Biomedical subjects
R C Kersten
Publications and source records attributed to R C Kersten.
Staple closure of the retroauricular donor site.
Suturing is the usual method employed to close retroauricular skin graft donor sites. We present our 8-year experience with 163 cases demonstrating that such donor sites can be closed with equal efficacy using skin staples. This technique is simple and takes less surgical time.
Anterior chamber paracentesis.
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Traumatic orbital decompression.
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Absence of Chlamydia in trachomatous lacrimal sacs.
We performed lacrimal sac biopsies in 35 patients who underwent dacryocystohinostomies in Saudi Arabia. The nasolacrimal duct obstructions were presumably secondary to trachoma in 22 cases and unknown in the remaining 13 cases. Lacrimal sac specimens were submitted for routine histopathologic examination and the direct-smear fluorescent antibody test. All specimens were negative for chlamydia. Possible reasons for the low detection rate of chlamydia in the trachomatous group were the frequent finding of clinically inactive disease, common canalicular obstruction, and loss of the epithelial lining in the lacrimal sac.
Suturing of stents after dacryocystorhinostomy.
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Chronic hematic cyst of the orbit. Role of magnetic resonance imaging in diagnosis.
Chronic hematic cysts of the orbit are rare causes of proptosis. They progressively enlarge causing expansion or erosion of the orbital bones and may give the appearance on computed tomography (CT) scan of a malignant orbital process. Hematic cysts have a characteristic appearance on magnetic resonance imaging (MRI) which is virtually pathognomic. The authors present two cases in which MRI was used to establish the diagnosis.
Hemangioblastoma of the optic nerve. Report of a case and review of literature.
The authors present a case of an optic nerve hemangioblastoma in a young woman with von Hippel-Lindau disease. The initial diagnosis was made by incisional biopsy. Tumor growth led to progressive proptosis and loss of light perception. Excision was carried out by lateral orbitotomy. Clinically and radiographically, the tumor resembled an optic nerve meningioma or glioma. Review of the other known cases offers no information as to the potential spread of this benign tumor from the intraorbital optic nerve to the optic canal. Optic nerve hemangioblastoma must be considered in the differential diagnosis of optic nerve tumors in patients with or without von Hippel-Lindau disease.
Blowout fracture of the orbital floor with entrapment caused by isolated trauma to the orbital rim.
There are two main theories on the cause of blowout fractures of the orbit: the "hydraulic" theory and the "buckling force" theory. Although both mechanisms have been shown responsible for experimental blowout fractures, the role of isolated rim trauma in producing clinical blowout fractures with entrapment of orbital soft tissues continues to be questioned. I examined a 69-year-old patient who developed a blowout fracture with clinical evidence of entrapment after isolated trauma to the orbital rim. Five days previously the patient had had a cataract extraction and implantation of an intraocular lens in the ipsilateral eye, which remained undisturbed by the trauma. This case supports the role of a buckling force to the rim in producing orbital blowout fractures. Review of the circumstances of injury in large series of blowout fractures suggests that this mechanism may be operative in the majority of cases.
A warning on antimetabolites and cryosurgery in the reconstruction of eyelids. Case report.
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Subperiosteal orbital hematoma: visual recovery following delayed drainage.
Subperiosteal orbital hematomas are rare sequelae of blunt periorbital trauma. Visual loss in such cases is very infrequent, but reportedly irreversible, unless treated with early decompression. A 17-year-old boy developed marked visual loss secondary to an acutely developing traumatic subperiosteal orbital hematoma. Despite delayed referral surgical evacuation of the hematoma remarkably restored his vision. Postoperative clinical examination, fluorescein angiography, and electrophysiologic testing confirmed that a compressive optic neuropathy had caused the visual dysfunction. Although immediate surgical decompression remains the treatment of choice for subperiosteal hematomas producing visual loss, this case demonstrates that the optic nerve may recover dramatically even after a prolonged period of dysfunction from compression.
Correction of upper eyelid retraction using tissue removed in blepharoptosis repair.
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Tarsal rotational flap for upper eyelid reconstruction.
Reconstruction of full-thickness defects in the upper eyelid presents a special challenge to the oculoplastic surgeon. We present and discuss a new, surgically simple technique for posterior lamella reconstruction of the upper eyelid, which can also be used with other procedures. The surgical technique calls for a vertical strip of tarsus (tarsal flap) to be rotated horizontally and sutured to canthal tendon remnants or periosteum at the orbital rim. This procedure has produced satisfactory to excellent results in our test group, and presents the reconstructive surgeon with several advantages over other techniques.
Orbital myiasis.
Invasion of the orbit by dipterous fly larvae is a rarely reported from of myiasis. We present a 65-year-old man with orbital myiasis caused by the tissue obligatory larvae of the Old World screw-worm fly Chrysomyia bezziana Villeneuve. Larvae were found invading the orbital apex and exenteration was carried out to prevent intracranial invasion. In this case of orbital myiasis, CT scanning was used to document the extent of intraorbital invasion. To our knowledge, this is the first reported case of ophthalmomyiasis caused by C. bezziana.
The use of a periosteal strip for eyelid reconstruction.
Strips of periosteum from the zygoma were used to reconstruct very extensive lateral canthal and temporal eyelid defects in 11 patients. The strips were reflected nasally, sutured to residual tarsal stumps, and covered anteriorly with myocutaneous flaps. After a minimum follow up of one year, cosmesis was excellent in five patients, satisfactory in five, and poor in one. Minor complications related to this procedure included ectropion and low lateral contour (one patient each), blunting of the lateral canthal angle (three patients), eyelid notching and dehiscence (one patient each), and symblepharon formation (one patient). However, only one patient had a complication that was significant enough to require a second surgery. This technique allows for one-stage reconstruction, an open palpebral fissure, and the ability to reconstruct extensive loss of the temporal portion of two adjacent eyelids when sharing techniques are not possible.
The role of orbital exenteration in choroidal melanoma with extrascleral extension.
The management of choroidal melanoma with extrascleral extension has been a subject of controversy with some proposing orbital exenteration whenever extrascleral extension is demonstrated and others feeling it to be of no value in increasing survival. We reviewed the cases of 43 patients with extrascleral extension of choroidal melanoma. Although five-year survival had previously been demonstrated to be significantly improved in patients undergoing early orbital exenteration at our institution, extended follow-up in 16 consecutive cases revealed ultimate tumor related mortality to approach that of patients refusing exenteration. Only in cases with nonencapsulated or surgically transected extension did exenteration appear to improve survival. In ten cases with delayed recurrence of tumor in the orbit, exenteration proved to be palliative rather than curative.
Hematoporphyrin photoradiation therapy for intraocular and orbital malignant melanoma.
Photoradiation therapy (PRT) is a new technique that is currently under investigation for the treatment of a variety of solid malignant tumors. The technique involves systemic administration of hematoporphyrin derivative (HpD), a photosensitizing compound that is preferentially retained by malignant cells and photoactivation of the neoplasm with red light (630 nm) to achieve selective destruction of cancer cells. We used HpD PRT for seven patients with malignant melanoma of the uvea and conclude that initial results of HpD PRT for uveal malignant melanoma are encouraging and justify further investigation.