Search PubMed⌕ Search

Biomedical subjects

Peter A D Rubin

Publications and source records attributed to Peter A D Rubin.

At least 19 recordsLinked to original sources
PubMed2003

Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome.

OBJECTIVE: To evaluate the distribution and clinical as well as treatment outcome characteristics of idiopathic orbital inflammation with the aim of delineating a more systematic approach to diagnosis and treatment. METHODS: A 10-year retrospective review of patients with idiopathic orbital inflammation treated at one institution. RESULTS: Ninety eyes in 65 patients (22 men and 43 women) were studied. Diagnoses were isolated dacryoadenitis (n = 21), isolated myositis (n = 19), concurrent dacryoadenitis and myositis (n = 5), orbital apex syndrome (n = 6), and idiopathic inflammation involving the preseptal region, supraorbital region, sclera, Tenon capsule, orbital fat, or optic nerve (n = 14). The mean age at presentation was 45 years. Pain and periorbital swelling were the most common clinical features and were observed in 45 (69%) and 49 (75%) patients, respectively. Seventeen patients (26%) had bilateral involvement. Biopsy was performed in 19 patients (29%) with atypical presentations or who failed to respond to the initial therapy. Patients were treated with steroids alone (n = 45), steroids and subsequent radiation therapy (n = 8), steroids and nonsteroidal anti-inflammatory agents (n = 6), nonsteroidal anti-inflammatory agents alone in mild cases (n = 2), and, rarely, radiation therapy without steroids (n = 1) or surgical debulking alone (n = 1). Of 65 patients, 41 (63%) represented treatment successes, with complete symptom relief at the time of the last follow-up, and 24 (37%) represented treatment failures, with partial or no relief of symptoms. Treatment failures were often characterized by recurrence of inflammation after a period of quiescence (58%) and unremitting, recalcitrant inflammation (38%); 1 patient ultimately required an exenteration. CONCLUSION: Systemic steroid with a slow taper has been the established first-line treatment for idiopathic orbital inflammation, but refractory cases accounted for a significant portion of treatment failures in our study, reflecting the need for a more systematic approach to the study of this multifaceted disease and for therapeutic alternatives to systemic steroids.

Adolescent↗
PubMed2003

Bilateral cavernous sinus thromboses and intraorbital abscesses secondary to Streptococcus milleri.

PURPOSE: To report the first case of bilateral cavernous sinus thromboses and bilateral intraorbital abscesses secondary to Streptococcus milleri. STUDY DESIGN: Single interventional case report. INTERVENTION AND TESTING: The findings of the ophthalmic evaluation, radiographic imaging, medical and surgical intervention, specimen cultures, and clinical course were analyzed. RESULTS: A 17-year-old female had bilateral proptosis, decreased vision in the left eye, and altered mental status at presentation. An orbital compartment syndrome developed in the left eye and purulent material was present after lateral canthotomy, suggestive of an intraorbital abscess. Magnetic resonance imaging (MRI) scans revealed bilateral cavernous sinus thromboses, and subsequent computed tomographic (CT) scans revealed bilateral intraorbital abscesses in the setting of acute ethmoid and sphenoid sinusitis. Antibiotic treatment and surgical drainage of the orbital abscess and sinuses was performed, and specimen cultures revealed S. milleri. After surgery, the patient experienced hearing loss and a right internal capsule infarct, in addition to complete vision loss in the left eye. A second intraorbital abscess developed in the right eye and was drained surgically. The vision remained 20/20. CONCLUSIONS: Streptococcus milleri is a virulent organism with a propensity to form abscesses in multiple areas of the body and should be considered as a possible etiologic agent in abscess formation of the orbit and cavernous sinus thrombosis.

Abscess↗
PubMed2003

Perforating follicular hybrid cyst of the tarsus.

Follicular hybrid cysts are cutaneous tumors that arise from different portions of the hair follicle. We describe a follicular hybrid cyst of the tarsus that contained features of pilomatricoma and steatocystoma and perforated the palpebral conjunctiva. The unusual location and histopathologic features are discussed.

Adult↗
PubMed2003

Medial rectus muscle injuries associated with functional endoscopic sinus surgery: characterization and management.

OBJECTIVE: To characterize and evaluate treatment options for medial rectus muscle (MR) injury associated with functional endoscopic sinus surgery (FESS). DESIGN: Retrospective interventional case series. PARTICIPANTS: A total of 30 cases were gathered from 10 centers. METHODS: Cases of orbital MR injury associated with FESS surgery were solicited from members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) through an e-mail discussion group. MAIN OUTCOME MEASURES: Variables assessed included patient demographics, computerized tomography and operative findings, extent of MR injury and entrapment, secondary orbital/ocular injuries, initial and final ocular alignment and ductions, and interventions. RESULTS: A spectrum of MR injury ranging from simple contusion to complete MR transection, with and without entrapment, was observed. Four general patterns of presentation and corresponding injury were categorized. CONCLUSIONS: Medial rectus muscle injury as a complication of FESS can vary markedly. Proper characterization and treatment are important, particularly with reference to the degree of direct MR injury (muscle tissue loss) and entrapment. Patients with severe MR disruption can benefit from intervention but continue to show persistent limitation of ocular motility and functional impairment. Prevention and early recognition and treatment of these injuries are emphasized.

Adult↗
PubMed2003

Transcaruncular orbital decompression for management of compressive optic neuropathy in thyroid-related orbitopathy.

This study was conducted to assess the outcome of transcaruncular orbital decompression to treat compressive optic neuropathy in thyroid-related orbitopathy. It involved a retrospective, noncomparative case series of 18 eyes of 10 consecutive patients with documented vision loss secondary to thyroid-related orbitopathy. Bony decompression of the orbital apex was performed via a transcaruncular approach. Main outcome measures were visual acuity, color vision, presence of diplopia, and reduction of exophthalmos. Of 18 eyes, 16 (89 percent) had improved visual acuity after the operation. One eye had no improvement and one had worsening of vision in the setting of diabetic retinopathy. Color vision was improved in 12 eyes (67 percent). Five of the patients did not have diplopia before the operation; none of these patients developed double vision after intervention. Exophthalmos was decreased by an average of 2.6 mm. The authors conclude that transcaruncular orbital decompression for compressive optic neuropathy in thyroid-related orbitopathy is successful in restoring visual function. Compared with other approaches used for decompression surgery, the transcaruncular approach offers direct access to the medial wall and orbital apex without a cutaneous incision or disruption of the medial canthus. In addition, this approach allows a controlled, graded removal of the ethmoidal air cells and reduced recovery time.

Adult↗
PubMed2003

Isolation and characterization of cultured human conjunctival goblet cells.

PURPOSE: To isolate and characterize goblet cells from normal human conjunctival tissue to determine whether epidermal growth factor (EGF) receptors are present and whether EGF can influence goblet cell proliferation. METHODS: Goblet cells were isolated from explant cultures established from normal conjunctival tissue harvested from patients during periocular surgery. The cells were grown in RPMI culture medium supplemented with 10% fetal bovine serum and characterized using morphology, histochemistry, indirect immunofluorescence microscopy, molecular biology, and biochemistry. Proliferation was determined with a MTT proliferation assay after exposing goblet cells, which had been serum deprived for 48 hours, to increasing concentrations of epidermal growth factor (EGF; 0-80 ng/mL) for 24 hours. RESULTS: Goblet cells were isolated from conjunctival explants by scraping nongoblet cells from the culture dish. Human goblet cells exhibited positive reactivity with alcian blue-periodic acid Schiff (PAS) reagent, goblet cell-specific cytokeratin-7, HPA lectin, and MUC5AC, but negative reactivity to the stratified squamous epithelial cell marker, cytokeratin-4. The mRNA for MUC5AC was detected using RT-PCR. The presence of the EGF receptors EGFR, ErbB2, and ErbB3 was confirmed through Western blot analysis of cell lysates. EGF elicited a concentration-dependent increase in goblet cell proliferation of 160% +/- 0.5%, 188% +/- 0.45%, 293% +/- 1.3%, and 220% +/- 0.5% of control values with 10, 20, 40, and 80 ng/mL EGF, respectively. CONCLUSIONS: Human goblet cells that retain characteristics of goblet cells in vivo can be cultured. EGF receptors are present in human goblet cells, and EGF stimulates their proliferation.

Adult↗
PubMed2003

Activation of mitogen-activated protein kinase by cholinergic agonists and EGF in human compared with rat cultured conjunctival goblet cells.

PURPOSE: To compare activation of the p42/p44 mitogen-activated protein kinase (MAPK) by cholinergic agonists and epidermal growth factor (EGF) in cultured human and rat goblet cells. METHOD: . Conjunctiva was removed from either humans during ocular surgery or male Sprague-Dawley rats and cultured in RPMI medium. These cells were incubated with the cholinergic agonist carbachol (10(-4) M) or EGF (10(-8) M) for various times. Before stimulation, cells were incubated with the EGF receptor (EGFR) inhibitor, AG1478 (10(-7) M) or the muscarinic M(3) receptor inhibitor, 4-diphenylacetoxy-N-(2-chloroethyl)-piperidine hydrochloride (4-DAMP; 10(-5) M) for 10 minutes. Proteins were analyzed by Western blot analysis, using antibodies specific to phosphorylated (activated) p42/44-MAPK or total p42-MAPK. Immunoreactive bands were quantified, and data were expressed as percentage of increase over basal. RESULTS: Carbachol (10(-4) M) increased MAPK activity in human and rat cultured goblet cells in a time-dependent manner, increasing pMAPK with a maximum at 10 minutes. EGF (10(-8) M) activated MAPK in human and rat goblet cells in a time-dependent manner with a maximum at 5 minutes. Carbachol- and EGF-induced activation of pMAPK was completely inhibited by AG1478 in cultured conjunctival goblet cells from both species. Carbachol-induced MAPK activity was also completely inhibited by 4-DAMP in both species. CONCLUSIONS: In human and rat cultured conjunctival goblet cells, cholinergic agonists and EGF activate MAPK with a similar time dependency, this activation is receptor mediated, and cholinergic agonists transactivate the EGF receptor. Thus, rat cultured conjunctival goblet cells can be used as a model to study human conjunctival goblet cells.

Adult↗
PubMed2002

Bilateral multifocal hemangiomas of the orbit in the blue rubber bleb nevus syndrome.

PURPOSE: To report the clinical findings and surgical treatment of multifocal, bilateral orbital hemangiomas in a patient with the blue rubber bleb nevus syndrome, a rare vascular disorder characterized by distinctive cutaneous and visceral hemangiomas. DESIGN: Interventional case report. METHODS: Review of clinical findings, radiologic studies, and treatment of the patient. RESULTS: A 36-year-old female with multifocal, bilateral orbital lesions was seen with severe proptosis and decreased visual acuity of the left eye. Surgical debulking of multiple cavernous hemangiomas of the orbit resulted in decreased proptosis and an improvement in visual acuity. Subsequent histopathologic analysis and the results of a systemic workup revealing multiple, distinctive, cutaneous and visceral lesions were found to be consistent with the blue rubber bleb nevus syndrome. CONCLUSIONS: Although hemangiomas of the orbit are relatively common occurrences, multifocal, bilateral lesions may exist in the setting of underlying systemic hemangiomatosis. Bilateral or multifocal hemangiomas associated with cutaneous or visceral lesions should alert the clinician to the possibility of a number of syndromes that may have life-threatening consequences.

Adult↗
PubMed2002

Idiopathic orbital inflammation: ocular mechanisms and clinicopathology.

Pathogenesis of idiopathic orbital inflammation remains elusive but several lines of evidence point to immune-mediated processes as the likely underlying ocular mechanism. The exact nature of the immunological process and possible role of infection need to be elucidated in greater depth. There is an obvious need for a more satisfactory animal model for orbital pseudotumor. Given the prevalence of recurrent and persistent orbital inflammation, therapeutic alternatives to corticosteroids need to be further explored and systematically investigated.

Humans↗
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

Mechanisms of acquired blepharoptosis.

Blepharoptosis can be the presenting symptom in a variety of disorders ranging from the relatively common and benign levator dehiscence to debilitating and potentially life-threatening conditions such as myasthenia gravis and aneurysms of the posterior communicating artery. For these reasons, a comprehensive understanding of the clinical and pathophysiological features of the different causes of acquired ptosis is essential in guiding the ophthalmologist toward the appropriate medical and surgical management of these patients (see the following list).

Blepharoptosis↗
PubMed2002

Acquired monocular vision: functional consequences from the patient's perspective.

PURPOSE: The study is conducted to determine the effect of acquired monocular vision (enucleation, phthisis) on the daily activities of patients. METHODS: Sixty-five patients in a case series completed a 30-question survey evaluating the functional consequences of monocular vision. RESULTS: Patients with sudden visual loss adapted more slowly than those with gradual loss (8.8 versus 3.6 months). Difficulties with depth perception and cosmesis were prevalent. Unexpected consequences included neck pain, strain with reading, employment change, depression, car accidents, and alcoholism. Ninety-one percent of patients had no formal training to help them adapt. CONCLUSIONS: More than previously appreciated, there are many obstacles that patients face in making the transition to monocular vision. Few patients receive any formal instruction to help them adapt, yet many indicate that it would be beneficial.

Activities of Daily Living↗
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↗