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Biomedical subjects

Roger A Dailey

Publications and source records attributed to Roger A Dailey.

15 recordsLinked to original sources
PubMed2005

Characteristics and outcomes of strabismus surgery after orbital decompression for thyroid eye disease.

PURPOSE: To compare characteristics and outcomes of strabismus surgery in patients who have undergone orbital decompression for thyroid eye disease with those who have not. SUBJECTS AND METHODS: A chart review of all patients with thyroid eye disease requiring strabismus surgery in one physician's practice. RESULTS: There were 36 patients in the decompression group (DG) and 14 patients in the no-decompression group (NDG). There was a significantly greater amount of preoperative esotropia in the DG ( P = 0.02). There was an increased incidence of A-pattern in the DG ( P = 0.09). There was a slightly higher number of operated muscles in the DG ( P = 0.005). A good or excellent outcome was achieved in 93% of the NDG and in 94% of the DG ( P = 0.83). DISCUSSION: Previous studies suggest that patients requiring orbital decompression have a more complex thyroid eye disease and a lower success rate after strabismus surgery. Our findings suggest that this is not necessarily the case, and the difference in surgical success rates between the studies may in part be due to orbital decompression technique or indication. CONCLUSION: In this series, using a fixed suture technique, outcomes of strabismus surgery in patients with thyroid eye disease who underwent orbital decompression are similar to those who did not.

Adult↗
PubMed2005

Customized, single-incision, three-wall orbital decompression.

PURPOSE: To present the clinical outcome in 55 consecutive patients by using a customized, single-incision, 3-wall orbital decompression. METHODS: A retrospective chart review was performed of 97 customized, single-incision, 3-wall decompressions in 55 consecutive patients within one surgeon's practice. A standardized surgical technique featuring lateral small-incision, 3-wall decompression with specific "strut" preservation was used in all patients. Success of the procedure was assessed on the basis of the amount of proptosis reduction achieved, as measured by the difference in Hertel exophthalmometry measurements, and by improvement in or preservation of preoperative visual acuity and color vision in the setting of compressive optic neuropathy. Subjective diplopia was recorded before and after surgery, as was the presence of extraocular muscle restriction. RESULTS: A total of 97 orbital decompressions in 55 consecutive patients were reviewed. The majority of surgeries were performed for disfiguring proptosis with some degree of exposure-related symptoms (81%), with other indications including compressive optic neuropathy (17%), and pain (2%). The average amount of proptosis reduction achieved at 3 months was 5 mm (range, 1 to 11 mm). Visual acuity in patients with compressive optic neuropathy improved an average of 2 lines on the standard Snellen chart testing (range, 1 to 5). Color vision improved an average of 5 Ishihara plates (range, 0 to 13). Seventy-one percent of patients had subjective diplopia before surgery; 21% of these patients reported improvement or complete resolution of diplopia after surgery. Of the 29% of patients without preoperative subjective diplopia, all but one (1.8 of total patients) remained symptom free. CONCLUSIONS: We find that a customized, single-incision, 3-wall orbital decompression provides adequate decompression and proptosis reduction while minimizing postoperative strabismus and providing an aesthetically desirable result.

Adult↗
PubMed2005

Treatment of multiple apocrine hidrocystomas with trichloroacetic acid.

The apocrine hidrocystoma is a benign adenomatous cystic proliferation derived from apocrine glands, which frequently occurs in periocular tissues. These cystadenomas may occur bilaterally, in multiple disfiguring confluent groups on both the upper and lower lids. Although these lesions have been treated successfully with meticulous surgical extirpation and electrosurgery, this report describes the successful treatment of two patients, each with multiple large (>7 mm) periocular apocrine hidrocystomas by either chemical ablation of the cystic epithelium with trichloroacetic acid (TCA) or surgical excision. Examination of the cysts at 1, 3, and 6 months after TCA treatment revealed well-healed lesions without cyst recurrence. Most of the TCA-treated cysts resolved completely, without leaving any trace to clinical examination. Treatment of cysts with TCA was technically simpler and much less time-consuming than surgical excision. The treatment of large apocrine hidrocystomas with TCA is an effective and expeditious method of treating these disfiguring and recalcitrant lesions.

Aged↗
PubMed2005

Frosted jones pyrex tubes.

PURPOSE: To describe the use of a new, frosted Jones Pyrex tube in the treatment of obstructed canaliculi of the upper lacrimal system. The frosted Jones tube retains the advantages of the traditional smooth Pyrex tube yet appears to improve the positional stability in the surgically created fistula. METHODS: Ten patients of a single surgeon who had previously undergone external conjunctivodacryocystorhinostomy and placement of a Jones Pyrex tube, with subsequent Pyrex tube extrusion, were included in the study. All had previous success with Pyrex tubes, with follow-up ranging from 1 month to 14 years. In each case, when the patient presented with an extruded tube, it was replaced with a frosted Jones tube (Weiss Scientific Glass Blowing Company, Portland, OR, U.S.A.). RESULTS: In this preliminary study, none of the 10 patients fitted with a frosted Jones Pyrex tube had a recurrence of extrusion. All patients reported proper functioning of the tubes, with no complaints of epiphora or discomfort. CONCLUSIONS: Compared with a standard Jones Pyrex tube, a frosted tube functions equally well and reduces the possibility of extrusion, which is the main complication of traditional conjunctivodacryocystorhinostomy. We have exchanged smooth tubes for frosted tubes in patients who have had extrusion of the original tube, and we are currently investigating primary placement of the frosted Jones Pyrex tube.

Dacryocystorhinostomy↗
PubMed2004

Gold weight implantation: a better way?

PURPOSE: To introduce an alternative surgical technique for gold weight implantation for the treatment of lagophthalmos. We suggest that unwrapped intraorbital gold weight implantation provides adequate function, better cosmetic appearance, and lower morbidity than conventional implantation with wrapped or unwrapped pretarsal gold weights. METHODS: The charts of a single surgeon were reviewed (1994 to 2003). All patients who underwent intraorbital gold weight implantation were included in the study. The technique was noted to be consistent with intraorbital fixation of a custom 2.2-gm gold weight (MedDev Corporation, Sunnyvale, California). Implants were not wrapped. Efficacy was defined as elimination of exposure keratopathy with preservation of the visual axis. Morbidity was defined as extrusion of the weight, shift of positioning requiring intervention, inflammation/infection of the eyelid, or poor cosmetic appearance. RESULTS: Of 59 patient charts reviewed, 2 patients had morbidity as defined by our study: One had shifting of the gold weight, necessitating repositioning of the weight; the other had extrusion of the gold weight, requiring its removal. The remaining patients had no complaints or cosmetic concerns. Follow-up examinations found no incidence of exposure keratopathy. CONCLUSIONS: We found intraorbital gold weight implantation, without the use of a wrap, to be simple and effective, with adequate function, an acceptably low postoperative morbidity rate, and an excellent cosmetic outcome.

Adolescent↗
PubMed2004

Endoscopic pretrichial brow lift: surgical indications, technique and outcomes.

PURPOSE: To present an alternative technique for rejuvenating the upper face of patients with high hairlines. METHODS: A chart review was performed to ascertain the longevity and aesthetic quality of endoscopically assisted pretrichial brow lifts. The charts of a single surgeon were reviewed (2000 to 2003). The technique was noted to be consistent, and in the majority of cases, additive to other concurrent procedures. Morbidity was defined as asymmetry, poor longevity, and patient dissatisfaction. All patients were included who had the procedure performed. No exclusions were recognized for race, age, gender, medical history, or any other patient demographic. RESULTS: Results for the clinical outcome were graded as excellent, good, fair, or poor. Subjective and objective assessments were made by using history, examination, and photos. A rating of excellent incorporates symmetry, longevity, smoothness of the brow skin, and patient satisfaction both with the recovery process and with the results. CONCLUSIONS: In properly selected cosmetic patients, the endoscopic pretrichial brow lift is an effective method for rejuvenating the upper face. A more youthful appearance is achieved with the procedure, and it is easily combined with eyelid rejuvenation. We believe that this technique is the procedure of choice for addressing brow ptosis in patients with high hairlines.

Adult↗
PubMed2003

Infection after blepharoplasty with and without carbon dioxide laser resurfacing.

PURPOSE: To determine the rate of infection in patients who underwent blepharoplasty with and without carbon dioxide laser resurfacing. DESIGN: A retrospective, nonrandomized, consecutive case series. PARTICIPANTS: Eighteen hundred sixty-one patients who underwent upper or lower blepharoplasty, with or without carbon dioxide laser resurfacing. METHODS: Charts of patients who underwent blepharoplasty, with or without laser resurfacing, were analyzed for the presence of postoperative infection, method of treatment, and possible sequelae. MAIN OUTCOME MEASURES: The rate of infection (%) was determined for each group of patients. RESULTS: Infection occurred in 0.2% of patients who underwent blepharoplasty without laser resurfacing and 0.4% of patients who had adjunctive laser resurfacing. No permanent functional or cosmetic sequelae resulted from the episodes of infection. CONCLUSIONS: Infection after blepharoplasty without laser resurfacing is uncommon, indicating that topical antibiotic ointment prophylaxis is a sufficient postoperative regimen. The use of adjunctive laser resurfacing may increase the infection rate slightly.

Blepharoplasty↗
PubMed2003

Orbital and periorbital myofibromas in childhood: two case reports.

PURPOSE: Infantile myofibromatosis is an uncommon tumor that occurs rarely in the periorbit and orbit. This article reports two cases of infantile myofibromatosis of the orbital adnexa and describes the associated clinical, histopathologic, and immunohistochemical findings. DESIGN: Two retrospective, interventional case reports with clinicopathologic correlation. INTERVENTION: Treatment consisted of excision of the tumors. MAIN OUTCOME MEASURES: Histologic and immunohistochemical evaluation and clinical evaluation for tumor recurrence. RESULTS: The first patient was a newborn male with a large tumor extending from his eyelid that was excised at day 2 of life. Histologic and immunohistochemistry analyses were used to make a diagnosis of infantile myofibromatosis. He remains disease free at age 7 years. The second case was a 6-year-old boy with a 1-month history of proptosis resulting from an orbital mass. Incisional biopsy revealed a tumor consistent with infantile myofibromatosis. He remains tumor free 12 months after complete gross surgical resection. CONCLUSIONS: Infantile myofibromatosis is an uncommon tumor that is rare in the orbit. Differential diagnosis can be difficult based solely on histologic analysis. Immunohistochemistry evaluation demonstrating cytoplasmic actin filaments within neoplastic spindle cells confirms the diagnosis. As soon as the diagnosis is made, chest and abdominal imaging is of value to define the prognosis and to direct further treatment. After the diagnosis of nonvisceral infantile myofibromatosis, complete gross resection, if possible, is the treatment of choice.

Biomarkers, Tumor↗
PubMed2003

Medial rectus muscle injuries associated with functional endoscopic sinus surgery: characterization and management.

OBJECTIVE: To characterize and evaluate treatment options for medial rectus muscle (MR) injury associated with functional endoscopic sinus surgery (FESS). DESIGN: Retrospective interventional case series. PARTICIPANTS: A total of 30 cases were gathered from 10 centers. METHODS: Cases of orbital MR injury associated with FESS surgery were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) through an e-mail discussion group. MAIN OUTCOME MEASURES: Variables assessed included patient demographics, computerized tomography and operative findings, extent of MR injury and entrapment, secondary orbital/ocular injuries, initial and final ocular alignment and ductions, and interventions. RESULTS: A spectrum of MR injury ranging from simple contusion to complete MR transection, with and without entrapment, was observed. Four general patterns of presentation and corresponding injury were categorized. CONCLUSIONS: Medial rectus muscle injury as a complication of FESS can vary markedly. Proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment. Patients with severe MR disruption can benefit from intervention but continue to show persistent limitation of ocular motility and functional impairment. Prevention and early recognition and treatment of these injuries are emphasized.

Adult↗
PubMed2003

Current treatments for brow ptosis.

PURPOSE OF REVIEW: In this text, we describe and compare the most current brow-lifting techniques, including endoscopic, coronal, and pretrichial approaches, as well as subperiosteal and subgaleal dissection planes, and we discuss the advantages and disadvantages of each. RECENT FINDINGS: Over the past decade, we have witnessed tremendous advances in the anatomic understanding of brow ptosis and in the procedures used to correct the resulting functional and aesthetic deformities.

Blepharoplasty↗
PubMed2003

Graft contraction: a comparison of acellular dermis versus hard palate mucosa in lower eyelid surgery.

PURPOSE: To compare graft contraction rates of acellular dermis versus hard palate mucosa when used as free spacer grafts in lower eyelid surgery and to provide clinical outcome data. METHODS: A prospective, nonrandomized clinical trial involving the placement of 19 spacer grafts in the lower eyelids of 14 patients was performed. Indications for spacer graft placement included lower eyelid retraction and mildly contracted socket. Patients with lower eyelid retraction also underwent an endoscopic subperiosteal midface lift. For all procedures, the height of each graft was measured during and after surgery. The amount of contraction was measured for each graft, and a mean was calculated for each spacer material. The clinical success was evaluated for all procedures, based on improvement of the functional concern being addressed. RESULTS: The mean graft contraction rate was 57% for the acellular dermis and 16% for the hard palate mucosal grafts (P <0.005). Of the 7 procedures using acellular dermis for lower eyelid retraction, 6 were considered a success, and 1 was considered a partial success. Of the 6 procedures using hard palate for lower eyelid retraction, 5 were considered a success, and 1 was considered a failure unrelated to the graft. Of the 5 procedures with acellular dermis used for mildly contracted socket, 2 were considered a success, 2 were considered a partial success, and 1 was considered a failure because of graft contraction. The one case using hard palate for mildly contracted socket was considered a success. CONCLUSIONS: Acellular dermis contracts significantly more than hard palate mucosa when used as a lower eyelid spacer graft. Acellular dermis and hard palate mucosa were both associated with a high rate of clinical success in all categories except for patients with a mildly contracted socket who received acellular dermis; more than 60% of these patients (n=5) had only partial success or failure caused by graft contraction.

Adult↗
PubMed2002

Bilateral congenital lacrimal anlage ducts (lacrimal fistula) in a Patient With the VACTERL association.

PURPOSE: To present a case of bilateral congenital lacrimal anlage ducts in a patient with the VACTERL (vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, renal anomalies, and limb anomalies) association. METHODS: Case report. RESULTS: A 19-year-old man presented with intermittent facial swelling. Examination revealed bilateral lacrimal anlage ducts. The patient underwent excision of the ducts with silicone intubation. CONCLUSIONS: We add the VACTERL association to the list of systemic conditions associated with lacrimal anlage ducts.

Abnormalities, Multiple↗
PubMed2002

Endoscopic subperiosteal midface lift: surgical technique with indications and outcomes.

PURPOSE: To review the surgical technique of the endoscopic subperiosteal midface lift and present our clinical outcome in 22 consecutive patients. METHODS: We retrospectively evaluated the clinical outcomes of 39 endoscopic subperiosteal midface lifts in 22 consecutive patients. Of the 39 sides, 21 had a lower eye conjunctival spacer graft inserted (15 hard palate mucosal graft, 6 AlloDerm). The success of the procedure was graded based on the aesthetic and functional results. Subjective and objective assessments were made using history, examination, and photos. RESULTS: Results for the clinical outcome were graded as excellent, good, fair, or poor. Among the 39 sides, indications for the procedure included facial rejuvenation (41%), postblepharoplasty lower eyelid retraction (26%), eyelid retraction secondary to midfacial ptosis (15%), severe cicatricial ectropion (13%), and paralytic ectropion secondary to 7th nerve palsy (5%). The operating surgeons evaluated the clinical outcome as "excellent" in 24 sides (61%), "good" in 10 sides (26%), "fair" in 2 sides (5%), and "poor" in 3 sides (8%). The procedure was successful at increasing malar projection, improving lower eyelid fullness, and elevating the lower eyelid in cases of lower eyelid retraction. The procedure was less effective in decreasing the prominence of the deep nasolabial fold. CONCLUSIONS: The endoscopic subperiosteal midface lift is an effective method for elevating the midface. A more youthful appearance is achieved with the procedure, and when necessary, recruitment of anterior lamella allows elevation of the lower eyelid to correct retraction.

Adult↗
PubMed2002

Müller muscle-conjunctival resection: effect on tear production.

PURPOSE: To study the effect of upper eyelid ptosis repair by Müller muscle-conjunctival resection on tear production. METHODS: The authors retrospectively reviewed the charts of 174 patients who underwent ptosis repair by Müller muscle-conjunctival resection at the Casey Eye Institute between October 1996 and August 2001. After exclusions for insufficient data and confounding ocular morbidities, the charts of 38 patients, consisting of 71 ptosis repair surgeries, were analyzed. A single surgeon performed the same procedure on all patients. All subjects underwent Schirmer testing before ptosis repair and again during the period between 6 weeks to 18 months after surgery. Patients responded to questions pertaining to dry eye symptoms during preoperative and postoperative visits. RESULTS: No statistically significant change in tear production (as measured by Schirmer strip testing) associated with ptosis correction by Müller muscle-conjunctival resection was observed. Before surgery, 34% (24 of 71) of eyes measured dry before ptosis repair. This ratio remained unchanged on long-term follow-up. A transient increase in dry-eye symptoms was reported in at least one eye of 29% (11 of 38) of patients in the immediate postoperative period (<2 weeks). On long-term follow-up, a persistent increase in dry-eye symptoms or new diagnosis of dry eye was observed in at least one eye of 16% (6/38) of patients, whereas 13% (5/38) of patients noticed diminution of their presurgical dry eye symptoms. CONCLUSIONS: Upper eyelid ptosis repair by Müller muscle-conjunctival resection had no significant effect on tear production as measured by Schirmer testing. Subjective dry-eye symptoms transiently increased in the immediate postoperative period but resolved frequently by the late follow-up period.

Adult↗