Tattoo granuloma of the eyelid mimicking carcinoma.

A 68-year-old woman was referred to the Oculofacial Plastic and Reconstructive Surgery service for evaluation of a left upper eyelid lesion that was worrisome for carcinoma. The mass measured 8 × 8 mm; it was well-circumscribed, pink, and firm with distortion of the eyelid margin, central ulceration, and loss of the lashes. The patient denied previous surgery or trauma in this area, but she had a history of blepharopigmentation (tattoo eyeliner) of all 4 eyelids approximately 7 years prior. Incisional biopsy revealed inflammatory changes consistent with a localized reaction to the tattoo pigment granules. Local kenalog injection was attempted with improvement of the overall appearance but with persistent deformity including irregularity of the margin and loss of lashes. The persistent abnormal appearance was worrisome for an underlying carcinoma missed on the initial incisional biopsy and prompted a full-thickness wedge resection and reconstruction of the abnormal area. The results of biopsy of the excised tissue confirmed absence of malignant neoplasm and showed changes consistent with tattoo granuloma. Tattoo granuloma of the eyelid should be considered in the differential diagnosis of eyelid lesions worrisome for carcinoma in patients with a history of blepharopigmentation.

Removal of calcific band keratopathy without ethylenediaminetetraacetic acid (EDTA) in eyes with limited visual potential.

PURPOSE: Treatment of calcific band keratopathy (CBK) is commonly performed with ethylenediaminetetraacetic acid (EDTA), but EDTA has become more difficult to obtain. This paper describes a technique for treating CBK using a diamond-dusted burr without EDTA in eyes with limited visual potential. PATIENTS AND METHODS: In this paper, we provide detailed instructions on how to perform the surgical technique for treating CBK, along with a surgical video. We performed a retrospective review of consecutive patients with clinically significant CBK who underwent this procedure from December 2012 to July 2015. RESULTS: Seven eyes of six patients were included for analysis. Preoperatively, all patients suffered from ocular discomfort. All eyes had poor preoperative visual acuity due to non-corneal ocular disease. The most common causes of CBK in this series were retinopathy of prematurity (three eyes) and chronic uveitis (two eyes). Postoperatively, all patients reported partial or complete relief of discomfort. The length of follow-up ranged from 15 days to 31 months. Two eyes experienced recurrence of CBK. This occurred at 4 and 28 months after treatment. CONCLUSION: The diamond-dusted burr can easily and effectively remove the corneal epithelium and underlying calcium deposits. Therefore, it may be used to effectively treat discomfort from CBK.

Histopathological analysis of retinopathy of prematurity after intravitreal bevacizumab.

We report the case of a premature infant with end-organ failure who developed high-risk retinopathy of prematurity (ROP) bilaterally and was treated with intravitreal bevacizumab (IVB) injection therapy with regression noted on follow-up clinical examination. The infant died 3 weeks after IVB injection therapy. Histopathological analysis was conducted on bilateral globes and revealed persistent preretinal vessels.

Descemet stripping automated endothelial keratoplasty after 2 previously rejected femtosecond laser-assisted keratoplasties.

PURPOSE: To report on a patient with a welding flash burn with subsequent scarring and edema who twice underwent femtosecond laser-assisted keratoplasty (FLAK). Both grafts failed due to endothelial decompensation. He subsequently underwent successful Descemet stripping automated endothelial keratoplasty (DSAEK) under the second FLAK graft to decrease rejection risk and prevent further full-thickness keratoplasty. METHODS: A 51-year-old man with a history of 2 FLAK procedures with subsequent graft failures likely from noncompliance with postoperative medications had diffuse microcystic edema with a visual acuity of counting fingers at 5 feet. The patient underwent DSAEK procedure 4 months after the second FLAK procedure. RESULTS: No dehiscence occurred during second laser trephination of cornea. Sections of mild misalignment between the first and second FLAK graft trephinations were noted on optical coherence tomography. Post-DSAEK, the patient had a rapidly clearing, well-attached graft with mild temporal overlap of the graft-host interface. All sutures were removed from the overlying FLAK graft by 3 months after DSAEK (7 months after repeat FLAK). At 9 months post-DSAEK, the patient's uncorrected visual acuity was 20/40 and best spectacle-corrected visual acuity was 20/30. CONCLUSIONS: Early secondary femtosecond laser trephination after first FLAK is possible even if the second graft is misaligned. A crescent remnant of the original graft was well-healed into the host cornea 7.5 months after the original surgery. The 3-month-old second FLAK graft was able to support a DSAEK surgery and rapid postoperative visual recovery. All sutures were removed from the cornea by 7 months after the second FLAK surgery.

Serum vitamin D levels in orthopaedic trauma patients living in the northwestern United States.

OBJECTIVE: To determine the incidence of vitamin D deficiency in orthopaedic trauma patients undergoing fracture surgery living in the Northwest United States. DESIGN: Retrospective observational cohort study. SETTING: Level 2 trauma center. PATIENTS: Two cohorts of patients undergoing fracture repair surgery during a 3-month period in winter and summer had serum vitamin D levels drawn at the time of surgery. One hundred three patients were reviewed in the winter cohort and 98 in the summer cohort. MAIN OUTCOME MEASURE: Serum 25(OH) vitamin D levels of patients undergoing fracture repair surgery. RESULTS: Normal levels of vitamin D were considered to be between 32 and 80 ng/mL. Most patients in both cohorts were vitamin D insufficient. The average level for the winter cohort was 26.4 ng/mL, which was significantly lower than the average level for the summer cohort, 29.8 ng/mL (P = 0.03). CONCLUSIONS: A high incidence of vitamin D insufficiency and deficiency likely exists across all age groups in orthopaedic trauma patients living in the Northwest United States and regions with similarly northern latitude. Further study is required to confirm improved fracture healing with normalization of serum vitamin D levels. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.