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Biomedical subjects

D R Jordan

Publications and source records attributed to D R Jordan.

At least 91 records · Page 5Linked to original sources
PubMed1996

The extended Jones tube.

Conjunctivo-dacryocystorhinostomy with a Jones glass tube serving as a conduit for tear flow is used in patients with epiphora resulting from obstructed canaliculi. The glass tube runs from the medial canthus into the nose. The author describes the use of an extended Jones tube in a patient without a nose.

Dacryocystorhinostomy↗
PubMed1996

The scleral filet technique for secondary orbital implantation surgery.

OBJECTIVE: To describe a simple procedure, the scleral filet technique, to place a secondary implant and take advantage of the scleral remnant. SETTING: Oculoplastic service at a university-affiliated hospital in Ottawa. PATIENTS: Three patients from Middle Eastern countries who had undergone evisceration following trauma without placement of an orbital implant. All three had a scleral remnant, enophthalmos and poor prosthetic motility. INTERVENTIONS: The scleral remnant was incised (fileted) in a crisscross fashion, allowing access to the retrobulbar space. A hydroxyapatite implant was placed, and the scleral remnants were closed without disrupting the muscle attachments, leaving the socket motility intact. RESULTS: All three patients had an uneventful postoperative course and were fitted with a prosthesis between 6 to 8 weeks. There was no implant exposure during the follow-up period of 8 to 15 months. Implant drilling and peg placement was carried out 6 to 10 months postoperatively. One of the patients had excellent motility, and two had good or fair motility. All were very satisfied with the results. CONCLUSIONS: Advantages of the scleral filet technique include simplicity, ability to use the patient's own vascularized scleral remnant to act as a protective cap over the implant and avoidance of donor material. We advocate the use of this procedure when a scleral remnant is present in a patient presenting for consideration of secondary implantation.

Adult↗
PubMed1995

Late proptosis following orbital floor fracture repair.

OBJECTIVE: Late proptosis is an unusual complication of orbital floor fracture repair. We report 12 cases and propose a classification scheme and differential diagnosis for this rare complication. DESIGN: Retrospective multi-institutional case review. SETTING: Two tertiary referral centers. RESULTS: We report 12 cases of late proptosis following orbital floor fracture repair. Causes of late proptosis include peri-implant inflammation, capsular hemorrhage, gelatin film cyst, implant infection, sino-orbital fistula, intraorbital sinus mucocele, and carotid-cavernous fistula. We describe the treatment of each case individually; in most cases, the implant was removed. All 12 patients had a satisfactory outcome after treatment. CONCLUSIONS: Proptosis presenting 2 months or more after orbital floor fracture is rare. We classify the origin of late proptosis into three groups: implant, sinus, and neurovascular. We describe the diagnosis and management of this unusual complication.

Adult↗
PubMed1995

The use of Vicryl mesh (polyglactin 910) for implantation of hydroxyapatite orbital implants.

Hydroxyapatite (HA) implants currently are most commonly wrapped in donor sclera before implantation to facilitate placement within the orbit and allow attachment of the extraocular muscles. Although the risk of acquiring a transmittable disease through donor sclera is extremely low, some individuals remain concerned about receiving nonautologous material. As an alternative to sclera, autologous temporalis fascia, or autologous fascia lata, we have been wrapping HA in "Vicryl mesh" before insertion into the orbit. The Vicryl mesh-wrapped implant goes into the socket readily, allows one to easily attach the extraocular muscles, and has no risk of transmittable disease. In addition, the Vicryl mesh is readily available at most hospitals and is dissolvable.

Durapatite↗
PubMed1995

Air guns: the main cause of enucleation secondary to trauma in children and young adults in the greater Ottawa area in 1974-93.

OBJECTIVES: To determine the proportion of enucleation procedures attributable to injuries from air guns in people aged 18 years or less and to identify the associated pathological findings. DESIGN: Case series. SETTING: Ophthalmic Pathology Registry, University of Ottawa, and affiliated Children's Hospital of Eastern Ontario (Ottawa), Ottawa General Hospital and Ottawa Civic Hospital. In addition, information on air gun injuries from April 1990 to December 1993 was obtained from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database, with data from 10 pediatric and 5 general hospitals across Canada. PATIENTS: All patients aged 18 years or less who underwent enucleation between Jan. 1, 1974, and Dec. 31, 1993. RESULTS: Eighty-five patients were identified as having undergone enucleation. Trauma accounted for 51 cases (60%), of which 13 (25%) were caused by air guns, the largest single cause of enucleation secondary to trauma. Overall, air gun injuries accounted for 15% of enucleation procedures, whereas retinoblastoma accounted for 21%. All air gun injuries were in boys (median age 14 years, range 9 to 16 years). Of the 13 eyes with air gun injuries 7 had ocular perforation and 6 had ocular penetration. In all cases the intraocular structures were severely disrupted. The CHIRPP database included 165 air gun injuries; 32 were to the eye or ocular adnexa, resulting in 26 hospital admissions. CONCLUSIONS: Air guns were the largest single cause of enucleation secondary to trauma in our study. These guns are widely available in Canada and are unrestricted at muzzle velocities capable of causing death or serious injury, especially to the eye. We feel that air guns should be licensed only to people aged 16 to 18 years or older and that education in their use should be mandatory.

Adolescent↗
PubMed1995

Vicryl-mesh wrap for the implantation of hydroxyapatite orbital implants: an animal model.

OBJECTIVE: To evaluate host fibrovascularization of hydroxyapatite orbital implants wrapped in sclera or in Vicryl (polyglactin 910) mesh in a rabbit model. NUMBERS: Eight adult New Zealand white rabbits that received hydroxyapatite orbital implants wrapped in homologous donor sclera (four animals) or Vicryl mesh (four animals). INTERVENTIONS: The rabbits had one eye enucleated and then received a 12-mm hydroxyapatite implant wrapped in sclera or Vicryl mesh. Magnetic resonance imaging (MRI) and bone scintigraphy were done to assess host fibrovascularization of the implant 4, 8, 12 and 20 weeks after implantation. Two animals (one in each group) were killed at each of these times, and the implant was removed for histopathological examination. MAIN OUTCOME MEASURES: Enhancement on MRI, uptake on bone scintigraphy, fibrovascularization seen on histopathological examination. RESULTS: The degree of fibrovascularization was substantial in all the specimens but appeared greater in the Vicryl-mesh-wrapped implants in the first 12 weeks after implantation on both histopathological and MRI studies. At 20 weeks these findings were similar in the two groups. A granulomatous foreign-body giant-cell reaction to both the Vicryl mesh and the implant itself was present up to 8 weeks after implantation. Bone scans showed only grade 1+ activity in all the implants. CONCLUSIONS: Host fibrovascularization in the rabbit appears to occur to a greater degree in Vicryl-mesh-wrapped hydroxyapatite implants than in those wrapped in donor sclera during the first 12 weeks after implantation. Vicryl mesh appears to be an acceptable alternative wrap for the hydroxyapatite implant, eliminating the need for donor sclera and its potential risks of transmissible diseases.

Animals↗
PubMed1994

Wegener's granulomatosis. Eyelid and conjunctival manifestations as the presenting feature in two individuals.

BACKGROUND: Wegener's granulomatosis is a necrotizing granulomatous vasculitis that may exist in a generalized or limited form and has a variety of unusual and uncommon presentations. Although ocular manifestations are relatively common in the disease at some point, the eyelid and its conjunctival lining are rarely involved. When this area is the initial focus of the disease, diagnosis may be difficult. RESULTS: The authors present two patients with Wegener's granulomatosis who had involvement of the palpebral conjunctiva as the initial manifestation. CONCLUSION: Eyelid and conjunctival involvement in Wegener's granulomatosis is uncommon. When it is the initial manifestation of this disease, a diagnosis of Wegener's may be delayed unless this unusual presentation is recognized.

Adult↗
PubMed1994

Irradiated homologous aorta in eyelid reconstruction. Part 1: Technique and animal research.

Reconstruction of full thickness eyelid defects requires the correction of posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Various tarsal substitutes--conchal and nasal cartilage, banked sclera, hard palate, irradiated homologous tarsal plates, periosteum, temporalis fascia, and composite grafts from the opposite eyelid--have been used for posterior lamellar replacement over the years. Eyelid-sharing procedures and full thickness flaps have also been described. At times, because of extensive tissue loss, the eyelid reconstruction can be particularly challenging because of the shortage of tissue. We describe a new posterior lamellar technique using irradiated homologous aorta. The experimental surgical procedure in rabbits, the clinical response, and the histological fate of the donor aorta are described in Part 1 followed by our experience with four patients in Part 2.

Animals↗