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Biomedical subjects

J W Karesh

Publications and source records attributed to J W Karesh.

At least 37 records · Page 2Linked to original sources
PubMed1991

Orbital roof "blow-in" fractures.

Seven patients with significant frontal trauma involving the supraorbital region associated with orbital roof "blow-in" fractures were admitted to the Maryland Institute for Emergency Medical Services Systems (MIEMSS) at the University of Maryland Medical System over a 16-month period. High-resolution computed tomography (HRCT) with three-dimensional reconstructions demonstrated a downward displacement of the orbital roof in the absence of any orbital rim discontinuity. Associated findings included contussive and hemorrhagic injury to the ipsilateral frontal and parietal lobes, proptosis, ptosis, chemosis, orbital hematoma, and optic nerve contusion. The only long-term ocular pathology in this group of patients was mild to severe optic atrophy. It is recommended that all patients with frontal bone trauma have thin-cut computed tomographic evaluation of the orbit.

Accidents, Traffic↗
PubMed1991

Interpositional polytetrafluoroethylene grafts. Conjunctival biocompatibility.

Polytetrafluoroethylene (PTFE) is a synthetic, woven, nonabsorbable, nonantigenic, Teflon-related material that has been shown to be useful in correcting eyelid retraction and as an implant enveloping material in primary and secondary surgery to correct anophthalmos. Implanted PTFE will extrude if not entirely covered with a layer of conjunctival epithelium. In vitro studies demonstrated that coating PTFE with collagen, fibronectin, gelatin, or laminin promotes epithelial cell and fibroblast migration over and adherence to PTFE. In vivo studies showed that a coating of type 1 collagen is most successful in preventing graft extrusion by promoting conjunctival epithelial attachment and growth over exposed PTFE. Further studies are needed to determine the optimum PTFE coating and pore size needed to ensure the consistent retention of uncovered implanted PTFE grafts.

Animals↗
PubMed1991

Multilevel full-thickness eyelid resection for the correction of severe acquired ptosis in the poorly functioning eyelid.

Six eyelids (4 patients) with severe myogenic (4 eyelids), neurogenic (1 eyelid), or mechanical (1 eyelid) ptosis underwent surgical correction with a multilevel full-thickness resection of eyelid tissue combined with a plication of the levator aponeurosis-Müller's muscle complex. All eyelids had poor levator function, fair to poor orbicularis function, and a poor Bell's phenomenon. In all cases, the upper eyelids were elevated to an acceptable functional level without exposure keratopathy. This resection procedure preserves orbicularis function while allowing correction of severely ptotic eyelids with poor levator function, providing an acceptable alternative to other techniques for correcting this problem.

Adult↗
PubMed1989

Polytetrafluoroethylene as an interpositional graft material for the correction of lower eyelid retraction.

Polytetrafluoroethylene (PTFE), a nonantigenic, autoclavable, inert, woven synthetic graft material was used to correct ten lower eyelids with retraction secondary to either thyroid disease (7 eyelids) or surgically repaired maxillofacial trauma (3 eyelids). The material was well tolerated for postoperative periods ranging from 10 to 26 months. In two eyelids, a portion of the PTFE was removed to treat eyelid thickening and an infected meibomian gland. Results of histopathologic examination of the graft showed minimal inflammation and capillary and connective ingrowth into the graft matrix as well as a dense fibrous capsule around the graft. In selected cases, PTFE may be an acceptable substitute for other graft materials used in oculoplastic surgery.

Adult↗
PubMed1989

Mucoepidermoid carcinoma of the lacrimal gland fossa: confirmation by ultrastructural study.

We have described a patient with a biopsy-proven mucoepidermoid carcinoma of the orbit. Although it may have represented a metastasis from a malignancy of the upper respiratory tract, clinically it appeared to be a primary neoplasm of the lacrimal gland. This case emphasizes the value of transmission electron microscopy in diagnosing poorly differentiated orbital tumors.

Carcinoma↗
PubMed1989

A prospective ophthalmic evaluation of patients with acute myeloid leukemia: correlation of ocular and hematologic findings.

We report the results of a prospective 2-year study of the ocular manifestations of myeloid leukemia. Fifty-three patients underwent complete ophthalmic evaluation prior to the initiation of treatment as well as during the course of their disease. All ocular abnormalities were confined to the retina and optic nerve and were present in 34 patients, 30 of whom had either hemorrhages or cotton-wool spots alone or in combination. These findings were unrelated to age, sex, French-American-British (FAB) classification, and pretreatment leukocyte count or hematocrit. Patients with retinopathy had significantly lower platelet counts than those without retinopathy. Three patients had funduscopic evidence of optic nerve edema. None of these had clinical evidence of CNS leukemia. The presence of retinopathy was unrelated to therapeutic response. There was complete resolution of all ocular findings in those patients surviving the induction phase of therapy.

Adult↗
PubMed1988

Reconstruction of the partially contracted ocular socket or fornix.

Foreshortening of the conjunctival fornices by symblepharon or scar formation can result in a variety of cosmetic and functional abnormalities for the anophthalmic and the sighted patient. To correct this problem, we have modified a technique for the treatment of totally contracted ocular sockets. Unlike the procedure for total reconstruction of the socket that uses a custom-designed conformer wrapped with a full-thickness mucous membrane graft, reconstruction of a partially contracted socket uses a 0.5-mm-thick mucous membrane graft sutured to the resected socket conjunctiva and splinted in place by a custom-designed conformer. Seventeen patients with a variety of underlying pathologic conditions associated with trauma and prior surgery underwent successful ocular fornix reconstruction using this technique.

Adolescent↗
PubMed1988

A surgical technique for the successful and stable reconstruction of the totally contracted ocular socket.

We describe the successful and stable reconstruction of 47 severely contracted sockets over a 10-year period. The surgical technique employed in all these cases used a large custom-designed, C-shaped conformer wrapped with a full-thickness oral mucous membrane graft. After all cicatricial tissue within the socket was excised, the wrapped conformer was sutured at its midperiphery to the inferior and superior orbital rims. In contrast to other procedures using flatter conformers, which direct their force in a vertical dimension, this uniquely designed conformer directs its force both vertically and deeply posteriorly within the socket. A somewhat modified but similar conformer also can be used for sockets compromised by total symblepharon formation. Excluding six patients with inadequate follow-up, we were able to successfully reform spacious and stable fornices in 40 of 41 severely contracted sockets. The average postoperative follow-up after reconstruction in these cases was 23.9 months. This technique represents an effective approach to successfully reconstruct and maintain stable ocular cul-de-sacs in cases of severe socket contracture or total symblepharon formation.

Adolescent↗
PubMed1987

Polytetrafluoroethylene as a graft material in ophthalmic plastic and reconstructive surgery. An experimental and clinical study.

A clinical and experimental study was performed to demonstrate the usefulness of polytetrafluoroethylene (PTFE) as a graft material in ophthalmic plastic surgery. PTFE is non-antigenic, autoclavable, inert, and incorporated into surrounding tissue through fibrous ingrowth. PTFE implanted into rabbit eyelids for periods ranging from 2 to 21 weeks was examined grossly and microscopically. PTFE left uncovered by a conjunctival flap extruded; PTFE covered by a conjunctival flap was well tolerated without inflammation or extrusion and demonstrated dense fibrous capsular development with fibrous ingrowth along suture tracts and extensive vascular ingrowth. Fibrous tissue showed minimal growth into intrafiber pore spaces. PTFE was implanted into seven anophthalmic patients (one patch graft and six PTFE-wrapped secondary implants), with a postoperative follow-up of from 6 to 13 months. The material was well tolerated without extrusion, granuloma formation, or irritation. PTFE offers advantages over other graft materials and appears to be a useful addition to ophthalmic plastic surgery.

Adult↗
PubMed1987

Correction of postoperative eyelid retraction with a simplified levator palpebrae superioris (LPS) muscle recession: analysis of a 10-year experience.

A simplified levator palpebrae superioris (LPS) muscle recession was performed to correct eyelid retraction in 56 eyelids of 48 patients. Improvement of preoperative keratopathy and cosmetically acceptable results were achieved in 93% of the eyelids. Based on preoperative surgical intervention, eyelids were divided into four groups: levator resection, levator aponeurosis advancement, surgery associated with dysthyroid ophthalmopathy, and miscellaneous reconstructive eyelid procedures. For each group the mean preoperative and postoperative eyelid levels, the mean change in eyelid level following surgery, and the mean amount of surgery performed were analyzed statistically with the two-tailed student's t-test. Linear regression was used to analyze the relationship between the change in eyelid level and the amount of levator recession performed. No significant relationship was demonstrated between eyelid retraction and dysthyroid ophthalmopathy or reconstructive eyelid surgery. However, a significant relationship was demonstrated between the amount of recession and the eyelid level change for eyelids retracted following levator resection (P less than .01) and levator aponeurosis surgery (P less than .05). This may indicate that the change in eyelid level following a simplified LPS recession in these two groups is predictable. However, additional prospective studies are required to further assess the clinical applicability and use of this finding.

Adolescent↗
PubMed1986

Proptosis from maxillary sinus inverted papilloma with malignant transformation.

We describe a 58-year-old woman who presented with proptosis, upward displacement, and decreased vision in her right eye. A computed tomography scan revealed a mass filling the right maxillary sinus, destroying bone and invading the inferolateral orbit. The tumor proved to be an inverted squamous papilloma with focal transformation to squamous cell carcinoma. Although a rare cause of proptosis, inverted papilloma with orbital invasion must be considered when a patient describes associated nasal or sinus disease.

Biopsy↗
PubMed1986

Conjunctiva-Müller's muscle excision to correct anophthalmic ptosis.

We treated 35 eyelids with ptosis and anophthalmos by resecting conjunctiva and Müller's muscle. Before surgical intervention all patients were evaluated by an experienced ocularist who, if necessary, modified or refit the prosthesis. All eyelids had a positive response to 10% phenylephrine hydrochloride. Preoperatively, the margin reflex distance-one (MRD-1) of the ptotic eyelids ranged from -2.0 to +3.5 mm. The amount of conjunctiva-Müller's muscle excision ranged from 7.25 to 9.25 mm. Following surgery, the average change in MRD-1 was 3.33 mm. Thirty-one eyelids (88.6%) achieved a post-operative level within 1 mm of the opposite eyelid. There were two overcorrections and two undercorrections. Postoperatively, no patients had any compromise of the superior fornix, socket dryness, or inability to retain their prosthesis. Resection of conjunctiva and Müller's muscle is a simple and effective method to treat ptosis associated with anophthalmos.

Adolescent↗
PubMed1986

Cystoid macular edema following penetrating keratoplasty: incidence and prognosis.

The incidence of clinically significant and angiographically documented cystoid macular edema (CME) following penetrating keratoplasty was studied in a consecutive series of 102 eyes over an average follow-up of 30 months. CME was seen only in the aphakic eyes. Twenty out of 68 eyes in this group developed CME. There was a statistically significant higher incidence of CME in eyes undergoing vitrectomy than in eyes not undergoing vitrectomy (p less than .01). Also, there was a higher incidence of CME in eyes with aphakic bullous keratopathy (p less than .01) and pseudophakic bullous keratopathy (p less than .05), when compared to eyes undergoing combined cataract extraction and corneal transplantation. All eyes with CME were empirically treated with oral prednisone (two eyes) or oral ibuprofen (18 eyes). Over an average follow-up of nine months, 13 of these eyes showed complete resolution of their CME with improvement in visual acuity to 20/60 or better in 12 eyes.

Adrenal Cortex Hormones↗
PubMed1986

An improved method for the delivery of artificial tears using an infusion pump.

Patients with markedly decreased or absent tear duct production require the frequent instillation of artificial tear preparations. Through animal experiments, a new method has been developed for the continuous infusion of these solutions. In this procedure, the canalicular system is intubated with fenestrated silastic tubing, which is subcutaneously tunnelled and then attached to a miniaturized and computerized pumping device. This makes it possible for a predetermined volume of solution to be automatically and continuously delivered. Using this technique, artificial tear solution was instilled at a rate of 1.75 microliter/min, a rate approximately the normal basic tear secretion rate (0.5-2.2 microliters/min). This resulted in a 14% increase in tear flow from preoperative values. This represents a 74% increase in tear secretion rates for patients with keratoconjunctivitis sicca. None of the experimental animals developed subcutaneous infections, dacryocystitis, or corneal ulcers. By utilizing the normal anatomy of the lacrimal drainage system, this new technique: does not compromise the conjunctival cul-de-sac or the salivary system, avoids the inconvenience of previous external devices, and allows for the automatic instillation of predetermined volumes of artificial tear solutions.

Animals↗