Reconstruction of full thickness lower eyelid defects using a lateral advancement flap with Z-plasty and periosteal strip.

PURPOSE: To describe a single stage technique of reconstruction of full thickness lower eyelid defects using a lateral advancement flap and Z-plasty combined with a lateral periosteal strip. METHODS: A retrospective case series of six patients who underwent reconstruction using this technique is presented documenting surgical technique, clinical photographs and postoperative outcomes. RESULTS: All six patients demonstrated good eyelid position and cosmesis following reconstruction. CONCLUSION: A lateral advancement flap with Z-plasty combined with a periosteal strip is an effective technique to close lower eyelid defects of up to eighty percent of eyelid width, providing a good structural and aesthetic outcome.

Bisphosphonate-Induced Orbital Inflammation: A Case Series and Review.

INTRODUCTION: To present a series of patients with bisphosphonate induced orbital inflammation, and to review the clinical presentation, radiological features, treatment options and outcomes. METHODS: We present a multicentre, retrospective case series review of patients with a clinico-radiological diagnosis of bisphosphonate induced orbital inflammation and review all the reported cases of this complication in the literature. RESULTS: Four new patients with bisphosphonate induced orbital inflammation were added to the 25 cases in the literature. Intravenous zoledronate was the commonest precipitant (22/29, 75.9%) and inflammation occurred 1-28 (mean 3) days post-infusion. Orbital imaging identified orbital inflammation in 22/29 cases and extra-ocular muscle enlargement in 8/29. Five patients presented with reduced vision of which one - with anterior ischaemic optic neuropathy - did not resolve. The vision resolved in all except one patient, with most requiring steroid treatment. CONCLUSIONS: Bisphosphonates have a pro-inflammatory effect, which can precipitate orbital inflammation. This rare, but potentially serious complication of bisphosphonate treatment should be considered by clinicians using bisphosphonate treatment and by ophthalmologists seeing patients with orbital inflammatory disease.

The dexamethasone suppression test for the diagnosis of Cushing syndrome in a patient with central serous chorioretinopathy.

PURPOSE: To describe a case whereby the dexamethasone suppression test was used to diagnose Cushing syndrome in a patient presenting with central serous chorioretinopathy. METHODS: A 60-year-old woman presented with central serous chorioretinopathy and was investigated with the dexamethasone suppression test; the result was positive and lead to a diagnosis of an adrenal tumor. RESULTS: The adrenal tumor was removed and her central serous chorioretinopathy resolved. CONCLUSION: The dexamethasone suppression test can be used safely in an outpatient procedure to investigate cases of central serous chorioretinopathy, and it may be a useful screening tool in these patients.

In vitro effects of histone deacetylase inhibitors and mitomycin C on tenon capsule fibroblasts and conjunctival melanoma cells.

OBJECTIVE: To investigate the effects of mitomycin C and the histone deacetylase inhibitors sodium butyrate and trichostatin on the viability and growth of conjunctival melanoma cell lines and Tenon capsule fibroblasts. METHODS: Cells were treated with a range of concentrations of sodium butyrate, trichostatin, and mitomycin C. The MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide) assays were performed 48 hours after treatment. Treated cells were stained with acridine orange/ethidium bromide to assess for cell death. Cell-cycle changes in histone deacetylase inhibitor-treated melanoma cells were quantified using flow cytometry. RESULTS: All agents induced dose-dependent cell death in the melanoma cell lines; however, sodium butyrate and trichostatin were relatively nontoxic to Tenon capsule fibroblasts. Acridine orange/ethidium bromide staining indicated that sodium butyrate and trichostatin induced apoptotic cell death. At low doses, sodium butyrate and trichostatin induced a G1 cell-cycle block in the melanoma cells. CONCLUSIONS: Sodium butyrate and trichostatin induced cell death in melanoma cells, comparable with mitomycin C, with minimal effect on Tenon capsule fibroblasts. In addition, they induced a G1 cell-cycle block. These findings support the need for further investigation into the in vivo efficacy of these agents.

Lung metastases in a case of metatypical basal cell carcinoma of the eyelid: an illustrative case and literature review to heighten vigilance of its metastatic potential.

Basal cell carcinoma (BCC) is an extremely common malignancy; however, unlike other skin cancers, they very rarely metastasize. Here we present an unusual case of metatypical BCC of the eyelid which metastasized to the lung nine years after initial surgical treatment. We include a review of the literature regarding metastatic BCC and suggest that metatypical features in primary BCC should prompt careful patient monitoring and consideration of adjuvant treatment at the time of diagnosis.