Light-activated sutureless closure of wounds in thin skin.

BACKGROUND AND OBJECTIVES: Closing lacerations in thin eyelid and periorbital skin is time consuming and requires high skill for optimal results. In this study we evaluate the outcomes after single layer closure of wounds in thin skin with a sutureless, light-activated photochemical technique called PTB. STUDY DESIGN/MATERIALS AND METHODS: Dorsal skin of the SKH-1 hairless mouse was used as a model for eyelid skin. Incisions (1.2 cm) were treated with 0.1% Rose Bengal dye followed by exposure to 532 nm radiation (25, 50, or 100 J/cm(2); 0.25 W/cm(2)) for PTB. Other incisions were sutured (five 10-0 monofilament), exposed only to 532 nm (100 J/cm(2)), or not treated. Outcomes were immediate seal strength (pressure causing leakage through incision of saline infused under wound), skin strength at 1, 3, and 7 days (measured by tensiometry), inflammatory infiltrate at 1, 3, and 7 days (histological assessment), and procedure time. RESULTS: The immediate seal strength, as measured by leak pressure, was equivalent for all PTB fluences and for sutures (27-32 mmHg); these pressures were significantly greater than for the controls (untreated incisions or laser only treatment; P < 0.001). The ultimate strength of PTB-sealed incisions was greater than the controls at day 1 (P < 0.05) and day 3 (P < 0.025) and all groups were equivalent at day 7. Sutures produced greater inflammatory infiltrate at day 1 than observed in other groups (P = 0.019). The average procedure time for sutured closure (311 seconds) was longer than for the PTB group treated with 25 J/cm(2) (160 seconds) but shorter than the group treated with 100 J/cm(2) (460 seconds). CONCLUSION: PTB produces an immediate seal of incisions in thin, delicate skin that heals well, is more rapid than suturing, does not require painful suture removal and is easy to apply.

Spontaneous subconjunctival abscess because of Haemophilus influenzae.

PURPOSE: To report a case of a spontaneous subconjunctival abscess in a patient with no previous ocular surgery or trauma. METHOD: Case report. RESULTS: We report a case of a subconjunctival abscess caused by Haemophilus influenzae after several days of worsening conjunctivitis. Computed tomography scans of the orbits confirmed an abscess cavity adjacent to the globe without orbital extension. The abscess was spontaneously draining at presentation and resolved completely with topical and oral antibiotic therapy. CONCLUSIONS: To our knowledge, this is the first-described case of spontaneous subconjunctival abscess formation in an immunocompetent individual unrelated to preexisting ocular pathology, previous ocular surgery, or trauma. H. influenzae species may possess the ability to penetrate an intact conjunctiva and develop subconjunctival abscess. We recommend that patients presenting with bacterial conjunctivitis be closely examined to rule out subconjunctival abscess, which may require additional aggressive medical or surgical management.

Neoadjuvant chemotherapy-specific and overall treatment outcomes in patients with cutaneous angiosarcoma of the face with periorbital involvement.

BACKGROUND: Recent isolated case reports have suggested a potential role for neoadjuvant chemotherapy in patients with angiosarcoma. The goal of this report was to investigate the overall treatment outcomes and the neoadjuvant chemotherapy-specific outcomes in patients with cutaneous angiosarcoma of the face with periorbital involvement. METHODS: Our tumor database was searched for patients with angiosarcoma and periorbital involvement seen at our institution between 1981 and 2005. RESULTS: Twenty-one patients were identified,15 of whom had neoadjuvant chemotherapy and 6 of whom had a traditional approach of surgery followed by adjuvant therapy. Fourteen of 15 patients who had neoadjuvant chemotherapy had complete clinical response. Neoadjuvant chemotherapy made definitive surgery unnecessary for 9 patients. The median disease-free interval for the neoadjuvant chemotherapy group was 11.8 months (mean, 38.1 months; range, 2.4-239.6 months). Nine of the 15 patients had recurrences. The time from end of treatment to recurrence ranged from 2.6 to 24.5 months (median, 12.7 months). Five of the 6 patients who had primary surgical resection followed by adjuvant radiotherapy and/or chemotherapy had a complete clinical response, and the median disease-free interval was 31.8 months (mean, 35.9 months; range, 2.7-85 months). Two later developed recurrences, one at 2.7 months and the other at 31.8 months after the end of treatment. CONCLUSION: On the basis of this series, the authors conclude that neoadjuvant chemotherapy for periorbital angiosarcoma is a potentially attractive option and in some patients may obviate the need for major surgery, thereby preserving the eye and/or ocular adnexal structures. Given the propensity for recurrence and poor survival, the authors strongly recommend that these patients receive multidisciplinary evaluation and treatment at a major cancer center.

Severe eye injuries in the war in Iraq, 2003-2005.

PURPOSE: To document the incidence and treatment of patients with severe ocular and ocular adnexal injuries during Operation Iraqi Freedom. DESIGN: Retrospective hospital-based observational analysis of injuries. PARTICIPANTS: All coalition forces, enemy prisoners of war, and civilians with severe ocular and ocular adnexal injuries. METHODS: The authors retrospectively examined severe ocular and ocular adnexal injuries that were treated by United States Army ophthalmologists during the war in Iraq from March 2003 through December 2005. MAIN OUTCOME MEASURES: Incidence, causes, and treatment of severe ocular and ocular adnexal injuries. RESULTS: During the time data were gathered, 797 severe eye injuries were treated. The most common cause of the eye injuries was explosions with fragmentation injury. Among those injured, there were 438 open globe injuries, of which 49 were bilateral. A total of 116 eyes were removed (enucleation, evisceration, or exenteration), of which 6 patients required bilateral enucleation. Injuries to other body systems were common. CONCLUSIONS: Severe eye injuries represent a significant form of trauma encountered in Operation Iraqi Freedom. These injuries were most commonly caused by explosion trauma.

Orbital septal resection and the hanging curtain of fat.

PURPOSE: To describe a technique of lower eyelid blepharoplasty and report observations on 274 consecutive surgeries. METHODS: Retrospective, noncomparative case series of lower eyelid blepharoplasty by 2 surgeons from January 2004 through January 2006. RESULTS: Two-hundred seventy-four eyelids of 137 patients underwent transcutaneous lower eyelid blepharoplasty for the treatment of steatoblepharon. There were 27 men and 110 women with an age range of 35 years to 85 years. Minimum length of follow-up was 6 months. Two-thirds of patients had simultaneous horizontal lower eyelid tightening. Four patients (3%) had surgical enhancement for retained lower eyelid fat. CONCLUSIONS: With appropriate patient selection, orbital septal excision is an effective aesthetic technique for lower eyelid blepharoplasty. It combines surgical simplicity with good cosmetic outcomes.

Broad fascia fixation enhances frontalis suspension.

PURPOSE: To report the use of a modified frontalis suspension procedure for congenital ptosis patients with minimal to no levator function. METHODS: Retrospective, non-comparative case series of frontalis suspension by 2 surgeons over a 21-year period. RESULTS: Frontalis suspension with broad fascia fixation was performed on 48 eyelids of 25 patients. All patients had visual obscuration due to blepharoptosis with only 0 mm to 2 mm of measurable levator function. Age ranged from 3 to 13 years. Minimum length of follow-up was 6 months (range, 6-174 months). The palpebral fissure was increased in all patients, improving their head position and unmasking their visual axis in primary gaze. Postoperatively, all patients developed transient exposure symptoms. There were no migrations, extrusions, infections, or granulomas. All patients achieved a satisfactory postoperative result based on eyelid position, function, and contour. CONCLUSIONS: This modified frontalis suspension procedure maximizes frontalis muscle recruitment, creating powerful eyelid elevation with stable effect over time. The technique minimizes other procedures' pitfalls and advances in cosmesis are achieved with enhanced eyelid crease formation and adjustable eyelid contour.

Exacerbation of Graves ophthalmopathy with interferon-alpha therapy.

Thyroid dysfunction, particularly hypothyroidism, following interferon-alpha therapy is not uncommon. To our knowledge, this is the first case report of exacerbation of Graves ophthalmopathy during treatment with interferon-alpha for chronic hepatitis C virus.

Exacerbation of Graves Ophthalmopathy With Interferon-α Therapy.

Thyroid dysfunction, particularly hypothyroidism, following interferon-α therapy is not uncommon. To our knowledge, this is the first case report of exacerbation of Graves ophthalmopathy during treatment with interferon-α for chronic hepatitis C virus.

Tarsal switch levator resection for the treatment of blepharoptosis in patients with poor eye protective mechanisms.

PURPOSE: The authors report the use of a tarsal switch levator resection procedure that opens the palpebral fissure while reducing the risk of postoperative exposure in ptosis patients with poor eye protective mechanisms. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Fifteen consecutive patients of 2 surgeons at Texas Oculoplastic Consultants from July 1997 through July 2005. INTERVENTION: A composite tarsal-levator-conjunctival graft was taken from the upper eyelid and was transferred to the lower eyelid. MAIN OUTCOME MEASURES: Clinical assessment of postoperative exposure keratopathy and position of palpebral fissure relative to visual axis. RESULTS: A composite tarsal-levator-conjunctival graft was taken from the upper eyelid and was transferred to the lower eyelid in 26 eyelids of 15 patients. One patient was excluded because of lack of follow-up. There were 7 men and 7 women; the age ranged from 20 months to 74 years. The average duration of follow-up was 34 months, with a range of 3 to 85 months. The palpebral fissure was moved cephalad in all patients, improving their head position and unmasking their visual axis in primary gaze. One patient experienced exposure symptoms after surgery and required recession of the levator aponeurosis of both upper eyelids. Overall patient satisfaction was excellent. CONCLUSIONS: The tarsal switch levator resection procedure elevates both the upper and lower eyelids a predetermined amount. This displaces the palpebral fissure superiorly, effectively opening the visual axis in primary gaze and decreasing the risk of postoperative exposure problems in patients with diminished eye protective mechanisms.

A permanent and reversible procedure to block tear drainage for the treatment of dry eye.

PURPOSE: To describe a technique of canalicular ligation and report observations on 59 consecutive surgeries. METHODS: Retrospective, non-comparative case series of canalicular ligation by 3 surgeons over a 7-year period. RESULTS: Fifty-nine eyelids of 29 patients (2 men and 27 women) underwent canalicular ligation for the treatment of severe dry eyes. Patient age ranged from 34 to 90 years. Average length of follow-up was 20 months. There were no complications. Ninety-one percent of patients noted an improvement in their symptoms. Two patients developed symptomatic epiphora more than 1 year postoperatively and both underwent successful reversal. CONCLUSIONS: Canalicular ligation is an effective technique for punctal occlusion in patients with severe dry eyes. It combines surgical ease with excellent cosmetic outcomes.