Rate of vascularization and exposure of silicone-capped porous polyethylene spherical implants: an animal model.

PURPOSE: This pilot study examines the rates of exposure and fibrovascular ingrowth of silicone-capped, porous, polyethylene orbital implants in the New Zealand white rabbit animal model. METHODS: Unwrapped, silicone-capped, porous, polyethylene orbital spheres were implanted in 16 enucleated rabbit orbits. Four implants were removed at 3, 6, 9, and 12-month intervals and submitted for histopathologic analysis. A board-certified pathologist reviewed and graded vascular ingrowth, inflammation type, and severity for all specimens. RESULTS: Fibrovascular ingrowth in the center of all implants occurred as early as 3 months. No fibrovascular ingrowth occurred at the interface between the silicone cap and the porous polyethylene implant. The overlying Tenon's and conjunctival tissues remained intact without significant host inflammatory response. No implant exposure occurred at any time point. CONCLUSIONS: Silicone-capped porous polyethylene orbital implants appear to offer an inexpensive, easy-to-manufacture implant that resists exposure without the need for a wrapping material and achieves successful biointegration soon after implantation.

Canalicular obstruction: a histopathologic case series.

OBJECTIVE: To investigate the histopathologic causes of canalicular obstruction in a case series of patients treated by canalicular trephination for symptomatic epiphora. DESIGN: A university and private practice retrospective chart review. PARTICIPANTS: The study involved 12 consecutive patients who underwent unilateral canalicular trephination with tissue retrieval for the treatment of canalicular obstruction. METHODS: Canalicular obstruction was confirmed at the time of preoperative and intraoperative probing and irrigation. Treatment consisted of canalicular trephination combined with silicone intubation and a concomitant dacryocystorhinostomy in 6 cases. Tissue was recovered from the trephine lumen and submitted for pathologic analysis. Predisposing factors that could have caused canalicular obstruction and the clinical course following treatment were reported. RESULTS: The most common histopathologic finding was nonspecific inflammation with associated fibrosis. Cases demonstrating sebaceous gland adenoma, skeletal muscle, adipose tissue, and bone were identified. CONCLUSIONS: Use of the lacrimal trephine to open canalicular obstructions provided tissue samples that revealed nonspecific inflammation and fibrosis as a common underlying histopathology. The presence of skeletal muscle and adipose tissue suggests a decrease in canalicular diameter or such dense scarring that the normal canalicular architecture could not be followed. Other causes of canalicular obstruction such as lacrimal sac tumors should be considered in the differential diagnosis.

Double-blind, bilateral pain comparison with simultaneous injection of 2% lidocaine versus buffered 2% lidocaine for periocular anesthesia.

PURPOSE: Determine if raising the pH of 2% lidocaine with epinephrine 1:100 000 to a physiologic level decreases pain perception during periocular, subcutaneous anesthesia. DESIGN: Double-blind, prospective, randomized study. Simultaneous unilateral injections of buffered and unbuffered lidocaine solutions were given before surgery to patients having bilateral, periocular surgery. PARTICIPANTS: Fifty-four consecutive patients (27 male and 27 female; mean age, 68 years; standard deviation, 11 years). INTERVENTION: Patients were given simultaneous injections of buffered and unbuffered 2% lidocaine with epinephrine 1:100 000. The needles were inserted simultaneously and the anesthesia was injected for a 20-second count for a total volume of 1.0 ml per injected side. MAIN OUTCOME MEASURES: After the simultaneous injections, the patients were asked to rate the pain on each side on a Likert-type visual analog scale of 0 to 10. RESULTS: Sixty-five percent of patients preferred the buffered lidocaine with a scaled pain reduction of 0.9 (P = 0.0005). Additionally, for the patients who believed that the buffered solution was less painful, the mean decrease in scaled pain rating was 2, for a 51% reduction in pain level (P = 0.001). No gender differences were noted. CONCLUSIONS: Buffering 2% lidocaine with epinephrine 1:100 000 with sodium bicarbonate 8.4% offers a clinically and statistically significant reduction in pain experienced by two-thirds of patients receiving periocular subcutaneous anesthesia.

Use of the Boston Ocular Surface Prosthesis in the management of severe periorbital thermal injuries: a case series of 10 patients.

PURPOSE: To report the use of the Boston Ocular Surface Prosthesis (BOSP) in patients with severe periorbital thermal injuries. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Patients with severe periorbital thermal injuries treated with the BOSP. METHODS: Chart review of 10 consecutive patients (16 eyes) who sustained severe periorbital thermal injuries during combat missions in Iraq and Afghanistan and were treated for exposure keratopathy with the BOSP, a Food and Drug Administration-approved gas-permeable, scleral contact lens. MAIN OUTCOME MEASURES: Corneal epithelial defect healing, uncorrected and best-corrected visual acuity, and BOSP wear time. RESULTS: Exposure keratopathy occurred after severe periorbital thermal injuries and followed a predictable course of scar contracture. In all patients, vision-threatening ocular surface disease developed as a result of chronic ocular exposure. Rehabilitation of the ocular surface was accomplished using the BOSP, with 10 of the 16 treated eyes achieving a corrected visual acuity of 20/70 or better. Five eyes achieved a best-corrected visual acuity of 20/40 or better. The BOSP also was used as a drug-delivery vehicle to treat corneal ulcers successfully in 6 eyes. The only eye that required penetrating keratoplasty was an early intervention believed to be a direct sequelae of the original thermal burn, rather than a failure of the BOSP regimen. The mean BOSP wear time was 16 hours per day. CONCLUSIONS: The BOSP can play an important role in rehabilitation of the ocular surface for patients with severe periorbital thermal injuries and resultant exposure keratopathy. Use of the BOSP should be considered as a treatment option for these difficult cases of severe periorbital thermal injuries.

Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy.

OBJECTIVE: The objective of this study was to compare the results of videofluoroscopy (VFS) with flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in dysphagia testing. METHODS: The authors conducted a retrospective review of data collected over a 4-year period at a tertiary care medical center. The FEESST and VFS results for patients receiving both examinations within a 2-week period were compared with respect to swallowing function. Comparisons were categorized as full agreement, minor disagreement that would not result in a significant difference in diet recommendations, and major disagreement that would result in a significant difference in diet recommendations. Kappa with quadratic weighting was calculated to evaluate the inter-test agreement. RESULTS: Fifty-four patients met inclusion criteria and were reviewed. Forty-one percent of patients were not eating by mouth at the time of FEESST and the mean interval between the two examinations was 5 days. Laryngeal examination revealed edema/erythema in 93%, impaired pharyngeal squeeze in 66%, decreased laryngopharyngeal sensation in 82%, and absent laryngeal adductor reflex in 30%. FEESST with all consistencies revealed pooling in 89%, penetration in 83%, and aspiration in 65% of patients. VFS revealed pooling in 65%, penetration in 67%, and aspiration in 54% of patients. Comparison of FEESST and VFS revealed full agreement in 52%, minor disagreement in 13%, and major disagreement in 35% of patients. A weighted kappa value of 0.324 signified only "fair" agreement between the two tests. CONCLUSIONS: FEESST and VFS may not represent comparable tests of dysphagia. Further comparative studies of tests of swallowing function are required to determine the ideal approach to dysphagia testing.