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Biomedical subjects

P A Rubin

Publications and source records attributed to P A Rubin.

At least 19 recordsLinked to original sources
PubMed2000

Laser applications in oculoplastic surgery and their postoperative complications.

Laser surgery for oculoplastic or dermatological indications--whether incisional work, removal of pigmented or vascular lesions, removal of hair, or resurfacing--necessitates that the practitioner have appropriate training in and understanding of not only the techniques but also of their advantages and disadvantages. Understanding laser safety and how to handle complications is critical to appropriate management of laser-assisted surgery. Long-term results are limited at this time, but current information regarding the use of lasers in aesthetic oculoplastic surgery appears promising. New approaches to such operations include combining more than one type of laser or combining traditional cutting blades and lasers in an effort to reduce side effects and improve outcome.

Eye Diseases↗
PubMed1999

Prepartum mixed type cavernous-capillary hemangioma arising in nevus flammeus.

OBJECTIVE: Capillary hemangioma may appear de novo and involute during the first decade of life, but rarely during pregnancy. This study describes the clinical and histologic findings of an eyelid mixed type cavernous-capillary hemangioma arising in a nevus flammeus and discusses the differential diagnosis of this lesion. STUDY DESIGN: Clinicopathologic case report. INTERVENTION: A reddish, protruding eyelid mass arising from a nevus flammeus at the eyelid margin in a 26-year-old woman was monitored during her pregnancy. Postpartum, the mass was excised and examined histologically. RESULTS: The lobulated tumor recurred during the second pregnancy and partially regressed following delivery. It was composed of mixed elements of cavernous and capillary hemangioma that superficially resembled Kaposi sarcoma, set against the background of a nevus flammeus. CONCLUSION: The differential diagnosis of discrete prepartum vascular tumor arising in nevus flammeus includes mixed capillary-cavernous hemangioma, pseudo-Kaposi sarcoma, granuloma gravidarum, and angiodermatitis. A common stimulus during pregnancy may be the inciting factor for the development of these tumors.

Adult↗
PubMed1999

Ophthalmic plastic applications of acellular dermal allografts.

PURPOSE: Clinical problems of contracted conjunctival fornices, superior sulcus defects, and soft tissue contour defects in the periorbital region have not shown good, sustained results with a range of autologous and alloplastic implants. AlloDerm (Lifecell Corp., Woodlands, TX) is an acellular dermal graft processed from human donor tissue. The authors sought to assess the efficacy of AlloDerm as a soft tissue replacement in a variety of oculoplastic applications. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-three patients. METHODS: Applications were broadly classified as barrier/scaffolding (i.e., primary and secondary implant coverage, lid spacer graft) and volume augmentation (i.e., superior sulcus and other periorbital soft tissue contour defects). Barrier grafts were applied as single sheets. Stacked sheets or rolled grafts were used for augmentation. Collectively, this material was used in 29 cases with 3 to 16 months' follow-up. MAIN OUTCOME MEASURES: Clinical evaluation of outcome and complications. RESULTS: As a soft tissue scaffolding and barrier implant, AlloDerm persisted sufficiently to permit repopulation with native tissue. Rolled/stacked implants demonstrated unpredictable resorption. Upper eyelid grafts seemed to have higher resorption rates than lower eyelid grafts. One case of anophthalmic superior sulcus augmentation required two revision surgeries to provide sufficient volume augmentation. The grafts were well tolerated, with no cases of infection or explanation. CONCLUSION: Acellular human dermis is an excellent barrier and reconstructive grafting material that provides an alternative to autologous grafts and other alloplastic material, avoids harvesting autologous tissue, possesses excellent handling properties, and is associated with minimal inflammation. Long-term follow-up is required to evaluate persistence.

Coated Materials, Biocompatible↗
PubMed1999

Medpor Motility Coupling Post: a rabbit model.

PURPOSE: To verify if a Medpor porous polyethylene orbital implant (PPOI) (Porex Surgical, Atlanta, GA, U.S.A.), once vascularized, will tolerate a partially exposed titanium screw on its anterior surface. METHODS: Ten New Zealand white rabbits were enucleated and given Medpor PPOIs. Eight weeks postoperatively, Medpor Motility Coupling Posts (MCPs) (Porex Surgical) were placed into the orbital implants. Clinical tissue tolerance and histologic response to the new device were noted. RESULTS: The titanium screws were well tolerated by the animals. No case of post-operative infection, conjunctival inflammation, conjunctival erosion, MCP dislocation, or PPOI fragmentation was noted. A fibrous tissue growth over the titanium head was noted in all screws with a head height of 2.5 mm. The fibrous tissue overgrowth was not observed in screws with a head height of 4 mm or more. CONCLUSION: During the 6-month observation period, all implanted Medpor MCPs demonstrated favorable tissue tolerance and stable interfaces between the MCP and the conjunctiva and between the MCP and the PPOI.

Animals↗
PubMed1999

Functional indications for enophthalmos repair.

PURPOSE: In general, orbital augmentation to correct enophthalmos is pursued to prevent or address an aesthetic deformity. In some cases, however, functional deficits may accompany enophthalmos and may serve as an indication for surgical intervention. The authors describe a series of patients with such deficits. METHODS: A retrospective review at a tertiary health care center of all patients with enophthalmos was conducted to identify a subset of cases in which the enophthalmos was associated with nonaesthetic, functional deficits that could not be attributed to muscular or neural dysfunction, or soft tissue scarring. RESULTS: Six patients with either traumatic enophthalmos (orbital fractures) or non-traumatic enophthalmos (sinus disease and orbital soft tissue atrophy) demonstrated nonaesthetic ocular dysfunction, including gaze-evoked diplopia, eyelid retraction, lagophthalmos, and exposure keratitis. The symptoms and signs resolved in the three patients who underwent orbital augmentation. CONCLUSIONS: In some patients with enophthalmos and globe ptosis, globe malposition may alter the underlying eyelid mechanics or extraocular muscle alignment, resulting in functional as well as aesthetic problems. In these patients, restoring the native orbital anatomy through orbital augmentation can reverse eyelid malposition, ocular surface exposure, and symptomatic diplopia, avoiding the need for eyelid or strabismus surgery.

Adult↗
PubMed1999

A multidisciplinary approach to atypical lacrimal obstruction in childhood.

PURPOSE: This study explores the diagnosis and management of unusual anomalies involving the canaliculi, nasolacrimal duct, nasal cavity, and sinuses in childhood. METHODS: A case series of eight children with lacrimal outflow anomalies ranging from distal nasolacrimal duct cyst formation to persistent dacryocystitis following failed probing or silicone intubation were reviewed retrospectively. Diagnostic studies including intranasal endoscopy and preoperative or intraoperative dacryocystography (DCG) were of value. RESULTS: Treatment modalities included endoscopically guided resection of lacrimal cyst mucosa, endoscopic dacryocystorhinostomy (DCR), and monocanalicular or bicanalicular intubation of the lacrimal outflow system. In our series, endoscopic surgery was well tolerated by all patients with improvement in symptoms. CONCLUSIONS: This initial experience suggests that endoscopic techniques may be useful in the management of atypical lacrimal outflow obstruction in childhood.

Child↗
PubMed1999

Aesthetic periocular surgery including brow, midface, and upper face.

Because of the rapid evolution and wide scope of cosmetic surgery in this decade we focus on some of the newer techniques used by oculoplastic surgeons for the rejuvenation of the periorbital area. These procedures may be used alone or as adjuncts to more established plastic surgery techniques. We discuss the role of botulinum toxin in the treatment of facial furrows, new techniques in forehead and brow suspension, the suborbicularis oculi fat suspension, and the role of chemical peels in the periorbital area, upper face, and forehead. All four of these techniques are important in addressing facial rhytids in the periorbital region. It is important to realize that in modern-day cosmetic surgery the best results are achieved using a multidimensional approach incorporating surgical procedures together with nonsurgical techniques or minimally invasive procedures.

Esthetics↗
PubMed1998

Four-eyelid sebaceous cell carcinoma following irradiation.

BACKGROUND: Sebaceous cell carcinoma is a distinctive tumor of the eyelid associated with a high rate of metastasis and mortality. Involvement of both upper and lower lids has been described; however, involvement of all 4 eyelids is extremely rare. OBJECTIVE: To describe the evaluation and diagnosis of the clinicopathologic features in a 74-year-old patient with 4-eyelid sebaceous carcinoma and a history of whole face irradiation for eczema. METHODS: Bilateral eyelid, conjunctiva, map, and fine needle biopsy of enlarged, submandibular lymph node specimens were stained with hematoxylin-eosin and oil-red-O for light microscopy and fresh-frozen sections were evaluated by electron microscopy. RESULTS: The biopsy specimens from the eyelids and conjunctiva showed sebaceous carcinoma cells in the meibomian glands and scattered within the conjunctival epithelium. The cells were moderately well differentiated. Similar cells stained with oil-red-O were found in the submandibular lymph nodes. CONCLUSIONS: The appearance of bilateral sebaceous carcinoma supports the concept of simultaneous occurrence of multiple primaries in specific patients, especially after radiation therapy. Patients with a history of facial irradiation and atypical eyelid lesions should be evaluated for malignant tumors such as sebaceous carcinoma.

Adenocarcinoma, Sebaceous↗
PubMed1998

Bilateral nasolacrimal duct obstruction managed with endoscopic techniques.

We present 3 cases of bilateral acquired nasolacrimal duct obstruction secondary to Wegener granulomatosis, sarcoidosis, and chronic lymphocytic leukemia. In all cases significant paranasal sinus and intranasal disease coincided with bilateral nasolacrimal duct obstruction. Surgical treatment of the nasolacrimal duct obstruction with dacryocystorhinostomy was more successful if the paranasal sinus disease was also treated. Nontraumatic bilateral nasolacrimal duct obstruction heralds unusual underlying systemic diseases, and coexisting paranasal sinus disease should be suspected. The simultaneous surgical treatment of both lacrimal and paranasal sinus disease through an endoscopic approach is advocated.

Adult↗
PubMed1998

Orbital computed tomographic characteristics of globe subluxation in thyroid orbitopathy.

OBJECTIVE: Axial globe subluxation may complicate thyroid orbitopathy. This acute event is defined by anterior displacement of the globe equator beyond the orbital rim, lid retraction behind the equator, and tethering of the optic nerve. The authors explored the factors leading to spontaneous globe subluxation in patients with thyroid orbitopathy. DESIGN: A clinical review. MAIN OUTCOME MEASURES: The medical charts and axial and coronal orbital computed tomographic (CT) scans of all the patients with spontaneous globe subluxation were reviewed. The patients were categorized according to their CT scans into type I ("lipogenic" variant) or type II ("myogenic" variant). RESULTS: Four (0.1 %) of approximately 4000 patients with thyroid orbitopathy presented with spontaneous globe subluxation. All of these patients had increased orbital fat without significant enlargement of the extraocular muscles. Thus, they represent type-I thyroid orbitopathy. CONCLUSIONS: Globe subluxation in thyroid orbitopathy requires compliance of the orbital soft tissues and extensibility of the extraocular muscles. These are characteristics of type-I orbitopathy. The increased fat content results in more compliance of the soft tissues, and the normal caliber of the muscles allows them to become more extensible. This permits the acute contraction of the eyelids posterior to the equator of the globe. Patients with type-I orbitopathy and extensive proptosis may be at relatively greater risk of having globe subluxation develop.

Acute Disease↗
PubMed1998

Enhancement of the cosmetic and functional outcome of enucleation with the conical orbital implant.

OBJECTIVE: The authors evaluated a new design of a conical-shaped enucleation implant to help minimize the occurrence of superior sulcus defects and maximize motility of the prosthesis. The implant shape is a modification of a sphere. It has a posterior conical projection paralleling the orbital walls, a superior projection supporting the soft tissues of the upper eyelid sulcus, a flattened anterior surface, and channels for each rectus muscle. DESIGN: The study design was a consecutive case series from the Oculoplastics and Orbital Service of the Massachusetts Eye and Ear Infirmary. INTERVENTION/PARTICIPANTS: A total of 45 patients (average age, 40 years; range, 13-75 years) had placement of a conical implant (39 primary enucleations, 6 secondary implants) with a minimum of 1 year' follow-up (range, 12-36 months). All of the primary enucleations and two of the secondary procedures had the anterior portion of the implant covered with autologous fascia. Four of the secondary implants were covered with pseudocapsule harvested from the explanted primary implant. Prostheses were fit 6 to 10 weeks after surgery. MAIN OUTCOME MEASURES: Postoperative appearance of patients was assessed by qualitative appearance of the superior sulcus and prosthetic motility, and subjectively by patients' satisfaction. RESULTS: A total of 43 patients had minimal or no superior sulcus defect, whereas 2 patients had moderate defects. There were no severe sulcus defects. All patients were satisfied with their appearance and did not seek further surgery to correct any upper sulcus asymmetry. Prosthetic motility with small-angle ductions (<10 degrees) and saccades was good in all cases. There were two cases of conjunctival wound dehiscence. Both occurred within 4 weeks of surgery. One wound dehiscence was sutured, whereas the other healed spontaneously. There were no cases of implant extrusion, migration, or infection. CONCLUSION: The conical orbital implant provides appropriate reconstitution of orbital volume while minimizing superior sulcus defects with adequate prosthetic motility.

Adolescent↗
PubMed1998

Large-angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery.

PURPOSE: Surgical correction of large-angle exotropia, greater than 70 PD, traditionally requires operating on three or four horizontal muscles. However, in secondary exotropia from monocular visual loss, it is advisable to operate only on the eye with poor vision. We used intraoperative botulinum toxin as an adjunct to the monocular recession-resection procedure for large-angle sensory exotropia, therefore operating only on the visually impaired eye. METHODS: Three patients underwent monocular recession (10 mm) and resection (10 mm) along with intraoperative botulinum toxin A injection of 10 units into the recessed muscle. All had desired cosmetic repair of long-standing large-angle exotropia (range 100 to 110 PD) with amblyopia and vision worse than 20/200 in the deviated eye. RESULTS: Within 4 days after operation all patients demonstrated maximal paresis of the lateral rectus muscle. This lasted 8 to 12 weeks and resulted in stable orthotropia at 2.5 years in case 1 and stable 8 PD exotropia at 4 years in case 2. The third case demonstrated a stable 18 PD exotropia by 7 months with a satisfactory cosmetic result. CONCLUSION: This technique provides an alternative for the surgical correction of large-angle exotropia by operating only on two horizontal muscles. In sensory exotropia it also avoids subjecting a normal eye to an operative risk.

Adult↗
PubMed1998

Porous polyethylene sheet implant with a barrier surface: a rabbit study.

Soft tissue adhesion to the porous polyethylene sheet implant (PPSI) raises the concern of postoperative extraocular motility disturbance after orbital blowout fracture repairs using PPSI. A PPSI with a barrier surface (PPSI-B) has been developed to reduce adhesion between soft tissue and the implant. Six PPSI-B and six conventional PPSI were implanted under the scalps of three New Zealand white rabbits. The implants were harvested at 2-, 4-, and 20-week intervals. Clinical and histologic comparisons were made between PPSI-B and PPSI with regard to adhesion at the soft tissue-implant interface. Clinically, PPSI-B demonstrated less adhesion between soft tissue and implant compared with the conventional PPSI. Both types of implants demonstrated a complete fibrovascular ingrowth by 2 weeks. Because PPSI-B causes less adhesion at the soft tissue-implant interface, consideration should be given to the use of PPSI-B in repairs of orbital blowout fractures in which extraocular muscle is exposed to the implant surface.

Animals↗
PubMed1998

Repair of orbital blow-out fractures with nasoseptal cartilage.

The goals of reconstruction in orbital blow-out fractures are to restore floor continuity, provide support of orbital contents, and prevent fibrosis of soft tissues. Although ease of use has popularized alloplasts, autogenous material provides greater biocompatibility and results in low rates of infection, extrusion, and migration. Nasoseptal cartilage is an easily accessible, abundant, autogenous source that provides support to the orbital floor and minimal donor site morbidity. Thirteen patients who presented with orbital blow-out fractures underwent reconstruction with nasoseptal cartilage. Follow-up at 3 months to 4 years shows one patient with persistent manifest enophthalmos requiring further augmentation. There were no recipient or donor site complications. Nasoseptal cartilage is an underutilized and superior material for reconstruction of orbital blow-out fractures.

Adolescent↗