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Balchev G. Complications and Recurrences after Excision and Reconstruction of Eyelid Tumours. Curr Oncol 2024; 31:1713-1724. [PMID: 38668033 PMCID: PMC11049131 DOI: 10.3390/curroncol31040130] [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: 01/26/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The eyelids are a common site for skin tumours and account for 5-10% of all skin tumours. Treatment is mainly surgical and aims to preserve the anatomical structure of the eyelid, its function and not least its aesthetic appearance. AIM Presentation of recurrence and complication rates of tumour-related eyelid surgery in a cohort of 450 tumours. RESULTS Analysis of a cohort of 450 tumours operated on revealed 13 (2.8%) operations with recurrences and 32 (7%) with complications. The statistical significance of recurrences was observed for the involved and uninvolved ciliary margin. At the temporal canthus, 23.1% of recurrences occurred compared to 7.7% at the medial canthus. SGC has the highest recurrence rate. Complications include the following: ectropion, dehiscence, gross cicatrix with normal function, retraction, post-radiation damage, sub-graft haemorrhage and graft rejection. CONCLUSIONS The recurrence rate of eyelid tumours is lower than that of complications. The choice of surgical technique determines the frequency of complications and histological control of the excised tissue, as well as the frequency of recurrences.
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Affiliation(s)
- Georgi Balchev
- Ophthalmology Department, Medical University Pleven, 5800 Pleven, Bulgaria
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2
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Wu KY, Tabari A, Mazerolle É, Tran SD. Towards Precision Ophthalmology: The Role of 3D Printing and Bioprinting in Oculoplastic Surgery, Retinal, Corneal, and Glaucoma Treatment. Biomimetics (Basel) 2024; 9:145. [PMID: 38534830 DOI: 10.3390/biomimetics9030145] [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] [Received: 12/31/2023] [Revised: 02/04/2024] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
In the forefront of ophthalmic innovation, biomimetic 3D printing and bioprinting technologies are redefining patient-specific therapeutic strategies. This critical review systematically evaluates their application spectrum, spanning oculoplastic reconstruction, retinal tissue engineering, corneal transplantation, and targeted glaucoma treatments. It highlights the intricacies of these technologies, including the fundamental principles, advanced materials, and bioinks that facilitate the replication of ocular tissue architecture. The synthesis of primary studies from 2014 to 2023 provides a rigorous analysis of their evolution and current clinical implications. This review is unique in its holistic approach, juxtaposing the scientific underpinnings with clinical realities, thereby delineating the advantages over conventional modalities, and identifying translational barriers. It elucidates persistent knowledge deficits and outlines future research directions. It ultimately accentuates the imperative for multidisciplinary collaboration to enhance the clinical integration of these biotechnologies, culminating in a paradigm shift towards individualized ophthalmic care.
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Affiliation(s)
- Kevin Y Wu
- Division of Ophthalmology, Department of Surgery, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada
| | - Adrian Tabari
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, BC V1V 1V7, Canada
| | - Éric Mazerolle
- Division of Ophthalmology, Department of Surgery, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Castillejo Becerra CM, Wagner LH. Telemedicine in Oculoplastic Surgery During the COVID-19 Pandemic: A Single Center Experience. Telemed J E Health 2024. [PMID: 38350121 DOI: 10.1089/tmj.2023.0401] [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: 02/15/2024] Open
Abstract
Purpose: To investigate patterns in oculoplastic surgery telemedicine visits at our institution during the pandemic period. Methods: Retrospective chart review of all patients who had a virtual consultation with the oculoplastic surgery service at Mayo Clinic Rochester between March 1, 2020, and March 1, 2021. Results: There were a total of 148 patients. Mean age was 65 years (95% confidence interval [CI]: 62-68). The mean driving distance to the medical center was 468 kilometers (95% CI: 352-586) and 15 (10%) patients came from states with no practicing American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. Out of the 205 virtual visits, 35 (17%) were new, 45 (22%) were return, and 125 (61%) were postoperative. Conversion rate to surgery was 60%. A comparison between type of virtual visits (new vs. return vs. postoperative) revealed that a diagnosis of eyelid malposition was most frequent in postoperative visits (p = < 0.001), skin malignancy was most frequent in new visits (p = 0.009), and orbital tumors (p = 0.018) and thyroid eye disease (p = < 0.001) were most frequent in return visits. Most virtual encounters had supportive media attached including external photographs in 127 (62%) visits and other imaging or testing in 18 (9%) visits. The average virtual visit lasted 18 min (95% CI: 14-22) with technical difficulties noted in 9 (4%) visits. Unanticipated conversion to in-person visits was noted in three (1%) cases. Conclusions: A wide range of oculoplastic surgery conditions was managed virtually during the COVID-19 pandemic. Utilization of initial virtual visit versus follow-up care varied by diagnosis. Virtual visits may improve access to oculoplastic subspecialty care for patients from underserved areas.
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Affiliation(s)
| | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Wu KY, Fujioka JK, Goodyear E, Tran SD. Polymers and Biomaterials for Posterior Lamella of the Eyelid and the Lacrimal System. Polymers (Basel) 2024; 16:352. [PMID: 38337241 DOI: 10.3390/polym16030352] [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] [Received: 12/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
The application of biopolymers in the reconstruction of the posterior lamella of the eyelid and the lacrimal system marks a significant fusion of biomaterial science with clinical advancements. This review assimilates research spanning 2015 to 2023 to provide a detailed examination of the role of biopolymers in reconstructing the posterior lamella of the eyelid and the lacrimal system. It covers the anatomy and pathophysiology of eyelid structures, the challenges of reconstruction, and the nuances of surgical intervention. This article progresses to evaluate the current gold standards, alternative options, and the desirable properties of biopolymers used in these intricate procedures. It underscores the advancements in the field, from decellularized grafts and acellular matrices to innovative natural and synthetic polymers, and explores their applications in lacrimal gland tissue engineering, including the promise of 3D bioprinting technologies. This review highlights the importance of multidisciplinary collaboration between material scientists and clinicians in enhancing surgical outcomes and patient quality of life, emphasizing that such cooperation is pivotal for translating benchtop research into bedside applications. This collaborative effort is vital for restoring aesthetics and functionality for patients afflicted with disfiguring eyelid diseases, ultimately aiming to bridge the gap between innovative materials and their clinical translation.
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Affiliation(s)
- Kevin Y Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada
| | - Jamie K Fujioka
- Faculty of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Emilie Goodyear
- Department of Ophthalmology, Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Ghiam BK, Su RC, Orge F. Surgical Outcomes After Frontalis Suspension Using Expanded Polytetrafluoroethylene Sling for Congenital Ptosis. Cureus 2023; 15:e49020. [PMID: 38111459 PMCID: PMC10727487 DOI: 10.7759/cureus.49020] [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] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose The purpose of the study is to assess short- and long-term functional outcomes after frontalis suspension using expanded polytetrafluoroethylene (ePTFE) sling for congenital ptosis repair. Methods A retrospective, observational case review was conducted on pediatric patients who underwent frontalis suspension using ePTFE sling from 2008 to 2020. Functional success was assessed by lid height, lid symmetry, and parental satisfaction with the cosmetic outcome. Clinical course and long-term functional outcomes after surgery were assessed. Results Twenty-one cases met the inclusion criteria and were assessed. The follow-up time ranged from 13 months to 11 years (mean: six years). Functional success after one surgery was 62% at early and late postoperative periods. Six of 21 cases (29%) required revisional surgery in the early postoperative period due to undercorrection. Three cases (14%) were complicated by infection and/or granuloma formation. There were no cases of ptosis recurrence in the long term if success was seen in the early postoperative period. Conclusion ePTFE slings remain an excellent option for severe congenital ptosis repair with frontalis sling, demonstrating long-term functional success, with satisfactory lid symmetry and acceptable cosmetic outcome. This is of important consideration in patients younger than three years of age, where autogenous materials may not be recommended. The need for early revisional surgery for undercorrection is not uncommon. The current authors also demonstrate a low but considerable risk for infection and/or granuloma formation.
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Affiliation(s)
- Benjamin K Ghiam
- Department of Ophthalmology, Roski Eye Institute, University of Southern California, Los Angeles, USA
| | - Robin C Su
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, USA
| | - Faruk Orge
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, USA
- Department of Ophthalmology and Visual Sciences, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, USA
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Baghazal A, Hanafi S, Bogari A. Public and Physicians Perception of Oculoplastic Surgery Subspecialty in Saudi Arabia. Clin Ophthalmol 2023; 17:2493-2504. [PMID: 37637968 PMCID: PMC10460187 DOI: 10.2147/opth.s425712] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Objective Oculoplastic surgery is a highly specialized subspecialty that studies pathologies of the orbit, lacrimal system, and eyelids. Although it is an independent ophthalmological subspecialty, many procedures fall within the shared scope and anatomical area of oculoplastic surgery, otorhinolaryngology, and plastic and reconstructive surgery, which tend to confuse physicians and patients seeking medical advice. In this study, our goal is to evaluate the perception of oculoplastic surgery among the public and physicians. Methodology A cross-sectional study in which data were collected from an online questionnaire formulated by the authors. The questionnaire included 18 questions divided into two categories: demographics and targeted questions that serve the objective of the study. Each answer option to targeted questions was encoded with either one or zero points, and each participant's response was scored accordingly, with the maximum score being 22 points, reflecting the highest perception rate according to the questionnaire. Results Data were collected from 1029 questionnaire responses, with 202 of the respondents belonging to physicians. The highest number of responses was from females which consisted 82% of our sample. Perception scores were higher among physicians with a mean of 12.3 ± 2.9 points compared to a mean score of 11.2 ± 2.9 among the public. Age played a statistically significant factor in both physicians and the public as younger participants' scores were higher. Conclusion Insufficient knowledge of oculoplastic surgery subspecialty was observed among the public and physicians. Moreover, core aspects of oculoplastic field such as lacrimal system pathology and orbit pathology were less recognized by participants of our study, which highlights the importance of raising awareness of oculoplastic surgery and the diversity of the field, to enhance referral patterns among physicians and improve medical advice seeking among the public resulting in better health care.
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Affiliation(s)
- Alaa Baghazal
- Department of Ophthalmology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Somaya Hanafi
- Department of Ophthalmology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ahmad Bogari
- Department of Otorhinolaryngology, Head and Neck Surgery, Ministry of Health, Riyadh, Saudi Arabia
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Oliver-Gutierrez D, Dinarès MC, Segura-Duch G, Ros-Sanchez E, Goncharova T, Alonso T. Eyelid atypical fibroxanthoma: a rare challenging entity. Orbit 2023:1-4. [PMID: 37527158 DOI: 10.1080/01676830.2023.2237567] [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] [Received: 05/01/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023]
Abstract
Atypical fibroxanthoma (AFX) is a rare neoplasm, with a limited number of cases reported in the periocular region. In this case report, we detail a 63-year-old woman who presented with a polypoid, exophytic lesion on her right upper eyelid that had been progressing for a year. The lesion was meticulously excised with security margins and reconstructed using a glabellar flap. Following a thorough microscopic and immunohistochemical analysis, AFX was diagnosed. Despite its sometimes clinical and histological benign appearance, AFX is classified as a malignant neoplasm; however, it carries an excellent prognosis with low metastasis and recurrence rates. Complete excision with safety margins is essential and an adequate post-operative surveillance is recommended. Owing to its rarity, ophthalmologists should remain vigilant and include AFX in their differential diagnosis, as the tumor's benign appearance may lead to misdiagnosis of this malignant entity.
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Affiliation(s)
| | - M Carme Dinarès
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gloria Segura-Duch
- Ophthalmology Department, Centro Oftalmológico Barraquer, Barcelona, Spain
| | - Elena Ros-Sanchez
- Ophthalmology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tetiana Goncharova
- Ophthalmology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tirso Alonso
- Ophthalmology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Abstract
Facial skin defect reconstruction in medial-canthal area of the lids can be a challenge even when performed by a skilled surgeon. The excision of large tumors in this area leads to significant surgical defects that cannot be repaired by merely closing the wound. The glabellar area provides a source of redundant skin with similar characteristics to that of the medial-canthal lid area. The purpose show the possibility of the glabellar flap technique surgery in patients after tumor excision in the medial canthal area with the formation of a large surgical defect and especially those with defect under the medial canthal tendon. We selected 15 well-documented retrospective cases of patients operated over 2 years and followed up for a minimum of 36 months, who underwent surgery with a glabellar flap technique. Patients were operated with V-Y glabellar rotation, advancement, or combined transposition flap techniques. According to the defect’s location, we divided the patients into three groups: upper, medial, and lower surgical defects. A satisfactory functional result was obtained in all the patients. In most of them, the cosmetic results were also good. No additional surgical procedures were required in any of the patients. Our experience showed excellent results with the glabellar flap technique in all three types of lesions in the medial canthal zone—upper, medial, and especially lower which until recently was thought to be inappropriate.
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Affiliation(s)
- Georgi Balchev
- Department of Ophthalmology, Medical University Pleven, Pleven, Bulgaria
| | - Chavdar Balabanov
- Department of Ophthalmology, Medical University Pleven, Pleven, Bulgaria
| | - Snezhana Murgova
- Department of Ophthalmology, Medical University Pleven, Pleven, Bulgaria
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Assayag E, Tsessler M, Wasser LM, Drabkin E, Reich E, Weill Y, Zadok D, Nair AG, Andron A. Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons. Eur J Ophthalmol 2021; 31:2881-2885. [PMID: 33073613 PMCID: PMC8606803 DOI: 10.1177/1120672120965471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/19/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic. METHODS A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and z-score of proportions tests, respectively. RESULTS The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, p = 0.004), while only 12.8% (p < 0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% (p = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality. CONCLUSION Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.
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Affiliation(s)
- Elishai Assayag
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Maria Tsessler
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Lauren M Wasser
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Elena Drabkin
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ehud Reich
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Akshay Gopinathan Nair
- Ophthalmic Plastics and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India
| | - Aleza Andron
- Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Hussey VM, Tao JP. Oculofacial plastic surgeon distribution by county in the United States, 2021. Orbit 2021; 41:687-690. [PMID: 34672850 DOI: 10.1080/01676830.2021.1989468] [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: 10/20/2022]
Abstract
PURPOSE To characterize the number of oculofacial plastic surgeons (OPS) per county in the United States (U.S.). METHODS The 2021 public databases of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the American Academy of Ophthalmology were used to identify all OPS in the U.S. Surgeon practice location was used to determine per capita physician density by county. RESULTS A total of 1184 OPS in the U.S. were identified. Three hundred forty-eight counties were served by at least one OPS whereas 2795 counties (89%), and two states, North Dakota and Wyoming, had no OPS. The average ratio of OPS to 100,000 population was 0.3572 (1 per 279,955). Of the counties with at least one OPS, the average was 0.5860 surgeons per 100,000 population (1 per 170,648), ranging from 0.0705 (1 per 1,418,440) to 11.26 (1 per 8,881) per 100,000. The counties with the greatest OPS density were Pitkin County, CO (1 per 8,881), San Juan County, WA (1 per 17,580), and Montour County, PA (1 per 18,231). Counties with the lowest density of those with at least one OPS were Bronx County, NY (1 per 1,418,238), San Bernardino County, Ca (1 per 1,090,037), and Gwinnett County, GA (1 per 936,329). The counties with the most OPS were Los Angeles County, CA (46), New York County, NY (38), and Cook County, IL (25). CONCLUSIONS Geographic disparities in OPS distribution exist in the U.S. Future investigations of OPS supply according to population and other characteristics for demand may be useful.
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Affiliation(s)
- Vincent M Hussey
- Gavin Herbert Eye Institute, University of California, Irvine, California, USA
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine, California, USA
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Abstract
OBJECTIVE To test the applicability of a fresh tissue model for teaching facial plastic techniques and approaches to the eyelids and orbit. DESIGN Observational animal experiments. SUBJECTS Ten prepubescent sheep heads harvested following humane euthanasia at the completion of unrelated live animal research. METHODS Young sheep were saline perfused at the end of an in vivo protocol. Head and neck tissues were harvested and refrigerated for 3-7 days. An experienced oculoplastic surgeon and an otolaryngologist explored the feasibility of common oculoplastic procedures in the ovine model. RESULTS The model has potential for teaching basic principles in eyelid surgery including upper lid blepharoplasty, aponeurotic ptosis repair, upper lid gold weight lid loading for facial paralysis, lateral canthotomy and inferior limb cantholysis, lower lid tightening, and transconjunctival approach to the orbital floor. Eye muscle advancement, optic nerve sheath fenestration, and enucleation also accurately simulated human surgery. Anatomic variations limit the sheep model for orbital floor reconstruction and lacrimal drainage procedures. CONCLUSIONS The sheep head and neck provide an inexpensive, safe model for developing skills in several oculoplastic procedures. Formal simulation testing is needed to confirm these expert opinions.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head and Neck Surgery, 12314Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.,Departments of Pediatrics, 12314Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Allan E Wulc
- Department of Ophthalmology, 12312Drexel University College of Medicine, Philadelphia, PA, USA.,Department of Ophthalmology, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Abstract
Renal cell carcinoma (RCC) is a rare malignancy that often metastasizes to the lung, bones, liver, and brain. Only a few cases of RCC metastasis in periocular areas have been reported in the literature. This case report describes a 70-year-old male who was presented to the University of Florida, Gainesville ophthalmology clinic with two-day symptoms of diplopia, decreased vision, and mechanical ptosis of the left eye with superior temporal mass. The patient had a history of both prostate and RCC that were in remission for five years leading to his presentation. Excisional biopsy confirmed the metastasis of RCC to the eye. The patient reported no systemic symptoms. This report also reviews existing literature on RCC metastasis to the eye and orbit. Ultimately, RCC metastasis to the eye in patients with a history of known RCC should be considered in the differential diagnosis in those presenting with an atypical mass in periocular regions.
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Affiliation(s)
- Yong S Lee
- Ophthalmology, University of Central Florida College of Medicine, Orlando, USA
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13
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Wagner LH, Bradley EA, Giese I, Mehta VJ, Seiff SR. Delayed periorbital hemorrhage in oculoplastic surgery patients on oral anticoagulants. Orbit 2021; 40:150-154. [PMID: 32295502 DOI: 10.1080/01676830.2020.1752744] [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: 02/29/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital surgery has not been investigated. We describe four cases of severe delayed postoperative hemorrhage associated with NOACs, in addition to three cases in patients on traditional antithrombotic agents. Time of delayed hemorrhage ranged from postoperative day 2 to 6. Six patients required surgical intervention to achieve control of bleeding, and two patients required transfusion of blood products. Risk factors and management of this rare complication are discussed.
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Affiliation(s)
- Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic , Rochester, Minnesota, USA
| | | | - Isaiah Giese
- Department of Ophthalmology, California Pacific Medical Center , San Francisco, California, USA
| | - Viraj J Mehta
- Department of Ophthalmology, Mayo Clinic , Rochester, Minnesota, USA
| | - Stuart R Seiff
- Department of Ophthalmology, California Pacific Medical Center , San Francisco, California, USA
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14
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Abstract
BACKGROUND AND AIMS The aim of this study was to first produce and cross-culturally validate a Finnish version of the FACE-Q Eye module, a patient-reported outcome measure designed for patients undergoing eyelid surgery for esthetic reasons, and second assess the suitability of this instrument for use in a university hospital setting. MATERIAL AND METHODS The FACE-Q Eye module and the general FACE-Q components Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Satisfaction with Outcome were translated according to established guidelines. A postal survey study was conducted with the translated instrument and the generic health-related quality of life instrument 15D on 245 patients operated in the Helsinki University Hospital between 2009 and 2019. Cronbach's alpha, floor and ceiling effects, measurement reliability with repeat administration, and convergence with 15D dimensions were analyzed. RESULTS The FACE-Q Eye module and general components translated readily into Finnish. Eighty-one patients (33%) responded to the survey, most of whom (78%) had undergone blepharoplasty. Most subscales demonstrated acceptable internal consistency with Cronbach's alphas 0.79-0.96. A ceiling effect was observed for four of the seven subscales evaluated. Intra-class correlation coefficients were high (0.82-0.91) indicating good reliability. Results of the FACE-Q subscales correlated at best moderately with the 15D dimensions. CONCLUSION The Finnish versions of the FACE-Q Eye module and the FACE-Q components Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress, and Satisfaction with Outcome perform well when assessing outcomes relevant to patients after eyelid surgery. However, when used in patients operated on for mainly functional reasons, subtle variations may be missed.
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Affiliation(s)
- S P Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - A J Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J P Repo
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - P A Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Kopecký A, Němčanský J. TRAUMA IN OCULOPLASTIC SURGERY A REVIEW. Cesk Slov Oftalmol 2020; 76:103-110. [PMID: 33126805 DOI: 10.31348/2020/18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this article is to present the basics of traumatology in oculoplastic surgery and to review the literature about this topic. This review sums up the problematic of injuries of the eyelid, lacrimal system and orbit. The most important types of trauma, their treatment options, and the most common complications are described. In majority of oculoplastic traumas, surgical reconstruction is the treatment of choice. The surgery is often performer immediately, but sometimes the reconstruction of eyelid and lacrimal injuries can be postponed up to 48 hours, if the immediate surgery is not possible. Although the recommendations from the literature on this topic are variable, most of the patients require at least local antibiotics, more complex traumas systemic antibiotics. Careful diagnostics and correctly performed surgical treatment, either only by ophthalmologist, or oculoplastic surgeon, or a multi-disciplinary team for more complex injuries, are the key to good functional and aesthetic results of the reconstruction.
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Mortada H, Seraj H, Bokhari A. Screening for body dysmorphic disorder among patients pursuing cosmetic surgeries in Saudi Arabia. Saudi Med J 2020; 41:1111-1120. [PMID: 33026053 PMCID: PMC7841516 DOI: 10.15537/smj.2020.10.25380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/29/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the prevalence of positive screening of body dysmorphic disorder (BDD) among patients seeking cosmetic surgeries in plastic surgery and oculoplastic surgery clinics. METHODS The survey of this cross-sectional study was self-administrated and distributed among adults pursuing cosmetic surgeries in plastic surgery and oculoplastic surgery clinics at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between March 2019 and March 2020. The BDD questionnaire was validated, and a highly sensitive and specific tool was used to identify patients with BDD. Ethical approval was granted by the Research Ethics Committee. All analytic studies were performed using IBM SPSS, version 24. Results: A total of 344 patients participated in this study with a mean age of 39.66 ± 13.76 years. Of these, 296 (86%) were women and 298 (86.6%) were Saudi. The prevalence of positive screening for BDD was 19.2%. The most commonly requested procedures were abdominoplasty (21.2%) and skin lesion removal (21.2%). Smoking was found to be significantly associated with BDD with 21.2% of smokers having it (p less than 0.010). CONCLUSION Body dysmorphic disorder was unrecognized among patients pursuing cosmetic surgeries. One-fifth of patients requesting cosmetic procedures are potential cases of BDD requiring psychiatric evaluation and treatment. We recommend implementing screening protocols to identify cases before surgical plans.
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Affiliation(s)
- Hatan Mortada
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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17
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Quaranta-Leoni FM, Paridaens D, Verity D. European Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS) recommendations for oculoplastic surgeons during the COVID-19 pandemic: a hallenge for the future. Orbit 2020; 39:460-462. [PMID: 32808834 DOI: 10.1080/01676830.2020.1808022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
In March 2020, at the outset of the current pandemic, ESOPRS issued detailed advice on the appropriate procedures that practicing oculoplastic surgeons should consider to limit the transmission of COVID-19, with this information updated in April 2020. This paper highlights the threat to training opportunities for future generations of oculoplastic surgeons, adjustments in healthcare delivery, modifications of scientific activity, and the possible role of telemedicine in oculoplastics.
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Affiliation(s)
- Francesco M Quaranta-Leoni
- Oftalmoplastica Roma , Rome, Italy.,Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research , Rome, Italy
| | - Dion Paridaens
- Oculoplastic, Lacrimal & Orbital Service, Rotterdam Eye Hospital , Rotterdam, Netherlands.,Department of Ophthalmology, Erasmus Medical Center , Rotterdam, Netherlands
| | - David Verity
- Adnexal Service, Moorfields Eye Hospital , London, UK
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18
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Abstract
Purpose: To report the clinical outcomes of porcine acellular dermal matrix implants sandwiched between skin and conjunctival flaps for lower eyelid reconstruction following Mohs surgery. Methods: A retrospective review was performed on patients with lower eyelid defects following Mohs surgery treated using a porcine acellular dermal matrix sandwich graft from 2013 to 2018. Patient demographics, defect size and characteristics, and collagen matrix implant dimensions were evaluated. Postoperative course and complications were also reviewed. Results: The dermal matrix sandwich graft was performed in 13 cases (12 patients). Average horizontal marginal defect width was 11.7 mm (range: 6-16 mm). Mean width of the implanted dermal matrix was 7.7 mm (range: 5-9 mm). There were no instances of infection or graft failure. The reconstructed lid had an excellent marginal contour in 11 cases (84.6%), while 2 had minimal irregularities. All patients had an excellent thickness of the reconstructed margin. One patient (7.7%) required cauterization of overgrown marginal conjunctiva after surgery. Two patients (15.4%) experienced symptomatic trichiasis, requiring electrolysis (n = 1) and epilation (n = 1). Conclusions: The dermal matrix sandwich graft is an effective method for marginal defect repair when the remaining conjunctiva and skin are sufficient to develop the necessary flaps. While the resolution of edema and erythema may take several months, an excellent final result is achieved in the majority of cases. Complications are mild, relatively uncommon, and similar to those encountered in other reconstructive procedures. This single-stage, tissue-sparing technique preserves the capability of performing future tarsoconjunctival flaps or lateral canthal procedures, should the need arise.
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Affiliation(s)
- Philip L Custer
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine , St. Louis, Missouri, USA
| | - Robi N Maamari
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine , St. Louis, Missouri, USA
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Abstract
At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.
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Affiliation(s)
- Shiu Ting Mak
- Department of Ophthalmology, United Christian Hospital , Hong Kong.,Quality and Safety Office, Kowloon East Cluster, Hospital Authority , Hong Kong
| | - Hunter Kl Yuen
- Department of Ophthalmology, Hong Kong Eye Hospital , Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong , Hong Kong
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20
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Huffman CA, Timoney PJ. Masquerading dacryocystitis. Oxf Med Case Reports 2020; 2019:504-506. [PMID: 31908822 PMCID: PMC6937449 DOI: 10.1093/omcr/omz120] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/30/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), otherwise known as Masson’s tumor, is a benign lesion of the skin with no known malignant transformations reported. It is considered a non-neoplastic lesion, as it is reactive to some vascular insult, usually a thrombus in a vein leading to vascular endothelial cell proliferation. Masson’s tumor typically presents as a slow-growing, indolent lesion commonly affecting the head, neck and arms with a female predominance. It comprises ~2% of all malignant and non-malignant vascular tumors of the skin and subcutaneous tissue. We are presenting the first case of Masson’s tumor of the right medial canthal subcutaneous tissue, masquerading as dacryocystitis.
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Affiliation(s)
- Clayton A Huffman
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
| | - Peter J Timoney
- Director of Oculofacial Plastic and Orbital Surgery, University of Kentucky, Lexington, KY 40506, USA
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21
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Avisar I, Nahum Y, Mimouni M, Kremer I, Malhotra R. Oculoplastic aspects of ocular surface disease and their management. Surv Ophthalmol 2019; 65:312-322. [PMID: 31837384 DOI: 10.1016/j.survophthal.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
The normal structure and function of the eyelids, eyelashes, conjunctival fornices, and lacrimal system are essential for the health of the ocular surface, and abnormalities of these structures accompany many cases of ocular surface disease. We describe the role of oculoplastic intervention in the context of ocular surface disease, focusing on blink disorders, lagophthalmos, entropion, lid scarring and keratinization, trichiasis, and punctal and lacrimal sac disease.
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Affiliation(s)
- Inbal Avisar
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Israel Kremer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raman Malhotra
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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22
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Balgos JD, Amesty MA, Rodriguez AE, Al-Shymali O, Abumustafa S, Alio JL. Keratopigmentation combined with strabismus surgery to restore cosmesis in eyes with disabling corneal scarring and squint. Br J Ophthalmol 2019; 104:785-789. [PMID: 31527061 DOI: 10.1136/bjophthalmol-2019-314539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Therapeutic corneal pigmentation has modernly evolved into different sophisticated techniques to camouflage cosmetically disabling corneal opacities and scars with good reported outcomes. Blind eyes frequently suffer from strabismus which further deteriorates the cosmesis of the patient. Combined keratopigmentation (KTPG) with strabismus surgery may be an option for these patients. METHODS A total of 72 consecutive patients were retrospectively reviewed in this investigation. Main outcome measures were postoperative residual squint, and cosmesis evaluated by an independent observer, patient satisfaction, reoperation rates for KTPG and squint, and complications. RESULTS A total of 72 consecutive patients and 73 eyes that underwent KTPG and strabismus surgery were included in this study. Mean follow-up time was 2.5±3 years. Patient age ranged from 5 to 83 years, with 93% having visual acuity worse than 0.1. 14 eyes (24.5%) underwent repeated KTPG, 24 (42.1%) had repeated strabismus surgery. 14 patients (19.4%) had a repeat muscle surgery, although 55 (76.4%) of the 72 patients achieved orthotropia or had deviations within 10 prism dioptres at the end of the follow-up period. Corneal microperforation was encountered in two (2.8%) patients and conjunctival staining in 10 eyes. Cosmesis was good for all patients. Patients who required repeat KTPG or strabismus surgery, or those in whom orthotropia was not totally restored, considered their cosmetic appearance sufficiently improved. CONCLUSION Corneal KTPG combined with strabismus surgery provides good cosmesis for patients with corneal scarring and strabismus with minimal complications. Reoperation rates are relatively high in the short term to accomplish an optimal cosmetic result.
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Affiliation(s)
- Joan D Balgos
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Maria A Amesty
- Ocular, Plastic, Reconstructive, Lacrimal and Orbital Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Alejandra E Rodriguez
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Olena Al-Shymali
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Sabat Abumustafa
- Department of Ophthalmology, Ahmadi Hospital Kuwait, Kuwait City, Kuwait
| | - Jorge L Alio
- Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain .,Department of Ophthalmology, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
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Abstract
Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.
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Affiliation(s)
- Akshay Gopinathan Nair
- Opthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, Navi Mumbai; Aditya Jyot Eye Hospital, Wadala; Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | | | - Swati Singh
- LJ Eye Institute, Model Town, Ambala, Haryana, India
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24
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Wang JM, Fries FN, Hendrix P, Brinker T, Loukas M, Tubbs RS. Orbital Blowout Fracture with Complete Dislocation of the Globe into the Maxillary Sinus. Cureus 2017; 9:e1728. [PMID: 29201577 PMCID: PMC5707172 DOI: 10.7759/cureus.1728] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This rare case report describes the diagnosis and treatment of an isolated left-sided orbital floor fracture with a complete dislocation of the globe into the maxillary sinus and briefly discusses the indications of surgery and recovery for orbital floor fractures in general. Complete herniation of the globe through an orbital blow-out fracture is uncommon. However, the current case illustrates that such an occurrence should be in the differential diagnosis and should be considered, especially following high speed/impact injuries involving a foreign object. In these rare cases, surgical intervention is required.
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Affiliation(s)
- Joy Mh Wang
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Fabian N Fries
- Ophthalmology, Saarland University Medical Center, Germany
| | | | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
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Mishra K, Mathai M, Della Rocca RC, Reddy HS. Improving Resident Performance in Oculoplastic Surgery: A New Curriculum Using Surgical Wet Laboratory Videos. J Surg Educ 2017; 74:837-842. [PMID: 28284655 DOI: 10.1016/j.jsurg.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/19/2017] [Accepted: 02/11/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To develop a new oculoplastic curriculum that incorporates learning theory of skill acquisition. To develop and evaluate the effectiveness of instructional videos for an oculoplastic surgical wet laboratory. DESIGN Proof of concept, randomized controlled trial. SETTING New York Eye and Ear Infirmary of Mount Sinai-tertiary care academic institution. PARTICIPANTS AND METHODS In total, 16 ophthalmology residents were randomly assigned to 1 of 2 groups and given either video and text or text instructions alone for the following 2 procedures: blepharoplasty and eyelid laceration repair. Operating time and esthetic result were measured, and the groups were statistically compared. A brief survey was administered. RESULTS We developed a new 6 component oculoplastics curriculum that incorporates concepts of the Fitts and Posner skill acquisition model and mental imagery. In the wet laboratory pilot study, the group that watched the video of the laceration repair showed better esthetic grades than the group that received text alone (p = 0.038). This difference was not found for the blepharoplasty (p = 0.492). There was no difference between groups in operating time for the laceration repair (p = 0.722), but the group that watched the blepharoplasty video required more time to complete the task than those that reviewed text only (p = 0.023). In total, 100% of residents reported the videos augmented their learning. CONCLUSIONS Methods to optimize surgical education are important given limited operating room time in oculoplastics, a subspecialty in which the number of surgeries performed during residency is relatively low. We developed a curriculum based on learning theory and sought to formally test one important aspect, surgical video for wet laboratories. Our pilot study, despite its limitations, showed that wet laboratory surgical videos can be effective tools in improving motor skill acquisition for oculoplastic surgery.
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Affiliation(s)
- Kapil Mishra
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Mariam Mathai
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Robert C Della Rocca
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Harsha S Reddy
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
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Ong CT, Yap JF, Wai YZ, Ng QX. A Review Of Oculoplastic Photography: A Guide For Clinician Photographers. Cureus 2016; 8:e733. [PMID: 27630805 PMCID: PMC5017881 DOI: 10.7759/cureus.733] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Clinical photography in the field of oculoplastic surgery has many applications. It is possible for clinicians to obtain standardized clinical photographs without a studio. A clinician photographer has the advantage of knowing exactly what to photograph as well as having immediate access to the images. In order to maintain standardization in the photographs, the photographic settings should remain constant. This article covers essential photographic equipment, camera settings, patient pose, and digital asset management.
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Affiliation(s)
- Chin T Ong
- Ophthalmology, Beacon International Specialist Hospital
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27
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Abstract
Ptosis repair was performed in patients with ocular myasthenia gravis by a posterior approach (Fasanella-Servat, 12 eyelids of nine patients) or levator advancement (eight eyelids of five patients) techniques. There were eight males and five females. Median age was 73 years and range 30-86 years. The median duration of myasthenia was 10 years and range 2 to 28 years. Pyridostigmine and prednisone were widely used prior to surgical referral, but ineffective or intolerable in all. The mean preoperative upper margin-reflex distance (MRD) was 0.55 mm (range -1 to 2 mm). The levator excursion range was 10 to 16 mm and mean 12.4 mm. Mean follow-up was 9.1 months. Postoperatively, the MRD ranged from 0.5 to 4 mm, with a mean of 2.3 mm. Two patients had lagophthalmos postoperatively (one posterior approach, one levator advancement) that did not require correction. Three of five patients who underwent levator advancement required repeat ptosis repair.
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Affiliation(s)
- Michel J Belliveau
- a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada
| | - James H Oestreicher
- a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada
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28
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Abstract
BACKGROUND To avoid complications and improve patient satisfaction with lower lid blepharoplasty, a precise assessment of any preoperative eyelid asymmetry is essential. OBJECTIVES The authors describe a method of assessing preoperative eyelid asymmetry through readily available software and classifying the resulting measurements. METHODS Digital images of 204 patients were analyzed using Photoshop CS3 Extended software (Adobe Systems, San Jose, California). The left eye was superimposed over the right eye using layers in the software program, and the lower eyelid margin and axis were outlined to obtain a diagram with the superimposed outlines of both eyes. Several measurements (ie, lateral canthal height, lower eyelid margin length and axis angle, and lower palpebral fissure surface area) were obtained for each patient. Differences between the right and left eyelids were recorded, and these data were compared between patients. RESULTS Of the 204 patients studied, 184 (90.2%) had some degree of asymmetry. Most (118; 64.13%) presented with the right lower eyelid at a more inferior position than the left (R-), while 66 (35.87%) presented with the right lower eyelid at a higher position than the left (R+), a difference that was highly significant (P < .001). CONCLUSIONS This software is a powerful and precise tool to evaluate and measure eyelid asymmetries. The use of this method showed a large degree of eyelid asymmetry preoperatively (more than 90%), which proves the importance of detecting and adequately analyzing this condition prior to surgery. The authors' simple method may be an important adjunct to obtaining optimal results in patients who seek eyelid surgery.
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Affiliation(s)
- Francisco G. Bravo
- Dr Bravo is Assistant Professor of Plastic Surgery at the Complutense University of Madrid and Program Director of the Plastic and Reconstructive Surgery Department of the Doce de Octubre University Hospital in Madrid, Spain
| | - Matias Kufeke
- Dr Kufeke is a plastic surgery resident at the Doce de Octubre University Hospital in Madrid
| | - David Pascual
- Dr David Pascual was a biostatistics and cardiology specialist and a faculty member of the Cardiology Department of the Gregorio Maranon University Hospital in Madrid. He passed away on May 9, 2011, during the study period
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Fagien S, Walt JG, Carruthers J, Cox SE, Wirta D, Weng E, Beddingfield FC. Patient-reported outcomes of bimatoprost for eyelash growth: results from a randomized, double-masked, vehicle-controlled, parallel-group study. Aesthet Surg J 2013; 33:789-98. [PMID: 23873891 DOI: 10.1177/1090820x13495887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hypotrichosis of the eyelashes may negatively influence an individual's self-perception and appearance. Assessing the impact of treatment from a patient's perspective may be particularly relevant in trials of aesthetic agents. Once-daily dermal (topically applied) administration of bimatoprost ophthalmic solution 0.03% has been associated with increased eyelash prominence (ie, length, thickness, darkness). OBJECTIVES The authors assess patient-reported outcomes (PRO) after treatment with bimatoprost for hypotrichosis of the eyelashes. METHODS In this multicenter, double-masked, randomized, vehicle-controlled, parallel clinical trial, 4 PRO questionnaires were distributed to 278 patients (bimatoprost [n = 137] and vehicle [n = 141]). The primary PRO questionnaire was the 23-item Eyelash Satisfaction Questionnaire (ESQ), which measured satisfaction in 3 domains: length, fullness, and overall satisfaction (LFOS); confidence, attractiveness, and professionalism (CAP); and impact on daily routine (DR). RESULTS By week 16, the bimatoprost group reported significantly greater improvements from baseline on all ESQ items (P ≤ .0433). These improvements were sustained through the 4-week posttreatment study visit. Patient satisfaction was significantly greater in the bimatoprost group than in the vehicle group for all 3 domains: LFOS (weeks 8-20; P ≤ .0052), CAP (weeks 12-20; P < .0001), and DR (weeks 16 and 20; P ≤ .01). CONCLUSIONS The bimatoprost group reported significantly greater levels of positive patient outcomes and satisfaction than the vehicle group across all 23 questions and all 3 domains of the primary PRO questionnaire. These results support the effectiveness, as measured by objective measures and PRO, of once-daily bimatoprost ophthalmic solution 0.03% at producing more prominent eyelashes in adults.
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Abstract
BACKGROUND Dysfunction and/or dehiscence of the lateral canthus is 1 source of symptomatic eyelid closure disorder after blepharoplasty. Because the resulting concentric blinking movement resembles mouth closure in a fish, the name "fishmouthing" syndrome (FS) was given to this condition. Fishmouthing syndrome appears to be an overlooked complication of blepharoplasty. OBJECTIVES The authors performed dynamic assessments of patients who had eyelid discomfort after blepharoplasty to establish the clinical signs of FS. METHODS Preoperative and postoperative videos of 36 patients who presented for secondary blepharoplasty were analyzed retrospectively. All 36 patients experienced symptoms of dry eyes and eye discomfort after their initial blepharoplasty and desired symptomatic and cosmetic improvement. The dynamic signs and diagnostic criteria for FS were established clinically and through video analysis of patients' blinking movements. RESULTS The most common clinical characteristics of FS included lash deformity ("cow lash" sign), abnormal medial displacement of the lateral canthus during blinking, deformity (rounding/narrowing) of the lateral scleral triangle, and visible eyelid closure deficiency or gapping. Other characteristics were lower-lid retraction and compensatory hypercontraction of the orbicularis oculi adjacent to the inner canthus. CONCLUSIONS Patients with FS present with a combination of clinical symptoms and signs and are best diagnosed through dynamic visualization of the animated tissue during blinking. Evaluation of preoperative videos is an essential tool for surgical planning and for analyzing the results, both before and after corrective surgery, in patients with potential FS. LEVEL OF EVIDENCE 4.
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