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Biomedical subjects

J R Patrinely

Publications and source records attributed to J R Patrinely.

At least 37 records · Page 2Linked to original sources
PubMed1998

Tarsal patch-flap for orbital implant exposure.

The authors determine the efficacy of a new technique, the tarsal patch-flap, in the management of postenucleation and postevisceration porous orbital implant exposures that are recalcitrant to other surgical approaches. All patients treated during a 30-month period with recurrent orbital implant exposures who failed at least one surgical attempt at defect closure were treated using a tarsal patch-flap, a fornix-based tarsoconjunctival flap from the upper eyelid. Eight patients, six after enucleation and two after evisceration, were treated with a tarsal patch-flap. Five implants were porous polyethylene and three were hydroxyapatite. The defect size ranged from 4 mm to 12 mm (largest dimension). All eight patients have maintained closure of their defects for a mean follow-up of 13.8 months (range, 4-30 months). The vascularized tarsal patch-flap provides an excellent alternative surgical approach to the management of recurrent orbital implant exposures recalcitrant to Tenon-conjunctival advancement and autologous fascia grafting.

Biocompatible Materials↗
PubMed1998

Eyelid cancers.

Eyelid cancers, like most malignancies, are on the rise, creating an ever-enlarging population of patients with these diseases. Trends in eyelid cancer diagnosis, prognostic evaluation, prevention, and management are reviewed. Special emphasis is placed upon understanding perineural invasion by squamous cell carcinoma, the role of genetic mutations in eyelid cancer development and prognosis, and new techniques for total upper eyelid reconstruction.

Biopsy↗
PubMed1998

Optic nerve sheath decompression in pediatric pseudotumor cerebri.

The authors report a retrospective review of two cases of optic nerve sheath decompression in children (age younger than 16 years) and review the literature on the procedure. Two children underwent optic nerve sheath decompression. Optic disc edema resolved in both eyes after surgery. Some degree of visual improvement was obtained in one eye of each patient after surgery, but one eye was unchanged in one patient and one eye of the other patient had worsening of visual acuity after surgery. Neither patient suffered any systemic complications from the procedure. Of 12 patients in the literature (including these 2 patients), 66% experienced improved visual acuity following optic nerve sheath decompression, 33% had improvement in visual field, and 17% suffered worsening of visual acuity and visual field after surgery. Although optic nerve sheath decompression is a relatively safe and effective treatment for visual loss due to papilledema in adults, significant complications, including further visual loss, may occur. The experience with this procedure in children is limited, but retrospective data suggest that the safety and efficacy of the procedure may be comparable with that in adult patients.

Adolescent↗
PubMed1998

Intracranial Ewing's sarcoma.

Three patients with intracranial Ewing's sarcoma had neuro-ophthalmologic manifestations. In one patient, the primary tumor was in the skull and in two, it involved the long bones. Two patients complained of intermittent headache associated with bilateral, transient visual symptoms suggestive of migraine, which prompted imaging that showed occipital metastases. The third patient had an orbital syndrome.

Adolescent↗
PubMed1998

Surgery of the eyelids.

This article reviews the most common pediatric oculoplastic conditions and addresses clinical evaluation as well as medical and surgical management. The complex issues of amblyopia and special considerations for eyelid surgery in children are discussed. A step-by-step approach is used in the treatment of many common pediatric oculoplastic conditions, including congenital blepharoptosis and lid margin defects. Surgical options are explored and clinical examples are provided.

Amblyopia↗
PubMed1997

The perils of permanent punctal plugs.

PURPOSE: To describe previously unreported complications associated with permanent lacrimal punctal plugs. METHOD: Five oculoplastic practices reviewed patients referred to them over the preceding 2 years for permanent lacrimal punctal plug complications. RESULTS: In 12 patients, 14 lacrimal punctal plugs migrated distally within the lacrimal drainage system, causing symptoms and necessitating surgical removal. CONCLUSION: Luxation of permanent punctal plugs into the distal lacrimal drainage system can occur, sometimes requiring complex surgical intervention.

Foreign-Body Migration↗
PubMed1997

Orbital involvement in allergic fungal sinusitis.

BACKGROUND: Although allergic fungal sinusitis is a relatively common, noninvasive form of paranasal sinus mycosis, and despite frequent orbital involvement, there have been few reports of this condition in the ophthalmic literature. METHODS: Two cases of allergic fungal sinusitis having orbital symptoms are described. The current classification, typical presentation, and ideal management of fungal sinusitis are reviewed. RESULTS: Distinguishing radiologic and pathologic features were present in both patients. Aspergillus flavus was cultured in one case, and Bipolaris spicifera was cultured in the other. CONCLUSIONS: Allergic fungal sinusitis is a unique subset of sino-orbital disease with highly characteristic clinical, radiologic, and pathologic features. Unlike invasive forms of mycotic disease, allergic fungal sinusitis may be managed adequately with surgical debridement, aeration of the involved sinuses, and systemic and topical corticosteroids.

Adult↗
PubMed1997

Combined transconjunctival/intranasal endoscopic approach to the optic canal in traumatic optic neuropathy.

Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.

Adolescent↗
PubMed1997

Conjunctival cilia entrapment: an unrecognized cause of ocular irritation.

Conjunctival entrapment of cilia is form of ocular irritation that to our knowledge has not yet been described. Scarring predisposes the conjunctiva to this phenomenon by creating blind recesses in which loose cilia can become entrapped. Once caught, the rigid cilia can act as a mechanical irritant or act as a nidus for microbial growth. We present herein three patients with entrapped cilia and discuss their pathophysiology and management. The symptoms in all three patients resolved with conjunctivoplasty and removal of the cilia.

Adult↗
PubMed1996

Periocular autografts in socket reconstruction.

BACKGROUND: Current enucleation and socket reconstruction techniques often require reinforcement of an orbital implant or wound by the use of a tissue graft. Commonly, allograft tissue (cadaveric sclera, fascia, etc.) is used. Disadvantages of allografts include possible inflammatory reaction, unpredictable vascularization rate, variable resorption, antigenicity, and cost. Another alternative to implant reinforcement is autogenous tissue which usually is harvested from a remote site (fascia lata, split dermis, temporalis fascia, pericranium, etc.). An overlooked source of readily available autogenous grafts is the connective tissue in the periorbital region and the enucleated eye itself. These sources include autogenous lamellar sclera, the corneoscleral button, capsular tissue from a migrated implant, and orbital rim periosteum. METHODS: The authors used periocular autografts in primary and secondary socket reconstructions in 24 patients, with excellent success over a 2-year period. Seven autogenous corneoscleral buttons and two autogenous scleral grafts were used to cover biointegrated implant spheres. Ten implant capsules from migrated nonintegrated spheres were used to cover and reinforce secondary implants. In five patients, an autogenous periosteal graft was taken from the supraorbital rim and used to cover an exposed implant. RESULTS: Complications included one pyogenic granuloma, one conjunctival inclusion cyst, and one recurrent exposure after a periosteal graft, which necessitated explanation and a dermis fat graft. Postoperative motility was judged to be good to excellent in 21 patients. CONCLUSIONS: These techniques are presented as a new alternative to using human bank tissue or remote incision autografts for reconstruction of the anophthalmic socket.

Adolescent↗
PubMed1996

Reversal of iatrogenic punctal and canalicular occlusion.

PURPOSE: Significant epiphora occasionally develops after therapeutic punctal occlusion. When this complication occurs from combined scarring of the upper and lower proximal canaliculi, correction usually requires a conjunctivodacryocystorhinostomy. METHODS: The authors describe a new microsurgical technique for reversing iatrogenic occlusion of both the upper and lower canaliculi. The relatively straightforward reconstruction uses the remaining canalicular system to create new tear outflow sites. RESULTS: This procedure has been used successfully to repair eight of nine consecutive cases of iatrogenic canalicular occlusion, with an average follow-up of 2 years. CONCLUSION: Iatrogenic canalicular occlusion can be reversed microsurgically without a conjunctivodacryocystorhinostomy.

Adult↗
PubMed1996

Orbital hemorrhage during rhinoplasty.

The most common complication of rhinoplasty is perioperative and postoperative hemorrhage. We present two patients who experienced intraoperative orbital hemorrhage during rhinoplasty. Patients with a history of previous nasal trauma, because of scarring/altered anatomy, may be more prone to this serious complication. A precise and well-placed osteotomy must be done to avoid aberrant anatomy and complications. The proposed mechanism for orbital hemorrhage is shearing or tearing of fibrovascular scar tissue involving the angular vessels during the surgical dissection. Prompt recognition and management of an orbital hemorrhage during or following rhinoplasty is necessary to prevent possible ocular injury and loss of vision. A management algorithm for orbital hemorrhage is presented along with a discussion of surgical techniques to prevent this complication. Surgeons performing rhinoplasty should be cognizant of this type of intraoperative complication along with its medical and surgical management.

Adult↗
PubMed1995

Late proptosis following orbital floor fracture repair.

OBJECTIVE: Late proptosis is an unusual complication of orbital floor fracture repair. We report 12 cases and propose a classification scheme and differential diagnosis for this rare complication. DESIGN: Retrospective multi-institutional case review. SETTING: Two tertiary referral centers. RESULTS: We report 12 cases of late proptosis following orbital floor fracture repair. Causes of late proptosis include peri-implant inflammation, capsular hemorrhage, gelatin film cyst, implant infection, sino-orbital fistula, intraorbital sinus mucocele, and carotid-cavernous fistula. We describe the treatment of each case individually; in most cases, the implant was removed. All 12 patients had a satisfactory outcome after treatment. CONCLUSIONS: Proptosis presenting 2 months or more after orbital floor fracture is rare. We classify the origin of late proptosis into three groups: implant, sinus, and neurovascular. We describe the diagnosis and management of this unusual complication.

Adult↗
PubMed1995

Atypical mycobacterial infection of the orbit.

PURPOSE: To describe the clinical presentation and successful management of an orbital infection caused by Mycobacterium abscessus, a formerly unrecognized cause of orbital disease after penetrating trauma. METHODS: An orbital infection due to M. abscessus is described, and previously reported ocular and extraophthalmic infections caused by M. abscessus are reviewed. RESULTS: A 5-year-old boy had acute, painless visual loss shortly after being struck in his left lower eyelid with a fishing rod. Radiologic evaluation established a mass in the orbital apex. Initial biopsy and cultures of the apex mass were negative; however, additional orbital exploration and cultures demonstrated M. abscessus to be the causative organism. The orbital infection was treated successfully with long-term oral clarithromycin. Review of the literature on ocular/adnexal and soft tissue infections caused by atypical mycobacteria shows characteristic clinical and histopathologic features. CONCLUSIONS: To the authors' knowledge, only seven patients with atypical mycobacterial infections of the ocular adnexa have been reported. The patient reported in the current study illustrates the difficulty in establishing the preoperative diagnosis of atypical mycobacterial infections of the orbit. A chronic draining wound or a localized orbital abscess, after penetrating trauma, should alert the physician to the possibility of an M. abscessus infection. Clarithromycin, an oral macrolide antibiotic, appears to be the most effective medical therapy for these patients.

Administration, Oral↗
PubMed1995

Sebaceous gland hyperplasia of the caruncle.

The caruncle is an ocular adnexal structure composed of both mucosal and epidermal elements. Consequently, a number of benign and malignant lesions of epithelial and supportive tissues may arise in this area. Lesions of the caruncle are rarely reported, and their appropriate diagnosis and management may be uncertain. One such lesion is sebaceous gland hyperplasia. Of all caruncular lesions that undergo excision, sebaceous gland hyperplasia is infrequently encountered. We have observed four cases of sebaceous gland hyperplasia of the caruncle over the last 2 years. Our observations suggest that this lesion has a characteristic onset, progression, and appearance, enabling diagnosis to be made on clinical examination alone. Excision is indicated only if there is an atypical presentation, a carcinoma is suspected, if mass effect causes discomfort or epiphora, or if cosmesis is an issue.

Aged↗