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1.
Klin Monbl Augenheilkd ; 237(1): 35-40, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31968364

RESUMO

BACKGROUND: Primary localised orbital amyloidosis (PLOA) is a very rare disease. In contrast to the isolated manifestation, systemic involvement can be associated with potentially life-threatening consequences. However, the isolated involvement of the orbit can also lead to serious complications. MATERIAL AND METHODS: Two cases of PLOA are described and the necessary ophthalmic, internistic and immunohistochemical diagnostic testing are explained. RESULTS: The first case describes a 71-year-old woman with PLOA. In the clinic, a yellow-orange bumpy prominence in the nasal lower quadrant without further ophthalmological abnormalities was found. Extensive diagnostic testing found no systemic manifestation. The patient herself was free of complaints. In the follow-up over 4 years, patient showed slow progression without ocular complications. The second case is a 72-year-old male patient with similar clinical signs but localisation in the temporal superior quadrant. During the clinical course, multiple ophthalmological complications developed (ptosis, protrusio bulbi, diplopia, secondary glaucoma, perforated corneal ulcer in neurotrophic keratopathy). Perforating keratoplasty had to be performed. Fractioned radiotherapy led to stabilisation of the disease. The follow-up period was 4 years. CONCLUSION: PLOA can lead to visual and organ threatening complications. Accurate diagnosis is required for further diagnostic and therapeutic procedures and to counteract potential local and systemic complications. Interindividual differences in the course have to be considered.


Assuntos
Amiloidose , Blefaroptose , Exoftalmia , Ceratite , Idoso , Amiloidose/diagnóstico , Amiloidose/cirurgia , Blefaroptose/diagnóstico , Blefaroptose/cirurgia , Exoftalmia/diagnóstico , Exoftalmia/cirurgia , Feminino , Humanos , Ceratite/diagnóstico , Ceratite/cirurgia , Masculino , Órbita
5.
Zhonghua Yan Ke Za Zhi ; 55(11): 828-833, 2019 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-31715679

RESUMO

Objective: To report the clinical features and surgical treatment of orbitotemporal neurofibromatosis. Methods: It was a retrospective case series study. The clinical records of 24 patients who were treated for orbitotemporal neurofibromatosis between April 2007 and July 2017 at Beijing Tongren Hospital, Capital Medical University were analyzed. Data collected included sex, age, laterality, periorbital deformities, surgical treatment, follow-up time, complication and recurrence. Results: Sixteen males and 8 females were included. Age at surgery was (15±7) years (4-30 years). All patients were unilaterally involved. Twenty-three patients (96%) had upper lid involvement and ptosis. Nine patients (38%) had lower lid involvement. Fourteen patients (58%) had lateral canthal disinsertion. Three patients (13%) had brow involvement, 10 patients (42%) had conjunctival involvement and 2 patients (8%) had lacrimal gland infiltration. All patients had tumor debulking procedure. Twenty-two patients (92%) had correction of ptosis. Fourteen patients (58%) required lid reconstruction and lateral canthus reattachment surgery. Three patients (13%) had correction of brow ptosis.One patient (4%) had skull and orbit reconstruction. The median follow-up time was 3.5 (1.0-10.0) years. All patients had improved appearance. Ptosis recurred in 6 patients, but were corrected with surgery. On the last follow-up, 7 patients were free of ptosis. In 14 patients, mild ptosis was noted, but the upper lid did not cover the pupil. In 2 patients the pupil was half covered. Only in 1 patient who had not received ptosis correction surgery the pupil was covered completely. Conclusions: The periorbital deformities of orbitotemporal neurofibromatosis include upper eyelid infiltration with ptosis, lateral canthal disinsertion and infiltration of lower eyelid, brow, conjunctiva and lacrimal gland. The appearance of patients with orbitotemporal neurofibromatosis can be significantly improved through oculoplastic surgery. (Chin J Ophthalmol, 2019, 55: 828-833).


Assuntos
Neurofibromatoses/diagnóstico , Neurofibromatoses/cirurgia , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/cirurgia , Adolescente , Adulto , Blefaroplastia , Blefaroptose/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Estudos Retrospectivos , Adulto Jovem
6.
J Craniofac Surg ; 30(7): 2249-2250, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568158

RESUMO

INTRODUCTION: Lash ptosis is often an overlooked sign that may coexist with congenital and acquired blepharoptosis. This is a report of case series of patients presented in an oculoplastic clinic with visual field loss associated with lash ptosis. On examination, the primary pathology was attributed to lash ptosis dehiscence. METHODS: All patients underwent anterior lamellar repositioning and were followed for an average of 15 (10-24) months. RESULTS: All patients had resolution of visual field loss and heaviness of eyelids. CONCLUSIONS: Lash ptosis is associated with abnormalities such as floppy eyelid syndrome. However it may be a primary condition, with no background eyelid pathology and no external explanation for the eyelash ptosis. The condition might result from anatomical changes in the orbicularis oculi, Riolan's muscle, and tarsal plate. Patients in this series complained of upper lid visual field restriction. Anterior lamellar repositioning resulted in complete resolution of complaints. Additional studies are needed to learn about the pathophysiology of this entity.


Assuntos
Blefaroptose/fisiopatologia , Adulto , Blefaroptose/patologia , Pálpebras/patologia , Músculos Faciais/patologia , Humanos , Masculino
7.
J Craniofac Surg ; 30(8): 2396-2400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31577649

RESUMO

BACKGROUND: Oncoplastic lower eyelid reconstruction is a challenging task due to the complicated structure of the eyelid and requirement of high operative accuracy. Poorly treated defects result in ectropion and ptosis which may lead to keratitis and corneal ulceration. Previous related studies do not include a detailed comparison of the common reconstructive methods of the lower eyelid in terms of results and complication rates. OBJECTIVE: The authors aim to demonstrate whether the choice of reconstruction affects the aesthetic and functional outcome of oncoplastic lower eyelid reconstruction. METHODS & MATERIALS: The authors performed a 10-year retrospective review of all oncoplastic lower eyelid reconstructions carried out in our hospital. Information on patient background, diagnosis and the choice of reconstructive method were evaluated. Postoperative photographs of each patient were then subjectively evaluated for color match, cosmesis, quality of shape, symmetry, and overall appearance. The authors hypothesized that the outcome is related to the main trajectory of the flap. Patients treated with local flaps of horizontal and vertical trajectories were then compared in terms of outcome and complication rates. RESULTS: Reconstructions based on a horizontal trajectory compared with a vertical trajectory resulted with lower rates of ectropion and ptosis occurrence. The results were statistically significant.


Assuntos
Pálpebras/cirurgia , Idoso , Idoso de 80 Anos ou mais , Blefaroptose/cirurgia , Ectrópio/cirurgia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Retalhos Cirúrgicos
8.
Strabismus ; 27(4): 215-217, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31621456

RESUMO

The authors describe a patient with Parry-Romberg syndrome (PRS) who had acquired monocular elevation deficit (MED), ptosis, and facial hemiatrophy. A 12-year-old female patient manifested progressive ptosis and hypotropia companied with progressive hemifacial atrophy was conducted to the ophthalmology clinic for diagnosis and treatment. Forced duction and generation testing confirmed that her incomitant hypotropia was caused by paralytic muscles and not due to restriction, so it was diagnosed as MED. Knapp procedure was conducted to correct her eye positions. Six months later, the frontal muscle suspension surgery was performed to treat her ptosis. Postoperatively, the patient had orthotropia without residual left hypotropia in the primary position and her left upper eyelid function improved significantly. The ocular motor defect, in this case, is best explained by nerve paresis rather than muscle fibrosis.


Assuntos
Blefaroptose/etiologia , Hemiatrofia Facial/complicações , Estrabismo/etiologia , Blefaroptose/cirurgia , Criança , Feminino , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia
9.
BMJ Case Rep ; 12(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31537606

RESUMO

Oculopharyngeal muscular dystrophy (OPMD) is a relatively rare, adult-onset disorder characterised by proximal limb weakness, progressive eyelid drooping and swallowing difficulties. Preliminary research suggests there could be a link between OPMD and dementia; however, the current literature is relatively limited and inconsistent. This case study describes a 75-year-old female with OPMD, presenting to an older adults community mental health team with memory problems and word finding difficulties. A neuropsychological assessment was carried out. The results of her assessment were difficult to interpret; she demonstrated impairments in most cognitive domains tested and her presentation did not appear to reflect any typical dementia profile. It was thought she was most likely presenting with a dementia; however, the exact aetiology remains unclear. The dementia could be a result of OPMD, vascular changes or both. This report emphasises the need for further research into the possible causal link between OPMD and dementia/cognitive decline.


Assuntos
Disfunção Cognitiva , Demência/complicações , Distrofia Muscular Oculofaríngea/complicações , Idoso , Blefaroptose/etiologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Debilidade Muscular/etiologia , Testes Neuropsicológicos
10.
Ophthalmic Plast Reconstr Surg ; 35(6): 525-534, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498270

RESUMO

PURPOSE: Myopathic blepharoptoses (ptoses) is a complex group of disorders. To date, no formal categorization scheme has been developed based on associated ocular and systemic findings, genetic fingerprint, treatment, and prognosis for each ptosis in this group. We report a new classification scheme for myopathic ptoses. METHODS: Literature review and classification development. RESULTS: A new classification scheme of myopathic ptoses includes isolated static myopathic ptosis (congenital ptosis), static myopathic ptosis associated with aberrant innervation and those associated with periocular abnormalities, and progressive myopathic ptoses that affect the levator muscle and other muscle groups in childhood and adulthood. CONCLUSIONS: Making the distinction of myopathic ptosis type early will maximize patient outcomes by optimizing surgical and systemic management and facilitating the recruitment of subspecialists to care for patients with these challenging conditions.The authors present a comprehensive and effective myopathic ptosis classification scheme to optimize surgical management and facilitate subspecialty care.


Assuntos
Blefaroptose/diagnóstico , Músculos Oculomotores/patologia , Blefaroptose/classificação , Humanos
14.
J Neuromuscul Dis ; 6(3): 369-376, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424417

RESUMO

INTRODUCTION: In this study we quantitatively describe ocular weakness patterns in myasthenia gravis (MG) to help neurologists in making the clinical diagnosis and to investigate how the current outcome measures reflect ocular weakness in MG. METHODS: We investigated ptosis and diplopia patterns in a retro- and prospective cohort of 306 MG patients. Diplopia was systematically examined by testing extra-ocular muscle (EOM) fatigability in two horizontal and four oblique directions for 60 seconds. RESULTS: Of patients with initial symmetric ptosis, 40% developed asymmetric ptosis at the second visit. Changes in form of ptosis occurred less often in seronegative MG patients (50%) than in patients with acetylcholine receptor (AChR) antibodies (70%) or muscle-specific kinase (MuSK) antibodies (69%) (p = 0.038). Of patients with diplopia on the first visit, double vision contained both a vertical and horizontal component in 95%. At the second visit, 83% manifested diplopia in other gaze directions. The mean time (in seconds) to diplopia was 11.6±14.0 and the mean time to ptosis was 27.6±19.8. Diplopia or ptosis manifested within 30 seconds in 87% and 58%, respectively. Patients who manifested diplopia after 30 seconds, reported no limitations due to diplopia. DISCUSSION: Changes in the gaze directions in which diplopia occurs or ptosis side occur frequently in MG. In diagnostically challenging cases, we recommend testing ptosis and diplopia in multiple gaze directions for 30-60 seconds during at least two follow-up visits to maximize the chance of observing changes in ocular weakness patterns.


Assuntos
Blefaroptose/diagnóstico , Diplopia/diagnóstico , Debilidade Muscular/diagnóstico , Miastenia Gravis/diagnóstico , Idoso , Blefaroptose/complicações , Diplopia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/complicações , Miastenia Gravis/complicações , Músculos Oculomotores/fisiopatologia , Estudos Prospectivos
15.
Plast Reconstr Surg ; 144(3): 519e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461063
17.
J Med Case Rep ; 13(1): 273, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31466520

RESUMO

BACKGROUND: With increasing treatment options available, neuroendocrine tumor has become a chronic disease and may present later on with atypical manifestation of disease spread once resistant to treatment. CASE PRESENTATION: A 74-year-old white British woman undergoing treatment for metastatic well-differentiated neuroendocrine tumor for the past 9 years presented with a brief history of mild frontal headache, and progressive left ptosis and ocular palsy. She had no visual loss, and had neither speech nor motor deficit. At the outset, it was crucial to exclude acute or missed stroke. An urgent magnetic resonance imaging of her head revealed an unusual skull base metastasis extending into the cavernous sinus, with no peritumoral edema. Following discussion at a specialist neuro-oncology meeting and a neuroendocrine tumor multidisciplinary team meeting, she proceeded to have conventional fractionated radiotherapy followed by subsequent palliative chemotherapy. CONCLUSIONS: Intracranial metastasis is rare in patients with neuroendocrine tumor, particularly in those with well-differentiated histology; skull base metastasis is even more uncommon. Management of intracranial metastasis from a rare tumor should always be discussed in a specialist multidisciplinary meeting. Surgery or radiotherapy, including stereotactic radiosurgery, should be considered in skull base metastases. Hormonal abnormalities may occur following radiotherapy to skull base metastases and should be monitored closely in the first few months post treatment.


Assuntos
Neoplasias Intestinais/patologia , Tumores Neuroendócrinos/patologia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/secundário , Idoso , Blefaroptose/etiologia , Evolução Fatal , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Imagem por Ressonância Magnética , Doenças do Nervo Oculomotor/etiologia , Tomografia por Emissão de Pósitrons
19.
J Craniofac Surg ; 30(7): 2211-2213, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31369506

RESUMO

In this report, the authors introduce a rare complication after reduction malarplasty in 2 patients. One patient underwent temporal rhytidectomy and malar osteotomy. The other patient underwent zygoma grinding without osteotomy. Both patients presented malar depression and cheek ptosis after surgery and visited the clinic. Physical examination, cephalometric radiographs, and facial 3-dimensional computed tomography were conducted, which indicated total zygomatic arch bone resorption. After examining the possible causes of the complication, the authors concluded that preserving enough blood supply and performing adequate rigid fixation of the separated zygoma bone are key prevention for bone resorption. This is the first report of total zygomatic arch bone resorption after reduction malarplasty.


Assuntos
Reabsorção Óssea/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Zigoma/diagnóstico por imagem , Adulto , Blefaroptose/diagnóstico por imagem , Blefaroptose/etiologia , Reabsorção Óssea/etiologia , Craniotomia/efeitos adversos , Face/cirurgia , Ossos Faciais/cirurgia , Feminino , Humanos , Osteotomia , Exame Físico , Radiografia , Ritidoplastia , Tomografia Computadorizada por Raios X/métodos
20.
J Craniofac Surg ; 30(5): 1499-1502, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299753

RESUMO

BACKGROUND: The epicanthal fold is a distinct characteristic of the upper eyelid in many Asians. To achieve satisfactory results, epicanthoplasty is usually performed with double eyelid plasty and blepharoptosis. Although many surgical procedures have been reported for the elimination of epicanthal folds, such as recurrence, copious designs, conspicuous scar, and unnatural palpebral contours are challenges to the surgeon and also make patients worried. METHODS: From June 2010 to June 2015, epicanthoplasty was performed for 236 Chinese female patients using transverse incision combined with pouch incision. The transverse straight incision was performed in new inner canthus to the original eanthal corner point, after the original inner canthus corner point was reached, the oblique parallel incision was performed along the lower eyelid, so that full subcutaneous separation was obtained on the upper and lower incision, the malpositioned isomerous orbicular muscle and thickened tissue were released and excised, so that the epicanthus skin was naturally restored, and finally the incision was sutured without tension. The extent of postoperative scarring and improvement of the epicanthal fold were evaluated after surgery. The medial canthal distance was measured preoperatively and 12 months postoperatively. RESULTS: The average intercanthal distance decreased significantly from a mean of 41.68 ±â€Š2.57 mm preoperatively to 37.14 ±â€Š1.94 mm 12 months postoperatively (P < 0.05, paired t-test). And all patients were satisfied with the excellent aesthetic results in terms of an open medial canthus without definite recurrence, hypertrophic scarring, and other complications during the 12-month follow-up period. CONCLUSION: Epicanthoplasty with transverse incision and pouch incision is a simple and effective method for elimination epicanthal folds, resulting in a pleasant visualization, inconspicuous scar. However, its long-term effects require further study.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Blefaroptose/cirurgia , Estética Dentária , Pálpebras/cirurgia , Feminino , Humanos , Aparelho Lacrimal/cirurgia , Satisfação Pessoal , Recidiva , Pele , Ferida Cirúrgica , Adulto Jovem
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