1: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Congenital Blepharoptosis Co-occurring With VATER Association.

Ichinose A, Nomura K, Murakami H, Tahara S.

*Department of Plastic Surgery, Kobe University, Graduate School of Medicine;
and daggerDepartment of Ophthalmology, Hyogo Prefectural Kobe Children's
Hospital, Kobe, Japan.

VATER association is the tendency for 5 specific anomalies (vertebral and
vascular anomalies [V], anal atresia [A], esophageal atresia and/or
tracheoesophageal fistula [TE], and radial and renal anomalies [R]) to occur
together in one individual. Recently, malformations and abnormalities, other
than those of diagnostic criteria of VATER association, have been considered
significant for clarifying the nature of VATER association and for establishing
guidelines for the treatment of infants with VATER association because they are
supposed to be determinants of prognosis. Malformations associated with the eye
have, however, scarcely been highlighted in VATER association, although several
occurrences have been reported. The authors describe the first case of
congenital blepharoptosis co-occurring in a patient with VATER association. The
co-occurrence of several malformations in the ipsilateral face and hand of the
patient were indicative of their arising from the congeneric pathogenesis.
Surgical repair of the blepharoptosis was carried out by eyebrow suspension with
fascia lata when the patient was 5 years old; a favorable outcome was achieved
in both function and aesthetics.

PMID: 20639790  [PubMed - as supplied by publisher]

2: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

An Endoscopic Approach for the Management of Congenital Lacrimal Fistulae.

Ross JJ, Patel V, Malhotra R.

Queen Victoria Hospital, East Grinstead, United Kingdom.

A 26-year-old male presented with left epiphora from a congenital lacrimal
fistula. A dacryocystogram confirmed fistulous origin from the lacrimal sac,
while syringing demonstrated coexisting partial nasolacrimal duct obstruction.
Endoscopic dacryocystorhinostomy was performed with marsupialization of the
lacrimal sac medial wall, facilitating direct visualization of the internal
fistula origin on the lateral wall, and excision with a 3-mm punch biopsy
trephine over a cannula guide. Postoperatively, his symptoms resolved with a
minimal cutaneous scar. The authors present this modified surgical technique for
fistula excision using an endoscopic dacryocystorhinostomy approach.

PMID: 20639789  [PubMed - as supplied by publisher]

3: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Chitosan-Based Hemostatic Dressing in Dacryocystorhinostomy Surgery.

Wiwanitkit V.

PMID: 20639788  [PubMed - as supplied by publisher]

4: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Re: "Palpebral Spring in the Management of Lagophthalmos and Exposure
Keratopathy Secondary to Facial Nerve Palsy"

Levine RE, Fay A.

PMID: 20639787  [PubMed - as supplied by publisher]

5: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

MDM2-Positive Atypical Lipomatous Neoplasm/Well-Differentiated Liposarcoma
Versus Spindle Cell Lipoma of the Orbit.

Jakobiec FA, Nguyen J, Bhat P, Fay A.

*Cogan Ophthalmic Pathology Laboratory and daggerOphthalmic Plastic &
Reconstructive Surgery Service, Massachusetts Eye & Ear Infirmary, Boston,
Massachusetts, U.S.A.

PURPOSE:: To distinguish, in a 36-year-old man, an atypical lipomatous
neoplasm/well-differentiated liposarcoma from a spindle cell lipoma in a
recurrent orbital tumor. METHODS:: Clinical, radiographic, and histopathologic
evaluations coupled with immunohistochemical studies for CD34, factor XIII,
bcl-2, S-100, muscle-specific actin, Ki-67, and MDM2. RESULTS:: MDM2 gene
amplification was discovered in the CD34 tumor cells. An average Ki-67
proliferation index of 28% was ascertained for the original and recurrent
lesions. These findings established the diagnosis of a well-differentiated
liposarcoma with lipoma-like and spindle cell features and ruled out a spindle
cell lipoma. CONCLUSION:: Well-differentiated liposarcoma is a slow growing,
infiltrative, and nonmetastasizing neoplasm that is microscopically and
diagnostically challenging. It can be reliably separated from a benign spindle
cell or an atypical lipoma by using the markers MDM2 and Ki-67.

PMID: 20639786  [PubMed - as supplied by publisher]

6: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Isolated Cavernous Hemangioma of Conjunctiva.

Malik A, Bhala S, Arya SK, Narang S, Punia RP, Sood S.

Departments of *Ophthalmology and daggerPathology, Government Medical College
and Hospital, Chandigarh, India.

A 70-year-old Indian female presented with a lobulated, violet-colored mass in
the left eye involving the medial bulbar conjunctiva and caruncle. It was
smooth, vascular, compressible, and freely mobile. It was neither reducible nor
pulsatile and did not cause any proptosis or dystopia. Any syndromic
associations and orbital extension of the lesion were ruled out. Excisional
biopsy was performed, and histopathologic examination confirmed the diagnosis of
cavernous hemangioma of conjunctiva involving the caruncle.

PMID: 20639785  [PubMed - as supplied by publisher]

7: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Customized Jones Tube Using a Surgical Drill.

Lo K, Nguyen J, Fay A.

Department of Ophthalmology, Harvard Medical School, Ophthalmic Plastic and
Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston,
Massachusetts, U.S.A.

Conjunctivorhinostomy with Jones tube placement is performed in cases of
canalicular destruction. The glass tube is positioned between the inferomedial
conjunctival cul-de-sac and the middle nasal meatus. There is a broad range of
potential tube lengths, but it is very difficult to estimate tube size
preoperatively. Therefore, a large selection of tube sizes and shapes must be
maintained. Nevertheless, the optimal tube is occasionally not available. The
authors describe a method in which a longer Jones tube can be shortened in the
operating room to the desired length using a standard high-speed drill.

PMID: 20639784  [PubMed - as supplied by publisher]

8: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Bilateral Spontaneous Subperiosteal Orbital Hemorrhages Following Endoscopic
Retrograde Cholangiopancreatography.

Russell DJ, Dutton JJ.

Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel
Hill, North Carolina, U.S.A.

Spontaneous subperiosteal orbital hemorrhage is rare. The authors describe a
case of acute bilateral eyelid swelling, eyelid ptosis, and double vision in a
patient immediately following endoscopic retrograde cholangiopancreatography. CT
revealed bilateral subperiosteal orbital hemorrhages. The patient demonstrated
no signs of optic nerve compromise, and the hemorrhages resolved spontaneously
without sequela. Previous reports in the literature have documented
subperiosteal hemorrhages following increased intracranial venous pressure,
coagulopathies, and prone positioning during procedures. To the authors'
knowledge, subperiosteal orbital hemorrhages have not been previously described
following endoscopic retrograde cholangiopancreatography. Ophthalmologists and
gastroenterologists should be aware of this potential complication associated
with this procedure.

PMID: 20639783  [PubMed - as supplied by publisher]

9: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Pseudodacryocystitis and Nasolacrimal Duct Obstruction Secondary to Ethmoiditis.

Yazc B, Yazc Z.

Departments of *Ophthalmology and daggerRadiology, Uludag University, Bursa,
Turkey.

A 23-year-old woman presented with clinical symptoms suggestive of acute
dacryocystitis. She had no history of epiphora, and her lacrimal drainage system
was patent on irrigation. CT findings were consistent with anterior ethmoiditis
and maxillary sinusitis. Although the symptoms responded to antibiotic
treatment, they recurred 2 times within the following 5 months. During the last
episode, a complete obstruction of the nasolacrimal duct developed. The
condition did not recur after external dacryocystorhinostomy and anterior
ethmoidectomy during a follow-up of 21 months. Ethmoiditis may rarely cause a
localized infection in the lacrimal sac region mimicking dacryocystitis.
Recurrent infections may progress to complete obstruction of the nasolacrimal
duct.

PMID: 20639782  [PubMed - as supplied by publisher]

10: Ophthal Plast Reconstr Surg. 2010 Jul 15; [Epub ahead of print] 

Retention Rate of Silicone Punctal Plugs Placed by Residents in a General Clinic
Setting.

Parikh NB, Francis JH, Latkany RA.

New York Eye and Ear Infirmary, New York, New York, U.S.A.

PURPOSE:: To evaluate the retention rate of silicone punctal plugs placed in
patients with dry eye in a general clinic setting by ophthalmology residents.
METHODS:: A cohort study reviewing charts of 88 patients who underwent punctal
plug placement in the resident clinic at The New York Eye and Ear Infirmary from
January 2007 to November 2008. Information recorded included age and sex of the
patients, date of insertion, initial versus replacement plug, type and size of
plug, location of insertion, and retention versus spontaneous extrusion versus
removal of plugs at follow-up visits. Follow-up data were recorded at 30 and 60
days. RESULTS:: Follow-up data for 106 plug placements were available at 30
days. A total of 71.7% were retained, 23.6% were lost, and 4.7% were removed. At
60 days, data were available for 96 plug placements. A total of 50.0% were
retained, 47.9% were lost, 5.2% had been removed prior to 60 days, and 2.1% had
been replaced prior to 60 days. CONCLUSION:: Spontaneous extrusion is a common
complication in punctal plug insertion, and the retention rate in a general
clinic setting with ophthalmology residents is low. This may suggest that
attention should be placed on improved instruction in placement techniques and
sizing, better patient education on avoidance of rubbing, and importance of
follow-up. It may also support the need for better designed plugs or considering
alternatives to the silicone plugs, or the placement of such plugs in a
dedicated punctal plug clinic under supervision of an experienced attending
physician.

PMID: 20639781  [PubMed - as supplied by publisher]

11: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

A Technique for Capturing Migratory Periocular Worms: A Case Series and Review
of Literature.

Tse BC, Siatkowski R, Tse DT.

*University of Miami Miller School of Medicine, Miami, Florida; daggerDean McGee
Eye Institute, University of Oklahoma School of Medicine, Oklahoma City,
Oklahoma; and double daggerBascom Palmer Eye Institute, University of Miami
Miller School of Medicine, Miami, Florida, U.S.A.

PURPOSE:: To describe the clinical presentation of migratory nematodes and to
outline a simple strategy to ensure capture. METHODS:: Retrospective case
series. RESULTS:: Two consecutive patients with suspected migratory nematodes
were treated promptly by strategic placement of a pharmacological barrier in the
forniceal conjunctiva using 1% lidocaine with epinephrine to block the routes of
retreat and to immobilize the worms for controlled retrieval. Two live nematode
worms, one subcutaneous dirofilaria and one subconjunctival Loa loa, were
successfully removed. CONCLUSIONS:: A sense of urgency is conveyed to isolate
the migratory worm while it is still visible and residing in a location for easy
surgical removal. The retreat of the worm to the deeper, inaccessible orbit is
prevented by strategic placement of a perimeter of anesthetic.

PMID: 20622701  [PubMed - as supplied by publisher]

12: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Surgical Microanatomy of the Muller Muscle-Conjunctival Resection Ptosis
Procedure.

Marcet MM, Setabutr P, Lemke BN, Collins ME, Fleming JC, Wesley RE, Pinto JM,
Putterman AM.

Departments of *Surgery and daggerPathology, University of Chicago; double
daggerDepartment of Ophthalmology, University of Illinois, Chicago, Illinois;
section signDepartment of Ophthalmology, University of Wisconsin, Madison,
Wisconsin; parallelHamilton Eye Institute, University of Tennessee, Memphis; and
paragraph signVanderbilt University Eye Institute, Nashville, Tennessee, U.S.A.

PURPOSE:: To assess for alterations in the microscopic anatomy that occur as a
result of the Muller muscle-conjunctival resection (MMCR) ptosis procedure and
to better understand the mechanisms by which MMCR elevates the eyelid. METHODS::
Sixteen orbits from 8 fresh frozen Caucasian cadaver heads, ranging from 38 to
100 years of age were used. For each head, MMCR was performed on one side. The
contralateral, unoperated orbit served as an anatomic control. Each exenterated
orbital contents and excised MMCR specimen was evaluated. The histopathology of
the eyelids and MMCR specimens were studied microscopically by staining with
hematoxylin-eosin, elastic, and Verhoeff-Masson trichrome. RESULTS:: Muller
muscle and conjunctiva were present in all 8 of the excised MMCR specimens.
Elastic fibers consistent with Muller muscle tendon or among the smooth muscle
fibers were seen within all excised MMCR specimens. The levator aponeurosis was
intact in 8 of 8 operated eyelids; however, the aponeurosis was plicated in all.
The accessory lacrimal gland tissues were intact in all of the operated and
unoperated eyelids. CONCLUSIONS:: MMCR works by shortening the posterior
lamella, which results in advancement of the levator palpebrae superioris muscle
and plication of the levator aponeurosis. Plication of the levator aponeurosis
likely contributes to the increased volumetric effect seen clinically after
MMCR. Phenylephrine testing can help in fine-tuning the amount of resection, but
given the mechanism of action of MMCR, adequate levator muscle function remains
a critical factor in the success of the surgery. Moreover, MMCR preserves
accessory lacrimal gland tissues.

PMID: 20622700  [PubMed - as supplied by publisher]

13: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Ophthalmic Plastic and Reconstructive Surgery (OPRS) Fellowships: Assessment and
Comparative Data From the 2009 Specialties Matching Service.

Dewan MA, Meyer DR.

Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College,
Slingerlands, New York, U.S.A.

INTRODUCTION:: Among specialty fellowships available in the United States,
matching in ophthalmic plastic and reconstructive surgery (OPRS) is widely
thought of as an exceptionally competitive process. There are articles
discussing fellowship selection and competition in other fields of medicine;
however, little information is available in the peer review literature regarding
the process for OPRS. METHODS:: In this study, the authors evaluate match
statistics, available from the National Resident Matching Program, for the class
of fellows with appointments for training beginning in 2009. These statistics
are compared with the 36 other advanced specialty training programs, in a wide
range of medical and surgical fields, also participating in the Specialties
Matching Service. RESULTS:: OPRS fellowships are 1 of only 5 specialties that
filled all available positions in the 2009 match and 1 of only 3 programs to
fill all available positions in each of the past 4 years. In addition, 88.9% of
positions were filled by U.S. graduates, the highest among all programs (range =
5.0%-88.9%, mean = 54.8%). Of those applicants who matched, OPRS fellowships had
the lowest percentage of applicants, 22.9%, match at their first choice program
among single specialty matches (range = 22.9%-75.0%). A total of 48.6% of OPRS
applicants did not match-the highest among single specialty matches and the
second highest among all programs, including combined specialty matches (range =
4.3%-53.5%). CONCLUSIONS:: OPRS fellowships are among the most selective
advanced specialty positions available in the United States. Among all specialty
programs participating in the Specialties Matching Service, OPRS fellowships
have nearly the highest unmatched applicant rate, highest U.S. graduate fill
rate, and lowest first-choice match rate. These statistics indicate that the
applicant pool is competitive and that both applicants and program directors
(preceptors) are selective with their rankings. The authors believe these
findings will be of interest to residents interested in further training in OPRS
and to program directors, chairs, and others involved in the specialist
educational process.

PMID: 20622699  [PubMed - as supplied by publisher]

14: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Amniotic Membrane in Medial Canthal Reconstruction.

Harris MA, Vidor IA, Sivak-Calcott J.

West Virginia University Eye Institute, Morgantown, West Virginia, U.S.A.

Amniotic membrane grafts have been used in various ophthalmic procedures,
including corneal surface restoration, pterygium excision, and conjunctival
reconstruction. The authors used amniotic membrane in a more extensive manner,
as a component of medial canthal reconstruction in 4 patients. These grafts were
placed over large areas of exposed sclera and orbital fat. Patients were
followed up between 1 month and 5 years. Retrospective data were collected,
including diagnosis, length of follow-up, extent of excision, preoperative and
postoperative visual acuity, motility, subjective diplopia, surface keratopathy,
Hertel exophthalmometry, upper eyelid position, and subjective tearing. Each
patient had good functional and cosmetic results, with 2 patients reporting only
mild diplopia in peripheral gaze. Amniotic membrane is useful in reconstructing
large medial canthal defects involving exposed sclera and orbital soft tissue.

PMID: 20622698  [PubMed - as supplied by publisher]

15: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Hypertrichosis of the Upper Cheek Area Associated With Travoprost Treatment of
Glaucoma.

Ortiz-Perez S, Olver JM.

Oculoplastic and Orbital Service, Western Eye Hospital and the Eye Department,
Charing Cross, London, United Kingdom.

Travoprost is a prostaglandin analog used in the treatment of open-angle
glaucoma. This drug is safe and efficacious and has a low incidence of systemic
and local side effects. Common local side effects are conjunctival hyperemia,
iris pigmentation, and hypertrichosis of the eyelashes. The authors present a
case of a patient who developed marked hypertrichosis of the cheek vellus 3
months after starting treatment with travoprost.

PMID: 20622697  [PubMed - as supplied by publisher]

16: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

The Use of Fibrin Tissue Glue in the Repair of Cicatricial Ectropion of the
Lower Eyelid.

Osborne SF, Eidsness RB, Carroll SC, Rosser PM.

Ophthalmology Department, Greenlane Clinical Centre, Auckland, New Zealand.

PURPOSE:: To evaluate the effectiveness of full-thickness skin graft adhesion
using fibrin tissue glue (TISSEEL) in cicatricial ectropion repair of the lower
eyelid. METHOD:: This study was a prospective case series. Nine eyes of 8
consecutive patients with cicatricial ectropion were included. All patients
underwent a conjunctival approach lower eyelid retractor plication, lateral
tarsal strip, and insertion of a full-thickness skin graft secured with TISSEEL.
Symptoms of epiphora, eye and eyelid irritation, discharge, and graft size were
recorded pre- and postoperatively. RESULTS:: All of the patients were satisfied
with their postoperative appearance, and the symptoms of eye and eyelid
irritation, discharge, and visual disturbance were eliminated. Fifty-five
percent of patients had complained of watering some or all of the time
preoperatively, whereas only 33% admitted to occasional watering
postoperatively. The average size of the graft reduced by 18% at 1 week, 39% at
1 month, and 40% at 3 months from the initial size. CONCLUSIONS:: Fibrin tissue
glue used to attach a full-thickness skin graft during cicatricial ectropion
repair is an effective technique and may offer additional benefits over sutured
graft fixation. Most of the reduction in graft size occurred in the first
postoperative month, which indicates that the time window for modulation of the
graft is in the first few weeks after surgery. The vertical graft length was
affected to a greater extent than the horizontal length.

PMID: 20622696  [PubMed - as supplied by publisher]

17: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Phosphatidylcholine for the Treatment of Prominent Lower Eyelid Fat Pads: A
Pilot Study.

Tawfik HA, Zuel-Fakkar N, Elmarasy R, Talib N, Elsamkary M, Abdallah MA.

Departments of *Ophthalmology and daggerDermatology, Ain-Shams University,
Cairo, Egypt; and double daggerDepartment of Ophthalmology, Selayang hospital,
Selangor, Malaysia.

PURPOSE:: To find out whether the off-label use of Lipostabil is as effective as
advertised for the nonsurgical treatment of bulging lower eyelid fat pads.
METHODS:: This is a pilot, randomized, placebo-controlled, double-blind,
comparative, single-center study. Participants were 45 patients with full lower
eyelids who were injected with 0.5 ml of Lipostabil in one eyelid and 0.5 ml of
isotonic saline in the opposite lower eyelid as a control. Inclusion criteria
were healthy adults older than 25 years. Exclusion criteria included patients
with a known bleeding tendency or bleeding disorder and patients addicted to
"antiwrinkle" products. The main outcome measures were reduction of lower eyelid
fat pads and the occurrence of ocular or systemic side effects. RESULTS:: The
pre- and postinjection pictures of the 23 patients who completed the study were
examined by 3 masked observers. They failed to differentiate the Lipostabil from
the saline-injected eyelids or even the pretreatment from the posttreatment
pictures in the majority of patients. CONCLUSIONS:: Mesotherapy is hailed in the
media as the most exceptional discovery since the introduction of botulinum
toxin. Unfortunately, we failed to observe any improvement in appearance or
reduction of fullness after multiple injections. Further studies are needed to
determine whether Lipostabil is indeed ineffective for the management of eyelid
fullness or the dose the authors used has to be increased.

PMID: 20622695  [PubMed - as supplied by publisher]

18: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Large Particle Hyaluronic Acid Gel for the Treatment of Lower Eyelid Retraction
Associated With Radiation-Induced Lipoatrophy.

Peckinpaugh JL, Reddy HS, Tower RN.

Department of Ophthalmology, University of Washington, Seattle, Washington,
U.S.A.

A 42-year-old female with a remote history of a left maxillary sinus tumor
treated with excision and radiation therapy was referred for dry eye symptoms.
Ophthalmic examination revealed left-sided exposure keratopathy, lagophthalmos,
lower eyelid retraction, and fat atrophy of inferior periorbital tissue with
associated hollowing. Large particle hyaluronic acid gel was injected to expand
and reinforce the lower eyelid. After treatment, there was significant
improvement in lagophthalmos, inferior scleral show, and periorbital hollowing.
Excellent symmetry with the fellow eye was achieved. The patient reported
markedly reduced dry eye symptoms. No adverse side effects were observed. The
use of large particle hyaluronic acid gel shows promise as a novel nonsurgical
therapy in the management of lower eyelid retraction associated with
radiation-induced lipoatrophy. Additionally, large particle hyaluronic acid gel
may provide better soft tissue expansion and retention than small particle
hyaluronic acid gel, increasing the longevity of treatment.

PMID: 20622694  [PubMed - as supplied by publisher]

19: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Why Optic Gliomas Should be Called Hamartomas.

Parsa CF.

PMID: 20622693  [PubMed - as supplied by publisher]

20: Ophthal Plast Reconstr Surg. 2010 Jul 12; [Epub ahead of print] 

Presumed Primary Orbital Neuroblastoma in a 20-Month-Old Female.

Zhang N, Lin LK.

Department of Ophthalmology, University of California, Davis, Sacramento,
California, U.S.A.

Neuroblastoma is the most common malignant disease of childhood, and it often
arises from either the adrenal gland or along the sympathetic chain. The authors
report a case of a 20-month-old female with a presumed primary neuroblastoma of
the orbit. Radiologically, the tumor showed a brightly enhancing mass lesion of
the left side with intraorbital, temporal extraorbital, transsphenoid, and
intracranial components. Histopathologically, the tumor was composed of small
round blue cells. Immunohistochemical staining was positive for neuron-specific
enolase. To the best of the authors' knowledge, primary orbital neuroblastoma
has only been previously reported once in children, although it has been
reported twice in adults.

PMID: 20622692  [PubMed - as supplied by publisher]

21: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Spectrum of Orbital Disease in South India: An Aravind Study of 6328 Consecutive
Patients.

Kim UR, Khazaei H, Stewart WB, Shah AD.

*Orbit and Oculoplasty Services, Aravind Eye Hospital, Madurai, Tamil Nadu,
India; and daggerInstitute for Health & Healing California Pacific Medical
Center, San Francisco, California, U.S.A.

AIM:: To review the incidence of orbital diseases in South India and to compare
with other case series published. METHODS:: Retrospective review of 6328
consecutive patients with orbital disease evaluated at Aravind Eye Hospital
between January 1997 and December 2008. The main outcome measure was incidence
of orbital disease in South Indian population, as determined by clinical and
histopathologic criteria. A literature review was conducted to compare the
results of this study with those of previously published reports. RESULTS:: Of
the 6328 patients, 2161 (34.1%) had inflammatory orbital disease, 1965 (31.0%)
had systemic conditions involving the orbit, 1277 (20.1%) had neoplasm, 600
(9.4%) had congenital lesions, 308 (4.8%) had trauma, and 17 (0.2%) had vascular
disease. Of the 2161 patients presenting with inflammatory disease, 1473 (68.1%)
had idiopathic orbital inflammation, 270 (12.5%) had infection, 126 (5.8%) had
dacryoadenitis, and 292 (13.5%) had other etiologies. Among the 1965 patients
presenting with systemic disease involving the orbit, 1938 (98.6%) were
diagnosed with thyroid orbitopathy, 22 (1.1%) with amyloidosis, and 5 (0.2%)
with sarcoidosis. Of the 1277 patients with neoplasm, the tumor was vascular in
369 (28.8%), neural in 336 (26.3%), lymphoid or leukemic in 131 (10.2%),
secondary neoplasm in 82 (6.4%), epithelial in 68 (5.3%), adipose in 53 (4.1%),
metastatic in 39 (3.0%), and fibrous, fibro-osseous, striated muscle,
histiocytic, and other cellular origin in 40 (3.1%), 37 (2.8%), 23 (1.8%), 21
(1.6%), and 78 (6.1%), respectively. Of the 600 patients with congenital
lesions, 427 (71.1%) had dermoid and 170 (28.3%) had dermolipoma, followed by
meningoencephalocele. CONCLUSIONS:: The most common causes of orbital disease in
South India are inflammatory (34.1%) and systemic conditions (31.0%). With the
exception of higher incidence of inflammatory etiologies, these data are largely
consistent with prior published reports.

PMID: 20592641  [PubMed - as supplied by publisher]

22: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Kindler Syndrome Causing Severe Cicatricial Ectropion.

Lelli GJ Jr.

Division of Oculoplastic Surgery, Department of Ophthalmology, Weill Cornell
Medical College, New York, New York, U.S.A.

A 32-year-old female with Kindler syndrome presented with a 5-year history of
lower eyelid malposition, corneal exposure, and recurrent erosions. Severe
anterior lamellar cicatricial changes were noted bilaterally, with bilateral
lower eyelid ectropion and retraction. Tarsal eversion was noted on the left
lower eyelid. The patient had repeatedly failed conservative treatments for
keratopathy and was treated surgically, with resolution of corneal disease and
improved lower eyelid position. A review of Kindler syndrome is provided, geared
toward the oculoplastic surgeon who may participate in the care of these
patients.

PMID: 20592640  [PubMed - as supplied by publisher]

23: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

The Study of Anatomic Relationship Between the Muller Muscle and the Tarsus in
Asian Upper Eyelid.

Ahn HB, Oh HC, Roh MS, Ryu WY, Lee DY, Rho SH, Park WC, Jeung WJ.

Departments of *Ophthalmology and daggerPathology, College of Medicine, Dong-A
University, Busan, Korea.

PURPOSE:: This study was performed to clarify the detailed anatomic relationship
between the insertion of Muller muscle and the tarsus in Asian upper eyelids.
MATERIALS AND METHODS:: Eight upper eyelids of 4 formalin-fixed Asian cadavers
(4 males; age range, 48-69 years; mean age, 60.2 years) were examined. Three
perpendicular dissected sections with a 2-mm thickness were obtained from each
eyelid. One section was obtained from the midline, and another 2 sections were
obtained, each 3-mm from the lateral and medial ends of the tarsus,
respectively. Samples were stained with hematoxylin-eosin, Masson trichrome, and
antismooth muscle actin antibody and examined microscopically. RESULTS:: Muller
muscle did not insert directly in the tarsus. However, its muscle tissues were
tapered to the superior margin of the tarsus, and the space between the Muller
muscle and the tarsus was bridged by fibrous connective tissue strands.
Meanwhile, according to a result that measured distance between the Muller
muscle insertion and the tarsus, the insertion of Muller muscle was positioned
closer in the tarsus at the midline section than at the lateral or medial
sections. CONCLUSIONS:: This study suggests that the Muller muscle is broadly
distributed around the superior border of the tarsus as tapered, aggregated
smooth muscle bundles without direct insertion on the superior border of the
tarsus, despite a few limitation.

PMID: 20592639  [PubMed - as supplied by publisher]

24: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

The Ethmoidal Sinus Roof: Anatomical Relationships With the Intracranial Cavity.

Takahashi Y, Kakizaki H, Nakano T, Asamoto K, Selva D, Leibovitch I.

Departments of *Ophthalmology and daggerAnatomy, Aichi Medical University,
Nagakute, Aichi, Japan; double daggerSouth Australian Institute of Ophthalmology
and Discipline of Ophthalmology and Visual Sciences, University of Adelaide,
South Australia, Australia; and section signDivision of Oculoplastic and Orbital
Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv
University, Tel-Aviv, Israel.

A detailed understanding of the relationship between the ethmoidal sinus and the
intracranial cavity is essential to prevent intracranial penetration during
orbital surgery. The authors analyzed 10 postmortem orbits with their adjacent
skull bases of 5 Asian cadavers (3 males and 2 females; mean age of 80 years at
death). After removing all orbital contents, skull and brain, the medial orbital
wall, ethmoidal cells, and ethmoidal roof were also removed. From the
intracranial cavity view, the ethmoidal roof was situated just lateral to the
cribriform plate. From the orbital view, the location of the roof was close to
the superior border of the medial orbital wall. These anatomical observations
may be useful to prevent intracranial penetration and cerebrospinal fluid
leakage during medial orbital wall decompression.

PMID: 20592638  [PubMed - as supplied by publisher]

25: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Investigation of Anthropometric Measurements of Anatomic Structures of Orbital
Soft Tissue in 102 Young Han Chinese Adults.

Wu XS, Jian XC, He ZJ, Gao X, Li Y, Zhong X.

Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People's Republic of China.

PURPOSE:: The aim is to measure and investigate the anatomic structures of
orbital soft tissue and the relationships between the adjacent regions in 102
normal young Han Chinese adults using a computer-assisted photography system to
provide reference data for periocular cosmetic and reconstructive surgery.
METHODS:: A random sample of 102 Han young Chinese adults (53 males and 49
females) aged from 18 to 25 years in Changsha, Hunan Province, was obtained.
Standard digital images were taken and then processed using Image-Pro Plus 6.0
software. The linear and angular measurements, including intercanthal distance,
outer canthal distance, palpebral fissure width (PFW), palpebral fissure height
(PFH), orbit height (OH), upper lid height, lower lid height, nasal eyebrow
height, central eyebrow height, temporal eyebrow height, reference line to
lateral canthus'inclination of palpebral fissure, were measured. The
proportional indices, including intercanthal distance/outer canthal distance,
PFH/PFW, PFH/OH, OH/PFW, upper lid height/OH, lower lid height/OH, nasal eyebrow
height/OH, central eyebrow height/OH, and temporal eyebrow height/OH, were
investigated. RESULTS:: Means and standard deviations of all the items had been
obtained and differences between male and female subjects were assessed.
CONCLUSIONS:: The normal measurement values of anatomic structures of orbital
soft tissue and the proportional indices for normal young Han Chinese adults
provided reference data for periorbital cosmetic and reconstructive surgery.

PMID: 20592637  [PubMed - as supplied by publisher]

26: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Anatomy-Based Surgical Concepts for Individualized Orbital Decompression Surgery
in Graves Orbitopathy. I. Orbital Size and Geometry.

Kamer L, Noser H, Schramm A, Hammer B, Kirsch E.

*AO Research Institute Davos, Davos Platz, Switzerland; daggerDepartment of Oral
and Maxillofacial Surgery, Plastic and Esthetic Facial Surgery, Military
Hospital Ulm, Academic Hospital, University of Ulm, Ulm, Germany; and double
daggercfc hirslanden Cranio Facial Center, Hirslanden Medical Center, Aarau,
Switzerland.

PURPOSE:: To analyze orbital morphological parameters that potentially could
influence the effect of decompression surgery on exophthalmos reduction in
Graves orbitopathy, thus making decompression surgery more predictable.
METHODS:: To generate a reference database, a CT-based study was performed in
140 orbits obtained from adult patients with unaffected orbits in a European
white ethnicity. The following parameters were chosen: orbital volume, globe
volume, globe to orbital volume ratio, and orbital cone angle. Volumes were
measured on postprocessed CT data using morphometric techniques. To define the
cone angle, a 3-dimensional approach was chosen using the program Amira.
RESULTS:: Significant interindividual variation was found in orbital volume from
18.9 to 33.4 ml and in globe volume from 6.0 to 10.1 ml. The globe to orbital
volume ratio showed a relatively broad variation from 0.25 to 0.4. Differences
in the orbital cone angle from 39.7 degrees to 65.7 degrees were observed.
CONCLUSION:: The experienced large variations in orbital morphology might
significantly influence the degree of exophthalmos reduction, which can be
obtained by standardized decompression procedures. Based on our results, a
prospective clinical study will be conducted to test our hypothesis.

PMID: 20592636  [PubMed - as supplied by publisher]

27: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Hypertrophic Changes of the Lower Eyelid Margin After Hughes Procedure for
Eyelid Reconstruction: The Management and Outcomes.

Luu ST, Cannon PS, Selva D.

Discipline of Ophthalmology and Visual Sciences, University of Adelaide and
South Australian Institute of Ophthalmology, Adelaide, Australia.

PURPOSE:: To describe the management of lower eyelid margin hypertrophy as a
complication of the Hughes procedure for eyelid reconstruction. METHODS:: A
retrospective review of all patients with lower eyelid hypertrophy after Hughes
procedure. Patient demographics, management, histologic findings, and outcomes
were recorded. The patients underwent wedge excision of the hypertrophic segment
of the eyelid with direct closure achieved in the majority of cases. RESULTS::
Five patients were identified. The mean age at presentation was 66 years. The
mean onset for the hypertrophic margin was 8.4 weeks after the Hughes flap. Four
patients complained of ocular irritation and 1 patient had a constant ocular
discharge. All patients were concerned by the appearance of the eyelid margin.
Four patients received topical steroid treatment and 4 patients underwent
triamcinolone subcutaneous injections with no improvement. The wedge excision
was successful in 4 patients at the mean follow-up of 10 months, with no
recurrence of the hypertrophic margin. One patient was reviewed in another
center. CONCLUSION:: The authors found no beneficial effect with topical or
subcutaneous courses of steroids on eyelid margin hypertrophy. In situations of
horizontal eyelid laxity, a full-thickness wedge excision offers a good means of
removing the offending eyelid segment.

PMID: 20592635  [PubMed - as supplied by publisher]

28: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Fellowship Selection Criteria in Ophthalmic Plastic and Reconstructive Surgery.

Meyer DR, Dewan MA.

Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical Center, Albany,
New York, U.S.A.

INTRODUCTION:: Competition for subspecialty fellowship positions in
ophthalmology continues to grow, and there is increasing interest regarding the
factors considered important in fellowship selection. While a previous report
evaluated the characteristics and criteria used by ophthalmology subspecialty
program directors to select fellows in retina, cornea/external disease, and
glaucoma fellowship programs, to the authors' knowledge no such study has
evaluated Ophthalmic Plastic and Reconstructive Surgery (OPRS) fellowships.
METHODS:: The authors surveyed the program directors of all American Society of
Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)-sponsored fellowships in
the United States and Canada. The survey contained 16 criteria related to the
selection of fellows. A Likert scale ranging from 1 (not important) to 9 (very
important) was used for prioritizing the criteria. Opportunity was afforded for
comment on other measures, and program directors were also asked to select their
most important factor used for fellow selection. RESULTS:: The return rate of
the completed surveys was 35 of 48 (73%). The 3 criteria with the highest mean
Likert scale scores were the interview process (8.7), the ability to work and
communicate with others (8.5), and letters of recommendation from subspecialty
faculty (7.8). Likewise, the criterion selected as the single most important by
respondents was the interview (58%), the ability to work and communicate with
others (15%), and letters of recommendation from subspecialty faculty (15%).
CONCLUSIONS:: The authors' findings demonstrate that OPRS program directors
place greater emphasis on qualities assessed during the interview, letters of
recommendation from same specialty faculty, and the ability of the applicant to
work and communicate with others. While not identical, our findings were similar
to those noted for other ophthalmology subspecialties. The results support the
suggestion that residents interested in fellowship training may benefit from
faculty mentors in their area of interest early in their training. With the high
interest in OPRS and other ophthalmology subspecialty fellowship training, the
authors hope that this report will be useful to applicants, residency programs,
and fellowship directors.

PMID: 20592634  [PubMed - as supplied by publisher]

29: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Experience With a Medpor-Coated Tear Drain.

Wojno T.

Department of Ophthalmology, The Emory Clinic, Atlanta, Georgia, U.S.A.

PURPOSE:: To determine the results with a Medpor-coated tear drain in
conjunctivodacryocystorhinostomy. METHODS:: This was a retrospective case review
of all patients who underwent conjunctivodacryocystorhinostomy with a
Medpor-coated tear drain by the author. The success rate and complications were
determined. RESULTS:: Sixteen patients had placement of 17 Medpor-coated tear
drains. Twelve of the 16 patients (75%) were doing well at the last follow-up
visit with a well-positioned, functioning tear drain tube. Four patients (25%)
required tube removal for assorted reasons, 2 of whom had an early prototype of
the tube. CONCLUSION:: The Medpor-coated tear drain is an effective device for
bypass of the lacrimal drainage system in conjunctivodacryocystorhinostomy. The
current design of the tube should minimize complications while ensuring stable
placement and retention.

PMID: 20592633  [PubMed - as supplied by publisher]

30: Ophthal Plast Reconstr Surg. 2010 Jun 29; [Epub ahead of print] 

Efficacy of Endoscopic Lacrimal Duct Recanalization Using Microendoscope.

Javate RM, Pamintuan FG, Cruz RT Jr.

*Orbital and Oculofacial Plastic Surgery Section, Department of Ophthalmology
and daggerDepartment of Otolaryngology, University of Santo Tomas Hospital,
Sampaloc, Manila, Philippines.

PURPOSE:: To describe a new endoscopic procedure to restore the passage of tears
in an obstructed lacrimal drainage system and to compare its efficacy with the
standard external dacryocystorhinostomy (SE-DCR). METHODS:: Patients with
complete and partial primary acquired nasolacrimal duct obstruction (PANDO) were
randomly allocated to 2 treatment groups using completely randomized design. The
first group was treated using endoscopic lacrimal duct recanalization (ELDR),
while the second group was treated using SE-DCR. Follow-up was conducted for at
least 6 months and evaluated for anatomical and functional patency.
Complications were also noted for both groups. RESULTS:: A total of 86 patients
underwent ELDR, 60 of whom had complete PANDO, while 26 patients had partial
PANDO. Eighty patients underwent SE-DCR; 58 had complete PANDO, and 22 had
partial PANDO. The combined success rate in terms of anatomical patency for ELDR
was 93.02% (95% confidence interval [CI], 0.88-98) compared with 93.75% (95% CI,
0.87-90) for SE-DCR (p = 0.85). Meanwhile, the combined success rate (functional
patency) for ELDR is 84.88% (95% CI, 0.77-93) versus 90.00% (95% CI, 0.83-97)
for SE-DCR (p = 0.32). CONCLUSIONS:: ELDR using microendoscope is as efficacious
as SE-DCR, without its associated major complications.

PMID: 20592632  [PubMed - as supplied by publisher]