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Biomedical subjects

A M Putterman

Publications and source records attributed to A M Putterman.

At least 37 records · Page 2Linked to original sources
PubMed1994

Lid crease and capsulopalpebral fascia repair in congenital entropion and epiblepharon.

Forty-one eyelids of 21 patients with congenital entropion or epiblepharon underwent transcutaneous reconstruction of the eyelid crease and retractor (capsulopalpebral fascia). All of the patients demonstrated lack of cutaneous-capsulopalpebral fascia attachment. In contrast with the patients with epiblepharon, those with congenital entropion also had partial or complete absence of tarsal-capsulopalpebral fascia attachment. Surgical treatment included anastomosis of the capsulopalpebral fascia, tarsal border, and eyelid skin crease; no skin or muscle was removed. With a minimum follow up of 1 year, malposition recurred in 3 of the 33 (9%) eyelids with epiblepharon, and in none of the 8 eyelids with entropion.

Adolescent↗
PubMed1993

Composite grafting for eyelid reconstruction.

Viable composite grafting is a technique used in eyelid reconstruction in which the graft is obtained from the contralateral eyelid. We reviewed the charts of 51 patients who underwent composite grafting of the eyelid since 1983. The average horizontal length of the defect repaired with this technique was 17.3 mm, and the most common indication for its use was basal cell carcinoma. Postoperatively, 39 (91%) of the 43 patients with available measurements had within 2.0 mm of palpebral fissure symmetry. Furthermore, this method of reconstruction allows survival of the eyelid margin and eyelid margin cilia. Composite grafting of the eyelid is a valuable method for eyelid reconstruction that provides acceptable cosmetic results.

Adolescent↗
PubMed1993

Postoperative mydriasis after repair of orbital floor fracture.

Mydriasis after operative repair of orbital floor fracture has been attributed to manipulation of the inferior oblique muscle. We treated two patients with mydriasis, one with an isolated mydriatic pupil and the other with a tonic pupil, which followed posterior orbital floor injuries and repair. The posterior location of the fractures suggests that surgical manipulation of or near the ciliary ganglion may account for these phenomena. Patients should be warned before posterior orbital floor repair about possible mydriatic or tonic pupils as a complication.

Adult↗
PubMed1993

Acquired blepharoptosis secondary to essential blepharospasm.

We treated four patients with essential blepharospasm, receiving botulinum A toxin, in whom, although they had no preexisting blepharoptosis, a concurrent bilateral acquired blepharoptosis developed. Since the blepharoptosis did not improve after the period of time during which the effects of botulinum A toxin would have been expected to resolve (2 to 10 weeks), we judged that its development was unrelated to the toxin. We propose, rather, that the stretching, attenuation, disinsertion, or dehiscence of the upper eyelid levator muscle caused by the blepharospasm were at least partly responsible for the onset of the blepharoptosis. To ensure appropriate treatment in these cases, careful clinical evaluation is required to differentiate the two conditions.

Aged↗
PubMed1992

Treatment and prognosis of orbital non-Hodgkin's lymphomas.

Twenty patients with orbital lymphomas were treated and followed over a 14-year period. Ten of these patients had well-differentiated lymphocytic lymphoma (WDL), and all of them were clinical stage IE. Five patients had nodular poorly differentiated lymphocytic lymphomas (NPDL), three patients had diffuse histiocytic lymphomas (DHL), one had nodular mixed-cell lymphoma, and one had diffused mixed-cell lymphoma. The patients with WDL received local radiation therapy, and all of them entered completed remissions. The projected survival at 10 years was 100% for these patients. The patients with low-grade lymphomas with advanced disease were treated with chlorambucil and prednisone or cytoxan and vincristine. The patients with high-grade lymphomas received treatment with methotrexate, cyclophosphamide, doxorubicin, vincristine, bleomycin, dexamethasone (mBACOD) or cyclophosphamide, vincristine, methotrexate, cytosine arabinoside, leucovorin (COMLA). The overall survival estimate for all patients was 63% at 10 years. The disease-free survival was 49% at 10 years. The patients with high-grade lymphomas had a poor prognosis, with no survivors after 4 years. This study suggests that patients with WDL usually present with localized disease to the involved orbit, and have an excellent prognosis with radiation therapy alone. Patients with high-grade orbital non-Hodgkin's lymphomas have a poor outcome despite use of aggressive combination chemotherapy regimens.

Aged↗
PubMed1992

Surgical treatment of thyroid-related lower eyelid retraction: a modified approach.

A 15-year retrospective study was performed in 68 patients who underwent scleral implantation for correction of lower eyelid retraction related to Graves' disease. Three variations of the scleral implantation procedure were used over three time periods. Scleral grafting alone ("old" procedure) was performed in 53 patients from 1974 to 1985. Because of persistent lower lid retraction postoperatively, this procedure was modified. Beginning in 1986, a lateral canthal suspension consisting of either a lateral tarsal strip or a lateral tarsorrhaphy was added to the scleral implantation ("intermediate" procedure) and was performed in seven patients. Since 1988, the procedure has been further modified to include both a lateral tarsal strip and a lateral tarsorrhaphy ("new" procedure). Eight patients underwent this procedure. Analysis with Student's t test indicated a statistically significant reduction in lower lid retraction when using the new procedure, as measured by a reduction in the margin reflex distance-2, the distance from the corneal light reflex to the central lower lid (p = 0.02), and by a reduction in inferior central scleral show, the distance from the central lower lid to the inferior limbus (p = 0.02). An analysis of covariance, controlling for age, Hertel exophthalmometry readings, and length of follow-up, also indicated that the reduction in the postoperative margin reflex distance-2 was significant (p = 0.04).

Adult↗
PubMed1992

Bilateral dacryocystitis after punctal occlusion with thermal cautery.

A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.

Anti-Bacterial Agents↗
PubMed1992

Conventional frozen sections in periocular basal-cell carcinoma: a review of 236 cases.

Two hundred thirty-six periocular basal-cell carcinomas were resected under conventional frozen-section control. Only two tumors recurred, yielding a success rate of 99.2%. The mean follow up was 56 months. Eighty-one of the 236 patients were followed for at least 5 years; the 5-year cure rate was 97.5%. To our knowledge, this is the largest reported series of periocular basal-cell carcinoma resected under conventional frozen-section control; also, we believe the follow-up data are superior to those of previous series. The high success rates with conventional frozen-section techniques in this and other series are comparable to those reported for the Mohs micrographic techniques.

Adult↗
PubMed1991

The domed dermis-fat graft orbital implant.

Dermis-fat grafts have been widely used in the reconstruction of the anophthalmic socket, both primarily after enucleation and secondarily after extrusion or migration of an existing implant. The dermis-fat graft is an effective means of replacing orbital volume and affording motility of the ocular prosthesis with both low morbidity and a satisfactory cosmetic result. We present a modification to the dermis-fat graft technique. Our modification creates a domed shape to the anterior surface of the graft that simulates the curvature of the eye. The dome-shaped graft creates deeper fornices than a standard flat-surfaced dermis-fat graft. It also allows better contact between the prosthesis and the dermis as the graft moves. The prosthesis can be thinner centrally and lighter than a prosthesis fabricated for a socket with a standard dermis-fat graft or spherical implant. This results in better motility of the prosthesis while also replacing orbital volume. There is no additional morbidity associated with this technique. We have used this procedure successfully in 18 patients; 10 were primary grafts and eight secondary grafts. Motility of the prosthesis was satisfactory in all cases. There was no abnormal graft shrinkage. All grafts maintained their domed shape. Follow-up ranged from 6 to 21 months.

Adipose Tissue↗
PubMed1991

Canaliculectomy in the treatment of keratitis sicca.

In patients with keratitis sicca (exposure keratopathy) in whom treatment with topical tear solutions and ointments is not effective, closure of the lacrimal puncta is performed with insertion of plugs or by cautery, hypercation, or laser. If punctal occlusion fails with these modalities, surgical excision of the canaliculi is recommended. Canaliculectomy successfully relieved ocular irritation and keratopathy in three patients with keratitis sicca, with no complications (follow-up, 10 to 26 months).

Follow-Up Studies↗
PubMed1991

Adrenal suppression and growth retardation after injection of periocular capillary hemangioma with corticosteroids.

Adrenal suppression and/or growth retardation were noted in two patients after injection of periocular capillary hemangiomas with corticosteroids. Parents should be warned of these two potential complications of intralesional corticosteroid therapy. Baseline and posttreatment adrenal function should be monitored. If iatrogenic adrenal suppression occurs, supplemental systemic corticosteroids may be necessary in situations involving systemic stress such as infection or surgery.

Adrenal Cortex Hormones↗
PubMed1990

Recurrent conjunctival papilloma causing nasolacrimal duct obstruction.

We treated two patients who had recurrent conjunctival papillomas that invaded the nasolacrimal sac and caused complete canalicular and nasolacrimal duct obstruction. The ophthalmologist should be aware of the possibility of a conjunctival papilloma invading the lacrimal sac when treating patients with conjunctival papillomas. Excision should be complete, and adjunctive therapy such as cryotherapy should be considered to reduce the chance of tumor recurrence.

Adult↗
PubMed1990

Scalpel neodymium:YAG laser in oculoplastic surgery.

In a three-year study, the scalpel Nd:YAG laser was compared with conventional surgery in 18 patients who underwent oculoplastic surgery. The postoperative follow-up was at least eight months. The contact Nd:YAG laser had distinct advantages over conventional surgery in the treatment of vascular orbital tumors, including less perioperative bleeding and a shorter operating time. In other oculoplastic procedures, ten of the 18 patients underwent surgery with the scalpel Nd:YAG laser on one side and conventional surgery on the other side. There was less bleeding, a shorter operating time, and less pain on removal of orbital fat on the laser-treated side. The postoperative scarring was initially more noticeable on the Nd:YAG laser-treated side, but after three months there was no appreciable difference in scar formation between the two sides. The amount of postoperative edema and ecchymosis did not appear to be significantly different with the Nd:YAG laser compared with conventional surgery. Additionally, microscopic evaluation showed minimal charring of tissues with the Nd:YAG laser.

Dermatologic Surgical Procedures↗
PubMed1990

A 16-year study of conjunctival dacryocystorhinostomy.

We reviewed a consecutive series of 79 conjunctival dacryocystorhinostomies performed over a 16-year period in 75 patients. Thirty-eight of 75 patients with canalicular blockage between the common canaliculus and the first 5 mm of the canaliculus as well as patients with common canalicular blockage who had failed previous dacryocystorhinostomy were treated with combined canalicular reconstruction, nasal lacrimal intubation, and conjunctival dacryocystorhinostomy. In 37 patients, less than 5 mm of proximal canaliculus remained open. These patients were treated with conjunctival dacryocystorhinostomy alone, including four patients who had bilateral procedures. Two of 38 patients who underwent combined canalicular and conjunctival procedures required further surgery for a successful outcome compared with 14 of 37 patients who underwent conjunctival dacryocystorhinostomy without canalicular reconstruction (P = .002). Overall, 71 of 74 patients (96%) had a successful outcome, and five patients were lost to follow-up.

Adolescent↗