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Biomedical subjects

R A Goldberg

Publications and source records attributed to R A Goldberg.

16 recordsLinked to original sources
PubMed1992

Eyelid anatomy revisited. Dynamic high-resolution magnetic resonance images of Whitnall's ligament and upper eyelid structures with the use of a surface coil.

We used a new radiofrequency surface coil and complementary software in eyelid magnetic resonance imaging. This custom-designed coil allows visualization of the eyelid structures in submillimeter resolution, providing detailed delineation of such structures as the orbital septum, levator aponeurosis, Müller's muscle, and orbital septa. The effect of Whitnall's ligament on the levator aponeurosis can be observed as a "tenting" of the aponeurosis; the change in vector force is persistent in upgaze and downgaze. This technology will allow accurate dynamic studies of eyelid anatomy in patients with various anatomically based eyelid diseases, before and after surgery, making it possible to test in vivo longstanding theories of normal and pathologic eyelid physiology.

Eyelids↗
PubMed1992

Microanatomy of the orbital apex. Computed tomography and microcryoplaning of soft and hard tissue.

PURPOSE: The anatomy of the orbital apex is characterized by a complex interplay between critical bony and neural structures. Traditional methods used to study this region include dissection, static sections, and computed tomography (CT). Tomographic techniques are very useful in understanding these complex relationships, but the resolution of conventional CT and magnetic resonance imaging (MRI) is not sufficient to recognize the intricate details of the optic nerve canal and associated structures. The purpose of this study is to determine the value of microcryoplaning and computer reconstruction in visualizing the orbital apex in detail not previously possible, at any orientation in three-dimensional space. METHODS: Microcryotomy of the orbital apex area was performed on cadaver specimens, and images of each cryosection were digitized. Subsequently, the lesser wing of sphenoid bone and optic nerve were outlined to allow for spatial manipulation and three-dimensional visualization of the orbital apex. RESULTS: The authors present reconstructed computer images of the orbital apex in coronal and axial planes with CT correlation. Clinically important anatomic points and landmarks as well as potential pitfalls are demonstrated. CONCLUSION: Microcryoplaning and computer reconstruction are useful techniques in viewing the detailed anatomy of the orbital apex. Although microcryoplaning has the limitation of poor soft tissue detail, the resolution of captured images is much greater than those obtained from CT or MRI scans; the improved resolution allows for accurate CT correlations. The technique has utility in education, surgical planning, and quantitative analysis of orbital apical anatomy.

Computer Simulation↗
PubMed1992

Exposed hydroxyapatite orbital implants. Report of six cases.

Six patients with complications of primary or secondary hydroxyapatite implants were studied. Complications included socket infection and/or conjunctival dehiscence. Complications were detected during regular follow-up examinations, and various treatment approaches were used. The hydroxyapatite implant exposure occurred 4 to 6 weeks (mean, 4.5 weeks) after implantation. Three of the six implants were wrapped in preserved donor sclera before implantation. One of the implants showed wide exposure and chronic infection and was removed. In two cases, scleral patch grafts with a conjunctival pedicle graft were performed, resulting in successful coverage of the implant without further conjunctival dehiscence. In one of the patients, a Tenon's conjunctival flap was advanced to cover the defect, and was unsuccessful with the spicules of the hydroxyapatite eroding through the vascular flap after 1 month. Three of the patients demonstrate a persistent conjunctival epithelial defect. These three patients with chronically exposed hydroxyapatite have remained stable with follow-up intervals ranging from 8 to 12 months. Early exposure of hydroxyapatite orbital implants is a potential problem despite meticulous technique. Implant coverage is difficult, although chronic exposure seems to be tolerated often in the hydroxyapatite orbital implant without migration or extrusion.

Adolescent↗
PubMed1992

The medical orbital strut in the prevention of postdecompression dystopia in dysthyroid ophthalmopathy.

Ocular dystopia with inferomedial displacement of the globe is an unusual but well-recognized complication of bony orbital decompression. It is caused by displacement of the muscle cone and orbital connective tissue system into the maxillary and ethmoidal sinuses. We illustrate a surgical variation of bony orbital decompression leaving intact a strut of bone at the maxillary-ethmoid junction. This bony strut reduces inferomedial displacement of the muscle cone and provides a medial supporting "ledge" in cases requiring late orbital reconstruction.

Eye Diseases↗
PubMed1992

Lower eyelid retraction following blepharoplasty.

Thirty consecutive patients with lower eyelid retraction after blepharoplasty were treated surgically with varying degrees of success. Successful outcome depended on various anatomic and pathologic factors, including the time elapsed since blepharoplasty, the prominence of the globe and its effect on eyelid contour, and the degree of septal or skin involvement. Satisfactory results were also dependent on surgical techniques used. We discuss several surgical techniques and offer advice concerning the selection of a surgical procedure in light of various pathologic parameters.

Blinking↗
PubMed1992

"Vertical slat" chalazion excision.

We describe a technique of chalazion excision in which multiple vertical incisions spaced approximately 1 mm apart are used to provide wide exposure of the chalazion. The entire extent of lipogranulomatous tissue can be excised under direct visualization, sparing normal tissues. No tarsoconjunctival tissue is extirpated. The vertical slats heal quickly, and horizontal incisions, which may cut across meibomian glands, are avoided.

Chalazion↗
PubMed1991

Concomitant lymphangioma and arteriovenous malformation of the orbit.

An 8-year-old girl had an orbital-adnexal lymphangioma and ipsilateral orbital and middle cranial fossa arteriovenous malformations. High-resolution magnetic resonance image scanning, orbital ultrasonography, and digital subtraction angiography were used for diagnosis and preoperative assessment. Complications related to this vascular neoplasm included amblyopia, acute hemorrhage with proptosis, exposure keratitis, cosmetic deformity, and recurrent preseptal cellulitis. The girl was treated with both embolization and orbital surgery for recurrent hemorrhage and proptosis. We postulated that the coexistence of a lymphangioma and arteriovenous malformation represents an unusual and extensive maldevelopment of vascular embryogenesis.

Angiography↗
PubMed1991

Tonic pupil and Czarnecki's sign following third nerve palsy.

A 71-year-old woman developed abnormal pupillary function in one eye after a third nerve palsy. Stimulation with light caused segmental constriction of the pupil, the near reflex was normal, and gaze upward elicited constriction of portions of the sphincter that were unreactive to light. This combination of findings has not been reported previously. We believe that this case supports the idea that a tonic pupil can be caused by aberrant reinnervation of the ciliary ganglion.

Aged↗
PubMed1990

Clinical characteristics of metastatic orbital tumors.

The authors reviewed the clinical and histopathologic records of 38 patients with metastatic orbital tumors. Diplopia, ocular motility limitation, and mass effect with displacement, proptosis, or palpable mass were common signs and symptoms. Enophthalmos occurred in 25% of cases. The authors found that the clinical presentations could be broken down into four generalized syndromes of presentation: infiltrative (20 cases, 53%); mass (14 cases, 37%); inflammatory (2 cases, 5%); and functional (1 case, 3%). An infiltrative pattern of presentation may be a clue to the metastatic nature of the orbital tumor. There may be no history of systemic cancer; in 25% of the patients in this series, the orbital tumor was the initial manifestation of systemic disease. Although the prognosis is poor for patients with metastatic cancer (average survival in this series, 10.2 months), modern treatment methods continue to improve and long-term palliation is often possible. The ophthalmologist plays a vital role in the diagnosis, histologic evaluation, and referral of these patients.

Adult↗
PubMed1990

The transconjunctival approach to the orbital floor and orbital fat. A prospective study.

The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. On self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly alter the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.

Adipose Tissue↗
PubMed1990

Blindness following blepharoplasty: two case reports, and a discussion of management.

We present two cases of unilateral permanent visual loss following four-eyelid blepharoplasty. Clinical and radiographic evidence suggested orbital hemorrhage was the cause of visual loss in both cases. In particular, electrophysiologic tests indicated that optic nerve dysfunction, and not retinal ischemia, was responsible for loss of vision. Timely orbital decompression is the cornerstone of managing these dramatic cases.

Blindness↗
PubMedDate not supplied

Tumors metastatic to the orbit: a changing picture.

Clinical characteristics of tumors metastatic to the orbit are related to primary tumor biology, and vary substantially among the various primary types. Common known primary sites include breast, lung, prostate, and melanoma. Tumor presentations can be classified into four generalized syndromes of mass, infiltrative, inflammatory, and functional effects. We found the infiltrative syndrome of presentation to be more common than for other types of orbital neoplasm. Accurate diagnosis often depends on recognition of the types of clinical syndromes and on the use of diagnostic modalities such as computed tomography, magnetic resonance imaging, fine needle aspiration biopsy, and open biopsy. Special histologic techniques are often useful in determining the origin of these often poorly differentiated tumors, and can provide a basis for specific hormonal therapy. Ophthalmologists play a vital role in the diagnosis of metastatic cancer; the orbital tumor was the presenting sign of systemic cancer in 42% of the cases reviewed. Although the overall prognosis for patients with metastatic cancer is quite poor, specific therapy is available for a growing number of cancers. Timely intervention based on accurate diagnosis can dramatically improve the duration and quality of life with selected tumors.

Aged↗
PubMedDate not supplied

Hearing loss in the Marine Corps.

Audiograms of 11,577 made Marine officers and enlisted personnel are analyzed by age group and level of hearing for six frequencies: 500, 1,000, 2,000, 3,000, 4,000, and 6,000 Hz. Speech reception thresholds are determined for the average of 500, 1,000, and 2,000 Hz as recommended by the American Academy of Ophthalmology; high-frequency thresholds are determined for the average of 3,000, 4,000, and 6,000 Hz. Hearing impairment (greater than 25 dB ISO) for the speech frequencies is between 0.6% and 5.9%; for the high frequencies the range is 3.4% to 76.5%. For the high frequencies the largest increase in impairment is in the age group 35 to 44 years. No difference in the percentage distribution of hearing impairment is found between a statistically comparable group of civilians and Marines. This is in sharp disagreement with the hypothesis that a greater degree of hearing loss would exist in a military population exposed to more noise than a civilian population. Hearing impairment in the high frequencies caused by noise exposure is a problem of significant magnitude, especially above the age of 35, and may have an effect on speech intelligibility. However, the magnitude of the problem seems to be the same in the military and civilian populations studied.

Adolescent↗