Non-incisional eyelid everting suture technique for treating lower lid epiblepharon.

BACKGROUND: This study investigated surgical outcomes of full-thickness eyelid everting sutures for lower lid epiblepharon and influential factors leading to surgical failure. METHODS: A retrospective review was conducted of patients with lower lid epiblepharon who underwent surgical correction using the full-thickness eyelid everting suture technique. Lower lid epiblepharon was assessed preoperatively using a morphological classification (class I-IV) according to the horizontal skin fold height and a functional classification (grade 0-3) according to the severity of keratopathy. Four stitches with 5-0 coated polyglactin 910 sutures per eyelid were made, and all procedures were conducted under local anaesthesia in an office-based setting. To assess surgical outcomes, we evaluated undercorrection at 1 month and surgical failure at 6 months after the procedure. Several factors affecting surgical failure were also investigated RESULTS: Sixty-eight eyes of 41 patients were included. There were no eyes showing an undercorrection at 1 month. Keratopathy was significantly improved at 6 months postoperation (P<0.01). All patients showed good cosmesis without undesired creation of a lower lid crease and no significant complications. Sixty-one eyes (89.7%) showed surgical success. Three patients (7.3%) required additional incisional surgery due to recurring irritation. The rate of surgical failure was significantly different between the patient groups classified by preoperative severity of keratopathy (P=0.026) and lower lid horizontal skin fold height (P<0.001). Multiple logistic regression analysis revealed that the lower lid horizontal skin fold height was significantly correlated with surgical failure (OR 18.367, P=0.002). CONCLUSION: Non-incisional eyelid everting sutures have utility for the correction of lower lid epiblepharon with advantages including its simplicity, being performed in office under local anaesthesia and minimal changes in appearance. We suggest mild to moderate epiblepharon with class I or II horizontal skin fold height and grade 1 or 2 keratopathy as the criteria for considering this suture procedure.

Sentinel lymph node biopsy for ocular adnexal melanoma.

BACKGROUND: We sought to update our prior report of findings on sentinel lymph node biopsy (SLNB) and predictors of a positive SLN in patients with conjunctival or eyelid melanoma. METHODS: We reviewed the records of all patients with ocular adnexal melanoma who underwent SLNB at one institution during 2000-2015. We determined rates of positive and false-negative findings on SLNB, primary tumour features correlated with positive findings and rate of nodal recurrence (false-negative event) after negative findings. RESULTS: The study included 51 patients, 31 with conjunctival and 20 with eyelid melanoma. These patients include 30 patients who underwent SLNB during 2000-2008, described in our previous report, and 21 additional patients who underwent SLNB during 2008-2015. There were 30 women and 21 men with median age at SLNB of 62 years (range, 24-83). The nodal basins most commonly sampled were intraparotid (27 patients) and level II (14 patients). Ten patients had positive SLNB findings. Compared to tumours with negative findings, tumours with positive findings had greater median thickness (3.5 mm versus 2.2 mm, p = 0.04), greater median number of mitotic figures (6 versus 2, p = 0.03) and greater incidence of ulceration (80% versus 26%, p = 0.003). Perineural and vascular invasion were not significantly associated with positive findings. There were three false-negative events. Three patients (6%) had temporary marginal mandibular weakness which resolved spontaneously. CONCLUSION: SLNB in patients with ocular adnexal melanoma is safe and identifies nodal micrometastasis in approximately 20% of cases. Histologic features associated with a positive SLN included greater tumour thickness, greater number of mitotic figures and ulceration.

Outcomes of dacryocystorhinostomy in patients with head and neck tumors.

BACKGROUND: The purpose of this study was to evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors. METHODS: The clinical records of all 31 patients with head and neck tumors who underwent DCR for nasolacrimal duct blockage at The University of Texas M. D. Anderson Cancer Center between 1999 and 2003 were retrospectively reviewed. RESULTS: The tumor diagnoses were squamous cell carcinoma (n = 18), chondrosarcoma (n = 3), sinonasal carcinoma (n = 2), adenoid cystic carcinoma (n = 2), sinonasal papilloma (n = 2), esthesioneuroblastoma (n = 1); hemangiopericytoma (n = 1); ameloblastoma (n = 1), and osteosarcoma (n = 1). Twenty-eight patients had a maxillectomy or other sinus surgeries, 10 had radiotherapy, and 14 had chemotherapy and radiotherapy before DCR. All 31 patients (35 eyes) experienced improvement of epiphora after DCR, but five patients (six eyes) had recurrent nasolacrimal duct blockage develop during the study period. Two patients had mild wound infections; none had osteoradionecrosis. CONCLUSIONS: DCR alleviates nasolacrimal duct blockage in most patients with head and neck tumors and is not associated with unusual complications in this setting.

Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center.

PURPOSE: To describe one center's experience with sentinel lymph node (SLN) biopsy in patients with eyelid and conjunctival malignancies performed with a smaller volume of technetium than was initially used and a small incision directly overlying the sentinel node(s). METHODS: A noncomparative interventional case series of 13 patients with clinically negative regional lymph nodes who underwent SLN biopsy for eyelid or conjunctival malignancies at The University of Texas M. D. Anderson Cancer Center between May 2002 and July 2003. Preoperative lymphoscintigraphy was performed with an injection of 0.3 mCi of technetium Tc-99m sulfur colloid in a volume of 0.2 mL. Images were taken as soon as the first SLN was detected through the gamma camera. Intraoperative mapping was performed with the same volume and concentration of technetium Tc-99m sulfur colloid along with an injection of isosulfan blue dye. RESULTS: Five patients had conjunctival melanoma, 6 had sebaceous cell carcinoma of the eyelid, and 2 had eyelid melanoma. SLN(s) were identified in all patients. In 12 patients, more than 1 SLN was identified. During surgery, no SLNs were blue. One patient with conjunctival melanoma had an SLN that was positive on histologic examination. There were no ocular or extraocular complications from the procedure except for mild temporary weakness of the marginal mandibular branch of the facial nerve in 2 patients that resolved completely within 4 to 6 weeks and without any further intervention. None of the patients had permanent blue tattooing of the conjunctival surface or eyelid skin. CONCLUSIONS: Our experience suggests that lymphoscintigraphy and SLN biopsy with a small volume of technetium Tc-99m sulfur colloid and small incisions, even without the use of the blue dye, can identify SLNs in patients with conjunctival and eyelid malignancies, and can be performed safely.

Docetaxel-induced histologic changes in the lacrimal sac and the nasal mucosa.

PURPOSE: To identify histopathologic changes in the lacrimal sac and the nasal mucosa caused by docetaxel in 3 patients with canalicular narrowing and nasolacrimal duct obstruction. METHODS: Small case series. Lacrimal sac and nasal mucosal specimens were obtained at the time of dacryocystorhinostomy or during silicone intubation to correct epiphora in 3 patients receiving docetaxel. Histologic evaluation was performed. RESULTS: Extensive fibrotic changes in the stroma of the lacrimal sac and the nasal mucosa were the prominent histologic features in all 3 patients. A biopsy specimen was taken from the lower portion of the nasal mucosa (near the inferior turbinate) in one patient at the time of silicone intubation and showed both clinical and histologic evidence of keratinization with marked epidermalization of the surface epithelium, thickening, and parakeratosis of the squamous epithelium. CONCLUSIONS: Nasolacrimal duct obstruction secondary to treatment with docetaxel may be in part due to stromal fibrosis in the mucosal lining of the lacrimal drainage apparatus.