Dinesh Selva

Publications (291)672.8 Total impact

• Article: Recurrent orbitofrontal cholesterol granuloma: a case report.

  David I T Sia, Garry Davis, Dinesh Selva
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  ABSTRACT: Orbitofrontal cholesterol granuloma is a rare entity that has a predilection for men in their fourth or fifth decade and occurs almost exclusively within the frontal bone overlying the lacrimal fossa. Surgery by drainage and curettage is virtually curative in all cases and recurrence is very rare. We describe the case of a 77-year-old man with recurrent orbitofrontal cholesterol granuloma 11 years after surgery, presumably due to subtotal curettage. The potential use of an endoscope to aid complete removal of lesion is discussed.
  Orbit (Amsterdam, Netherlands) 06/2012; 31(3):184-6.
• Article: Decompression of benign orbital apex lesion via medial endoscopic approach.

  David I T Sia, Weng Onn Chan, Peter J Wormald, Garry Davis, Dinesh Selva
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  ABSTRACT: The use of endoscopic orbital and optic nerve decompression for traumatic optic neuropathy and dysthyroid orbitopathy have been well documented; however, reports on endoscopic decompression for benign orbital apex lesions are scarce. The records of two patients who underwent endoscopic decompression of the bony orbit for progressive visual loss were reviewed. Patient 1 had fibrous dysplasia and presented with headache and visual field defects. Patient 2 had sphenoid wing meningioma and multiple previous attempts of transcranial tumor resection and orbital decompression. Both had progressive visual deterioration and ultimately underwent transnasal endoscopic orbital decompression. Post-operatively, both patients had subjective and objective improvement in visual function and compressive symptoms. No complications from the endoscopic decompression were observed in both patients. Transnasal endoscopic approach may be a viable option for decompression of benign orbital apex lesions.
  Orbit (Amsterdam, Netherlands) 05/2012; 31(5):344-6.
• Article: Tendon Sheath Fibroma of the Medial Canthal Tendon.

  Nicholas Andrew, Tom Dodd, Dinesh Selva, Garry Davis
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  ABSTRACT: Fibromas of the tendon sheath are slow-growing, benign tumors most commonly found on the hands and wrist. A fibromas of the tendon sheath arising from the medial canthal tendon presented as an enlarging nodule that had been present for 40 years. The fibroma was identified by microscopy and immunohistochemistry, and surgical resection appears to have been curative.
  Ophthalmic plastic and reconstructive surgery 05/2012; · 0.69 Impact Factor
• Article: Characterisation of lacrimal sac histology: an immunohistochemical study.

  Aanchal Gupta, Venkatesh C Prabhakaran, Tom Dodd, Dinesh Selva
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  ABSTRACT: Background:  A prospective observational study in a university hospital setting to study the immunohistochemical (IHC) characteristics of non-neoplastic human lacrimal sac epithelium. Methods:  Twenty paraffin-embedded specimens of human lacrimal sac were studied using monospecific monoclonal antibodies to 34 beta E12, cell adhesion molecule (CAM 5.2), epithelial membrane antigen (EMA), cytokeratins (CK) 7 and 20, estrogen receptor (ER) and progesterone receptor (PR). The distribution and histologic location of IHC staining were examined qualitatively, and the IHC stains scored as positive (+) or negative (-). Results:  The haematoxylin-eosin stains were reviewed for tissue morphology. All twenty specimens were positive for 34 beta E12, CAM 5.2, EMA and CK 7; and negative for CK 20, ER and PR. Conclusion:  To our knowledge, this is the first study to characterise the IHC properties of human lacrimal sac epithelium. This epithelium appears to possess consistent IHC properties as it stains for 34 beta E12, CAM 5.2, EMA and CK 7 and this information would be potentially useful in differentiating tumours arising in the region of the lacrimal sac. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.
  Clinical and Experimental Ophthalmology 05/2012; · 1.98 Impact Factor
• Article: Lacrimal scintigraphy: "interpretation more art than science".

  Suresh Sagili, Dinesh Selva, Raman Malhotra
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  ABSTRACT: Lacrimal scintigraphy (LS) or dacryoscintigraphy can demonstrate abnormalities in 80%-95% of patients with symptoms of epiphora and a patent lacrimal system on syringing and up to 40% asymptomatic individuals. Precise localization of the site of delay may not always be possible due to lack of anatomic detail on LS. LS is considered useful in patients with epiphora with delayed tear clearance and patency to syringing and suspected to have either nasolacrimal duct (NLD) stenosis or lacrimal pump failure. It remains unclear, however, as to whether LS can reliably distinguish between the two. The literature reports considerable variation in the technique, normative data, analysis, and interpretation of LS. Qualitative or visual analysis is simpler to perform and to our knowledge used more frequently in comparison to quantitative analysis. There is little extra information to be gained from LS in cases with complete NLD obstruction or severe NLD stenosis on syringing.
  Orbit (Amsterdam, Netherlands) 04/2012; 31(2):77-85.
• Article: Perspective: what does the term functional mean in the context of epiphora?

  Wengonn Chan, Raman Malhotra, Hirohiko Kakizaki, Igal Leibovitch, Dinesh Selva
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  ABSTRACT: The term 'functional block' is used to encompass the concept of lacrimal drainage dysfunction in the presence of anatomical patency. There is significant variability in the nomenclature, clinical and investigative criteria used in the literature to define this entity. This has led to confusion and lack of comparability of studies looking at this group. The clinical features, investigative findings and treatment options in this group of patients are described. In addition, the need to differentiate between nasolacrimal stenosis and 'functional block' is emphasized, as evidence suggest patients with nasolacrimal duct stenosis have better outcomes with dacryocystorhinostomy. To better define the disease entity and enable comparability of future studies, it was proposed that this entity be replaced by the term functional epiphora with no delay, pre- or post-sac delay.
  Clinical and Experimental Ophthalmology 03/2012; 40(7):749-54. · 1.98 Impact Factor
• Article: Medial rectus Botox injection with pterygium excision and autograft as a novel technique for management of recurrent pterygium.

  Sumu Simon, James Temlett, Mark Chehade, Dinesh Selva
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  ABSTRACT: © 2012 The Authors. Journal compilation © 2012 Royal Australian and New Zealand College of Ophthalmologists.
  Clinical and Experimental Ophthalmology 02/2012; 40(6):644-5. · 1.98 Impact Factor
• Article: Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye.

  Hirohiko Kakizaki, Yasuhiro Takahashi, Masayoshi Iwaki, Takashi Nakano, Ken Asamoto, Hiroshi Ikeda, Eiki Goto, Dinesh Selva, Igal Leibovitch
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  ABSTRACT: To characterize the microscopic anatomy of the lacrimal punctum and canaliculi in relation to the tarsal plate, muscle of Riolan, and Horner muscle; and to report a novel technique to excise the horizontal canaliculus in severe dry eye patients. Observational anatomic study and a retrospective case series. The microscopic anatomy was studied in 86 eyelids of 25 cadavers (age range: 45-96 years, mean: 79.5 years). Surgery was performed on 18 canaliculi of 7 patients with dry eyes (age range: 37-69 years, mean: 59.9 years). In the microscopic study, 32 eyelids were incised sagittally, 38 eyelids were incised horizontally (1 mm from the eyelid margin), and 16 eyelids were incised parallel to the tarsal plate. All specimens were stained with Masson trichrome. In the surgical group, probe-guided horizontal canalicular excision with incision of the Horner muscle to the lateral edge of the lacrimal caruncle was performed. Both canalicular stumps were cauterized. In the microscopic anatomic study, the punctum and the vertical canaliculus were part of the tarsal plate with the muscle of Riolan, whereas the horizontal canaliculus was surrounded by the Horner muscle. In the surgical group, all the operated canaliculi were completely occluded without recanalization 12 months postoperatively. No complications were recorded. Based on microscopic anatomic findings that the lacrimal punctum and the vertical canaliculus are part of the tarsal plate, and that the horizontal canaliculus is surrounded by the Horner muscle, excision of the horizontal canaliculus may be an effective technique to treat patients with severe dry eyes.
  American journal of ophthalmology 02/2012; 153(2):229-237.e1. · 3.83 Impact Factor
• Article: Refractive error in school children in an urban and rural setting in Cambodia.

  Zoe Gao, Ngy Meng, James Muecke, Weng Onn Chan, Horm Piseth, Aimee Kong, Theresa Jnguyenphamhh, Yalda Dehghan, Dinesh Selva, Robert Casson, Kim Ang
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  ABSTRACT: To assess the prevalence of refractive error in schoolchildren aged 12-14 years in urban and rural settings in Cambodia's Phnom Penh and Kandal provinces. Ten schools from Phnom Penh Province and 26 schools from Kandal Province were randomly selected and surveyed in October 2010. Children were examined by teams of Australian and Cambodian optometrists, ophthalmic nurses and ophthalmologists who performed visual acuity (VA) testing and cycloplegic refraction. A total of 5527 children were included in the study. The prevalence of uncorrected, presenting and best-corrected VA ≤ 6/12 in the better eye were 2.48% (95% confidence interval [CI] 2.02-2.83%), 1.90% (95% CI 1.52-2.24%) and 0.36% (95% CI 0.20-0.52%), respectively; 43 children presented with glasses whilst a total of 315 glasses were dispensed. The total prevalence of refractive error was 6.57% (95% CI 5.91-7.22%), but there was a significant difference between urban (13.7%, 95% CI 12.2-15.2%) and rural (2.5%, 95% CI 2.03-3.07%) schools (P < 0.0001). Refractive error accounted for 91.2% of visually impaired eyes, cataract for 1.7%, and other causes for 7.1%. Myopia (spherical equivalent ≤ -0.50 diopters [D] in either eye) was associated with increased age, female gender and urban schooling. The prevalence of refractive error was significantly higher in urban Phnom Penh schools than rural schools in Kandal Province. The prevalence of refractive error, particularly myopia was relatively low compared to previous reports in Asia. The majority of children did not have appropriate correction with spectacles, highlighting the need for more effective screening and optical intervention.
  Ophthalmic epidemiology 02/2012; 19(1):16-22. · 1.93 Impact Factor
• Source

  Available from: PubMed Central

  Article: Punctal stenosis: definition, diagnosis, and treatment.

  Uri Soiberman, Hirohiko Kakizaki, Dinesh Selva, Igal Leibovitch
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  ABSTRACT: Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.
  Clinical Ophthalmology 01/2012; 6:1011-8.
• Article: Anatomy of Tenons capsule.

  Hirohiko Kakizaki, Yasuhiro Takahashi, Takashi Nakano, Ken Asamoto, Hiroshi Ikeda, Akihiro Ichinose, Masayoshi Iwaki, Dinesh Selva, Igal Leibovitch
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  ABSTRACT:   The microscopic and macroscopic anatomy of the anterior and posterior Tenons capsule is described.   An observational anatomic study of twelve orbits of 6 cadavers (mean age 79.5 years) were examined microscopically and 8 orbits of 4 cadavers (mean age 76.8 years) were examined macroscopically. After orbital exenteration, an X-shaped incision was made in the specimens to include the posterior part of the globe. The sections were divided into four parts: superomedial; inferomedial; superolateral; and inferolateral. In the macroscopically examined specimens, the eyelids and globes were removed from the exenterated tissues and the appearance of Tenons capsule was studied.   In the microscopic study, Tenons capsule covered the sclera beneath the conjunctiva and contained smooth muscle fibres in the anterior area. This anterior fascia, which had a thick appearance, reached the globe equator. From there, the capsule of the orbital fat, which contained no smooth muscle fibres, enveloped the sclera and reached the optic nerve. This was defined as the posterior capsule. In the macroscopic specimens, Tenons capsule had a thick and fibrous white appearance in the anterior area. More posteriorly, the capsule was thinner and more translucent. This thin capsular part was generally larger in the lateral area than in the medial area.   Tenons capsule is composed of an anterior thick fibrous tissue comprising the orbital smooth muscle network and the posterior thin fibrous capsule of the orbital fat.
  Clinical and Experimental Ophthalmology 12/2011; 40(6):611-6. · 1.98 Impact Factor
• Article: The ophthalmic side-effects of imiquimod therapy in the management of periocular skin lesions.

  Paul S Cannon, Brett O'Donnell, Shyamala C Huilgol, Dinesh Selva
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  ABSTRACT: To describe the ophthalmic side-effects of topical imiquimod for periocular actinic keratoses, squamous cell carcinoma in situ and basal cell carcinoma. A retrospective study was carried out in two centres of all patients who underwent topical imiquimod therapy between January 2004 and January 2009. Imiquimod was applied three times weekly for 4-6 weeks. Diagnosis of the lesions, complications, clinical resolution and long-term ophthalmic side-effects was recorded. Patients on therapy were reviewed fortnightly and then every 6 weeks following completion of treatment. 47 patients were identified; the mean age was 74 years. 37 patients had actinic keratoses, seven patients had Bowen disease, and three patients had BCC. The lower lid was the commonest site involved (68%). Application site erythema occurred in all patients. Conjunctivitis occurred in 15 patients, and six patients complained of ocular stinging on application of imiquimod. One patient had a staphylococcal keratitis, which responded to topical antibiotic and steroid therapy. Two patients required oral antibiotics for preseptal cellulitis. Three patients had delayed conjunctivitis at a mean of 2.3 weeks. Nine patients discontinued imiquimod due to ocular irritation and conjunctivitis, of whom four patients recommenced and finished the treatment after a rest period. At a mean follow-up of 16 weeks, 34 patients had clinical resolution of the periocular lesions and no patient had any residual ophthalmic side-effects from imiquimod. Conjunctivitis and ocular stinging were the commonest ophthalmic side-effects encountered with the application of imiquimod for periocular skin lesions. These effects were temporary and resolved on terminating the imiquimod therapy.
  The British journal of ophthalmology 12/2011; 95(12):1682-5. · 2.92 Impact Factor
• Article: Two presentations of upper lid migration of rigid gas-permeable contact lenses.

  Akihide Watanabe, Michelle T Sun, Dinesh Selva, Kosuke Ueda, Koichi Wakimasu, Shigeru Kinoshita
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  ABSTRACT: To report two differing forms of upper lid migration of rigid gas-permeable contact lens and review the literature on embedded contact lenses. Two case reports and review of the literature. Case 1 was a 36-year-old woman, who presented with a 1-year history of a left upper lid mass. Eversion of the upper lid revealed a tarsoconjunctival mass with an overlying scar. Excision revealed a migrated contact lens within a cyst of conjunctival epithelium. She recalled she had lost the lens 1 year before noticing the mass. Case 2 was a 42-year-old woman, who had a 10-month history of mucopurulent discharge from the right eye. Double eversion of the upper lid revealed an embedded contact lens with pus. Excision demonstrated a lens surrounded by inflamed granulation tissue. She recalled having lost the lens after sleeping overnight with the lens in place approximately 1 year before the development of the mucopurulent discharge. These cases highlight the importance of acquiring a detailed history of contact lens loss in patients presenting with upper eyelid masses. Furthermore, the history of lens loss may be remote from commencement of symptoms, which may vary significantly between patients.
  Eye & contact lens 10/2011; 38(5):336-40.
• Article: Histological evidence of tissue reaction to platinum eyelid chain.

  WengOnn Chan, Craig James, Peter Sutton-Smith, Thomas Dodd, Dinesh Selva
  Archives of ophthalmology 09/2011; 129(9):1247-8. · 3.86 Impact Factor
• Article: Novel use of positron emission tomography/computed tomography in the diagnosis of infected porous orbital implant.

  WengOnn Chan, Eugenie Poh, Dylan Bartholomeusz, Dinesh Selva
  Clinical and Experimental Ophthalmology 09/2011; 39(7):704-5. · 1.98 Impact Factor
• Article: Management of upper eyelid cicatricial entropion.

  Adam H Ross, Paul S Cannon, Dinesh Selva, Raman Malhotra
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  ABSTRACT: There is a paucity of published data on the management of upper eyelid cicatricial entropion. We report on our results using such techniques as lamella repositioning, recession or augmentation and terminal tarsal rotation. Observational retrospective case series. Consecutive cases of upper eyelid cicatricial entropion of two specialist oculoplastic centres (Corneoplastic Unit, East Grinstead, UK and South Australian Institute of Ophthalmology, Adelaide, Australia) were reviewed over a 7-year period. All patients underwent anterior lamellar repositioning or terminal tarsal rotation. Success was defined by two definitions: anatomical success was defined where the lid margin was restored to its normal position. Complete success was defined where there were no eyelashes touching the globe. Gain or loss (≤ or ≥2 Snellen lines) in best corrected visual acuity using a Snellen chart and resolution of any corneal epitheliopathy at final follow-up were also recorded (as graded by experienced oculoplastic consultants). Fifty-two procedures were performed on 41 patients (11 bilateral). All patients underwent either an anterior lamellar repositioning or a terminal tarsal rotation. Trachoma, previous upper lid surgery, Stevens-Johnson syndrome and meibomian gland dysfunction were the commonest underlying diagnoses. Ninety-eight per cent of the group had a normal anatomical lid position at follow-up. Nine eyelids (17%) of the group had recurrence of trichiasis. This large case series demonstrates that upper eyelid cicatricial entropion is managed effectively utilizing procedures that involve recession and reposition. We recommend that excision of tissue is avoided, especially in pathology that has a progressive immunological cicatricial drive.
  Clinical and Experimental Ophthalmology 08/2011; 39(6):526-36. · 1.98 Impact Factor
• Article: Anatomy of medial canthal tendon in Caucasians.

  Eugenie Poh, Hirohiko Kakizaki, Dinesh Selva, Igal Leibovitch
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  ABSTRACT: To analyse the anatomy of the medial canthal tendon in Caucasians and to clarify the true anatomical nature of its posterior limb. This was an experimental anatomic study. Seven Caucasian cadavers (11 eyelids; age range: 78-101years at death). Anatomical dissection and histological examination of cadaveric eyelids fixed in 10% buffered formalin was performed. The axial sections were made in parallel with the eyelid margin at 1mm superior or inferior to the upper or lower eyelid margins, respectively. The histological specimens were first dehydrated and embedded in paraffin and then divided into 7µm thickness sections and stained with Masson's trichrome. Microscopic photographs were taken with a digital camera system attached to the microscope. The posterior limb of the medial canthal tendon was not detected in any of the specimens. The medial check ligament supported the posterior aspect of Horner's muscle and inserted into the medial orbital wall through the periosteum. The lacrimal diaphragm around the posterior lacrimal crest ran almost parallel to Horner's muscle and was usually difficult to distinguish from the tendon of Horner's muscle. The posterior limb of the medial canthal tendon was not detected in any of the studied specimens. This anatomical structure appears to be Horner's muscle, and the lacrimal diaphragm.
  Clinical and Experimental Ophthalmology 07/2011; 40(2):170-3. · 1.98 Impact Factor
• Article: Protein C deficiency with concurrent essential thrombocytosis and orbital compartment syndrome.

  Michelle T Sun, WengOnn Chan, Simon McRae, Dinesh Selva
  Clinical and Experimental Ophthalmology 06/2011; 40(3):325-6. · 1.98 Impact Factor
• Article: Killing two birds with one stone: the potential effect of cataract surgery on the incidence of primary angle-closure glaucoma in a high-risk population.

  WengOnn Chan, José A García, Henry S Newland, James Muecke, Stephen McGovern, Dinesh Selva, Tin Aung, Robert J Casson
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  ABSTRACT: To estimate the proportion of cataract surgery performed at various visual acuity and lens opacity thresholds that would coincidentally treat early angle-closure disease, and to estimate the effect of this surgery on the incidence of primary angle-closure glaucoma. Cross-sectional, population-based survey in Meiktila, Myanmar. Total of 2076 inhabitants, 40 years of age and over were included. Eyes with cataract-induced visual impairment, and primary angle-closure disease were identified. Analyses were stratified by various pinhole-corrected visual acuity and Lens Opacity Classification System III scores thresholds. The dual role of cataract surgery in primary cataract treatment and primary angle-closure glaucoma prevention was estimated. Of 4153 eyes available for analysis, 261 eyes were either primary angle-closure suspect or primary angle closure; 975 eyes had a visual acuity of <6/18 and Lens Opacity Classification System III score ≥ 3 on the nuclear or cortical scales. Of these, 86 eyes had either primary angle-closure suspect or primary angle closure. If cataract surgery were performed on all 975 eyes, this would potentially prevent up to 86 cases of primary angle-closure glaucoma in this population; 8.82% (95% confidence interval 7.12-10.78%) of the cataract surgery would address the cataract and prevent primary angle-closure glaucoma. This would achieve a 38.46% (95% confidence interval 20.23-59.43%) relative reduction in the incidence of primary angle-closure glaucoma in the adult population. In populations with a high prevalence of both visually significant cataract and angle-closure disease, quality cataract extraction can serve a dual role of visual restoration and reducing the incidence of angle-closure disease in the population: killing two birds with one stone.
  Clinical and Experimental Ophthalmology 06/2011; 40(4):e128-34. · 1.98 Impact Factor
• Article: Trends and impact of ophthalmology research.

  Michelle T Sun, Christopher X Wong, Robert Casson, Dinesh Selva
  Ophthalmology 06/2011; 118(6):1216.e3-4. · 5.45 Impact Factor