Shaheen Hasmat, Nigel H. Lovell, Gregg J. Suaning, Tsu-Hui (Hubert) Low, Jonathan Clark
The most devastating outcome of facial nerve paralysis is the inability to completely close the eye as it can lead to corneal ulceration and loss of vision. Gravity-assisted eye closure with upper lid loading is commonly used; however it is limited in replicating physiological eye closure to adequately lubricate the cornea. Superior results can be obtained using more advanced reconstructive approaches, however they depend on nerve regrowth which may be unpredictable and prolonged. This report describes a novel technique for creating an active eye closure using an implantable actuator. A generated magnetic field creates lateral movement in an electromagnet that is translated to the eyelid through a sling design. The device is powered wirelessly through a transcutaneous induction link and can be hermetically encapsulated for patient safety. The initial phase of device development is presented including data of a fully functioning prototype and the results of its application in animal and human cadavers.
Kyle J. Godfrey, MD, Michael Kinori, MD, Johnathan H. Lin, MD, Vivian S. Snyder, DO, David B. Granet, MD, Christopher W. Heichel, MD, Shira L. Robbins, MD
Benign hemangiomas are rare vascular tumors of the conjunctiva that typically present clinically in the first few weeks of life and resolve spontaneously. De novo presentation later in childhood has not been well documented. We present the unusual case of an 11-year-old boy with a rapidly growing benign de novo conjunctival hemangioma that was treated with surgical excision.
Lora R. Dagi Glass, MD, Alexandra T. Elliott, MD
Current techniques for repairing large eyelid colobomas require preparation of other tissue sites and occasionally more than one procedure. We present a technique that requires only one procedure and is limited to the colobomatous eyelid; in addition, it is specifically designed to help avoid postoperative astigmatic and obstructive amblyopia. Outcomes are demonstrated in 3 cases of hemifacial microsomia. Large colobomas on the upper eyelid can be successfully and aesthetically repaired with only one procedure, incising only the congenitally abnormal eyelid.
Hanan Hussein Shehata, MD, Azza Hassan Abou Ghalia, MD, Eman Khairy Elsayed, MD, Azza Mohamed Ahmed Said, MD, Safaa Saleh Mahmoud, MD
To evaluate the diagnostic and prognostic values of survivin and transforming growth factor beta-1 (TGF-B1) expression in aqueous humor and serum of retinoblastoma (RB) in comparison to the conventional RB marker lactate dehydrogenase (LDH) and to elucidate a possible correlation between them and the clinicopathological features of the disease.
This prospective, comparative study included 88 newly diagnosed children with RB and 80 age-matched controls with ophthalmic conditions other than tumors prepared for intraocular surgeries. Concentrations of survivin, TGF-B1, and LDH were measured in serum and aqueous humor before and 6 months after completion of therapy.
High serum and aqueous humor concentrations of the three proteins were detected in RB patients before treatment compared to the control group (P < 0.01), with a significant reduction of serum concentrations after treatment (P < 0.01). For the highest sensitivity and specificity, the optimal cutoff values of serum and aqueous survivin were 12.9 pg/ml and 25.2 pg/mg, with a significant positive correlation between aqueous survivin and RB staging and presence of optic nerve infiltration (r = 0.43, P = 0.04); the best cutoff values of serum and aqueous TGF-B1, 370.7 pg/ml and 39.8 pg/mg, with a significant positive correlation between aqueous TGF-B1 and poor differentiation of the tumor (r = 0.69, P = 0.001).
The high sensitivity, specificity, and accuracy of serum and aqueous humor survivin and TGF-B1 proteins make them promising markers for early detection and follow-up of RB patients.
Yu-Yun Huang, Wei-Kuang Yu, Chieh-Chih Tsai, Shu-Ching Kao, Hui-Chuan Kau, Catherine Jui-Ling Liu
Aims To compare the clinical features and treatment outcome between lacrimal plug-related canaliculitis and primary canaliculitis.
Methods Patients with plug-related canaliculitis and primary canaliculitis between 2007 and 2014 in a medical centre were collected. Charts were reviewed for clinical features, microbiological profiles, time lapse between plug insertion and symptom onset, type of plug and outcomes.
Results Of 76 eligible cases collected, 13 were plug-related canaliculitis and 63 were primary canaliculitis. The most common presenting symptom was discharge in both groups (85% and 79%, respectively). The average time interval from plug insertion to symptoms onset was 5.5 years. Most canaliculitis developed in women, especially for plug-related canaliculitis, when compared with primary canaliculitis (100% vs 65.1%; p=0.015). The most common isolated microorganism was Pseudomonas aeruginosa in plug-related canaliculitis (46%) and Streptococcus in primary canaliculitis (28%), respectively
Isolation of Pseudomonas was significantly higher in plug-related canaliculitis than in primary canaliculitis (46% vs 12%; p=0.029). Most plug-related canaliculitis resolved after removal of plugs by canaliculotomy (12 cases, 93%). Most identified plug was SmartPlug (seven cases), followed by EaglePlug (two cases) and Herrick Lacrimal Plug (two cases). There was no recurrence in patients with plug-related canaliculitis, however, recurrence developed in seven patients (11%) with primary canaliculitis.
Conclusions In comparison with primary canaliculitis, plug-related canaliculitis appear to be more prevalent in women and show a different microbiological profile. Retrieval of infected plug by canaliculotomy and adequate antibiotics can achieve a good outcome. Long-term follow-up is required because canaliculitis may develop several years after plug insertion.
Yan Wei, Xiao li Kang, Monte A Del Monte
Purpose To review the prevalence of preoperative and postoperative intorsion in patients with strabismus and Graves’ eye disease (GED), and to correlate the intorsion with coexisting superior rectus (SR) and superior oblique (SO) muscle enlargement as a possible mechanism causing intorsion in these patients.
Methods Charts of consecutive patients with GED who underwent strabismus surgery between 1 January 2010 and 1 April 2013 were retrospectively reviewed. Of these, patients with orbital CT or MRI scan were identified for further analysis. Clinical characteristics documented included age, gender, horizontal and vertical deviation, subjective torsional deviation, specific extraocular muscles (EOMs) operated upon, EOM enlargement on CT/MRI scans and width and thickness of SO, SR group and inferior rectus (IR).
Results Charts of 45 patients (14 males and 31 females) were reviewed. Mean age was 56.8±12.5 years. Of these, seven (15.6%) patients demonstrated intorsion, and 38 (84.4%) patients demonstrated extorsion preoperatively. But after strabismus surgery, 15 (39.5%) of the 38 patients with preoperative extorsion demonstrated postoperative intorsion and 23 (60.5%) patients continued to show postoperative extorsion. On analysis of CT/MRI scans in these patients, only an increase in the thickness of SR group and the thickness/width of SO muscle were significantly associated with preoperative and postoperative intorsion; while age, gender, preoperative horizontal or vertical deviation and IR recession were unrelated to preoperative or postoperative intorsion. Postoperative intorsion was also associated with smaller degrees of preoperative extorsion (<3.5°).
Conclusions Preoperative SR and/or SO muscle enlargement appear to be a primary contributing factor relating to preoperative and postoperative intorsion in patients with GED-associated strabismus. Patients with only small amounts of preoperative extorsion (<3.5°) in the presence of tight IRs should be carefully evaluated for possible SR and/or SO involvement by CT or MRI scan to predict those at risk for and plan for prevention/treatment of postoperative intorsion.
Md. Shahid Alam, Nisar Sonam Poonam, Jyotirmay Biswas, S Krishnakumar
Schwannoma or neurilemmomas are benign tumours of neural origin. They arise from the Schwann cells present in the peripheral myelinated nerves. The head and neck region is the most common site of occurrence for schwannomas, followed by flexor aspects of limbs and trunk. Ophthalmic schwannomas most commonly occur in the orbital region and account for 1% of all orbital tumours. Other rare ophthalmic sites include choroids, eye lids, sclera, and conjunctiva. Conjunctival or epibulbar schwannoma is an extremely rare entity with only 11 cases reported in the English literature to date.
Paul Ikgan Sia, Saul Rajak, Craig James, Shyamala Huilgol, Dinesh Selva
Sebaceous adenomas (SA) are rare tumours that have commonly been regarded as pathognomonic of the rare autosomal dominant cancer predisposition syndrome, Muir–Torre syndrome.1 We present 2 cases of isolated eyelid SA and examine their clinical features and investigations for association with Muir–Torre syndrome.
R. Tom Liu, Lucy Goold, Valerie A. White, Steve Rasmussen, Vivian T. Yin
Primary lacrimal sac malignancy is rare, but it is associated with significant morbidity and mortality. Classically, these tumours present as firm masses at or above the medial canthal tendon. However, this classic presentation may result from an unexpected outcome when complicated by comorbid patient factors, such as immunosuppression.
Vijay Kumar Wagh, Ki Crystal Lam, A.M Susana Morley
A 36-year-old woman of Afro-Caribbean descent was referred to our clinic with a history of painless swelling of the right upper eyelid for a few months. She had suffered intermittent right upper eyelid swelling for 10 years and had been seen in many hospitals. She had been given various diagnoses, most commonly allergic eyelid edema, but had also been treated for blepharitis and dry eyes. The swelling often resolved spontaneously or with the use of topical or oral steroids. A few months before review with us, she had developed a severe episode of persistent right upper eyelid swelling that partially resolved with systemic steroids.