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Simons AS, Shams PN, Thaung C, Vahdani K. Eyebrow Pilomatrixoma Presenting With Localized Alopecia and Skin Hypopigmentation. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00357. [PMID: 38427819 DOI: 10.1097/iop.0000000000002544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Anne-Sophie Simons
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Pari N Shams
- Adnexal service, Moorfields Eye Hospital, London, United Kingdom
| | - Caroline Thaung
- Department of Histopathology, Institute of Ophthalmology, London, United Kingdom
| | - Kaveh Vahdani
- Adnexal service, Moorfields Eye Hospital, London, United Kingdom
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Shams PN, Policeni B, Carter KD, Shriver E, Thurtell MJ. Bilateral septic cavernous sinus thrombosis, congestive orbitopathy, and ischemic optic neuropathy. Can J Ophthalmol 2016; 51:e75-7. [PMID: 27085286 DOI: 10.1016/j.jcjo.2015.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 11/27/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Pari N Shams
- Moorfields Eye Hospital, Adnexal Service, London, United Kingdom.
| | | | - Keith D Carter
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Erin Shriver
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Luk SMH, Shams PN, Joshi N. Fifteen year natural history of lower eyelid syringocystadenoma papilliferum in a young girl. Cont Lens Anterior Eye 2015; 38:466-7. [PMID: 26097022 DOI: 10.1016/j.clae.2015.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Sheila M H Luk
- Craniofacial Ophthalmic Plastic Service, Chelsea Westminster Hospital NHS Foundation Trust, London, UK; Department of Ophthalmology Chelsea Westminster Hospital London 369 Fulham Road, SW10 9NH UK
| | - Pari N Shams
- Craniofacial Ophthalmic Plastic Service, Chelsea Westminster Hospital NHS Foundation Trust, London, UK; Department of Ophthalmology Chelsea Westminster Hospital London 369 Fulham Road, SW10 9NH UK
| | - Naresh Joshi
- Craniofacial Ophthalmic Plastic Service, Chelsea Westminster Hospital NHS Foundation Trust, London, UK; Department of Ophthalmology Chelsea Westminster Hospital London 369 Fulham Road, SW10 9NH UK
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Shams PN, Bohman E, Baker MS, Maltry AC, Kopp ED, Allen RC. Chronic anophthalmic socket pain treated by implant removal and dermis fat graft. Br J Ophthalmol 2015; 99:1692-6. [PMID: 26041123 DOI: 10.1136/bjophthalmol-2014-306585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/16/2015] [Indexed: 11/03/2022]
Abstract
AIMS To report the outcome of orbital implant removal and dermis fat graft (DFG) implantation in patients with chronic anophthalmic socket pain (ASP), in whom all detectable causes of pain had been ruled out and medical management had failed. METHODS Retrospective, multicentre case series. A review of all cases undergoing orbital implant replacement with DFG between 2007 and 2013 was conducted at the University of Iowa Hospitals and Clinics (UIHC), USA, and St. Erik Eye Hospital, Sweden. Inclusion criteria included (1) chronic ASP >2 years and unresponsive to treatment, (2) absence of pathological or structural cause for pain established by socket examination and orbital imaging, and (3) minimum 12-month post-surgical follow-up. RESULTS Six cases with chronic ASP were identified, four were post-enucleation and two were eviscerated at an average age of 45 years. The incidence of chronic ASP among enucleations at UIHC over a 6-year period was 0.7%. Indications for enucleation and evisceration included tumours and glaucoma. Intractable ASP had been present for an average of 11 years and persisted despite medical management. All patients were free of pain within 3 months of implant removal and DFG placement and remained pain free at an average 24 months following surgery. CONCLUSIONS Orbital implant replacement with DFG was effective at relieving chronic ASP, and pain resolution was sustained in all cases. This surgical intervention may be a useful management option for patients in whom all detectable causes of chronic pain have been excluded and have failed medical pain management.
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Affiliation(s)
- Pari N Shams
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Elin Bohman
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institute, St. Erik Eye Hospital, Stockholm, Sweden
| | - Meredith S Baker
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Amanda C Maltry
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eva Dafgård Kopp
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institute, St. Erik Eye Hospital, Stockholm, Sweden
| | - Richard C Allen
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Shams PN, Chen PG, Wormald PJ, Sloan B, Wilcsek G, McNab A, Selva D. Management of Functional Epiphora in Patients With an Anatomically Patent Dacryocystorhinostomy. JAMA Ophthalmol 2014; 132:1127-32. [DOI: 10.1001/jamaophthalmol.2014.1093] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pari N. Shams
- South Australian Institute of Ophthalmology, Department of Ophthalmology and Visual Sciences, Adelaide University, Adelaide, South Australia, Australia
| | - Philip G. Chen
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J. Wormald
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Brian Sloan
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
| | - Geoff Wilcsek
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Alan McNab
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Department of Ophthalmology and Visual Sciences, Adelaide University, Adelaide, South Australia, Australia
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Shams PN, Ma R, Pickles T, Rootman J, Dolman PJ. Reduced risk of compressive optic neuropathy using orbital radiotherapy in patients with active thyroid eye disease. Am J Ophthalmol 2014; 157:1299-305. [PMID: 24582992 DOI: 10.1016/j.ajo.2014.02.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/19/2014] [Accepted: 02/19/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the risk of developing compressive optic neuropathy in patients with active thyroid eye disease (TED) treated with corticosteroids with or without orbital radiotherapy. DESIGN Retrospective single-center case-control study. METHODS The clinical charts of 351 patients with active TED who received corticosteroids with or without orbital radiotherapy between 1999 and 2010 were reviewed. Patients with compressive optic neuropathy at the time of presentation were excluded. Group 1 received corticosteroids only and Group 2 received corticosteroids as well as orbital radiotherapy. The primary outcome measure was the development of compressive optic neuropathy. Secondary outcome measures were changes in other parameters indicating the activity of TED, including soft tissue inflammation, diplopia, ocular motility restriction, and appearance. RESULTS There were 144 cases in Group 1 and 105 in Group 2. Both groups were matched for age, sex, and stability of thyroid function. The 2 groups differed only in the modality of treatment for active TED. The main indication for treatment in both groups was soft tissue inflammation. Corticosteroids were initiated an average of 2.6 months following symptom onset in Group 1 and 2.5 months in Group 2. Group 2 received orbital radiotherapy on average 4.2 months following the initiation of corticosteroid therapy and 8% (9/105) were intolerant to corticosteroids. At an average of 3.2 years follow-up, compressive optic neuropathy had developed in 17% (25/144) of Group 1 and 0% of Group 2 (P < .0001), on average 5.5 months following the initiation of corticosteroid therapy. Although both groups experienced a significant reduction in periocular inflammation, the radiotherapy-treated group demonstrated a significantly greater improvement in ocular motility. CONCLUSION The rate of compressive optic neuropathy was significantly lower and improvement in ocular motility greater in patients receiving orbital radiotherapy in addition to corticosteroids. Patients with active TED appear to have an effective and sustained response to orbital radiotherapy combined with corticosteroids that is protective against disease progression and the development of compressive optic neuropathy.
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Affiliation(s)
- Pari N Shams
- Department of Ophthalmology and Visual Sciences, Vancouver Hospital Eye Care Centre and University of British Columbia, Vancouver, British Columbia, Canada
| | - Roy Ma
- British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Pickles
- British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack Rootman
- Department of Ophthalmology and Visual Sciences, Vancouver Hospital Eye Care Centre and University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, Vancouver Hospital Eye Care Centre and University of British Columbia, Vancouver, British Columbia, Canada.
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Watanabe A, Shams PN, Katori N, Kinoshita S, Selva D. Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease. Eye (Lond) 2013; 27:1174-9. [PMID: 23907627 DOI: 10.1038/eye.2013.160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 07/02/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A turn-over septal flap has been reported as a spacer for levator lengthening in a single case report. This study reports the preliminary outcomes of this technique in a series of patients with upper-lid retraction (ULR) associated with thyroid eye disease (TED) causing symptomatic exposure keratopathy (EK). METHODS Retrospective, multicenter study of 12 eyelids of 10 patients with TED undergoing a transcutaneous levator-lengthening technique using the reflected orbital septum (OS) as a spacer. Change in palpebral aperture (PA) and contour, position of the skin crease (SC), symptoms of EK, and complications were recorded. RESULTS The average age was 47.5 years. Two patients were excluded, as their septa were found to be very thin at surgery. At an average of 13 months postoperatively, the PA was reduced by 2.5 mm on average (P<0.001) and was within 1 mm of the contralateral eyelid in 11 cases (92%); the position of the SC was within 1 mm of the desired position in all cases. EK resolved in all cases. Complications included one case of overcorrection and one case of recurrent lateral flare. CONCLUSIONS The turn-over orbital septal flap technique may be a viable option as an autogenous spacer for the treatment of ULR in TED. This technique may be possible in cases where the OS has been opened by previous surgery but may not be feasible in patients in whom the septum is very thin.
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Affiliation(s)
- A Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
The aims of this article are twofold: (1) to provide the facial plastic surgeon with a comprehensive and up-to-date overview of periocular anatomy including the brow, midface, and temporal region and (2) to highlight important anatomical relationships that must be appreciated in order to achieve the best possible functional and aesthetic surgical outcomes.
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Affiliation(s)
- Pari N Shams
- Oculoplastic and Craniofacial Service, Department of Ophthalmology, Chelsea and Westminster Hospital, London, United Kingdom.
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Abstract
ABSTRACT A 78-year-old woman with dementia presented with functional visual loss secondary to bilateral chronic purulent dacryocystitis. A right external dacryocystorhinostomy (DCR) under local anaesthesia and sedation (LAS) was performed which failed after one month. Wound care was problematic as the patient removed all dressings and picked at the incision resulting in dehiscence and wound infection. She then underwent bilateral dacryocystectomy (DCT) under LAS and cauterisation of the common canaliculus via an endoscopic endonasal approach. Post-operatively her symptoms fully resolved. An endoscopic approach to lacrimal sac excision may be feasible in selected cases where a skin incision may not be desirable.
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Affiliation(s)
- Pari N Shams
- South Australian Institute of Ophthalmology and Department of Ophthalmology and Visual Sciences, Adelaide University, Adelaide, South Australia, Australia.
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Abstract
A 31-year-old man with epiphora and mucous discharge from a traumatic lacrimal fistula underwent a computed tomographic dacryocystogram, revealing a fistula extending from the anterior ethmoid air cells through the lacrimal sac to the overlying skin with coexisting nasolacrimal duct obstruction. Endoscopic dacryocystorhinostomy enabled complete marsupialization of the lacrimal sac and agger nasi air cell, removing the tract between these structures. Simultaneous probing of the common canaliculus and fistula tract under direct visualization allowed the identification of the internal fistula origin in relation to the internal ostium on the lateral sac wall. The fistula was excised with a trephine over a guide wire via an external approach. Use of the endoscopic technique for excision of acquired lacrimal fistulas may be especially helpful in cases with coexisting nasolacrimal duct obstruction where the fistula extends to the sinus cavity or suspected foreign bodies.
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Affiliation(s)
- Pari N Shams
- South Australian Institute of Ophthalmology, Department of Ophthalmology and Visual Sciences, Adelaide University, Adelaide, South Australia, Australia
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Smith HB, Jyothi SB, Mahroo OAR, Shams PN, Sira M, Dey S, Adewoyin T, Cheung VTF, Jones CA. Patient-reported benefit from oculoplastic surgery. Eye (Lond) 2012; 26:1418-23. [PMID: 22975655 DOI: 10.1038/eye.2012.188] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE It is vital that surgeons undertaking oculoplastic procedures are able to show that the surgery they perform is of benefit to their patients. Not only is this fundamental to patient-centred medicine but it is also important in demonstrating cost effectiveness. There are several ways in which benefit can be measured, including clinical scales, functional ability scales, and global quality-of-life scales. The Glasgow benefit inventory (GBI) is an example of a patient-reported, questionnaire-based, post-interventional quality-of-life scale that can be used to compare a range of different treatments for a variety of conditions. METHODS A cross-sectional study was undertaken using the GBI to score patient benefit from four commonly performed oculoplastic procedures. It was completed for 66 entropion repairs, 50 ptosis repairs, 41 ectropion repairs, and 41 external dacryocystorhinostomies (DCR). The GBI generates a scale from -100 (maximal detriment) through zero (no change) to +100 (maximal benefit). RESULTS The total GBI scores of patients undergoing surgery for entropion, ptosis, ectropion, and external DCR were: +25.25 (95% CI 20.00-30.50, P<0.001), +24.89 (95% CI 20.04-29.73, P<0.001), +17.68 (95% CI 9.46-25.91, P<0.001), and +32.25 (95% CI 21.47-43.03, P<0.001), respectively, demonstrating a statistically significant benefit from all procedures. CONCLUSION Patients derived significant quality-of-life benefits from the four most commonly performed oculoplastic procedures.
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Affiliation(s)
- H B Smith
- Maidstone & Tunbridge Wells NHST, Maidstone Hospital, Maidstone, UK.
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Abstract
AIMS To describe the morphometric relationships and bony composition of the nasolacrimal fossa in a Caucasian population with particular reference to the lacrimo-maxillary suture (LMS). METHODS Forty-seven orbits from 24 formalin fixed cadavers were exenterated. Morphometric measurements were taken between anatomical landmarks forming the lacrimal fossa on the medial orbital wall. RESULTS The mean recorded distance from the anterior lacrimal crest (ALC) to the posterior lacrimal crest (PLC) and the LMS were 8.8 mm (± 1.6) and 4.3 mm (± 1.1), respectively. In 25.5% of the orbits the LMS was at the mid-vertical line (MVL), defined as a line equidistant from the ALC and PLC. In 42.5% the LMS was located anterior to the MVL toward the ALC. In 66% of the orbits the LMS was at or within one standard deviation (SD) of the MVL. The LMS was >1 SD away from the MVL toward the ALC and PLC in 19% and 15% of orbits, respectively. CONCLUSIONS In a quarter of the orbits in our Caucasian population the nasolacrimal fossa was formed equally by the maxillary and lacrimal bones. However, in nearly a third of the cases the LMS was located closer to the PLC, indicating predominance of the thicker maxillary bone. This may result in greater difficulty in initiating the surgical osteotomy when performing a dacryocystorhinostomy. These data contribute to our understanding of the variation in lacrimal fossa anatomy and encourage further studies in different racial groups.
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Affiliation(s)
- Pari N Shams
- Adnexal Service, Moorfields Eye Hospital, London, UK.
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Abstract
INTRODUCTION To describe the morphometric and geometric relationships of the orbital floor in a Caucasian population. MATERIALS AND METHODS Exenterations of 47 orbits from 24 formalin fixed cadavers were performed. Morphometric measurements were taken between anatomical landmarks located along the orbital floor and the orbital apex. The mean measurements were used to calculate geometric data. These results were analysed according to sex and side and compared to results from other ethnic populations. RESULTS The average distances from the infraorbital foramen to the nasolacrimal fossa, inferior orbital fissure, optic canal and inferior orbital rim were 20.67 mm (± 2.42), 25.40 mm (±2.70), 43.23 mm (±3.35) and 8.95 mm (± 1.53), respectively. The average distances from the tip of the infraorbital groove to the tip of the inferior orbital fissure, lateral aspect of the inferomedial strut, optic canal and the intersection with the inferior orbital fissure were 14.08 mm (±2.41), 12.12 mm (±2.42), 35.02 mm (±3.17) and 20.05 mm (± 2.87), respectively. The distances from the tip of the inferior orbital fissure to the optic canal and the intersection with the inferior orbital groove were 29.56 mm (±2.73) and 13.37 mm (±2.76), respectively. DISCUSSION Orbital surgeons should be aware of the morphometric relationships of the orbital floor due to the degree of variation that exists between different ethnic groups. Geometric data may be used to provide orbital surgeons with a navigational template that can be used to plan surgery and as a guide intraoperatively.
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Affiliation(s)
- Saif F Abed
- Division of Basic Medical Sciences, St. George's University of London, London, United Kingdom.
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Shams PN, Plant GT. Migraine-like Visual Aura Due to Focal Cerebral Lesions: Case Series and Review. Surv Ophthalmol 2011; 56:135-61. [DOI: 10.1016/j.survophthal.2010.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 07/23/2010] [Accepted: 07/27/2010] [Indexed: 11/26/2022]
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Shams PN, Plant GT. Optic neuritis: a review. Int MS J 2009; 16:82-89. [PMID: 19878630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 12/05/2008] [Indexed: 05/28/2023]
Abstract
Acute demyelinating optic neuritis (ON) is the initial presentation in approximately 20% of cases of multiple sclerosis (MS) and is characterized by unilateral, subacute, painful visual loss without systemic or neurological symptoms. The Optic Neuritis Treatment Trial (ONTT) has provided valuable insights into both the natural history and clinical course of demyelinating ON with respect to treatment. Visual function improves spontaneously over weeks and within 12 months 93% have recovered to a visual acuity of at least 20/40. Treatment with high-dose corticosteroids may accelerate visual recovery, but has little impact on long-term visual outcome. In the ONTT the 10-year risk of recurrence of demyelinating ON was 35%. The presence of white matter lesions on the initial magnetic resonance image of the brain has been identified as the strongest predictor for the development of MS. The 15-year risk of developing MS in the ONTT was 25% with no lesions, but 75% with one or more lesions. Since there is evidence of early axonal damage in acute demyelinating ON, disease-modifying drugs should be considered in patients at high risk of developing MS in the future as prophylaxis against permanent neurological impairment.
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Affiliation(s)
- P N Shams
- The National Hospital for Neurology and Neurosurgery, London, UK.
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Ahmadi H, Shams PN, Davies NP, Joshi N, Kelly MH. Age-related changes in the normal sagittal relationship between globe and orbit. J Plast Reconstr Aesthet Surg 2006; 60:246-50. [PMID: 17293280 DOI: 10.1016/j.bjps.2006.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 05/01/2006] [Accepted: 07/18/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE To establish the pattern of change in globe protrusion with advancing age. The findings contribute to our understanding of orbital ageing, and are useful in the longitudinal assessment of patients with orbital disease, craniofacial abnormalities and trauma. METHODS Ocular protrusion from the lateral orbital rim to the corneal apex was measured in 653 Caucasians aged 21-80 years. Healthy subjects only were included in the study excluding those with ocular or orbital diseases. Measurements were taken using a single instrument and observer. Data were analysed for both sexes and each eye separately. RESULTS The mean exophthalmometry reading in both sexes (318 female and 335 male) was 19+/-2mm. Ninety-eight percent of readings between the two eyes were within 1mm of each other and no subject had greater than 2mm of asymmetry. In all groups there was a negative linear correlation between ocular protrusion and age. This correlation was found to be highly statistically significant in all groups (r=0.56-0.65, p<0.0001). There was no statistically significant difference between change in ocular protrusion with age between the left and right eye for females or males. This study demonstrates a strong association between ocular protrusion and age in a Caucasian population. This association is an almost linear reduction in ocular protrusion with increasing age between the ages of 31 and 80. Asymmetry in ocular protrusion between the two eyes does not develop with increasing age.
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Affiliation(s)
- H Ahmadi
- Cranio-Orbito-Palpebral Service, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, United Kingdom
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Shams PN, Olver JM. A case of cutaneous collision tumour: the importance of photographic documentation and large incisional biopsy. Eye (Lond) 2006; 20:1324-5. [PMID: 16575419 DOI: 10.1038/sj.eye.6702192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Abstract
An 8-year-old girl presented with a papillomatous lower eyelid lesion, which had been present since infancy. An incisional biopsy diagnosed syringocystadenoma papilliferum. The origin and natural history of syringocystadenoma papilliferum remain disputed and are reviewed. In view of its association with basal cell carcinoma, further management options are discussed.
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Affiliation(s)
- Pari N Shams
- Department of Ophthalmology and Oculoplastic Surgery, Chelsea and Westminster Hospital, London, England
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Shams PN, Goadsby PJ, Crockard HA, Casey ATH, Plant GT. Paroxysmal raised intracranial pressure associated with spinal meningeal cysts. J Neurol 2005; 252:273-82. [PMID: 15750710 DOI: 10.1007/s00415-005-0430-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Accepted: 01/18/2004] [Indexed: 10/25/2022]
Abstract
Raised intracranial pressure in association with spinal meningeal cysts has rarely been reported. We describe four patients in whom evidence of paroxysmal raised intracranial pressure was found in association with spinal meningeal cysts. Cerebrospinal fluid diversion procedures have previously been shown to relieve local symptoms due to spinal cysts. In our patients symptoms of paroxysmal headache were alleviated by this method, suggesting a causal relationship with the raised pressure. This association may be an under diagnosed cause of paroxysmal headaches. We review the medical literature on the classification of spinal meningeal cysts, evaluate the theories of their origin and offer suggestions on the pathogenesis of the abnormal CSF dynamics that may allow an interplay between raised intracranial pressure and spinal meningeal cysts to produce paroxysmal symptoms.
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Affiliation(s)
- P N Shams
- The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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Abstract
The differential diagnosis of subacute onset ataxia in the setting of enteropathy is wide. A 54 year old patient with a pancerebellar syndrome and known ulcerative jejunoileitis is described. Small bowel biopsy showed evidence of enteropathy associated T cell lymphoma and subsequent neuropathological analysis and immunophenotyping confirmed metastasis of this tumour to the cerebellum. The presence of anti-gliadin antibodies and MRI evidence of a more longstanding process suggested additional immunologically mediated cerebellar dysfunction. Lymphomatous involvement of the CNS is rare in patients with complicated enteropathies, and has not been previously reported to involve the cerebellar parenchyma. This diagnostic possibility should be borne in mind before attributing cerebellar dysfunction in patients with the coeliac related enteropathies to nutritional compromise or immunological dysfunction (gluten ataxia) alone.
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Affiliation(s)
- P N Shams
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
A 54 year old man is described with signs compatible with ocular myasthenia gravis and an apparent excellent response to pyridostigmine. Subsequent clinical progression and further investigation suggested the presence of an inflammatory brain stem lesion, which responded to corticosteroid therapy. Clinical relapse, including the development of central neurogenic hyperventilation, led to a brain stem biopsy, confirming a diagnosis of B cell lymphoma. This case illustrates the propensity of primary CNS lymphoma (PCNSL) to mimic other conditions. Brain MRI is mandatory in presumed "test negative" ocular myasthenia with atypical clinical findings. Spontaneous regression of PCNSL or response to corticosteroids is common and should not mitigate against the diagnosis. Histopathological confirmation should ideally be made before starting therapy, as this may obscure or delay the correct diagnosis. Although PCNSL is rare, it must be considered in all patients with brain stem syndromes, and in all patients 50 years or older with contrast enhancing focal lesions.
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Affiliation(s)
- P N Shams
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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