1: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):68-9. 

Intolerance of jones tube placement in a patient using continuous positive
airway pressure.

Longmire MR, Carter KD, Allen RC.

Publication Types:
    Letter

PMID: 20090502  [PubMed - in process]

2: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):68. 

Watery epiphora after uncomplicated phacoemulcification.

Detorakis ET, Tsilimbaris MK.

Publication Types:
    Letter

PMID: 20090501  [PubMed - in process]

3: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):67; author reply 67. 

Re: "surgical treatment of familial dacryocystocele and lacrimal puncta
agenesis".

Allen RC, Nerad JA.

Publication Types:
    Comment
    Letter

PMID: 20090500  [PubMed - in process]

4: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):64-6. 

Idiopathic inflammatory pseudotumor of the eyelid.

Abrishami M, Bagheri A, Salour H, Aletaha M, Abrishami A, Parsafar H, Torbati P.

Shahid Beheshti University of Medical Sciences, Tehran, Iran.
labbafi@hotmail.com

A 40-year-old male presented with swelling and erythema in his right upper
eyelid that began 4 months prior. Clinical evaluation, rheumatologic serology,
sedimentation rate of erythrocyte, and C-reactive protein results were all
normal. The patient also did not respond to local and systemic antibiotic
therapy. Incisional biopsy revealed a pseudotumor. Oral prednisolone was
initiated, and the drug dose was slowly tapered according to the patient's
clinical response. After 6 months of follow-up, the eyelid lesion disappeared
entirely.

PMID: 20090498  [PubMed - in process]

5: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):63-4. 

Ultratine breakage.

Savar A, Shore J.

Section of Ophthalmology, Department of Head and Neck Surgery, University of
Texas MD Anderson Cancer Center, Houston, Texas, USA.

Both Endotines and Ultratines are made of polymers of polylactic acid and
polyglycolic acid and are used in brow elevation procedures. Ultratines appear
to be much more likely to break during loading and insertion than Endotines. The
authors report our experience with these devices and offer suggestions to
decrease the likelihood of breakage.

PMID: 20090497  [PubMed - in process]

6: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):61-3. 

Primary ocular presentation of sinonasal undifferentiated carcinoma.

Parbhu KC, Galler KE, Murphy BA, Pitchford CW, Mawn LA.

Department of Ophthalmology, University of Alabama, Birmingham, Alabama, USA.
keshini.parbhu@yahoo.com

The authors describe 2 consecutive patients who presented to Vanderbilt
University Medical Center with primary orbital presentation of sinonasal
undifferentiated carcinoma and were treated from July 2005 to April 2009. The
patients were a 39-year-old woman and 54-year-old woman who both presented to
the ophthalmology service due to complaints of diplopia. Imaging studies
demonstrated large soft tissue masses originating in the sinuses with extension
in the orbit in both cases. Both patients were treated with carboplatin,
paclitaxel, and dexamethasone as induction chemotherapy followed by concurrent
chemoradiation with intensity-modulated radiation therapy. This treatment
regimen resulted in significant tumor shrinkage, resolution of symptoms, and no
evidence of recurrence while avoiding surgical intervention and allowing orbital
preservation.

PMID: 20090496  [PubMed - in process]

7: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):59-61. 

Lupus miliaris disseminatus faciei of the eyelids: report of two cases.

Liao W, Jolly SS, Brownstein S, Jordan DR, Gilberg S, Prokopetz R.

University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, Ontario,
Canada.

Lupus miliaris disseminatus faciei is a rare chronic, asymptomatic papular
eruption, most commonly affecting the central face, including the eyelids. Our 2
patients presented with the typical clinical findings of small papular lesions
in which histopathologic examinations disclosed granulomatous inflammation with
necrosis associated with inflamed hair follicles. Except for its description as
acne agminata by Duke-Elder in 1974, to the authors' knowledge, this condition
has not been reported previously in the ophthalmic literature.

PMID: 20090495  [PubMed - in process]

8: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):57-9. 

Diffuse bilateral orbital inflammation in Churg- Strauss syndrome.

Pradeep TG, Prabhakaran VC, McNab A, Dodd T, Selva D.

South Australian Institute of Ophthalmology and Discipline of Ophthalmology and
Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide,
South Australia. thanugopal@yahoo.co.in

A 33-year-old man was diagnosed with asthma and within 5 weeks developed
bilateral periocular swelling. Examination revealed bilateral axial proptosis
with conjunctival nodules. His blood tests revealed a positive p-antineutrophil
cytoplasmic autoantibody with significant eosinophilia. MRI of the orbit showed
enlarged extraocular muscles, lacrimal glands, and infiltrative changes in the
orbital fat. Biopsy demonstrated granulomatous inflammation with eosinophil
predominance. A diagnosis of diffuse bilateral inflammation in Churg-Strauss
syndrome was made and the patient responded dramatically to prednisolone with
resolution of systemic and orbital findings. The second case was a 72-year-old
woman with a prolonged prodromal phase of asthma, paranasal sinus disease, and
bilateral orbital involvement by a process consistent with reactive lymphoid
hyperplasia on initial biopsy. Three years later she developed rapidly worsening
orbital disease, marked peripheral eosinophilia, and orbital biopsy showed
evidence of granulomatous inflammation with marked eosinophil infiltration and
vasculitic changes, and a weakly positive antineutrophil cytoplasmic
autoantibody. Hence, diffuse bilateral orbital inflammation occurring in the
setting of asthma and peripheral eosinophilia should raise the possibility of
Churg-Strauss syndrome and warrants biopsy as early institution of therapy can
reduce both systemic and ophthalmic complications.

PMID: 20090494  [PubMed - in process]

9: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):54. 

Corneal graft dehiscence during swinging eyelid orbital decompression.

Moesen I, Van Cleynenbreugel H, Paridaens D.

Department of Oculoplastic and Orbital Surgery, The Rotterdam Eye Hospital,
Rotterdam, The Netherlands.

A 68-year-old man with Graves orbitopathy underwent a bilateral swinging eyelid
orbital decompression for disfiguring proptosis. A penetrating keratoplasty for
keratoconus of the left eye had been performed 13 years earlier. Prior to
orbital decompression, biomicroscopy of the left eye showed a partially
decompensated sutureless corneal graft with good wound apposition. The corneal
stroma appeared edematous, and some epithelial bullae were seen. During orbital
wall removal, the corneal wound dehisced for 270 degrees. Swinging eyelid
orbital decompression is the technique of choice in the Netherlands for
proptosis reduction in Graves orbitopathy. However, spatula pressure on the eye
during surgery may cause rupture of the graft-host interface in eyes with
previous corneal surgery such as penetrating keratoplasty.

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

PMID: 20090493  [PubMed - in process]

10: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):54-6. 

Sinonasal adenoid cystic carcinoma presenting as an orbital mass.

Kwon RO, Lyon DB, Floyd M, Girod DA.

Eye Foundation of Kansas City and Vision Research Center, University of
Missouri-Kansas City School of Medicine, Truman Medical Center, Kansas City,
Missouri 64108, USA.

A 61-year-old man with a history of sinus polyposis and prior sinus surgery
presented with left-sided retrobulbar pain and headache. He was found to have
left-sided proptosis, and imaging studies showed a large left medial orbital
soft-tissue mass. Incisional biopsy revealed adenoid cystic carcinoma. Further
evaluation revealed extensive sinonasal adenoid cystic carcinoma. The patient
underwent en bloc maxillectomy with orbital exenteration and partial rhinectomy,
followed by radiation therapy. The medial orbit is an unusual location for
adenoid cystic carcinoma, which the authors believe was a secondary
manifestation due to perineural spread from the sinuses via the ethmoidal
nerves. Adenoid cystic carcinoma should be included in the differential
diagnosis of tumors of the medial orbit, especially if there is a history of
sinonasal disease.

PMID: 20090492  [PubMed - in process]

11: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):52-3. 

Conjunctival squamous cell carcinoma in situ in the anophthalmic socket.

Barrett RV, Meyer DR, Carlson JA.

Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical Center, Albany,
New York 12159, USA. rhondavbarrett@hotmail.com

A 58-year-old man who had his left eye enucleated at the age of 26 after
sustaining ocular trauma presented secondary to an inability to tolerate his
prosthesis. Examination revealed upper and lower eyelid cicatricial entropion
with areas of symblephara and conjunctival scarring causing forniceal
shortening. No areas suspicious for malignancy were noted. Surgical correction
was performed, and a segment of the conjunctiva sent for pathology revealed
squamous cell carcinoma in situ. Map biopsies of the conjunctiva were
subsequently performed, with no further areas of malignancy identified. The
patient has been followed with close clinical surveillance, with no evidence of
any recurrent suspicious areas within the conjunctiva. This case report confirms
that squamous cell carcinoma in situ may occur in an anophthalmic socket and be
managed conservatively, reserving the need for orbital exenteration for more
invasive disease.

PMID: 20090491  [PubMed - in process]

12: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):50-2. 

Eyelash growth after enucleation and evisceration surgery.

Williams ZY, Richard M, Stinnett SS, Woodward JA.

Department of Ophthalmology, Duke University School of Medicine, Durham, North
Carolina, USA. zywyzmd@gmail.com

Acquired eyelash hypertrichosis is associated with medications, systemic
diseases, and ocular inflammation. The authors present a study showing that
eyelash length is significantly longer following enucleation and evisceration
surgery compared with the contralateral side. This may be related to factors
involved in postoperative conjunctival and orbital inflammation and healing.

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

PMID: 20090490  [PubMed - in process]

13: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):48-50. 

Epibulbar schwannoma in a 17-year-old boy and review of the literature.

Demirci H, Shields CL, Eagle RC Jr, Shields JA.

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

A healthy, 17-year-old boy presented with a 2-month history of an epibulbar mass
on the left eye. Slit lamp examination showed an amelanotic, translucent, round,
well-circumscribed, superonasal subconjunctival nodule. On ultrasound
biomicroscopy, the tumor was acoustically hollow. The lesion was excised intact,
and cryotherapy was applied to the surrounding conjunctiva. Histopathologic
examination revealed a tumor composed of spindle cells with slender cytoplasmic
processes and bland cigar-shaped nuclei, consistent with schwannoma.
Immunohistochemistry showed positivity for S100 protein. The patient had no
signs of neurofibromatosis. There was no tumor recurrence after 18 months. This
case shows that conjunctival schwannoma can present as a translucent,
well-circumscribed subconjunctival mass.

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

PMID: 20090489  [PubMed - in process]

14: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):46-8. 

Hemangiopericytoma-solitary fibrous tumor of the eyelid.

Kakizaki H, Maden A, Ture M, Yilmaz S, Chan WO.

Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
cosme@d1.dion.ne.jp

The authors report a rare case of hemangiopericytoma-solitary fibrous tumor of
the eyelid. A 35-year-old male presented with approximately 1-year history of a
painless and slow growing mass on his right lower eyelid, which rapidly grew in
size over the last few months. The size of the lesion and the location resulted
in secondary mechanical ectropion at presentation. The tumor was excised and was
found to be a "hemangiopericytoma-solitary fibrous tumor" based on both
histopathological and immunohistochemical examinations. Immunohistochemically,
the tumor was positive for CD34 and Vimentin but negative for S100 protein and
smooth muscle actin. Although initial tumor removal was complete, the patient
required a subsequent operation for his residual ectropion. Despite the lesion
being large at presentation, surgical intervention resulted in good functional
and cosmetic outcome.

PMID: 20090488  [PubMed - in process]

15: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):44-6. 

White-eyed medial wall orbital blowout fracture.

McInnes AW, Burnstine MA.

Eyesthetica Oculofacial and Cosmetic Surgery Associates, Santa Monica,
California, USA. awmcinnes@gmail.com

The white-eyed orbital floor blowout fracture is most commonly seen in children
and adolescents. The orbital floor is the most common fracture location with
entrapment of inferior orbital contents and/or the inferior rectus muscle in a
"trapdoor" fashion. Other sites may also be fractured either simultaneous to the
floor or in isolation. The authors describe an isolated orbital medial wall
fracture with entrapment of the medial rectus muscle in an adolescent and
discuss treatment options.

PMID: 20090487  [PubMed - in process]

16: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):43-4. 

Lime burns resulting in total conjunctival defect, enucleation, and fused
eyelids.

Qin W, Liu M.

Oculoplastic and Orbital Division, Southwest Eye Hospital/Southwest Hospital,
Third Military Medical University, Chongqing 400038, China. weiqin0707@163.com

A rare case of right eye lime burns resulting in total conjunctival defect,
enucleation, and fused eyelids is reported. This article describes total
conjunctival sac reconstruction using a split-thickness skin graft combined with
a spherical orbital implant, which may be a good choice for treating such a
disorder.

PMID: 20090486  [PubMed - in process]

17: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):42-3. 

Maternal skin allograft for cicatricial ectropion in congenital icthyosis.

Das S, Honavar SG, Dhepe N, Naik MN.

Division of Ophthalmic Plastic Surgery, LV Prasad Eye Institute, Hyderabad,
India.

A 6-month-old infant with congenital icthyosis was brought to the authors with
bilateral cicatricial ectropion of the upper and lower eyelid with resultant
exposure keratopathy. Skin autograft was not possible due to generalized skin
involvement, leading to unavailability of a donor site. A maternal skin
allograft was performed for both eyelids of each eye. Prior human leukocyte
antigen typing was not done, and postoperative immunosuppressive agents were not
given. At 10 months' follow-up, the graft was well accepted, and the ectropion
was corrected.

PMID: 20090485  [PubMed - in process]

18: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):39-41. 

Buccal mucous membrane graft-assisted lacrimal drainage surgery.

Tao JP, Luppens D, McCord CD.

Department of Ophthalmology, University of California, Irvine, California 92697,
USA. j.tao@uci.edu

PURPOSE: Dacryocystorhinostomy (DCR) success may depend on mucous membrane
alignment across the osteotomy and entire surgical lacrimal outflow conduit.
Scar tissue, obliteration of the lacrimal sac, and obstruction at the level of
the common canaliculus may result from prior surgery or may occur as an isolated
problem. We describe and evaluate the efficacy of a technique of grafting
autologous buccal mucous membrane during external DCR in cases complicated by
scarring and/or common canalicular obstruction. METHODS: We retrospectively
reviewed 11 nasolacrimal outflow system obstructions (in 9 patients) treated
with a buccal mucous membrane graft-assisted DCR. The surgical technique is
described in detail. RESULTS: All cases presented with insufficient nasolacrimal
outflow. Ten tear ducts failed prior DCR procedures, while one case had isolated
common canalicular obstruction, resistant to multiple probing and intubation and
was previously recommended a Jones tube procedure. Three tear outflow systems
(in 2 patients) exhibited common canalicular obstruction; the rest were
obstructed at the level of the lacrimal sac. Two patients had bilateral
obstruction. Ten eyes had symptomatic epiphora. One eye had dacryocystitis
alone, and 2 eyes had dacryocystitis and epiphora. Six tear ducts had more than
one previous DCR procedure. Four tear ducts had prior endonasal DCR procedures,
while 6 had a previous external DCR. All eyes with epiphora preoperatively had
complete relief of tearing. All cases of dacryocystitis resolved with no
recurrences. Nine tear ducts were patent to irrigation testing postoperatively
(2 were not tested). CONCLUSIONS: Buccal mucous membrane grafting may improve
the success of DCR in cases complicated by scarring, mucosal shortage, and/or
common canalicular obstruction.

PMID: 20090484  [PubMed - in process]

19: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):36-8. 

Tonopen versus Goldmann applanation tonometry for detecting restrictive thyroid
eye disease.

Rahman I, Cannon PS, Sadiq SA.

Royal Manchester Eye Hospital, Manchester, United Kingdom.

PURPOSE: In thyroid eye disease (TED), intraocular pressure (IOP) measurements
are taken in both the primary and upgaze positions to elicit restrictive muscle
disease. The aim of this study was to assess whether the IOP when measured with
the eyes in upgaze (the Goldmann applanation tonometer [GAT] head applanating
the inferior/peripheral cornea) is similar when compared with the central
corneal IOP in upgaze using the Tono-Pen XL. METHODS: IOP was measured with the
GAT on the central cornea in primary gaze and on the inferior cornea in upgaze.
IOP was measured with the Tono-Pen XL in the central cornea in both primary gaze
and upgaze. The outcome measure was the difference in IOP readings between the
GAT and the Tono-Pen XL for patients with restrictive TED. RESULTS: Fifty-two
patients were included in the study; 31 patients with restrictive TED and 21
control patients. In the control group, there was no significant difference in
Tono-Pen XL and GAT readings for both primary gaze and upgaze (p = 0.99). Both
instruments detected an increase in IOP with upgaze in patients with restrictive
TED compared with controls (p = 0.0006). There was no significant difference
between the 2 instruments' readings in upgaze for patients with restrictive TED
(p = 0.39). CONCLUSIONS: Both the GAT and the Tono-Pen XL can be used to
establish IOP in patients with restrictive TED.

PMID: 20090483  [PubMed - in process]

20: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):33-5. 

Prospective randomized evaluation of short-term complications when using
buffered or unbuffered lidocaine 1% with epinephrine for blepharoplasty surgery.

Narvaez J, Wessels I, Bacon G, Chin VR, Baqai WK, Zimmerman GJ.

Department of Ophthalmology, Loma Linda University School of Medicine, Loma
Linda, CA 92350, USA. gbacon@llu.edu

PURPOSE: To determine whether there is a difference in the incidence of
short-term complications using plain lidocaine with epinephrine versus the
buffered equivalent in eyelid surgery. METHODS: The authors performed a
prospective, double-masked, randomized study in patients scheduled for combined
upper eyelid blepharoplasty and levator advancement ptosis repair surgery with
local anesthesia. Exclusion criteria included: documented allergies to lidocaine
and/or epinephrine; known pregnancy; profound cognitive impairment; inability to
understand the visual analog scale or the informed consent; and previous eyelid
surgery. Each subject was his/her own control by using the unbuffered local
anesthetic in one eye, while the buffered solution was used in the other eye.
The surgeon completed a specific standardized data collection form for
quantifying both intraoperative and postoperative complications, such as
bleeding, bruising, and edema. Data regarding pain on injection and
postoperative pain were collected from patients using a visual analog pain
scale. RESULTS: Thirty-nine patients were included in this study, of which 18
experienced less pain during the injection on the side where buffered lidocaine
was used, 11 reported no difference, and 10 reported less pain in the eye
injected with unbuffered lidocaine. Injection pain revealed a mean operative
pain rating of 4.01 +/- 2.45 in the eye with buffered lidocaine versus 4.49 +/-
2.58 in the control (p = 0.06). There were no significant differences between
the buffered and unbuffered lidocaine eyes as regards postoperative bleeding,
swelling, or pain, and there was a trend toward less pain on injection with the
buffered solution. CONCLUSIONS: There were no significant differences in
postoperative pain, swelling, or bleeding with the use of plain versus buffered
lidocaine in eyelid surgery. There was a trend for the buffered anesthetic to
cause less pain on injection.

PMID: 20090482  [PubMed - in process]

21: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):30-2. 

Orbital hyalinizing spindle cell tumor with giant rosettes.

Kim UR, Arora V, Ramchandran S, Shah AD, Phelps PO.

Orbit, Oculoplasty and Oncology Services, Drexel University College of Medicine,
Aravind Eye Hospital, Madurai, India. usha@aravind.org

PURPOSE: To evaluate the clinical and histopathologic characteristics of orbital
hyalinizing spindle cell tumor with giant rosettes (HSCTGR). METHODS:
Interventional case series of 2 patients, aged 4 and 9 years referred to the
Ocular Oncology Unit. Both patients presented with slowly progressive proptosis
with dimness of vision in the second patient. CT was performed for both patients
followed by excision of the masses. Histology was performed on tissue sections.
RESULTS: CT revealed a localized tumor in the first case and extensive mass
extending to the optic canal in the second patient. Histologic analysis revealed
features of HSCTGR with characteristic spindle-shaped cells with giant rosettes
with hyalinized foci. Tumor cells were positive for vimentin in both cases and
focal S100 positivity in first case. However, the second case showed a higher
Ki-67 index compared to the first case, suggestive of moderately high
proliferative activity. After excision, neither of the tumors demonstrated local
recurrence, and both patients were without regional or distant metastases. Mean
clinical follow-up was 12 months. CONCLUSIONS: HSCTGR involving the orbit has
not been previously reported in the literature. We report 2 cases of orbital
presentation at a much younger age than has been shown in patients with this
type of tumor in other areas of the body. Complete excision of this tumor with
close follow-up is the preferred treatment. HSCTGR should be considered in the
differential diagnosis of orbital fibrous tumor presenting as painless
progressive proptosis.

PMID: 20090481  [PubMed - in process]

22: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):26-9. 

Comparative computation of orbital volume from axial and coronal CT using
three-dimensional image analysis.

Kwon J, Barrera JE, Most SP.

Division of Facial Plastic Surgery and Reconstructive Surgery, Department of
Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
94305, USA.

PURPOSE: Volume measurements calculated from axial and coronal CT scans were
compared to determine which method more accurately determines orbital volume.
METHODS: Thirty facial CT scans were used to measure 30 normal orbits using an
image analysis program (Dextroscope, Singapore). The 3-dimensional volumes
determined from axial scans and coronal scans were analyzed. The coronal scan
volume measurements were further subdivided based on anterior limit criteria
(termed C1 and C2). Three novel cephalometric angular measurements of the
anterior orbital aperture were calculated and used to analyze the volumetric
methodologies described above. RESULTS: The calculated orbital volume was
greatest on axial scan, 25.6 +/- 2.4 ml, followed by volume based on coronal
calculations with C1 delimitation (23.8 +/- 2.9 ml) and C2 delimitation (16.6
+/- 2.2 ml). We measured 3 novel orbital aperture angles on sagittal
3-dimensional reconstruction images, anterovertical, posterovertical, and
horizontal orbital aperture angles that are related to the volume measurement
underestimation. CONCLUSION: The orbital volume from coronal scans is
underestimated compared with that from the axial scans, and the criterion for
anterior limit of measurement can affect volume determination. Three novel
cephalometric angle measurements may account for inaccuracies in orbital volume
measurements.

PMID: 20090480  [PubMed - in process]

23: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):23-5. 

Lacrimal canalicular transplantation with composite eyelid graft.

Meltzer MA, Zatezalo CC, Zoltan S.

Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
10029, USA. murray.meltzer@mssm.edu

PURPOSE: To describe a new surgical approach for secondary repair of canalicular
lacerations using a full-thickness en bloc eyelid transplantation. METHODS: This
a single case report of full-thickness en bloc eyelid transplantation. The
patient presented with symptomatic epiphora several years after traumatic
laceration of the left lower canalicular system. The canalicular system of the
right upper eyelid, including the punctum and a section of the canaliculus, was
resected and transplanted to repair a dysfunctional left lower eyelid. The
primary outcome measure was the functionality of the transplanted canalicular
system. RESULTS: The transplanted lacrimal system was patent by irrigation at
multiple visits postoperatively. In addition, the patient was asymptomatic and
was pleased with the cosmetic result. CONCLUSION: This is the first reported
case of successful canalicular transplantation. Although a single case report,
the authors anticipate future success with this technique.

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

PMID: 20090479  [PubMed - in process]

24: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):18-22. 

Social challenges of cancer patients with orbitofacial disfigurement.

Bonanno A, Esmaeli B, Fingeret MC, Nelson DV, Weber RS.

Department of Sociology, Sam Houston State University, Huntsville, Texas
77341-2446, USA. soc_aab@shsu.edu

PURPOSE: Patients who undergo orbital exenteration often experience social
problems because of their facial disfigurement. The authors studied the
interaction of cancer patients who had undergone orbital exenteration with
family members and friends (primary groups) and with acquaintances and strangers
(secondary groups) in small and large groups. METHODS: In-depth telephone
interviews were conducted with 12 patients treated at a cancer center (7 men and
5 women aged 51-81 years) and 12 family members (8 spouses and 4 children or
siblings). Three patients had adenoid cystic carcinoma of lacrimal gland, 3 had
squamous cell carcinoma of conjunctiva/eyelid, and 1 each had conjunctival
melanoma, eyelid sebaceous gland carcinoma, transitional cell carcinoma of
lacrimal sac, adenocarcinoma of orbit, neuroendocrine carcinoma of orbit, and
basal cell carcinoma of eyelid. Time from orbital exenteration to interview
ranged from 8 months to 36 years (median, 44 months). RESULTS: Two patient
groups were identified according to comfort in interactions with acquaintances
and strangers. Always comfortable patients were always at ease. Occasionally
comfortable patients were at ease in large groups in situations of "benign
neglect" and in small groups when they received "sympathy"; were uncomfortable
in large and small groups when episodes of "intrusion" occurred; and had mixed
responses to benign neglect in small groups and sympathy in large groups. Both
patient groups felt comfortable with family members and friends. CONCLUSIONS:
Patients who will undergo orbital exenteration should be warned about possible
difficulties with social interactions. Healthcare personnel should be trained to
help patients and family members prepare for such difficulties.

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

PMID: 20090478  [PubMed - in process]

25: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):14-7. 

Inferolateral migration of hydrogel orbital implants in microphthalmia.

Tao JP, LeBoyer RM, Hetzler K, Ng JD, Nunery WR.

Department of Ophthalmology, University of California, Irvine, California 92697,
USA. j.tao@uci.edu

PURPOSE: Hydrogel spheres may be useful in treating orbital hypoplasia
associated with congenital microphthalmia. The authors describe migration
associated with the use of these devices. METHODS: The authors retrospectively
reviewed 5 cases in which a hydrogel orbital expander (Osmed) was implanted to
treat orbital hypoplasia in pediatric patients with congenital microphthalmia
(with or without previous surgery). RESULTS: In all 5 cases, a lateral
orbitotomy, conjunctiva-sparing approach was used to insert the hydrogel
spheres. Two cases involved previously unoperated orbits; 3 patients had prior
orbit or socket surgery. Inferolateral movement outside the desired central,
deep orbital position occurred in all 5 cases. Four of 5 cases required further
procedures to achieve an adequate orbital implant position. CONCLUSIONS:
Inferolateral migration may occur with hydrogel spheres implanted via a lateral
orbitotomy approach in microphthalmia.

PMID: 20090477  [PubMed - in process]

26: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):11-3. 

Treatment of benign lymphoid hyperplasia of the orbit with rituximab.

Ho HH, Savar A, Samaniego F, Manning J, Kasyan A, Pro B, Esmaeli B.

Section of Ophthalmology, Department of Head and Neck Surgery, The University of
Texas M D Anderson Cancer Center, Houston, Texas 77030, USA.

Benign lymphoid hyperplasia is a disorder characterized by polyclonal
lymphocytic infiltration of orbital tissues, predominantly with B-cells.
Rituximab is a monoclonal antibody directed against CD20, a B-cell marker. Two
patients with recurrent orbital masses involving the lacrimal glands were
treated with rituximab. The diagnosis of benign lymphoid hyperplasia with
predominance of CD20 cells was confirmed in both cases based on a surgical
biopsy. Both patients had been previously treated with standard therapies,
including high-dose steroids, and one patient had failed external-beam radiation
therapy. They both responded well to treatment with intravenous rituximab.
Neither patient experienced any side effects associated with rituximab.

PMID: 20090476  [PubMed - in process]

27: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):7-10. 

Levator excursion as a predictor of both eyelid lag and lagophthalmos in thyroid
eye disease.

Lelli GJ Jr, Duong JK, Kazim M.

Weill Cornell Department of Ophthalmology, New York Presbyterian Hospital, New
York, New York 10021, USA.

PURPOSE: To evaluate the relationship between levator excursion and both eyelid
lag and lagophthalmos in thyroid eye disease. METHODS: We retrospectively
reviewed 104 eyelids of 52 thyroid eye disease patients over a 9-month interval
by measuring levator function (mm), eyelid lag (0-4+) and lagophthalmos (mm).
RESULTS: Lower levator excursion is associated with higher eyelid lag scores (p
< 0.001) and with greater degrees of lagophthalmos (p < 0.001). Both
associations were upheld after adjustment for upper eyelid margin reflex
distance and Hertel exophthalmometry (p < 0.0001). For every 1-mm decrease in
levator function, eyelid lag score increases on average by 0.29 and
lagophthalmos increases on average by 0.23 mm. CONCLUSIONS: Diminished levator
excursion is associated with increasing levels of eyelid lag and lagophthalmos.
Levator excursion is an important clinical measurement in thyroid eye disease
patients and may replace eyelid lag grading and lagophthalmos as a more accurate
indicator of eyelid retraction in thyroid eye disease.

PMID: 20090475  [PubMed - in process]

28: Ophthal Plast Reconstr Surg. 2010 Jan-Feb;26(1):1-6. 

Radiographic analysis of extraocular muscle volumetric changes in
thyroid-related orbitopathy following orbital decompression.

Hu WD, Annunziata CC, Chokthaweesak W, Korn BS, Levi L, Granet DB, Kikkawa DO.

USCD Department of Ophthalmology, University of California, San Diego School of
Medicine, La Jolla, California 92093, USA.

PURPOSE: To evaluate radiographic volume changes in extraocular muscles (EOM)
following orbital decompression for thyroid-related orbitopathy (TRO). METHODS:
Medical records of 22 orbits in 12 patients undergoing postoperative orbital CT
after orbital decompression for TRO were retrospectively reviewed. All orbits
demonstrated no signs of clinical reactivation of TRO. EOM volumes were
determined by the summation of each EOM's cross-sectional area in the coronal
plane of the CT scans and multiplying the sum by the slice thickness. Main
outcome measure was a comparison of EOM volumes preoperatively and
postoperatively. RESULTS: All orbits demonstrated proptosis reduction
postoperatively with a mean of 4.8 mm +/- 2.1 mm (p < 0.0001). The significant
increase in the medial rectus muscle (p = 0.0010) postoperatively accounted for
the primary change in the postoperative enlargement of total EOM volume (p =
0.028). The medial rectus muscle increased 27% from the preoperative volume. The
lateral rectus, superior rectus/levator complex, inferior rectus, and superior
oblique muscles did not demonstrate a significant volume increase
postoperatively (p = 0.23, 0.21, 0.17, 0.40, respectively). Two patients who
underwent unilateral orbital decompression demonstrated EOM enlargement
postoperatively in the operative orbit only. CONCLUSIONS: There is a significant
increase in medial rectus muscle volume postoperatively in orbits undergoing
orbital decompression for TRO despite lacking clinical evidence of disease
reactivation.

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

PMID: 20090474  [PubMed - in process]