Tanuj Nakra

Albany Medical College, Albany, New York, United States

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Publications (25)55.66 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE:: The aim of this article was to report the clinical presentation, radiography, culture results, treatment modalities, and outcomes of periocular abscesses associated with brow epilation. METHODS:: This was a retrospective case series including 26 patients referred for periocular abscess following brow epilation. RESULTS:: Twenty-six female patients with a median age of 20.5 (range, 12-73) years were referred for oculoplastic evaluation of periocular abscesses related to recent brow epilation. All patients were treated with incision and drainage along with systemic antibiotics. Culture results revealed 16 cases of methicillin-resistant Staphylococcus aureus, 3 of methicillin-sensitive Staphylococcus aureus, and 7 cultures that showed no growth. All patients had resolution of their abscesses at 1-month follow-up visits without progression to orbital cellulitis. CONCLUSIONS:: Periocular abscess formation after brow epilation has been previously described in only a single case report in the literature. The authors believe this entity is underreported given their current report describing 26 such cases. Given the high prevalence of cosmetic brow epilation in females, the authors believe a careful history regarding brow epilation in any patient presenting with a periocular abscess or preseptal cellulitis is essential to explore the possible cause of their infection. The majority of patients in the current study's cohort had methicillin-resistant Staphylococcus aureus-related abscesses, and treatment with antibiotics with methicillin-resistant Staphylococcus aureus coverage may be a prudent first line choice in such patients.
    Ophthalmic plastic and reconstructive surgery 10/2012; · 0.69 Impact Factor
  • Ophthalmic plastic and reconstructive surgery 11/2011; 27(6):469; author reply 469-70. · 0.69 Impact Factor
  • Ophthalmic plastic and reconstructive surgery 11/2011; 27(6):463-4. · 0.69 Impact Factor
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    ABSTRACT: Ectopic eyelid cilia is an uncommon congenital anomaly typically occuring in otherwise healthy children. It is asymptomatic, but parents may wish surgical excision for cosmetic benefits. The authors describe three cases of ectopic upper eyelid cilia, surgical intervention, and follow-up results.
    Journal of Pediatric Ophthalmology & Strabismus 01/2011; 48 Online:e16-8. · 0.86 Impact Factor
  • Ophthalmic plastic and reconstructive surgery 01/2011; 27(5):394; author reply 395. · 0.69 Impact Factor
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    ABSTRACT: Facial nerve paralysis can result from a number of causes, including neoplasms, Bell’s palsy, infections, trauma, congenital conditions, and idiopathic processes. Both the medical and social consequences of facial nerve paralysis can be distressing for patients. The most significant ophthalmic consequence of facial nerve paralysis is loss of function of the orbicularis oculi muscle. The complete assessment of a patient with facial nerve paralysis includes clinical evaluation of the resting tone and active function of the facial muscles, as well as determination of the extent of dry eye and the function of the lacrimal gland and lacrimal drainage system. The goal of medical therapy is symptomatic relief of dry eye and exposure keratopathy. Botulinum toxin can also be employed to treat other symptoms, such as synkinesis, hypertonicity, and spasms. The goal of surgical therapy is improved protection of the cornea, as well as a more symmetric static and dynamic appearance. Lagophthalmos and exposure keratopathy can be addressed with procedures such as surgical closure of the eyelids, known as tarsorrhaphy, or other alternatives, such as placement of an alloplastic gold weight in the upper eyelid, injection of hyaluronic acid gel into the upper eyelid, or palpebral springs. Ectropion also commonly results from facial nerve paralysis and can be improved with lateral or medial canthal procedures. Reanimation of the midface can be accomplished by any of several surgical techniques; some provide static support for the midface, while others attempt to restore dynamic movement to the paralyzed face.
    12/2010: pages 295-309;
  • Plastic and reconstructive surgery 05/2010; 125(5):199e-200e. · 2.74 Impact Factor
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    ABSTRACT: To report our technique and experience in using a minimally invasive approach for aesthetic lateral canthoplasty. Retrospective analysis of patients undergoing lateral canthoplasty through a minimally invasive, upper eyelid crease incision approach at Jules Stein Eye Institute by one surgeon (R.A.G.) between 2005 and 2008. Concomitant surgical procedures were recorded. Preoperative and postoperative photographs at the longest follow-up visit were analyzed and graded for functional and cosmetic outcomes. A total of 600 patients (1,050 eyelids) underwent successful lateral canthoplasty through a small incision in the upper eyelid crease to correct lower eyelid malposition (laxity, ectropion, entropion, retraction) and/or lateral canthal dystopia, encompassing 806 reconstructive and 244 cosmetic lateral canthoplasties. There were 260 males and 340 females, with mean age of 55 years old (range, 4-92 years old). Minimum follow-up time was 3 months (mean, 6 months; maximum, 6 years). Complications were rare and minor, including transient postoperative chemosis. Eighteen patients underwent reoperation in the following 2 years for recurrent lower eyelid malposition and/or lateral canthal deformity. Lateral canthoplasty through a minimally invasive upper eyelid crease incision and resuspension technique can effectively address lower eyelid laxity and/or dystopia, resulting in an aesthetic lateral canthus.
    Ophthalmic plastic and reconstructive surgery 01/2010; 26(3):190-4. · 0.69 Impact Factor
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    ABSTRACT: To report our preliminary experience using hyaluronic acid gel fillers as a nonsurgical alternative in the management of congenital eyelid malpositions. In this retrospective interventional case series, 5 patients (10 eyes) with congenital eyelid malpositions, including eyelid retraction, ectropion, euryblepharon, epiblepharon, and abnormalities associated with a shallow orbit, with resultant lagophthalmos and/or keratopathy and tearing were evaluated before and after injection with hyaluronic acid gel (Restylane) in the pretarsal and/or septal regions of the affected eyelid(s). Pretreatment, posttreatment, and follow-up photographs were analyzed for eyelid position and degree of eyelid closure and lagophthalmos, and slit-lamp evaluation of the degree of keratopathy. All 5 patients demonstrated significant improvement of eyelid position and degree of keratopathy. The mean improvement in lagophthalmos was 4.5 mm (range, 2-7 mm). The average volume of hyaluronic acid gel used was 0.5 ml per eyelid. Complications were minor, including transient edema and ecchymosis at the sites of injection. Of the 10 eyelids injected, only one had increased astigmatism after injection. Hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of certain eyelid malpositions, disorders traditionally requiring surgical intervention if aggressive ocular lubrication fails. This treatment is particularly useful in such patients who are commonly premature with poor general health and serves as a temporizing measure by allowing the much needed tissue expansion to take effect over time.
    Ophthalmic plastic and reconstructive surgery 01/2009; 25(4):259-63. · 0.69 Impact Factor
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    ABSTRACT: A fistula of the lesser sphenoid wing sinus is a rare dural arteriovenous fistula resulting from a connection between the middle meningeal artery and recipient vein in the sinus of the lesser sphenoid wing. In this report, MRI/magnetic resonance angiography of a 54-year-old man who presented with sudden-onset glaucoma and proptosis revealed a fistula in this anatomic location. Drainage patterns here may account for the absence of serious complications and optimistic prognosis following embolization. Care in diagnosis is required to avoid superfluous procedures, because classic signs of the more common carotid-cavernous fistula are absent.
    Ophthalmic plastic and reconstructive surgery 01/2009; 25(5):404-6. · 0.69 Impact Factor
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    ABSTRACT: Seprafilm is a hybrid product of carboxymethylcellulose and sodium hyaluronate that can act as an absorbable barrier to decrease the formation and severity of postoperative adhesions in abdominal, thoracic, and pelvic surgeries. The authors report their experience with use of Seprafilm in "trap door" orbital wall fracture repair. Retrospective case series of 4 consecutive patients with trap door orbital wall fractures secondary to blunt trauma with entrapped orbital soft tissue who underwent surgical repair with placement of Seprafilm implant in 2008. Orbitotomy was performed via standard transconjunctival and/or transcaruncular approaches with release of entrapped tissues, and placement of Seprafilm implant over the fracture site without fixation. Patients were followed for at least 6 months. Ophthalmic and orbital examinations, including ocular motility and Hertel exophthalmometry measurements, were recorded. All 6 orbital wall fractures (4 floor, 2 medial wall) were successfully corrected with resolution of restrictive motility in the follow-up period (average 10 months; range 6 months to 1.5 years). Mean patient age was 13.5 years (range, 9-20 years). Two of the 4 patients had 2 separate fractures. There were no complications and no need for reoperation. Seprafilm may have a role in reconstruction of the "trap door" type of orbital wall fractures. The ease of use, lack of fixation, and absorbable properties without inflammation are encouraging for further study.
    Ophthalmic plastic and reconstructive surgery 01/2009; 25(3):211-4. · 0.69 Impact Factor
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    ABSTRACT: To evaluate the safety and efficacy of injecting hyaluronic acid gel in the upper eyelid as a nonsurgical alternative in the treatment of paralytic lagophthalmos. This is a retrospective study of 9 patients (10 eyelids) with paralytic lagophthalmos treated with hyaluronic acid gel in the prelevator aponeurosis region and/or pretarsal region of the paralytic upper eyelid. Pretreatment, posttreatment, and follow-up photographs were digitized, and overall outcomes assessed. Measurements of lagophthalmos were standardized and compared. Slit-lamp examination was used to evaluate the degree of exposure keratopathy. ImageJ was used for photographic analysis. Ten eyelids (9 patients, 7 men; mean age 69.2 years; range, 31-90 years) with paralytic lagophthalmos were treated with hyaluronic acid gel. The average amount of injected hyaluronic acid gel was 0.9 ml (range, 0.2-1.2 ml). All patients demonstrated significant improvement in lagophthalmos and exposure keratopathy. The mean improvement in lagophthalmos was 4.8 mm (range, 0.9-11.9 mm; p = 0.001). Of the 5 patients with follow-up, the mean follow-up period was 3.6 months (range, 2-5 months). Of these, 2 had no change in lagophthalmos (both maintained 0 mm at 5 months), one had a slight decrease in lagophthalmos (4.8-4.6 mm at 2 months), one had a slight increase in lagophthalmos (0.3-0.5 mm at 2 months), and one had a more significant increase in lagophthalmos (1.9-4.3 mm at 4 months). The latter patient underwent a second treatment with further reduction of lagophthalmos to 0.4 mm. Overall, there was a decrease in margin reflex distance from the upper eyelid margin to the corneal light reflex (MRD1) but it was not statistically significant. Complications were minor and included transient ecchymosis, edema, and tenderness at the injection sites. On the basis of these preliminary results, hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of paralytic lagophthalmos. This treatment may be particularly useful in patients who are poor surgical candidates and/or as a temporizing measure in patients in whom return of facial nerve function is anticipated, given the hyaluronic acid gel's properties of slow resorption and reversibility with hyaluronidase.
    Ophthalmic plastic and reconstructive surgery 01/2009; 25(1):23-6. · 0.69 Impact Factor
  • Tanuj Nakra, Norman Shorr
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    ABSTRACT: In the family of ophthalmology subspecialties, ophthalmic plastic surgery is the adopted child. There are probably more differences than there are similarities with the other subspecialties. The diseases that oculoplastic surgeons treat are unique, and the surgeries they perform are quite different from those of ophthalmology colleagues. These unique attributes of ophthalmic plastic surgery warrant special consideration in the study of ophthalmology and the law. From a legal perspective, the practice of oculoplastic surgery has risks similar to those of other ophthalmology subspecialties, but perhaps most unique is the high visibility nature of the operations. The eye–periocular complex is arguably the most significant aesthetic feature of the entire body, and thus problems in oculoplastic surgery are highly visible to the patient. Problems in this area also fall under the scrutiny of all the patients’ family members and friends. Thus, there is a complex set of interactions between the patients’ emotions regarding their appearance and their functional oculoplastic problems. This emotion and high visibility are present not only with elective cosmetic procedures but also with reconstructive and functional surgeries, as well as medical treatments. This chapter should serve as a guide for physicians and is not designed to delineate the standard of care in ophthalmic plastic surgery. We practice in a unique academic and university environment. Our approach is not necessarily representative of the community at large and should not be construed as the standard in the community
    12/2007: pages 187-200;
  • Ophthalmology 10/2007; 114(10):1959–1960. · 5.56 Impact Factor
  • Ophthalmology 10/2007; 114(10):1960–1961. · 5.56 Impact Factor
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    ABSTRACT: To compare clinical outcomes of enucleation and evisceration by functional and aesthetic measures. Retrospective, nonrandomized, comparative analysis. Eighty-four patients who underwent enucleation or evisceration. The medical records of the participants were retrospectively reviewed. Clinical photographs were graded by blinded observers for qualitative measures. Postoperative eyelid and motility measurements, as well as subjective grades of various aesthetic and functional outcomes. There is no statistically significant difference in the overall aesthetic outcome of enucleation and evisceration, although several specific comparisons were found to be significant. Implant motility score is higher in eviscerated eyes (5.58+/-2.08) than in enucleated eyes (4.35+/-1.69) (P = 0.05). Adduction of the implant is significantly less than abduction in eviscerated eyes (1.34 vs. 1.44; P = 0.02). Implant motility is greater than prosthesis motility. Both enucleation and evisceration result in enophthalmos and a sulcus defect. Seven of 32 patients (21.9%) who underwent enucleation experienced a complication, whereas only of 7 of 52 patients (13.5%) who underwent evisceration experienced a complication (P = 0.0002). The 2 most common complications were implant exposure and formation of a pyogenic granuloma. Although enucleation and evisceration produce aesthetically similar outcomes, eviscerated eyes have better implant motility and experience fewer complications. Both enucleation and evisceration result in enophthalmos, sulcus contour defects, and incomplete transfer of implant motility to the prosthesis.
    Ophthalmology 01/2007; 113(12):2270-5. · 5.56 Impact Factor
  • Ophthalmology 05/2006; 113(5):889. · 5.56 Impact Factor
  • Ophthalmology 02/2006; 113(2):354. · 5.56 Impact Factor
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    ABSTRACT: To describe the clinical manifestations, diagnoses, treatments, and outcomes of orbital mass lesions at a tertiary care referral center. All cases of newly diagnosed or referred orbital tumors at the Jules Stein Eye Institute from 1999 to 2003 were reviewed retrospectively. Demographic and clinical data were extracted from the electronic oculoplastics registry of the Division of Orbital and Ophthalmic Plastic Surgery. Three hundred sixty-nine cases of orbital mass lesions were evaluated (167 males and 202 females; mean age = 48 years). The most common presenting symptoms were mass/proptosis, pain, swelling, inflammation, and diplopia. The most common categories of diagnosis were cystic or structural lesions, benign tumors, inflammatory processes, neuronal processes, and fibrous processes. Increasing age was associated with an increased incidence of primary and metastatic malignant tumors. Half of all cases required surgical intervention consisting of excision, debulking, or exenteration; 20% to 30% of cases were managed conservatively. The differential diagnosis of orbital mass lesions differs across age groups. No clinical sign or symptom is specific for the underlying diagnosis and the biological behavior of the abnormal process may be misleading. Therefore, a careful diagnostic approach that considers the benefit of imaging studies must be undertaken. Almost 50% of these mass lesions can be managed with nonsurgical intervention.
    Ophthalmic Surgery Lasers and Imaging 01/2006; 37(1):25-32. · 1.46 Impact Factor
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    ABSTRACT: To evaluate the safety and efficacy of intralesional triamcinolone acetonide (TA) injection in primary and recurrent chalazia. Retrospective, interventional, consecutive case series. One hundred forty-seven patients with primary or recurrent chalazia (155 cases) treated at the oculoplastic clinic at the Jules Stein Eye Institute between January 1, 2000, and December 31, 2003. Patients received an intralesional injection of 0.1 to 0.2 ml TA (40 mg/ml). Data regarding lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination, were recorded at the time of injection and at different intervals until resolution or surgical excision. Success was defined as at least an 80% decrease in size with no recurrence. If the lesion recurred or regression was minimal (<50%), further injections were given as needed. Patients who declined injection or who did not respond to 2 to 3 injections were referred for surgical excision and drainage. Lesion size, clinical resolution, time to resolution, recurrence, and complications. Most of the patients received 1 injection (93 patients; 60%) or 2 injections (31 patients; 20%) with resolution of the lesion (more than 80% decrease in size), with an average time to resolution of 2.5 weeks. Patients who did not respond to 2 injections were more likely to fail treatment (minimal or no regression), to respond to further injections, or to undergo surgical excision and drainage (P = 0.0001, chi-square test). Patients with blepharitis required more injections to resolution (2+/-1.3 vs. 1.4+/-1; P = 0.05, independent samples t test). Intraocular pressure and visual acuity remained stable after treatment. No complications, such as visual loss, subcutaneous fat atrophy, or skin depigmentation changes, were noted with steroids injections; assuming a complication rate of 2%, our power was adequate to rule out these complications. Intralesional TA injection in primary and recurrent chalazia is effective in achieving lesion regression. Most cases resolve with an average of 1 to 2 injections. Chalazia that fail to respond to 2 or 3 injections are more likely to benefit from surgical excision. It may be considered as a first treatment in cases where diagnosis is straightforward.
    Ophthalmology 06/2005; 112(5):913-7. · 5.56 Impact Factor

Publication Stats

120 Citations
55.66 Total Impact Points

Institutions

  • 2012
    • Albany Medical College
      Albany, New York, United States
  • 2006–2010
    • Jules Stein Eye Institute
      Maryland, United States
  • 2005–2010
    • University of California, Los Angeles
      • Department of Ophthalmology
      Los Angeles, CA, United States