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Biomedical subjects

G E Rose

Publications and source records attributed to G E Rose.

At least 19 recordsLinked to original sources
PubMed2003

Management of lacrimal sac tumours.

PURPOSE: To report a series of 15 primary lacrimal sac tumours and present an algorithm in managing this rare condition. DESIGN: Noncomparative interventional case series. METHODS: A retrospective review of the clinical, radiological, and pathological records of 15 patients with primary lacrimal sac tumours. Main outcome measures Histologic evaluation and clinical follow-up, including tumour clearance and recurrence, were assessed. RESULTS: Of the patients, 11 were female and the median age at presentation for the whole group was 59 years (range 22-94 years). The commonest tumour was non-Hodgkins B-cell lymphoma (five cases), followed by two cases each of squamous cell carcinoma and transitional cell carcinoma, one case of benign transitional papilloma, haemangiopericytoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, mixed (squamous/transitional) carcinoma, and a highly malignant undifferentiated tumour. Treatment modalities included surgery, radiotherapy and chemotherapy and, with a median follow-up of 30 months (range 2 months to 17 years), two patients had died from metastatic disease but nine patients remained without evidence of recurrent tumour. CONCLUSIONS: Primary lacrimal sac tumours are extremely rare, require long-term follow-up for recurrence and metastasis, and can be fatal.

Adult↗
PubMed2002

Primary orbital melanoma masquerading as vascular anomalies.

PURPOSE: To review two cases of primary orbital melanoma presenting like orbital vascular anomalies. METHODS: Retrospective review of clinical presentation, treatment, radiology and pathology for two patients under the care of the Orbital Clinic at Moorfields Eye Hospital. RESULTS: Both lesions presented with the appearance and behaviour of vascular anomalies. In one case, a spindle cell melanoma appeared to be a low flow vascular anomaly with a loculated secondary haemorrhage and, in the other case, a melanoma of soft parts was considered to be an arteriovenous malformation and responded partially to embolisation. CONCLUSION: Primary malignant melanoma may present as a secondary vascular lesion of the orbit and this very rare tumour should be considered in the differential diagnosis of any vascular anomaly.

Adult↗
PubMed2002

Clinical, radiological and pathological examination of periocular dermoid cysts: evidence of inflammation from an early age.

INTRODUCTION: Periocular dermoid cysts are common and leakage of the lipid or keratin contents leads to an inflammation-often asymptomatic-around the cyst, which may cause adherence of the dermoid cyst to neighbouring structures. PURPOSE: To investigate the frequency of clinical and radiological signs of inflammation with periocular dermoid cysts, to relate this to the histopathological examination of the excised specimens, and to assess whether the degree of inflammation is related to age at presentation. PATIENTS AND METHODS: A retrospective non-comparative series of 124 patients with periocular dermoid cysts that had undergone imaging. Case-notes were reviewed for clinical and histopathological details and there was independent review of the radiological imaging. RESULTS: Surgery was undertaken at between 1 and 66 years of age, most patients being under 10 years, and the duration of symptoms varied from 4 weeks to 30 years. Symptoms of inflammation-mainly intermittent lid swelling with localised redness and pain-occurred in all age groups, the proportion being greatest in the fourth decade. Clinical signs of inflammation at the time of clinic visit were relatively few, although 8% had some localised erythema and 7% had tenderness at the site of lesion. In more than two-thirds of the excised cysts, pathological examination demonstrated various degrees of chronic inflammation, even in those cysts removed before the age of 5 years. CONCLUSION: Even if the patient does not have symptoms or signs of inflammation, most periocular dermoid cysts show histological evidence of inflammation due to leakage of the lipid and keratin contents from the cyst, the incidence being similar at all ages.

Adolescent↗
PubMed2001

Two unusual osteogenic orbital tumors: presumed parosteal osteosarcomas of the orbit.

OBJECTIVE: To report two cases of suspected parosteal osteosarcoma of the orbit, with dedifferentiation into a high-grade liposarcoma occurring in one patient. DESIGN: Two retrospective case reports. METHODS: The clinical, radiologic, and pathologic records of two patients with suspected orbital parosteal osteosarcoma were retrospectively reviewed. MAIN OUTCOME MEASURES: Histologic evaluation and clinical follow-up were measured. RESULTS: The first patient was a 47-year-old male presenting with a 5-month history of painless right lower lid swelling; excision biopsy suggested a well-differentiated parosteal osteosarcoma of the orbital floor, which recurred 3 years later. Six months after excision of the recurrence, the mass demonstrated accelerated growth, and a lid-sparing exenteration was performed; histologic examination showed a high-grade liposarcoma. The patient remains disease-free at 4 years. The second patient, a 40-year-old male, presented with an 8-year history of proptosis and a right superotemporal orbital mass. The mass was excised completely at lateral orbitotomy; histologic examination suggested a well-differentiated parosteal osteosarcoma. The patient remains well 9 months postoperatively. CONCLUSIONS: Parosteal osteosarcoma is an uncommon tumor, usually affecting long bones, that is extremely rare in the orbit. It is a low-grade sarcoma that tends to recur locally after excision but has a favorable prognosis. Dedifferentiation into a high-grade sarcoma occasionally occurs in parosteal osteosarcoma, but transformation into liposarcoma does not seem to have been previously reported. It is important to recognize dedifferentiated parosteal osteosarcoma, because the prognosis is poor, and radical treatment may be required.

Adult↗
PubMed2001

Pediatric dacryocystorhinostomy for nasolacrimal duct obstruction.

OBJECTIVE: To determine the outcome of pediatric dacryocystorhinostomy (DCR) for large mucoceles or for primary nasolacrimal duct obstruction unresponsive to multiple probings. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: One hundred thirty-four external dacryocystorhinostomies were performed in 121 children. METHODS: Clinical case notes were reviewed for a series of cases operated on at Moorfields Eye Hospital by specialist lacrimal surgeons between 1987 and 1999. MAIN OUTCOME MEASURES: Postoperative relief of presenting symptoms and signs and complications. RESULTS: Fifty-nine percent of admissions (75 of 127) were day cases, and the other 52 admissions were inpatient. Simultaneous bilateral surgery was performed in 7 of 121 (6%) children, all but one having day case admission, and sequential bilateral surgery in 6 of 121 (5%) cases. Silicone intubation was performed in 20% of operations, these generally being early in the series. Three children had Down syndrome, five had craniofacial anomalies, and two had systemic disorders. Mild postoperative cellulitis occurred in three cases, all of which settled without complication after systemic antibiotic therapy, and there was one case of suture granuloma. There were no cases of immediate postoperative complication in either the day case or the inpatient groups. Complete cure of symptoms was achieved in 96% and an improvement of symptoms (with mild persistence of epiphora under challenge) in five cases (4%). CONCLUSION: For surgeons experienced in pediatric lacrimal surgery, external DCR with sutured mucosal flaps can be accomplished through an 8-mm incision with no surface sutures and minimal scarring. Symptoms are improved in all cases and complete cure achieved in 96%, with no immediate postoperative complications and only few (3%) short-term complications. The surgery is amenable to day case management, without significant morbidity, and may be performed as a simultaneous bilateral procedure.

Adolescent↗
PubMed2001

The failed probing.

The management of failed probing for congenital nasolacrimal duct obstruction is given by a panel of authors. Treatment options examined are repeat probing, inferiorturbinate infracture, closed lacrimal intubation and dacryocystorhinostomy. There is considerable variation as to the timing of these interventional techniques.

Dacryocystorhinostomy↗
PubMed2001

Autogenous hard palate mucosa: the ideal lower eyelid spacer?

BACKGROUND/AIMS: Raising a displaced lower eyelid frequently involves recession of the lower eyelid retractors with interposition of a "spacer," and several materials for this purpose have been described. This study reviewed the results of autogenous palatal mucosa in the treatment of lower eyelid displacement, including assessment of any donor site morbidity. METHODS: A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent insertion of hard palate mucosa between the inferior border of the tarsus and the recessed conjunctiva and lower eyelid retractors. Parameters studied included the underlying diagnosis, measurements of lower lid displacement or retraction, related previous surgery, the experience of the operating surgeon, intraoperative and postoperative complications, surgical outcome, and length of follow up. The main outcome measure was the position of the lower eyelid relative to the globe in primary position of gaze. RESULTS: 102 lower eyelids of 68 patients were included and a satisfactory lid position was achieved in 87/102 (85%), with inadequate lengthening or significant recurrence of displacement occurring in 15 cases. Donor site haemorrhage requiring treatment in the early postoperative period occurred in seven patients (10%). CONCLUSION: Autogenous hard palate mucosa is an effective eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative management.

Adult↗
PubMed2001

Major orbital complications of endoscopic sinus surgery.

BACKGROUND: The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. METHODS: A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS: All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION: Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.

Blindness↗
PubMed2000

A comparative study of two procedures for repair of involutional lower lid entropion.

OBJECTIVE: The study compares the use of Jones' retractor plication and the Wies procedure as a primary procedure for the repair of involutional lower lid entropion in the absence of horizontal lid shortening. DESIGN: Retrospective case series comparison. PARTICIPANTS: One hundred two cases with at least 6 months follow-up after primary surgery for involutional lower lid entropion performed between 1993 and 1996. INTERVENTIONS: Two groups were compared: Jones' retractor plication was performed in one group and the Wies procedure in the other; neither group had horizontal shortening of the lower eyelid. MAIN OUTCOME MEASURES: The rates of cure, recurrence, and overcorrection of the lower lid entropion. RESULTS: Jones' retractor plication was performed in 37 (36%) patients and the Wies procedure in 65 (64%). Two of the 37 (5%) Jones cases had recurrent entropion develop, both at 31 months after surgery, compared with 1 1 of 65 (17%) recurrences after the Wies procedure (P = 0.81); recurrence after Wies procedure was earlier, at a median of 6 months after surgery. There were 20 of 65 (31 %) overcorrections after the Wies procedure and 4 of 37 (11 %) after the Jones procedure (P < 0.02); one quarter of each group required secondary repair of the overcorrection (5 of 20 after failed Wies procedure; 25% after failed Jones procedure). Overall, there were 6 of 37 (16%) unsatisfactory results after the Jones procedure in contrast to 31 of 65 (48%) after the Wies procedure (P < 0.001). CONCLUSIONS: These data provide strong evidence (P < 0.001) that, in the absence of horizontal shortening of the lower eyelid, a successful outcome is more likely after Jones retractor plication than after the Wies procedure.

Aged↗
PubMed2000

Prevention of cellulitis after open lacrimal surgery: a prospective study of three methods.

OBJECTIVE: Soft-tissue cellulitis after open lacrimal surgery, almost exclusively caused by infection, is associated with a reduced surgical success rate, inconvenience for the patient, and may predispose to secondary hemorrhage. Although postoperative oral antibiotics have been shown to significantly reduce the infection rate, this investigation was designed to compare this regimen with two other methods for the prevention of postoperative infection. DESIGN: A prospective nonrandomized comparative trial of three methods for prevention of postoperative infection. PARTICIPANTS: Patients, recruited over a 16-month period from the Lacrimal Clinic at Moorfields Eye Hospital, who required primary open dacryocystorhinostomy. METHOD: Two hundred and sixty-five patients were assigned, on the basis of hospital number, to one of three groups: to receive either an intravenous broad-spectrum antibiotic immediately after induction of anesthesia (group 1), intraoperative lavage of the rhinostomy site just after suture of the anterior mucosal flaps (group 2), or a postoperative course of oral antibiotics (group 3). OUTCOME MEASURES: Cellulitis was considered to be present when there was marked tenderness along a swollen and erythematous incision line, evidence of frank pus from the suture line, or late postoperative hemorrhage occurred. Patients were reviewed within a week of surgery. RESULTS: Signs of infective cellulitis occurred in 1 of 127 (0.8%) cases in group 1, 7 of 41 (18%) cases in group 2, and 2 of 127 (1.5%) cases in group 3. Whereas the infection rate in group 2 was significantly greater than that in group 1 (P << 0.001) or group 3 (P<0.001), no significant difference was found between that in groups 1 and 3 (0.75>P>0.5; chi-square test with Yates' correction). CONCLUSION: Compared with intraoperative saline lavage, intraoperative or postoperative broad-spectrum antibiotics have comparable efficacy in the prevention of postoperative soft-tissue cellulitis after open lacrimal surgery. Intraoperative administration of antibiotics has the advantages of compliance and economics.

Adolescent↗
PubMed2000

Postherpetic lacrimal obstruction.

OBJECTIVE: The purpose of the study was to review the surgical management of postherpetic lacrimal obstruction. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: One hundred sixty patients (111 female, 49 male) with a mean age at presentation of 31 years. All had a history typical of primary herpes simplex blepharoconjunctivitis. INTERVENTION: Open lacrimal surgery was performed on 158 patients (171 eyes), of whom 99 patients (108 eyes) had undergone no surgery before being seen at Moorfields. The most common primary procedure was dacryocystorhinostomy (DCR) with anterograde or retrograde intubation (94 eyes, 54%), and primary placement of a Lester Jones tube (conjunctivo-DCR) was performed in 56 eyes (32%). A secondary procedure was required in 43 eyes (26%), the most common being closed placement of a Lester Jones tube (40 eyes). MAIN OUTCOME MEASURES: Persistent symptoms of impaired lacrimal drainage and need for additional surgery. RESULTS: Reduction of epiphora was good or complete in 171/173 eyes (98%). CONCLUSIONS: This study shows that there is a justification for procedures that use any remaining unaffected portion of canaliculi, such as DCR, with anterograde or retrograde intubation, as well as the more commonly used Lester Jones tube.

Adolescent↗
PubMed2000

Radiological and clinicopathological features of orbital xanthogranuloma.

BACKGROUND: Orbital xanthogranuloma, a diagnosis confirmed histologically, occurs rarely in adults and children. With its characteristic macroscopic appearance the adult form may be associated with a spectrum of biochemical and haematological abnormalities including lymphoproliferative malignancies. METHOD: The clinicopathological features and imaging appearances on computed tomography and magnetic resonance imaging of this condition are described in eight adults and a child. RESULTS: Radiological evidence of proptosis was present in seven patients. In all nine patients an abnormal infiltrative soft tissue mass was seen, with increased fat in six cases. All patients had associated enlargement of extraocular muscles suggestive of infiltration and five had lacrimal gland involvement. Encasement of the optic nerve, bone destruction, and intracranial extension was present only in the child with juvenile xanthogranuloma. Haematological and/or biochemical abnormalities were detected in seven patients and seven patients had other systemic diseases which were considered to have an immune basis. One patient subsequently developed non-Hodgkin's lymphoma. CONCLUSION: The investigation and management of orbital xanthogranulomas requires a multidisciplinary approach even though the diagnosis may be suspected clinically. Imaging delineates the extent of disease and involvement of local structures and may influence the differential diagnosis. The juvenile form may be more locally aggressive, causing bone destruction with consequent intracranial extension.

Adult↗
PubMed2000

Lacrimal drainage surgery in Wegener's granulomatosis.

AIM: To examine the results of open lacrimal surgery in patients with Wegener's granulomatosis. METHODS: A retrospective review of patients with Wegener's granulomatosis who underwent lacrimal surgery over a 17 year period. RESULTS: 11 patients were identified and a total of 14 primary dacryocystorhinostomies (DCR) and one revisional DCR were performed; symptomatic relief was achieved in 13/14 operations and one patient required revisional surgery for persistent symptoms. There were no intraoperative and few postoperative complications. CONCLUSIONS: In contrast with some previous reports, open DCR appears to be a safe procedure and it is recommended as a treatment for lacrimal obstruction in patients with Wegener's granulomatosis, but an increase of perioperative immunosuppression is recommended in certain cases.

Adult↗