Beare-Stevenson Syndrome With Blepharoptosis as a Complication of Front-Orbital Advancement and Remodeling.

Beare-Stevenson syndrome (BSS) is an extremely rare genetic disorder characterized by a broad range of congenital malformations including craniosynostosis, cutis gyrata, facial deformities, and abnormal genitalia. The authors report a case of a 7 month old female who developed a mechanical ptosis secondary to dermatochalasis as a complication of fronto-orbital advancement and remodeling (FOAR) surgery which subsequently required multiple lid surgeries to reverse ptosis. This is the first report of blepharoptosis correction in a child with BSS as a complication of FOAR.

Scalping forehead transposition flap for total eyelid reconstruction with periocular involvement associated with a conjunctival cyst formation.

INTRODUCTION: Total upper and lower eyelid loss due to carcinoma or trauma while conserving a functioning eye is rarely seen. In such cases being able to maintain the ocular surface may prove to be a surgical challenge, more so when there is a history of tumor recurrence, multiple procedures or tissue loss that exceeds the palpebral region, thus limiting the reconstructive options. CASE AND TECHNIQUE: We present a case report where a scalping forehead transposition flap pedicled on the superficial temporal artery territory was performed to reconstruct a full thickness skin defect that involved the dorsum of the nose, cheek, upper and lower eyelids. A conjunctival advancement flap for ocular surface protection was used that unexpectedly rendered a cystic cavity that functioned as a tissue expander. COMMENT: Although the technique requires at least two surgical stages, we recommend this approach when other options are not feasible.

The Alberta standardized orbital technique in the management of spheno-orbital meningiomas.

PURPOSE: To describe a standardized orbital resection technique and outcomes for spheno-orbital meningiomas with soft-tissue invasion of the orbit. METHODS: A retrospective case review of patients with spheno-orbital meningioma that underwent resection utilizing the Alberta Standardized Orbital Technique (ASOT) between 2008 and 2017 was performed. RESULTS: Twenty patients met the inclusion criteria. Fifteen females and five males, with an average age of 53.4 years (SD ± 13.1 years). Mean follow-up was 57.3 months (SD ± 29.5 months). Eight cases (40%) had attempted resection prior to referral. Based on pre-operative plan, patients were divided into two groups based on goal of resection. Of those with planned complete resection (Group I), 11/13 patients (84.6%) underwent complete excision, with no cases of orbital recurrence. Incomplete resection in two cases occurred because of unexpected involvement of critical intra-cranial structures. Thus, in total 9/20 patients (Group II and 2 from Group I) underwent subtotal resection. Of these incomplete resections, five cases of orbital recurrence were observed; four patients required adjuvant external beam radiotherapy (EBRT) and one patient underwent further debulking surgery. Orbital control was achieved in three of these recurrent cases. Complications reported were persistent postoperative diplopia (three cases/15%) and wound infection (one case/5%). Overall, stable orbital disease was obtained in 18 patients (90%). CONCLUSION: The ASOT demonstrated to be effective, achieving the pre-operative plan of complete resection in 11/13 cases (84.6%) with no recurrence in those with clear orbital margins.

Enucleation and evisceration: an analysis of indications, histopathological findings, and surgical trends over 23 years at a tertiary care hospital in western Canada.

OBJECTIVE: To report indications for eye removal, histopathological diagnosis, and surgical trends in enucleation versus evisceration over a 23-year period. DESIGN: Retrospective consecutive case series. PARTICIPANTS: All patients undergoing enucleation or evisceration at the Royal Alexandra Hospital in Edmonton, Canada, between January 1994 and December 2016. METHODS: Demographic information was recorded and archived hospital charts were accessed and reviewed for clinical diagnosis, histopathological diagnosis, and the type of implant used. Univariate and multivariable logistic regression analysis was performed. The study cohort was divided into 2 time periods by separating the first 10 years of the study period (1994-2004 inclusive) from the rest of the study time period (2005-2016 inclusive). RESULTS: A total of 786 patients with a mean age (±â€…SD) of 52 ±â€…23 years were included. The most common clinical diagnosis was blind painful eye (56%) followed by intraocular tumour (23%). Corresponding pathological examination of specimens revealed chronic inflammatory change (46%) and intraocular tumour (25%). Eyes with active infection were more likely to be eviscerated (odds ratio: 4.67; p < 0.001) when compared to other diagnostic groups, and all eyes diagnosed with intraocular tumours were enucleated. While most eyes in the study were enucleated, the proportion of eyes eviscerated increased over the study period (p = 0.010) from 8% between 1994-2004 to 14% between 2005-2016. CONCLUSIONS: While enucleation was performed more commonly overall, the incidence of evisceration increased throughout the study period. There were no instances of occult intraocular tumour in patients who were eviscerated.

Intracranial hemorrhage complicating an orbital decompression.

We report a case of intracerebral hemorrhage in the left frontal lobe following a left medial wall orbital decompression for thyroid-related optic neuropathy. There was no obvious fracture in the orbital roof bone but the hemorrhage was felt to occur from a disruption in the orbito-frontal branch of the anterior cerebral artery. The patient was asymptomatic and remained so during the follow-up period.

Cerebrospinal fluid leaks complicating orbital or oculoplastic surgery.

OBJECTIVES: To report cerebrospinal fluid (CSF) leakage as an unusual complication following orbital or oculoplastic procedures and to describe its diagnosis and management. METHODS: Retrospective case review. RESULTS: Three cases of CSF leaks are described in patients following orbital or oculoplastic procedures. Two patients developed CSF leaks after orbital decompression surgery for compressive optic neuropathy and 1 patient had a CSF leak following endonasal dacryocystorhinostomy. In the first case, high-resolution computed tomography confirmed the site of the leak that required surgical repair. In the second case, a beta(2)-transferrin test result confirmed the presence of CSF in the nasal drip, and coronal computed tomography identified a small fracture near the fovea ethmoidalis, but the leak resolved within 2 days of bed rest. In the third case, the patient reported several days of nasal dripping, but the problem had already resolved at the first follow-up appointment. CONCLUSIONS: A CSF leak following certain orbital and oculoplastic procedures is a rare but well-recognized complication. This case report reviews the mechanisms, diagnostic techniques, and staged management of CSF leaks.

Superior ophthalmic vein cannulation through a lateral orbitotomy for embolization of a cavernous dural fistula.

Many embolization procedures have been described for the treatment of cavernous dural fistulas, including direct superior ophthalmic vein cannulation. Sometimes thrombosis of the superior ophthalmic vein or an anatomic variant will not allow its cannulation. Herein, we describe a case of a cavernous dural fistula in which an anteriorly narrowed and thrombosed superior ophthalmic vein was cannulated in the deep orbit through a lateral orbitotomy.

Methods of antibiotic instillation in porous orbital implants.

PURPOSE: Soaking porous implants in antibiotic solution at the time of implantation is often recommended to promote fibrovascular ingrowth and reduce risk of infection. This study evaluated antibiotic penetration in porous implants using different instillation techniques. METHODS: Penetration of methylene blue in three 20-mm diameter porous implants (hydroxyapatite, porous polyethylene, and aluminum oxide) was measured using 4 different techniques: 1) soaking in dye for 5 minutes; 2) compressing the implant in dye in a 60-ml syringe for 1 and 2 minutes; 3) aspirating dye through the implants in a 60-ml syringe for 1 and 2 minutes; and 4) direct injection of dye in the center of the implants. Each implant was cut in half to measure penetration in 4 quadrants by 2 independent observers. RESULTS: Soaking the implants for 5 minutes resulted in 6 mm penetration of dye from the surface in hydroxyapatite and no penetration in the others. Compressing or aspirating implants in dye for both 1 minute and 2 minutes resulted in complete penetration to the center in all implants. Direct injection resulted in complete distribution in hydroxyapatite, localized within 4 mm of the injection site in porous polyethylene, and no penetration in aluminum oxide. CONCLUSIONS: Best penetration of fluid in all implants was achieved with aspiration or compression within a syringe. If an implant becomes infected, topical instillation of antibiotic is unlikely to reach the sites of infected pores. Direct injection of antibiotic may be helpful for porous implants providing the needle pore does not get blocked while penetrating the implant as it did with the 3 aluminum oxide implants tested in this study.

Orbital myositis involving the oblique muscles associated with herpes zoster ophthalmicus.

An 81-year-old woman with right orbital inflammation and acute retinal necrosis following Herpes zoster ophthalmicus was evaluated and treated. CT showed right massive superior and inferior oblique enlargement and moderate enlargement of the remaining extraocular muscles with tendon sparing. The myositis and acute retinal necrosis dramatically improved following prednisone and intravenous acyclovir therapy.

Predicción de la ganancia diaria de peso mediante el uso del modelo nrc en novillas suplementadas en el trópico húmedo de costa rica / Prediction of the Daily Weight Gain by the Use of the NRC Model in Supplemented Heifers in the Humid Tropics of Costa Rica

El objetivo del presente estudio fue evaluar el modelo NRC (1996) nivel I para la predicción de la ganancia diaria de peso en novillas suplementadas bajo condiciones tropicales. Para tal fin, se realizaron dos experimentos. En el experimento 1 se evaluaron 30 novillas divididas en dos grupos de 15 animales cada uno, el grupo suplementado (GS) presentó un peso inicial de 365,27 ± 24,40 kg, recibió concentrado a razón de 1% del peso vivo (5,5% PC, 2,85 Mcal ED) y el no suplementado (GNS) con un peso inicial de 367,47 ± 31,65 kg. En el experimento 2 se utilizaron 45 novillas divididas en dos grupos, el GSb con 22 animales, teniendo un peso inicial de 342,23 ± 36,04 kg se les proporcionó alimento a razón del 1% del peso vivo (13% PC; 3,15 Mcal ED) y el GNSb se constituyó por 23 animales teniendo un peso inicial promedio de 326,30 ± 31,53 kg. En ambos experimentos los animales fueron suplementados a lo largo de 45 días, y estuvieron pastoreando praderas de Estrella Africana (Cynodon nlemfuensis), Candelario (Pennisteum purpureum) y Ratana (Ischaemum indicum). En ambos experimentos no se observaron diferencias (P > 0,05) para los cambios de peso. El GS obtuvo ganancias diarias de peso (GDP) de 0,27 kg/d, mientras que el GNS mostró pérdidas de -0,05 kg/d; en el experimento 2 el GSb presentó GDP de 0,90 kg/d y el GNSb de 0,60 kg/d. La GDP predicha en el experimento 1 fue similar a la ganancia observada para el grupo suplementado (P > 0,05) en contraste con la presentada en el grupo no suplementado en el que la ganancia de peso fue sobrestimada (P < 0,05). En el segundo experimento, la predicción de la GDP tanto para el grupo suplementado como el no suplementado fue subestimada (P < 0,05). El nivel 1 del modelo de simulación NRC no fue apropiado para la predicción de los cambios de peso en novillas bajo condiciones tropicales.

The aim of this study was to evaluate the model NRC level 1 to predict the daily weight gain in heifers supplemented under tropical conditions. For this purpose, two experiments were done, in the first experiment 30 heifers were divided into two groups of fifteen animals each, the supplemented group (GS) showed an initial weight of 365.27 ± 24.40 kg, received commercial concentrate to the ratio of 1% of live weight (5.5% PC 2.85 Mcal ED) and the control group which was not supplemented (GNS) with an initial weight of 367.47 ± 31.65 kg. In the second study 45 heifers were divided in two groups, the GSb with 22 animals having an initial weight of 342.23 ± 36.4 kg and given concentrate to the rate of 1% of live weight (13% PC 3.5 Mcal ED) and the GNSb were made up of 23 animals having an initial average weight of 326.0 ± 31.3 kg. In both trials the animals were supplemented throughout for forty-five days and let them grazed on African Star grass (Cynodon nlemfuensis), Candelario grass (Pennisteum purpureum) and Ratana grass (Ischaemum indicum). In both experiments no differences were observed (P > 0.05) in weight change .The GS had daily weight gains (GDP) of 0.27 kg/d while the GNS showed losses of -0.05 kg/d. In the second trial the GSb showed a GDP of 0.90 kg/d and the GNSb of 0.60 kg/d. The predicted GDP of the first experiment was similar in comparison with the observed value for the supplemented group (P > 0.05), in contrast with that presented in the GNS group in which the daily weight gain was over estimated (P < 0.05). In the second trial the GDP predicted for both groups was under estimated (P < 0.05). The level 1 of the NRC simulation model does not seem to be appropriate for predicting changes in weight in heifers under tropical conditions.