Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 39
Filtrar
1.
Ophthalmology ; 2024 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-38912980

RESUMO

PURPOSE: To review the efficacy and safety of the use of intraoperative image guidance (IIG) in orbital and lacrimal surgery. METHODS: A literature search of the PubMed database was last conducted in November 2023 for English-language original research that assessed the use of any image guidance system in orbital and lacrimal surgery that included at least 5 patients. The search identified 524 articles; 94 were selected for full-text analysis by the panel. A total of 32 studies met inclusion criteria. The panel methodologist assigned a level II rating to 2 studies and a level III rating to 30 studies. No study met the criteria for level I evidence. RESULTS: Procedures reported on were as follows: fracture repair (n = 14), neoplasm and infiltrate biopsy or excision (n = 6), orbital decompression for Graves ophthalmopathy (n = 3), dacryocystorhinostomy (n = 1), and mixed etiology and procedures (n = 8). Four studies used more than one IIG system. One study that met level II evidence criteria compared the outcomes of orbital fracture repair with IIG (n = 29) and without IIG (n = 29). Borderline better outcomes were reported in the IIG group: 2% versus 10% with diplopia (P = 0.039) and 3% versus 10% with enophthalmos (P = 0.065). The other level II study compared the repair of fractures with navigation (n = 20) and without (n = 20). The group in which navigation was used had a measured mean volume reduction of 3.82 cm3 compared with 3.33 cm3 (P = 0.02), and there was a greater measured reduction in enophthalmos in the navigation group of 0.72 mm (P = 0.001). Although the remaining 30 assessed articles failed to meet level II criteria, all alleged a benefit from IIG. No complications were reported. CONCLUSIONS: A small number of comparative studies suggest that there are improved outcomes when IIG is used in orbital fracture repair, but each study suffers from various limitations. No high-quality comparative studies exist for the management of lacrimal surgery, neoplastic disease, or decompression. Complications attributable to the use of IIG have not been identified, and IIG has not been analyzed for cost savings. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

2.
Curr Opin Ophthalmol ; 35(5): 382-390, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38934244

RESUMO

PURPOSE OF REVIEW: In recent years, the field of aesthetic medicine has witnessed a paradigm shift with an increasing demand for minimally invasive cosmetic procedures, including cosmetic injectables. This review aims to delineate the distinctive role played by oculoplastic surgeons in the administration of cosmetic injectables, comparing their expertise to that of nonphysician practitioners. RECENT FINDINGS: Complications arising from cosmetic injections are discussed, including skin discoloration, inflammation, necrosis, vision loss, retinal pathology, and central nervous system adverse effects. Injector expertise, patient factors, type of filler, location of injection, and management strategies are reviewed. Findings highlight diverse practitioner involvement, common adverse effects like skin necrosis and vision loss, with hyaluronic acid fillers being prominent. Areas at the highest risk for ocular complication include the glabella and nose with potential management involving dissolving fillers and reducing pressure. Emphasis is placed on expert injector selection and patient awareness. SUMMARY: The administration of cosmetic injectables requires a profound understanding of facial anatomy, vasculature, and potential complications. In contrast to nonphysician practitioners, oculoplastic and aesthetic surgeons bring a level of anatomical precision and clinical acumen that is essential for navigating the complexities of cosmetic injectables. Emphasis on training and collaboration among practitioners will be essential in advancing the field while prioritizing patient safety and satisfaction.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos , Humanos , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Preenchedores Dérmicos/administração & dosagem , Procedimentos Cirúrgicos Minimamente Invasivos , Injeções , Papel do Médico , Cirurgiões , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos
3.
Ophthalmic Plast Reconstr Surg ; 40(1): 75-87, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37656909

RESUMO

PURPOSE: To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN: Retrospective cohort study. METHODS: Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS: In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION: Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.


Assuntos
Boxe , Traumatismos Oculares , Traumatismos Faciais , Artes Marciais , Fraturas Orbitárias , Humanos , Boxe/lesões , Estudos Retrospectivos , Artes Marciais/lesões , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/etiologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/etiologia
4.
Ophthalmic Plast Reconstr Surg ; 40(2): e42-e45, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37995143

RESUMO

Cutaneous mucormycosis is a rare, opportunistic fungal infection that typically affects immunocompromised hosts. Current treatment consists of systemic antifungal therapy, surgical debridement, and when applicable, restoration of immune function. Despite intervention, the morbidity and mortality of invasive fungal disease remains high. There are few reports of primary or secondary cutaneous mucormycosis involving the ocular adnexa. The authors describe the course of 2 children with cutaneous mucormycosis of the eyelid treated with subcutaneous liposomal amphotericin B (LAmB) injections (3.5 mg/ml) in an off-label application as an adjunct to debridement and systemic antifungal therapy. To the authors' knowledge, these are the first 2 cases of invasive fungal disease involving the eyelid treated with subcutaneous LAmB injections, and the first reported case of disseminated fungal infection with secondary cutaneous involvement of the eyelid.


Assuntos
Anfotericina B , Infecções Fúngicas Invasivas , Mucormicose , Criança , Humanos , Antifúngicos/uso terapêutico , Pálpebras , Injeções Subcutâneas , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico
5.
Orbit ; 42(4): 372-382, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920583

RESUMO

PURPOSE: This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery. METHODS: Adult, English-speaking patients undergoing periocular surgery with telemedicine follow-up were studied prospectively in this interventional case series. Participants submitted visual acuity measurements and photographs via a web-based tool prior to routine telemedicine post-operative visits. An after-visit survey assessed patient perceptions. Surgeons rated photographs and live video for quality and blurriness; external raters also evaluated photographs. Images were analyzed for facial centration, resolution, and algorithmically detected blur. Complications were recorded and graded for severity and relation to telemedicine. RESULTS: Seventy-nine patients were recruited. Surgeons requested an in-person assessment for six patients (7.6%) due to inadequate evaluation by telemedicine. Surgeons rated patient-provided photographs to be of higher quality than live video at the time of the post-operative visit (p < 0.001). Image blur and resolution had moderate and weak correlation with photograph quality, respectively. A photograph blur detection algorithm demonstrated sensitivity of 85.5% and specificity of 75.1%. One patient experienced a wound dehiscence with a possible relationship to inadequate evaluation during telemedicine follow-up. Patients rated the telemedicine experience and their comfort with the structure of the visit highly. CONCLUSIONS: Augmented telemedicine follow-up after oculofacial plastic surgery is associated with high patient satisfaction, rare conversion to clinic evaluation, and few related post-operative complications. Automated detection of image resolution and blur may play a role in screening photographs for subsequent iterations of the web-based tool.


Assuntos
Procedimentos de Cirurgia Plástica , Cirurgia Plástica , Telemedicina , Adulto , Humanos , Seguimentos , Telemedicina/métodos , Satisfação do Paciente , Complicações Pós-Operatórias
6.
Ophthalmology ; 129(11): 1313-1322, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35768053

RESUMO

PURPOSE: To identify initial, preintervention magnetic resonance imaging (MRI) findings that are predictive of visual and mortality outcomes in acute invasive fungal rhinosinusitis (AIFRS). DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with histopathologically or microbiologically confirmed AIFRS cared for at a single, tertiary academic institution between January 2000 and February 2020. METHODS: A retrospective review of MRI scans and clinical records of patients with confirmed diagnosis of AIFRS was performed. For each radiologic characteristic, a modified Poisson regression with robust standard errors was used to estimate the risk ratio for blindness. A multivariate Cox proportional hazards model was used to study AIFRS-specific risk factors associated with mortality. MAIN OUTCOME MEASURE: Identification of initial, preintervention MRI findings associated with visual and mortality outcomes. RESULTS: The study comprised 78 patients (93 orbits, 63 with unilateral disease and 15 with bilateral disease) with AIFRS. The leading causes of immunosuppression were hematologic malignancy (38%) and diabetes mellitus (36%). Mucormycota constituted 56% of infections, and Ascomycota constituted 37%. The overall death rate resulting from infection was 38%. Risk factors for poor visual acuity outcomes on initial MRI included involvement of the orbital apex (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1-3.8; P = 0.026) and cerebral arteries (RR, 1.8; 95% CI, 1.3-2.5; P < 0.001). Increased mortality was associated with involvement of the facial soft tissues (hazard ratio [HR], 4.9; 95% CI, 1.3-18.2; P = 0.017), nasolacrimal drainage apparatus (HR, 5.0; 95% CI, 1.5-16.1; P = 0.008), and intracranial space (HR, 3.5; 95% CI, 1.4-8.6; P = 0.006). Orbital soft tissue involvement was associated with decreased mortality (HR, 0.3; 95% CI, 0.1-0.6; P = 0.001). CONCLUSIONS: Extrasinonasal involvement in AIFRS typically signals advanced infection with the facial soft tissues most commonly affected. The initial, preintervention MRI is prognostic for a poor visual acuity outcome when orbital apex or cerebral arterial involvement, or both, are present. Facial soft tissues, nasolacrimal drainage apparatus, intracranial involvement, or a combination thereof is associated with increased mortality risk, whereas orbital soft tissue involvement is correlated with a reduced risk of mortality.


Assuntos
Micoses , Rinite , Sinusite , Humanos , Rinite/diagnóstico por imagem , Rinite/microbiologia , Prognóstico , Estudos Retrospectivos , Micoses/diagnóstico , Sinusite/diagnóstico por imagem , Sinusite/microbiologia , Imageamento por Ressonância Magnética/métodos , Doença Aguda
7.
Eye Contact Lens ; 48(4): 162-168, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35296627

RESUMO

OBJECTIVES: To evaluate whether use of an antibiotic improves the efficacy of care for a chalazion or hordeolum. METHODS: A cross-sectional retrospective review was performed. All patients treated for a newly diagnosed chalazion or hordeolum at the University of California, San Francisco from 2012 to 2018 were identified. Patients were excluded when clinical notes were inaccessible or there was inadequate documentation of treatment modality or outcome. Patient demographics, setting of initial presentation, treatment modalities, antibiotic use, and outcomes were analyzed. RESULTS: A total of 2,712 patients met inclusion criteria. Management with an antibiotic was observed in 36.5% of patients. An antibiotic was 1.53 times (95% confidence interval [CI], 1.06-2.22, P=0.025) more likely to be prescribed in emergency or acute care setting for a chalazion. Older age was associated with a higher risk of receiving an antibiotic for a hordeolum (adjusted RR 1.07 per decade, 95% CI, 1.05-1.11, P<0.001). The addition of an antibiotic to conservative measures for a chalazion (adjusted RR, 0.97, 95% CI, 0.89-1.04, P=0.393) or hordeolum (adjusted RR, 0.99, 95% CI, 0.96-1.02, P=0.489) was not associated with an increased likelihood of treatment success. CONCLUSION: Although frequently prescribed, an antibiotic is unlikely to improve the resolution of a chalazion or hordeolum.


Assuntos
Calázio , Terçol , Antibacterianos/uso terapêutico , Calázio/diagnóstico , Calázio/tratamento farmacológico , Estudos Transversais , Terçol/tratamento farmacológico , Humanos , Resultado do Tratamento
8.
Ophthalmic Plast Reconstr Surg ; 38(4): 393-400, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35170569

RESUMO

PURPOSE: Tumors of the medial orbital apex can be challenging to resect. Primary endonasal resection can be limited by requirements for fat retraction and poor angulation for lateral orbital dissection. Orbital resection alone can have space limitations and a limited view for dissection of the posterior aspect of the tumor. The combined transorbital transnasal approach integrates the retraction and instrumentation advantages of the transorbital approach with the optical and space advantages of the transnasal approach. METHODS: In this cross-sectional cohort study, patients who underwent surgical resection of an apical orbital tumor via a combined endoscopic and orbital approach from 2014 to 2019 were identified. Clinical history, examination findings, imaging, surgical technique, histopathology, and complications were reviewed. RESULTS: Six patients were included. Patients presented with proptosis (5), optic neuropathy (3), and motility restriction (2). Surgery involved a medial orbitotomy and endoscopic ethmoidectomy ± sphenoidotomy, medial wall removal, and periosteum opening. The lesion was prolapsed into the sinus, dissected at the apex via the orbital approach, and removed through the nasal cavity. Pathologic diagnoses were cavernous venous malformation (4), venolymphatic malformation (1), and metastatic carcinoid (1). Improvement in pain (2/2), optic neuropathy (2/3), and proptosis (5/5) were noted. Complications included ethmoid mucocele and nasal polyps. CONCLUSIONS: The combined endonasal and orbital approach involves prolapsing the lesion into the nasal cavity to aid in dissection on the lateral and posterior aspects, maximizing visibility of the tight intraconal space. This technique can be performed by a team of orbital surgeons experienced in both orbital and endonasal surgery.


Assuntos
Exoftalmia , Doenças do Nervo Óptico , Neoplasias Orbitárias , Estudos Transversais , Endoscopia/métodos , Humanos , Órbita/diagnóstico por imagem , Órbita/cirurgia , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/cirurgia
9.
Ophthalmic Plast Reconstr Surg ; 37(3S): S62-S65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32852374

RESUMO

PURPOSE: Opioids may be indicated to mitigate pain after oculofacial surgery. The opioid crisis prompted attention to how these medications are dispensed and disposed. This study aims to characterize opioid usage and handling of patients undergoing oculofacial plastic surgery. METHODS: Eighty-nine adult patients were surveyed on their opioid usage after undergoing orbital, lacrimal, or eyelid (including esthetic) surgery at a tertiary oculofacial plastic surgery practice. Each patient was prescribed 10 tablets of hydrocodone/acetaminophen 5 mg/325 mg; one tablet taken orally as needed every 6 hours for pain not relieved by acetaminophen. Subset analysis was performed for type of surgery, age, and gender. RESULTS: Patients consumed an average of 3 ± 0.4 tablets. In the subsets, the averages were 2.1 ± 0.5 (n = 38) tablets after eyelid surgery, 1.6 ± 0.6 (n = 24) after lacrimal surgery, and 5.6 ± 0.9 (n = 27) after orbital surgery. Greater opioid usage was observed after orbital versus eyelid surgery (p = 0.0007) and orbital versus lacrimal surgery (p = 0.0005) but not eyelid versus lacrimal surgery (p = 0.8604). Forty-six patients (51.7%) used no opioids. Over half (57.3%; n = 51) filled their prescription. Thirty-three patients (37.1%) had unused medications, of which 21 patients did not properly dispose of their medications. The mean age of patients who used opioids was less than the mean age of those who needed no opioids (p = 0.024). There were no gender differences in opioid usage use versus not (p = 0.62). CONCLUSIONS: Opioid needs after oculofacial plastic surgeries, especially eyelid and lacrimal, were minimal in this cohort. For most patients, the prescription exceeded needs. Younger age but not gender was associated with opioid use versus not. Most did not properly discard these medications. Quality improvement in both the dispensing and disposal of opioids in oculofacial surgical practice may be warranted.


Assuntos
Analgésicos Opioides , Dor Pós-Operatória , Adulto , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Pálpebras/cirurgia , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica
10.
Ophthalmic Plast Reconstr Surg ; 37(2): e40-e80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33229953

RESUMO

Acute invasive fungal rhinosinusitis is a rare, although highly morbid, infection primarily affecting immunosuppressed individuals. The same population is at particularly high risk of complications and mortality in the setting of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. The authors present a case of acute invasive fungal rhino-orbital mucormycosis in a patient with COVID-19 and discuss the prevalence, diagnosis, and treatment of fungal coinfections in COVID-19. Prompt recognition, initiation of therapy, and consideration of the challenges of rapidly evolving COVID-19 therapy guidelines are important for improving patient survival.


Assuntos
COVID-19/complicações , Mucormicose/complicações , Micoses/diagnóstico , Síndrome do Desconforto Respiratório/diagnóstico , SARS-CoV-2/isolamento & purificação , Sinusite , Humanos , Mucormicose/diagnóstico , Doenças Nasais/microbiologia , Doenças Orbitárias/microbiologia , Síndrome do Desconforto Respiratório/etiologia
11.
Ophthalmic Plast Reconstr Surg ; 36(3): 222-230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923097

RESUMO

PURPOSE: To review the literature for the safety and efficacy of intralesional 5-fluorouracil (5-FU) in the management of oculofacial scars. METHODS: A literature search was performed in July 2019 in the PubMed database to identify reports of the use of 5-FU injections for modulating oculofacial cutaneous scars. The search yielded 152 articles, of which 15 met criteria outlined for assessment. Data were abstracted from these 15 relevant articles. RESULTS: While there were no high-level prospective randomized controlled trials, 8 were lower-quality randomized controlled trial, 3 were retrospective cohort studies, and 4 were case series. Most studies pooled results of facial and nonfacial cutaneous applications. Three studies focused solely on oculofacial applications, and these were all lower-level evidence studies. The study outcomes included scar dimension reduction, erythema, patient satisfaction score, observer assessment of scar improvement, and recurrence rates. 5-Fluorouracil was administered as monotherapy or as part of multimodality treatment with other agents (usually corticosteroids) or with CO2 laser, radiotherapy, or pulsed dye laser. 5-Fluorouracil was usually given as an intralesional injection, but in some studies, it was applied topically after micropuncture of the skin. The number and timing of treatments varied between studies. Overall, the level of safety of 5-FU was high. Pain with injection was the most common reported side effect. Other common adverse side effects included pruritus, telangiectasias, changes in pigmentation, and purpura, and 2 studies noted more serious events, such as ulceration, superficial necrosis, and local infection. There were no severe side effects such as anaphylaxis, immune suppression, secondary malignancy, systemic infection, blindness, or death. In all studies, 5-FU was associated with prophylaxis of oculofacial scars or improvement of keloids or hypertrophic scars in terms of reducing size, erythema, and pruritus. 5-Fluorouracil application was associated with favorable patient satisfaction and observer assessment scores especially compared with corticosteroid injections alone. CONCLUSIONS: High-quality randomized controlled trials are currently lacking, and the existing literature is predominately not specific to use of 5-FU on the face. These studies, however, suggest that intralesional 5-FU is safe and probably more effective than other options in the management of cutaneous scars in the oculofacial region. The delivery methods, timing, dosing, and concomitant therapies were highly variable. Further high-quality controlled studies specific to oculofacial scars may be indicated to assess the efficacy of 5-FU and to establish the best protocols for administering this medication.


Assuntos
Cicatriz Hipertrófica , Fluoruracila , Humanos , Recidiva Local de Neoplasia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
12.
Ophthalmic Plast Reconstr Surg ; 36(6): 613-616, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32427733

RESUMO

PURPOSE: To describe and evaluate the use of a lateral tarsoconjunctival suspension flap (TCSF) for the management of post blepharoplasty lower eyelid retraction. METHODS: Two-center, retrospective chart review of patients who received a lateral TCSF between 2010 and 2018 for correction of post blepharoplasty lower eyelid retraction. The postoperative follow-up was a minimum of 3 months. Pre- and postoperative lower eyelid position (margin reflex distance 2 on standard photographs), degree of ocular surface disease, symptoms, complications, and need for further intervention were recorded. Pre- and postoperative photographs were scored using an objective grading system for cosmetic surgical results (MDACS). RESULTS: Forty-eight eyelids from 30 patients met inclusion criteria for this study. Twenty (67%) of the patients were female. Age ranged from 55 to 89 (mean, 73.2). After the TCSF, ocular surface exposure improved in all cases. Lower eyelid retraction (average margin reflex distance 2 pre- vs. postintervention) improved in 98% of cases. Objective scoring of appearance improved; the mean MDACS score was 8 pre- and 3 post-TCSFs (p < 0.0001). One patient required midface lift and lateral canthoplasty 7 months later for undercorrected eyelid retraction. Another case required partial resection due to visibility of the flap in the interpalpebral zone. Postoperative pyogenic granulomas were noted in 8% (4/48) of eyelids. CONCLUSIONS: The lateral TCSF was safe and effective in improving both functional and esthetic parameters in this series of post blepharoplasty eyelid retraction patients.


Assuntos
Blefaroplastia , Doenças Palpebrais , Doenças Palpebrais/etiologia , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Retalhos Cirúrgicos
13.
Ophthalmic Plast Reconstr Surg ; 36(2): e40-e43, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31868787

RESUMO

The authors present a case of an eyelid eccrine porocarcinoma, a very rare malignant sweat gland tumor characterized histopathologically by nests of atypical poromatous cells and the presence of duct-like lumina. Histopathologic analysis of this case also exhibited numerous loose tumor cells in the adjacent tear film, a finding that has not been previously described.


Assuntos
Porocarcinoma Écrino , Neoplasias Palpebrais , Neoplasias Cutâneas , Neoplasias das Glândulas Sudoríparas , Porocarcinoma Écrino/diagnóstico , Porocarcinoma Écrino/cirurgia , Pálpebras , Humanos , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/cirurgia
14.
Ophthalmic Plast Reconstr Surg ; 36(4): 359-364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049943

RESUMO

PURPOSE: To report the characteristic clinical and imaging findings in a series of patients with thrombosed orbital venolymphatic malformations. METHODS: Patients affected by acute thrombosis of an orbital venolymphatic malformation were reviewed. Clinical findings including symptoms and signs of presentation, characteristic imaging features, and clinical course are presented. RESULTS: Ten patients were identified. The mean age at presentation was 56 years. All patients presented with acute pain or pressure sensation, with the most common additional presenting symptoms being proptosis (6/10) and diplopia (5/10). CT imaging typically demonstrated a nonspecific orbital mass. Nine patients underwent MRI which revealed a soft tissue mass with peripheral rim enhancement and a central, typically T2 hypointense, core. Seven out of 10 patients were observed and had improvement in symptoms and signs without surgical intervention. Two patients underwent surgical intervention for intractable pain. CONCLUSION: Patients with thrombosis of a venolymphatic malformation often present with acute pain, proptosis, and diplopia. Characteristic MRI findings of a peripheral rim enhancing mass with a T2 hypointense core can be noted. Careful observation is a reasonable management option for cases without visual compromise or intractable pain.


Assuntos
Doenças Orbitárias , Trombose , Malformações Vasculares , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Veias
15.
Ophthalmic Plast Reconstr Surg ; 35(3): 286-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30624413

RESUMO

PURPOSE: To describe a surgical technique of orbital roof reconstruction with a thin nylon foil implant. METHODS: This study is a description of a surgical technique with a retrospective chart review of 3 consecutive patients treated with a nylon foil implant for a complete superior orbital defect after meningioma resection via craniotomy approach. RESULTS: The nylon foil reconstruction achieved an anatomically stable orbit without globe dystopia, pulsatile proptosis, cerebrospinal fluid leak, or other serious cranio-orbital problems, in all cases. Postoperative visual acuity, pain, extraocular motility, proptosis, and globe position remained stable or improved in each case. There were no complications related to the orbital roof reconstruction. CONCLUSIONS: Nylon foil implantation was an effective and inexpensive surgical technique for orbital roof reconstruction after tumor resection in this small series.


Assuntos
Craniotomia/métodos , Meningioma/cirurgia , Nylons , Órbita/cirurgia , Implantes Orbitários , Neoplasias Orbitárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningioma/diagnóstico , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico , Desenho de Prótese , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
Orbit ; 38(3): 259, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30118611

RESUMO

A 53-year-old male presented with a bony lesion over the superior orbital rim increasing in size over several months. CT imaging showed a circumscribed, osseous lesion involving the outer table of the right frontal bone and superior orbital rim with a honeycomb appearance. Anterior orbitotomy revealed an osseous lesion along the superior orbital rim with purple cavernous spaces. Histopathological examination demonstrated cavernous vascular channels with variably-sized lumens and variably-thickened vascular walls interspersed among bony trabeculae consistent with an osseous cavernous hemangioma.


Assuntos
Hemangioma Cavernoso/patologia , Neoplasias Orbitárias/patologia , Osso Frontal/diagnóstico por imagem , Osso Frontal/patologia , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/cirurgia , Tomografia Computadorizada por Raios X
17.
Ophthalmic Plast Reconstr Surg ; 34(6): e189-e192, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30234833

RESUMO

A 51-year-old woman presented with no light perception vision of the right eye 12 hours after another provider injected calcium hydroxylapatite into the glabella and dorsum of the nose. Exam and fluorescein angiography demonstrated optic nerve edema and choroidal hypoperfusion consistent with ischemia of the posterior ciliary circulation. The central retinal circulation appeared intact. One thousand two hundred units of retrobulbar hyaluronidase were injected urgently in several boluses. Oral prednisone and aspirin also were administered. Ocular massage was also initiated. One day later, visual acuity improved to light perception that remained stable at 3 months. Retrobulbar hyaluronidase injection, ocular massage, prednisone, and aspirin were correlated to recovery of light perception vision in this case of calcium hydroxylapatite filler embolization to the choroidal circulation. The mechanism for the recovery of some vision and the role of hyaluronidase and other medications remain uncertain. Further research in treatments for ophthalmic complications of facial fillers is warranted.


Assuntos
Cegueira/etiologia , Durapatita/efeitos adversos , Hialuronoglucosaminidase/administração & dosagem , Recuperação de Função Fisiológica , Acuidade Visual/fisiologia , Percepção Visual/fisiologia , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/efeitos adversos , Cegueira/diagnóstico , Cegueira/tratamento farmacológico , Técnicas Cosméticas/efeitos adversos , Durapatita/administração & dosagem , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções , Injeções Intraoculares , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Nariz , Tomografia de Coerência Óptica
18.
Ophthalmic Plast Reconstr Surg ; 33(3S Suppl 1): S188-S190, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26808177

RESUMO

A 49-year-old male presented with proptosis and was found to have optic nerve edema with peripapillary hemorrhages. Diagnostic testing showed a suppressed thyroid-stimulating hormone. CT orbits showed homogenous tendon-sparing enlargement of the medial and inferior rectus muscles, characteristic of thyroid eye disease. Intravenous methylprednisolone was administered given the concern for compressive optic neuropathy. He initially had improvement of his symptoms, so orbital decompression was deferred. Subsequently he presented with worsening diplopia and right proptosis, a new afferent pupillary defect, and a cecocentral visual field defect. Dilated examination revealed significant optic nerve head edema and diffuse retinal hemorrhages in all 4 quadrants consistent with a central retinal vein occlusion. The patient underwent an urgent 3-wall orbital decompression on the right. Close follow up postoperatively showed resolution of the central retinal vein occlusion and the associated optic disc edema, peripapillary hemorrhages, and macular edema. Orbital decompression is known to improve many manifestations of thyroid eye disease, but this is the first report of orbital decompression resulting in resolution of a central retinal vein occlusion.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Oclusão da Veia Retiniana/cirurgia , Angiofluoresceinografia , Fundo de Olho , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/etiologia , Tomografia Computadorizada por Raios X
19.
Ophthalmic Plast Reconstr Surg ; 33(1): e1-e4, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-25564256

RESUMO

A 55-year-old woman had a right orbital cyst detected incidentally on radiographic imaging. The patient's symptoms were mild and included intermittent pain and vertical diplopia; the patient was not aware of any visual decline. There was a palpable mass beneath the superior orbital rim. Radiographic imaging revealed a well-demarcated cystic lesion in the right superior orbit between the levator palpebrae superioris and superior rectus muscles. The mass was completely excised via a transconjunctival approach. Histopathologic evaluation disclosed a conjunctival cyst lined by nonkeratinized squamous epithelium with scattered, rare goblet cells. This case combined with 5 other similar reported cases suggests that an intermuscular cyst located in the superior rectus-levator complex is most likely of congenital embryonic conjunctival origin.


Assuntos
Doenças da Túnica Conjuntiva/patologia , Cistos/patologia , Músculos Oculomotores/patologia , Doenças Orbitárias/patologia , Doenças da Túnica Conjuntiva/diagnóstico por imagem , Cistos/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Músculos Oculomotores/diagnóstico por imagem , Doenças Orbitárias/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA