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Biomedical subjects

G E Rose

Publications and source records attributed to G E Rose.

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

Rhinostomies: an open and shut case?

AIMS: To analyse bone fragments from rhinostomies of patients undergoing revisional dacryocystorhinostomy, looking for evidence of new bone formation. METHODS: 14 consecutive patients undergoing secondary lacrimal surgery were included in this study. In each case the existing rhinostomy was enlarged with bone punches, care being taken to use the punches with the jaws cutting perpendicularly to the edge of the rhinostomy, to allow accurate orientation of the specimens. The fragments were examined histologically for evidence of new bone formation. RESULTS: Histological sections showed fragments of bone with variable fibrosis at the edge of the rhinostomy. There was evidence of only very little new bone formation. CONCLUSION: This study has clearly shown that, at the edge of a rhinostomy, healing is predominantly by fibrosis and there is only very limited new bone formation.

Aged↗
PubMed1999

Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction.

AIM: It appears from the literature that no standardised examination exists for patients with functional nasolacrimal duct obstruction. The role of dacryocystography and lacrimal scintigraphy was compared in the diagnosis and management of these patients. METHOD: Patients who were clinically diagnosed as having unilateral or bilateral functional nasolacrimal duct obstruction were prospectively entered into the study and data collected over 12 months in Moorfields Eye Hospital and Whipps Cross Hospital, London. All cases had, on separate occasions, a standardised dacryocystogram with delayed erect films and a lacrimal drainage scintigram. RESULTS: 45 lacrimal systems of 32 patients (mean age 62 years; 59% male) fulfilled the inclusion criteria. Abnormalities were detected with dacryocystography in 93% of systems and with lacrimal drainage scintigraphy in 95% of systems. Based on the results of previous quantitative studies, the positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (13%), delay at the lacrimal sac/duct junction (35%), or delay within the duct (47%). Combining the two imaging techniques increased the sensitivity to 98%. CONCLUSIONS: Both investigations are very sensitive at detecting abnormalities in patients with a clinical diagnosis of functional nasolacrimal duct obstruction. Lacrimal drainage scintigraphy is a slightly more sensitive test, but missed an abnormality detected by dacryocystography in two (4%) systems. A combination of the two techniques gives the highest sensitivity with maximum anatomical and physiological information but, in clinical practice, it is reasonable to perform a dacryocystogram initially and proceed to scintigraphy only if contrast radiography is normal.

Adult↗
PubMed1998

Involutional lower lid entropion: to shorten or not to shorten?

OBJECTIVE: Involutional entropion of the lower eyelid is a common problem in the aging population, and manifest horizontal laxity is often present. The authors therefore examined the cure rate, dependent on whether the lid had been shortened horizontally. DESIGN: A retrospective case series. PARTICIPANTS: Five hundred eighty-three surgical records of entropion surgery at Moorfields Eye Hospital over a 4-year period (1993-1996, inclusive) were examined, and those patients with involutional entropion and adequate follow-up data were selected. INTERVENTION: One hundred eighty of the 313 primary procedures included horizontal shortening, as did 28 of the 47 reoperations for recurrent entropion or consecutive ectropion. MAIN OUTCOME MEASURES: Surgical success was analyzed after primary correction or after reoperation, and the groups were compared with respect to age, gender, and length of follow-up. RESULTS: A cure after primary surgery was achieved in 178 (99%) of 180 patients in whom the lower eyelid was shortened compared with 104 (78%) of 133 patients in whom the eyelid was not shortened (P < 0.001). Reoperation for recurrent eyelid malposition cured 28 (100%) of 28 patients if the eyelid was shortened and 12 (63%) of 19 patients if the eyelid was not shortened (P < 0.001). CONCLUSIONS: Recurrent malposition of the eyelid was significantly more likely when horizontal eyelid shortening was not included at either primary repair or at reoperation for recurrence or overcorrection. As horizontal laxity is probably the main pathogenic factor for age-related entropion, it is doubtful whether surgical correction without horizontal shortening of the eyelid has any role in the treatment of this condition.

Aged↗
PubMed1998

Correction of lower eyelid retraction in thyroid eye disease: a randomised controlled trial of retractor tenotomy with adjuvant antimetabolite versus scleral graft.

BACKGROUND/AIMS: Lower eyelid retraction in thyroid eye disease contributes to ocular discomfort and an unsightly appearance, especially if asymmetrical. The use of donor scleral grafts is effective in lengthening the lower eyelids but carries a risk of virus transmission. Other techniques, including those which do not use grafts, need to be compared with scleral grafts. Recurrent retraction is a recognised complication of thyroid eyelid surgery; therefore, the authors investigated the use of antimetabolites to reduce postoperative fibrosis. METHODS: In this prospective randomised controlled trial of 25 patients (35 eyelids), the use of donor sclera in 20 lower eyelids (13 patients) was compared with partial tenotomy of the anterior part of the lower eyelid retractors (ALER) with adjuvant peroperative antimetabolite in 15 lower eyelids (12 patients). A 5 minute peroperative application of either 5-fluorouracil (25 mg/ml) in nine lower eyelids (eight patients) or mitomycin C (0.2 mg/ml) in six lower eyelids (four patients) was used to focally inhibit fibroblasts. Follow up ranged from 3 to 18 months (mean 7.8). RESULTS: One month after surgery the results of both groups were similar. However, at 3 months after surgery the results of scleral grafting were better than tenotomy with antimetabolites: 3/12 patients (25%) treated with tenotomy and adjuvant antimetabolite required subsequent surgery using grafts for correction of recurrent retraction. There were no significant complications associated with the use of antimetabolites in the eyelid in the doses used in this study. CONCLUSIONS: This randomised prospective trial shows that donor scleral grafts were more effective in the long term than partial tenotomy with adjuvant antimetabolite in the correction of lower eyelid retraction associated with thyroid eye disease. The use of peroperative antimetabolites in the lower eyelid was safe.

Adult↗
PubMed1998

Open lacrimal surgery: a comparison of admission outcome and complications after planned day case or inpatient management.

AIMS: To assess the outcome, in terms of completion of admission and complication rates, for two series of patients undergoing open lacrimal surgery, one group planned for a day case admission and the other planned for inpatient stay. METHODS: A retrospective analysis of case notes was performed for 200 patients planned to have day case admission (for 209 open lacrimal operations) and the details compared with those for 200 inpatient admissions (for 228 lacrimal procedures) during the same period of study. The success rates for surgery were not examined. RESULTS: 9% of planned day cases required overnight admission, 5.5% for medical reasons and 3.5% for social or administrative reasons. There was a similar incidence of postoperative complications in planned day cases and inpatients, although 6% of day case patients developed postoperative cellulitis, compared with 1.3% of the inpatients (p = 0.01). Overall, the incidence of cellulitis was greater in cases complicated by intraoperative haemorrhage (p < 0.05) or the use of absorbable nasal packing (p < 0.0001). A similar number of patients in each group attended the accident and emergency department before the planned first postoperative clinic visit. CONCLUSION: Patients undergoing open lacrimal surgery can be safely managed as day cases if carefully selected for suitability on social and medical criteria. The use of general anaesthesia is not, in itself, a contraindication to day case lacrimal surgery.

Adolescent↗
PubMed1998

Ultrasonic assessment of rhinostomy size following external dacryocystorhinostomy.

AIM: To assess the dimensions and patency of the surgical epithelial fistula after external dacryocystorhinostomy, using B mode ultrasonography to define the postoperative soft tissue anastomosis. METHODS: 12 patients undergoing 16 external dacryocystorhinostomies, with the creation of large osteotomies, were included in a prospective study. The horizontal and vertical dimensions of the bone ostium was recorded during surgery and compared with the ultrasonographic dimensions of the soft tissue anastomosis at 1 day, 2 weeks, and 6 months after surgery. Functional patency was confirmed with dye testing and irrigation. RESULTS: Compared with an osteotomy of between 100 and 380 mm2 (mean 235 mm2), the soft tissue anastomosis on the day after surgery was, in all cases, markedly smaller (72-252 mm2; mean 144 mm2, or 61% of the bone window). The soft tissue anastomosis decreased to between 8 and 208 mm2 (mean 98 mm2; 68% of immediate postoperative value) at 2 weeks and 3-208 mm2 (mean 71 mm2; 49% of immediate postoperative value) at 6 months. 14 of the 16 (88%) dacryocystorhinostomies were functional at the end of the study, the two failures being associated with marked contracture of the soft tissue anastomosis; the outcome of surgery correlated significantly with the area of the anastomosis at 2 weeks (chi 2 = 16.3; p < 0.01) and at 6 months (chi 2 = 16.0, p = 0.01). CONCLUSIONS: B mode ultrasonography provides a simple and effective method for assessing the size of the soft tissue anastomosis after external dacryocystorhinostomy and there is a significant reduction in size after surgery, to which the functional outcome of surgery appears related. As the initial soft tissue anastomosis cannot be larger than (and is, on average, about 60% of) the area of the osteotomy, this emphasises the paramount importance of a large rhinostomy to the success of lacrimal surgery.

Anastomosis, Surgical↗
PubMed1997

Prenatal diagnosis of orbital heterotopic brain tissue.

Biopsy of fetal tissues is a relatively new procedure for the diagnosis of congenital malformations. The authors report the first case in which this technique has been applied to an orbital mass, in which heterotopic brain tissue was diagnosed by prenatal biopsy and excised in infancy. The wider implications of such intrauterine procedures are discussed.

Adult↗
PubMed1997

Multidisciplinary management of refractory orbital rhabdomyosarcoma.

PURPOSE: Combined chemotherapy and radiation therapy have improved the survival of children with primary orbital rhabdomyosarcoma, but recurrence or persistence of the local orbital tumor still occurs. There are no established guidelines for dealing with these uncommon patients, and the authors present a review of the combined method treatment and outcome of children with refractory primary orbital rhabdomyosarcoma. METHODS: From clinical databases, 67 children with orbital rhabdomyosarcoma were identified. Seven (10%) of the 67 children had tumors refractory to combined chemotherapy and radiation therapy and underwent exenteration or eye-sparing tumor excision. Their clinical course and outcome were reviewed retrospectively. RESULTS: No patient was lost to follow-up, which ranged from 3.2 to 11 years. Five (71%) of the seven children with refractory tumor are still alive at more than 3 years after surgery (3.2-11 years; mean, 6.9). In one of the two children who died, tumor extended beyond the operative margins at exenteration, and the other child died with regional metastasis within a month of exenteration. CONCLUSIONS: Although more than 90% of children with orbital rhabdomyosarcoma respond to combined therapy by pediatric oncologists and radiotherapists, local orbital (salvage) surgery by ophthalmologists may be of value in the minority of children with refractory tumors. All of the five surviving children appear to be disease free.

Adolescent↗
PubMed1997

Outcome of orbital myositis. Clinical features associated with recurrence.

PURPOSE: Although orbital myositis usually responds to prompt systemic therapy, recurrent or persistent episodes often require prolonged therapy. This study presents the clinical and radiologic features of 26 patients with orbital myositis and suggests a treatment regimen with special emphasis on recurrent or persistent orbital myositis. METHODS: Retrospective analysis and comparison of clinical and radiologic parameters with clinical outcome in 26 patients with strictly defined orbital myositis was performed. A consultant radiologist reviewed computed tomography studies without knowledge of the clinical data or outcome. The frequency of certain clinical and radiologic parameters among two outcome groups was analyzed using Fisher's exact test. RESULTS: Comparison of clinical and radiologic features of 20 patients with a single acute episode and 6 patients with recurrent episodes disclosed several characteristics associated with recurrence. Male gender, lack of proptosis, eyelid retraction, horizontal extraocular muscle (EOM) involvement, multiple or bilateral EOM involvement (P = 0.05), muscle tendon sparing, and lack of response to systemic corticosteroids (P = 0.01), or nonsteroidal anti-inflammatory agents (P = 0.01) were associated with recurrent orbital myositis. CONCLUSIONS: A treatment algorithm is suggested for patients with orbital myositis. Those patients whose clinical or radiologic features are associated with recurrence may benefit from early systemic steroid therapy.

Acute Disease↗
PubMed1995

Inadequately irradiated solitary extramedullary plasmacytoma of the orbit requiring exenteration.

PURPOSE: To emphasize that solitary orbital extramedullary plasmacytoma, a rare tumor, is not invariably radiosensitive. METHOD: We examined a patient who had undergone empirical irradiation that failed to control an orbital tumor. RESULTS: After a second biopsy had secured the diagnosis of a solitary extramedullary plasmacytoma, further irradiation proved ineffective and exenteration was required. The patient was free of recurrence one year after exenteration and had satisfactory cosmesis with a prosthesis. CONCLUSION: A histologic diagnosis is essential before treatment is commenced so that the correct radiation dosage is used.

Adult↗
PubMed1995

Lacrimal gland hemangiopericytoma.

PURPOSE/METHODS: A 49-year-old woman with a left orbital mass was referred to an orbital clinic. Clinical investigation suggested a lacrimal gland lesion and the patient underwent lateral orbitotomy and excisional biopsy for a suspected pleomorphic adenoma in the lacrimal gland. RESULTS/CONCLUSION: Histopathologic evaluation disclosed a hemangiopericytoma originating within the lacrimal gland. Although hemangiopericytoma does not usually occur in this location, it may be added to the differential diagnosis of lacrimal gland enlargement.

Female↗
PubMed1995

Congenital orbital cysts associated with the common sheath of superior rectus and levator palpebrae superioris muscles.

PURPOSE: To review the clinical and operative features of a subgroup of superior congenital orbital cysts that intimately are associated with the common sheath of the superior rectus and levator palpebrae superioris muscles. METHODS: Records from four eligible patients were reviewed retrospectively. RESULTS: All four patients had ptosis or lid swelling at initial presentation and were found at surgery to have large cysts within the common tendon sheath of the superior rectus and levator palpebrae superioris muscles. The lining of these cysts resembled that of conjunctiva. There was no precedent conjunctival disease or surgery. CONCLUSIONS: The authors propose that these cysts are congenital and arise as misdirected cleavage of mesoderm during formation of the superior fornix. As such, this type of cyst has not been described previously and may represent a third group of congenital orbital cysts distinct from both conjunctival inclusion and dermoid cysts. Particular caution is required in their excision.

Adult↗
PubMed1995

Midline nasal dermoids presenting like discharging lacrimal sac mucocoeles.

Two cases of midline intranasal dermoid cysts presenting like discharging lacrimal sac mucocoeles in children are described. The diagnosis of this rare condition is suggested by the presence of midline nasal cutaneous dimples, although these may be associated with isolated anomalies such as nasal dermoid cyst, encephalocoele or glioma.

Child, Preschool↗
PubMed1994

Soft tissue infections after open lacrimal surgery.

BACKGROUND: Soft tissue infection after open lacrimal surgery is said to be uncommon. This study was designed to determine the rate of infection and the effect of early antibiotic prophylaxis after open lacrimal surgery. METHODS: Two consecutive patient groups undergoing open lacrimal surgery were studied by review of case notes: the first group (152 patients) did not receive antibiotic prophylaxis after surgery, and the second group (128 patients) did. RESULTS: Infection occurred in 2 of the 128 patients who were given prophylactic antibiotics (1.6%) and in 12 of the 152 patients who were not (7.9%; P < 0.02). Silicone intubation did not affect the infection rate, but patients who had sustained previous facial trauma did have a significantly increased rate of infection (P < 0.01). CONCLUSIONS: Soft tissue infection occurs in approximately 8% of patients after open lacrimal surgery. A 5-fold reduction in this rate can be achieved with routine administration of antibiotics after surgery. The use of silicone tubing does not increase the risk of infection.

Adolescent↗