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Biomedical subjects

D Selva

Publications and source records attributed to D Selva.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of the ICare rebound tonometer with the Goldmann applanation tonometer by experienced and inexperienced tonometrists.

PURPOSE: To assess the agreement between ICare rebound tonometer and Goldmann applanation tonometer in the hands of experienced and inexperienced tonometrists. PATIENTS AND METHODS: Two tonometrists, experienced with both Goldmann applanation tonometry (GAT) and ICare Tonometry (ICT) measured intraocular pressure (IOP), in a masked fashion, in 100 patients. In another series of 58 patients, ICT was performed by an inexperienced tonometrist and GAT by an experienced tonometrist. RESULTS: In approximately 80% of patients, the difference in IOP between GAT and ICT was <or=2 mmHg in group 1 and <or=3 mmHg in group 2. The 95% limits of agreement were -4.0-4.4 mmHg in group 1 and -6.0-5.0 mmHg in group 2. CONCLUSION: ICT compares reasonably with GAT, in both experienced and inexperienced hands. Its ease of use, portability, and sterility make it an attractive tonometer. Its degree of accuracy in inexperienced hands would make it a useful instrument for health care workers with limited ophthalmic experience.

Aged↗
PubMed2006

South Australian adolescent ophthalmic sun protective behaviours.

AIMS: To study student's knowledge of the effects of sunlight on the eyes, as well as their sun protective behaviours. METHODS: In total, 640 [corrected] students aged 13-18 years were surveyed in South Australia, during August-September 2004, using a standardized previously used survey. Scores were calculated regarding knowledge about ultraviolet light, sunlight effects on eyes, as well as eye and body protection. Risk factor scores were produced for each student. The data were analysed by the analysis of variance (ANOVA), as well as the Cochran-Mantel-Haenszel methods. Results were compared to the same survey conducted in 1995 in Queensland Australia. RESULTS: This group demonstrated a moderate level of knowledge, similar to the 1995 survey. Students in the older age groups demonstrated significantly higher knowledge. The majority of students (74%) owned a pair of sunglasses; however, 44.5% almost never wore their glasses. The reported frequency of wearing sunglasses was significantly related to advertising, believing sunglasses protect the eyes, as well as personal, family, and peer attitudes towards wearing sunglasses. CONCLUSION: The results of our survey suggest no significant change in knowledge and behaviours of students, compared to the 1995 survey. We feel it is imperative that adolescents be made more aware of the damaging effects of sunlight and the benefits of eye protection. Health promotion campaigns should target the youth and consider that as a group, they are significantly influenced by the media, peers, and family attitudes.

Adolescent↗
PubMed2006

Linear basal cell carcinoma: A distinct clinical entity.

The purpose of the study is to describe linear basal cell carcinoma (BCC) as a distinct clinical entity, and highlight its existence to the plastic surgery literature. A Medline and PubMed literature search was conducted, and 33 reported cases of linear BCC were analysed. Of these 33 cases, the most common site for linear BCC was the periocular region, accounting for 49% (n= 16). The most common histologic subtype, was nodular BCC, accounting for 50% (n= 17). Of the 33 reported cases the postoperative defect size was mentioned in five cases only. None of these would have been completely excised if a 2 mm margin was applied, and only one out of five if a 4 mm margin was applied. Linear BCC is a distinct clinical entity. Presence of the tumour along relaxing skin tension lines, increase in subclinical extension, and aggressive tumour behavior are reported observations. Because of these observations it is suggested that margin-controlled excision should be considered for linear BCC.

Adult↗
PubMed2006

Idiopathic orbital inflammation with extraorbital extension: case series and review.

Idiopathic orbital inflammation (IOI) is a well-recognised pathological process usually confined to the orbit. It is an orbital mass lesion characterised by infiltration of soft tissues by inflammatory cells and fibrous tissue. It is essentially a diagnosis of exclusion. Extraorbital extension (EOE) is rare and, to the best of the authors' knowledge, inclusive of our series, there have been 22 cases of IOI with EOE reported in the literature. We describe four patients with IOI with EOE-their presentation, histopathological findings and management strategies. Histopathology of three patients revealed sclerosing and one had a nonspecific variant of IOI. In our series, all four patients required additional immunosuppression. Hence, corticosteroid therapy often needs to be supplemented by radiotherapy and/or immunosuppressive therapy.

Adult↗
PubMed2006

Refractive change in thyroid eye disease (a neglected clinical sign).

BACKGROUND/AIMS: The literature on refractive change in thyroid eye disease (TED) is limited. This study documents the refractive change in patients with TED undergoing orbital decompression. The authors propose possible mechanisms for their acquired refractive error. METHODS: This is a retrospective observational case study of five patients with progressive TED. Their detailed eye examinations including refractive state preoperatively and postoperatively are presented. RESULTS: An acquired hypermetropic shift with active TED before orbital decompression of up to 3.75 D spherical equivalent refraction (SER) is reported in one patient. Post-orbital decompression, an induced myopic shift of between 1.00-2.50 D SER for all patients is observed, noted to range from 1 day following surgery to up to 9 months, dependent on the availability of data. Axial length increased in two cases corresponding to postoperative myopic shift. Magnetic resonance imaging findings of one patient demonstrate flattening of the posterior pole as a cause of the acquired preoperative hypermetropia. CONCLUSIONS: TED has a significant effect on the refractive state of patients. The proposed mechanism of acquired hypermetropia relates to increased volume of orbital contents with flattening of the posterior globe. This is reversed with successful orbital decompression. Documentation of refractive error in all cases of progressive TED is recommended. Progressive acquired hypermetropia may be suggestive of TED activity.

Adult↗
PubMed2005

Cutaneous lip tumours treated with Mohs micrographic surgery: clinical features and surgical outcome.

BACKGROUND: The Australian Mohs micrographic surgery (MMS) database was initiated in 1993 by the Skin and Cancer Foundation Australia (SCFA) with the aim of collecting prospective data, and involved all Mohs surgeons in the country. OBJECTIVES: To present a large series of patients with cutaneous lip tumours treated with MMS in Australia between 1993 and 2002. METHODS: This prospective multicentre case series included all patients with cutaneous lip tumours who were monitored by the SCFA. The main outcome measures were patient demographics, reason for referral, duration of tumour, site, preoperative tumour size and postoperative defect size, recurrences prior to MMS, histological subtypes, perineural invasion and 5-year recurrence after MMS. RESULTS: There were 581 patients (66.1% women and 33.9% men, P < 0.0001) with a mean +/- SD age of 58 +/- 15 years. The upper lip was the most common site involved (81.1%). Basal cell carcinoma (BCC) was diagnosed in 82.3%, squamous cell carcinoma (SCC) in 16.5%, Bowen's disease (BD) in 0.7% and microcystic adnexal carcinoma (MAC) in 0.5% of cases. BCC was more common on the upper lip and in women, whereas SCC was more common on the lower lip and in men (P < 0.0001). Most upper lip tumours occurred in women (75.4%), whereas most lower lip tumours occurred in men (73.6%). SCC was associated with a larger tumour and postoperative defect size compared with the other tumours. The 5-year recurrence for BCC was 3.0%, and there were no cases of recurrence for SCC, BD or MAC. CONCLUSIONS: BCC was the most common cutaneous lip tumour managed by MMS, and was significantly more common on the upper lip and in women. The low 5-year recurrence rate emphasizes the importance of margin-controlled excision.

Adult↗
PubMed2005

Incidence of host site complications in periocular full thickness skin grafts.

AIM: To evaluate the complications of periocular full thickness skin grafts (FTSG) in patients treated with Mohs' micrographic surgery (MMS) for periocular malignancy. METHOD: This prospective, multicentre case series included all patients in Australia treated with MMS for periocular malignancy followed by reconstruction with FTSG, who were monitored by the Skin and Cancer Foundation, between 1993 and 1999. The parameters recorded were patient demographics, reason for referral, histological classification of malignancy and evidence of perineural invasion, duration of tumour, site, recurrences prior to MMS, preoperative tumour size, and postoperative defect size. FTSG donor sites included upper lid, preauricular, retroauricular, inner brachial, and supraclavicular. The primary outcome measures were FTSG host site complications (partial/complete graft failure, graft infection, acute bleeding/haematoma, graft hypertrophy, and graft contracture). RESULTS: 397 patients (229 males, 168 females), mean age 60 (SD 15) years (range 20-91 years). 92.7% were diagnosed with basal call carcinoma, 2.0% with Bowen's disease, and 3.3% with squamous cell carcinoma. Medial canthus was involved in 66.5% of patients, lower eyelid in 28.0%, and upper eyelid in 5.5%. Postoperative complications were recorded in 62 patients (15.6% of all patients), and consisted of graft hypertrophy (45.1% of complications), graft contraction (29.1%), and partial graft failure (12.9%). The only statistically significant association found was a higher rate of graft hypertrophy in medial canthal reconstruction (p = 0.007). CONCLUSION: Host site complications of periocular FTSG are not common. Graft hypertrophy accounted for most complications and was more common in the medial canthal area. No other variables such as patient demographics, tumour characteristics, or donor site factors were associated with a higher risk of complications.

Adult↗
PubMed2005

Periocular keratoacanthoma: can we always rely on the clinical diagnosis?

AIM: To present a series of patients with a clinical diagnosis of periocular keratoacanthoma and assess the incidence of histologically proven invasive squamous cell carcinoma (SCC). METHODS: This retrospective case series included all patients with periocular tumours seen in the authors' unit between 1996 and 2004, and who were initially diagnosed with keratoacanthoma based on the clinical presentation. RESULTS: Twelve patients (eight males, four females) were clinically diagnosed with keratoacanthoma. The final histological diagnosis revealed two cases (16.7%) of invasive SCC, and 10 cases (83.3%) of keratoacanthoma. The lower lid was most commonly involved in cases of keratoacanthoma (50.0%). Six patients (60.0%) underwent Mohs surgery, and four (40.0%) were treated with excision under frozen section control. There were no cases of recurrence during a mean follow up period of 21 (SD 13) months. CONCLUSION: Although the clinical presentation of periocular keratoacanthoma is usually characteristic, a significant percentage of patients will prove to have invasive SCC. Complete excision with margin control offers a definitive diagnosis, as well as tissue conservation and a low recurrence rate.

Adult↗
PubMed2004

Aberrant facial nerve regeneration (AFR): an under-recognized cause of ptosis.

INTRODUCTION: Aberrant facial nerve regeneration (AFR) following facial nerve palsy may give rise to ptosis because of increased orbicularis tone. We describe a series of patients presenting with ptosis where the underlying aetiology of AFR was often not recognized by the referring clinicians. METHODS: Retrospective case review. RESULTS: A total of 15 cases with ptosis, secondary to AFR, were seen at the Royal Adelaide Hospital Oculoplastic Clinic between 2000 and 2002. Of these, 10 (67%) were referred by general ophthalmologists. Ptosis was the only reason for referral in 11 patients (73%) and features of AFR or a past history of facial nerve palsy were not mentioned in seven referrals (overall 46%). All patients reported a previous facial palsy. The palpebral aperture was reduced on the affected side with reduction in both upper and lower margin reflex distance (MRD) by a mean of 1.5+/-0.7 mm (P<0.001) and 1.0+/-0.3 mm (P<0.001), respectively. The orbicularis tone was increased and strength reduced on the affected side in all patients. However, none had lagophthalmos. Signs of AFR were demonstrated in all patients with either an increase in ptosis or eyelid closure on the affected side during cheek puffing. CONCLUSION: Patients with AFR following facial nerve palsy may present with ptosis without recognition of the underlying aetiology. Signs of AFR ptosis include a decreased palpebral aperture with a reduced upper and lower MRD. The diagnosis can be established with demonstration of an increase in ptosis during cheek puffing. Recognition of AFR is important in these cases owing to the implications for management and post-operative patient satisfaction.

Adult↗
PubMed2004

Early division of a modified Cutler-Beard flap with a free tarsal graft.

AIMS: We describe a variation of the Cutler-Beard flap in the reconstruction of upper eyelid defects. METHODS: The technique of upper eyelid reconstruction with a free tarsal graft and a cutaneous lower eyelid advancement flap divided at 2 weeks is described. Four cases where this technique was used for reconstruction of eyelid defects due to periocular malignancy are also reported. RESULTS: There were three male and one female patients ranging in age from 61 to 78 years. The underlying diagnoses were squamous cell carcinoma, trichilemmal carcinoma, and two basal cell carcinomas. Follow-up of 6-28 months revealed a good outcome in all four cases with one patient developing a mild cicatricial lower eyelid ectropion that was managed conservatively. CONCLUSIONS: A modified Cutler-Beard flap with free tarsal graft and early division may provide an effective alternative for upper eyelid reconstruction in cases with sufficient lower eyelid skin laxity.

Aged↗
PubMed2004

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement.

PURPOSE: To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases. METHODS: Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002). RESULTS: A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy. CONCLUSION: ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.

Adolescent↗