Delayed reconstruction after eyelid tumor excision.

BACKGROUND: The aim of this study is to report the feasibility of one to two weeks delayed reconstruction after eyelid tumor excision. PATIENTS AND METHODS: A retrospective case-series study was designed. Fourteen consecutive outpatients referred to a tertiary referral eye center for eyelid tumor management were enrolled. The intervention imvolved eyelid tumor excision (with four millimeters surrounding clinically tumor-free tissue), compressive patching of the excised area until reconstruction (with or without a therapeutic contact lens), extensive histological work-up to assess histological tumor clearance, and reconstruction one week after excision (in a couple of patients after two weeks when further excision was necessary to achieve tumor clearance). Excision and closure were performed by a single external trained oculoplastic surgeon (IOH) with a day per week (Fridays) operating slot. As outcome we assessed whether such an approach has led before, during, or after eyelid reconstruction to unusual major adverse events (follow-up time: 18 - 36 months). RESULTS: Delaying up to one week, in some cases even two weeks, reconstruction after eyelid tumor excision was not associated with any unusual major adverse events before, during, or after surgery. CONCLUSIONS: When necessary, after eyelid tumor excision, it is possible to delay for one week or even for two weeks reconstruction, apparently without experiencing major unusual adverse events.

Mucosal excision instead of fashioning nasolacrimal mucosae flaps during external dacryocystorhinostomy: a pilot study.

BACKGROUND: To report results of a simplified external dacryocytorhinostomy procedure in which nasal and lacrimal sac mucosal flaps are simply removed instead of being sutured together. DESIGN: Retrospective non-comparative case-series study. PARTICIPANTS: Fourteen consecutive outpatients patients undergoing external dacryocytorhinostomy. INTERVENTION: Modified and simplified transcutaneous external dacryocytorhinostomy where basically the lacrimal sac and the nasal mucosae are widely excised in front of DCR's osteotomy instead of being used to fashion nasolacrimal flaps. OUTCOME: Assessment of dacryocytorhinostomy anatomical patency by syringing and patient's self-perception of epiphora symptoms improvement about twelve weeks and one year after surgery, as well as patient's report of ocular air-reflux during Valsalva maneuver a year after surgery. RESULTS: Syringing showed anatomic patency in 93 % and 92 % of patients twelve weeks (mean ± SD: 12 weeks ± 6 weeks) and one year (15 months ± 3 months) after surgery, respectively. One year after surgery, 62 % of patients reported ocular air-reflux. Twelve weeks and one year after surgery, mean symptom improvement was 82 % ± 17 % and 79 % ± 29 %, respectively. Furthermore, 79 % and 85 % of patients reported a postoperative improvement of their symptoms greater or equal to 80 % after twelve weeks and one year, respectively. CONCLUSIONS: Removing lacrimal sac and nasal mucosae in front of the osteotomy did not appear to have a major negative impact on the outcome of the external dacryocytorhinostomy. The findings of this pilot study need to be confirmed by a larger prospective trial.

Improvement of chronic epiphora symptoms after surgery in patients with different preoperative schirmer-test values.

BACKGROUND: To compare improvement of epiphora symptoms after surgery between patients who had different preoperative basal Schirmer test values. DESIGN: Retrospective comparative case-series study. PARTICIPANTS: Twenty-two consecutive patients (one eye/patient) undergoing surgery for chronic epiphora symptoms resistant to ≥ 6 months of medical treatments (who incidentally had a preoperative basal [oxybuprocain-HCL 0.4 %] Schirmer-test and a postoperative one-year follow-up) were ranked according to their preoperative basal Schirmer test values and divided into two groups of equal size: group I, patients with lower (0 to 6 mm) and group II, patients with higher (7 to 25 mm) Schirmer test values. INTERVENTION: Combination of Piffaretti's endocanlicular endoscopic lacrimal drainage (22 patients), lacrimal intubation (8 patients), lacrimal punctoplasty (22 patients), lateral canthoplasty (18 patients), and/or conjunctivochalasis (8 patients) surgical procedures. OUTCOME: Subjective self-perceptions of improvement of their epiphora symptoms was made by the patients one-year after surgery. RESULTS: While between groups I and II mean (± SD) preoperative basal Schirmer test values significantly differed (4 ± 3 mm/ 5 min vs. 10 ± 6 mm/ 5 min, p ≤ 0.001, Mann-Whitney rank sum test), the mean postoperative improvement of epiphora symptoms did not (82 ± 30 % vs. 76 ± 34 %, p = 0.92) and no significant (rho = -0.11, p = 0.62, Spearman rank correlation coefficient) correlation between Schirmer test values and symptoms improvement was found. In both groups > 70 % of patients reported ≥ 70 % (satisfactory) postoperative improvement. CONCLUSIONS: In the present study, patients who had different preoperative basal Schirmer test values reported having very similar epiphora symptoms improvement one-year after surgery.

Pathophysiology of intraocular pressure increase and glaucoma prevalence in thyroid eye disease: a mini-review.

BACKGROUND: The aim of this study was to assess the pathophysiological mechanisms leading to intraocular pressure (IOP) increase and to review the prevalence of glaucoma in thyroid eye disease (TED), an autoimmune reaction affecting extra-ocular muscles and intra-orbital content in thyrotoxicosis (Grave's disease, hyperthyroidism). MATERIAL AND METHODS: We applied the modified Friedenswald's and Goldmann's equations to explain the mechanisms by which IOP increases in TED and gave a brief review of the literature. RESULTS: In TED, Friedenswald's equation explains the ultra-short term IOP increase observed when eyes deviate from their primary gaze position (eyeball compression by enlarged and infiltrated extra-ocular muscles). Goldmann's equation explains the long-term IOP increase seen in TED (episcleral venous pressure elevation secondary to intraorbital content and pressure increase). Most studies did not find a significant increase in glaucoma prevalence in patients with TED. CONCLUSION: In TED, glaucoma prevalence does not seem to be significantly increased and, from a pathophysiological standpoint, the long-term IOP increase is essentially due to episcleral venous pressure elevation.

Large upper eyelid full-thickness defects reconstructed only with an anterior lamella.

BACKGROUND: The purpose of this study is to report a surgical procedure that only uses anterior lamella structures (muscle and skin) to reconstruct large upper eyelid full-thickness total defects. PATIENTS AND METHODS: The study design is a non-comparative retrospective interventional small case series. Three patients with upper eyelid full-thickness (anterior and posterior lamellae) total-defect (horizontal extent: > 3/4 length, vertical extent: > 15 mm) after tumor excision (basal cell, squamous cell, or Merkel's cell carcinoma). As intervention an eyelid reconstruction using only a rotation/advancement muscular-skin flap was used. The outcome was postoperatively an upper eyelid anatomic cosmetic-appearance and lid-closure function. RESULTS: Good anatomic cosmetic-appearance and lid-closure function were achieved soon after surgery. No remarkable ocular as well as extra-ocular side effects or complications were noted. CONCLUSIONS: In a single-stage procedure it appears possible to repair upper eyelid full-thickness total defects by reconstructing only the anterior lamella. With this procedure there is no need to reconstruct the posterior lamella and/or to use tissue from other eyelids or parts of the body.

Free autologous buccal mucosal graft transplantation to treat ocular complications after toxic epidermal necrolysis: case report.

BACKGROUND: Toxic epidermal necrolysis (TEN) can lead to ocular surface scarring associated with pain, dry eye symptoms, and decreased visual acuity that often are difficult to treat. HISTORY AND SIGNS: A 34-year-old woman was referred to our department two-years after TEN induced by lamotrigin (lamictal(R)). She was complaining of severe visual acuity loss, pain, and dry eye symptoms. Visual acuity was reduced to light perception in the right eye (RE) and to 0.2 in left eye (LE). Basal Schirmer test was 2 mm in RE and 3 mm in LE. With or without therapeutic contact lenses, the patient was experiencing severe discomfort requiring tear supplementation up to 50 - 80 times/day in both eyes. THERAPY AND OUTCOME: A free autologous mucosal graft (3.5 x 2.0 cm) was transplanted from the lower lip into the upper RE fornix. Six months after surgery, with therapeutic contact lenses, the need for tear supplementation was markedly reduced to 3 - 4 times/day in RE while it remained unchanged in LE. In RE, slit-lamp examination revealed decreases in the corneal stromal edema and in the diameter of neo-vessels associated with an improvement of visual acuity (counting fingers at 30 cm). Basal Schirmer test values were unchanged. It has to be mentioned that the improvement observed after surgery was markedly dependent on wearing a therapeutic contact lens. CONCLUSIONS: Free autologous buccal graft transplantation (with its presumably accessory salivary glands) in association with the use of a therapeutic contact lens can be an efficient approach to treat ocular complication following drug-induced TEN (Lyell's syndrome).

Interstitial dendritic cells of the heart harbor Trypanosoma cruzi antigens in experimentally infected dogs: importance for the pathogenesis of chagasic myocarditis.

Heart sections from 16 mongrel dogs, two normal controls and 14 infected with Trypanosoma cruzi, were submitted to immunohistochemical staining with either rabbit anti-cow S100 Protein monoclonal antibody or rabbit anti-T. cruzi purified specific antibody, using the peroxidase technique to investigate the participation of the interstitial dendritic cells of the heart (IDCs) in myocarditis of Chagas disease. Trypanosoma cruzi antigens were revealed as granular and dense deposits in IDC membrane in the heart of infected dogs both during acute and chronic myocarditis, but not in normal controls. Anti-S100 Protein labeled the IDCs, both in normal and infected dogs and a significant increase in the numbers of IDCs occurred in the myocardium, proportionally to the intensity of the inflammatory infiltration. These findings suggest that IDCs, probably by presenting T. cruzi antigens to immune-competent cells, play an important role in the pathogenesis of Chagas disease.

Experimental chemotherapy of Trypanosoma cruzi infection: persistence of parasite antigens and positive serology in parasitologically cured mice.

Mice infected with Trypanosoma cruzi, but parasitologically cured after specific chemotherapy, continued to exhibit positive indirect immunofluorescence serological tests 3-6 months after the therapy. Treatment of trypanosome antigens with monospecific antisera produced in rabbits, and examination by immunoelectron-microscopy following peroxidase labelling disclosed the presence of membrane deposits in cell processes in the spleens of the mice. Similar deposits were observed in the external membranes of T. cruzi amastigotes in the spleens of acutely infected mice, but not in normal control mice. No reaction occurred in tissues not previously treated with the monospecific anti-T. cruzi serum. Positive cells in treated and cured mice, as well as in the not cured or untreated control mice, were located in germinal centres of the splenic white pulp and presented long and branching cytoplasmic processes, which are indicative of dendritic cells of the lymphoid follicles of the spleen.