1: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):164-5. 

Successful treatment of nasolacrimal duct obstruction secondary to fibrous
dysplasia by external dacryocystorhinostomy with mitomycin C.

Tambe K, Vydianath SR, Mudhar HS, Sandramouli S.

Wolverhampton and Midland Counties Eye Infirmary, New Cross Hospital,
Wolverhampton, UK.

A 60-year-old woman developed polyostotic fibrous dysplasia involving the right
zygomatic and maxillary bones, which led to swelling along the right side of her
nose that was associated with constant epiphora. A sac washout revealed a
blocked right nasolacrimal duct, which was confirmed by CT dacryocystography. CT
also showed signs of fibrous dysplasia in the maxillary and zygomatic bones in
the form of bony expansion and ground-glass bone density. The patient underwent
external dacryocystorhinostomy with mitomycin C and O\'Donoghue tube insertion.
Bone punched out while fashioning the bony nasal ostium was subjected to
histopathologic examination, which confirmed the diagnosis of fibrous dysplasia.
The O\'Donoghue tubes were removed 8 weeks later. At 15 months postoperatively,
the dacryocystorhinostomy was patent and the patient was completely relieved of
her symptoms.

PMID: 19300175 [PubMed - in process]

2: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):161-3. 

Optic nerve and chiasmal germinoma.

Rath S, Vemuganti GK, Biswas G, Mod H.

Ocular Oncology Service, L.V. Prasad Eye Institute, Bhubaneswar, India.
suryasnata@lvpei.org

A 15-year-old boy presented with visual acuity of 20/200 OD and no light
perception OS. The anterior segment of the left eye showed a relative afferent
pupillary defect. A large (4.5 x 4.5 x 2.0 mm) infiltrative optic nerve head
lesion with dilated vessels was seen OS with disc pallor OD. MRI of the brain
and orbit revealed lobulated optic nerve thickening and chiasm. A biopsy
revealed features consistent with germinoma and was positive for marker
placental alkaline phosphatase. Systemic examination, chest x-ray, abdominal
ultrasound, cerebrospinal fluid, and serology were normal. He received 27 Gy to
the craniospinal region followed by a boost of 27 Gy to the left optic nerve.
Eight months postirradiation, vision stabilization was achieved with 20/200 OD
and light perception with inaccurate projection of rays OS.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300174 [PubMed - in process]

3: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):158-61. 

Repair of isolated abortive cryptophthalmos with lower eyelid switch flap and
amniotic membrane graft.

Fung AT, Martin P, Petsoglou C, Kourt G.

Sydney Eye Hospital, Sydney, Australia.

The surgical correction of a case of bilateral isolated abortive cryptophthalmos
is described. An upper eyelid and superior fornix were successfully created in a
2-stage procedure using a switch flap from the patient\'s normal lower eyelid and
an amniotic membrane graft. Exposure keratopathy was significantly reduced with
resultant visual improvement.

PMID: 19300173 [PubMed - in process]

4: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):157-8. 

Adult orbital langerhans cell histiocytosis with frontal bone involvement.

Sokol JA, Kazim M, Kelly KM, Lantos G, Leung LS, Baron E.

Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore
Medical Center, Bronx, New York, USA. jsokolmd@gmail.com

A 28-year-old woman presented with a 2-week history of right upper eyelid
swelling and intermittent frontal headaches. CT demonstrated an ill-defined
superior right orbital mass with adjacent right frontal bone erosion and
undeveloped frontal sinuses. The orbital biopsy revealed tissue strongly
positive for CD1a and S100, diagnostic of Langerhans cell histiocytosis. The
systemic workup was negative for multifocal lesions and for diabetes insipidus.
In addition to subtotal resection, the patient was treated with a 6-month course
of oral prednisone and intravenous vinblastine.

PMID: 19300172 [PubMed - in process]

5: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):155-7. 

Frontal sinus osteoma presenting with orbital emphysema.

Jack LS, Smith TL, Ng JD.

School of Medicine, Oregon Health and Science UniversityPortland, Oregon, USA.

Osteoma is the most common neoplasm of the paranasal sinuses usually involving
the frontal sinus. Osteomas are benign, but can cause serious intracranial or
orbital complications. The authors report a frontal sinus osteoma with orbital
emphysema in a 16-year-old boy with a history of right-eye swelling after nose
blowing. CT showed a right frontal sinus bony mass. Intraoperatively, strands of
mucosa extending from the frontal sinus around the periphery of the mass in the
right orbit were seen. The mass was excised and the orbital roof repaired.
Histopathology was consistent with osteoma. The osteoma facilitated entrance of
sinus air in the orbit, resulting in recurrent orbital emphysema with nose
blowing. There was no recurrence of orbital emphysema after resection.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300171 [PubMed - in process]

6: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):154-5. 

Primary orbital leiomyosarcoma.

Yeniad B, Tuncer S, Peksayar G, Mete O, Minareci O.

Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University,
Istanbul, Turkey. byeniad@yahoo.com

A 79-year-old woman was presented with a 6-month history of painless proptosis
in the left eye. On examination, there was a palpable superotemporal mass
displacing the left eye inferomedially. Orbital CT revealed a heterogeneous,
lobulated mass occupying the left orbital space with no bone erosion or
destruction. MRI showed an extraconal, heterogenous, lobulated orbital mass in
the lacrimal gland region of the left eye. The lesion was excised, and the
diagnosis of leiomyosarcoma was made by histopathologic examination and
immunohistochemistry. Systemic examinations were negative for a primary or a
metastatic tumor. There was no evidence of tumor recurrence after 12 months of
follow-up. Primary orbital leiomyosarcoma is a rare tumor that mainly occurs in
older women and presents with painless proptosis. It should be considered in the
differential diagnosis of superotemporal extraconal lesions.

PMID: 19300170 [PubMed - in process]

7: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):152-3. 

Bilateral dacryoadenitis: a new addition to the spectrum of reactive arthritis?

Madge SN, James C, Selva D.

Discipline of Ophthalmology and Visual Sciences, University of Adelaide, South
Australia, Australia. smadge007@yahoo.co.uk

Reactive arthritis is a well-known sequel to both dysenteric and urethritic
illnesses, classically occurring in combination with conjunctivitis, arthritis,
and/or a variety of dermatologic conditions. Dacryoadenitis has not been
previously described as part of the spectrum of reactive arthritis. The authors
describe a case of biopsy-proven bilateral dacryoadenitis, which developed in
the setting of chlamydial urethritis.

PMID: 19300169 [PubMed - in process]

8: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):150-2. 

Foreign body after pterygium surgery simulating an epibulbar tumor.

Marback PM, Marback EF, Marback RL.

Federal University of Bahia and Sao Rafael Hospital, Monte Tabor Foundation,
Salvador, Bahia, Brazil. patriciamarback@uol.com.br

A 60-year-old woman was referred for evaluation of a rapidly growing
conjunctival neoplasm after pterygium surgery. The lesion proved to be a foreign
body granuloma, with exogenous material that seemed to be cotton mesh, probably
used for tamponade of subconjunctival bleeding that was unintentionally left in
place.

PMID: 19300168 [PubMed - in process]

9: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):148-50. 

Conjunctival edema and distichiasis in association with congenital lymphedema of
the lower legs.

Ramasubramanian A, Shields CL, Palamar M, Rousta ST, Shields JA.

Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107, USA.

An 8-year-old boy with mild congenital lymphedema of both legs was noticed to
have a conjunctival lesion of the right eye since birth. Topical corticosteroid
eyedrops for slight irritation did not alter the appearance of the lesion. On
ocular examination, diffuse conjunctival edema in the inferotemporal and
inferonasal quadrants and mild injection of the right eye was noted. There was
no edema on the left eye. Three extra rows of eyelashes (congenital
distichiasis) were found bilaterally on upper and lower eyelids. Related
systemic anomalies included mild aortic coarctation, left ventricular
hypertrophy, and simian crease on each palm. Conjunctival edema and distichiasis
are important ophthalmic features of the congenital lymphedema distichiasis
syndrome.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300167 [PubMed - in process]

10: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):147-8. 

Steatocystoma simplex of the eyelid.

Procianoy F, Golbert MB, Golbspan L, Duro KM, Bocaccio FJ.

Department of Ophthalmology, Universidade Federal do Rio Grande do Sul School of
Medicine, Porto Alegre, Rio Grande do Sul, Brazil. procianoy@yahoo.com

A 68-year-old woman presented with a nodular pretarsal tumor on her right upper
eyelid that had slowly grown over 6 months. Excisional biopsy was performed
through an eyelid crease approach, and histopathology evidenced the lesion to be
steatocystoma simplex. Steatocystoma simplex is an uncommon benign cutaneous
lesion thought to be a circumscribed malformation arising from the pilosebaceous
duct junction, rarely reported to occur in the periorbital region.

PMID: 19300166 [PubMed - in process]

11: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):146-7. 

Tarsal dermoid cyst: clinical presentation and treatment.

Koreen IV, Kahana A, Gausas RE, Potter HD, Lemke BN, Elner VM.

Department of Ophthalmology and Visual Sciences, University of Michigan, Ann
Arbor, Michigan, USA.

The authors present 2 cases of eyelid dermoid cyst attached to tarsus in
pediatric patients. Both patients were infants who presented with a firm,
nontender upper eyelid mass firmly adherent to tarsus. In both cases, the lesion
was excised en bloc, and histopathology revealed a dermoid cyst. To the authors\'
knowledge, there are no previously reported cases of tarsal dermoid cyst. These
cases demonstrate the importance of including dermoid cyst in the differential
diagnosis of a tarsus-based eyelid mass. Misdiagnosis may lead to incision and
curettage, resulting in spillage of cyst contents and the risk of severe
inflammation and scarring.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300165 [PubMed - in process]

12: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):144-6. 

Darier disease mimicking Basal cell carcinoma of the eyelid.

Russell DJ, Dutton JJ, Fowler AM.

Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel
Hill, North Carolina, USA.

Darier disease is a rare autosomal dominant skin disorder that infrequently has
ocular manifestations. The authors describe 2 cases of patients with known
Darier disease presenting with eyelid lesions resembling basal cell carcinomas.
Biopsies demonstrated histopathologic changes consistent with Darier disease. To
the authors\' knowledge, this presentation has not been previously reported.
Ophthalmologists and dermatologists should be aware of this type of presentation
in Darier disease.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300164 [PubMed - in process]

13: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):142-4. 

Myeloma of the eyelid: a rare necrotizing lesion.

Kim KH, Woo KI, Kim YD.

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea.

A 77-year-old man was referred to the authors with an impression of recurrent
chalazion of the left lower eyelid. He had suffered from multiple myeloma and
had undergone chemotherapy for 11 months. A 2.0 x 0.8 cm, firm, tender,
oval-shaped, ulcerated mass with an accompanying black crust on its surface, and
erythematous swelling around it was observed. Evaluation of an eyelid biopsy
specimen revealed neoplastic plasma cells with eccentric nuclei and
monoclonality for lambda light chain, which the authors report as the first case
of metastatic multiple myeloma presenting as a rare necrotizing eyelid lesion.

PMID: 19300163 [PubMed - in process]

14: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):141-2. 

Parotid tumor presenting with hemifacial spasm.

Behbehani R, Hussain AE, Hussain AN.

Oculoplasic and Orbital Surgery Service, Ibn Sina Hospital, Kuwait City, Kuwait.
r_behbehani@hotmail.com

A 47-year-old man presented with right parotid swelling and a history of
frequent attacks of hemifacial spasm. MRI of the brain and neck showed a mass in
the right parotid gland. Fine needle aspiration biopsy of the mass revealed a
pleomorphic adenoma of the parotid gland, which was confirmed after total right
parotidectomy. His attacks of hemifacial spasm did not improve after surgery and
8 months postoperatively, he received botulinum toxin-A injections, which
improved his symptoms. Clinicians need to be aware that patients with occult
parotid tumors can present like patients with classic hemifacial spasm.

PMID: 19300162 [PubMed - in process]

15: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):140-1. 

Frontalis suspension sling using palmaris longus tendon in chronic progressive
external ophthalmoplegia.

Salvi SM, Currie ZI.

Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.
drsachin@doctors.org.uk

A 26-year-old woman referred with bilateral ptosis was diagnosed to have
underlying chronic progressive external ophthalmoplegia. The authors report
satisfactory result at 18-month follow-up with palmaris longus tendon used as an
autologous sling material for ptosis surgery in this patient.

PMID: 19300161 [PubMed - in process]

16: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):139-40. 

Hypotony maculopathy after eyelid massage for overcorrected blepharoptosis.

Nguyen VT, Hwang TN, Alvarado JA, McCulley TJ.

Department of Ophthalmology, College of Medicine, The University of California
at San Francisco, San Francisco, California 94143-0336, USA.

A 57-year-old woman with a history of left eye trabeculectomy was evaluated for
gradual ipsilateral visual loss. Several months prior, she had undergone levator
advancement of the left upper eyelid. For management of resulting retraction,
she was instructed to "massage" her eyelid. Examination was notable for left eye
visual acuity of 20/200 and an intraocular pressure of 5 mm Hg. On fundoscopic
examination, the macula was edematous with multiple folds, consistent with
hypotony maculopathy. Two years later, after obliteration of the bleb and
placement of a Seton valve, the intraocular pressure has increased to 8 mm Hg
with an acuity correctable to 20/50. Ocular hypotony may result from digital
eyelid massage in patients with filtering blebs. Clinicians should bear this in
mind when managing patients with eyelid retraction after blepharoptosis repair.

PMID: 19300160 [PubMed - in process]

17: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):136-8. 

Normalization of conjunctival flora after dacryocystorhinostomy.

Owji N, Khalili MR.

Department of Ophthalmology, Khallili Hospital, Shiraz University of Medical
Sciences, Shiraz, Iran. owjin@sums.ac.ir

PURPOSE: To determine the time of normalization of conjunctival flora after
successful dacryocystorhinostomy. METHODS: Forty consecutive adult patients with
nasolacrimal duct obstruction and chronic dacryocystitis who had been referred
for dacryocystorhinostomy were included in the study. Conjunctival cultures were
obtained preoperatively from the involved and normal sides of each patient.
Cultures from the lacrimal sac contents were obtained at the time of
dacryocystorhinostomy. Postoperatively, conjunctival specimens were obtained
from the operated side weekly until the result of the cultures was negative or
the colony count was less than that of the normal side. RESULTS: The mean time
of normalization was 4.5 weeks (range, 3-8 weeks). The time of normalization was
significantly related to the type of organisms (p = 0.04) and the colony count
(p < 0.001). The mean time of normalization was 3.5 weeks in patients with a
colony count <10 and 4.93 weeks in patients with a colony count > or =10. The
time of normalization was significantly related to the presence of a silicone
tube (p < 0.0001). The mean time of normalization was 6.2 weeks and 3.9 weeks in
patients with and without a silicone tube, respectively. CONCLUSION: A few weeks
is needed for the conjunctival flora to normalize after dacryocystorhinostomy.
The time of normalization is related to the type of bacteria, colony count, and
presence of silicone tube.

PMID: 19300159 [PubMed - in process]

18: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):134-5. 

Rectangular 3-snip punctoplasty outcomes: preservation of the lacrimal pump in
punctoplasty surgery.

Chak M, Irvine F.

Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Headley Way,
Headington, Oxford, UK. melchak@hotmail.com

PURPOSE: To report a method of rectangular 3-snip punctoplasty (2 vertical cuts
at either side of the vertical canaliculus and 1 cut at the base). Outcomes are
compared with the more conventional and anatomically destructive 3-snip
triangular punctoplasty (1 cut at the vertical canaliculus, 1 cut at the
horizontal canaliculus, and 1 cut at the base). METHODS: Retrospective review of
all eyes undergoing 3-snip punctoplasty between January 1, 2003 and January 8,
2005. RESULTS: Seventy-five patients were eligible for this study. One hundred
eight eyes with patent punctum and lacrimal systems prior to surgery underwent
punctoplasty (49 rectangular and 59 triangular punctoplasty). Follow-up of 8
days to 2.3 years (mean, 0.68 years). Ages ranged between 16.8 and 99.8 years
(mean, 69.5 years). Forty-five patients (60%) were women. There was a trend for
patients to be symptomatic postoperatively despite patent punctum and lacrimal
systems following triangular (10 of 59, 16.9%) than those who underwent
rectangular punctoplasty (5 of 49, 10.2%) although this difference was not
significant (difference in proportions = 0.05; CI: -17.635 to 17.645; p = 0.99).
CONCLUSIONS: This study showed that there were more failures in eyes with
triangular punctoplasty. Previous studies have shown that the punctae and
canaliculi are important in normal lacrimal drainage. Rectangular punctoplasty
is a simple, safe, and quick procedure that maintains the normal anatomy and
physiology of the canalicular system, while maintaining a patent punctum and
should be considered as a less destructive alternative to the traditional
triangular punctoplasty.

PMID: 19300158 [PubMed - in process]

19: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):130-3. 

Enucleation with hydroxyapatite implantation versus evisceration plus scleral
quadrisection and alloplastic implantation.

Tari AS, Malihi M, Kasaee A, Tabatabaie SZ, Hamzedust K, Musavi MF, Rajabi MT.

Department of Ophthalmology, School of Medicine, Medical Sciences/Tehran
University, Tehran, Iran.

PURPOSE: To compare the motility and complications of enucleation with
evisceration plus scleral quadrisection. METHODS: In a prospective study between
January 2006 and June 2007, 50 patients underwent evisceration with scleral
quadrisection and alloplastic implantation (group 1) and 50 patients underwent
enucleation and hydroxyapatite implantation (group 2). Horizontal and vertical
excursions of implants and complications such as exposure or extrusion and deep
superior sulcus deformity were evaluated postoperatively. RESULTS: After a mean
follow-up interval of 11.5 months for group 1 and 13.2 months for group 2,
vertical measurements were approximately 20% less than horizontal measurements
in both groups. The mean horizontal and vertical movements in group 2 were
significantly less than in group 1 (p < 0.001). There was 1 case of small
hydroxyapatite exposure in group 2 (1 in 50; 2%) and 2 cases of implant
extrusion in group 1 (4%) (p = 0.50). Deep superior sulcus deformity was noted
in 10 patients in group 1 (20%) and 7 patients in group 2 (14%) (p = 0.43).
Analysis of covariance in both groups showed that age, gender, and follow-up
interval were not predictors of movement in either direction (all p-values
>0.05). CONCLUSIONS: Evisceration with scleral quadrisection and alloplatic
sphere implantation can effectively substitute for a more extensive procedure
such as enucleation in patients with painful blind eyes, cosmetically
unacceptable blind eyes, and medically uncontrolled endophthalmitis. It provides
rapidity, ease, and better implant excursion and lower cost of the implants
compared with their porous counterparts.

PMID: 19300157 [PubMed - in process]

20: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):126-9. 

Visual outcomes in patients with paranasal mucoceles.

Loo JL, Looi AL, Seah LL.

Singapore National Eye Centre, Singapore. loo.jing.liang@singhealth.com.sg

PURPOSE: To describe the ophthalmic complications and visual outcome of patients
with paranasal mucoceles. METHODS: This is a retrospective case series of
patients with a diagnosis of paranasal mucocele. Their medical records were
examined with particular emphasis on the location of the paranasal mucoceles,
presence of inflammation (mucocele vs. pyelocele), presence of optic neuropathy,
and final visual outcome. RESULTS: Ten patients with an average age of 57.6
years (range, 30-71 years) were studied. Seven mucoceles were in the frontal or
fronto-ethmoidal sinuses, one was in the sphenoidal sinus, one was within an
Onodi cell, and one was in the maxillary sinus. Four patients developed optic
neuropathy, of which 2 cases were related to fronto-ethmoidal mucoceles. Four
patients had pyeloceles. Two of these 4 patients had resultant loss of light
perception: one case was associated with a fronto-ethmoid sinus and the other
with an Onodi cell). CONCLUSIONS: Our series highlights the greater risk of
optic neuropathy and poor visual outcome with sphenoid sinus and Onodi cell
mucoceles because of their proximity to the optic nerve. However,
fronto-ethmoidal mucoceles are not benign and may compromise vision, especially
if a posterior ethmoid component is present, or if treatment is delayed and
secondary infection has ensued to form a pyelocele. Management of paranasal
mucoceles should be prompt, particularly when signs of inflammation are present.

PMID: 19300156 [PubMed - in process]

21: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):123-5. 

Hess area ratio and diplopia: evaluation of 30 patients undergoing surgical
repair for orbital blow-out fracture.

Grenga PL, Reale G, Cofone C, Meduri A, Ceruti P, Grenga R.

Department of Ophthalmology, University of Rome La Sapienza, Rome, Italy.
plgrenga@hotmail.it

PURPOSE: To determine if the Hess area ratio is effective in predicting
postoperative diplopia in patients undergoing surgery for orbital blow-out
fracture. METHODS: Our retrospective, interventional case series study involved
30 consecutive cases affected by orbital fractures and diplopia undergoing
surgical correction within 7 days after injury. To evaluate ocular motility
disturbance, we measured the involved ocular motility range by use of a manual
Hess screen test before and 4 months after surgery. The percentage of Hess area
ratio % was used to express the range of ocular motility in a numerical value.
RESULTS: All patients with preoperative Hess area ratio >85% had no
postoperative diplopia, and most patients (57%) having a preoperative Hess area
ratio <65% had postoperative diplopia. When the Hess area ratio was between 65%
and 85%, surgical outcomes were variable and most patients (55%) described no
problematic diplopia in the peripheral visual field. CONCLUSIONS: The Hess area
ratio is a useful procedure to convert Hess graphic representation in a
numerical value so that Hess chart data can be compared among clinicians and
used to predict surgical outcomes in patients undergoing surgery for orbital
blow-out fractures.

PMID: 19300155 [PubMed - in process]

22: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):119-22. 

Use of Lorenz titanium implants in orbital fracture repair.

Chang SH, Custer PL, Mohadjer Y, Scott E.

Department of Ophthalmology, Washington University in St. Louis, Missouri 63110,
USA.

PURPOSE: To present the experience and outcomes of orbital fracture repair using
Lorenz titanium orbital implants in one tertiary care center. METHODS: Five-year
retrospective chart review of 55 patients who underwent orbital fracture repair
with Lorenz titanium orbital implants since 2002. The following data were
recorded: age; gender; mechanism of injury; prior fracture repair; concomitant
ocular injuries; time elapsed between injury and surgery; and preoperative and
postoperative visual acuity, diplopia, extraocular motility, and Hertel
exophthalmometry. All patients underwent preoperative CT. Operative data
included surgical approach, type of Lorenz implant used, duration of surgery,
and presence of extraocular muscle entrapment. Length of follow-up and
complications were also recorded. RESULTS: Of those undergoing primary repair,
diplopia in primary gaze was present in 29.3% of patients preoperatively and 0%
postoperatively. Severe, moderate, and mild motility restriction in any gaze
direction were 5.5%, 14.5%, and 34.5% preoperatively and decreased to 0%, 1.8%,
and 7.3% postoperatively. Although only 14.3% of primary repair patients had
full extraocular motility prior to surgery, this number increased to 80% after
surgical repair. More than 80% of patients achieved symmetry within 1 mm by
Hertel exophthalmometry. The authors did not encounter instances of implant
extrusion, infection, or eyelid malposition during follow-up. CONCLUSIONS:
Orbital fracture repair using Lorenz titanium orbital implants provides reliable
and reproducible stabilization of orbital wall defects, while offering
outstanding functional and cosmetic results comparable with other alloplastic
materials.

PMID: 19300154 [PubMed - in process]

23: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):115-8. 

Photodynamic therapy using methyl aminolevulinate acid in eyelid basal cell
carcinoma: a 5-year follow-up study.

Puccioni M, Santoro N, Giansanti F, Ucci F, Rossi R, Lotti T, Menchini U.

Department of Oto-Neuro-Ophthalmological Surgical Sciences, Eye Clinic,
University of Florence, Florence, Italy.

PURPOSE: To evaluate retrospectively the long-term results of methyl
aminolevulinate photodynamic therapy for the treatment of eyelid basal cell
carcinoma. METHODS: Sixteen consecutive patients with eyelid basal cell
carcinoma were treated with methyl aminolevulinate photodynamic therapy between
January 2002 and April 2003. Selection criteria were tumors located at least 3
mm from the tarsus, surgery not indicated because of poor general health, and
recurrences with unclear location definition. Patients were treated with an 80-J
cm light-emitting diode light source (632 nm) after topical application of
methyl aminolevulinate cream and occlusion for 4 hours. Data were available for
follow-up at day 1, week 1, month 1, and every 6 months for 5 years. RESULTS:
The mean number of photodynamic therapy session per patient was 3.1 (range, 2-6)
Complete clinical recovery was observed after the 5-year follow-up in 13 of 16
patients (82%). Two patients did not respond at all to treatment and 1 patient
presented with recurrence after 3 years of tumor-free follow-up. Tolerance of
treatment was good with few side effects. CONCLUSIONS: The absence of
complications, good tolerance, and a notable success rate make this nonsurgical
procedure promising for the treatment of basal cell carcinoma of the eyelid in
selected patients.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300153 [PubMed - in process]

24: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):111-4. 

Selective embolization and resection of a large noninvoluting congenital
hemangioma of the lower eyelid.

Ooi KG, Wenderoth JD, Francis IC, Wilcsek GA.

Department of Ophthalmology, Prince of Wales Hospital, University of New South
Wales, Sydney, Australia.

PURPOSE: To present a combined interventional radiologic and resection technique
for the management of a large amblyogenic, highly vascular lesion of the lower
eyelid associated with severe mechanical ectropion, conjunctival pyogenic
granuloma, and recurrent, spontaneous conjunctival bleeding. METHODS:
Preoperative selective embolization and coil placement were followed by
resection of the tumor. RESULTS: Embolization, coil placement, and resection
were uneventful with cosmetic and functional visual improvement obtained.
Pathology indicated a noninvoluting congenital hemangioma. CONCLUSIONS: To the
authors\' knowledge, this is the first surgical technique reported in the
ophthalmic literature for the selective embolization of a noninvoluting
congenital hemangioma prior to its resection. Such a technique should be
considered in the management of large lesions of this type.

PMID: 19300152 [PubMed - in process]

25: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):109-10. 

Infection rates in outpatient eyelid surgery.

Lee EW, Holtebeck AC, Harrison AR.

Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota,
USA.

PURPOSE: The authors used the database of eyelid surgeries performed at the
Phillips Eye Institute in Minneapolis, MN, to help determine the infection rate
in outpatient eyelid surgery. METHODS: The authors retrospectively reviewed the
reported cases of infections after all eyelid surgeries performed between
January 1, 1999 and December 31, 2004 at the Phillips Eye Institute in
Minneapolis, MN. RESULTS: Of a total of 2,227 patients who underwent
oculoplastic procedures, there was only one reported infection (0.04%).
CONCLUSIONS: The infection rate in outpatient eyelid surgery is extremely low.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300151 [PubMed - in process]

26: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):103-8. 

Clinical characterization and blepharoptosis surgery outcomes in Hispanic New
Mexicans with oculopharyngeal muscular dystrophy.

Allen RC, Jaramillo J, Black R, Sandoval D, Morrison L, Qualls C, Carter KD,
Nerad JA.

Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals
and Clinics, Iowa City, Iowa, USA. richardcutlerallen@hotmail.com

PURPOSE: To clinically characterize blepharoptosis in Hispanic New Mexicans with
oculopharyngeal muscular dystrophy and examine eyelid surgery outcomes. METHODS:
A retrospective noncomparative case series and retrospective, nonrandomized,
comparative interventional case series was performed on medical records from 86
patients. Main outcome measures included preoperative correlations between
margin reflex distance, palpebral fissure height, levator function, and age and
postoperative change in palpebral fissure height and time to reoperation for
recurrent blepharoptosis after blepharoplasty, levator advancement, or frontalis
sling surgery. RESULTS: Preoperative measurements between the right and left eye
were symmetrical with respect to margin reflex distance, palpebral fissure
height, and levator function (all p < 0.001). There were correlations between
age and margin reflex distance, palpebral fissure height, and levator function
(all p < or = 0.02). There was no gender difference detected with respect to
age, margin reflex distance, palpebral fissure height, and levator function (p >
0.39). Eighty-three patients underwent eyelid surgery. As initial surgery, 15
underwent blepharoplasty, 17 levator advancement, and 51 frontalis suspension.
Overall, 93.3% of blepharoplasty patients, 47.1% levator advancement patients,
and 7.84% undergoing frontalis suspension had additional surgery for recurrent
ptosis (rates differed, p < 0.001). Postoperative change for palpebral fissure
height was 0.33 +/- 1.83 mm OD and 1.1 +/- 0.86 mm OS for levator advancement
and 2.63 +/- 1.34 mm OD and 2.68 +/-1.47 mm OS for frontalis suspension (p =
0.03, OD and p = 0.004, OS). CONCLUSIONS: Oculopharyngeal muscular dystrophy in
Hispanic New Mexicans is a symmetrical, progressive disease that affects men and
women similarly. Frontalis suspension is an effective primary surgery with
respect to upper eyelid elevation, need for reoperation, and time to reoperation
in this patient population.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 19300150 [PubMed - in process]

27: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):99-102. 

Comparison of fibrin sealant versus suture for wound closure in Muller
muscle-conjunctiva resection ptosis repair.

Kavanagh MC, Ohr MP, Czyz CN, Cahill KV, Perry JD, Holck DE, Foster JA.

Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio, USA.
mcheung26@yahoo.com

PURPOSE: To compare fibrin sealant (Tisseel) versus suture for wound closure in
Muller muscle-conjunctiva resection ptosis repair. METHODS: The charts of 114
patients (211 eyelids) who had undergone Muller muscle-conjunctiva resection
were retrospectively reviewed. Suture versus Tisseel were used for wound
closure. Preoperative and postoperative eyelid measurements, postoperative
symmetry within 0.5 mm, and complications were compared. RESULTS: Muller
muscle-conjunctiva resection ptosis repair was performed on 211 eyelids of 114
patients. Seventeen cases were unilateral and 97 cases were bilateral. Method of
wound closure included suture (45 eyelids of 31 patients) versus Tisseel (166
eyelids of 83 patients). For the suture group, the mean preoperative MRD1 was
1.2 mm and the postoperative MRD1 was 3.0 mm; the difference was 1.9. For the
Tisseel group, the mean preoperative MRD1 was 1.2 mm and the postoperative MRD1
was 3.0 mm; the difference was 1.8. The 2 groups did not differ statistically in
preoperative (p = 0.97) or postoperative MRD1 values (p = 0.53), the difference
(p = 0.63), or postoperative symmetry within 0.5 mm (p = 0.39). In the suture
group, complications included moderate to severe pain (10%), suture granuloma
(6%), corneal abrasion (3%), loose suture (3%), and persistent keratopathy (3%).
We found no evidence of keratopathy attributable to the Tisseel (p = 0.0001).
This difference in the prevalence of complications was statistically significant
(p = 0.0001). Four patients in the suture group (13%) underwent subsequent
procedures including suture granuloma removal (2) and suture removal (1); 1
patient (3%) required levator resection. Three patients in the Tisseel group
(4%) subsequently underwent levator resection. CONCLUSIONS: Muller
muscle-conjunctiva resection ptosis repair using fibrin sealant for wound
closure offers comparable eyelid position results compared with suture. Use of
Tisseel showed fewer postoperative complications and was associated with fewer
subsequent surgical procedures.

PMID: 19300149 [PubMed - in process]

28: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):94-8. 

Addition of dermis-fat graft to diminish cable visibility in frontalis
suspension for patients with pre-existing deep superior sulci.

Proffer PL, Czyz CN, Cahill KV, Kavanagh MC, Everman KR, Burns JA, Foster JA.

The Eye Center of Columbus/Grant Medical Center, Columbus, Ohio, USA.

PURPOSE: To propose and demonstrate a technique modification for frontalis
suspension to simultaneously address ptosis and diminish abnormalities related
to deep superior sulcus defect. METHODS: Six patients underwent simultaneous
frontalis suspension and placement of a superior sulcus dermis-fat graft.
RESULTS: Postoperative visibility of the cables, anticipated in patients with
deep superior sulci, was prevented in these 6 patients. CONCLUSIONS: Dermis-fat
grafting may be added to improve cosmesis after frontalis suspension in patients
at risk for postoperative cable visibility.

PMID: 19300148 [PubMed - in process]

29: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):90-3. 

Upper eyelid ptosis surgery using a preparatory ocular prosthesis.

Mombaerts I, Groet E.

Orbital Clinic, Department of Ophthalmology, University Hospitals Leuven,
Belgium. ilse.mombaerts@uz.kuleuven.ac.be

PURPOSE: When an ocular prosthesis is unable to correct upper eyelid ptosis,
surgery is performed with the existing prosthesis, which may be difficult and
unsatisfactory. We used an alternative approach, in which the prosthesis was
modified as a preparation to surgery. METHODS: This retrospective,
noncomparative, interventional case series included 26 anophthalmic and 3
microphthalmic patients with unilateral, moderate to severe upper eyelid ptosis
who underwent levator aponeurosis surgery via an anterior approach. Excluded
were cases of congenital anophthalmos, contracted socket, and neurogenic ptosis.
Before surgery, the prosthesis was modified to vertically align the pupils while
neglecting the position of the upper eyelid. The outcome measures were palpebral
fissure height and cosmetic appearance. RESULTS: The amount of ptosis before the
procedure ranged from 1 to 6 mm (mean, 3 mm). After surgery, 24% (7 of 29) of
patients received a minor adjustment to the preparatory prosthesis to improve
the pupil or eyelid position. After the entire procedure, the ptosis was
symmetrically corrected with the contralateral eye in 19 patients (66%), with 1
mm of residual ptosis in 6 patients (17%), and with 2 mm of residual ptosis in 4
patients (14%). No overcorrection was seen. CONCLUSION: The alternative sequence
of a preparatory prosthesis before surgery provides good results in the
correction of moderate to severe ptosis.

PMID: 19300147 [PubMed - in process]

30: Ophthal Plast Reconstr Surg. 2009 Mar-Apr;25(2):85-9. 

Full-thickness eyelid resection in the treatment of secondary ptosis.

Bassin RE, Putterman AM.

Department of Ophthalmology, University of Illinois-Chicago, Chicago, Illinois,
USA.

PURPOSE: To describe horizontal full-thickness eyelid resection for the
treatment of ptosis as related to overcorrections after levator recession for
eyelid retraction in Graves disease or repeatedly failed external levator
advancement. METHODS: The authors present a retrospective case study of 19
eyelids of 17 patients with refractory ptosis. Patients were selected based on
history of horizontal full-thickness eyelid resection to treat ptosis secondary
to over-recessed Muller and levator muscles, persistent ptosis after levator
advancement/resection, or persistent ptosis after internal levator advancement.
Results were graded from eyelid measurements taken before and at least 6 weeks
after treatment. RESULTS: All eyelids were measured preoperatively and
postoperatively for the following parameters: palpebral fissure in primary gaze
nasally (N), centrally (C), and temporally (T); upper eyelid margin to light
reflex distance in primary gaze; upper eyelid margin to crease distance; and
upper eyelid margin to fold distance. Final postoperative measurements were
taken at a minimum of 2 months. Thirteen eyelids had a history of previous
Muller muscle excision/levator recession, 3 eyelids had a history of previous
levator advancement/resection, 2 eyelids had previous internal levator
advancement, and 1 eyelid had previous cosmetic eyelid surgery. All 17 patients
were women. Patients ranged in age from 41 to 63 years. All patients had
cosmetically and functionally satisfactory results. CONCLUSIONS: Horizontal
full-thickness eyelid resection is a unique procedure that can provide an
excellent result for patients with residual ptosis with no recurrence of ptosis
during an average of 2 to 3 months follow-up.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov\'t

PMID: 19300146 [PubMed - in process]