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At least 433 records · Page 24Linked to original sources
PubMed2003

Temporal lift by galeapexy: a review of 270 cases.

The purpose of this technique is to correct the ptotic tail of the brow and crow's feet as well as to redrape the premalar skin to allow us to make a greater skin resection in the lower lid. The purpose of this presentation is to expose the advantages, the inconveniences, and the complications of this technique. We reviewed the charts of 270 patients who were operated on between June 1996 and January 2002. The average age of the patients was 45 years old. Temporal lifts were performed during a frontotemporal lift in 92 cases, and during a three-stage lift (frontal, facial, and cervical) in 170 cases. In eight cases, an isolated temporal lift was performed. An upper blepharoplasty was performed in 252 cases and transconjunctival fat pad excision was performed in 188 cases. Finally, a lower lid skin resection was done following a galeapexy in 241 cases. The surgical approach consists of a temporal incision, followed by a subgaleal dissection, and then a subcutaneous dissection that allows the cephalic galea, previously incised, to be anchored to the temporal aponeurosis. This allows good cutaneous redraping that raises the brow tail and a detachment of the orbicularis fibers. The suturing of the scalp is done without tension and without eliminating hair. The results of the technique with a follow-up period of more than five years for the earlier cases and six months for the last cases, were evaluated with three criteria: (1) the distance between the brow and the eyelashes, (2) the reduction of crow's feet, (3) the reduction of wrinkles at the level of the lower lid and the malar region. Overall satisfaction was also rated. Of 270 patients, 225 had ratings of very good to good, 13 had average results, and 13 had unsatisfactory results. As far as complications, five had unilateral hematoma requiring an evacuation, four patients had temporary alopecia, and eight patients had temporary frontal muscle weakness that resolved within one to three months. This technique, performed under local anesthesia, is very efficient, reproducible, and simple. The incidence of complications can be reduced when one is meticulous during dissection.

Adult↗
PubMed2002

Effect of 0.005% latanoprost once daily on intraocular pressure in glaucomatous patients not adequately controlled by beta-blockers twice daily: a 3-year follow-up. Experience and incidence of side effects in a prospective study on 76 patients.

PURPOSE: To assess the efficacy and side effects of 0.005% latanoprost once daily during 3 years of treatment in glaucomatous patients in whom intraocular pressure (IOP) was not adequately controlled by beta-blockers twice daily. METHODS: An unmasked prospective study was performed on 76 glaucomatous patients (145 eyes) treated with 0.005% latanoprost at bedtime, after a 21-day wash-out period from beta-blockers. IOP measurement and visual field examination were recorded over the follow-up period. RESULTS: Latanoprost significantly reduced IOP from 26.5+/-6.6 mmHg (mean +/- SD) to 17.4+/-2.7 mmHg after 36 months of treatment in 48 patients (63.1%), who completed the trial. Twenty-eight patients (36.8%) discontinued the therapy. In 12 patients (15.8%) the treatment did not obtain a satisfactory target IOP. In two subjects (2.6%), despite the IOP reduction, visual field damage progressed. The remaining 10 patients (13.1%) discontinued the treatment because of the following side effects: microfollicular conjunctivitis (seven cases); severe oedema of conjunctiva and eyelids (one case); corneal punctate erosion (one case); cystoid macular oedema (one case). No flare or pigmentary changes of iris and eyelash were observed. CONCLUSION: Latanoprost 0.005% once daily significantly reduces IOP in the majority of glaucomatous patients uncontrolled by beta-blockers. The reduction of IOP was statistically significant during 3 years of follow-up, confirming the clinical efficacy of this compound. The ocular side effects requiring cessation of therapy were mainly allergic reactions. The most severe adverse effects were one case of corneal punctate erosion and one case of cystoid macular oedema in a pseudophakic patient.

Adrenergic beta-Antagonists↗
PubMed2004

A 6-month randomized clinical trial of bimatoprost 0.03% versus the association of timolol 0.5% and latanoprost 0.005% in glaucomatous patients.

BACKGROUND: New effective hypotensive agents have been recently introduced into clinical practice, but often more than one drug has to be used to prevent further visual field loss. The aim of this study was to evaluate the intraocular pressure (IOP)-lowering efficacy and safety of bimatoprost 0.03% compared with the association of timolol 0.5% and latanoprost 0.005% in open-angle glaucoma patients. METHODS: In this 6-month, prospective, parallel, randomised, investigator-masked clinical trial, 61 glaucomatous patients treated with timolol 0.5% twice in both eyes were enrolled. The timolol 0.5% was replaced by bimatoprost 0.03% once daily (group I) or by latanoprost 0.005% plus timolol 0.5% (group II). IOP measurements were performed at the baseline visit and at days 15, 30, 60, 90, 120 and 180. Digital colour photography was used to evaluate topical side effects. RESULTS: Fifty-six of the 61 patients were included for the intent-to-treat analysis (28 in group I and 28 in group II). Baseline mean IOP was similar in the two groups (p=0.5). Both treatments lowered the mean IOP at every visit significantly compared with the baseline (p<0.01). Comparing the IOP reductions obtained by the two treatments, no significant differences were found at any time during the study. Conjunctival hyperaemia, skin pigmentation and eyelash growth in group I and headache in group II were the most common side effects observed during the study. CONCLUSIONS: Bimatoprost and the association of latanoprost plus timolol were equally effective in lowering the IOP in glaucomatous patients previously treated with timolol. Latanoprost plus timolol showed a better ocular safety profile.

Adult↗
PubMed2005

Proton radiotherapy as an alternative to exenteration in the management of extended conjunctival melanoma.

BACKGROUND: Diffuse and multifocal patterns of conjunctival melanoma may not be treatable with standard eye-sparing methods. The purpose of this study was to evaluate the usefulness of proton beam radiation therapy as an alternative to exenteration. METHODS: Twenty patients with extended conjunctival melanoma were treated by proton beam irradiation. Most cases were T3 tumours which were not accessible to brachytherapy due to their extension, localisation with fornical or caruncular involvement. Only 2 patients had a tumour limited to the bulbar conjunctiva. Both were recurrent tumours with multiple lesions. Sixteen cases were recurrences after various pre-treatments. The area of the conjunctiva which was suspected to have microscopic disease was treated by 31 Gy in 6 fractions. The "high risk" areas with a clinically detectable tumour (primary target volume) were treated by an additional boost using a smaller beam size and applying 2 fractions up to 45 Gy. An individually shaped compensator was brought into the beam to modify the range of the protons so that the eye was irradiated only at a depth of 2 mm. RESULTS: The mean follow-up time was 38.1+/-26.6 months (median 34 months). Recurrent disease occurred in 6 cases (30%); 2 of them outside the irradiated volume, 3 within the target volume treated by 31 Gy, and just one in the primary target volume treated by 45 Gy. An exenteration followed only in two patients (10%). 6 patients (30%) suffered from metastatic disease and 4 (20%) of them have died by now. During follow up we found no statistically significant association between the occurrence of local recurrence after proton radiotherapy and the development of metastases. Best corrected visual acuity remained stable in 12 cases (60%); in 14 patients the best corrected visual acuity was 0.25 or better. A sicca-syndrome developed in 19/20 patients. However, only 10/20 patients used artificial tears more than 5x/d. A focal cataract developed in 7 patients (35%). There was eyelash loss in the area of irradiated eyelids. In 4 cases a limbal stem cell deficiency occurred with the consequence of corneal vascularisation. CONCLUSIONS: Proton radiotherapy may serve as an alternative to exenteration in case of T3 and diffuse T1 or T2 conjunctival melanomas.

Adolescent↗
PubMed2000

Hypertrichosis in systemic lupus erythematosus (SLE).

We describe a 14-year-old female with systemic lupus erythematosus (SLE) involving the skin, joints and central nervous system who developed hypertrichosis of the upper eyelashes. This clinical finding has been observed in immunocompromised patients with acquired immune deficiency syndrome (AIDS), malnutrition, cancer or kala-azar. Although the pathogenic mechanism for this type of hypertrichosis is unknown, we believe the immunological defects seen in SLE may be responsible for such manifestation in our patient.

Adolescent↗
PubMed1981

Coats' disease in a patient with Cornelia de Lange syndrome.

A 16-month-old boy had the mental and physical retardation, low-pitched cry, phocomelia with syndactyly, hirsutism, low-set ears, bushy eyebrows, elongated eyelashes, blepharoptosis, and strabismus characteristic of Cornelia de Lange syndrome along with ophthalmoscopic findings characteristic of Coats' disease. Cryotherapy made the abnormal telangiectatic vessels less prominent, but macular scarring produced poor visual acuity. Occlusion therapy was unsuccessful.

Amblyopia↗
PubMed1983

Treatment of eyelid retraction with two pedicle tarsal rotation flaps.

Five patients with eyelid retraction (seven eyelids, four upper and three lower eyelids) associated with blepharoptosis surgery, Graves' disease, and vertical extraocular muscle surgery were effectively treated with a new technique involving recessing the respective eyelid retractor beyond the tarsal border. Direct attachment of the levator aponeurosis or the inferior aponeurosis (capsulopalpebral head of the inferior rectus muscle) into the tarsus was maintained through an extended framework created by two pedicle tarsal rotation flaps. This anatomic retention of the tarsal-retractor junction enhanced transfer of muscle contracture into eyelid movement. The only adverse effect was a 4-mm gap in the eyelashes of one patient.

Adolescent↗
PubMed1994

The assessment of trichotillomania.

Trichotillomania is a disorder characterized by hair-pulling and resulting hair loss. Hair is usually pulled from the scalp, eyelashes, eyebrows, beard, and pubic area. Sufferers often resort to wearing wigs or elaborate hair styles and make-up to camouflage bald patches. It occurs more frequently in women and is associated with considerable distress. The two treatments of choice currently are pharmacotherapy and cognitive-behavioral therapy. The choice of assessment procedures includes self-monitoring, saving hairs, interview, observational rating, digital photograph and computer scoring, significant others' report, and standardized measures. Goals of assessment in trichotillomania and advantages and disadvantages of assessment procedures are discussed. The Trichotillomania Diagnostic Interview is presented as a standardized diagnostic interview.

Awareness↗
PubMed1996

Nager acrofacial dysostosis: management of a difficult airway.

Nager acrofacial dysostosis, first described by Nager and deReynier in 1948, is a rare syndrome characterized by mandibulofacial dysostosis with associated radial defects. The facial features include downward slanting palpebral fissures, absent eyelashes in the medial third of the lower lids, mandibular and malar hypoplasia, dysplastic ears with conductive deafness, and variable degrees of palatal clefting. Upper limb malformation is a constant feature of Nager syndrome and ranges from thumb hypoplasia to absence of the radial ray. The maxillo-mandibular hypoplasia and associated retroplaced tongue set the stage for early and significant upper airway obstruction. The craniofacial anomalies and associated trismus make emergent airway intubation challenging. We present a case of Nager syndrome with life threatening airway obstruction unresponsive to conservative management. This case and a review of the literature emphasize the importance of early tracheotomy for these patients.

Abnormalities, Multiple↗
PubMedDate not supplied

The effects of transplacental and mammary movement of PCBs on infant rhesus monkeys.

Sixteen adult female rhesus monkeys were fed diets containing 2,5 and 5.0 ppm PCB (Aroclor 1248) for approx. 1.5 years. 6 of the 8 animals on 5 ppm PCB and 8 of the 8 animals on 2.5 ppm PCB conceived when bred after 6 months' exposure to PCB. Only 1 live infant was born to the animals of the 5.0 ppm group and 5 infants to the animals in the 2.5 ppm PCB group. All of the infants had PCBs in their tissues at birth. Thereafter, there was a rapid increase in the PCB levels of the infants' tissues. This increase was attributed to consumption of PCB-containing milk from their mothers. Within 2 months following birth the infants had facial acne and edema, swelling of the eyelids, loss of facial hair including eyelashes, and hyperpigmentation of the skin. Three of the 6 infants had expired within 8 months following birth due to PCB intoxication. The three survivors were weaned and subsequently showed marked improvement in their physical state.

Animals↗
PubMed1995

Sevoflurane versus halothane for general anesthesia in pediatric patients: a comparative study of vital signs, induction, and emergence.

STUDY OBJECTIVE: To compare vital signs and the speed of induction and emergence with sevoflurane versus halothane in pediatric patients. DESIGN: Prospective, randomized, open study. SETTING: Thomas Jefferson University Hospital. PATIENTS: 40 unpremedicated ASA Physical Status I and II children age 9 months to 16 years undergoing elective inpatient otorhinolaryngologic or orthopedic surgery. INTERVENTIONS: Standardized induction of anesthesia with sevoflurane (start: 1%, maximum: 7%) or halothane (start: 0.5%, maximum: 5%) in nitrous oxide/oxygen (N2O/O2). Intubation following vecuronium and 4 minutes of controlled ventilation with 2 minimum alveolar concentration (MAC) drug in O2; 1.5 MAC drug in N2O/O2 delivered for 20 minutes; then 0.75 MAC until the end of surgery. Fentanyl 1 mcg/kg was administered 15 minutes before the anticipated end of surgery, at which time anesthetics were stopped and mechanical ventilation continued until eye opening (emergence). MEASUREMENTS AND MAIN RESULTS: Blood pressure, heart rate (HR), oxygen saturation, end-tidal gas concentrations, and temperature were recorded. Induction and emergence times were measured to the nearest second. Induction (loss of eyelash reflex) was faster with sevoflurane (97 +/- 31 sec) than halothane (120 +/- 36 sec; p < 0.05), despite a lower inspired sevoflurane MAC. Emergence was faster with sevoflurane (9.9 +/- 2.9 min vs. 12.5 +/- 4.7 min; p < 0.05), despite a higher MAC multiple of end-tidal sevoflurane concentration at the end of surgery. Following intubation, HR (compared with the preinduction value in the operating room) was significantly higher in the halothane group (136.8% +/- 16.3% vs. 115.0% +/- 25.6%), as was mean arterial pressure (113.2% +/- 25.5% vs. 87.8% +/- 22.6%). This finding corresponded with a higher MAC multiple of end-tidal concentration in the sevoflurane group than in the halothane group. CONCLUSIONS: Induction of and emergence from anesthesia was faster with sevoflurane than halothane. Airway complications were low in both groups. Vital signs were more stable with sevoflurane during induction through intubation, and were comparable during maintenance. Sevoflurane is an excellent drug for inhalational induction in pediatric patients.

Adolescent↗
PubMed2006

[Abbé-Mustardé's flap with lower lid transposition: three clinical cases].

The ideal solution first recommended is the use of Abbé-Mustardé's flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes.

Basal Cell Carcinoma↗
PubMed2006

2q24-q31 deletion: report of a case and review of the literature.

We report a patient with a de novo interstitial deletion of the long arm of chromosome 2 involving bands 2q24.3-q31.1. The patient shows postnatal growth retardation, microcephaly, ptosis, down-slanting palpebral fissures, long eyelashes and micrognathia. Halluces are long, broad and medially deviated, while the other toes are laterally deviated and remarkably short with hypoplastic phalanges. She also showed developmental delay, seizures, lack of eye contact, stereotypic and repetitive hand movements and sleep disturbances with breath holding. Prenatal and three independent postnatal karyotypes were normal. Array-CGH analysis allowed us to identify and characterize a "de novo" 2q interstitial deletion of about 10.4Mb, involving segment between cytogenetic bands 2q24.3 and 2q31.1. The deletion was confirmed by quantitative PCR. About 30 children with 2q interstitial deletion have been reported. The deletion described here is overlapping with 15 of these cases. We have attempted to compare the clinical features of our patient with 15 overlapping cases. The emerging phenotypes include low birth weight, postnatal growth retardation, mental retardation and developmental delay, microcephaly, and peculiar facial dysmorphisms. Peculiar long and broad halluces with an increased distance between the first and the second toe are ("sandal gap" sign) present in most of the described patients. The gene content analysis of the deleted region revealed the presence of some genes that may be indicated as good candidates in generating both neurological and dysmorphic phenotype in the patient. In particular, a cluster of SCNA genes is located within the deleted region and it is known that loss of function mutations in SCNA1 gene cause a severe form of epilepsy.

Abnormalities, Multiple↗
PubMed2006

Bilateral basal ganglia involvement in a patient with Griscelli syndrome.

We report a 6-year-old Iranian boy with silvery-gray hair, eyelashes and the eyebrows who was admitted because of seizures and subsequent stupor. He had previous history of acute hemiparesis at 1 year of age and hepatitis-like syndrome 3 months ago. Microscopic examination of the patient's hair shaft revealed different sized clumps of melanin seen in the center of the shafts. Bone marrow aspiration revealed erythroid hyperplasia and erythrophagocytic cells. Bilateral frontal cortical and subcortical high signal lesions, dirty white matter, high signal areas in the upper pons and in both caudates and lentiform nuclei in T2 WI were the brain MRI findings of the patient. He died in the accelerated phase of Griscelli Syndrome (GS) type 2. To our knowledge we report the first case of GS from Iran.

Basal Ganglia↗
PubMed2005

A new method for accurate and fast measurement of 3D eye movements.

Videooculography (VOG) is an eye movement measurement method used in the objective evaluation of vestibulo-ocular reflexes (VOR). An important requirement of VOG is to accurately estimate pupil center and ocular torsion, irrespective of drooping eyelids, eyelashes, corneal reflection, and blinking. Finding the accurate center of the pupil is particularly important in three-dimensional VOG, since otherwise, significant errors can occur in measuring torsional eye movement. A fast algorithm was proposed to accurately ascertain the pupil center, in spite of the complicating factors mentioned above. In this study, real-time three-dimensional VOG, which can measure horizontal, vertical, and torsional eye movements and calculate the pupil radius, was implemented using the proposed method. When the pupil radius was determined, the vertical position was measured within an error margin of less than 3%, even though only 10% of the pupil was visible. The time required to measure both three-dimensional eye movements and the pupil radius was less than 16 ms. Thus, eye movements can be measured in real-time. The resolutions of horizontal, vertical, and torsional eye movement were 0.2 degrees, 0.2 degrees, and 0.1 degrees, respectively, with maximum ranges of +/- 35 degrees, +/- 25 degrees, and +/- 18 degrees.

Algorithms↗
PubMed2005

The Pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation.

OBJECTIVE: To investigate histopathologic alterations of eyelid biopsy specimens from patients with floppy eyelid syndrome (FES) with special regard to elastic fiber content and ultrastructure as well as to the expression of elastin-degrading enzymes to elucidate the pathogenesis of this disorder. DESIGN: Retrospective, interventional case series. PARTICIPANTS AND CONTROLS: Eleven consecutive patients with FES and 10 age-matched control patients with basal cell carcinoma of the eyelid. METHODS: Horizontal pentagonal eyelid resections of 16 upper lids were performed in 11 patients with FES. Full-thickness eyelid biopsy specimens from study and control patients were examined by light and transmission electron microscopy, semiquantitative morphometry, and immunohistochemistry using antibodies against matrix metalloproteinase (MMP)-2, MMP-7, MMP-9, and MMP-12 and neutrophil elastase. RESULTS: All patients treated with surgical horizontal eyelid shortening were asymptomatic at follow-up. Histopathologic analysis of the surgical specimens showed, apart from unspecific signs of chronic inflammation, a significant decrease in the amount of elastin within the tarsal plate and eyelid skin as compared with controls. Residual elastic fibers revealed an abnormal ultrastructure with a diminished elastin core. Immunohistochemistry demonstrated an increased immunoreactivity for elastolytic proteases, particularly MMP-7 and MMP-9, in areas of elastin depletion in FES specimens as compared with controls. CONCLUSIONS: The findings indicate that upregulation of elastolytic enzymes, most probably induced by repeated mechanical stress, participates in elastic fiber degradation and subsequent tarsal laxity and eyelash ptosis in FES.

Aged↗
PubMed2006

Type I congenital multiple intraspinal extradural cysts associated with distichiasis and lymphedema syndrome.

OBJECTIVE: The hereditary syndrome of multiple congenital intraspinal cysts associated with distichiasis, lymphedema and other congenital deformities is extremely rare. Modern imaging techniques have promoted the non-invasive diagnosis of spinal pathology and paved the way for better surgical planning. We reviewed the clinical data, imaging studies and treatment outcomes of a 12-year-old boy with this syndrome. CLINICAL PRESENTATION: Progressive spastic paraparesis with signs of spinal cord compression leading to frequent falls. This was associated with bilateral double row of eyelashes and pretibial edema. The MRI of thoracic spine depicted two large elongated extradural lesions extending from D5-D10 with signal intensity compatible with cerebrospinal fluid leading to severe compression of the spinal cord dorsally. TREATMENT: Laminotomy and complete microsurgical excision of the cysts resulted in a fast and full clinical recovery of his neurological deficit. CONCLUSION: Type I congenital intraspinal cysts is a rare etiology of cord compression syndrome and may be associated with distichiasis, lymphedema and other congenital deformaties. It has several characteristics, which include the higher incidence in thoracic spine and younger age group, disproportional sever motor deficit as compared with sensory disturbances and the excellent clinical recovery following successful surgical treatment.

Child↗