Biomedical subjects

J J Dutton

Publications and source records attributed to J J Dutton.

At least 19 recordsLinked to original sources

PubMed2000

Anterior tarsal V-wedge resection for cicatricial entropion.

PURPOSE: To determine the effectiveness of using a radiofrequency instrument to resect a V-shaped tarsal wedge for the correction of cicatricial upper eyelid entropion. METHODS: Prospective evaluation of 16 upper eyelids of 11 consecutive patients. RESULTS: The operation was successful in all 16 eyelids, with excellent cosmetic and functional outcomes. CONCLUSIONS: Tarsal V-wedge resection is an effective alternative to other complicated techniques in the management of upper eyelid cicatricial entropion.

Adult↗

PubMed2000

Direct internal eyelash bulb extirpation for trichiasis.

PURPOSE: To evaluate the success of internal eyelash bulb extirpation in the management of trichiasis. METHODS: The procedure was performed on 26 consecutive eyelids. RESULTS: Our technique was successful in all cases, with no recurrence of signs or symptoms. CONCLUSIONS: Internal eyelash bulb extirpation is a safe and effective technique to remove trichiatic lashes, while avoiding injury to the conjunctiva.

Eyelashes↗

PubMed2000

A comparative study of bovine pericardium (periguard) and homologous sclera as lower eyelid spacer graft analogs in New Zealand white rabbits.

PURPOSE: To compare bovine pericardium (Periguard; Bio-Vascular, Inc., St. Paul, MN, U.S.A.) and homologous sclera as spacer graft analogs in a rabbit model. METHODS: A nonrandomized experimental animal study was conducted. Elliptical subconjunctival implants were placed in one lower eyelid each of 10 rabbits. Five rabbits received homologous sclera implants, and five received bovine pericardium implants. The rabbits were killed 7 weeks later, and the lower eyelids were examined clinically and histopathologically. RESULTS: Rabbit eyelids implanted with Periguard had a more marked inflammatory reaction and more significant collagen lamellar disruption than eyelids implanted with homologous sclera, although clinically they appeared quite similar. CONCLUSIONS: Although bovine pericardium elicited a more intense inflammatory response at the histopathologic level, both implants were similarly tolerated at the clinical level. These findings are consistent with animal and human investigations of bovine pericardium in other parts of the body, and warrant further studies into its potential use in the human eyelid.

Animals↗

PubMed2000

Orbital Ewing's sarcoma of the orbit.

PURPOSE: Ewing's tumor is a primary tumor of bone in childhood that only rarely involves the orbit. Most such cases are metastatic from distant sites. This tumor may be confused with other small round cell malignancies of childhood, and immunohistochemical studies are essential in making the diagnosis. METHODS: We present two cases of Ewing's tumor of the orbit. One was in a 22-year-old boy with an occult primary tumor in the frontal bone that became symptomatic after forehead trauma. The other example was in a 7-year-old boy with a known Ewing's primary of the clavicle. The clinical manifestations and diagnostic criteria are discussed. RESULTS: In most cases with orbital involvement, ophthalmic symptoms consist of proptosis, pain, and occasionally visual loss and motility restriction. The diagnosis is typically unsuspected before histologic evaluation. Electron microscopic and immunohistochemical analyses are essential in making the diagnosis and are necessary for all such small round cell tumors. CONCLUSIONS: Ewing's sarcoma is a rare orbital tumor of bone mainly affecting children. Local treatment relying on surgical extirpation and radiotherapy alone has proven inadequate, with 5-year survival rates of <10%. The addition of chemotherapy has improved survival rates significantly to approximately 50%.

Biopsy↗

PubMed1999

Hard palate mucosal grafts in the treatment of the contracted socket.

PURPOSE: The treatment of the traumatic contracted anophthalmic socket is challenging. The ability to wear an ocular prosthesis may require multiple operations to replace orbital volume, mucosa, or both. Hard palate mucosal grafts are a logical choice to augment mucosa and volume in the reconstruction of a contracted socket. METHODS: Ten patients with severely contracted sockets underwent socket reconstruction using hard palate mucosal grafts. The mucosal surface lining the contracted sockets was undermined and recessed toward the lid margins. Hard palate mucosal grafts that were harvested freehand and by using a radiofrequency instrument were placed in the socket fundus and sutured to the recessed mucosal edges. Forniceal sutures were placed full thickness through the lids, and custom conformers were placed in the sockets. In six patients, fixation sutures were passed through the conformer, fornices, and full thickness through the lid. In four patients, temporary tarsorrhaphies were placed for a minimum of 4 weeks postoperatively. RESULTS: Postoperatively, 8 of the 10 patients were able to wear an ocular prosthesis comfortably. Cosmesis was acceptable. Two patients had recurrent socket contracture and were unable to wear a prosthesis. CONCLUSIONS: Hard palate mucosal grafts are a useful option in the surgical rehabilitation of contracted sockets. A mucosal surface, resistance to contracture, ease of harvesting, and ability for additional harvesting are advantages over other graft materials.

Adult↗

PubMed1999

Bovine pericardium versus homologous sclera as wrapping materials for hydroxyapatite ocular implants: an animal study.

PURPOSE: We compared bovine pericardium and homologous sclera as wrapping materials for hydroxyapatite (HA) ocular implants in enucleated New Zealand white rabbits. METHODS: Eighteen rabbits were unilaterally enucleated and the sockets implanted with 10-mm HA spherical implants. Six implants were wrapped with homologous sclera, 6 with bovine pericardium, and 6 were not wrapped. The rabbits were killed 7 weeks later and the sockets were examined clinically for inflammation and implant exposure. Exenterated specimens were assessed histopathologically for inflammation and vascularization. RESULTS: No clinical evidence of implant exposure or extrusion was detected in rabbits receiving sclera or bovine pericardium wrapped implants. Histopathologically, the bovine pericardium displayed more inflammation in its outer portion, as well as more disruption of its lamellar arrangement than did the sclera. Fibrovascular in-growth was complete in all wrapped implants. CONCLUSION: Bovine pericardium behaves similar clinically to homologous sclera as a wrapping material for spherical HA ocular implants in a rabbit model, and may represent a reasonable alternative to sclera in such procedures in humans.

Animals↗

PubMed1999

The influence of hyperbaric oxygen therapy and irradiation on hydroxyapatite ocular implant exposure and fibrovascular ingrowth in New Zealand white rabbits.

PURPOSE: Lack of adequate fibrovascular ingrowth has been implicated as a cause of exposure of hydroxyapatite (HA) implants in anophthalmic sockets. We investigated the vasculopathic effects of external beam irradiation, and the fibrovascular-enhancement effects of hyperbaric oxygen (HBO), on HA implant exposure and fibrovascular ingrowth in a rabbit model. METHODS: Eighteen rabbits underwent enucleation with implantation of a 12-mm HA sphere. Six rabbits received 20 Gy of external beam orbital irradiation prior to enucleation. Three irradiated and 6 nonirradiated rabbits received postoperative HBO. Three weeks postoperatively, all rabbits were evaluated clinically for evidence of implant exposure. Implants were then removed, and histopathologic analysis of fibrovascular ingrowth was performed. RESULTS: The amount of vascularization as measured by the depth of ingrowth was greater for nonirradiated (89% ingrowth) than for irradiated (71% ingrowth) animals. HA implant exposure occurred in 1 of 12 (8%) of the nonirradiated, and 4 of 6 (67%) of the irradiated rabbit orbits. HBO did not protect irradiated rabbits from exposure, but did enhance fibrovascular ingrowth in nonirradiated rabbits (100% ingrowth vs. 77% ingrowth). CONCLUSION: Impaired orbital vascularization from prior irradiation appears to retard fibrovascular ingrowth into HA implants, and is associated with an increased incidence of exposure. While HBO did not diminish the likelihood of exposure in irradiated sockets, HA fibrovascular ingrowth in normal orbits appeared to increase with HBO. This may have beneficial clinical application in cases of exposure in nonirradiated orbits.

Animals↗

PubMed1998

Sebaceous gland carcinoma: a subtle second malignancy following radiation therapy in patients with bilateral retinoblastoma.

BACKGROUND: Second primary malignancies are common after bilateral retinoblastoma; their estimated incidence has been as high as 51% 50 years after diagnosis. Fifteen patients who developed sebaceous gland carcinoma after radiation therapy have been reported in the literature, five of whom were treated for bilateral retinoblastoma. METHODS: The authors conducted a retrospective chart review of patients treated for bilateral retinoblastoma at Duke University Medical Center who later developed sebaceous gland carcinoma. RESULTS: This article reports two patients who developed sebaceous gland carcinoma after radiation therapy for bilateral retinoblastoma. CONCLUSIONS: Delay in diagnosis is often associated with sebaceous gland carcinoma. Because high mortality is observed with metastatic disease, the recognition of this association is important for anyone who follows patients with a history of bilateral retinoblastoma or prior cranial radiation therapy.

Adult↗

PubMed1998

Age-related changes in type-I collagen synthesis in human eyelid skin.

PURPOSE: This study was to determine whether age-related decrements in type I collagen synthesis occur in human eyelid skin. METHODS: Using an antibody to procollagen I, we investigated collagen synthetic activity in skin removed for cosmetic purposes from 10 white patients between the ages of 4 and 77 years. Eleven masked referees graded the immunostaining on a scale of 1 (most intense) to 10 (least intense). RESULTS: The multiple range test for rank by group demonstrated more intense staining in younger patients compared with older patients. An average correlation coefficient of 0.8432 (p < 0.05) existed between each of the referee's rankings. CONCLUSION: Type I collagen synthesis diminishes with age in eyelid skin.

Adolescent↗

PubMed1998

Rate of vascularization of coralline hydroxyapatite spherical implants pretreated with saline/gentamicin, rTGF-beta 2, and autogenous plasma.

Several authors have reported significant exposure rates using the hydroxyapatite orbital implant in the treatment of the anophthalmic socket. Histologic studies by ourselves and others have suggested that lack of fibrovascular ingrowth into the implants may contribute to conjunctival breakdown and exposure. Recently, much attention has been given to angiogenic factors, such as rTGF-beta 2 and those found in plasma, in accelerating wound healing and fibrovascular ingrowth. This pilot study compares the rate of vascularization of hydroxyapatite orbital implants pretreated with plasma, rTGF-beta 2, and a saline/gentamicin solution with that in untreated controls ina population of New Zealand albino rabbits. Hydroxyapatite orbital spheres were implanted subcutaneously and in enucleated orbits. Untreated implants were used as a control. Implants pretreated with plasma, rTGF-beta 2, and a saline/gentamicin solution were removed and examined histologically at weekly intervals for the first 3 weeks after implantation. Histologic studies demonstrated that the rate of vascularization significantly increased between 2 and 3 weeks postoperatively in all study groups. Pretreating the implants with rTGF-beta 2 in phosphate buffered solution (PBS) or autogenous plasma did not significantly increase the rate of vascularization in comparison with controls at weeks 1 and 2. However, pretreating the implants with a saline/gentamicin solution or PBS alone was associated with an increased rate of vascularization at weeks 2 and 3. No statistically significant difference in vascularization was noted between the subcutaneous and orbital implants at any week. Hydroxyapatite implants pretreated with saline/gentamicin or phosphate buffered solutions underwent more rapid vascularization at weeks 2 and 3 in comparison with controls. Additionally, all groups were noted to have a more rapid rate of ingrowth between weeks 2 and 3 than between weeks 1 and 2. Plasma and rTGF-beta 2 (at the dose used) did not significantly alter the rate of vascularization of hydroxyapatite implants during the first 2 to 3 weeks. The significance of these findings is discussed.

Animals↗

PubMed1998

Changes in astigmatism after ptosis surgery measured by corneal topography.

A computerized topographic analysis system (EyeSys [EyeSys Technologies, Houston, TX, U.S.A.]) was used to evaluate corneal astigmatic changes (central corneal power and astigmatic axis) after blepharoptosis surgery on 29 eyelids (22 patients). Fifteen nonoperated eyelids of study patients undergoing unilateral ptosis repair were used as controls. All patients were evaluated preoperatively and again 6 weeks after surgery. Fifteen operated eyelids and five controls were also examined 12 months after surgery to evaluate the stability of these measurements. In 72.4% of operated eyes, corneal topography demonstrated increased with-the-rule astigmatism 6 weeks after surgery, 13.8% of surgical eyes showed increasing against-the-rule astigmatism, and in 13.8%, no change was noted from preoperative measurements. None of the 15 control eyes demonstrated any change in corneal astigmatic axis or significant change in central corneal power. By 12 months after surgery, all of the operated eyes showed a regression toward the amount and pattern of preoperative astigmatism. Only two of 15 eyes maintained a difference of > 0.3 D of central corneal power greater than their preoperative measurement at 1 year. These data suggest that corneal topography may be altered by changes in eyelid position, although the changes appear to be temporary in most patients.

Adult↗

PubMed1998

Decrease in intraocular pressure after orbital decompression for thyroid orbitopathy.

BACKGROUND: The effect of thyroid orbitopathy on intraocular pressure (IOP) remains controversial. We carried out a study to determine the effect of orbital decompression surgery on the IOP in patients with advanced thyroid orbitopathy. METHODS: The records of 12 consecutive patients (22 eyes) who underwent decompression surgery for severe thyroid orbitopathy between 1985 and 1996 were reviewed. All patients were maintained on essentially the same medications before and after surgery. The IOP readings, obtained by means of applanation tonometry in primary gaze, from the pre- and postoperative visits were recorded, and the net change was calculated. RESULTS: The mean preoperative and postoperative IOP values were 19.8 mm Hg and 16.8 mm Hg respectively, a significant difference (p = 0.008). Seven of eight eyes with an IOP of 21 mm Hg or greater preoperatively had a postoperative IOP less than 21 mm Hg; these eyes showed a mean decrease in IOP of 5.6 mm Hg. The degree of preoperative IOP elevation was found to be a strong predictor of the amount of IOP lowering after surgery (p = 0.014). INTERPRETATION: Our results support the concept that orbital congestion associated with thyroid orbitopathy produces an increase in IOP by elevation of episcleral venous pressure (EVP) and that orbital decompression may reduce the IOP by decreasing EVP. Decompression surgery may obviate the need for more aggressive management of glaucoma in patients with severe thyroid orbitopathy.

Adult↗

PubMed1997

Deviated hydroxyapatite orbital implant syndrome.

PURPOSE: To describe a patient with a deviated orbital implant after enucleation. METHOD: Case report. RESULT: We examined a postenucleation patient with a medially deviated ("esotropic") implant after peg drilling. Modification of the posterior surface of the prosthesis improved cosmesis in the primary position. CONCLUSIONS: During enucleation surgery, surgeons may use a spherical implant rather than modify the anterior face in patients with preexisting strabismus, with severe trauma to the extraocular muscles, or with risk of implant deviation. Additionally, secondary procedures may alter implant position. Occasionally, patients without obvious preoperative risk factors may have deviation of the modified face of the implant. Flattening the implant creates an asymmetric surface that may lead to a deviated orbital implant.

Adult↗

PubMed1997

Lower eyelid recession combined with ptosis surgery in patients with poor ocular motility.

BACKGROUND: The authors treated ten patients (13 eyelids) with visually significant blepharoptosis and compromised corneal protective mechanisms resulting from paresis of ocular motility and absent Bell phenomenon. METHODS: Traditional upper eyelid surgery consisting of frontalis suspension (6 eyelids) or levator aponeurosis advancement (7 eyelids) was used. In all patients, the ptosis repair was combined with maximum recession of the lower eyelid, using a posterior lamellar scleral spacer graft. The goal was to maintain a narrow, vertical, interpalpebral fissure to allow for eyelid closure, but to reposition this opening centrally over the pupil. RESULTS: Postoperatively, all patients achieved significant improvement in superior visual field, with no associated keratopathy. Complications were few, minor, and transient. The postoperative cosmetic appearance was acceptable in all patients. CONCLUSIONS: This combined procedure allows repair of fair- to poor-function ptosis in patients in whom ptosis surgery previously has been considered risky. For the authors, this technique has been proven safe and effective and should be considered in any patient population with compromised corneal protective mechanisms.

Adult↗

PubMed1996

Holmium laser canaliculoplasty.

Thirty canaliculi of 18 patients with complete or nearly complete canalicular obstruction were subjected to laser canaliculoplasty as a substitute for the standard Jones-type bypass conduct. Etiologies for the obstruction included congenital lacrimal system atresia, eyelid trauma, scarring following previous lacrimal surgery, and chronic inflammatory fibrosis. The procedure utilized a holmium laser delivered via a 1,000 mu optical fiber to cut a 1-mm channel from the punctum into the lacrimal sac. In nine eyes, this procedure was combined with a surgical dacryocystorhinostomy (DCR) for concurrent lower nasolacrimal duct obstruction. Silicone stents were left in place for 6 months postoperatively. Follow-up data were available for 28 canaliculi of 17 patients. Moderate or better improvement in symptomatic epiphora and evidence of canalicular patency to drainage was seen in 16 of 28 (57%) treated canaliculi, and significant improvement was recorded in 12 of 28 (43%). Although these figures are lower than those obtainable after repair of small areas of focal canalicular stenosis or obstruction, the procedure is superior to any previous attempts at reconstruction of extensive obstructions, short of placement of a Jones tube. When successful, this procedure offers re-establishment of a near normal physiologic system, and avoids the complications of and patient dissatisfaction associated with a Jones tube.

Adult↗

PubMed1994

Hürthle cell carcinoma metastatic to the uvea.

BACKGROUND: The authors present a case of Hürthle cell carcinoma metastatic to the uvea in a patient with known Hürthle cell tumor of the thyroid. The fluorescein angiogram suggested a neoplastic lesion, and the collar-button configuration resembled a malignant melanoma. However, standardized echography revealed high internal reflectivity and an irregular acoustic structure suggestive of a metastatic carcinoma. METHODS: The clinical history and examination were consistent with the diagnosis of metastatic Hürthle cell carcinoma of the eye. Results of a fine-needle aspiration biopsy and histopathology of the intraocular lesion confirmed the diagnosis. RESULTS: Because this was the patient's better-seeing eye, the tumor was treated with an 125I radioactive episcleral plaque. Over the subsequent 27 months, the lesion demonstrated a gradual regression. CONCLUSIONS: We have not found any previously reported cases of Hürthle cell carcinoma of the thyroid metastatic to the eye. The diagnosis may be confirmed safely by intraocular aspiration biopsy. The lesion is responsive to radioactive plaque application. The origin, pathology, and management of this unusual tumor are reviewed.

Adenocarcinoma↗

PubMed1992

Rate of vascularization of coralline hydroxyapatite ocular implants.

Twelve patients received a coralline hydroxyapatite sphere as a buried integrated ocular implant after enucleation surgery. The implant was modified by drilling 5 access holes, 1 mm in diameter, to the center of the sphere to allow more rapid host tissue ingrowth. 99Tc MDP static and dynamic bone scan studies were performed at various intervals after implantation to confirm the time course for vascularization. Complete vascularization was noted in 1 of 2 patients at 8 weeks after surgery, in 7 of 7 patients at 10 to 12 weeks, and in 3 of 3 patients at 16 weeks. This modified technique allows the hydroxyapatite ocular implants to be drilled for the final motility peg at an earlier time than currently possible, thereby resulting in more rapid cosmetic rehabilitation and obviating the need for secondary modification or replacement of the prosthesis.

Bone and Bones↗

PubMed1992

Influence of coralline hydroxyapatite used as an ocular implant on the dose distribution of external beam photon radiation therapy.

Coralline hydroxyapatite spheres are used as buried integrated ocular implants after enucleation or evisceration surgery. Because such implants are used after surgery for intraocular malignancy and because some patients may require postoperative radiation therapy for orbital tumor recurrence, the radiation attenuation characteristics of the implant are of interest. The authors evaluated the attenuation and scattering properties of coralline hydroxyapatite implants using a 4 MV photon beam and film dosimetry. Optical density analyses indicate that coralline hydroxyapatite implants have no significant influence on the attenuation or scattering properties of the photon beam. As such, there is no basis for concern that such implants might adversely affect external beam photon irradiation.

Absorptiometry, Photon↗