Mullers Muscle Conjunctival Resection for Treatment of Contact Lens-Associated Ptosis.

PURPOSE: The aim of this study was to look at the surgical outcomes of posterior approach Mullers muscle conjunctival resection surgery for contact lens-related ptosis. METHODS: This was a retrospective, comparative interventional case series. All patients and controls underwent phenylephrine 10% testing and had a positive response prior to surgical intervention. RESULTS: Thirty-one eyelids with ptosis were identified in 20 contact lens wearing patients, which were matched with 27 eyelids in 15 controls. The contact lens wearing patients wore contact lenses for a mean of 20.6 ± 12.1 years. More than half (60%) wore soft contact lenses, as opposed to rigid gas-permeable contact lenses. Preoperative margin-to-reflex distance-1 was lower in patients who wore rigid contact lenses (0.8 ± 0.7 mm) as compared with patients with soft contact lenses (1.7 ± 1.1 mm) (p = 0.01). Surgical success, as defined by margin-to-reflex distance-1 ≥3 mm or symmetry of upper eyelid height (within 1 mm), was achieved in 93.5% in the contact lens group and 92.6% of controls. Postoperative margin-to-reflex distance-1 was significantly higher in the contact lens wearers (3.9 ± 1.3 mm) compared with the controls (3.2 ± 1.1 mm; p = 0.01). There was a significant correlation between the amount of tissue resected intraoperatively and the improvement in margin-to-reflex distance-1 (Pearsons correlation coefficient, r =0.36; p = 0.006). There were no surgical complications of any patients in the study. CONCLUSION: Mullers muscle conjunctival resection surgery is an effective surgical correction for contact lens-associated ptosis. Patients can achieve excellent results with minimal risk of residual ptosis or asymmetry.

Endocrine Mucin-Producing Sweat Gland Carcinoma and Primary Cutaneous Mucinous Carcinoma: A Case Series.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) and primary cutaneous mucinous carcinoma (PCMC) are rare low-grade neoplasms thought to arise from apocrine glands that share many histological features and are proposed to be on a single histopathologic continuum, with EMPSGC as the in situ form that may progress to the invasive PCMC. Management involves a metastatic workup and either wide local excision (WLE) with greater than 5 mm margins or Mohs micrographic surgery (MMS) in anatomically sensitive areas. We present 2 cases of EMPSGC and 3 cases of PCMC and review their clinical and histopathologic features, differential diagnoses, and treatment.

Primitive neuroectodermal tumor of the orbit in adults: a case series.

PURPOSE: To present the clinical, radiologic, and histopathologic features of orbital primitive neuroectodermal tumor (PNET) in 5 adult patients. METHODS: Retrospective case series of 5 adult patients with orbital PNET. Orbitotomy was performed in all cases. The authors report clinical findings, radiologic features, histopathology, immunohistochemical analysis, management, and outcomes for 5 patients with orbital PNET. RESULTS: Five adult patients presented with progressive unilateral proptosis and visual impairment. Common radiographic findings included a heterogeneous mass without associated destructive features, located in the superior and/or lateral orbit. Four cases demonstrated strong immunohistochemical staining for CD99 in a membranous pattern. One case required chromosomal analysis with fluorescence in situ hybridization to confirm the diagnosis. All patients received chemotherapy and/or orbital radiation with resolution of proptosis but no improvement of vision. One patient died of disease. CONCLUSIONS: To the authors' knowledge, this is the largest series of orbital PNET in adults. This tumor has an age demographic wider than previously believed and should be considered in the differential diagnosis of a hypercellular small round cell orbital tumor in both children and adults. Current treatment regimens are not standardized but typically use a similar approach to the treatment of Ewing sarcoma. Orbital PNET appears to have less propensity for metastasis compared with PNET in other locations. However, long-term aggressiveness remains to be proven.

Transcanalicular approach to adult lacrimal duct obstruction: a review of instruments and methods.

Developments in fiberoptic technology and increasing interest in minimally invasive surgery have fueled advances in transcanalicular surgery. This article presents a review of instruments and methods for diagnostic and therapeutic approaches to adult lacrimal drainage obstruction. Available endocanalicular probes, microendoscopes, lasers, microdrills, trephines, and antegrade lacrimal balloon catheters are discussed and compared. Developments in microendoscopy, laser transcanalicular dacryocystorhinostomy, laser canaliculoplasty, transcanalicular drilling and trephination, and transcanalicular balloon dacryoplasty are also discussed in detail. Transcanalicular surgery provides a minimally invasive approach to adult lacrimal drainage obstruction that may also address the pathology causing the obstruction. Long-term success rates of transcanalicular dacryocystorhinostomy appear to be improving, but cost and a paucity of data on long-term results continue to limit the use of transcanalicular surgery.

Müller muscle conjunctival resection for blepharoptosis in patients with poor to fair levator function.

It has been suggested that Müller muscle conjunctival resection might not be a good procedure for the treatment of blepharoptosis in patients with less than optimal levator function. This case series includes four eyelids (three patients) that had fair preoperative levator function (4 to 8 mm) and good response to phenylephrine. The mean preoperative levator function was 6.25 mm and the mean amount of resection was 10.25 mm. The mean preoperative marginal reflex distance was -0.50 mm and the mean postoperative marginal reflex distance was 3.38 mm. Müller muscle conjunctival resection may be effective for treating patients with fair levator function and satisfactory response to phenylephrine.

Müller muscle-conjunctiva resection for blepharoptosis in patients with glaucoma filtering blebs.

PURPOSE: To study the safety and efficacy of Müller muscle-conjunctiva resection (MMCR) for blepharoptosis in patients with functional glaucoma-filtering blebs. METHODS: Retrospective chart review of patients who underwent MMCR in the presence of a functioning filtering bleb. Patients offered MMCR all responded satisfactorily to preoperative topical phenylephrine hydrochloride testing. Using a similar technique, MMCR was performed by 6 surgeons at 6 different centers. Two patients had simultaneous upper blepharoplasty. Postoperative slit lamp examination was performed to assess for bleb injury or infection. In addition, all patients had routine glaucoma follow-up visits to assess for bleb functioning. RESULTS: Nine patients with functional filtering blebs tolerated MMCR well and had no bleb complications. All blebs remained functional after surgery. One patient had anterior chamber reaction for 10 days and another patient had foreign body sensation for 6 weeks. At 9.2-months mean follow-up time, the mean change in margin reflex distance-1 was 2.9 mm. CONCLUSION: MMCR may be safe and effective in the setting of a glaucoma-filtering bleb.

Evaluation of patient comfort with outpatient orbital surgery.

PURPOSE: To evaluate patient comfort with outpatient orbital surgery. DESIGN: Prospective, non-randomized study. METHODS: The experience of 34 consecutive outpatient orbital procedures in 30 patients was evaluated. The data obtained included subjective postoperative pain and discomfort at 3 time intervals (immediate, postoperative day 1 and 1 week) using a 100 mm visual analogue scale (VAS). Patients were also asked to rate the overall experience after one week of follow-up. RESULTS: The average pain and discomfort scores in the immediate postoperative period measured 13.95 and 12.61, respectively. Overnight scores of 5.91 and 7.25 were determined for pain and discomfort, and at the one-week follow-up these were 0.91 and 3.42, respectively. All 30 patients reported that they were "satisfied with their overall experience." The highest VAS score for pain at any time was 50. The highest VAS score for discomfort at any time was also 50. All 30 patients had recovered or improved their visual acuity at week one. There was no incidence of retrobulbar hemorrhage, significant loss of vision (greater than two lines), increased intraocular pressure or pupillary defects in any of the patients. None of the study patients required re-hospitalization. CONCLUSIONS: This study suggests that outpatient orbital surgery, in the hands of an experienced orbital surgeon, is safe and well tolerated by the patients regardless of the type of anesthesia or type of procedure.