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Biomedical subjects

Mark P Hatton

Publications and source records attributed to Mark P Hatton.

At least 19 recordsLinked to original sources
PubMed2005

Successful treatment of idiopathic orbital inflammation with mycophenolate mofetil.

PURPOSE: To report our experience with the use of mycophenolate mofetil for treatment of idiopathic orbital inflammation (IOI). DESIGN: Noncomparative interventional case series. METHODS: We reviewed the records of five patients with IOI who were treated with mycophenolate mofetil. The indications for use included recurrent inflammation after other therapies (four patients) and to avoid corticosteroid-induced blood sugar elevation in poorly controlled diabetes mellitus (one patient). Treated patients were followed for a median of 8.5 months (range, 4-30 months) after mycophenolate mofetil therapy was begun. Main outcome measures were response to treatment, treatment-related side effects, drug dosage, previous and final treatment regimens, and discontinuation of systemic corticosteroids. RESULTS: Mycophenolate mofetil therapy was discontinued in one patient because of nausea. Each of the remaining four patients experienced complete resolution of orbital inflammation. Of these, only one patient remains on prednisone, but at a significantly reduced dose (1 mg/d). CONCLUSION: Mycophenolate mofetil therapy resulted in the resolution of inflammation in patients with refractory or corticosteroid-dependent IOI and was used successfully for a first episode of IOI in a patient for whom corticosteroids were contraindicated.

Adult↗
PubMed2005

Simplified repair of zygomatic fractures through a transconjunctival approach.

OBJECTIVE: To describe a simplified technique of zygomatic fracture repair. DESIGN: Retrospective, noncomparative case series with description of a surgical technique. PARTICIPANTS: Twenty consecutive patients with zygomatic fractures undergoing repair with the described technique. INTERVENTION: Fracture repair was accomplished with a technique that used a T-bar screw for reduction through a transconjunctival approach. MAIN OUTCOME MEASURE: Successful fracture reduction. RESULTS: Twenty patients with zygomatic fractures underwent successful reduction with the simplified technique. No complications were observed. CONCLUSIONS: The use of the T-bar through a transconjunctival approach is a simplified and effective technique for zygomatic fracture repair.

Adolescent↗
PubMed2005

Endocanalicular laser dacryocystorhinostomy analysis of 118 consecutive surgeries.

PURPOSE: To describe the outcomes of endocanalicular laser dacryocystorhinostomy (ECL DCR) for patients with nasolacrimal duct obstruction (NLDO). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred eight consecutive patients who underwent ECL DCR. METHODS: The records of the patients who underwent ECL DCR at 1 of 2 academic centers were reviewed and the data analyzed. MAIN OUTCOME MEASURES: Success was defined as the resolution of symptoms or unobstructed lacrimal irrigation. RESULTS: One hundred eighteen consecutive ECL DCR surgeries performed on 108 patients between June 1997 and June 2003 were reviewed, excluding 6 lost to follow-up. Endocanalicular laser DCR was the initial surgical intervention for all cases except 6 that had previously undergone surgery (external or endonasal DCR) at outside hospitals. Twenty-seven of the surgeries were considered failures on the basis of recurrent epiphora or discharge, or reflux on nasolacrimal irrigation. One of the failures was permanently corrected with balloon dacryoplasty. Nine of the other failures had a repeat procedure, with 7 remaining patent after one repeat procedure and an additional one remaining patent after a third procedure. All 6 ECL DCR procedures that were performed after external or endonasal DCR at an outside institution remained patent. Among the 102 initial lacrimal surgeries in this series, there was a 73.6% success rate. The overall success, including repeat procedures, was 81.5%. The success of this technique as a repeat procedure after previous external, endonasal, or ECL DCRs was 87.5%. CONCLUSIONS: Endocanalicular laser DCR offers a minimally invasive alternative procedure for the treatment of NLDO. In our series, the success rates are comparable to those previously reported. The technique had a high success rate when used to treat recurrent NLDO after previous lacrimal surgery.

Adolescent↗
PubMed2005

"Pseudo-pseudochalazion": giant chalazion mimicking eyelid neoplasm.

A 33-year-old man presented with a solid lesion encompassing the entire left upper eyelid. Multiple biopsies revealed lipogranuloma consistent with chalazion. The induration resolved after multiple triamcinolone injections. This is the only case report to our knowledge of a chalazion that involved the entire upper eyelid.

Adult↗
PubMed2005

Gender differences in etiology and outcome of open globe injuries.

PURPOSE: Patterns of injury and outcomes after multi-system trauma differ between men and women. Few data exist regarding the epidemiology of gender differences in severe eye trauma. We hypothesized that the incidence and patterns of open globe injuries might differ between men and women. METHODS: Charts of 220 patients with open globe injuries presenting to the Massachusetts Eye and Ear Infirmary during a three-year period were retrospectively reviewed. The data were analyzed with respect to gender, type of open globe injury (penetrating, perforating, or rupture), and mechanism of globe injury (projectile, non-projectile, assault, fall, sports, motor vehicle crash). RESULTS: The majority (78.6%) of patients were men. Women with open globe injuries were older (median age 73 years) than men (median age 36 years). Men were more likely to suffer from penetrating injuries (69.9%) while women were more likely to experience blunt globe rupture (68.1%). Projectile objects accounted for the majority of open globe injuries in men (54.9%) and were an infrequent cause in women (4.3%). Nearly one-third (31.8%) of the projectile injuries in men were work-related, and 19.7% occurred during home improvement projects. Compared with men, falls were more frequently responsible for globe injuries in women (55.3% versus 8.1%). Injuries limited to the cornea were more common in men than women (46.2% versus 23.4%), while more posterior globe injuries were more common among women (46.8% versus 28.3% men). Women were more likely than men to have poor visual acuity at 3 months after injury. CONCLUSIONS: The causes and patterns of open globe injuries differ between men and women. In this series, the majority of injuries to men were caused by projectile objects related to work or home improvement projects. Open globe injuries in women were most often resulted from fall, and were more likely to cause rupture posterior to the limbus.

Adult↗
PubMed2004

Attrition from ophthalmology residency programs.

PURPOSE: To investigate the incidence of and reasons for voluntary resident attrition from ophthalmology training programs. DESIGN: Retrospective survey. METHODS: A survey was mailed to residency program directors of the 121 Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs asking them to report the number of residents who withdrew from training during 2001 to 2002 and the reasons for withdrawal. RESULTS: Of 102 responding programs, 13 (12.7%) had one resident withdraw from training in the academic year 2001 to 2002. These 13 residents represented 1.1% of all ophthalmology residents in training at the responding institutions during that academic year. The most frequent reason for withdrawing was to enter another medical specialty. CONCLUSIONS: Voluntary resident attrition from ophthalmology training programs is uncommon. The 1.1% attrition rate in this study is the lowest among published reports of attrition from other specialties.

Career Choice↗
PubMed2004

Corneal oedema in ocular hypotony.

We describe the pattern of corneal oedema observed in five patients with chronic hypotony. The patients had marked stromal oedema from presumed endothelial dysfunction, but no epithelial oedema. These observations corroborate the concept that the intraocular pressure is the driving force in the generation of epithelial oedema.

Adult↗
PubMed2004

Preface.

Explore the source record for details and available documents.

Boric Acids↗
PubMed2004

Oculoplastic technique of connecting a glaucoma valve shunt to extraorbital locations in cases of severe glaucoma.

PURPOSE: To describe a technique for inserting glaucoma shunts to the sinuses or the lacrimal sac as a means of lowering intraocular pressure in patients with refractory glaucoma associated with severe ocular surface disease. METHODS: Nineteen patients with severe ocular surface disease necessitating a keratoprosthesis and with intractable glaucoma underwent placement of a modified Ahmed shunt to direct aqueous in the maxillary or ethmoid sinus or lacrimal sac. RESULTS: Intraocular pressure is presently well controlled without glaucoma medications in two thirds of patients. None of the patients had endophthalmitis. CONCLUSIONS: Established oculoplastic surgery techniques may be used to redirect aqueous to extraorbital locations and effectively lower intraocular pressure in patients with severe ocular surface disease and refractory glaucoma. This procedure has not been associated with endophthalmitis.

Cornea↗
PubMed2002

The pathophysiology of thyroid-associated ophthalmopathy.

TAO is an inflammatory disease of the orbital tissues. The effects of inflammation, mediated through cytokine release, include proliferation of fibroblasts, increased deposition of extracellular matrix, and adipocyte differentiation and proliferation. As a result, edema, enlargement of the extraocular muscles, and increased volume of the orbital soft tissues occur with ensuing exophthalmos and, in some patients, compression of the optic nerve. Edema, inflammation, and late fibrosis, account for the decreased function of the extraocular muscles, despite relative preservation of the fibers themselves. The recruitment of T cells to the orbits of these patients may result from the expression of the target of the aberrant immune response in Graves' disease, the TSH receptor, in the orbits of patients with TAO. The orbital fibroblasts, especially those present within patients with TAO, may be more sensitive to the effects of cytokines, accounting for the frequent, and relatively selective, involvement of the orbit in Graves' disease. Insight into the cellular and molecular pathways proposed in this cascade introduces potential sites for new therapeutic approaches and understanding of the mechanisms of current treatments. Corticosteroids, used frequently in the treatment of TAO, have a detectable effect at the molecular level. While glucocorticoids do not directly influence extracellular matrix production [62] or baseline proliferation of orbital fibroblasts [27] they do attenuate the effect of several cytokines on inducing proliferation of these fibroblasts or extracellular matrix production, and this influence is greater in fibroblasts from TAO patients [27,36]. The consistent observation of early inflammation suggests that immunomodulation early in the course of the disease should be a primary goal of management of TAO. The elucidation of the specific cytokines that are released and active in the orbits of patients with TAO may aid in the development of more specific immunomodulatory therapies. Improved understanding of the pathophysiology of TAO may also help identify more rational approaches to treatment. For example, identification of the molecules involved in the inflammatory cascade which results in TAO may help predict progression of disease and identify specific treatment modalities which may benefit individual patients [11,70].

Graves Disease↗
PubMed2002

Orbital and adnexal trauma associated with open-globe injuries.

PURPOSE: To describe the incidence and patterns of orbital and adnexal injuries in patients with open-globe injuries. METHODS: Charts of 300 consecutive patients with open-globe injuries presenting to the Massachusetts Eye and Ear Infirmary were retrospectively reviewed. The data were analyzed with respect to the type of open globe (penetrating, perforating, or rupture) and location (zone) of globe injury. Each of these subgroups was then evaluated for the absence (group 1) or presence (group 2) of coexisting orbital and/or adnexal injury. Visual acuity at presentation was compared between the two groups. RESULTS: Orbital and adnexal injuries were present in 25.7% of patients with open globes. The most common concurrent injuries were lacerations of the eyelid, orbital fracture, and retrobulbar hemorrhage. The mechanisms of globe injury differed significantly between groups 1 and 2. Penetrating injuries accounted for 82.1% of group 1 but only 49.3% of group 2 patients, whereas rupture occurred more frequently in group 2 (48.1%) than in group 1 (17.0%) patients. Orbital and adnexal injuries were associated with poorer visual acuity at presentation, probably because of the high incidence of posterior globe injuries in these patients. CONCLUSIONS: Orbital and adnexal injuries were observed in 25.7% of patients who sustained trauma that resulted in open globes. Concurrent injury to these extraocular structures is associated with worse visual acuity at presentation and an increased likelihood of posterior globe injuries.

Eye Injuries↗
PubMed2002

Clinical applications of color Doppler imaging in the management of orbital lesions.

PURPOSE: To present the clinical applications of color Doppler imaging (CDI) as an adjunctive study in the diagnosis and treatment of orbital lesions. METHODS: Retrospective noncomparative case series. Medical records of 17 patients with orbital lesions who underwent orbital CDI were reviewed, and their orbital CDI results, diagnosis, and treatment were studied. The main outcome measures were detection of abnormal orbital vascular flow and presence or absence of blood flow within orbital lesions by CDI. RESULTS: Absence of intralesional flow was associated with an orbital lesion considered benign. Tumors in which flow was present were more frequently malignant or had malignant potential. Reversal of flow in the superior ophthalmic vein was observed in patients with carotid-cavernous fistula and orbital varix. CONCLUSIONS: CDI is a useful adjunctive imaging study for evaluating the vascularity of orbital tumors. The absence or presence of intratumoral blood flow as demonstrated by CDI can help determine the nature of the orbital mass and can assist with surgical planning.

Adult↗