SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Ophthalmic plastic and reconstructive surgery

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A 25-year-old woman presented with a painless inferomedial subconjunctival mass in the right eye. The growth had been present since birth and had been increasing in size for over 1 year. Incisional biopsy with debulking proved the lesion to be a dermolipoma extending behind the globe that contained ectopic lacrimal gland tissue. The authors describe a very rare case of a complex dermolipoma arising in an atypical location and containing ectopic lacrimal gland.

Concepts: Cancer, Biopsy, Eye, Lacrimal gland

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A 48-year-old man was seen in the Wills Eye Institute emergency room for pain and decreased vision after having a diesel engine fuel cylinder explosion in his face. Clinical examination showed proptosis, decreased extraocular motility, and increased intraocular pressure; CT scan imaging revealed hypodense areas within the orbit. His orbital signs rapidly worsened despite aggressive antibiotics, steroids, and surgical intervention. Two orbitotomies revealed diesel fuel infiltration of the intraconal and extraconal spaces that proved impossible to evacuate completely. The patient ended up losing vision from an intense chemical cellulitis with subsequent orbital compartment syndrome and optic neuropathy. This case highlights the severity of orbital chemical injuries and their variable prognoses despite aggressive management.

Concepts: Surgery, Petroleum, Ophthalmology, Internal combustion engine, Diesel fuel, Diesel engine, Biodiesel, Rudolf Diesel

28

PURPOSE:: To describe a modified Fasanella-Servat procedure and nomogram for the correction of minimal amounts of ptosis. METHODS:: Retrospective review of this modified Fasanella-Servat procedure was performed on 118 eyelids in 86 consecutive patients over 2, 4-year periods by 1 surgeon (S.C.D.). The amount of tarsectomy was based on the amount of ptosis. RESULTS:: Mean pre- and postoperative margin-to-reflex distance 1 were +0.7 mm and +2.4mm, respectively. One hundred and twelve eyelids (95%) had satisfactory results with postoperative margin-to-reflex distance 1 ≥ 1.5 mm. Eyelid symmetry was achieved in 92% of eyelids to within 0.5 mm. There was no incidence of overcorrection, tarsal buckling, or corneal abrasion. One eyelid had a contour deficit. Tarsectomy amount ranged from 2 mm to 5 mm. Average amount of tarsectomy to eyelid elevation was 2.4:1. CONCLUSION:: The modified Fasanella-Servat procedure is technically easy, time-efficient, and has a low complication rate for the treatment of minimal blepharoptosis (< 2.5 mm) with good levator function and negative phenylephrine test. In the authors' hands, the ratio of tarsectomy to eyelid elevation is approximately 2:1. In addition to other techniques such as levator advancement and Müller's muscle conjunctival resection, the modified Fasanella-Servat technique is a useful adjunct to the modern ptosis surgeon's armamentarium.

Concepts: Ratio, Eye, Conjunctiva, Eyelid, Lacrimal nerve, Ptosis, Levator palpebrae superioris muscle, Dermatochalasis

28

A 77-year-old male patient presented to our attention with violaceous nodular lesions on the skin of his hands and lower extremities. Clinical and histologic examination supported the diagnosis of Kaposi sarcoma. A first-line systemic chemotherapy based on liposomal doxorubicin at a dosage of 40 mg/m every 3 weeks for 5 cycles was carried out, resulting in partial resolution of skin lesions. However, 1 year later, a relapse of the disease in the lower limbs and a new lesion of the left eyelid were found, therefore the patient began a second-line therapy with 100 mg/m paclitaxel every 2 weeks. After 8 cycles of therapy, we observed a complete remission of eyelid tumor and a partial response of lower limbs lesions up to 6 months of follow up. In conclusion, eyelid Kaposi sarcoma was successfully treated with paclitaxel every 2 weeks, obtaining a complete response.

Concepts: Cancer, Medical terms, Chemotherapy, Anatomical pathology, Doxorubicin, Kaposi's sarcoma, Sarcoma, Paclitaxel

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A 31-year-old man with a history of severe facial trauma and multiple reconstructive operations presented with a conjunctival-orbital fistula in the OS. Successful treatment required a vascularized orbicularis oculi flap with a temporalis fascia overlay. Risk factors for fistula formation included extensive orbital trauma, devascularized tissue from previous operations and infection, and prior strabismus surgery using the fornix-based approach.

Concepts: Strabismus, Orbicularis oculi muscle

27

To describe a simple technique to correct tarsal lower eyelid ectropion with or without marked eyelid laxity (The Leicester Modified Suture technique).

Concepts: Surgical suture, Eyelid, Ectropion, Entropion

27

To delineate signals by which the vascular abnormalities inherent to ocular rosacea arise and to correlate these signals with elements of the innate immune system.

Concepts: Immune system, Innate immune system, Toll-like receptor, Immunity, Pattern recognition receptor, Rosacea

27

A 49-year-old woman with acute myeloid leukemia, FAB M1 subtype, and 12p deletion, presented with progressive right proptosis and diplopia for 1 week. Orbital CT revealed a homogenously enhancing, orbital mass engulfing the inferior rectus muscle. Histopathology revealed myeloid sarcoma for which she underwent external beam radiotherapy. Subsequently, there was no sign of local recurrence, but she succumbed to leukemia involving the central nervous system. This is the first case, to the authors' knowledge, of an orbital sarcoma of FAB M1 myeloblasts bearing a 12p deletion.

Concepts: Central nervous system, Nervous system, Cancer, Brain, Leukemia, Acute myeloid leukemia, Blood disorders, Myeloid sarcoma

27

: To describe current indications, methods, and outcomes of sentinel lymph node (SLN) biopsy for eyelid and conjunctival tumors.

Concepts: Cancer, Oncology, Lymph node, Lymphatic system, Sentinel lymph node, Lymph node biopsy

27

An 83-year-old woman with Sjögren syndrome underwent insertion of large punctal plugs in the right upper and lower puncti. Nine months later, she presented with upper canaliculitis, although the plugs were not found in the puncti. Dacryoendoscopic examination revealed punctal plug migration, granulation, and a large amount of debris in the upper canaliculus. The plug was situated parallel to the canaliculus, occluding the intracanalicular space. The lower canaliculus also showed plug migration, but little granulation and debris were present. The plug was situated perpendicular to the intracanalicular space, securing a space around the plug. The migrated plugs were pushed directly toward the nasal cavity by the dacryoendoscope. Curettage was performed in the upper canaliculi. Bicanalicular silicone intubation was performed, and removal was performed 3 months later. The patient remained symptom-free for 6 months postoperatively.

Concepts: Canaliculus