstruction. METHODS: We performed a retrospective, controlled, case series study on patients evaluated from 2000 to 2002 for epiphora. The height of the tear meniscus was measured using the slit lamp by one experienced observer. Nasolacrimal outflow status was assessed by probing and irrigation. Patency on the nontearing eye was also confirmed by probing and irrigation, and the corresponding tear meniscus levels comprised one control group (59 sides of 62 patients). Tear meniscus levels in patients with ptosis or dermatochalasis without epiphora comprised the second control group (78 sides of 39 patients). The 2 control groups were combined to determine the normal tear meniscus level and ratio between the two sides. The control tear meniscus levels and ratios in patients without epiphora were compared with the tear meniscus levels and ratios in patients with nasolacrimal obstruction (65 sides of 62 patients). RESULTS: The 2 control groups examined did not statistically differ with respect to tear meniscus height (P = 0.06). The control median tear meniscus level (0.2 mm) significantly differed from the obstructed median tear meniscus level (0.6 mm) (P<0.0001). The control median ratio between the two sides (1.0) significantly differed from the obstructed ratio (2.5) (P<0.0001). The absolute tear meniscus level and the tear meniscus ratio were both accurate indicators of obstruction. The percent change in absolute tear meniscus level after lacrimal surgery was -58.3%. CONCLUSIONS: To our knowledge, a quantitative analysis of the tear meniscus height has not been previously documented in the literature. Patients with nasolacrimal system stenosis or obstruction have elevated tear meniscus levels and ratios relative to control subjects. The absolute tear meniscus level and ratio tests are excellent diagnostic indicators of nasolacrimal obstruction and its resolution after successful lacrimal surgery.

Case-Control Studies↗
PubMed2005

Sympathetic ophthalmia following evisceration: a rare case.

We describe a case of sympathetic ophthalmia following evisceration of a blind, painful, posttraumatic, glaucomatous eye. Although rare, this complication has been reported previously in the literature. We provide a brief review of sympathetic ophthalmia following evisceration and discuss the importance of a high degree of clinical suspicion and prompt treatment with high-dose systemic corticosteroids or other immunomodulators.

Aged↗
PubMed2005

Rhabdomyosarcoma masquerading as acute dacryocystitis.

An 11-year-old boy presented with right medial canthal swelling. He was initially diagnosed with dacryocystitis and treated with oral antibiotics, followed by incision and drainage of a presumed lacrimal sac abscess. Rapid recurrence of the swelling led to further clinical evaluation, including a maxillofacial CT, which revealed an extensive nasal and orbital mass that was consistent with embryonal rhabdomyosarcoma on histopathologic analysis. This represents an unusual case of rhabdomyosarcoma manifesting as acute dacryocystitis. Rhabdomyosarcoma should be considered in the differential diagnosis for acquired nasolacrimal obstruction and dacryocystitis in the pediatric population.

Biopsy↗
PubMed2005

Severe subcutaneous emphysema following orbital blowout fracture.

A 19-year-old man sustained a blowout fracture to the left orbital floor. Subcutaneous emphysema developed after a protracted sneezing episode. Some signs of respiratory distress ensued, and the patient was emergently intubated. He underwent surgical repair of the fracture and then had further extension of the subcutaneous emphysema. The left nasal cavity was packed and the emphysema slowly resolved. Clinically significant subcutaneous emphysema is an uncommon complication of orbital blowout fracture. Informing the patient to avoid excessive nose-blowing and to avoid occluding the nose while sneezing may prevent this complication.

Adult↗
PubMed2004

Heritable unilateral clinical anophthalmia.

We examined a newborn child with unilateral right-sided clinical anophthalmos born to a mother with unilateral left-sided anophthalmos. Although rare, isolated nonsyndromic heritable unilateral anophthalmia and microphthalmia have been reported in the literature. We briefly review the genetics of such anomalies and discuss the importance of a full clinical genetics evaluation. Treatment of this patient's anophthalmic socket consists of progressive conformer expansion to be followed by placement of a self-inflating polymer expander.

Adult↗
PubMed2003

Ocular adnexal lymphoma: clinical behavior of distinct World Health Organization classification subtypes.

PURPOSE: To evaluate the clinical behavior and treatment outcome of ocular adnexal lymphomas classified by the World Health Organization system, with emphasis on marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). MATERIALS AND METHODS: The clinicopathologic materials from 98 consecutive patients treated for ocular adnexal lymphoma were reviewed. Fourteen patients had prior lymphoma and 84 patients had primary disease (75% Stage I, 6% Stage III, and 19% Stage IV). Radiation (photons/electrons) was administered to 102 eyes to a median dose of 30.6 Gy. The mean follow-up was 82 months. RESULTS: The most common subtypes among the primary patients were MALT (57%) and follicular (18%) lymphoma. The 5-year actuarial local control rate in 102 irradiated eyes was 98%. Among the low-grade lymphomas, the 5-year local control rate correlated with the radiation dose in the MALT lymphoma subgroup (n = 53): 81% for <30 Gy and 100% for > or =30 Gy (p <0.01). For the non-MALT low-grade lymphomas such as follicular lymphoma (n = 30), the local control rate was 100% regardless of dose. For 39 Stage I MALT lymphoma patients treated with radiation alone, the distant relapse-free survival rate was 75% at 5 years and 45% at 10 years. Distant relapses were generally isolated and successfully salvaged by local therapy. The overall survival for this subgroup was 81% at 10 years, with no deaths from lymphoma. CONCLUSIONS: Dose-response data suggest that the optimal radiation dose for MALT lymphoma of the ocular adnexa is 30.6-32.4 Gy in 1.8-Gy fractions and follicular lymphoma is adequately controlled with doses in the mid-20 Gy range. The substantial risk of distant relapse in Stage I ocular adnexal MALT lymphoma underscores the importance of long-term follow-up for this disease and the need for additional comparative studies of MALT lymphoma of different anatomic sites.

Adolescent↗
PubMed2003

Differential expression of matrix metalloproteinases in monkey eyes with experimental glaucoma or optic nerve transection.

Extracellular matrix (ECM) remodeling after neuronal injury and reactive gliosis is carried out by activation of matrix metalloproteinases (MMPs) regulated by their tissue inhibitors (TIMPs). In glaucoma, there is a loss of retinal ganglion cells and extensive ECM remodeling (cupping) at the level of the optic nerve head, frequently associated with elevated intraocular pressure. To determine whether ECM remodeling in the glaucomatous optic nerve head occurs in response to loss of axons or to elevated intraocular pressure we compared the patterns of MMP and TIMP expression in the eyes of monkeys with laser-induced glaucoma or with optic nerve transection. MT1-MMP and MMP1 expression was markedly increased in reactive astrocytes in optic nerve heads with experimental glaucoma but not in the optic nerve head of transected eyes. In normal control eyes retinal ganglion cells expressed MMP2, TIMP1 and TIMP2 constitutively, and the proteins were detected in their axons. At the site of transection, MT1-MMP, MMP1, MMP2, TIMP1 and TIMP2 were expressed by reactive astrocytes. Inflammatory cells, fibroblasts and reactive astrocytes at the transected site expressed MMP3 and MMP9, which were undetectable in the retina and optic nerve head in any condition. Constitutive expression of MMP2, TIMP1 and TIMP2 in retinal ganglion cells suggests a role in maintenance of synaptic integrity and plasticity and maintenance of the periaxonal space. Increased MMP1 and MT1-MMP1 expression in the glaucomatous optic nerve head is specific to tissue remodeling due to elevated intraocular pressure and not secondary to loss of axons.

Animals↗
PubMed2003

Conjunctival melting syndrome associated with the use of bovine pericardium wrapping material.

PURPOSE: To report 18 cases of unusually large, early conjunctival breakdown occurring with the use of bovine pericardium wrapping material for orbital implants. METHODS: Retrospective case series. The clinical course and histopathologic features of 18 cases of early conjunctival breakdown in patients who had undergone orbital implantation of bovine pericardium-wrapped hydroxyapatite or porous polyethylene are reviewed. RESULTS: Eighteen patients presented with unusually large (average 13.44 mm) conjunctival defects over bovine pericardium-wrapped implants. The average time from enucleation to exposure was approximately 4 months. Implants had to be removed in 8 of 18 cases. There was clinical and histologic evidence of tissue inflammation and conjunctival melting. CONCLUSIONS: The conjunctival melting phenomenon we report herein is alarming. We have abandoned the use of bovine pericardium as a wrapping material for implants after enucleation because of the unfavorable results.

Adolescent↗
PubMed2002

Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature.

BACKGROUND: Ocular sebaceous carcinoma (SC) is a rare tumor of the eyelids. Clinically it frequently involves the upper lid in older women. Microscopically it tends to extend far beyond its assessed clinical margins. SC is characterized by a variety of tissue invasion mechanisms. It may spread by direct extension, be multifocal in advanced cases, and develop "skip areas" after trauma. Despite its ability to develop discontinuity, over the past two decades there have been several favorable case reports of SC treated by Mohs micrographic surgery (MMS). OBJECTIVE: To illustrate by case report the clinical presentation and management of patients with SC and to document our series of SC patients treated by MMS over the last 14 years. METHODS: A retrospective study was conducted of all cases of sebaceous carcinoma involving the ocular adnexa treated at the University of Wisconsin Mohs Surgery Clinic from 1987 to 2001. We also reviewed the accumulated medical literature of SC treated by MMS. RESULTS: In our series, there were nine cases of periocular SC. Five cases originated on the upper lid and four on the lower lid. Five of nine patients (55%) showed epithelial invasion. One patient developed a local recurrence 1.5 years later and was treated by orbital exenteration. This patient has had no evidence of disease for 5 years. Eight of nine patients (88%) had no evidence of local recurrence with a follow-up of 1-14 years. In our literature review we found 40 additional cases of orbital SC treated by MMS. Intraepithelial spread of SC was found in 50% of patients (24 of 48). Six patients developed local recurrence. The overall local cure rate following MMS is 87.8% (43 of 49), with a mean follow-up of 3.1 years. The regional metastatic rate was 8% (4 of 49). There were no deaths reported. CONCLUSION: We present nine new cases of SC. The age, sex, and site distribution are compatible with other SC cases reported in the literature. We reviewed the medical literature and compiled 49 cases of SC treated by Mohs surgery. Intraepithelial spread was discovered in 50% of the cases. Multifocal disease or discontinuity was present in 6% (3 of 49). Mohs surgery appears to be an effective method for excising the microscopic ramifications of primary SC. When feasible, we recommend in SC cases where intraepithelial pagetoid spread has been observed, that removal of another Mohs layer should be considered in order to provide an additional assurance layer against local tumor recurrence.

Adenocarcinoma, Sebaceous↗
PubMed2002

Eyelid lymphatics I: histochemical comparisons between the monkey and human.

PURPOSE: To study the lymphatic drainage of the cynomolgus monkey and human eyelid and periocular tissue by means of histochemistry. METHODS: Eyelid and periocular tissue from three cynomolgus monkeys undergoing sacrifice for glaucoma and retina research purposes and discarded tissue from a wedge resection of one human eyelid were used for histochemical analysis. Lymphatic capillaries were distinguished histochemically in monkey and human eyelids by light microscopy with a 5'-nucleotidase (5'-Nase) staining method. Identification of lymphatic vessels was based on strict morphologic criteria combined with specific 5'-Nase staining. RESULTS: Histochemical analysis with 5'-nucleotidase revealed a subcutaneous and pretarsal lymphatic plexus in both the human and monkey. CONCLUSIONS: Histochemical results demonstrate similar lymphatic plexi in the monkey and human. Future studies will help to clarify the lymphatic drainage pathways of monkey and human eyelids.

5'-Nucleotidase↗
PubMed2002

Eyelid lymphatics II: a search for drainage patterns in the monkey and correlations with human lymphatics.

PURPOSE: To study the lymphatic drainage of the cynomolgus monkey through the use of lymphoscintigraphy. METHODS: Lymphoscintigraphy with 500 microCi of 99mTechnetium sulfur colloid injected at specific sites around the eyelids was performed with five cynomolgus monkeys in lateral and ventral positions. RESULTS: Lymphoscintigraphy of the monkey eyelid and periocular tissue revealed lymphatic drainage to the parotid lymph nodes from the entire upper eyelid, medial canthus, and lateral lower eyelid and drainage to the submandibular lymph nodes from the medial and central lower eyelid. In addition to draining to the parotid lymph nodes, the central upper eyelid was also seen to drain to the submandibular lymph nodes. CONCLUSIONS: Lymphoscintigraphy of the cynomolgus monkey eyelids reveals discrete lymphatic drainage pathways for the upper and lower eyelids and a dual pathway for the central upper eyelid. Future studies will help to clarify the lymphatic drainage pathways of human eyelids.

Animals↗
PubMed2002

The cynomolgus monkey eyelid as an anatomic model for oculoplastic surgery.

PURPOSE: To investigate the Cynomolgus monkey eyelid as an experimental model for oculoplastic surgery METHODS: Eyelid and periocular tissue were removed from Cynomolgus monkeys being euthanized. After fixation, the macroscopic and microscopic characteristics of the Cynomolgus monkey eyelid were studied. RESULTS: Macroscopic and microscopic characteristics of the Cynomolgus monkey eyelids were described. The Cynomolgus monkey eyelid bears resemblance to the human eyelid in its compartmentalization and complexity. CONCLUSIONS: The Cynomolgus monkey eyelid is a suitable experimental research model. Its compartmentalization resembles that of the human eyelid both microscopically and macroscopically.

Animals↗
PubMed2002

A simple algorithm for selection of implant size for enucleation and evisceration: a prospective study.

PURPOSE: This prospective study tested a simple formula for selecting an implant size for patients undergoing enucleation, evisceration, and secondary implantation. The formula axial length-2 mm=implant diameter (subtract 1 mm from implant diameter for evisceration and for hyperopia) was tested by the outcome measures, superior sulcus deformity, enophthalmos, and volume of the prosthesis. METHODS: Fifty-four patients undergoing primary or secondary implant surgery after enucleation or evisceration received implants based on the above formula. The volume of the eye, volume of the implant, volume of the prosthesis, and the total percent volume replacement were recorded for each patient. Outcome measures considered clinically acceptable were <2 mm enophthalmos and less than grade 1 superior sulcus deformity, which is defined as barely perceptible deepening of the medial superior sulcus. RESULTS: The average volume replacement was 101%; average prosthetic volume was 2.1 mL; average grade of superior sulcus deformity was 0.6; and average enophthalmos was 1.2 mm. CONCLUSIONS: This formula allows 100% replacement of the volume removed, leaves space for a prosthesis 1.5 to 2.5 mL, and eliminates clinically unacceptable superior sulcus deformity and enophthalmos in 85% of patients. Patients with a history of infection, radiation, buphthalmos, or large orbital fractures (15%) had residual superior sulcus deformity greater than grade 1 and enophthalmos > or =2 mm despite 100% volume replacement. Further study will elucidate the histopathologic processes responsible for residual superior sulcus deformity and enophthalmos in the latter subgroup of patients.

Adult↗
PubMed2002

Corneal ectasia associated with massage of dacryocystoceles.

PURPOSE: To report a patient with corneal ectasia and bilateral dacryocystoceles. METHODS: Case report, review of medical literature. RESULTS: The patient experienced gradual bilateral worsening of visual acuity caused by increasing corneal ectasia. Vigorous and frequent massaging of the lacrimal sacs and globes preceded development of symptomatic corneal ectasia. CONCLUSIONS: The timing of the development of this patient's corneal ectasia suggests an association between the dacryocystoceles massage and the ectasia.

Adult↗
PubMedDate not supplied

Histologic comparison of autologous fat processing methods.

PURPOSE: To perform a quantitative analysis of adipocyte viability after fat processing during autologous fat transfer, comparing the processing methods of washing, centrifuging, and sedimentation. METHODS: An experimental study was conducted in which 24 fat samples were obtained after processing from 22 patients undergoing autologous fat transfer. Histologic analysis of periodic acid-Schiff-stained specimens was then performed. RESULTS: Cell counts per high-powered field of intact adipocytes and nucleated adipocytes and adipocyte cross-sectional area were significantly greater in samples processed by sedimentation, compared with those by centrifuging or washing. CONCLUSIONS: Of the various processing techniques currently used during autologous fat transfer, sedimentation appears to yield a higher proportion of viable adipocytes than does washing or centrifuging.

Adipocytes↗