Necrobiotic xanthogranuloma with posterior scleritis.
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Adult↗
Biomedical subjects
Michael T Yen
Publications and source records attributed to Michael T Yen.
Correspondence: avoiding lower eyelid ectropion after full thickness skin grafting.
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Blepharoplasty↗
Quantitative analysis of temporal artery contraction after biopsy for evaluation of giant cell arteritis.
BACKGROUND: Although the degree of contraction of temporal artery biopsy specimens after formalin fixation has been previously reported to range from 6% to 13%, the degree of contraction before fixation has not been previously studied. The aim of this study was to quantify the postexcision (prefixation) contraction of temporal artery biopsy specimens and to determine the relationship between contraction and the result of the biopsy. METHODS: All patients undergoing temporal artery biopsies from February 2003 through May 2004 were retrospectively reviewed. Contraction was determined by subtracting the in vivo and ex vivo lengths, then dividing the difference by the in vivo length to obtain a percentage of contraction. Statistical analysis was performed with the unpaired t test and Fisher exact test. RESULTS: We reviewed 37 negative and 7 positive biopsies for giant cell arteritis (GCA). For specimens positive for GCA, the mean contraction was 12%, whereas for negative specimens, mean contraction was 22%. There was a significant difference in the contraction between the specimens positive and negative for GCA (p = 0.009). The Fisher exact test revealed that GCA was positively associated with arterial contraction of less than 15% (p = 0.002). INTERPRETATION: The temporal artery can contract substantially after excision and before tissue fixation. GCA-positive specimens exhibit statistically less contractility than negative specimens.
Biopsy↗
The eyelid crease incision for dermoid cysts of the eyebrow in pediatric patients.
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Child↗
Modulation of sensory photophobia in essential blepharospasm with chromatic lenses.
PURPOSE: To determine the effect of photochromatic modulation with tinted lenses on the sensory symptoms of photophobia in blepharospasm patients. DESIGN: Nonrandomized case-control study. PARTICIPANTS: Thirty-four subjects (24 benign essential blepharospasm patients and 10 normal controls). METHODS: Subjects were seated in front of a calibrated light source. Beginning at 0%, the intensity of the light source was increased gradually until the patient reported symptomatic photophobia. The intensity of the light source was then measured with a light meter. This procedure was performed first with no chromatic lens and then with 7 different chromatic lenses, each blocking specific wavelengths of the visible spectrum. The subject was then asked which lens provided the greatest symptomatic improvement of photophobia. Statistical significance was calculated with analysis of variance and t test analysis. MAIN OUTCOME MEASURES: Objective measurement of light intensity tolerated and subjective assessment of photophobia were obtained for each chromatic lens tested. RESULTS: The light intensity tolerated by the normal subjects compared with the blepharospasm group was not statistically significant with no lens, but grew to 3.5 times that tolerated by the blepharospasm group as more of the higher wavelengths of the visible spectrum were blocked (P = 0.048). Lenses 4, 5, 6, and 7 allowed blepharospasm patients to tolerate a significantly higher intensity of light when compared with no lens (P = 0.04, P = 0.007, P = 0.03, and P = 0.01, respectively). Although the highest intensity of light tolerated was measured with lens 6, 71% of blepharospasm patients reported the greatest relief of photophobia with lens 7. CONCLUSIONS: Blepharospasm patients tolerate a lower intensity of light when compared with normal subjects; this differential in light tolerance becomes significantly more pronounced as the higher wavelengths of the visible spectrum are blocked. The symptoms of photophobia in blepharospasm patients can be reduced significantly with photochromatic modulation. Despite lens 6 allowing the patients to tolerate a higher intensity of light, the majority of patients preferred lens 7 for symptomatic relief of photophobia. These findings suggest that sensory photophobia may be related more to the wavelength than to the intensity of the light exposure.
Blepharospasm↗
Combined positron emission tomography/computed tomography imaging of orbital lymphoma.
PURPOSE: To report a case of orbital lymphoma with systemic dissemination that was identified and localized by combined positron emission tomography (PET)/computed tomography. DESIGN: Case report. METHODS: A 75-year-old woman presented with a 6-month history of painless, progressive fullness of her right upper eyelid. A PET/computed tomography was obtained to provide functional and anatomic assessment of the orbits. An orbitotomy was performed with sub-total excision of the lesion to obtain histologic diagnosis. RESULTS: The PET/computed tomography scan revealed intensive uptake of tracer in a right orbital mass measuring 2.3 x 1.8 x 2.6 cm. Foci of abnormal tracer uptake were also noted in the right neck, right hilar region, and central abdomen. Histopathologic findings were consistent with follicular cell lymphoma. CONCLUSIONS: The combination of PET/computed tomography provides accurate and precise information in an expedited manner not offered by alternative imaging modalities. PET/computed tomography imaging should be considered in the evaluation of orbital neoplasms, especially if lymphoma is suspected.
Aged↗
Octyl-2-cyanoacrylate tissue adhesive in external dacryocystorhinostomy.
PURPOSE: To review our experience using octyl-2-cyanoacrylate for closing the cutaneous incision in external dacryocystorhinostomy (DCR). METHODS: A retrospective review was performed of all cases of external DCR with cyanoacrylate wound closure performed during a 12-month period. At the completion of the DCR, octyl-2-cyanoacrylate was used to close the incision. No subcutaneous sutures were placed to approximate the wound edges. Fifteen seconds of drying time elapsed before a second application of the adhesive was applied. Follow-up consisted of examinations at 1 week, 1 month, and 3 months after surgery. RESULTS: Twenty-one cases of wound closure using octyl-2-cyanoacrylate in external DCR were performed on 19 patients. Cyanoacrylate was applied to the wound without complications, and all patients had excellent closure of the wound with the cyanoacrylate at the end of the case. No wound infections were noted during the follow-up period. One patient had a wound dehiscence that was treated with forceps debridement of residual cyanoacrylate and reapplication of additional octyl-2-cyanoacrylate. One patient had hypertrophic scar formation that resolved with daily massage. In all patients, the incision was believed to be aesthetically equivalent to the expected appearance of suture closed DCR incisions. CONCLUSIONS: Closure of the DCR incision with cyanoacrylate is safe, quick, does not compromise wound integrity, and provides an aesthetic result that is equivalent to suture wound closure. Additional benefits could potentially include safer operative environment and postoperative convenience for patient and surgeon.
Adolescent↗
Effect of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.
PURPOSE: To determine the effect of intravenous corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess. METHODS: The inpatient records of all patients treated for orbital cellulitis with subperiosteal orbital abscess between January 2001 and August 2003 were reviewed. The use of corticosteroids, length of hospital stay, need for surgical drainage, treatment course, and clinical outcomes were reviewed. A t test and Fisher exact test analysis were calculated to evaluate statistical significance. RESULTS: Twelve patients received intravenous corticosteroids and 11 patients did not receive corticosteroids. All patients had complete resolution of their abscess without complications. Length of hospitalization between the patients treated with and without intravenous corticosteroids was not significantly different (p = 0.26). Four of 12 patients treated with intravenous corticosteroids underwent orbitotomy for drainage of the abscess, and 6 of 11 patients treated without intravenous corticosteroids underwent surgical drainage (p = 0.20). Two of 12 patients treated with corticosteroids received intravenous antibiotics after discharge, whereas 7 of 11 in the group not treated with corticosteroids received intravenous antibiotics after discharge (p = 0.03). CONCLUSIONS: The use of intravenous corticosteroids does not appear to adversely affect clinical outcomes and may be beneficial in the treatment of pediatric orbital cellulitis with subperiosteal abscess. Review of our data suggests that a prospective, randomized trial is warranted to further clarify the role of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.
Abscess↗
Diagnosis of metastatic carcinoma to the cavernous sinus by computed tomograpy-guided fine-needle aspiration.
PURPOSE: To describe a case of metastatic lung carcinoma to the cavernous sinus and orbital apex diagnosed by fine-needle aspiration guided by computed tomography. DESIGN: Case report. METHOD: A 52-year-old man who presented with right-sided ptosis and ophthalmoplegia was found to have an enhancing mass of the right orbital apex and cavernous sinus extending into the temporal fossa on magnetic resonance imaging. Chest computed tomography revealed hilar adenopathy and a lesion of the right lower lobe of the lung. Bronchial washings and transbronchial needle biopsies of the lung were nondiagnostic. Computed tomography-guided fine-needle aspiration of the temporal fossa portion of the mass was performed. RESULT: Biopsy of the mass showed malignant cells consistent with metastatic non-small cell lung carcinoma. CONCLUSION: Computed tomography-guided fine-needle aspiration can be useful in the diagnosis and management of some masses involving the cavernous sinus.
Biopsy, Fine-Needle↗
Perivascular dermatitis of the eyelid secondary to chronic epiphora.
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Aged↗
Nasolacrimal sac hematoma masquerading as an orbital mass.
A distended or infiltrated nasolacrimal sac can present as a mass in the medial orbit. We present a case of aspergillus sinusitis complicated by intractable epistaxis after debridement of the nasal septum, which caused pain and rapid distension of the nasolacrimal sac. The clinical and radiographic appearance of the distended nasolacrimal sac mimicked the appearance of an orbital mass and orbital extension of aspergillosis. After embolization of the maxillary artery to control the epistaxis, the nasolacrimal sac hematoma spontaneously resolved, and the patient proceeded with his medical treatment without the need for orbital surgery.
Adolescent↗
Current trends in managing the anophthalmic socket after primary enucleation and evisceration.
PURPOSE: To evaluate current trends in the management of the anophthalmic socket after primary enucleation and evisceration. METHODS: The active membership of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) was surveyed regarding primary enucleations and eviscerations performed between January and December 2002. Survey questions included practice demographics, orbital implant use, wrapping materials, placement of a motility peg, reasons for implant choice, and complications encountered. RESULTS: A total of 2,779 primary orbital implants were reported, comprising 1,919 (69.1%) enucleations and 860 (30.9%) eviscerations. The high-density porous polyethylene implant was used most frequently for enucleations (42.7%), followed by coralline hydroxyapatite (27.3%) and nonporous alloplastic implants (19.9%). For eviscerations, the high-density porous polyethylene implant was the most commonly used implant (42.3%), followed by hydroxyapatite (25.9%) and nonporous alloplastic implants (25.7%). The top 3 reasons for implant choice were outcome (69.3%), cost (43.6%), and experience (39.5%). Most implants were either not wrapped (59.8%) or were wrapped in donor sclera (25.2%) or polyglactin mesh (7.2%). Pegs were used in 8.1% of all implants reported. The most frequent complications encountered for unpegged implants were exposure (3.2%) and infection (0.4%). For pegged implants, the most common complications reported were pyogenic granuloma (13.7%), exposure (5.7%), and discharge (5.7%). CONCLUSIONS: In managing the anophthalmic socket, ASOPRS survey respondents preferred to use the porous polyethylene implant after primary enucleation and evisceration. Most orbital implants were not wrapped, and most surgeons preferred not to place a motility post or peg in the implant.
Anophthalmos↗
Orbital apex syndrome after ethmoidal artery ligation for recurrent epistaxis.
A 34-year-old man with severe, recurrent epistaxis underwent external anterior and posterior ethmoidal artery ligation on the right side. Visual loss from optic neuropathy and complete ophthalmoplegia developed after surgery. Computed tomography revealed surgical clips within the right orbital apex. Emergent removal of the surgical clips and medial wall decompression were performed. Four weeks later, his visual acuity and extraocular motility were unchanged, and diffuse pallor of the right optic disc was observed. Orbital apex syndrome can be a complication of ethmoidal artery ligation. Severe visual loss and ophthalmoplegia may persist despite prompt recognition and treatment.
Adult↗
Management of the late ocular sequelae of Stevens-Johnson syndrome.
The acute conjunctivitis seen initially in Stevens-Johnson syndrome is followed by a cicatricial phase, which often leads to severe ocular surface disease and visual morbidity. Manifestations include keratinization of the conjunctiva, lid margins, and lacrimal and meibomian ducts, resulting in an unstable tear film and mechanical trauma to the conjunctiva and cornea with blinking. Limbal stem cell deficiency is the most vision-threatening sequela of Stevens-Johnson syndrome, as it causes corneal neovascularization, chronic corneal inflammation, and an irregular corneal epithelium. Management of late sequelae often requires a multipronged approach, including strategies for ocular surface protection, ocular surface support, and ocular surface reconstruction. In this review, established therapies, as well as new experimental therapies, are discussed.
Journal Article↗
Orbicularis oculi muscle graft augmentation after protractor myectomy in blepharospasm.
PURPOSE: To evaluate the effectiveness of free orbicularis oculi muscle grafts in correcting volume deficit deformities after protractor myectomy in patients with essential blepharospasm. METHODS: Prospective case series. During the 13-month period from October 2000 through November 2001, all patients with essential blepharospasm undergoing primary eyelid protractor myectomy received an orbicularis oculi muscle graft to replace the volume deficit deformity created by the myectomy. Only patients who had at least 6 months of postoperative follow-up were included in the analysis. RESULTS: Forty-six patients underwent primary eyelid protractor myectomy and had a free orbicularis oculi muscle graft for volume replacement. All patients had significant functional improvement of their eyelid spasms after the myectomy. Of the 38 patients who underwent upper eyelid myectomy, 3 patients were overcorrected and no patients were undercorrected with the orbicularis muscle graft. Two of the overcorrected patients underwent surgical debulking of their muscle grafts. Of the 8 patients who underwent lower eyelid myectomy, no patients were overcorrected and 1 patient was undercorrected. None of the patients were observed to have any spasms, contractions, or other signs of muscular activity or aberrant innervation of the muscle graft. CONCLUSIONS: The orbicularis oculi muscle graft is a useful adjunct to protractor myectomy in improving the aesthetic outcomes for blepharospasm patients. Our study demonstrates the viability of the orbicularis oculi muscle graft and may lead to future applications of the graft in facial aesthetics.
Adult↗
Capsular calcification of alloplastic orbital implants.
PURPOSE: To report calcification of the capsule surrounding alloplastic orbital implants and postulate this calcification as a possible cause of poor implant motility. DESIGN: Interventional case reports. METHODS: Two patients with alloplastic spherical implants after enucleation presented with poor implant motility. Both patients underwent orbital implant exchange with a quasi-integrated porous polyethylene orbital implant. RESULTS: During removal of the original alloplastic orbital implant, a hard, thick shell adherent to the surrounding orbital tissues was encountered. After complete excision of the shell, microscopic evaluation confirmed a dense, fibrous capsule with calcification. No evidence of inflammation or malignancy was associated with either capsule. Postoperatively, both patients had significant improvement in motility of their new orbital implant. CONCLUSIONS: Although calcification of the fibrous capsule surrounding alloplastic orbital implants is an unusual finding, it may result in poor implant motility. Capsule excision and implant exchange may significantly improve the motility of the orbital implant.
Calcinosis↗
No-scar Asian epicanthoplasty: a subcutaneous approach.
PURPOSE: The epicanthal fold is a normal finding in the medial portion of the upper eyelid in many Asians. We describe a simple technique of removing the excess muscle and softening or eliminating the epicanthal fold without making incisions in the medial canthal region, thus avoiding complications such as scarring or web formation METHODS: Interventional case series. The subcutaneous epicanthoplasty was performed on all Asian patients undergoing concurrent upper eyelid blepharoplasty or aponeurotic ptosis repair. RESULTS: Thirty-eight Asian patients underwent epicanthal fold correction between January 1996 and December 2000. All patients had softening of the epicanthal fold; however, some cases of mild undercorrection were noted. CONCLUSIONS: Softening or elimination of the Asian epicanthal fold can be accomplished without making skin incisions in the medial canthal region. Our technique is a simple, graded procedure that can be performed in conjunction with upper blepharoplasty or ptosis repair.
Asia↗