Subtenon's local anesthesia for optic nerve sheath fenestration.

PURPOSE: We used subtenon's local anesthesia for optic nerve sheath fenestration as an alternative to either general or retrobulbar anesthesia. METHODS: Thirty patients with pseudotumor cerebri, who were unresponsive to medical treatment, underwent optic nerve sheath fenestration after administration of topical and subtenon's local anesthesia. RESULTS: When topical tetracaine, in conjunction with subtenon's anesthesia, was administered at the beginning of the procedure, excellent anesthesia and maximal patient comfort were achieved. CONCLUSIONS: The use of local anesthesia allows for a pain-free, expeditious operation with fewer potential anesthetic complications.

Orbitocraniofacial gunshot wounds: craniofacial reconstruction and preparation of the anophthalmic socket.

This article is a retrospective clinical and radiographic analysis of four patients who survived high caliber orbitocraniofacial gunshot injuries. Early multidisciplinary craniofacial reconstruction included repair of comminuted orbital fractures with multiple autogenous bone grafts and/or porous polyethylene implants, enucleation, and insertion of a hollow silicone sphere as an anophthalmic socket implant. Migration of the silicone implant occurred in one case, requiring replacement with an autogenous dermis fat graft. There were no cases of extrusion or infection. Socket motility remained limited in all cases, despite reapposition of the extraocular muscles. In two cases with autogenous bone grafts along the orbital roof, there was no radiographic evidence of graft resorption after three years. Soft tissue volume deficiency and superior sulcus deformity developed in the three cases which were followed for more than six months. Despite these limitations, all four patients are wearing comfortable ocular prostheses. The postoperative results support immediate preparation of the anophthalmic socket after craniofacial reconstruction of these injuries.

Interleukin-2 receptor beta and CD57 expression in orbital tissues from patients with chronic, stable thyroid-associated ophthalmopathy.

In order to determine whether components of the interleukin-2 receptor (IL-2R) and lymphoid cells are present in extra ocular and periocular tissues from patients with chronic, stable thyroid-associated ophthalmopathy (TAO) we studied 16 specimens of extra ocular muscle and periorbital connective tissue from 14 patients with chronic, stable, TAO using an immunohistochemical assay and a panel of murine monoclonal antibodies reactive with IL-2R alpha and beta components and lymphoid cell surface markers. As controls we studied orbital tissues from 11 patients undergoing surgery for unrelated orbital disorders. All extra ocular muscle specimens from patients with TAO exhibited IL-2R beta expression primarily on the perimysium and endomysium surrounding the ocular muscle fasciculi and fibers of which nine specimens stained intensely. The Natural Killer (NK) cell marker CD57 was the most common cell surface antigen detected, in seven of nine specimens, whose localization often corresponded to that of IL-2R beta distribution. No IL-2R alpha expression was detected in any specimen. Seven of the 11 control specimens were positive for IL-2R beta but in a less intense fashion than in TAO specimens while no CD57 staining was detected. T cell, B cell, and cells of granulocyte and monocyte lineage were only occasionally found in both TAO and control specimens. The aberrant expression of IL-2R beta and CD57 which may be representative of NK cell presence in extra ocular muscle tissues from patients with stable, chronic TAO may play a role in the pathogenesis of the ophthalmopathy.(ABSTRACT TRUNCATED AT 250 WORDS)