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Lee MHH, Smith EJ, Hardy TG, Graf N, Tumuluri K. Paediatric Orbital Juvenile Xanthogranuloma: A Case Series and Review of the Literature. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00389. [PMID: 38687290 DOI: 10.1097/iop.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE Juvenile xanthogranuloma (JXG) is a subtype of histiocytosis characterised histologically by foamy non-Langerhan cells with Touton giant cells. It typically manifests as a single self-limiting cutaneous nodule in the paediatric population. Orbital JXG is extremely rare, and its clinical course and management are not well understood or defined. Herein we present 3 cases of orbital JXG and provide a detailed literature review. METHODS Review of 3 cases with orbital JXG and literature review of all published cases. RESULTS Three presented cases demonstrate the heterogeneous clinical course of orbital JXG. Although centred around the use of steroids, there is neither robust evidence nor consensus on its management. The wider JXG literature is currently concentrated around the classification of JXG with respect to histiocytosis, especially the exclusion of extracutaneous JXG as separate diseases. This separation is based on clinical, histopathological, and molecular findings. It is unclear where orbital JXG best fits in this emerging classification of JXG. CONCLUSION Our review of the cases and literature on orbital JXG show that it may manifest with variable clinical course and its molecular pathogenic mechanism may be different to that of the cutaneous JXG.
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Affiliation(s)
- Ming-Han H Lee
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, The University of Sydney
- Save Sight Institute, Sydney, New South Wales
| | - Ebony J Smith
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- Department of Ophthalmology, Sunshine Coast University Hospital, Queensland
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne
- Department of Ophthalmology, Royal Children's Hospital
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria
| | - Nicole Graf
- School of Medicine, The University of Sydney
- Department of Histology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Krishna Tumuluri
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead
- School of Medicine, The University of Sydney
- Save Sight Institute, Sydney, New South Wales
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2
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Chung IY, Hardy TG, Khong JJ. Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre. Eye (Lond) 2024; 38:1168-1172. [PMID: 38081935 PMCID: PMC11009319 DOI: 10.1038/s41433-023-02856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES To determine risk factors and treatment outcomes in dysthyroid optic neuropathy (DON) at a single tertiary ophthalmic centre. METHODS Retrospective audit of DON patients who have received intravenous methylprednisolone (IVMP) therapy at Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 2015 to October 2021. RESULTS Study included 24 patients (58% female) with an average age of 59.8 ± 14.7 years at DON diagnosis. Majority (92%) had Graves' hyperthyroidism and 77% had a smoking history. At diagnosis, average visual acuity (VA) of worse eye was LogMAR 0.46, and 48% had relative afferent pupillary defect. Proptosis (89%) and diplopia (73%) were most commonly present at diagnosis. 78% showed predominantly extra-ocular muscle enlargement, and apical crowding (52%) on radiology. 38% (n = 9/24) responded to IVMP alone, 58% (n = 14/24) progressed to surgical orbital decompression. The average total cumulative dose of IVMP during DON treatment was 6.8 ± 1.9 g. 29% required further treatment after IVMP and surgical decompression, 4 (17%) had additional radiotherapy, and three (13%) required immuno-modulatory therapy. Average final VA was LogMAR 0.207, with all patients having inactive TED at final follow-up (mean 1.7 years). In refractory DON cases, 71% retained VA ≥ 6/9 and 48% had DON reversal. CONCLUSIONS DON patients typically present in late 50s, with a smoking history and predominant extra-ocular muscle enlargement. High-dose IVMP fully resolved DON in only 38%. A considerable proportion required urgent orbital decompression. Most patients retained good vision at final follow-up.
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Affiliation(s)
- In Young Chung
- Department of Ophthalmology, Austin Hospital, Heidelberg, VIC, Australia.
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Unit. The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, VIC, Australia
| | - Jwu Jin Khong
- Department of Ophthalmology, Austin Hospital, Heidelberg, VIC, Australia
- Orbital, Plastic and Lacrimal Unit. The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, VIC, Australia
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3
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Ang T, Tong JY, Patel S, Hardy TG, McNab A, Selva D. Magnetic Resonance Imaging of Idiopathic Orbital Myositis. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00358. [PMID: 38427822 DOI: 10.1097/iop.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE To characterize the qualitative and quantitative features of idiopathic orbital myositis (IOM) on MRI. METHODS This was a multicenter retrospective study of patients with active IOM with MRI. Patients with incomplete clinical records, poor-quality or interval scans without active myositis, and specific orbital myositis (i.e., orbital myositis secondary to an identified condition) were excluded. An enlargement ratio was calculated by dividing the diameters of the affected extraocular muscle (EOM) by the contralateral unaffected EOM. RESULTS Twenty-four patients (mean age: 44.4 ± 17.8 years-old, male: 11) between 2011 and 2022 were included. One case (4.2%) was pediatric (17 years old), and 6 cases presented with recurrence. Active IOM was characterized by fusiform EOM enlargement, high T2 signal, and contrast enhancement. Average maximal EOM diameters ranged from 4.6 to 7.7 mm (enlargement ratio: 1.4-2.2). Eighteen (75%) patients had single EOM involvement, most commonly the medial rectus. Other ipsilateral structures affected included focal orbital fat (16/24, 66.7%) and lacrimal gland (8/24, 33.3%). Contralateral changes in the EOM and/or lacrimal gland were observed in 7 patients (29.2%). Patients presenting with recurrence were likely to develop ongoing recurrent episodes (p = 0.003). CONCLUSIONS Various radiological patterns of involvement described including EOM enlargement, contrast enhancement, abnormal signal, and involvement of other orbital structures are indicative of active IOM. IOM remains a heterogeneous spectrum of acute and chronic clinico-radiological presentations. Inflammation may involve other ipsilateral or contralateral orbital structures or may be bilateral despite presenting clinically as unilateral disease. Quantitative measurements may have utility in differentiating IOM from other causes of orbital myositis.
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Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide
| | | | - Sandy Patel
- Department of Medical Imaging, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Thomas G Hardy
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Alan McNab
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Boynes AC, Enright NJ, Hardy TG, Khong JJ. Interrater reliability of photographic assessment of thyroid eye disease using the VISA classification. Int Ophthalmol 2024; 44:98. [PMID: 38376802 PMCID: PMC10879244 DOI: 10.1007/s10792-024-02934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE To determine the interrater reliability (IRR) of thyroid eye disease (TED) photographic assessment using the VISA classification. To assess whether a VISA grading atlas improves ophthalmology trainees' performance in photographic assessment of TED. METHODS A prospective, partially randomized, international study conducted from September 2021 to May 2022. Online study invitation was emailed to a volunteer sample group of 68 ophthalmology college accredited consultants and trainees, and 6 were excluded from the study. Participants were asked to score 10 patient photographs of TED using only the inflammation and motility restriction components of the VISA classification. IRR was compared between groups of practitioners by their level of experience. A clinical activity grading atlas was randomized to 50% of the ophthalmology trainees. RESULTS Overall rater ICC was 0.96 for inflammation and 0.99 for motility restriction. No statistically significant difference in IRR between rater groups was identified. Trainees with a grading atlas had the highest IRR for inflammation (ICC = 0.95). Each subcomponent of the inflammation and motility restriction components of VISA classification had an ICC considered good to excellent. The mean overall rater score was 4.6/9 for inflammation and 3.5/12 for motility restriction. For motility restriction there was a reduced mean score variance among all raters when scoring photographs with more severe motility restriction. CONCLUSION IRR using the inflammation and motility restriction components of the VISA classification was excellent. A VISA grading atlas improved trainee performance in grading inflammation.
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Affiliation(s)
- Antony C Boynes
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia.
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC, Australia.
- Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia.
| | - Nicholas J Enright
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Thomas G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jwu Jin Khong
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC, Australia
- Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
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O'Rourke MA, Hardy TG, McNab AA. Acute periocular haemorrhage associated with severe proptosis as a presenting sign of orbital tumours. Orbit 2023; 42:347-350. [PMID: 37190966 DOI: 10.1080/01676830.2021.2018716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/11/2021] [Indexed: 05/17/2023]
Abstract
Periocular haemorrhage without a preceding history of trauma, and in the absence of vascular malformations is rare. While acute proptosis is well described in the setting of orbital pathology, accompanying periocular haemorrhage has been rarely reported. We describe three cases with these concomitant presenting signs in orbital malignancies - metastatic small cell bladder carcinoma, haemangiopericytoma (solitary fibrous tumour) and myeloma. Clinical photographs and radiology are presented with review of the current literature. All cases had an associated rapid onset of severe proptosis and co-existing periocular bruising on the same side. The presence of ecchymosis of the eyelids in addition to proptosis without a history of trauma warrants thorough investigation to rule out underlying potential sight and life threatening illness.
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Affiliation(s)
- Micheal A O'Rourke
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Alan A McNab
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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6
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Ang TW, Juniat V, O’Rourke M, Slattery J, O’Donnell B, McNab AA, Hardy TG, Caplash Y, Selva D. The use of the paramedian forehead flap alone or in combination with other techniques in the reconstruction of periocular defects and orbital exenterations. Eye (Lond) 2023; 37:560-565. [PMID: 35241795 PMCID: PMC9905546 DOI: 10.1038/s41433-022-01985-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The paramedian forehead flap (PMFF) is a reconstructive option for large eyelid defects and orbital exenterations. We report a series of cases where PMFF reconstruction was carried out at various institutions in Australia. METHODS This study was a multi-centre, retrospective, non-comparative case series investigating the clinical outcomes of the PMFF for reconstructing periocular defects and orbital exenterations. RESULTS This case series describes twenty-seven patients (Female = 15, Male = 12), operated between 1991 to 2019, with a median age of 81 years (range: 45-93 years). Defect locations involved combinations of the medial canthus (16/27, 59.3%), upper eyelids (7/27, 25.9%), lower eyelid (4/27, 14.8%), both upper and lower eyelids (5/27, 18.5%), and orbital (7/27, 25.9%). There were no cases of flap necrosis. Minor post-operative complications were observed in ten patients with the most common being lagophthalmos. Median duration of follow-up was 17months (Range: 2months- 23years). CONCLUSIONS The PMFF is a versatile reconstructive tool for a range of periocular defects and orbital exenterations with minor post-operative complications.
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Affiliation(s)
- Terence W. Ang
- grid.1010.00000 0004 1936 7304Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA Australia
| | - Valerie Juniat
- grid.416075.10000 0004 0367 1221South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA Australia ,grid.416075.10000 0004 0367 1221Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA Australia
| | - Micheal O’Rourke
- grid.410670.40000 0004 0625 8539Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Vic Australia
| | - James Slattery
- grid.416075.10000 0004 0367 1221Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA Australia
| | - Brett O’Donnell
- grid.412703.30000 0004 0587 9093Department of Ophthalmology, Royal North Shore Hospital, Sydney, NSW Australia
| | - Alan A. McNab
- grid.410670.40000 0004 0625 8539Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Vic Australia ,grid.1008.90000 0001 2179 088XCentre for Eye Research Australia, University of Melbourne, Melbourne, Vic Australia
| | - Thomas G. Hardy
- grid.410670.40000 0004 0625 8539Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Vic Australia ,grid.1008.90000 0001 2179 088XDepartment of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic Australia
| | - Yugesh Caplash
- grid.416075.10000 0004 0367 1221Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, SA Australia
| | - Dinesh Selva
- grid.416075.10000 0004 0367 1221South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA Australia ,grid.416075.10000 0004 0367 1221Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA Australia
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Hong Z, Noonan JE, Mitchell PJ, Hardy TG. Peripheral Ophthalmic Artery Aneurysm Associated with Multifocal Intracranial and Extracranial Aneurysms: Case Report and Literature Review. Case Rep Ophthalmol 2023; 14:257-266. [PMID: 37383172 PMCID: PMC10294283 DOI: 10.1159/000530475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/28/2023] [Indexed: 06/30/2023] Open
Abstract
Peripheral ophthalmic artery aneurysm is a rare disease entity. We review the relevant literature and report a case of fusiform aneurysm involving the entire intraorbital ophthalmic artery in association with multiple intracranial and extracranial aneurysms, diagnosed on digital subtraction angiography. The patient suffered irreversible blindness secondary to compressive optic neuropathy which did not improve after a 3-day trial of intravenous methylprednisolone. Autoimmune screen was normal. The underlying cause is unknown.
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Affiliation(s)
- Zixin Hong
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan E. Noonan
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Peter J. Mitchell
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas G. Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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8
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Shapira Y, Juniat V, Dave T, Hussain A, McNeely D, Watanabe A, Yoneda A, Saeed P, Woo KI, Hardy TG, Price B, Drummond K, Selva D. Orbito-cranial schwannoma-a multicentre experience. Eye (Lond) 2023; 37:48-53. [PMID: 34999720 PMCID: PMC9829917 DOI: 10.1038/s41433-021-01850-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/10/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To describe the features, management approaches, and outcomes of orbito-cranial schwannomas. METHODS Retrospective review of ten patients with orbito-cranial schwannomas managed in six orbital services over 22 years. Data collected included demographics, presenting features, neuroimaging characteristics, histology, management approach, complications, and outcomes. RESULTS Mean age of the patients was 41.4 ± 19.9 years, and 6 (60%) were females. The majority presented with proptosis (90%), limited extraocular motility (80%), eyelid swelling (60%), and optic neuropathy (60%). Most lesions (80%) involved the entire anterior-posterior span of the orbit, with both intra- and extraconal involvement. All tumours involved the orbital apex, the superior orbital fissure, and extended at least to the cavernous sinus. Surgical resection was performed for all. Seven (70%) of the tumours were completely or subtotally resected combining an intracapsular approach by an orbital-neurosurgical collaboration, with no recurrence on postoperative follow-up (6-186 months). Three underwent tumour debulking. Of these, two remained stable on follow-up (6-34 months) and one showed progression of the residual tumour over 9 years (cellular schwannoma on histology) necessitating stereotactic radiotherapy (SRT) for local control. Adjuncts to the orbito-cranial resection included perioperative frozen section (n = 5), endoscopic transorbital approach (n = 2), and image-guided navigation (n = 1). Post-surgical adjuvant SRT was used in three subjects. CONCLUSIONS These results highlight the possibility of successful surgical control in complex orbito-cranial schwannomas. A combined neurosurgical/orbital approach with consideration of an intracapsular resection is recommended. Recurrence may not occur with subtotal excision and observation may be reasonable. Adjunctive SRT for progression or residual tumour can be considered.
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Affiliation(s)
- Yinon Shapira
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia.
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia.
| | - Valerie Juniat
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia
| | - Tarjani Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Ahsen Hussain
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Daniel McNeely
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Akihide Watanabe
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akiko Yoneda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Peerooz Saeed
- Departments of Ophthalmology, Orbital Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Benjamin Price
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kate Drummond
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, SA, Australia
- Department of Ophthalmology, Royal Adelaide Hospital and South Australian Institute of Ophthalmology, Adelaide, SA, Australia
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Tynan D, Ng J, Hardy TG. Primary Extradural Ectopic Orbital Meningioma in a Child. Ophthalmic Plast Reconstr Surg 2022; 38:e154-e158. [PMID: 35550454 DOI: 10.1097/iop.0000000000002200] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors describe a rare case of primary extradural ectopic meningioma of the orbit in a 13-year-old female managed with surgical excision, adding to the very limited literature of this diagnosis in children. This is the second case to show a radiological abnormality in the gyrus rectus and olfactory bulb; however, in our case, there was no radiological evidence of connection seen.
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Affiliation(s)
- Dominique Tynan
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Ng
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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10
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Tran D, Varma S, Hardy TG. Odontogenic Lemierre's syndrome with septic superior ophthalmic vein and cavernous sinus thrombophlebitis complicated by blindness and ophthalmoplegia. Orbit 2021; 42:299-305. [PMID: 34781813 DOI: 10.1080/01676830.2021.1992788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lemierre's syndrome is a triad consisting of oropharyngeal infection, internal jugular vein thrombophlebitis, and systemic embolisation typically involving lung and brain. Orbital involvement in this life-threatening condition is rare but potentially blinding and may be an indicator of intracranial involvement. We describe a case of odontogenic Lemierre's syndrome complicated by extensive orbital and intracranial septic venous thrombosis, with optic and cranial neuropathy resulting in monocular blindness and ophthalmoplegia. A multidisciplinary approach with abscess drainage, antibiotic and antithrombotic therapy, and close radiological monitoring was critical for preserving contralateral vision and neurological function.
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Affiliation(s)
- Donald Tran
- Department of Ophthalmology, The Royal Melbourne Hospital, Parkville, Australia
| | - Shivesh Varma
- Department of Ophthalmology, The Royal Melbourne Hospital, Parkville, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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Abstract
PURPOSE To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma. METHODS We reviewed 32 cases of spheno-orbital lesions involving the GWS from our own practice, as well as 109 published cases (total 141), with emphasis on available imaging features on computerized tomography (CT) and MRI. Features that might assist in differentiating meningioma from its mimics were analyzed for each lesion, including the presence of an osteoblastic or hyperostotic response, bone erosion or osteolysis, homogeneous hypo- or hyperintensity on T2-weighted MRI, leptomeningeal involvement, and the absence of a "dural tail" on contrast-enhanced MRI. The clinical and imaging features were also briefly summarized for each diagnostic group. RESULTS The largest diagnostic group was metastasis (67 cases, 47.5%). The most useful imaging features that helped differentiate meningioma from its mimics were the presence of bone erosion and the absence of a "dural tail." Other features were helpful in a small minority of cases only. Metastatic prostate cancer was the largest single group (21 cases), and 18 (85.7%) of these were osteoblastic and most closely mimicked meningioma. Prostate cancer patients were generally older than males with GWS meningioma. Almost all other (44/46, or 95.7%) metastatic lesions showed evidence of bone erosion. Almost half (30 of 61, 49.2%) of patients with metastasis presented without a known diagnosis of malignancy. Among children 16 years of age and less, Langerhans cell histiocytosis (10 cases), dermoid cyst (5), and Ewing's sarcoma (5) were the most common diagnoses. CONCLUSIONS A combination of a careful history and both CT and MRI gives information, which can best guide the management of patients with spheno-orbital lesions. Metastatic prostate cancer to the GWS most closely mimics GWS meningioma but can in most cases be differentiated on clinical and imaging features. Older males with hyperostotic lesions of the GWS should be investigated for prostate cancer. Other metastatic lesions and primary tumors of the GWS, as well as benign and structural lesions can readily be differentiated from meningioma on clinical and imaging features.
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Affiliation(s)
- Alan A McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital
- Centre for Eye Research Australia, University of Melbourne
| | - Randall S Jones
- Department of Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Barkley MR, Ben Artsi E, McNab AA, Hardy TG. Extraocular Muscle Enlargement and Proptosis Associated with Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Ophthalmic Plast Reconstr Surg 2021; 37:e176-e178. [PMID: 33795609 DOI: 10.1097/iop.0000000000001982] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, which commonly causes peripheral neuropathy. It has rarely been associated with cranial nerve hypertrophy and neuro-ophthalmic manifestations. Proptosis secondary to cranial nerve hypertrophy has been reported in association with CIDP. The authors present a case of a 67-year-old man with CIDP who presented with bilateral proptosis, strabismus, and episodes of globe subluxation. The proptosis was mainly attributed to significant enlargement of the extraocular muscles, in addition to bilateral enlargement of the trigeminal nerves. There has been no published case of CIDP with associated enlargement of extraocular muscles without a history of underlying hyperthyroidism, inflammation, or malignancy. This may represent a new clinical finding in CIDP and adds to the limited literature on the neuro-ophthalmic and orbital associations of CIDP. The proptosis was managed with an uncomplicated bilateral orbital decompression.
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Affiliation(s)
- Michael R Barkley
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Elad Ben Artsi
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Alan A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Centre for Eye Research, University of Melbourne, Melbourne, Australia
| | - Thomas G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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13
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Wilson MM, O'Rourke MA, Crock CT, McNab AA, Hardy TG. Referral and diagnostic accuracy in orbital cellulitis. Emerg Med Australas 2021; 33:951-952. [PMID: 34420265 DOI: 10.1111/1742-6723.13852] [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] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew M Wilson
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Micheal A O'Rourke
- Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Carmel T Crock
- Emergency Department, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,Macquarie University, Sydney, New South Wales, Australia
| | - Alan A McNab
- Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Centre for Eye Research Australia (CERA), The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Ryan TG, Juniat V, Stewart C, Malhotra R, Hardy TG, McNab AA, Davis G, Selva D. Clinico-radiological findings of neuroendocrine tumour metastases to the orbit. Orbit 2021; 41:44-52. [PMID: 33729098 DOI: 10.1080/01676830.2021.1895845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: We present the clinico-radiological findings of neuroendocrine tumour metastases to the orbit.Methods: This was a multicentre, retrospective study of patients with neuroendocrine tumour metastases to the orbit. Data was collected from medical records across five different sites within Australia and the United Kingdom.Results: Nine patients (eleven lesions) were identified. The most common presenting complaint was diplopia (5/9, 56%). Disease occurred bilaterally in two patients. Seven patients (78%) had extraocular muscle involvement. The lateral recti (4/9, 44%) and superior recti (2/9, 22%) were the most commonly affected. Ocular presentation preceded primary tumour diagnosis in three patients (33%). On orbital imaging, metastases were most commonly reported as well circumscribed, ovoid or round, heterogeneous, contrast-enhancing masses. Features of intralesional haemorrhage and bony invasion are uncommonly reported.Conclusions: Neuroendocrine tumour metastasis to the orbit is uncommon. Metastases have a propensity for the extraocular muscles, commonly presenting as heterogeneous, well circumscribed, contrast-enhancing lesions on neuroimaging. New ocular symptoms, a history of neuroendocrine tumours, and these radiological findings, should lead to high clinical suspicion of metastatic disease. Atypical findings warrant biopsy to exclude other causes of orbital lesions.
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Affiliation(s)
- T G Ryan
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - V Juniat
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - C Stewart
- Department of Ophthalmology, Gold Coast University Hospital, Gold Coast, Australia
| | - R Malhotra
- Oculoplastics Unit, East Grinstead Hospital, East Sussex, UK
| | - T G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - A A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Centre for Eye Research Australia Ltd, University of Melbourne, East Melbourne, Australia
| | - G Davis
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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15
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Jui-Chi Chang R, Kuang V, Meyer J, Chang E, Roberts-Thomson SJ, McKelvie P, Hardy TG, Pick ZS. Orbital giant cell myositis is an unusual and potentially lethal cause of bilateral ophthalmoplegia - A case report and literature review. Orbit 2020; 41:354-360. [PMID: 33297808 DOI: 10.1080/01676830.2020.1856144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We present a case of orbital giant cell myositis (OGCM), presenting with bilateral subacute progressive ophthalmoplegia and optic nerve dysfunction. An early extraocular muscle biopsy confirmed the diagnosis and guided appropriate management. Comprehensive investigation excluded any underlying systemic disease, including myocarditis. Twenty two months after presentation, the patient remains well on azathioprine with complete resolution of orbital signs.
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Affiliation(s)
| | - Vivian Kuang
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
| | - Joos Meyer
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
| | - Ewan Chang
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | | | - Penny McKelvie
- Department of Anatomical Pathology, St. Vincent's Hospital, Parkville, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Zelda S Pick
- Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Australia
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16
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Juniat V, Lee J, Sia P, Curragh D, Hardy TG, Selva D. High nasolacrimal sac-duct junction anatomical variation - retrospective review of dacryocystography images. Orbit 2020; 40:505-508. [PMID: 32893697 DOI: 10.1080/01676830.2020.1817101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE In assessing epiphora, dacryocystography (DCG) is often performed to determine the presence of any structural anomaly of the nasolacrimal drainage apparatus. We describe an anatomical variation of the nasolacrimal duct, termed high sac-duct junction (HSDJ) morphology, that is seen on DCG, which could lead to more difficult, and possibly unsuccessful, intubation of the nasolacrimal duct (NLD). METHODS This was a multi-center, retrospective, observational case series. Seven hundred and thirty-four DCGs were included in this study, of which 45 were pediatric images. DCG images underwent a blinded review by an oculoplastic surgeon for the presence of HSDJ morphology. The direct extension of the NLD from the inferior border of the lacrimal sac is commonly regarded as a normal morphology. HSDJ was defined as NLD originating from the inferior aspect of the medial wall of the lacrimal sac. RESULTS HSDJ was seen in 28/689 (4.1%) adult scans and 7/45 (15.6%) pediatric scans. In total, there were 35/734 (4.8%) DCGs demonstrating lacrimal sacs with HSDJ. CONCLUSIONS We report the prevalence of an anatomical variant of the lacrimal sac and NLD, observed on DCG, in a population of patients with epiphora, where the NLD originates from the inferior aspect of the medial wall of the lacrimal sac. Knowledge of this anatomic variant may have management implications for patients with epiphora as it may make nasolacrimal intubation more technically difficult. Further studies are needed to correlate this anatomic variation with symptoms and management outcomes.
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Affiliation(s)
- Valerie Juniat
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - John Lee
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - Paul Sia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - David Curragh
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Ophthalmology, Royal Children's Hospital, Parkville, Australia
| | - Dinesh Selva
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
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17
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Fuzzard DRW, Gin TJ, Hardy TG, Harper CA. Subretinal fluid and choroidal venous congestion secondary to a presumed dural cavernous sinus fistula. Clin Exp Ophthalmol 2020; 48:517-519. [PMID: 32077195 DOI: 10.1111/ceo.13732] [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] [Received: 08/21/2019] [Revised: 11/26/2019] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dujon R W Fuzzard
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Thomas J Gin
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Alex Harper
- Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.,Medical Retina Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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18
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Abstract
A 78-year-old Caucasian woman presented with pain in her right and only eye that was worse on abduction. Her history was significant for a choroidal melanoma affecting her left eye for which she underwent an orbital exenteration 12 years previously. Computed tomography and magnetic resonance imaging of the right orbit identified a mass lesion affecting the medial rectus, suspicious for metastatic melanoma. A histopathological diagnosis of metastatic melanoma was subsequently made following biopsy of the right medial rectus.
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Affiliation(s)
- Elizabeth McElnea
- Royal Victorian Eye and Ear Hospital, Orbit, Plastics and Lacrimal Unit, East Melbourne, Victoria, Australia
| | - Louis J. Stevenson
- Royal Victorian Eye and Ear Hospital, Orbit, Plastics and Lacrimal Unit, East Melbourne, Victoria, Australia
| | - Cesar Salinas La Rosa
- St. Vincent’s University Hospital, Anatomical Pathology Department, Fitzroy, Victoria, Australia
| | - Sem Liew
- Victorian Oncology Care, Berwick, Victoria, Australia
| | - Thomas G. Hardy
- Royal Victorian Eye and Ear Hospital, Orbit, Plastics and Lacrimal Unit, East Melbourne, Victoria, Australia
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19
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Malik R, English J, Hardy TG. Paediatric orbital conjunctival epithelial cyst with positive asialotransferrin. Orbit 2019; 39:426-432. [PMID: 31856620 DOI: 10.1080/01676830.2019.1694044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conjunctival orbital cysts are rare; they are typically either conjunctival dermoid or conjunctival epithelial cysts - congenital or acquired (inclusion). We describe the case of a 15-month-old girl presenting with strabismus and proptosis who had a retrobulbar intraconal cystic lesion displacing the optic nerve, with an adjacent middle cranial fossa anomaly. Aspiration of the orbital cyst tested positive for asialotransferrin, raising the suspicion of a direct communication with cerebrospinal fluid (CSF). Subsequent fine cut CT scanning disproved any connection with the intracranial space, and the cyst was excised complete and intact. Histopathology showed a conjunctival epithelial cyst. To our knowledge, this is the first case report in the literature of an asialotransferrin positive pediatric orbital conjunctival epithelial cyst. It is of clinical relevance as it explores the possibility of either a false positive asialotransferrin or potentially a prior developmental communication with the subarachnoid space. These two diagnostic possibilities are discussed.
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Affiliation(s)
- Rukaiya Malik
- Department of Paediatrics, Sydney Children's Hospital , Randwick, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle , Newcastle, New South Wales, Australia
| | - James English
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital , East Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Victorian Eye & Ear Hospital , East Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Melbourne Hospital , Parkville, Victoria, Australia.,Department of Ophthalmology, Royal Children's Hospital , Parkville, Victoria, Australia.,Department of Surgery, University of Melbourne , Parkville, Victoria, Australia
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20
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Ben Artsi E, Barkley MR, Khong JJ, Mckelvie PA, McNab AA, Hardy TG. Multiple myeloma manifesting as an ocular salmon patch - a case report. Orbit 2019; 39:379-382. [PMID: 31722590 DOI: 10.1080/01676830.2019.1691608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Multiple myeloma (MM) is the second most prevalent hematologic malignancy after non-Hodgkin lymphoma and is currently considered incurable. Clinical ophthalmic manifestations of MM are rare but at the same time diverse. Ocular surface manifestations of multiple myeloma are uncommon. Conjunctival 'salmon patch' is a typical ocular surface ophthalmological sign with a distinct set of differential diagnoses, including most often ocular adnexal lymphoma. This case report presents a 33-year-old female with a relapse of MM manifesting as a conjunctival 'salmon patch'. The patient initially responded well to medical management including high dose melphalan supported by a third autologous stem cell transplantation (ASCT) and did not require further surgical excision of the ocular lesion. It is suggested that MM should be included in the differential diagnosis of 'salmon patch' conjunctival lesions.
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Affiliation(s)
- Elad Ben Artsi
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Michael R Barkley
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Jwu J Khong
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Penny A Mckelvie
- Department of Anatomical Pathology, St. Vincent's Hospital , Melbourne, Australia
| | - Alan A McNab
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia
| | - Thomas G Hardy
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia.,Department of Surgery, University of Melbourne , Melbourne, Australia
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21
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McElnea EM, Elder JE, Hardy TG, McNab AA. Acquired lacrimal drainage apparatus obstruction in children. J AAPOS 2019; 23:217.e1-217.e5. [PMID: 31229611 DOI: 10.1016/j.jaapos.2019.04.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/16/2019] [Accepted: 04/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pediatric acquired lacrimal drainage apparatus (LDA) obstruction is much rarer than congenital LDA obstruction. Its etiology and treatment outcomes have not been well defined. Our aim was to examine the etiology and management of acquired LDA obstruction in children and report the results of its management. METHODS We retrospectively reviewed the medical records of patients ≤16 years of age who presented with acquired epiphora to investigate the causes and describe the management of this condition. RESULTS A total of 31 patients (16 males [52%]) were included. Mean age of patients was 10.9 years (range, 3-16). The main causes of acquired LDA obstruction were keratoconjunctivitis, herpes simplex blepharokeratoconjunctivitis, and trauma. Silicone tube intubation, endonasal or external dacryocystorhinostomy, and the insertion of lacrimal bypass tubes were the mainstays of management. CONCLUSIONS It is important to suspect acquired LDA obstruction in children with acquired, persistent epiphora. Surgical management is similar to that in adults.
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Affiliation(s)
- Elizabeth M McElnea
- Orbital, Plastics and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - James E Elder
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Ophthalmology, University of Melbourne, Parkville, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastics and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Alan A McNab
- Orbital, Plastics and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, East Melbourne, Victoria, Australia.
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22
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Nguyen CT, Goh C, Desmond P, Abel LA, Lim CH, Andrew Symons R, Hardy TG. Congenital achiasma and see-saw nystagmus in VATER syndrome association with hydrocephalus. J Clin Neurosci 2018; 51:63-65. [DOI: 10.1016/j.jocn.2018.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/21/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022]
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23
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Ho CYD, Hardy TG. Acute crocodile tear syndrome without antecedent facial nerve palsy. Clin Exp Ophthalmol 2018; 46:809-811. [PMID: 29442433 DOI: 10.1111/ceo.13173] [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] [Received: 11/28/2017] [Accepted: 01/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Chi Yun Doreen Ho
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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24
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Eade EL, Hardy TG, McKelvie PA, McNab AA. Review of extraocular muscle biopsies and utility of biopsy in extraocular muscle enlargement. Br J Ophthalmol 2018; 102:1586-1590. [DOI: 10.1136/bjophthalmol-2017-311147] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/31/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023]
Abstract
AimsTo review the distribution of pathology in extraocular muscle (EOM) biopsies performed at a tertiary orbital centre, identify clinical and imaging features which are associated with benign or malignant diseases and indicate when biopsy is necessary for EOM enlargement.MethodsRetrospective case series including 93 patients with EOM enlargement who underwent an EOM biopsy. Clinical, radiological and histopathological information was recorded from the medical records. Statistical analysis was used to compare variables between patients with malignant and benign biopsies.ResultsThe median age of subjects was 61.1 years. Forty-eight cases (52%) were benign and 45 (48%) were malignant. Those with malignant pathology were significantly older (P<0.0001). Males were more likely affected by a benign disease and females by a malignancy (P=0.029). A history of malignancy (P<0.0001) and diplopia (P=0.029) were significant factors in predicting a malignancy. Pain (P=0.005) and eyelid erythema (P=0.001) were more likely in benign conditions. Idiopathic orbital inflammation was the most common benign diagnosis and lymphoma the most common malignancy.ConclusionsBiopsy is warranted in those with an atypical presentation of EOM enlargement or suspected of having a malignancy. Some features such as age, gender, pain, diplopia, history of malignancy and eyelid erythema may help indicate a particular diagnosis; however, clinical features and imaging findings are often not pathognomonic of each disease.
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25
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Abstract
PURPOSE To describe the etiology of acquired pediatric blepharoptosis in a large clinical series and to elucidate the causes of the disease. METHODS The medical records of all patients presenting with acquired blepharoptosis at two specialist ocular plastics practices and a pediatric ophthalmology practice during a period of up to 25 years were reviewed retrospectively and classified according to their diagnosis. Patients were grouped into children (<18 years), younger adults (18-40 years), and older adults (>40 years). RESULTS A total of 268 patients <18 years of age were identified. The most common identifiable causes of acquired blepharoptosis in children were infantile hemangioma (n = 92 [34.3%]) and trauma (n = 41 [15.3%]). In 42 cases (15.7%) a definite diagnosis could not be made. CONCLUSIONS The etiology of pediatric acquired blepharoptosis can frequently be determined by history and examination; additional diagnostic tests are sometimes required. A high percentage of pediatric patients have blepharoptosis of unknown cause.
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Affiliation(s)
- Sulakshan Rasiah
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC Australia.
| | - Thomas G Hardy
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC Australia; Royal Children's Hospital, Parkville, VIC Australia; Department of Surgery, University of Melbourne, Parkville, VIC Australia
| | - James E Elder
- Royal Children's Hospital, Parkville, VIC Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC Australia
| | - Cheng Yi Ng
- Royal Children's Hospital, Parkville, VIC Australia
| | - Alan McNab
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC Australia; Department of Ophthalmology, University of Melbourne, Parkville, VIC Australia; Centre for Eye Research Australia, East Melbourne, VIC Australia
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26
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Abstract
PURPOSE To report 4 cases of Marcus Gunn jaw-winking synkinesis (MGJWS) in the absence of ptosis. METHODS A retrospective review of patients with MGJWS and congenital ptosis was compiled from the public and private subspecialty adult and pediatric oculoplastic practices of the 2 senior authors (AAM, TGH). Clinical data collected on patients with MGJWS included visual acuity, stereopsis, ocular motility, side of jaw-wink, presence or absence of ptosis, levator function, clinical photographs and videos, and any management undertaken. RESULTS A total of 848 cases of congenital ptosis were seen. Of these, there were 72 consecutive patients with MGJWS, of which 4 cases (5.6%) had no ptosis. One patient had bilateral MGJWS, with ptosis on one side only. The authors found the incidence of MGJWS in our study population to be 8.5% of all congenital ptosis cases. When the authors excluded syndromic, neurogenic, and myopathic causes of congenital ptosis, the incidence was 12.1%. In addition, the authors found a trend toward females with simple congenital ptosis and MGJWS being affected on the left side, however this was not statistically significant. CONCLUSIONS The authors report the first case series of MGJWS in the absence of ptosis within the second largest series ever reported. These findings may help further our understanding of the etiology behind MGJWS.
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Affiliation(s)
- Fiona C Pearce
- *Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, †Centre for Eye Research Australia, Department of Ophthalmology, ‡Department of Surgery, Royal Melbourne Hospital, University of Melbourne, and §Department of Ophthalmology, Royal Children's Hospital, Melbourne, Australia
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27
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Abstract
PURPOSE To identify the causes of blepharoptosis in young adults, and explore cases that do not fit into current diagnostic categories. METHODS A retrospective cohort study of all patients aged 18-40 years ("young adults") with acquired blepharoptosis that presented to two specialist ocular plastics practices and a paediatric ophthalmologist over a period of up to 25 years. Each patient was classified according to diagnosis. Where the diagnosis was uncertain, the files were examined in detail to try and further establish a cause. RESULTS A total of 266 young adult patients were included. The most common causes of acquired blepharoptosis were trauma-related (28.2%) and anophthalmic blepharoptosis (19.9%). In 12.4% of the cases, a definite diagnosis could not be made. Of these, one-third had a history of soft contact lens use, a possible etiologic factor. CONCLUSIONS The cause of acquired blepharoptosis can usually be established by an appropriate history and examination, with additional diagnostic tests sometimes required. Nearly half of all young adult ptosis is related to trauma or acquired anophthalmos. Around one in eight young adults have blepharoptosis of unknown cause, a group warranting further study.
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Affiliation(s)
- Sulakshan Rasiah
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Thomas G Hardy
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,b Royal Children's Hospital , Parkville , Victoria , Australia.,c Department of Surgery, University of Melbourne , Parkville , Victoria , Australia
| | - James E Elder
- b Royal Children's Hospital , Parkville , Victoria , Australia.,d Department of Paediatrics, University of Melbourne , Parkville , Victoria , Australia
| | - Cheng Y Ng
- b Royal Children's Hospital , Parkville , Victoria , Australia
| | - Mpopi Lenake
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Alan A McNab
- a Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,e Department of Ophthalmology, University of Melbourne , Parkville , Victoria , Australia.,f Centre for Eye Research Australia, East Melbourne , Victoria , Australia
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28
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Abstract
The aim of this study was to determine whether pre-operative levator function and degree of ptosis affect surgical outcomes in children with congenital ptosis undergoing anterior levator resection under general anaesthesia. Retrospective cohort study. Children with 'simple' congenital ptosis who underwent anterior levator resection under general anaesthesia. Consecutive cases were reviewed with regards to achievement of the desired lid height (surgical success), and the influence of preoperative levator function and degree of ptosis. The amount of pre-operative levator function and degree of ptosis, with corresponding surgical outcomes. Forty-two lids (37 patients) were included in the study: 36 primary and 6 revision cases (which were excluded from analysis due to small sample size). Mean age was 7 years (range 3-17 years), with similar male to female ratio (1.2:1). The overall success rate for primary was 86%. There were small to moderate trends towards greater amount of levator resection for lower levator function (r2 = -0.25, p < 0.05) and higher degree of ptosis (r2 = 0.38, p < 0.05). All successful primary cases (n = 31) had pre-operative levator function of at least 8 mm. Levator resection in children under general anaesthesia continues to be an imprecise science. Degree of ptosis and levator function were poorly correlated to each other; however, there was an expected small to moderate correlation between resection amount and levator function (negative correlation) or degree of ptosis (positive correlation). Patients with levator function of 8mm or more are likely to have a successful outcome.
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Affiliation(s)
- Chinh T Nguyen
- a Orbital, Plastic & Lacrimal Unit , Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia
| | - Thomas G Hardy
- a Orbital, Plastic & Lacrimal Unit , Royal Victorian Eye and Ear Hospital , East Melbourne , Victoria , Australia.,b Department of Ophthalmology , Royal Children's Hospital , Parkville , Victoria , Australia.,c Department of Surgery , Royal Melbourne Hospital, University of Melbourne , Parkville , Victoria , Australia
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Khong JJ, Burdon KP, Lu Y, Leonardos L, Laurie KJ, Walsh JP, Gajdatsy AD, Ebeling PR, McNab AA, Hardy TG, Stawell RJ, Davis GJ, Selva D, Tsirbas A, Montgomery GW, Macgregor S, Craig JE. Association of Polymorphisms in MACRO Domain Containing 2 With Thyroid-Associated Orbitopathy. Invest Ophthalmol Vis Sci 2017; 57:3129-37. [PMID: 27304844 DOI: 10.1167/iovs.15-18797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Thyroid-associated orbitopathy (TO) is an autoimmune-mediated orbital inflammation that can lead to disfigurement and blindness. Multiple genetic loci have been associated with Graves' disease, but the genetic basis for TO is largely unknown. This study aimed to identify loci associated with TO in individuals with Graves' disease, using a genome-wide association scan (GWAS) for the first time to our knowledge in TO. METHODS Genome-wide association scan was performed on pooled DNA from an Australian Caucasian discovery cohort of 265 participants with Graves' disease and TO (cases) and 147 patients with Graves' disease without TO (controls). Top-ranked single nucleotide polymorphisms (SNPs) then were genotyped in individual DNA samples from the discovery cohort, and two replication cohorts totaling 584 cases and 367 controls. RESULTS In the GWAS of pooled DNA samples, several SNPs showed suggestive association with TO at genome-wide P ≤ 10-6; rs953128 located on chr10q21.1, rs2867161 on chr7q11.22, rs13360861 on chr5q12.3, rs7636326 on chr3q26.2, rs10266576 on chr 7q11.22, rs60457622 on chr3q23, and rs6110809 on chr20p12.1. However, the only SNP consistently associated with TO on individual genotyping in the discovery and replication cohorts was rs6110809, located within MACROD2 on chromosome 20p12.1. On combined analysis of discovery and replication cohorts, the minor A allele of rs6110809 was more frequent in TO than in Graves' disease controls without TO (P = 4.35 × 10-5; odds ratio [OR] = 1.77; 95% confidence interval [CI], 1.35-2.32) after adjusting for age, sex, duration of Graves' disease, and smoking. CONCLUSIONS In patients with Graves' disease, a common genetic variant in MACROD2 may increase susceptibility for thyroid-associated orbitopathy. This association now requires confirmation in additional independent cohorts.
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Affiliation(s)
- Jwu Jin Khong
- Melbourne Clinical School-Western Campus Department of Medicine, University of Melbourne, Sunshine Hospital, St. Albans, Victoria, Australia 2Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Victoria, Australia 3Department of
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yi Lu
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lefta Leonardos
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Kate J Laurie
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia 8School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Adam D Gajdatsy
- Centre for Ophthalmology and Visual Sciences, University of Western Australia, Western Australia, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Alan A McNab
- Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Victoria, Australia 11Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Victoria, Australia 3Department of Surgery, University of Melbourne, Victoria, Australia
| | - Richard J Stawell
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
| | - Garry J Davis
- South Australian Institute of Ophthalmology, University of Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, University of Adelaide, South Australia, Australia
| | - Angelo Tsirbas
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Grant W Montgomery
- Molecular Epidemiology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Stuart Macgregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
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Khong JJ, Wang LY, Smyth GK, McNab AA, Hardy TG, Selva D, Llamas B, Jung CH, Sharma S, Burdon KP, Ebeling PR, Craig JE. Differential Gene Expression Profiling of Orbital Adipose Tissue in Thyroid Orbitopathy. Invest Ophthalmol Vis Sci 2016; 56:6438-47. [PMID: 26444724 DOI: 10.1167/iovs.15-17185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We aimed to determine differentially expressed genes relevant to orbital inflammation and orbital fat expansion in thyroid orbitopathy (TO) using microarray gene profiling in a case-control study. METHODS Human orbital adipose samples were obtained from individuals with active TO (n = 12), inactive TO (n = 21), and normal controls (n = 21). Gene expression profiles were examined using microarray analysis and were compared between active and inactive TO, and between active TO and normal controls. Top ranked differentially expressed genes were validated by real-time RT-PCR in an additional eight active TO, 13 inactive TO, and 11 normal controls and correlated with gene set enrichment analysis (GSEA) and molecular pathways analysis. RESULTS Seven hundred twenty-one probes (683 genes) and 806 probes (735 genes) were significantly differentially expressed in comparing active to inactive TO and in comparing active TO to healthy controls, respectively. All selected genes were confirmed to be differentially expressed by real-time RT-PCR. Multiple top ranked genes in active versus inactive TO comparison are overrepresented by immune and inflammatory response genes. They include defensins (DEFA1, DEFA1B, DEFA3), which were overexpressed by 3.05- to 4.14-fold and TIMD4 by 4.20-fold. Markers for adipogenesis were overexpressed including SCD, FADS1, and SCDP1. Gene set enrichment analysis revealed dysregulation of epigenetic signatures, T-cell activation, Th1 differentiation, defensin pathway, cell adhesion, cytoskeleton organization, apoptosis, cell cycling, and lipid metabolism in active TO. CONCLUSIONS Active TO is characterized by upregulation of genes involved in cell-mediated immune, innate immune, and inflammatory response and enhanced orbital adipogenesis. TIMD4, DEFA1, DEFA1B, and DEFA3 genes may be involved in the innate immune-mediated orbital inflammation in TO. Epigenetic mechanisms may play a role in the pathogenesis of TO.
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Affiliation(s)
- Jwu Jin Khong
- Department of Medicine North West Academic Centre, University of Melbourne, St. Albans, Victoria, Australia 2Orbital, Plastics, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Lynn Yuning Wang
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Gordon K Smyth
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia 4Department of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Alan A McNab
- Orbital, Plastics, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastics, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Dinesh Selva
- Department of Ophthalmic and Visual Science, University of Adelaide, South Australia, Australia
| | - Bastien Llamas
- School of Earth and Environmental Sciences, University of Adelaide, South Australia, Australia 7Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
| | - Chol-Hee Jung
- VLSCI, Life Sciences Computation Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Shiwani Sharma
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
| | - Kathryn P Burdon
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia 9Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Peter R Ebeling
- Department of Medicine North West Academic Centre, University of Melbourne, St. Albans, Victoria, Australia 10Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
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Kurniawan ED, Davis G, McKelvie P, Hardy TG. Malignant transformation of a lacrimal gland pleomorphic adenoma with pulmonary metastases. Clin Exp Ophthalmol 2015; 43:591-2. [PMID: 25615874 DOI: 10.1111/ceo.12495] [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] [Received: 12/28/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Emil D Kurniawan
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Garry Davis
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Penelope McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
PURPOSE To determine the anatomical location and laterality of orbital cavernous haemangiomas (OCH). DESIGN Retrospective case series. METHODS The records of 104 patients with OCH were analyzed. MAIN OUTCOME MEASURES The anatomical location of each OCH defined by the location of a point at the centre of the lesion, and its laterality. RESULTS There were 104 patients included in the study. No patient had more than one lesion. Sixteen (15.4%) were located in the anterior third of the orbit, 74 (71.2%) were in the middle third, and 14 (13.5%) in the posterior third. In the middle third, 10 of 74 (13.5%) were extraconal and 64 intraconal (86.5%), with 30 of 64 (46.9%) middle third intraconal lesions lying lateral to the optic nerve. Of 104 lesions, 56 (53.8%) were left sided, showing a trend towards a predilection for the left side (p = 0.065). If data from other published series which included data on laterality is added to our own data and analysed, 270 of 468 (57.7%) OCH occurred in the left orbit (p < 0.005). CONCLUSIONS OCH may occur at almost any location within the orbit. The commonest location is the middle third of the orbit, in the intraconal space lateral to the optic nerve. This may reflect an origin of these lesions from the arterial side of the circulation, as there are more small arteries in the intraconal space lateral to the optic nerve than in other locations. A predilection for the left orbit remains unexplained.
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Affiliation(s)
- Alan A McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital , Melbourne , Australia
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33
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Chan HHL, Asadi H, Dowling R, Hardy TG, Mitchell PJ. Facial nerve injury as a complication of endovascular treatment for cavernous dural arteriovenous fistula. Orbit 2014; 33:462-4. [PMID: 25207743 DOI: 10.3109/01676830.2014.950291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Facial nerve injury following endovascular treatment of cavernous dural arteriovenous fistulae may be caused by ischemia from inadvertent embolisation of vasa nervorum, shearing or compressive forces. We report a case of unilateral facial nerve palsy as a complication of cavernous dural arteriovenous fistula embolisation.
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34
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Nguyen CT, McKelvie P, Hardy TG. Subacute presentation of eyebrow intravascular papillary endothelial hyperplasia causing ophthalmic nerve compression. Clin Exp Ophthalmol 2014; 43:285-8. [PMID: 25112660 DOI: 10.1111/ceo.12406] [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: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Chinh Tien Nguyen
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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35
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Hardy TG, McNab AA, Rose GE. Enlargement of the Infraorbital Nerve. Ophthalmology 2014; 121:1297-303. [DOI: 10.1016/j.ophtha.2013.12.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/24/2022] Open
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36
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Abstract
Primary signet ring cell carcinoma of the eyelid (PSCE) is a very rare tumour. Only a few cases having been reported to date. The majority of patients have been middle-age to elderly men. Different treatment modalities have been applied in cases of PSCE. Here, we report a case of PSCE in a man treated with orbital exenteration and radiotherapy.
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Affiliation(s)
- Jennifer S L Tan
- Orbital, Plastic & Lacrimal Service, The Royal Victorian Eye and Ear Hospital , Melbourne , Australia and
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37
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Praeger AJ, Tsui A, Hardy TG. Kimura disease: rare cause of a slowly progressive orbital mass. Clin Exp Ophthalmol 2013; 42:385-7. [PMID: 24119195 DOI: 10.1111/ceo.12242] [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: 08/25/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Adrian J Praeger
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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38
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Khong JJ, Hardy TG, McNab AA. Prevalence of Oculo-auriculo-vertebral Spectrum in Dermolipoma. Ophthalmology 2013; 120:1529-32. [DOI: 10.1016/j.ophtha.2013.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 12/18/2012] [Accepted: 01/09/2013] [Indexed: 10/26/2022] 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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40
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Dawson EL, Hardy TG, Collin JR, Lee JP. The incidence of strabismus and refractive error in patients with blepharophimosis, ptosis and epicanthus inversus syndrome (BPES). Strabismus 2004; 11:173-7. [PMID: 14710475 DOI: 10.1076/stra.11.3.173.16645] [Citation(s) in RCA: 29] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective review was carried out of 204 patients with blepharophimosis, (blepharo) ptosis and epicanthus inversus syndrome (BPES). Of these, 94 (46%) had an autosomal dominant family history of BPES. Forty (20%) had manifest strabismus. Of these, 28 (70%) had esotropia, 10 (25%) had exotropia and 2 (5%) had hypertropia. Twelve (6%) patients had nystagmus. Seventy (34%) patients had a significant refractive error requiring spectacles. Twenty-one (30%) of these patients had anisometropic hypermetropia and 24 (34%) had anisometropic myopia. Forty-three patients had bilateral amblyopia and 40 had unilateral amblyopia, with 26 (65%) of these undergoing occlusion treatment. Of these, 14 had strabismus and refractive error, 7 refractive error only, 2 strabismus only and 3 neither refractive error nor strabismus. We conclude that there is a higher incidence of strabismus and refractive error in patients with BPES than in the normal population.
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Affiliation(s)
- E L Dawson
- Moorfields Eye Hospital, City Road, London EC1V 2PD, England, U.K
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41
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Abstract
PURPOSE To describe a case of familial Paget disease of bone associated with bilateral enophthalmos and mild exposure keratopathy. METHODS Case report and literature review. RESULTS A 71-year-old woman with familial Paget disease of bone had a long history of "receding eyes," headaches, and moderately dry eyes. She had bilateral enophthalmos with mild exposure keratopathy. Radiologic and endocrinologic investigation confirmed Paget disease of bone affecting the skull. CONCLUSIONS Enophthalmos in association with Paget disease of bone is rare and is likely to result from differential expansion of the cranium compared with the orbital bones.
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Affiliation(s)
- Thomas G Hardy
- Orbital, Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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42
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Hardy TG, Samson RB, Stewart WR, Hartmann RF, Fatayer WT. Management of inflammatory bowel disease: an effective and concise approach. Dis Colon Rectum 2001; 23:244-8. [PMID: 6248309 DOI: 10.1007/bf02587092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Experience in treating 100 patients with inflammatory bowel disease, for periods ranging from one to 15 years, is reviewed. A concise clinical classification of inflammatory bowel disease, correlated with a method of management, is presented. Relative rates of operation appear to be reduced over previously reported series: among chronic ulcerative colitis patients, 11 per cent had major precedures; for Crohn's disease, 36 per cent.
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43
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Hardy TG, Hartmann RF, Samson RB, Stewart WR, Aguilar PS. Percutaneous intrahepatic chemotherapy via indwelling portal vein catheter and subcutaneous injection reservoir. Dis Colon Rectum 2001; 25:292-6. [PMID: 7092987 DOI: 10.1007/bf02553598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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44
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Hardy TG. A rectal sump in treatment of severe diarrhea. Dis Colon Rectum 2001; 24:20-1. [PMID: 7472096 DOI: 10.1007/bf02603443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Hardy TG, O'Day J. Retinal arteriovenous malformation with fluctuating vision and ischemic central retinal vein occlusion and its sequelae: 25-year follow-up of a case. J Neuroophthalmol 1998; 18:233-6. [PMID: 9858001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A patient with a retinal arteriovenous malformation (AVM) had experienced episodic visual loss with spontaneous recovery for many years, followed by permanent visual loss secondary to central retinal vein occlusion. She subsequently progressed to development of retinal neovascularization extending onto the posterior vitreous face with recurrent vitreous hemorrhage requiring vitrectomy. A brief review of the literature is presented, and the cause of the fluctuations in vision and central retinal vein occlusion are discussed.
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Affiliation(s)
- T G Hardy
- Department of Neuro-Ophthalmology, Melbourne University, Royal Victorian Eye & Ear Hospital, Australia
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46
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Rahman SM, McKibben BT, Hardy TG, Schloss CD, Cho CC, Hartmann RF, Aguilar PS, Khanduja KS, Stewart WR. Preoperative versus postoperative adjuvant radiotherapy for surgically curable carcinoma of the rectum and distal sigmoid colon. South Med J 1990; 83:774-7. [PMID: 2371600 DOI: 10.1097/00007611-199007000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
From January 1979 to October 1986, 86 patients with surgically resectable adenocarcinoma of the rectum or rectosigmoid were treated with adjuvant radiotherapy consisting of preoperative 2,400 cGy (22 patients), preoperative 4,000 cGy (14 patients), "sandwich" technique (27 patients), and postoperative irradiation (23 patients). Average follow-up was 42.9 months. The local recurrence rate was 4.5%, 9.1%, 7.4%, and 34.8%, respectively. The distant metastasis rate was 18.2%, 18.2%, 7.4%, and 30.4%, respectively. Preoperative radiotherapy with adequate surgical resection appears more effective in reducing the incidence of local recurrence.
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Affiliation(s)
- S M Rahman
- Department of Radiotherapy, Grant Medical Center, Columbus, OH 43215
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47
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Hardy TG, Aguilar PS, Stewart WR. Complete obstruction of the sigmoid colon treated by primary resection and anastomosis--an improved technique (preliminary report). Report of three cases. Dis Colon Rectum 1989; 32:528-32. [PMID: 2791791 DOI: 10.1007/bf02554512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Three patients with complete colonic obstruction treated by primary resection and anastomosis with intraoperative colon tube decompression and bowel lumen sterilization without a protective colostomy are presented. An improved colonic decompressor was used. It is postulated that this procedure is an alternative safe technique in patients with colonic obstruction in whom an end-colostomy, mucous fistula, or Hartmann pouch would be necessary.
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Affiliation(s)
- T G Hardy
- Central Ohio Colon and Rectal Center, Grant Medical Center, Columbus 43215
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48
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Corman ML, Prager ED, Hardy TG, Bubrick MP. Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial. Dis Colon Rectum 1989; 32:183-7. [PMID: 2646083 DOI: 10.1007/bf02554523] [Citation(s) in RCA: 103] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In a randomized, prospective study of 438 patients, the safety and efficacy of the Valtrac biofragmentable anastomotic ring (BAR) was compared with stapling and with conventional suture techniques. There was no significant difference in the morbidity, mortality, and clinical course of the patients. The BAR can effect reestablishment of intestinal continuity somewhat more rapidly, but its major advantage is its uniform applicability to all areas of the intestinal tract, except the low rectum.
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Affiliation(s)
- M L Corman
- Sansum Medical Clinic, Santa Barbara, California 93102
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49
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Abstract
Experience with a new silicone prosthesis in the modified Thiersch operation for rectal procidentia in 16 extremely poor-risk patients is presented. The technique of implantation, structural details of the prosthesis, and the clinical results are described. The use of a new silicone prosthesis in the modified Thiersch procedure is a viable alternative in this group of patients. Surgical technique is a primary determining factor in preventing complications.
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Affiliation(s)
- K S Khanduja
- Division of Colon and Rectal Surgery, Grant Hospital, Columbus, Ohio
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50
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Maney JW, Katz AR, Li LK, Pace WG, Hardy TG. Biofragmentable bowel anastomosis ring: comparative efficacy studies in dogs. Surgery 1988; 103:56-62. [PMID: 3336869] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three studies were conducted in a total of 178 dogs to determine the efficacy of a biofragmentable bowel anastomosis ring (BAR) composed of polyglycolic acid and 12.5% barium sulfate. Wound strength and healing of BAR, suture, and staple colonic anastomoses were compared for intervals of up to 1 year. The effect of systemic steroid treatment and BAR size on anastomotic wound strength and healing was also studied. The BARs fragmented at a mean time of 15.06 days postoperatively and were passed in the feces without injury. Wound strength was determined by measurements of the pressure required to burst the anastomosed colonic segment and measurements of the tension required to break 10 mm wide longitudinal strips of the anastomosed segment. The studies demonstrated that wound strength had progressed to a point where continued mechanical support (with sutures or staples) was no longer required by 14 days in both nontreated and steroid-treated dogs. Gross healing evaluations at 21 days and beyond showed no differences due to anastomotic method. Microscopic evaluations suggested that residual granulation tissue was less at the sites of BAR asastomoses than at sites of suture or staple anastomoses at the 1-year interval, suggesting that healing may be better with BAR than with standard methods of colon anastomosis.
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Affiliation(s)
- J W Maney
- Medical Device Research Division, American Cyanamid Company, Pearl River, NY 10965
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