Short-term patency of iliofemoral to tibial bypass with vascular allografts in a minority population: A retrospective analysis of a single center acute care facility.

OBJECTIVE: The aim of this study was to examine the short-term patency rates and associated factors of open lower limb, iliofemoral to tibial bypass using cryopreserved saphenous vein (CSV) in a minority population at an acute care hospital in New York City. METHODS: A retrospective analysis of patients undergoing infra-inguinal bypass from iliofemoral vessels to tibial arteries with CSV between March 2020-April 2022 at an acute care facility (Harlem Hospital Center, Harlem, New York) was performed. Data including patient demographics, comorbidities, type of operation, follow-up surveillance, and salvage procedures were collected. Results were presented in patency line graphs and a life table. Target limb revascularization (TLR) and amputation free survival (AFS) were also calculated. RESULTS: Eleven bypass procedures were included in the analysis. Patients were followed for a mean of 10.8 months. Cumulative primary patency rates at 1, 6, and 12 months were 72.7%, 54.5%, and 40.9%, respectively. TLR was 36.4% and the AFS was 66.67% at the mean 10.8-month follow-up. CONCLUSIONS: The patency rates of minority patients undergoing bypass with CSV were analyzed with creation of a life table and calculation of patency rates, TLR and AFS. The short-term primary patency rates and post-operative outcomes were found to be comparable to larger studies in non-minority cohorts. These results suggest that larger studies as well as prospective analyses and randomized controlled trials in this patient cohort and demographic are needed, as well as optimal selection of patients to determine true clinical implications.

Orbital cholesterol granuloma: Case report and literature review.

Cholesterol granuloma is a chronic foreign-body inflammatory response that is often seen in the middle ear, mastoid antrum, and petrous apex. However, it can also occur in other anatomical locations, including the orbit. A 34-year-old male presented with painless nonaxial proptosis of the left eye, and imaging revealed a well-defined intraorbital extraconal lesion consistent with an orbital cholesterol granuloma. The pathogenesis of this rare cystic condition is unknown, but trauma and inadequate airflow through pneumatized temporal bone air cells have been proposed as potential triggers. Treatment involves total excision of the granuloma with careful removal of residual tissue adherent to the bone and the periosteum to minimize the risk of recurrence. Cholesterol granulomas usually have a good prognosis.

Recurrent solitary fibrous tumor of eyelid: A rare entity.

Orbital and adnexal solitary fibrous tumors (SFT) are rare entities. The clinico-radiological and histologic features overlap with those of other spindle cell variants, and hence the use of immunohistochemical stains helps in making an accurate diagnosis. Furthermore, a thorough surgical resection is imperative to prevent tumor recurrences. We report a rare case of SFT arising primarily from the eyelid with multiple recurrences.

Case presentation of delayed superficial femoral artery pseudoaneurysm causing an acute deep vein thrombosis.

In the present report, we have described the case of a significantly delayed presentation of a pseudoaneurysm (PSA) and subsequent mass effect causing an acute deep vein thrombosis (DVT). The patient had presented with a mass in the right groin and edema of the right lower extremity prompting further imaging studies. The imaging studies demonstrated a superficial femoral artery PSA and an acute femoral vein DVT. Our patient had no history of recent trauma or femoral access procedures performed in the last ≥5 years. Surgical repair of the PSA was performed, and the DVT was managed with anticoagulation therapy.

Surgical resection of orbital primitive neuroectodermal tumor without adjuvant chemotherapy.

Primitive neuroectodermal tumor (PNET) of the orbit is a very rare entity. We report a case of a 10-year-old boy having progressive protrusion of the eyeball, restricted ocular motility, ptosis, and ocular pain for 2 months. On examination, a fixed, nontender, firm, hyperemic, nonpulsatile globular mass was palpated in the superomedial quadrant of the orbit. Computed tomography scans of the orbit depicted a well-defined, soft tissue density lesion within the orbit without evidence of any bone defect or erosion. Surgical resection of the encapsulated lesion through anterior orbitotomy followed by histopathology and immunohistochemistry examination confirmed the diagnoses of PNET. The patient has been on regular follow-up for 2 years and has shown no sign of recurrence.

A glued technique of external dacryocystorhinostomy.

PURPOSE: Fibrin glue was used for anastomosis of lacrimal sac and nasal mucosal flaps and was compared with the conventional suture technique in external dacryocystorhinostomy. METHODS: A prospective interventional randomized control study in which 50 consecutive patients of primary acquired nasolacrimal duct obstruction (PANDO) were equally allocated into two groups. The case group underwent glued technique of external dacryocystorhinostomy (Ext DCR) in which fibrin glue was used for the apposition of the anterior lacrimal sac and nasal mucosal flaps. In the control group, conventional technique of Ext DCR was used to suture the flaps. Functional success was assessed by improvement in epiphora and fluorescein dye disappearance test (FDDT), whereas anatomical success was assessed by lacrimal irrigation and endoscopic view of the osteotomy site. RESULTS: The anatomical success in both the groups was 92%, whereas the functional success was 92% in the case group and 88% in the control group. The difference in the success rates between the two groups was statistically non-significant. CONCLUSION: Glued technique of Ext DCR is a simple and easy alternative to suturing of the flaps. Though the final outcome was comparable in both the groups, glue can be especially useful in uncooperative cases, in cases of excessive bleeding, or in situations where the flaps are very thin or have become friable.

A prospective study on epidemiology of dacryocystitis at a tertiary eye care center in Northern India.

AIM: The aim of this study is to study the prevalence, incidence, and the epidemiological characteristics of the patients of acquired dacryocystitis at a tertiary eye care center of Northern India. MATERIALS AND METHODS: It was a prospective, cross-sectional study carried out over a period of 2 years (July 2016-July 2018). The prevalence, incidence, and the epidemiological characteristics of acquired dacryocystitis were studied and analyzed. Chi-square test was used to test the qualitative distribution. RESULTS: A total of 212 cases were included in the study. The prevalence rate of dacryocystitis was 19.5 cases per 10,000 patients, and the incidence rate was 15 cases per 10,000 patients. Chronic dacryocystitis (183; 86.30%) was more commonly encountered clinical type than acute dacryocystitis. Majority of cases (204; 96.23%) were due to the primary acquired nasolacrimal duct (NLD) obstruction, whereas eight cases (3.78%) were due to the secondary acquired NLD obstruction. Females were more commonly affected (156; 73.58%). The mean age was 44.44 ± 18.95 (range: 12-86) years. Majority of the patients 108 (50.94%) belonged to 3rd-6th decades of life. The disease was more prevalent in people belonging to lower-middle socioeconomic class (92; 43.40%) living in rural areas (130; 61.32%) and the majority of them were housewives (125; 59%). CONCLUSIONS: The incidence and prevalence of acquired dacryocystitis were 15 and 19.5 cases per 10,000 patients. It was much more common in females of lower socioeconomic status and is seen commonly in the 3rd to 6th decades of life.

A Prospective Comparative Study Between Subcuticular and Sutureless Technique of Skin Closure Following External Dacryocystorhinostomy.

PURPOSE: To compare the cosmetic outcome of the surgical scar of external dacryocystorhinostomy by the subcuticular versus sutureless technique. METHODS: This was a prospective interventional randomized control study conducted at tertiary level hospital. Fifty patients of primary-acquired nasolacrimal duct obstruction were included in this study. The control group patients underwent the technique of wound closure in 2 layers, subcutaneous interrupted suture with 6-0 vicryl and superficial skin with 6-0 prolene continuous subcuticular sutures. In the case group, interrupted subcutaneous sutures with 6-0 vicryl with Steristrip for skin apposition was used. The surgical scars were assessed and graded by still photographs on a computer screen by 2 independent observers unaware of the surgical technique used at 2, 6 and 12 weeks postoperatively. RESULTS: The mean scar assessment score by the 2 observers were 2.60 (0.57), 2.04 (0.64), and 1.16 (0.89) in control group and 2.02 (0.65), 1.44 (0.70), and 0.44 (0.61) in case group at 2, 6, and 12 weeks, respectively. Scar grades were analyzed using chi-square test between the 2 group and Wilcoxon signed rank test within the group. The difference between the 2 groups were found to be statistically significant at 2, 6, and 12 weeks (P < 0.05). Thus, the technique of wound closure with steristrip lead to comparatively less scarring as compared with subcuticular technique. CONCLUSION: The authors recommend the sutureless technique of wound closure using steristrip in Ext DCR as it has superior cosmetic results as compared with subcuticular technique of external dacryocystorhinostomy.

Hybrid approach with endovascular and open surgical techniques for challenging aneurysms.

This study is a case series describing the management of complex aneurysmal disease using the principles of both open and endovascular techniques.

Cosmetic evaluation of surgical scars after external dacryocystorhinostomy.

AIM: To evaluate the surgical scars of external dacryocystorhinostomy (DCR) cosmetically. METHODS: Totally 50 consecutive cases of primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Surgical scars were assessed by the patients and two independent observers at 2, 6 and 12wk postoperatively on the basis of visibility of the scars and still photographs respectively and were graded from 0-3. Kappa test was utilised to check the agreement of scar grading between the two observers. Wilcoxan signed ranks test was used to analyse the improvement of scar grading. RESULTS: Thirty-four (68%) patients graded their incision site as very visible (grade 3) at 2wk. At 6 and 12wk, incision site was observed as grade 3 by 7 (14%) and 1 (2%) patients respectively. Photographic evaluation of patients by 2 observers showed an average score of 2.75, 1.94 and 0.94 at 2, 6 and 12wk respectively. Change in scar grading from grade 3 to grade 0 in consecutive follow-up (2, 6 and 12wk) was found to be highly significant both for the patient as well for the observers (P<0.0001). CONCLUSION: The external DCR is a highly effective and safe procedure and in view of low percentage of cases who complained of marked scarring in the present study, thus scarring should not be the main ground for deciding the approach to DCR surgery, even in young cosmetically conscious patients.

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

CONTEXT: Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. AIMS: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). SETTINGS AND DESIGN: Prospective randomized controlled trial. Tertiary care hospital setting. SUBJECTS AND METHODS: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. STATISTICAL ANALYSIS USED: Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. RESULTS: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [-0.05-0.11]), VF-14 score (7.92 [-1.03-16.86]) and QALYs (1.14 [-0.89-3.16]). However, with significantly lower costs (INR 3228 [2700-3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.30]) than PE. CONCLUSIONS: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

Managment of superficial infantile capillary hemangiomas with topical timolol maleate solution.

Capillary hemangioma is the most common benign tumor of eyelids and orbit in children. Recently, a topical beta blocker has been reported as an effective treatment for superficial capillary hemangiomas. We present a case report of two children having large capillary hemangiomas who responded well to topical treatment by 0.5% timolol maleate solution. After 12 months of treatment, the lesion has significantly reduced in size, thickness, and color in both cases. Thus, we conclude that long-term use of topical 0.5% timolol maleate solution is safe and effective in treating superficial capillary hemangiomas.

Evaluation of safety and efficacy of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis.

PURPOSE: To evaluate the efficacy and safety of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis. METHODS: A prospective, case series study was performed in 46 patients (56 eyelids) who underwent tarsofrontalis sling surgery using silicone rod for severe congenital ptosis. The efficacy of the silicone rod in tarsofrontalis sling surgery was evaluated by marginal reflex distance1 (MRD1), postoperative eyelid symmetry, and recurrence of ptosis. Safety of silicone rod was assessed by noting postoperative complications. The postoperative results were considered as good if MRD1 was 4.0 ± 0.5 mm (3.5-4.5 mm) and symmetry ≤1 mm; fair if MRD1 was 2.5 ± 0.5 mm (2-3 mm) and symmetry 1.5 to 2.0 mm; and poor if MRD1 was <2.0 mm and symmetry <2.0 mm. RESULTS: In cases of unilateral congenital ptosis, good results were seen in 83.3% cases, fair results in 11.1% cases, and poor results in 5.5% cases. In cases of bilateral congenital ptosis, good results were seen in 80.0% cases, fair in 15.0% cases, and poor result in 5.0% cases. Satisfactory postoperative eyelid elevation of ≥2 mm was seen in 93% cases. Complications in the form of granuloma formation, subsequent silicone rod extrusion, and recurrence occurred in 4% cases. CONCLUSIONS: The use of silicone rod in tarsofrontalis sling surgery for severe congenital ptosis repair is a safe and effective surgery, with few complications and easy removal and adjustment.

Sebaceous carcinoma with apocrine differentiation: a rare entity with aggressive behavior.

Sebaceous carcinomas are rare neoplasms but have aggressive behavior. Although they can be found anywhere in the body ocular region is the most common site which comprises 75% of all cases of sebaceous carcinomas. Due to their rarity, varied histopathological features, and diverse clinical presentation, their diagnosis is often delayed, sometimes by a year. They are divided on the basis of histological differentiation into well and poorly differentiated. Apocrine differentiation is a still rarer finding and only two cases have been reported in the literature so far. We report a case of sebaceous carcinoma with apocrine differentiation in a 60-year-old male who presented with a painless swelling in right upper eyelid for 2 months which was gradually progressive. Computed tomography (CT) scan was performed and a provisional diagnosis of hemangioma was made. The mass was excised and histopathological examination revealed it to be sebaceous carcinoma. However, there were areas with decapitation secretions and granular eosinophilic cytoplasm. These were positive for cytokeratin (CK) 7 and CK 19 which confirmed their apocrine nature. Therefore, a final diagnosis of sebaceous carcinoma with apocrine differentiation was made. Thus, it can be concluded that ocular sebaceous carcinomas with apocrine differentiation are extremely rare and have significant clinical importance since they can mimic a benign lesion and the nature of surgical intervention and follow up is more aggressive than that of simple sebaceous carcinoma alone.

Management of traumatic dacryocystitis and failed dacryocystorhinostomy using silicone lacrimal intubation set.

The aim of this work is to study the management and success rate of traumatic dacryocystitis and failed dacryocystorhinostomy (DCR) using Silicone lacrimal intubation set. A prospective study was conducted at a tertiary eye care hospital, India from February 2006 to January 2008. This study material comprised 50 patients of traumatic dacryocystitis and failed dacryocystorhinostomy. Anterior single flap external dacryocystorhinostomy with Silicon intubation was performed in all the patients. The patients were followed up at weekly intervals for 1 month and thereafter every 2 months for 1 year post operatively. Criteria determining success were based on resolution of epiphora and patency on syringing. In traumatic dacryocystitis, 21(91.3%) cases fulfilled these criteria while 23(85.2%) cases of failed DCR were successful. The overall success rate (88%) was determined with an average follow-up of 1 year. Globally, the technique was effective in 85% of cases. The results were comparable with other similar studies. This study concludes that performing a DCR in traumatic dacryocystitis and failed DCR taking into consideration the complications and chances of failure is a challenge for the surgeon. We opine that External dacryocystorhinostomy with Silicon Intubation is one of the most effective modality in dealing with such cases.

Advanced upper eyelid sebaceous gland carcinoma with deep orbital extension.

Sebaceous gland carcinomas (SGC) are highly malignant lid tumors which originate from meibomian glands and rarely from the gland of Zeis, sebaceous gland of caruncle, eyebrows and periocular skin. In many cases correct diagnosis of SGC is delayed because of its ability to masquerade as a variety of other ocular conditions. A forty year old male presented with a left upper eyelid swelling with an ulcerated wound on its nasal aspect. A differential diagnosis of sebaceous gland carcinoma or preseptal cellulitis was made. Contrast enhanced computed tomography showed an ill defined soft tissue density mass in the left orbit encasing the whole of the optic nerve. A total exentration was performed. A diagnosis of meibomian gland carcinoma was confirmed on histopathology. This is a report of an advanced sebaceous gland carcinoma with deep orbital extension. An early diagnosis and appropriate treatment may decrease the long term morbidity and extend the survival rate of such patients.