Nir Seider

Effect of timing of external dacryocystorhinostomy on surgical outcome.

Purpose: To present our experience with external dacryocystorhinostomy (DCR) outcome and to compare cases of early and late DCR. Methods: Retrospective data review of all patients who had external DCR with silicone intubation in a 7-year period. Data were collected and analyzed concerning patients’ preoperative and postoperative symptoms, and the lacrimal drainage system examination before, during, and after surgery. Results: In all, 162 patients underwent 195 DCR surgeries for nasolacrimal duct obstruction. Success was achieved in 81% of surgeries. Success rates were higher in patients who had early DCR (tearing only or early inflammatory signs of the lacrimal sac, 84% success) than in cases that had late DCR (more than 6 months after inflammation started, 77% success). These differences were statistically insignificant. Failure of DCR was much higher in posttraumatic DCR than in DCR for other etiologies. Complications (in 9% of surgeries) were generally mild and infrequent, except 1 case of meningitis. Conclusions: In experienced hands, external DCR has good postoperative success with a low complication rate. Early DCR does not have a substantial advantage over late surgery with regard to surgical outcome.

Orbital fractures complicated by late enophthalmos: higher prevalence in patients with multiple trauma.

Purpose: To present our experience with orbital fracture treatment outcomes in patients with multiple trauma and those suffering localized orbital trauma. Methods: Retrospective data review of all patients examined for ocular motility problems and/or enophthalmos following orbital trauma in a 4-year period. Results: Forty-three patients were included in the study: 31 (72%) had localized orbital trauma (LOT) and 12 (28%) had concomitant traumatic insults to other organs (MT). More orbital walls were affected in MT patients than in LOT patients, and the incidence of zygomatic fracture was higher in MT patients. Late enopthalmos was much more prevalent in the MT group compared with the LOT group. Differences of outcome of extra ocular motility disturbance between groups in our series did not reach statistical significance. Conclusions: The findings of more walls affected and higher incidence of zygomatic fractures in MT patients probably represent a stronger impact of the original insult, causing both more damage to other organs and more severe damage to the orbit. The increased rate of late enophthalmos in MT patients may be associated with their primary presentation to the emergency room with potentially life-threatening injuries. Under such circumstances, thorough ophthalmologic examination is nearly impossible, both because the patient cannot cooperate sufficiently and because medical priorities dictate concentration on taking care of the injuries threatening life. The lack of a thorough ophthalmic examination prevents early comprehensive treatment.

Posterior lamellar gold-weight extrusion.

We report a case of a man who had undergone gold eyelid loading for lagophthalmos 22 years earlier. During examination for a complaint of foreign body sensation in the operated eye, the gold weight was found under the palpebral conjunctiva. Although extrusion of a gold weight through the skin anteriorly is well recognized, posterior extrusion has not been previously reported. Although such an extrusion involves tarsal plate erosion, the patients complaints in this case were minor, probably due to the chronic nature of the process. This finding should serve to draw the attention of surgeons using gold eyelid loading to the possible, albeit rare, complication of posterior extrusion.

Congenital Combined Orbito-Nasal Lipoblastoma: Clinico-Pathologic Study

The authors present the clinical picture, histopathologic findings and surgical treatment of an infant born with a lipoblastoma involving an unusual combined orbito-nasal location. To the best of our knowledge, this is the first report of congenital lipoblastoma extension from orbit to the nasal cavity. Transconjunctival orbitotomy with excisional biopsy of tumor was performed. Histology specimen that demonstrates the small embryonal fat cells in different stages of maturation and the characteristic lobulation of the fat tissue are presented. The embryonic origin, timing of development of the tumor during gestation, as well as the route of propagation from orbit to nose are discussed. The authors conclude that complete excision of this tumor, with preservation of normal tissue, may bring cure to the young patient without gross functional deformity.

Haptoglobin phenotype in age-related macular degeneration patients ☆

PURPOSE To investigate a possible role of the haptoglobin phenotype in the development of exudative age-related macular degeneration (AMD) in human subjects. DESIGN Prospective, observational, comparative population study. METHODS The study was carried out in an institutional setting. All patients referred because of exudative AMD in one eye during an 18-month period were included in the study group. A group of patients treated for other ocular diseases and not having AMD in either eye served as control. Haptoglobin phenotype was determined from a blood sample drawn from each patient in both the study and control groups. The main outcome measure was the distribution of the haptoglobin phenotype in the study and control group. RESULTS One hundred eighty-five participants were included in the study. Ninety-eight had exudative AMD, and 87 were AMD-free. The difference between the study and control groups in distribution of the haptoglobin phenotype was found to be statistically insignificant. CONCLUSIONS Our results suggest that the haptoglobin phenotype has no effect on the prevalence of exudative AMD.