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Biomedical subjects

D R Jordan

Publications and source records attributed to D R Jordan.

At least 55 records · Page 3Linked to original sources
PubMed1999

Wrapping hydroxyapatite implants.

Hydroxyapatite (HA) implants currently are most commonly wrapped in fresh unprocessed human donor sclera before implantation to facilitate entry into the orbital space and allow extraocular muscle attachment. Autologous temporalis fascia or autologous fascia lata are alternatives, but prolong surgery time and require a second operative site. Recently, a number of other wraps, such as processed human pericardium, processed human fascia lata, processed human sclera, bovine pericardium and expanded polytetrafluoroethylene [e-PTFE], have being marketed. Although they also facilitate implant placement, they can be costly. Polygalactin (Vicryl, Ethicon, Somerville, NJ) mesh is another readily available wrap that is easy to use and cost effective. To obtain a high success rate with this wrap, the polygalactin mesh wrapped HA implant must be moistened and seated into the orbit properly. If it is not, exposure may occur, which may explain why some surgeons shy away from its use. The proper technique is reviewed in this paper.

Biocompatible Materials↗
PubMed1999

Jones tube insertion in children with canalicular agenesis.

The purpose of this report is to describe a simplified method of Jones tube insertion in the management of pediatric patients with symptomatic upper and lower punctal and canalicular agenesis. A 5-year-old female with bilateral upper and lower canalicular agenesis, and a 4-year-old male with agenesis of the right upper and lower canaliculi, underwent placement of Jones tubes without performing standard external conjunctivodacryocystorhinostomy. The first child requiring bilateral Jones tube insertion has remained asymptomatic for 24 months. The Jones tube dislodged in the second patient 6 weeks postoperatively. The tube was replaced, and the child has been asymptomatic for 16 months. The technique of Jones tube insertion without a previous or concomitant external dacryocystorhinostomy may be a useful modification in the management of pediatric patients with symptomatic upper and lower canalicular agenesis.

Child, Preschool↗
PubMed1999

Bilateral eyelid edema: an uncommon presentation of Rosai-Dorfman disease.

PURPOSE: Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is a rare entity with ophthalmic manifestations in 11% of patients. Orbital and eyelid involvement as the presenting features is even more unusual. METHODS: The authors report the clinical findings of a 41-year-old man with Rosai-Dorfman disease presenting as eyelid edema. Biopsy of the involved tissue was analyzed by light microscopy. RESULTS: Histologically the orbicularis muscle contained a patchy infiltrate of lymphocytes, plasma cells, and large pale histiocytes. The histiocytes had lymphocytes within them, a condition referred to as lymphocytophagocytosis. CONCLUSIONS: Rosai-Dorfman disease is a rare clinical entity that may occasionally manifest with eyelid edema. Biopsy reveals a characteristic histopathologic picture.

Adult↗
PubMed1998

Ptosis in Waldenström's macroglobulinemia.

PURPOSE: To report a case of chronic, progressive unilateral blepharoptosis in a 73-year-old woman with Waldenström's macroglobulinemia. METHOD: Case report. A biopsy was performed on a thickened and indurated tarsal plate that we believed had resulted in mechanical blepharoptosis. RESULTS: Histologic and immunohistochemistry studies of the biopsy specimen demonstrated a lymphoplasmacytoid cell infiltrate with monoclonal antibodies consistent with Waldenström's macroglobulinemia. CONCLUSION: Involvement of the tarsal conjunctiva and tarsus in Waldenstrom's macroglobulinemia is a newly recognized cause of eyelid thickening and ptosis.

Aged↗
PubMed1998

Necrotizing fasciitis caused by group A streptococcus infection after laser blepharoplasty.

PURPOSE: To describe a patient who developed early signs of necrotizing fasciitis after undergoing laser blepharoplasty. METHODS: A 36-year-old woman developed wound discharge, wound dehiscence, and facial swelling 66 hours postblepharoplasty. Cloxacillin was administered but changed to high-dose intravenous penicillin G and clindamycin when the eyelid cultures grew group A streptococcus (an organism capable of causing necrotizing fasciitis organism). RESULTS: The patient was treated with intravenous antibiotics for 10 days followed by 3 weeks of oral medications. The wounds healed spontaneously with an excellent result. CONCLUSIONS: Infection postblepharoplasty is rare. When it occurs, tissue destruction can be potentially devastating. Prompt diagnosis, intravenous antibiotics, and close follow-up are essential.

Administration, Oral↗
PubMed1998

Spindle-cell lipoma of the preseptal eyelid.

An 82-year-old woman had experienced progressive enlargement of a long-standing left upper lid mass for 3 weeks. The superior visual field was compromised secondary to mechanical ptosis from this lid lesion. Computed tomography showed a large lid mass with a low density signal, similar to intraorbital fat. The tumor was completely excised. Histopathologic examination showed an encapsulated tumor composed of mature adipose tissue interspersed with fibrovascular septa containing spindle-cells, confirming a diagnosis of spindle-cell lipoma.

Aged↗
PubMed1998

Use of temporalis fascia for exposed hydroxyapatite orbital implants.

The hydroxyapatite implant (Bio-Eye, Intergrated Orbital Implant, Inc., San Diego, CA, U.S.A.) has gained increasing popularity as an orbital implant in recent years. Several complications may occur, including infection, exposure, extrusion, and various peg problems. Exposure of the implant appears to be the most common complication, ranging up to 21.6%. Many techniques, including nonsurgical and surgical approaches, have been described to manage these exposures. When surgery is indicated, a patch graft may be required to cover the defect. We report our experience and technique with autogenous temporalis fascia as a patch graft. Autografts such as temporalis fascia are easily obtained, bring about no immunological reaction, and have no risk of infectious transmission.

Adult↗
PubMed1998

A synthetic hydroxyapatite implant: the so-called counterfeit implant.

This article evaluates three generations of synthetic hydroxyapatite implants in a rabbit model. Fourteen New Zealand white rabbits received synthetic hydroxyapatite orbital implants (first, second, and third generation). The rabbits underwent enucleation of one eye and then received a 12-mm synthetic hydroxyapatite implant wrapped in Vicryl (polygalactin 910; Ethicon, Inc.) mesh or sclera. Magnetic resonance imaging was conducted to assess host fibrovascularization of the implant 4 and 12 weeks after implantation. Animals were killed at each of these times and the implant was removed for histopathologic examination. Enhancement on magnetic resonance imaging and extent of fibrovascularization by histopathologic examination were assessed. The first-generation synthetic hydroxyapatite (FCI, Issy-Les-Moulineaux, France) was not 100% hydroxyapatite as is the Bio Eye (Integrated Orbital Implants, Inc., San Diego, CA, U.S.A.). It contained 3.2% calcium oxide. The implant was heavier and much less porous than the original Bio Eye implant. Central vascularization eventually occurred but was not extensive. The second-generation implant was more porous than the first, with rapid central vascularization to the center of the implant by 4 weeks. However, the second-generation implant was very fragile and crumbled easily. The second-generation synthetic implant was chemically identical to the original Bio Eye implant with no calcium oxide. The third-generation implant was more porous than its predecessors. When compared side by side with the Bio Eye, a difference in pore uniformity and interconnectivity seems apparent. However, an early extensive vascularization pattern to the center of the implant is seen histopathologically, similar to that with the Bio Eye. Magnetic resonance imaging also shows extensive enhancement as is the case with the Bio Eye. The third-generation synthetic implant is not fragile as was the second-generation implant, and chemically it is identical to the Bio Eye with no calcium oxide present. The third-generation implant is approximately half the price of the original Bio Eye implant.

Animals↗
PubMed1998

The synthetic hydroxyapatite implant: a report on 65 patients.

Sixty-five patients receiving the FCI synthetic hydroxyapatite implant (FCI3, FCI, Issy-Les-Moulineaux, France) after enucleation, evisceration, or as a secondary implant were studied under human trial guidelines established by Health and Welfare Canada. The implant is chemically identical to the original coralline Bio Eye (Integrated Orbital Implants Inc., San Diego, CA, U.S.A.), is easy to work with, and was implanted without difficulty using a wrap of polygalactin 910 (Vicryl mesh, Ethicon, Inc.) in the majority of patients. Postoperative drilling was carried out at approximately 6 months and found to be much easier than drilling of the Bio Eye. The implant could be hand drilled using drill bits rolled between the thumb and index finger. Postoperatively, patients were followed-up from 7 to 24 months and did not have any problems different from those associated with the original hydroxyapatite implant derived from sea coral (Bio Eye). One case of conjunctival dehiscence occurred at 4 weeks and required a temporalis fascia patch graft to repair. One implant became infected after drilling and had to be removed. The motility obtained with the third-generation FCI implant (FCI3) was similar to that seen with the Bio Eye, in comparable patients. That is, those receiving implants after an evisceration, on the whole, had better motility than those receiving an implant after primary enucleation or secondary implantation. The FCI3 hydroxyapatite implant is a viable alternative to the original Bio Eye hydroxyapatite implant. It's advantages are: 1) reduced cost, and 2) ease of drilling (a motorized drill is not required). The implant was given Health and Welfare approval in Canada on February 26, 1997.

Biocompatible Materials↗
PubMed1998

An unusual complication associated with hard palate mucosal grafts: presumed minor salivary gland secretion.

Hard palate grafts are commonly used in eyelid reconstructive procedures as a replacement for posterior lamellar defects. Four patients are presented with an unusual complication after placement of a hard palate graft: presumed minor salivary gland secretion. They were experiencing stringy mucous discharge over the graft and along the eyelids, causing visual blurring. Removal of the graft in one patient and cryotherapy to the grafts in the others (presumably causing atrophy of the minor salivary gland tissue found within the grafts) allowed resolution of symptoms. The authors propose the application of cryotherapy to the graft surface to atrophy the salivary glands, prevent any further production of mucus, and return the tear film to a more normal consistency. Alternatively, surgical removal of the grafts can be performed. To our knowledge, this complication (saliva-like mucoid discharge) has not been previously reported.

Adult↗
PubMed1998

Ruptured globe during orbital decompression surgery.

A 74-year-old patient sought treatment for visual obscuration and clinically had signs of Graves orbitopathy. Past medical history was unremarkable except for the use of antihypertensive medication. During the hospital admission, a fluorescent treponemal antibody absorption test was reactive, indicating infection with syphilis at some time in the past. Visual deterioration despite oral corticosteroid therapy prompted orbital decompression. At the time of surgery, she sustained a globe rupture. Presumably, syphilitic scleritis was responsible, in part, for scleral thinning and weakening, predisposing her to this complication. To the authors' knowledge, globe rupture has not been previously reported during orbital decompression.

Aged↗
PubMed1998

Intervention within days for some orbital floor fractures: the white-eyed blowout.

Management of blowout fractures involving the orbital floor has been controversial over the past several decades. One school of thought recommends conservative treatment for 4 to 6 months while another recommends a 'wait and watch' period of 2 weeks before intervention. The authors have encountered a group of patients with such fractures, commonly children (less than 16 years of age), who have sustained a blow to the periocular area, yet have marked motility restrictions in up and down gaze, minimal soft tissue signs of trauma, lack of enophthalmos, and very minimal evidence of floor disruption on radiologic exam. A 2-week waiting period has been found to be of little benefit in these persons and possibly harmful to their motility. We advocate surgery within the first few days after injury as it may help to avoid permanent motility restriction. The authors have termed this entity 'the white-eyed blowout fracture.'

Adolescent↗