One patient with infection at different times of 2 hydroxyapatite implants, each requiring explantation.
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Biocompatible Materials↗
Biomedical subjects
David R Jordan
Publications and source records attributed to David R Jordan.
Soft-tissue fillers for wrinkles, folds and volume augmentation.
Hyaluronic acid gels, with or without dextran beads, and collagen with suspended PMMA microbeads are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Each material provides wrinkle reduction, contour improvement and volume augmentation when placed into lines and furrows or when used for lip augmentation. The duration of action varies from 6 months to permanent, depending on the product.
Animals↗
Hydroxyapatite orbital implant vascularization assessed by magnetic resonance imaging.
PURPOSE: To report hydroxyapatite (HA) implant enhancement patterns on magnetic resonance (MR) images at varying time intervals after implantation. METHODS: We retrospectively reviewed the records of 45 consecutive patients(from one author's practice) who underwent an MR imaging study 2 to 157 months after HA orbital implant placement. Implant fibrovascular ingrowth was assessed by analyzing the extent of implant enhancement seen on MR imaging. RESULTS Of 21 patients undergoing gadolinium-DTPA T1-weighted MR imaging 2 to 7 weeks after HA placement, 15 had enhancement limited to the implant rim (Grade I or less). Five patients had peripheral foci of enhancement (Grade II), and one patient had foci of enhancement extending to the center of the implant (Grade III). MR images obtained 9 to 15 weeks after HA insertion in all 14 patients had some degree of central enhancement (Grade III) and 11 had homogeneous enhancement throughout the implant (Grade IV or V). Seven patients in the homogeneous group were believed to have particularly intense enhancement patterns (Grade V). Of the 10 patients undergoing MR imaging from 31 to 69 weeks after surgery, 5 had Grade III enhancement and 5 had Grade IV enhancement. CONCLUSIONS: This study demonstrated consistent central HA orbital implant enhancement on MR imaging in the 9- to 15-week group and the >31-week postoperative group. HA orbital implant drilling and peg placement should be performed after central vascularization of the spherical implant has occurred. The results of this study support the principle of performing orbital implant drilling and peg placement at least 5 to 6 months after HA implant insertion.
Adolescent↗
The use of vicryl mesh in 200 porous orbital implants: a technique with few exposures.
PURPOSE: To report the results of a wrapping technique for porous orbital implants by using polyglactin 910 (Vicryl) mesh (Ethicon Inc., Somerville, NJ, U.S.A.). METHODS: We retrospectively reviewed the records of 200 consecutive patients from one author's practice who received a polyglactin 910 mesh-wrapped porous orbital implant after enucleation or as a secondary implant between October 1, 1996, and April 15, 2001. We recorded potential problems that might be attributed to polyglactin 910 mesh both before pegging (excessive inflammatory response to the material, conjunctival thinning, and implant exposure) and after pegging (exposure of the implant around the sleeve, conjunctival thinning, and implant exposure other than adjacent to the peg). RESULTS: One hundred twenty-two men and 78 women underwent placement of a polyglactin 910 mesh-wrapped porous orbital implant. The average age at the time of implantation was 48.9 years (range, 11 to 85 years). The average follow-up interval in the 200 patients was 19.4 months (range, 2 to 80 months). Thirteen of the 200 patients had less than 6 months of follow-up, leaving 187 patients with an average follow-up of 20.5 months (range, 6 to 80 months). There were 76 primary enucleations and 124 secondary orbital implants. Thirty-seven patients received a Bio-Eye hydroxyapatite implant (HA) (Integrated Orbital Implants, San Diego, Calif), 97 received a synthetic FCI hydroxyapatite implant (FCI, Issy-Les-Moulineaux, France), and 66 received a Bioceramic implant (aluminum oxide-Al2O3) (FCI, Issy-Les-Moulineaux, France). One hundred fourteen patients (57%) underwent peg placement. The average time to pegging was 9.9 months (range, 6 to 16 months). Before pegging, 4 of 187 patients (2.1%) had implant exposure. Three of these exposures followed secondary orbital implant placement (2 Bio-Eye HA, 1 synthetic FCI3 HA) and one followed an enucleation (synthetic FCI3 HA). Two patients required a temporalis fascia graft and one required a scleral patch; the remaining defect closed spontaneously. One patient had conjunctival thinning 6 months after orbital implantation, which remained stable with no frank exposure for 36 months. No patient had excess socket inflammation. After peg placement, 3 additional patients had exposure of the implant around the peg site. There were no cases of conjunctival thinning or exposure of the implant other than adjacent to the peg site. CONCLUSIONS: Polyglactin 910 mesh is an excellent option as a wrapping material for porous orbital implants. It is simple to use, readily available, eliminates the need for donor tissue, does not require a second operative site, and it is less expensive than other currently available wrapping materials. We attribute our high success rate to our technique, which emphasizes proper placement of the implant within the Tenon space, suturing the extraocular muscles anterior to their normal anatomic sites, and meticulous closure of the Tenon capsule and conjunctiva in separate layers.
Adolescent↗
Topical mitomycin treatment for primary acquired melanosis of the conjunctiva.
A case of primary acquired melanosis of the conjunctiva primarily treated with topical mitomycin chemotherapy is presented. The patient underwent treatment with one 2-week course of topical mitomycin 0.02% four times daily, followed 4 weeks later by a 2-week course of topical mitomycin 0.04% four times daily, followed by a 3-month course of topical mitomycin 0.02% twice daily. Map biopsies were performed after the initial two courses of mitomycin therapy and 12 months after all courses of mitomycin treatment had been completed. Complete resolution of the conjunctival pigmentation was noted after the final course of treatment. Map biopsies performed at 12 months following completion of treatment showed normal conjunctiva histopathologically. No recurrence of pigmentation was noted in follow-up 26 months after completion of treatment. Topical mitomycin chemotherapy may be a successful primary treatment for primary acquired melanosis of the conjunctiva.
Administration, Topical↗
The bioceramic orbital implant: experience with 107 implants.
PURPOSE: To assess the problems associated with the Bioceramic (Aluminum oxide, Al(2)O(3)) orbital implant. METHODS: A consecutive case series of 107 patients receiving a Bioceramic orbital implant by two surgeons over a 3-year period were reviewed. The authors analyzed patient age, type of surgery, size of implant, peg system, follow-up duration, time of pegging, complications encountered, and treatment. RESULTS: Seven patients were lost to follow-up after 2 months, leaving 100 patients who were followed from 3 to 38 months (average, 13.4 months). Three patients died during the follow-up period (one with 2 months' follow-up, one with 7 months' follow-up, and the third with 9 months' follow-up). Implant-related problems occurred in 11 (11%) patients. Discharge occurred in 5 (5%) patients, implant exposure in 2 (2%), socket discomfort in 1 (1%), trochleitis in 1 (1%), and conjunctival thinning in 2 (2%). Peg problems occurred in 11 (34.3%) of 32 pegged patients: discharge in 4 (12.5%) and in 1 patient (3.1%) each, pyogenic granuloma, conjunctiva overgrowing the peg, implant exposure around the sleeve, clicking, accumulation of black material, and broken peg during insertion. Infection did not occur in any patient. CONCLUSIONS: The Bioceramic orbital implant represents an alternative porous orbital implant that is biocompatible with orbital tissues, easy to manufacture, structurally strong, and less expensive than other commercially available porous orbital implants (e.g., Bio-Eye hydroxyapatite implant). Problems encountered with its use are similar to those seen with the Bio-Eye orbital implants but appear to occur less often. The incidence of exposure associated with the Bioceramic implant is less than that reported for the Bio-Eye.
Adolescent↗
Hydroxyapatite and calcium phosphate coatings on aluminium oxide orbital implants.
BACKGROUND: Hydroxyapatite and calcium phosphate have been used as bone graft substitutes as they facilitate and promote tissue ingrowth. We carried out a study to examine uncoated and coated aluminium oxide (alumina) spherical orbital implants and assess whether the coatings influence fibrovascular ingrowth. METHODS: The aluminium oxide spheres (three coated with hydroxyapatite, three coated with calcium metaphosphate and three uncoated) were manufactured at the School of Materials Engineering, Yeungnam University, Kyongsan, Kyongbuk, Korea. The implants were examined macroscopically and with scanning electron microscopy and were analysed chemically by means of x-ray powder diffraction and x-ray fluorescence spectrophotometry. Implantation of three hydroxyapatite-coated, three calcium metaphosphate-coated and three uncoated aluminium oxide spheres was done in nine adult male New Zealand albino rabbits. Implant vascularization was evaluated at 4, 8 and 12 weeks by means of histopathological sectioning. RESULTS: All three types of implant had multiple interconnected pores. The coatings increased the size of the trabeculae from 150 microm to 300 microm. As a result, the pores appeared slightly smaller but still ranged in size from 300 microm to 750 microm, compared to 400 microm to 800 microm in the uncoated implants. The coatings also increased the weight of the implants slightly. The implants were all strong mechanically. They were made up primarily of aluminium oxide. The coated implants contained significant amounts of calcium oxide (a contaminant). There was no clinical difference in the socket response between the three groups. Histopathologically, fibrovascularization occurred uniformly throughout each implant at 4, 8 and 12 weeks after implantation. INTERPRETATION: The hydroxyapatite and calcium metaphosphate coatings did not appear to facilitate or inhibit fibrovascular ingrowth at 4, 8 and 12 weeks. Longer-term studies are need to determine whether the coatings play a role in long-term acceptance and retention of the implants.
Aluminum Oxide↗
Multiple epidermal inclusion cysts of the eyelid: a simple technique for removal.
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Adult↗
Monocanalicular lacerations: to reconstruct or not?
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Humans↗
No-scar Asian epicanthoplasty: a subcutaneous approach.
PURPOSE: The epicanthal fold is a normal finding in the medial portion of the upper eyelid in many Asians. We describe a simple technique of removing the excess muscle and softening or eliminating the epicanthal fold without making incisions in the medial canthal region, thus avoiding complications such as scarring or web formation METHODS: Interventional case series. The subcutaneous epicanthoplasty was performed on all Asian patients undergoing concurrent upper eyelid blepharoplasty or aponeurotic ptosis repair. RESULTS: Thirty-eight Asian patients underwent epicanthal fold correction between January 1996 and December 2000. All patients had softening of the epicanthal fold; however, some cases of mild undercorrection were noted. CONCLUSIONS: Softening or elimination of the Asian epicanthal fold can be accomplished without making skin incisions in the medial canthal region. Our technique is a simple, graded procedure that can be performed in conjunction with upper blepharoplasty or ptosis repair.
Asia↗
Eyelash loss associated with hyperthyroidism.
PURPOSE: To describe a patient with eyelash loss as the presenting feature of hyperthyroidism. METHODS: Case report. RESULTS: A 19-year-old woman presented with right upper eyelid eyelash loss. Thyroid function studies confirmed hyperthyroidism. She subsequently lost further eyelashes and a patch of scalp hair. Once the hyperthyroidism was treated, the eyelashes and scalp hair regrew. CONCLUSIONS: Eyelash loss may be an early sign of the hyperthyroid state.
Adult↗
Investigation of a bioresorbable orbital implant.
PURPOSE: To analyze a new bioresorbable orbital implant (open-celled polylactic acid, also known as OPLA). METHODS: The implants were examined macroscopically, with chemical analysis (Fourier transform infrared spectroscopy), and microscopically with scanning electron microscopy. Animal implantation of OPLA implants was carried out in 9 adult male New Zealand albino rabbits. Implant vascularization was evaluated by histopathologic sectioning. RESULTS: The OPLA implant is porous and lightweight but fragile. Histopathologically it stimulated primarily a multinucleated giant cell granulomatous reaction with little fibrovascular ingrowth seen at 4 and 8 weeks. By 20 and 24 weeks, the implant was replaced predominantly by necrotic debris and peripheral giant cells. CONCLUSIONS: The OPLA implant is not an acceptable alternative to other currently available orbital implants.
Absorbable Implants↗
Accumulation of a black material around some titanium coupling posts.
PURPOSE: To report 5 patients with a black material accumulating in the conjunctiva around the titanium peg and sleeve systems. METHODS: Retrospective small case series. The clinical features of 5 patients were reviewed. Histopathologic analysis was performed on specimens from 3 patients. Neutron activation analysis was performed on 1 sample. RESULTS: Five asymptomatic patients with black material accumulating in the conjunctiva at the conjunctival-titanium peg interface were evaluated. All patients had a hydroxyapatite-coated titanium sleeve with a titanium peg in position. Histopathologic analysis performed on specimens from 3 patients revealed a mixed inflammatory cell infiltrate with focal areas of a black, foreign-appearing material showing birefringence under polarized light that was predominantly intracytoplasmic. This black material did not respond to bleaching, and in 2 patients, it showed positive staining for iron (Perls method). The material from one patient was evaluated by neutron activation analysis and was found to contain titanium, aluminum, and vanadium. In 18 to 48 months of follow-up, the presence of the material did not appear to be associated with any problems. CONCLUSIONS: The presence of a black substance accumulating in the conjunctiva around some titanium coupling posts is uncommon and appears to be without any consequence in 18 to 48 months of follow-up. Our analysis revealed this substance to be consistent with titanium alloy (Ti-6Al-4V).
Adolescent↗
Aneurysmal bone cyst associated with fibrous dysplasia.
We report the clinicopathologic features of a 22-year-old patient with aneurysmal bone cyst and fibrous dysplasia of the orbit. The patient was evaluated clinically with computed tomography of the orbit before surgery. An orbital biopsy specimen was examined histologically with conventional light microscopy. The lesion was treated with combined neurosurgical and orbital intervention. Clinical evaluation revealed axial and inferior displacement of the globe. Computed tomography revealed a cystic mass in the superotemporal left orbit with adjacent bone erosion. "Ground-glass" thickening of the adjacent frontal bone and sphenoid bone was observed. Microscopic examination showed fibrous stroma with giant cells and hemosiderin-laden macrophages with adjacent trabeculae of woven bone and osteoblast cells. A fronto-orbital craniotomy was performed, the cystic cavity was excised, and the hyperostotic bone was debulked. After treatment, the globe position and patient appearance have improved. There has been no sign of recurrence of the aneurysmal bone cyst. Aneurysmal bone cyst should be considered in patients with fibrous dysplasia that has a cystic component, or in patients with fibrous dysplasia who present with sudden expansion of their lesion.
Adult↗
Metastatic large-cell lung carcinoma to the orbit in a 25-year-old nonsmoker.
Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the orbit is uncommon. We report the unusual occurrence of a 25-year-old male nonsmoker with an aggressive form of lung cancer who developed metastatic orbital disease involving the medial rectus.
Adult↗