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PURPOSE: The aim of this study is to test the hypothesis that margin-reflex distance 1 (MRD1) on the day of surgery will be higher than the MRD1 measured at the in-clinic consult visit among patients undergoing blepharoptosis repair due to an increased sympathetic drive. METHODS: Patients evaluated for involutional blepharoptosis repair were prospectively enrolled over a 12-month period in this single-center, self-controlled study. Three investigators independently determined MRD1 using cropped photos taken of patients at the in-clinic consult visit and on the day of surgery. A difference in height was tested for by using the 2-tailed Wilcoxon signed rank test. RESULTS: Evaluated in this study were 76 eyelids from 38 patients. Over 3-quarters of study participants had a higher MRD1 in the right and OSs on the day of surgery than at their in-clinic consultation visit (p < 0.001). The mean increase in MRD1 for the right eyelid and left eyelid was 1.0 mm (range: 0-3.15 mm) and 1.1 mm (range: 0-2.7 mm), respectively. CONCLUSIONS: In patients with involutional blepharoptosis, we conclude that MRD1 is higher on the day of surgery as compared with the in-clinic consult visit. This may be secondary to the stress of surgery and an associated increase in sympathetic drive. In some cases, this change in eyelid position led to resolution of apparent involutional ptosis altogether. Caution should be used when considering deferral of ptosis repair on the basis of exam findings present on the day of surgery.
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Blefaroplastia , Blefaroptose , Pálpebras , Humanos , Blefaroptose/cirurgia , Blefaroptose/fisiopatologia , Feminino , Masculino , Pálpebras/cirurgia , Estudos Prospectivos , Idoso , Blefaroplastia/métodos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , AdultoRESUMO
PURPOSE: To review clinical presentations of periocular sebaceous carcinoma (SC) and introduce standardized nomenclature for multicentric and multifocal disease presentation. METHODS: A comprehensive PubMed/Medline search was conducted to identify all articles reporting periocular multicentric or multifocal SC presentations. The authors also highlight an additional case of SC presenting with 2 clinically distinct tumor foci and complete secondary invasion of the lacrimal gland. RESULTS: This review summarizes clinical presentations of periocular SC exhibiting discrete foci of microinvasion reported in the literature. Discrete microinvasion was associated with high rates of misdiagnosis (80%), simultaneous involvement of both upper and lower eyelids (80%), pagetoid spread (80%), multinodular growth (33%), local tumor spread (60%), previous eyelid manipulation (40%), and local recurrence (40%). Eyelid multifocality with clinically discrete nodules (42%) was associated with more advanced disease including orbital extension and regional invasion (80%). CONCLUSIONS: Despite previous reported associations with poorer outcomes, there is no consensus in the definition or nomenclature for discrete microinvasive or clinical disease presentations in periocular SC. The authors recommend defining multicentric disease as discrete foci of microinvasive tumor with basement membrane disruption and multifocal disease as discrete clinically evident nodules involving both the upper and lower eyelids. Differentiating between discrete microinvasive (multicentric) and clinically nodular (multifocal) disease may improve risk stratification to most accurately identify patients who require more aggressive management and surveillance.
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Adenocarcinoma Sebáceo , Neoplasias Palpebrais , Neoplasias das Glândulas Sebáceas , Humanos , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias Palpebrais/patologia , Adenocarcinoma Sebáceo/diagnóstico , Pálpebras/patologiaRESUMO
ABSTRACT: Esthesioneuroblastoma is a rare neoplasm originating from the olfactory neuroepithelium at the cribriform plate. The superior nasal cavity is primarily affected. Morbidity and mortality are related to locally destructive growth as well as metastatic potential. Orbital involvement is associated with decreased survival. The authors describe a case of advanced esthesioneuroblastoma with bilateral orbital involvement, presenting with a rare constellation of orbital hypertelorism and Foster-Kennedy Syndrome.
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Estesioneuroblastoma Olfatório , Hipertelorismo , Neoplasias Nasais , Doenças do Nervo Óptico , Estesioneuroblastoma Olfatório/cirurgia , Humanos , Cavidade Nasal/diagnóstico por imagem , Neoplasias Nasais/complicações , Neoplasias Nasais/cirurgiaRESUMO
Defects in the outer blood-retinal barrier have significant impact on the pathogenesis of diabetic retinopathy and macular edema. However, the detailed mechanisms involved remain largely unknown. This is, in part, attributed to the lack of suitable animal and cell culture models, including those of mouse origin. We recently reported a method for the culture of retinal pigment epithelial (RPE) cells from wild-type and transgenic mice. The RPE cells are responsible for maintaining the integrity of the outer blood-retinal barrier whose dysfunction during diabetes has a significant impact on vision. Here we determined the impact of high glucose on the function of RPE cells. We showed that high glucose conditions resulted in enhanced migration and increased the level of oxidative stress in RPE cells, but minimally impacted their rate of proliferation and apoptosis. High glucose also minimally affected the cell-matrix and cell-cell interactions of RPE cells. However, the expression of integrins and extracellular matrix proteins including pigment epithelium-derived factor (PEDF) were altered under high glucose conditions. Incubation of RPE cells with the antioxidant N-acetylcysteine under high glucose conditions restored normal migration and PEDF expression. These cells also exhibited increased nuclear localization of the antioxidant transcription factor Nrf2 and ZO-1, reduced levels of ß-catenin and phagocytic activity, and minimal effect on production of vascular endothelial growth factor, inflammatory cytokines, and Akt, MAPK, and Src signaling pathways. Thus high glucose conditions promote RPE cell migration through increased oxidative stress and expression of PEDF without a significant effect on the rate of proliferation and apoptosis.
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Movimento Celular/fisiologia , Proteínas do Olho/metabolismo , Glucose/metabolismo , Fatores de Crescimento Neural/metabolismo , Estresse Oxidativo/fisiologia , Serpinas/metabolismo , Acetilcisteína/metabolismo , Animais , Antioxidantes/metabolismo , Apoptose/fisiologia , Células Cultivadas , Células Epiteliais/metabolismo , Células Epiteliais/fisiologia , Integrinas/metabolismo , Camundongos , Camundongos Transgênicos , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Epitélio Pigmentado da Retina/metabolismo , Epitélio Pigmentado da Retina/fisiologia , Pigmentos da Retina/metabolismo , Transdução de Sinais/fisiologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , beta Catenina/metabolismoRESUMO
OBJECTIVES: To measure growth-related changes in orbital volume from childhood to the late teenage years using cone-beam computed tomography (CBCT) scans. METHODS: This retrospective cohort study involved 65 (24 male, 41 female) healthy Caucasian children (ages 6-18 years) with existing serial craniofacial CBCT scans. CBCT scans were available for 292 orbits. Each orbit was transformed into a closed space with well-defined boundaries, and orbital volume was measured using manual segmentation. A novel statistical analysis was applied to extract the maximum amount of longitudinal information from the data. Intra- and inter-operator correlation coefficients were calculated from replications performed on a random subset of 10% of the sample. RESULTS: Orbital volume increased at a rate of 1-2% annually until the late teenage years. Intra- and inter-operator agreement between repeated measurements were >90%. CONCLUSIONS: Orbital volume increases by 1-2% per year throughout childhood continuing until the late teenage years. This annual increase is large enough to be clinically relevant as it may lead to less-than-optimal long term surgical outcomes when reconstructive surgery for the pediatric anophthalmic socket is required.
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Tomografia Computadorizada de Feixe Cônico , Órbita , Adolescente , Criança , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Crescimento e Desenvolvimento , Humanos , Masculino , Órbita/diagnóstico por imagem , Estudos RetrospectivosRESUMO
PURPOSE: If not recognized and treated promptly, nontraumatic orbital subperiosteal hemorrhage (NTSOH) can have serious sequelae including compressive optic neuropathy and permanent vision loss. The following case establishes erotic asphyxiation as a cause of NTSOH. OBSERVATIONS: A 29 year-old patient presented with diplopia and periorbital edema and ecchymosis. Complete ophthalmologic exam showed no optic neuropathy. Computed tomography of the orbits revealed a subperiosteal fluid collection in the right orbit. The patient had no risk factors for NTSOH, but after detailed questioning she admitted to participating in erotic asphyxiation prior to the onset of her symptoms. She was observed and subsequently lost to follow up. CONCLUSIONS AND IMPORTANCE: To the authors' knowledge, erotic asphyxiation as a cause of orbital subperiosteal hematoma has not been previously reported. Lack of knowledge about erotic asphyxiation amongst healthcare providers may contribute to hesitance to directly question patients about the practice. Clinicians should be aware of erotic asphyxiation as a potential cause of orbital subperiosteal hemorrhage.
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A 4-year-old girl with a history of Pearson marrow-pancreas syndrome presenting with severe, progressive photophobia was found to have bilateral, diffuse corneal thickening and peripheral pigmentary retinopathy. She underwent Descemet stripping automated endothelial keratoplasty (DSAEK) surgery in both eyes using a modified suture pull-through technique. Postoperatively there was no evidence of cataract formation or graft detachment; her corneas thinned, and her photophobia improved dramatically.
Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Endotélio Corneano/fisiopatologia , Fotofobia/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Acuidade Visual , Acil-CoA Desidrogenase de Cadeia Longa/deficiência , Pré-Escolar , Síndrome Congênita de Insuficiência da Medula Óssea , Doenças da Córnea/complicações , Doenças da Córnea/fisiopatologia , Paquimetria Corneana/métodos , Endotélio Corneano/patologia , Feminino , Humanos , Erros Inatos do Metabolismo Lipídico , Doenças Mitocondriais , Doenças Musculares , Fotofobia/etiologia , Fotofobia/fisiopatologiaRESUMO
Giant cell arteritis (GCA) requires a prompt diagnosis to avoid significant morbidity among the elderly. An accurate diagnosis is also paramount given the side effect profile of long-term corticosteroid treatment. Temporal artery biopsy (TAB) has long remained the gold standard for the diagnosis of GCA but requires an invasive procedure that is not without risk. This article discusses the argument for and against the use of noninvasive imaging including ultrasound, magnetic resonance imaging, and positron emission tomography scanning for the diagnosis of GCA. It also provides a suggested diagnostic algorithm for when to consider noninvasive imaging versus TAB.