Biomedical subjects
Publications and source records attributed to J W Shore.
Hemangiopericytoma is a rare soft-tissue neoplasm composed histologically of pericytes. Hemangiopericytoma of the lacrimal sac is exceedingly rare. This case provided the first known computed tomographic image of a hemangiopericytoma of the lacrimal sac prior to surgical intervention.
Periorbital intraosseous hemangiomas are a rare clinical entity that may present with visual or cosmetic disturbances. They may be difficult to distinguish from other bony lesions such as malignant metastases. If the diagnosis of hemangioma can be confidently made in a mildly symptomatic patient, the lesion may be observed. In patients in whom the diagnosis is uncertain or when there is visual compromise such as optic nerve compression, total surgical excision is recommended. Preoperative evaluation with angiography should be strongly considered, particularly if embolization can be accomplished prior to surgery. Even then, the surgeon and the patient must be prepared for the risk of significant hemorrhage.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The transconjunctival inferior fornix incision provides access to the floor, rim, lateral, and inferior medial walls of the orbit. Complications of this surgical approach to the orbit are known to be rare but heretofore have not been clearly defined. Over an 8-year period, in an estimated 1200 cases, the authors have encountered cicatricial entropion, lower eyelid retraction, canthal dehiscence, lower eyelid avulsion, canalicular laceration, buttonhole laceration of the lower eyelid, conjunctival chemosis, and lacrimal sac laceration. Attention to anatomic landmarks and sound surgical execution will prevent these complications in most patients.
Three patients with bilateral tumors presenting as multiple keratinizing and verrucous lesions of the bulbar and tarsal conjunctiva were determined by DNA amplification and hybridization studies to harbor human papillomavirus type 16 (HPV-16). Results of biopsy in two patients showed infiltrating squamous cell carcinoma in one eye and dysplasia or carcinoma in situ in the fellow eye. In the third patient, focal, inflamed, hypertrophic, papillary lesions with pseudoglandular invaginations of the surface epithelium were found in the tarsal conjunctivae of both eyes. These are the first documented cases of bilateral conjunctival tumors associated with human papillomavirus.
The application of antibiotic prophylaxis to fractures of the orbital floor is controversial. The incidence of infection following this injury remains undefined. We report a case of orbital cellulitis following orbital floor fracture, and attempt to define guidelines for the appropriate use of antibiotics in the setting of an isolated blowout fracture.
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We examined an orbital exenteration specimen from an anophthalmic patient with focal dermal hypoplasia. Eyelid angiofibromas were evident and immunoperoxidase studies for human papilloma virus were negative. Orbital tissue contained a ductal cyst, chronic inflammation of the lacrimal duct and sac, rudimentary conjunctival fornices, lacrimal gland, striated muscle, and adipose tissue. Microscopic examination revealed a posteriorly located cystic structure with uveal and lens remnants. Neuroectodermal structures consistent with retina, optic nerve, or meninges were not observed, thus representing true anophthalmia. These findings remain as the only histopathologic description of ocular tissues in patients with focal dermal hypoplasia.
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The authors reviewed 157 cases (207 eyes) of blepharoptosis corrected by external levator resection. Twenty-eight patients (29 eyelids) had unsatisfactory results. The authors adjusted 13 eyelids within 1 week of surgery. Eleven eyelids were reoperated 6 or more weeks after surgery. The mean delay between the initial and final surgery in the early group was 2.0 weeks; and, for the late group, 33.5 weeks. For those having reoperations, there was no difference in the number of procedures required to achieve satisfactory outcomes. Four patients (5 eyelids) with unsatisfactory results were offered, but declined, late repair. Early or late reoperation is effective in correcting unsatisfactory results after external levator resection. The benefits of early surgery are a reduction in time to final result, the ease with which it is performed, potential cost savings, and the opportunity one has to correct unsatisfactory results.
Current thought on the pathophysiology of orbital wall fractures postulates either a "hydraulic" or a "buckling" mechanism. Evidence from cadaver, dried skull, and theoretical model studies supports both theories. No in vivo data, human or nonhuman primate, are available that quantitate the force necessary to fracture the orbital floor by either of the two mechanisms. We developed an apparatus that delivers quantifiable force only to the globe, without occluding the orbital opening or striking the orbital rim. We used it on 11 anesthetized Macaca fascicularis monkeys. Following a single bilateral application, the orbits were exenterated, and the orbital walls and orbital contents were examined to determine the extent of injuries. Fractures were described, diagrammed, and photographed. Fracture of the orbital floor was consistently produced at and above a force of 2.08 J. Posterior ruptures of five eyes occurred over the same range. We provide the first accurate measurements of the force required to produce orbital blow-out fractures in a live primate model. We show that orbital floor fractures can occur at low energies with direct ocular trauma only ("pure" hydraulic mechanism). Orbital wall fractures failed to protect the globe from rupture in 23% of cases.
Conventional, full-tendon, rectus muscle surgery disrupts the anterior ciliary vessels. This may lead to anterior segment ischemia when the number of interrupted vessels is sufficient to significantly compromise anterior segment blood flow. Clinical observations and histologic studies provide new anatomic information concerning the course of the anterior ciliary vessels in the sub-Tenon's region. These studies demonstrate the feasibility of dissection and preservation of the anterior ciliary vessels during rectus muscle surgery. Dissection and preservation of 35 clinically apparent anterior ciliary vessel groups were attempted on 15 rectus muscles during strabismus surgery. The unplanned vessel destruction rate was 9.5%. Procedures included 12 recessions, 1 resection, and 2 full-tendon transpositions. The possible role of this procedure in the prevention of anterior segment ischemia is discussed.
Optic nerve injury after retrobulbar injection of anesthetic agents may damage the optic nerve and vascular supply to the eye. We describe a case of documented orbital optic nerve injury with central artery occlusion after retrobulbar injection before cataract surgery. Early computed tomography documentation of optic nerve injury associated with retrobulbar injection is suggested to allow early consideration of optic nerve sheath decompression.
We used delayed primary wound closure in three cases of bacterial endophthalmitis to minimize the risk of implant extrusion following evisceration. In a fourth case, the wound was closed primarily, but wound dehiscence and implant extrusion occurred six weeks postoperatively, and reoperation was required. The advantages of delayed primary wound closure following evisceration of the globe for endophthalmitis include rapid removal of the intraocular abscess, continued drainage and mechanical débridement of the infected scleral pouch, and the development of granulation tissue resistant to bacterial growth at the wound margins prior to wound closure. These factors are important in reducing the risk of implant extrusion following evisceration of the globe for endophthalmitis.
Proton beam therapy for uveal malignant melanoma has been advocated as effective therapy because of documented reduction in tumor size and few clinical complications. However, some eyes have been removed because of adverse effects. The authors report the clinical courses and pathologic findings of five eyes enucleated after proton beam irradiation. Neovascular glaucoma had developed in three eyes, two eyes had vitreous hemorrhage, and two had extraocular extension. The tumors in the radiation treatment field showed continued postirradiation growth clinically in four of the five eyes, and mitotic activity histologically in all five cases. Two and one half years after irradiation, and nearly 2 years after subsequent enucleation, one of those two patients had biopsy-proven liver metastases, and later died. Despite the considerable success rate of proton beam irradiation, the potential for clinical complications and subsequent tumor growth remains.