-
[show abstract]
[hide abstract]
ABSTRACT: Two main patterns of orbital fractures are encountered: zygomaticomaxillary complex (ZMC) fractures and isolated orbital fractures. ZMC fractures, also known as tripod fractures, are frequently caused by a direct trauma to the zygomatic bone (e.g., with a fist, or a baseball bat) and are characterized by multiple fractures involving the inferior orbital rim, the zygomatic arch, the frontozygomatic suture and the zygomaticomaxillary suture; the orbital floor is frequently involved during ZMC fractures. The management of a tripod fracture is complex, requires a multidisciplinary approach and it is not the goal of this perspective. Isolated orbital fractures, also known as blow-out fractures, are internal fractures of the orbital floor and/or medial wall, with displacement of orbital soft tissues (fat and/or muscle) in the adjacent sinuses. This paper will focus on the pathophysiology, diagnosis and management of orbital blow-out fractures.
Expert Review of Ophthalmology 05/2008; 3(3):269-272.
-
Ophthalmology 05/2008; 115(4):759; author reply 759. · 5.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Levator aponeurosis advancement is an effective technique that is routinely used to correct aponeurogenic ptosis. The standard technique involve a skin incision of the upper eyelid crease for the entire length of the eyelid, with or without associated blepharoplasty. We believe that, in a selected group of patients, a less invasive approach with an upper lid skin incision of only 0.8 cm is equally effective for the final result and offers several advantages compared to the traditional technique.
We retrospectively reviewed the data of 48 patients affected by involutional ptosis with good levator function that underwent unilateral or bilateral levator advancement ptosis repair through a mini-invasive approach. Final outcome measures included postoperative eyelid height, contour, symmetry, periocular edema, surgical time and visibility of the incision site.
The mini-invasive approach for the correction of involutional ptosis resulted in our hands as effective and reliable as the traditional technique, required a shorter surgical time, offered an improved early post-operative course with minimal bruising and swelling and produced no visible scar.
This mini-invasive ptosis correction technique replaced in our practice the traditional approach for the treatment of a selected subset of patients affected by aponeurogenic ptosis.
Orbit 07/2006; 25(2):111-5.
-
[show abstract]
[hide abstract]
ABSTRACT: A 57-year-old white man presented with extensive bilateral, symmetric, confluent papules involving the upper and lower eyelids, causing visual impairment and cosmetic deformity. Surgical debulking of the papules was initially performed, but the lesion rapidly recurred and enlarged. Histopathologic examination revealed cutaneous amyloidosis. Six months later, extensive excision of the upper eyelid lesions was required to restore normal visual function.
Ophthalmic Plastic and Reconstructive Surgery 10/2005; 21(5):397-8. · 0.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report the clinical features and surgical treatment of a 15-year-old girl with unilateral microblepharon. The anomaly was characterized by a vertical shortage of upper and lower eyelid skin, causing nocturnal lagophthalmos, corneal exposure, and cosmetic deformity. Treatment consisted in hard-palate grafting and lateral tarsal strip suspension of the lower eyelid of the affected side. The outcome was considered satisfactory by the surgeon and by the patient. No further surgery was required.
Ophthalmic Plastic and Reconstructive Surgery 12/2004; 20(6):467-9. · 0.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the appearance of the skin incision in external dacryocystorhinostomy 6 weeks and 6 months after surgery.
A prospective, interventional, noncomparative case series of consecutive cases of external dacryocystorhinostomy was performed by 3 surgeons. At 6 weeks and 6 months after surgery, patients were asked to grade their incision, and standardized photographs were evaluated by 3 blinded observers.
Thirty-four consecutive patients were admitted and followed for 6 months. Six weeks after surgery, 9 of 34 patients could not see their incision site (26%), 13 of 34 graded it as minimally visible (38%), 9 of 34 (26%) graded it as moderately visible, and 3 of 34 patients (9%) graded it as very visible (grade 3). Two of 34 patients (6%) were not satisfied with the appearance of the incision. Six months after surgery, 15 of 34 patients (44%) could not see their incision site (grade 0), 16 of 34 (47%) graded it as minimally visible, 3 of 34 patients (9%) graded it as moderately visible, and no patient graded it as very visible. All patients were satisfied with the appearance of their incision. Photographic evaluation of patients 6 weeks after surgery by the 3 observers showed an average score of 1.12, 1.18, and 1.24. There was not a statistically significant difference between the observers (p = 0.95). At 6 months after surgery, the average scores were 0.56, 0.74, and 0.79. There was not a statistically significant difference between the observers (p = 0.43). The change in appearance of the incision at 6 weeks and at 6 months was statistically significant (p < 0.044), as evaluated by patients and observers (p < 0.001).
The skin incision in external dacryocystorhinostomy is satisfactory to most patients. Its appearance is improved with time; 86% of the incisions were graded invisible or minimally visible by observers and 91% by patients after 6 months.
Ophthalmic Plastic and Reconstructive Surgery 10/2004; 20(5):358-61. · 0.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The real incidence of solitary fibrous tumor (SFT) of the orbit is unknown, but it seems that since it was first described in 1994, orbital SFT has been increasingly recognized. We believe that the orbital SFT is a relatively common tumor and that it should be considered in the differential diagnosis of any orbital tumor.
Interventional case series.
Four new cases of orbital SFT.
Four patients affected by solitary fibrous tumor of the orbit are described. One patient experienced a recurrent SFT shortly after initial surgical excision performed elsewhere. Thirty-eight cases have been reported in the literature in 7 years.
The number of orbital SFTs reported has been increasing, reaching an average of more than five tumors reported per year. Since the first orbital SFT was described in 1994, 37 cases have been reported in the literature. We add four new cases in our series, including a recurrent tumor. A total of 42 cases have now been described, eight with recurrences. Malignant transformation occurred in one case.
We believe that before 1994, the diagnosis orbital SFT was confused with other benign orbital tumors, such as fibrous histiocytoma and hemangiopericytoma because of a lack of use of immunohistochemical techniques. This entity should now be considered relatively common and should be included in the differential diagnosis of orbital tumors in any age group. Local recurrences of SFT are possible and usually follow an incomplete initial excision. Recurrent tumors in the orbit have shown the tendency to infiltrate the surrounding tissues and the bone, rendering complete secondary excision more difficult. Recurrent orbital SFT also has the potential for malignant transformation. The treatment of choice of orbital SFT is complete surgical excision and careful follow-up. Considering the more aggressive course followed by recurrent tumor, correct diagnosis and management is essential.
Ophthalmology 08/2003; 110(7):1442-8. · 5.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The charts of 10 patients affected by myogenic ptosis who underwent surgical correction by means of a frontalis suspension sling using a silicone rod were reviewed. The patients included in the study were affected by ptosis secondary to myasthenia gravis (MG), chronic progressive external ophthalmoplegia (CPEO) or mitochondrial myopathy (MM). In every patient the ptosis was severe (MRD( 1) < 2 mm), with the eyelid partially or totally occluding the visual axis; levator function was poor (<5 mm), Bell's phenomenon was poor or absent and the orbicularis function was reduced. Final eyelid height, patient satisfaction and the presence of complications were our main outcome measures. Analysis of the results showed that the ptosis was corrected in every patient with a clear visual axis. One patient with absent Bell's and poor levator function had exposure keratopathy resistant to medical treatment and required surgical revision. We believe that the frontalis suspension sling is safe, effective and is the procedure of choice for patients affected by poor-function acquired ptosis. A silicone rod, because of its elasticity, is the material of choice in this selected category of patients.
Orbit 09/2002; 21(3):195-8.
-
[show abstract]
[hide abstract]
ABSTRACT: To describe a minimally invasive technique for conjunctivodacryocystorhinostomy with the Jones tube. This technique creates a direct communication between the conjunctiva and the middle meatus with the use of a 14-gauge angiocatheter. The glass tube is inserted under endoscopic or direct visualization.
A retrospective review of consecutive patients who underwent the minimally invasive technique for conjunctivodacryocystorhinostomy for complete bicanalicular lacrimal obstruction was performed. The surgical time, intraoperative and postoperative complications, length of the tubes, long-term patency, tube displacement, and need for secondary revision were evaluated.
Fifty-five consecutive patients were included in the study. All surgical procedures were successfully performed without significant complications, in an operating time that averaged 16 minutes. In one early case, a patient had persistent postoperative bleeding that required cauterization of the middle turbinate. In 3 patients, late migration of the Jones tube into the nasal cavity required secondary intervention with successful Jones tube repositioning. Minor office tube cleaning was performed without removal of the tube. The patency of the Jones tube was regularly tested with demonstration of aspiration of 2% fluorescein solution from the tear meniscus in the tear lake opening of the tube at the slit lamp, the passage of the same solution in the nose with endoscopic view, and finally, with irrigation of saline solution in the tube.
The minimally invasive technique for conjunctivodacryocystorhinostomy with the Jones tube can be successfully performed with a simple "poke-through" technique from the conjunctiva to the nose with direct or endoscopic control. This technique has proved to be time-effective and well tolerated by patients.
Ophthalmic Plastic and Reconstructive Surgery 22(4):253-5. · 0.69 Impact Factor
-
Ophthalmic plastic and reconstructive surgery 26(6):498; author reply 498-9. · 0.69 Impact Factor
