B R Frueh

University of Michigan, Ann Arbor, MI, United States

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Publications (58)134.65 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the effect of orbital decompression surgery on lid retraction as a function of proptosis reduction in the setting of thyroid eye disease. Retrospective interventional case series of all consecutive medial and lateral orbital decompressions performed by the authors for thyroid eye disease from 1999 to 2008. Primary outcome measures included postoperative proptosis and lid retraction. One hundred sixty-five eyes of 89 patients were included. The average amount of proptosis reduction at final follow up (average 30 months) was 4.6 mm. The average improvement in upper lid retraction was 0.9 mm, and the average improvement in lower lid retraction was 0.8 mm. There was a statistically significant correlation (0.12, p = 0.005) between the amount of proptosis reduction and lower lid elevation. No such correlation (-0.010, p = 0.90) was seen for upper lid position. In cases where inferior rectus recession was performed subsequent to decompression surgery (n = 20), the effect of proptosis reduction on lower lid position was negated (correlation -0.01, p = 0.980). A statistically significant correlation exists between the amount of proptosis reduction from orbital decompression surgery and improvement in lower lid retraction. No such correlation exists between proptosis reduction and upper lid retraction. Inferior rectus recession negates the positive effect of orbital decompression on lower lid position.
    Ophthalmic plastic and reconstructive surgery 07/2011; 27(6):436-8. · 0.69 Impact Factor
  • Bartley R. Frueh
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    ABSTRACT: Small-incision, minimal-dissection external levator advancement results in less disruption of the eyelid retractors. Preserving many of the levator aponeurosis attachments to the tarsus results in reduced operative time and less advancement of the levator needed to achieve satisfactory results.
    12/2010: pages 175-178;
  • Hakan Demirci, Bartley R Frueh, Christine C Nelson
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    ABSTRACT: To evaluate the clinical features including eyelid excursion and management of Marcus Gunn jaw-winking synkinesis (MGJWS). Observational case series. Forty-eight consecutive patients with MGJWS. Clinical features and management of 48 patients with MGJWS were reviewed retrospectively. Upper eyelid excursion was measured and graded. Complications of surgical intervention were evaluated. Resolution of MGJWS and symmetry of upper eyelids in primary position. Excursion of the ptotic eyelid with jaw movement in MGJWS was graded as mild (<2 mm) in 16% of patients, moderate (2-4 mm) in 76% of patients, and severe (> or = 5 mm) in 8% of patients. Thirty patients with moderate or severe MGJWS underwent disabling of the involved levator muscle and bilateral or unilateral frontalis suspension and had more than 6 months of follow-up. After a mean follow-up of 62 months, MGJWS resolved in 29 (97%) patients and improved from 6 mm to 2 mm in 1 (3%) patient. Relative upper eyelid height was within 1 mm in 87% of patients in primary position and within 1 mm in 80% of patients in downgaze. Twenty-six patients had bilateral frontalis suspension with disabling of unilateral levator muscle on the involved side. Relative upper eyelid height was within 1 mm in 88% of patients in the primary position and within 1 mm in 88% of patients in downgaze. Four non-amblyopic patients had unilateral frontalis suspension with levator muscle disabling. Relative upper eyelid height was symmetrical in 75% of the patients in primary position and in 25% of patients in downgaze. Complications included eyelash ptosis in 10% of the patients, loss of eyelid crease in 10%, and entropion in 3%. Most of the patients with MGJWS exhibited moderate eyelid excursion. Disabling of the involved levator muscle and bilateral frontalis suspension and, in selected cases, disabling of the involved levator muscle and unilateral frontalis suspension were effective in the treatment of MGJWS. Eyelash ptosis and loss of eyelid crease were the most common complications, each occurring in 10% of the patients. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    Ophthalmology 02/2010; 117(7):1447-52. · 5.56 Impact Factor
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    ABSTRACT: To compare the prevalence of nondiagnostic conjunctival map biopsies in patients with extensive pagetoid sebaceous carcinoma (defined as involvement of 3 or 4 quadrants of the ocular surface) and in patients without extensive pagetoid tumor (defined as involvement of 1 or 2 quadrants of the ocular surface). Retrospective medical record and pathologic specimen review of 20 patients treated for sebaceous carcinoma at a tertiary care center. Biopsies with artifactual loss of or damage to the epithelium were categorized as nondiagnostic. One hundred forty-four map biopsies were reviewed, an average of 7.2 (standard deviation [SD], 4.4) biopsies per patient. Sixteen patients had extensive pagetoid tumor, 4 did not. Fifteen percent of biopsies were nondiagnostic. The frequency of nondiagnostic biopsies in patients with and without extensive pagetoid tumor was 37% and 10%, respectively. The odds ratio of nondiagnostic biopsy in the setting of extensive pagetoid tumor was 5.9 (95% confidence interval, 2.3-15.6; P = .004). Six of the sixteen patients (38%) without extensive pagetoid tumor had at least 1 nondiagnostic biopsy, with an average of 1.8 (SD, 1.6) nondiagnostic biopsies per patient (22% of biopsies). Two of the 4 patients (50%) with extensive pagetoid tumor had at least 1 nondiagnostic biopsy, with an average of 5.5 (SD, 3.5) nondiagnostic biopsies per patient (57% of biopsies). Nondiagnostic, de-epithelialized conjunctival map biopsies are more common in patients with extensive pagetoid tumor than in those with limited or no pagetoid tumor. Artifactual epithelial loss may result from disruption of epithelial adhesion to the basement membrane by infiltrating tumor cells.
    Archives of ophthalmology 09/2009; 127(8):961-3. · 3.86 Impact Factor
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    ABSTRACT: The authors describe two patients with squamous cell carcinoma arising in benign mixed tumor of the lacrimal gland. One tumor arose in a 77-year-old woman with an incompletely excised benign mixed tumor 25 years previously. the other squamous cell carcinoma was present in a 57-year-old man with a subtotally removed benign mixed tumor 20 years prior to discovery of malignant transformation. the fact that squamous cell carcinoma may arise in benign mixed tumors of the lacrimal gland is illustrated and the use of combined surgery and radiation therapy for palliation or cure of these tumors is discussed.
    07/2009; 7(2):79-86.
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    ABSTRACT: A 59-year-old man sought evaluation for a rapidly enlarging, nontender, ulcerated right medial canthal lesion unresponsive to antibiotics. Biopsy revealed CD30+ anaplastic large cell lymphoma. CT demonstrated contiguous spread in the orbit. Systemic evaluation for lymphoma was negative, and he underwent local radiotherapy. The lesion regressed completely, and he has remained disease free for 7 months. CD30+ anaplastic large cell lymphoma of the periocular skin and orbit are usually distinct, exceedingly rare entities; no reported cases had simultaneous involvement of both tissues. The authors present the first reported case, to their knowledge, of simultaneous skin and orbital involvement by anaplastic large cell lymphoma.
    Ophthalmic plastic and reconstructive surgery 01/2009; 25(1):63-5. · 0.69 Impact Factor
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    ABSTRACT: To evaluate the outcome of the square procedure, a multidisciplinary, staged excision technique using standard formalin-fixed, vertically oriented sections for periocular cutaneous melanoma. Observational, retrospective, case series. Forty patients with periocular cutaneous melanoma treated with the square procedure. Demographic features, tumor data, and recurrence rate were reviewed retrospectively for 40 patients with periocular cutaneous melanoma treated with the square procedure. Local recurrence rate. Of 40 patients, 26 (65%) had lentigo maligna melanoma in situ (MIS), 12 (30%) had lentigo maligna melanoma, and 2 (5%) had superficial spreading melanoma. Tumor-free margins were reached within a mean margin of 13 mm for patients with MIS and of 16 mm for patients with invasive melanoma. There was no statistical difference for the margin width in patients with MIS and invasive melanoma. The lesion size and margin width were significantly correlated. Recurrence was observed in 1 (2.5%) patient at 8 months after the square procedure, and a Kaplan-Meier survival curve estimated a local recurrence rate of 2.5% at 8 years. The square procedure is an effective procedure for management of periocular lentigo maligna melanoma in situ and lentigo maligna melanoma with a low local recurrence rate of 2.5% at 8 years. The authors have no proprietary or commercial interest in any materials discussed in this article.
    Ophthalmology 09/2008; 115(12):2295-2300.e3. · 5.56 Impact Factor
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    ABSTRACT: Appearances of and increases in Graves' ophthalmopathy (GO) have been reported after treatment of patients with hyperthyroidism with radioiodine. We sought to determine the rates of appearance or increase in manifestations of GO in American patients treated with radioiodine for hyperthyroidism. The study population, which consisted of 76 patients (range, 10.6-72 y), included 61 women and individuals of diverse ethnicity. The patients were followed for 1 y after radioiodine treatment. The clinical activity score (CAS) included 10 items of ophthalmic change that were evaluated at 2 and 6 mo and at 1 y; appearance of a new item scored 1 point. We evaluated interactions of 6 covariates-prolonged hyperthyroidism, prolonged hypothyroidism, smoking, treatment with an antithyroid drug (ATD), and serum levels of thyroid-stimulating immunoglobulin (TSI) and of high free T3 (FT3)--with the numbers of patients with 2 or more CAS points and with exophthalmometer readings increased by at least 2 mm. In addition, patients completed a scored quality-of-life (QOL) questionnaire at baseline and at 1 y to assess eye symptoms. The mean CAS points for all patients at 2 mo was 0.63 and was not significantly different at 1 y. In 9 of 10 CAS items, there were few patients affected at 1 y and for the most part there were fewer patients affected than at baseline. However, exophthalmometer readings increased in 39% of patients by a mean of 2.6 mm. Individual patients frequently exhibited increases and decreases in item manifestations. Exophthalmometer readings decreased by 2 mm or less in 13%. Of the covariates, only hyperthyroidism prolonged by at least 2.5 mo was significantly associated with 2 or more CAS points at 1 y; no covariate was significantly associated with the development of increased exophthalmometer readings. Eye symptoms recorded in the QOL were insignificantly improved over the year; symptoms did not correlate with CAS points or with exophthalmometer readings. After radioiodine treatment, no substantial change was seen in manifestations of CAS items except for a modest increase in exophthalmometer readings in 39% of patients. Manifestations of CAS items frequently appeared and disappeared. Prolonged hyperthyroidism is best avoided. Ocular symptoms were insignificantly fewer at 1 y after radioiodine therapy. The observed changes do not warrant prophylactic treatment of patients with steroids.
    Journal of Nuclear Medicine 07/2008; 49(6):923-30. · 5.77 Impact Factor
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    ABSTRACT: A 75-year-old woman developed epiphora and a slowly enlarging right medial canthal mass for 1 year. CT revealed a mass with ground-glass radiodensity and hazy borders in the lacrimal sac. At external dacryocystorhinostomy, a tan, gritty, spherical mass was easily removed from the sac lumen. Histopathologic characteristics were typical of fibrous dysplasia. The postoperative course was uneventful.
    Ophthalmic plastic and reconstructive surgery 01/2008; 24(5):423-5. · 0.69 Impact Factor
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    ABSTRACT: A 25-year-old woman presented for evaluation of a rapidly enlarging mass of the left bulbar conjunctiva. Debulking biopsy was performed, which led to the diagnosis of myxoid malignant fibrous histiocytoma. The patient underwent left orbital exenteration with clear margins. Histopathology showed involvement of the conjunctiva substantia propria, superior conjunctival fornix, and episclera, as well as extension from the lateral rectus muscle sheath. Immunohistochemical staining was strongly positive for CD68, alpha1-antitrypsin, CD34, and vimentin.
    Ophthalmic Plastic and Reconstructive Surgery 01/2007; 23(4):338-40. · 0.67 Impact Factor
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    ABSTRACT: The purpose of this study is twofold: to assess the incidence and implications of complications unique to placing a freestanding polycarbonate peg in patients with hydroxyapatite implants and to compare the incidence of complications in these patients with the incidence in patients with non-pegged hydroxyapatite implants. This is a retrospective clinical case series of 103 patients who underwent hydroxyapatite implant insertion at our institution. The incidence of postoperative complications in patients who underwent freestanding polycarbonate pegging procedures (n = 21) and those who had not (n = 82) were compared. One postoperative complication - infection - occurred in a significantly higher percentage of patients in the pegged group (42.9%, 9/21) compared with the non-pegged group (19.5%, 16/82), (p = 0.037). Fifteen of the 21 patients (71.4%) in the pegged group experienced complications unique to freestanding polycarbonate pegging. Overall, 95.2% (20/21) of patients in the pegged group experienced a complication compared with 58.5% (48/82) of patients in the non-pegged group, (p = 0.001). In addition, there was an average of 3.1 (66/21) complications per patient in the pegged group compared with an average of 1.9 (106/82) complications per patient in the non-pegged group (p = 0.010). Patients who received a freestanding polycarbonate pegged implant had a high risk of experiencing complications unique to pegging, and therefore a significantly higher rate of complications overall when compared with patients whose implant was not pegged. In addition, patients who received a pegged implant had a higher incidence of infection. However, most patients retained their pegs despite complications.
    Ophthalmic Plastic and Reconstructive Surgery 01/2007; 23(3):206-10. · 0.67 Impact Factor
  • Gary J Lelli, Hakan Demirci, Bartley R Frueh
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    ABSTRACT: A 27-year-old man suffered simultaneous avulsion of the optic nerve and luxation of an intact globe in a motor vehicle accident. CT was not diagnostic of the nerve avulsion. The injury was addressed by emergent replacement of the globe within the orbit. The patient obtained psychological benefit by retaining the eye initially, but required subsequent enucleation for prolonged ocular inflammation. Initial repositioning of intact, luxated globes offers potential cosmetic and psychological benefits. If necessary, enucleation can be performed later.
    Ophthalmic Plastic and Reconstructive Surgery 01/2007; 23(2):158-60. · 0.67 Impact Factor
  • Bartley R. Frueh, David C. Musch
    Ophthalmology 10/2006; 113(10):1890–1891. · 5.56 Impact Factor
  • Victor M Elner, Adam S Hassan, Bartley R Frueh
    American Journal of Ophthalmology 02/2006; 141(1):233; author reply 233-4. · 3.63 Impact Factor
  • Bartley R. Frueh, Hector McDonald
    Ophthalmology 01/2006; 113(1):164.e1–164.e3. · 5.56 Impact Factor
  • Adam S Hassan, Bartley R Frueh, Victor M Elner
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    ABSTRACT: Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to lagophthalmos. To evaluate the role of müllerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Müller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, lagophthalmos, and keratopathy were compared. Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm (P<.001). Lagophthalmos (P = .002) and corneal exposure (P<.001) were significantly improved. Three patients required levator aponeurosis repair, 2 for preexisting dehiscence and 1 for inadvertent aponeurosis transection. Müllerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
    Archives of Ophthalmology 10/2005; 123(9):1221-5. · 3.83 Impact Factor
  • Bartley R Frueh, Adam S Hassan, David C Musch
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    ABSTRACT: When performing ptosis surgery, a suture is placed between the levator and the tarsal plate at the point of the desired peak. This placement is done while the patient's eye is closed, but its effects are observed with the patient's eye open. Unaccounted-for horizontal eyelid movement on eyelid closing may therefore adversely affect the desired outcome. The purpose of this study was to characterize the horizontal translation of the eyelid on closing the eyes. In this experimental case series study, a randomly selected upper eyelid of normal subjects, subjects with ptosis, and subjects with exophthalmos, ages 21 through 70, was studied to determine the horizontal eyelid movement on closing the eyes by videotape analysis of the movement of dots placed above the eyelid margin and on the eyelid crease above the center of the pupil. The eyelid translation on closing the eye is medial and varies among subjects from 0.1 mm to 3.5 mm. The movement is usually greater at the eyelid margin than at the eyelid crease. The amount of horizontal eyelid translation on closing the eyes is clinically significant in many people. The clinical impact of this finding should affect how ptosis surgery is performed. The desired point of peaking of the eyelid should be marked at the beginning of the case with the eyes open and the mark used as a guideline for placing the suture that will determine the peak.
    Ophthalmic Plastic and Reconstructive Surgery 04/2005; 21(2):109-11. · 0.67 Impact Factor
  • Bartley R. Frueh, Adam S. Hassan, David C. Musch
    Ophthalmic Plastic and Reconstructive Surgery - OPHTHALMIC PLAST RECONSTR SUR. 01/2005; 21(6).
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    ABSTRACT: To compare the efficacy and efficiency of a new small anterior incision, minimal dissection ptosis procedure with that of a traditional anterior aponeurotic approach for the correction of aponeurotic ptosis. Retrospective, comparative, interventional case series. Seventy-two patients with aponeurotic ptosis who had undergone ptosis correction surgery by 1 surgeon: 36 patients (49 ptotic eyelids) who had ptosis correction by a small-incision, minimal dissection procedure and 36 patients (49 ptotic eyelids) who had ptosis correction by a traditional aponeurotic approach. Charts and available photographs were reviewed for each patient. Postoperative upper eyelid height relative to the center of the pupil and relative to the opposite upper eyelid and the postoperative eyelid contour. Successful correction of the eyelid height and the rate of recommended reoperation were not significantly different for the 49 lids corrected in each arm of the study. The incidence of attaining good eyelid contour was significantly better in the small incision group, in which 41 of 42 lids (97.6%) evaluated by photographs had good contour compared with 29 of 37 lids (78.4%) in the traditional group. Operating time per lid was significantly less for the small-incision, minimal dissection group, 25.3+/-13.0 minutes (range, 13-68 minutes) compared with 55.4+/-16.6 minutes (range, 35-119) for the traditional group. The small-incision, minimal dissection technique for ptosis correction is equally effective in correcting eyelid height, superior in producing desirable eyelid contour, and much quicker to perform than the traditional aponeurotic approach.
    Ophthalmology 01/2005; 111(12):2158-63. · 5.56 Impact Factor
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    Bartley R Frueh, David C Musch, Hector McDonald
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    ABSTRACT: This was a retrospective study to compare the efficacy and efficiency of a new small anterior incision, minimal dissection ptosis procedure with that of a traditional anterior aponeurotic approach for the correction of aponeurotic ptosis. The results of a chart and photograph review of 36 patients with 49 ptotic eyelids who had ptosis correction by a small-incision, minimal dissection procedure were compared with those of 36 patients with 49 ptotic eyelids who had ptosis correction by a traditional aponeurotic approach. The successful correction of the eyelid height and the rate of recommendation for reoperation were not significantly different for the 49 lids corrected in each arm of the study. The incidence of attaining good eyelid contour was significantly better in the small-incision group, where 41 (97.6%) of 42 lids evaluated by photographs had good contour compared with 29 (78.4%) of 37 lids in the traditional group. Operating time per lid was significantly less for the small-incision, minimal dissection group, 25.3 +/- 13.0 minutes (range, 13 to 68 minutes), compared with 55.4 +/- 16.6 minutes (range, 35 to 119) for the traditional group. Compared with the traditional aponeurotic approach, the new small-incision, minimal dissection technique for ptosis correction is equally efficacious in correcting eyelid height, superior in producing desirable eyelid contour, and much quicker to perform.
    Transactions of the American Ophthalmological Society 02/2004; 102:199-206; discussion 206-7.

Publication Stats

463 Citations
134.65 Total Impact Points

Institutions

  • 1985–2011
    • University of Michigan
      • • Department of Ophthalmology and Visual Sciences
      • • Department of Radiology
      Ann Arbor, MI, United States
  • 1985–2006
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States