Nachum Rosen

Transcanalicular laser-assisted dacryocystorhinostomy

BACKGROUND AND OBJECTIVEnCurrent techniques of laser-assisted dacryocystorhinostomy are mostly endonasal. In this report, the authors describe their technique of laser-assisted dacryocystorhinostomy performed through the canaliculi and the surgical results they achieved.nnnPATIENTS AND METHODSnFourteen patients with nasolacrimal duct obstruction underwent transcanalicular laser-assisted dacryocystorhinostomy. The bony ostium was perforated using a fiber optic-transmitting, giant-pulse Nd:YAG laser, with an energy of 0.5 to 4 J per pulse. The total energy used to create an ostium was 18 to 34 J. A silicone tube was inserted through the canaliculi and the ostium into the nasal cavity and kept in place for 5 to 7 months. Patients were observed for 18 to 22 months.nnnRESULTSnNine of the 14 patients (64%) reported the disappearance of epiphora following surgery. In 3 patients, no relief of epiphora was obtained. In 1 patient the operation was not completed because of severe nasal bleeding. In another, tearing began 12 months after surgery (6 months after tube removal).nnnCONCLUSIONSnTranscanalicular laser-assisted dacryocystorhinostomy is a potentially useful method for performing dacryocystorhinostomy. Technical modifications and improvements are needed to increase the success rate.

Relapsing migratory idiopathic orbital inflammation: six new cases and review of the literature

Aims To present a case series of relapsing migratory idiopathic orbital inflammation. Patients and methods Case series and review of the literature. The medical records of six patients with recurrent orbital myositis or idiopathic inflammation at different sites treated at the Goldschleger Eye Institute between April 2006 and December 2009 were collected and analysed; one patient treated at the orbital service in Priyamvada Birla Aravind Eye Hospital, Kolkata, India, was also included (June 2008 to August 2010). Orbital biopsy was performed in patients who failed to respond to steroids treatment. Results A total of six patients with recurrent episodes of orbital myositis or inflammation were identified. Four patients had orbital myositis of one extraocular muscle at the initial episode and recurrent myositis of a different extraocular muscle on the contralateral orbit. One patient had recurrent myositis of a different extraocular muscle on the same orbit. Two patients had a third episode of recurrence on a different site, that is, an extraocular muscle or an eyelid. One patient had eyelid and soft tissue involvement on one orbit and recurrence of orbital myositis on the contralateral eyelid. Histological findings in the latter case showed small perivascular lymphocytic aggregates and scattered histiocytes. The mean time for recurrence was 7.2u2005months. All patients were treated successfully with oral steroids and/or intralesional triamcinolone injection. Conclusions Idiopathic orbital inflammation or orbital myositis can recur on a different extraocular muscle and on the contralateral orbit. These cases can be successfully treated with orally administered or intralesionally injected steroids.

Successful Treatment With Mitomycin C Eye Drops for Conjunctival Diffuse Intraepithelial Neoplasia With Sebaceous Features

Conjunctival biopsy specimens from the right eye of a 66-year-old woman who had a 10-year history of an irritated and swollen right upper eyelid were diagnosed as diffuse intraepithelial neoplasia with sebaceous features. The treatment consisted of two courses, 2 weeks apart, of 0.02% mitomycin C eye drops. Biopsies performed after completion the second course showed no evidence of neoplastic involvement. Severe trichiasis that developed after the biopsies was managed surgically. Today, 46 months after completion of mitomycin C treatment, the conjunctiva shows no inflammation, the eyelid is not swollen or irritated, and there is no clinical indication of recurrence. This case report demonstrates that conjunctival diffuse intraepithelial neoplasia of the conjunctiva with sebaceous features can be successfully treated by treatment with mitomycin C drops.

Repair of the severely contracted socket with meshed skin graft and semi-rigid conformer

Nine severely contracted sockets were reconstructed using a meshed skin graft in conjunction with a semi-rigid conformer-stent. Particularly useful following unsuccessful surgery with mucosal grafting, or in cases where for some reason mucosal grafts cannot be obtained, this technique is superior to current procedures utilizing nonmeshed split-thickness skin grafts.

Cryo‐assisted anterior approach for surgery of retroocular orbital tumours avoids the need for lateral or transcranial orbitotomy in most cases

Acta Ophthalmol. 2010: 88: 675–680

Comparison of lateral orbital decompression with and without rim repositioning in thyroid eye disease

PurposeRim-off lateral wall decompression may be associated with functional and cosmetic deficit. Our objective, therefore, was to describe the functional and cosmetic results of deep lateral orbital decompression with and without anterior rim repositioning for thyroid eye disease.MethodsIn this retrospective comparative case series all consecutive thyroid eye disease patients who underwent deep lateral wall decompression at the Royal Victorian Eye and Ear Hospital between 1990–2007 and the Goldschleger Eye Institute, Sheba Medical Center between 2008–2011 were included. Patients were divided into two groups: the “rim-on” group in which the anterior lateral orbital rim was repositioned and the “rim-off” group in which it was left off. Main outcome measures were: proptosis reduction, postoperative oscillopsia and diplopia, presence of visible or palpable lateral orbit depression.ResultsOne hundred and twelve patients who underwent 186 orbital decompressions were included in the final analysis. The average proptosis reduction for two- and three-wall decompressions ranged between 4.6-4.9xa0mm in the rim-on and 4.6-5.7xa0mm in the rim-off group respectively. The prevalence of postoperative oscillopsia was similar in both groups. The preoperative diplopia worsened in 17 patients (32.1xa0%) in the rim-on group and in seven patients (12.3xa0%) in the rim-off group (Pu2009=u2009.02, chi-square test). None of the patients developed visible or palpable lateral orbit depression.ConclusionsDeep lateral orbital decompression without anterior rim repositioning may be an effective approach to enhance functional and cosmetic outcomes in thyroid eye disease patients without increasing the risk of lateral wall depression or postoperative oscillopsia.

Gunshot wound to the eye and orbit: a descriptive case series and literature review.

BACKGROUNDnThe objective of this study is to report ocular and orbital findings in a series of six patients (8 eyes) with gunshot wounds and to review the literature on the pathophysiology, management, and outcome of such patients.nnnMETHODSnRetrospective case series and review of the literature. Main outcome measures were ocular and orbital injury, surgical intervention, and presenting and final visual acuity.nnnRESULTSnSix male patients (mean age, 32 years) were enrolled. Three patients with globe concussion and low presenting visual acuity were treated by observation. Two patients (25%) underwent primary enucleation or evisceration. Retinal detachment developed in one patient who had a globe perforation, and he underwent vitrectomy and lensectomy with silicone oil injection. Visual acuity remained unchanged in all but one patient who underwent retinal detachment surgery. Final visual acuity was poor in all patients, with five eyes ending in no perception of light. Four patients had orbital fractures, two of whom underwent orbital reconstruction. One of these patients also underwent drainage of orbital abscess, eyelid surgery, and a dacryocystorhinostomy. The mean follow-up time was 26 months.nnnCONCLUSIONSnGunshot wounds to the eye and orbit cause severe open and closed ocular injuries with guarded outcome and poor visual acuity. When feasible, initial wound closure may preserve the globe and allow further surgical rehabilitation. Primary evisceration may be required in cases of a severely ruptured globe. Orbital surgery may be needed in cases of infection, orbital wall disruption with disfigurement, or late enophthalmos.

Nasal reconstruction combined with dacryocystorhinostomy in a patient with absence of half of the nose

This article describes a rare case of unilateral arhinia (congenital absence of half of the nose), in which total nasal reconstruction was performed. A glass Jones tube was used to create a new nasolacrimal duct connecting the lumen of the existing lacrimal sac to the contralateral normal nasal cavity.

Eyelid splitting and extirpation of hair follicles using a radiosurgical technique for treatment of trichiasis.

BACKGROUND AND OBJECTIVEnTo describe a new, simple, and rapid surgical modification for the treatment of trichiasis.nnnPATIENTS AND METHODSnIn this noncomparative, prospective, interventional case series, 12 eyelids of 8 consecutive patients suffering from acquired trichiasis were treated by splitting the eyelid margin using a radiosurgical technique and then extirpating the hair follicles. The main outcome measure was successful resolution of trichiasis without recurrence during a follow-up period of at least 1 year.nnnRESULTSnComplete recovery of the trichiatic eyelashes at the site of the treatment occurred in 10 of the 12 eyelids treated. There were no complications during or after healing of the surgical wound during the follow-up period.nnnCONCLUSIONnRadiosurgery provides a simple and rapid modification of the surgical treatment for acquired trichiasis, with good functional results.

Intrascleral Implantation of Glass Beads During Evisceration

BACKGROUND AND OBJECTIVEnTo review the results after small glass bead implantation in the scleral cavity during evisceration.nnnMATERIALS AND METHODSnIn this retrospective study, we retrieved the follow-up data of 17 patients who underwent evisceration with glass bead implantation from 1993 to 1996.nnnRESULTSnAll patients achieved good cosmetic results with good motility of the prosthesis. Complications included transient chemosis at the early postoperative period in 3 patients (17.6%), 1 patient (5.9%) with local dehiscence of the wound, 1 patient developed a cyst in the socket (5.9%), and 1 patient was afflicted with thinning of the conjunctiva over the surgical wound.nnnCONCLUSIONnThe use of glass beads to fill the scleral cavity during evisceration has the advantage of an excellent fit in accordance with the scleral cavity volume, as well as ease of treatment in case of extrusion. The prosthesis movement is good because of its engagement with the scleral bulges caused by the glass beads.