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Ophthalmic Plastic and Reconstructive Surgery

Anupam Kotwal, Marius Stan
PURPOSE: Thyroid autoimmunity affects approximately 5% of the population, and its investigation relies heavily on the use of autoantibodies. Thyroid stimulating hormone receptor (TSHR) autoantibodies (TRAb) play a central role in the evaluation of Graves disease (GD), Graves ophthalmopathy (GO) and pretibial myxedema (PTM). However, there is still controversy regarding overall TRAb assay diagnostic accuracy and their prognostic utility. METHODS: We reviewed and analyzed the literature reporting TRAb assays and their clinical utility...
May 2, 2018: Ophthalmic Plastic and Reconstructive Surgery
Tanja Diana, George J Kahaly
BACKGROUND: Thyroid stimulating hormone receptor antibodies (TSHR-Ab) cause autoimmune hyperthyroidism and are prevalent in patients with related thyroid eye disease (TED). PURPOSE: To provide a historical perspective on TSHR-Ab and to present evidence-based recommendations for clinical contemporary use. METHODS: The authors review the recent literature pertaining to TSHR-Ab in patients with TED and describe the various immunoassays currently used for detecting TSHR-Ab and their clinical applications...
May 2, 2018: Ophthalmic Plastic and Reconstructive Surgery
Lilangi S Ediriwickrema, Bobby S Korn, Don O Kikkawa
PURPOSE: To describe historical and modern surgical approaches to orbital decompression in patients with thyroid-related orbitopathy in the quiescent phase. METHODS: A literature review of published techniques using the National Institutes of Health PubMed database. RESULTS: Historically, orbital decompression has been accomplished via transantral, transcranial, transnasal, and orbital approaches. Current techniques use predominately periocular incisions to achieve effective decompression and proptosis reduction...
May 2, 2018: Ophthalmic Plastic and Reconstructive Surgery
Kevin R Zhang, Alexander D Blandford, Catherine J Hwang, Julian D Perry
PURPOSE: The infraorbital foramen (IOF) represents a highly conserved structure but demonstrates morphologic variability. The purpose of this study is to describe the IOF location, size, and supernumerary foramina in an African American population and compare it with a Caucasian population. METHODS: Sixty African American and 60 Caucasian skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. The primary outcome was the number of accessory IOF and measurements of the location, size, shape, and direction of each foramen...
May 2, 2018: Ophthalmic Plastic and Reconstructive Surgery
Kyle J Godfrey, Michael Kazim
PURPOSE: To critically review the published literature on orbital radiotherapy as a treatment modality for thyroid eye disease (TED). METHODS: A systematic review and analysis of the relevant published literature was performed. RESULTS: Thyroid eye disease is an autoimmune condition that is amenable to treatments that modulate the immune response, including orbital radiotherapy (ORT). Ideal candidates for ORT are patients in the early, active phase of TED with moderate to severe, or rapidly progressive, disease, including patients with significant motility deficits and compressive optic neuropathy...
May 2, 2018: Ophthalmic Plastic and Reconstructive Surgery
Philip L Custer, Robi N Maamari
PURPOSE: The purpose of this study is to report the surgical technique and functional outcomes of the hatchet flap with transposed nasal inset for midfacial defect repairs. METHODS: An Institutional Review Board-approved, retrospective review was performed to identify patients treated using the hatchet flap with transposed nasal inset. Patient demographics, disease etiology, defect characteristics, and postoperative complications were collected from preoperative and follow-up visits...
April 17, 2018: Ophthalmic Plastic and Reconstructive Surgery
Stephanie Ming Young, Yoon-Duck Kim, Stephanie S Lang, Kyung In Woo
PURPOSE: To evaluate the role of transconjunctival triamcinolone acetonide (TA) injection in the management of upper eyelid retraction in thyroid eye disease. METHODS: Retrospective interventional review of all patients who underwent transconjunctival TA injection (40 mg/mL) for thyroid eye disease-related upper eyelid retraction from January 2010 to December 2016 in a single tertiary institution. The present study comprised 2 groups: Patients receiving only TA injection (group 1), and patients receiving both TA injection and other immunosuppressive therapy (group 2)...
April 17, 2018: Ophthalmic Plastic and Reconstructive Surgery
Hung-Chang Chen, Jacob T Cox, Abanti Sanyal, Nicholas R Mahoney
PURPOSE: In evaluating patients sustaining bilateral isolated internal orbital fractures, the authors have observed both similar fracture locations and also similar expansion of orbital volumes. In this study, we aim to investigate if there is a propensity for the 2 orbits to fracture in symmetrically similar patterns when sustaining similar trauma. METHODS: A retrospective chart review was performed studying all cases at our institution of bilateral isolated internal orbital fractures involving the medial wall and/or the floor at the time of presentation...
April 13, 2018: Ophthalmic Plastic and Reconstructive Surgery
Christine L Bokman, Christopher C Lo, Knut Eichhorn, Robert A Goldberg
The occurrence of an accessory palpebral fissure and eyelid is an extremely rare phenomenon. An isolated accessory palpebral fissure and eyelid have been reported only twice in the literature, and in one case as an extension of Delleman syndrome, or oculocerebrocutaneous syndrome. The authors report a case of a full-term newborn who presented with an accessory palpebral fissure and eyelid associated with microcornea, skin polyps and tags, cutis dysplasia, and hypoplasia of the corpus callosum with an otherwise normal systemic workup and negative genetic screening...
April 13, 2018: Ophthalmic Plastic and Reconstructive Surgery
Claudia M Prospero Ponce, Amina I Malik, Aroucha Vickers, Patricia Chevez-Barrios, Andrew G Lee
A 34-year-old previously healthy Hispanic male presented to the emergency room complaining of progressive left upper eyelid swelling and pain for more than 2 weeks. He was previously diagnosed and treated for a "pink eye" but failed to improve. He reported a previous "bug bite" around the left lateral canthus a few weeks prior to admission. Computer tomography orbit with contrast showed left exophthalmos, an enhancing left lacrimal gland and orbital inflammatory signs suggestive of possible intraorbital abscess...
April 13, 2018: Ophthalmic Plastic and Reconstructive Surgery
Ramón Medel, Salvador Molina, Luz Maria Vasquez, Josep Visa, Ana Wert, Charlotte Wolley-Dod
PURPOSE: To compare 2 surgical techniques (frontalis flap versus maximal anterior levator resection) as first surgical options for the treatment of congenital ptosis with poor levator function in patients younger than 2 years of age with a follow up of 10 years. METHODS: A retrospective study of 58 patients (71 eyelids) with severe ptosis and poor levator function who underwent frontalis muscle flap (FMF = 47) or maximal anterior levator resection (ALR = 24) for correction of their ptosis...
April 12, 2018: Ophthalmic Plastic and Reconstructive Surgery
Lauren N DeMaria, Nora K Silverman, Roman Shinder
PURPOSE: Topical timolol has been increasingly demonstrated to be an effective treatment for pyogenic granulomas (PG). The authors review the treatment outcomes of 17 patients with ocular PG treated with topical timolol. METHODS: Retrospective interventional study of 17 patients with ocular PGs treated with timolol 0.5% solution. Patient demographics, clinical features, treatment response, and recurrence were noted. RESULTS: Nine females and 8 males with a mean age of 23 years (range, 3-67 years) were included...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Elizabeth Chiang, Jasmina Bajric, Gerald J Harris
The authors describe 2 patients who presented with orbital findings and later developed vesicular lesions that were positive for varicella zoster virus and consistent with Herpes Zoster ophthalmicus. One case is the first to involve dacryoadenitis and orbital myositis preceding disseminated Herpes Zoster. In the other case, a patient developed zoster orbital syndrome leading to elevated intraocular pressure, loss of vision, and afferent pupillary defect. Canthotomy and cantholysis were required to restore vision...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Siddharth Madan, Zia Chaudhuri
Amniotic band syndrome is a rare congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero that presents with complex multisystem anomalies. The authors report 2 children with amniotic band syndrome who presented to the ophthalmic unit of the authors' pediatric hospital. One of them presented with telecanthus, syndactyly, amputated toes, and unilateral epiphora diagnosed as congenital nasolacrimal duct obstruction. She was managed conservatively with lacrimal sac massage and provided with refractive correction while she simultaneously underwent multiple surgeries for correction of clubfoot and craniosynostosis...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Daphne L Mourits, Jelmer S Remmers, Stevie H Tan, Annette C Moll, Dyonne T Hartong
PURPOSE: To introduce a novel technique to design individually customized conformers for postenucleation sockets with dermis fat implants. METHODS: We use a 3-dimensional scan of the frontal face/orbit and eyelid contour to design an individualized conformer. This polymethylmetacrylate printed conformer is adapted to patients' socket, palpebral fissures, horizontal eyelid aperture, curvature of the eyelids, and mean diameter of patients' contralateral eye. Sutures through holes in the inferior part of the conformer and in the extension can be placed to fixate the conformer and anchor fornix deepening sutures...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Seong Jun Park, Sun Young Jang, Ji Sun Baek, Susie Chin, Jae Woo Jang
PURPOSE: To determine the relationship between the distribution of adrenergic receptors in the human eyelid and the eyelid elevation after topically instilling 0.5% apraclonidine in blepharoptosis patients. METHODS: A total of 26 blepharoptotic patients (30 eyelids) were included in the experimental study. Marginal reflex distance 1 was measured before and after topical instillation of 0.5% apraclonidine. Eyelids were divided into 2 groups according to the responses to topical 0...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Chad C Zatezalo, Mehdi Tavakoli, Juan Ayala-Haedo, Marcus J Ko, Apostolos G Anagnostopoulos, Elizabeth A Vanner, Wendy W Lee
PURPOSE: Conjunctival Muller's muscle resection (CMMR) is a posterior approach surgical technique to correct blepharoptosis. The purpose of this study is to compare patient-reported pain scores and surgical outcomes for patients who received 2 different anesthetic techniques during CMMR, frontal nerve block and subconjunctival injection. METHODS: A prospective randomized comparative clinical trial enrolled 33 CMMR subjects from one tertiary eye center. Patients undergoing unilateral CMMR were randomized to receive either frontal nerve block or subconjunctival injection...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Kyung In Woo, Oded Sagiv, Jisang Han, Steven J Frank, Yoon-Duck Kim, Bita Esmaeli
PURPOSE: To describe the clinical outcomes of eye-preserving surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma. METHODS: Thirty-seven patients with lacrimal gland carcinoma who underwent eye-preserving surgery were studied. RESULTS: At last follow up, 32 patients were alive without disease, 3 patients were alive with disease with distant metastasis, 1 patient had died of disease, and 1 patient had died of other cause...
April 3, 2018: Ophthalmic Plastic and Reconstructive Surgery
Sathyadeepak Ramesh, Danica Fiaschetti, Robert A Goldberg
The authors herein describe a case of orbital and ocular ischemic syndrome with blindness after cosmetic hyaluronic acid filler injection. Orbital function, but not visual function, returned after treatment with orbital hyaluronidase and corticosteroids.
March 14, 2018: Ophthalmic Plastic and Reconstructive Surgery
Kristen E Dunbar, Cristina Abascal, Saagar A Pandit, Michael Kazim
PURPOSE: This study evaluates the reliability of a frequently used subjective measurement of orbital compliance (0-3 scale) and describes a simple, quantitative measure with excellent intra- and interrater reliability. METHODS: Two examiners performed both measurements on 100 orbits (50 consecutive patients) from the office of 1 oculoplastics surgeon. Each measurement was obtained at 2 different time points, 10 minutes apart. For the subjective measurement, the patient was asked to close their eyes, and the globe was displaced posteriorly with digital pressure until moderate resistance was felt...
March 14, 2018: Ophthalmic Plastic and Reconstructive Surgery
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