Day-Case Admission for External Dacryocystorhinostomy in Preschool Children

25 Jan 2021

Juniat, Valerie; Rose, Geoffrey E.; Timlin, H.; Wagh, V.J.; Abou-Rayyah, Y.; Uddin, J.; Verity, David H.

Purpose:

Epistaxis during or after dacryocystorhinostomy may present a risk of circulatory compromise, particularly in young children. In view of this concern, we reviewed the outcome and complications of external dacryocystorhinostomy in preschool children, aged less than 4½ years.

Design:

Retrospective noncomparative series.

Patients and Methods:

A case-note review for a series of preschool children undergoing external dacryocystorhinostomy as a day-case admission at Moorfields Eye Hospital between 1992 and 2018; all surgery was consultant-led. Details were taken of the type of surgery, any intraoperative or postoperative complications (surgical or anesthetic), any unplanned admissions after surgery, and the functional outcome. To assess the veracity of the medical records, the parents for a sample of 67 children were contacted to check whether there had been any unrecorded events or concerns.

Outcome Measures:

Anesthetic or surgical complications, unplanned admissions, and postoperative events.

Results:

One-hundred and eighty-seven children (117 boys; 63%) underwent 228 external dacryocystorhinostomies during 201 admissions, the average admission age being 36.8 months (median, 37.5; range, 5.5–53.5 months). Forty-one children (20%) underwent bilateral dacryocystorhinostomy: the 27 having simultaneous bilateral surgery dacryocystorhinostomy were operated at a mean age of 38.2 months (median, 37.5; range, 15.5–53.5 months), this being significantly different from the average age at first operation in 14 children undergoing sequential admission for bilateral dacryocystorhinostomy (mean, 24.9 months; median, 27.0; range, 5.5–42.5) (p = 0.0023). No adverse anesthetic events were recorded, 2 children (2 dacryocystorhinostomies) required temporary nasal packing at the end of surgery for epistaxis, and one further child was admitted for overnight observation because of persistent mild epistaxis after bilateral dacryocystorhinostomy. Three children (3 dacryocystorhinostomies) had a mild, self-limiting secondary epistaxis, and there were no unplanned emergency admissions. The telephone survey did not reveal any disparity in the medical records.

Conclusion:

With experienced surgeons and anesthetists in a suitable specialist hospital, external dacryocystorhinostomy in preschool children would appear to be a safe and effective procedure, with few and minor complications. Although facilities for overnight observation should be available, the surgery can typically be planned as a day-case admission, and simultaneous bilateral surgery is also possible in this age-group.

https://journals.lww.com/op-rs/Abstract/2021/01000/Day_Case_Admission_for_External.11.aspx

Journal : OPRS

Ref : Epiphora External DCR Lacrimals

The Role of Postoperative Bandage Contact Lens in Patients Undergoing Fasanella-Servat Ptosis Repair

25 Jan 2021

Adam, Robert S.; Harvey, John T.; Gould, Jonah N.; Suntheralingam, Sivisan; Farrokhyar, Forough

Journal : OPRS

Ref : Fasanella-Servat Oculoplastics Ptosis

Primary Nasocutaneous Fistulae in Granulomatosis With Polyangiitis: A Case Series and Literature Review

25 Jan 2021

Bahrami, Bobak; Curragh, David; McNab, Alan A.; Davis, Garry; Dolman, Peter J.; Selva, Dinesh

Journal : OPRS

Ref : Granulomatosis with Polyangitis Nasocutaneous fistula Oculoplastics

Rapid Rehabilitation With Skin-Muscle Sparing Orbital Exenteration: A Single-Center Series

25 Jan 2021

Jayaprakasam, Anuradha; Vahdani, Kaveh; Rose, Geoffrey E.; Saleh, George M.; Hussain, Badrul; Verity, David H.; Collin, J. Richard O.

Aims:

To examine the features and clinical management of patients who underwent skin-muscle sparing orbital exenteration in a tertiary referral center.

Patients and Method:

Retrospective case-note review for patients undergoing skin-muscle sparing orbital exenteration at Moorfields Eye Hospital between 1997 and 2012. Patient demographics, clinical features, histopathology, clearance, surgery, adjuvant therapy, and outcomes were analyzed.

Results:

Seventy-four patients (33 male; 45%) had skin-muscle sparing orbital exenteration at a median age of 63.8 years (median 65.5, range 13–96 years) for malignancies primarily arising in the eyelids (34 cases; 46%), orbit (25 cases; 34%) or conjunctiva (15 cases; 20%). The commonest pathologies were sebaceous carcinoma (20 cases; 27%), melanoma (19 cases; 26%), squamous cell carcinoma (12 cases; 16%), and basal cell carcinoma (9 cases; 12%). The patients had very rapid rehabilitation with primary closure of skin-muscle flaps over the cavity, either directly (63/74 patients; 85%), or with addition of local flaps. Local radiotherapy had been given before exenteration to 18 (24%) patients, was administered after exenteration in 19 (26%) patients, and both before and after surgery in 5 (7%); those having postoperative radiotherapy were referred at 2–3 weeks after exenteration, and the initial prosthetics fitting was started at 3–6 weeks after surgery. Thirty-eight (51%) patients died during a follow-up of 1–164 months (mean 55, median 47 months); 20/38 (53%) died from metastases—although 9/20 had known metastatic disease prior to palliative exenteration. Three patients were alive with apparently inactive metastases at 30, 39, and 140 months after surgery.

Conclusion:

Direct closure of skin-and-muscle flaps is achievable in almost all undergoing orbital exenteration. In contrast to skin-grafting, free myocutaneous flaps or secondary intention healing, this allows early referral if adjunctive orbital radiotherapy is needed, and the initial fitting of prosthetics can be within weeks of surgery. The technique also avoids the much greater donor-site morbidity of other reconstructive techniques, such as local or free myocutaneous flaps.

https://journals.lww.com/op-rs/Abstract/2021/01000/Rapid_Rehabilitation_With_Skin_Muscle_Sparing.8.aspx

Journal : OPRS

Ref : Exenteration Eyelid Sebaceous Gland Carcinoma

Corneal Neurotization for Postherpetic Neurotrophic Keratopathy: Initial Experience and Clinical Outcomes

25 Jan 2021

Kim, Jane S.; Rafailov, Leon; Leyngold, Ilya M.

Purpose:

To assess early outcomes of corneal neurotization for postherpetic neurotrophic keratopathy (NK).

Methods:

Retrospective analysis of patients who underwent corneal neurotization for postherpetic NK by a single experienced oculoplastic surgeon was performed. Collected data included stage and etiology of NK as well as comorbidities, prior treatment history, neurotization technique, donor nerve site, preoperative and postoperative examination findings (i.e., ocular surface quality, corneal clarity, corneal sensation by Cochet-Bonnet esthesiometry, and visual acuity [VA]), and follow-up duration. Differences between preoperative and postoperative values were analyzed by Wilcoxon signed-rank test.

Results:

Of 23 adult patients who underwent corneal neurotization, 3 (13%) had history of herpes simplex keratitis and/or endotheliitis, and 4 (17%) had history of herpes zoster ophthalmicus. One patient with herpes zoster ophthalmicus was excluded due to inadequate follow-up duration. Of the 6 patients included in the study, 3 (50%) had Mackie stage 1 disease, 1 (17%) had stage 2, and 2 (33%) had stage 3 with impending perforation, but all had markedly diminished corneal sensation, with a median denervation time of 11.8 months (interquartile range [IQR] 9.4–29.2 months). Following neurotization, median corneal sensation improved significantly from 1.6 cm (interquartile range 0.0–1.9 cm) to 3.6 cm (IQR 3.0–5.6 cm, p = 0.028), with 1 patient achieving full sensation by postoperative month 5. All patients with a persistent epithelial defect preoperatively showed complete corneal healing by their last follow-up visit. VA also improved postoperatively in all patients (p = 0.028). Median follow-up duration was 11.3 months (interquartile range 9.6–17.9 months).

Conclusions:

Corneal neurotization can successfully reinnervate corneas previously devitalized by herpetic disease and halt the progressive nature of postherpetic NK. If utilized appropriately and early in the disease process, neurotization may reduce morbidity and maximize visual potential in postherpetic NK.

https://journals.lww.com/op-rs/Abstract/2021/01000/Corneal_Neurotization_for_Postherpetic.7.aspx

Journal : OPRS

Ref : Neurotrophic keratopathy Oculoplastics

Update on Idiopathic Canalicular Inflammatory Disease (ICID): Outcomes With Addition of Topical Cyclosporine and the Modified Treatment Protocol

25 Jan 2021

Ali, Mohammad Javed; Bothra, Nandini

Purpose:

The objective of this study is to present clinical outcomes with addition of topical cyclosporine while managing cases of “idiopathic canalicular inflammatory disease” and to propose a modified treatment protocol.

Methods:

Prospective case series of 88 canaliculi of 44 eyes of 22 patients diagnosed as “idiopathic canalicular inflammatory disease” at a tertiary care Dacryology service over a period of 2 years. All the patients were diagnosed based on the published major and minor criteria and each of the canaliculus was clinically staged. All patients were treated initially with a combination of topical cyclosporine (0.05%) and rapidly tapering topical steroids followed by punctal dilatation and placement of mini-monoka stents after control of inflammation. Monoka stents were extubated at 6 weeks and the cyclosporine was continued for at least up to 3 months beyond the extubation of stents. Patient demographics, investigations, response to cyclosporine, management modalities, recurrence of inflammation, anatomical and functional outcomes were analyzed.

Results:

Eighty-eight canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (77%, 17/22) and the mean age at presentation was 51 years. All patients presented with bilateral epiphora (mean duration 4.5 months) without any discharge. Staging revealed 18, 27, 24, and 19 canaliculi were involved with stages 1–4, respectively. The mean duration of cyclosporine use was 5.7 months. All patients except 3 (19/22) underwent monoka dilatation. Complete anatomical and functional resolution were noted in 62% (55/88), of which 12 puncta and canaliculi, all stage 1 (13.6%, 12/88) showed complete resolution with cyclosporine alone. Relentless disease progression to stage 5 was noted in 30% (26/88) of the puncta and canaliculi. All the younger patients (<30 years, 13.6%, 3/22) demonstrated poor outcomes.

Conclusions:

The addition of topical cyclosporine is beneficial in controlling inflammation and disease downstaging in patients with idiopathic canalicular inflammatory disease. The current modified treatment protocol salvages majority of the canaliculi.

https://journals.lww.com/op-rs/Abstract/2021/01000/Update_on_Idiopathic_Canalicular_Inflammatory.6.aspx

Journal : OPRS

Ref : Cyclosporin Idiopathic Canalicular Inflammatory Disease Lacrimals Mini-Monoka intubation

Topical Corticosteroid Use Associated With Increased Degree of Ptosis and Rate of Ptosis Repair Failure

25 Jan 2021

Dermarkarian, Christopher R.; Williams, Katherine J.; Sweeney, Adam R.; Allen, Richard C.; Yen, Michael T.

Journal : OPRS

Ref : Mueller’s muscle-conjunctiva resection Oculoplastics Ptosis

Incidence and Risk Factors of Moderate to Severe Postoperative Pain Following the Placement of Primary and Secondary Orbital Implants: A Prospective Observational Study

25 Jan 2021

Zhu, Yanling; Li, Zuohong; Chen, Wenshi; Fan, Peiting; Yang, Shiying; Liu, Xuehua; Guo, Wenjun; Gan, Xiaoliang

Journal : OPRS

Ref : Enucleation Evisceration Orbit Orbital implant

Multidisciplinary Frontotemporal Orbitozygomatic Craniotomy for Spheno-orbital Meningiomas: Ophthalmic and Orbital Outcomes

25 Jan 2021

Idowu, Oluwatobi O.; Ashraf, Davin C.; Magill, Stephen T.; Kersten, Robert C.; McDermott, Michael W.; Vagefi, M. Reza

Purpose:

Advances in surgical approaches have improved access for total or near-total resection of spheno-orbital meningiomas (SOM). Herein, the outcomes of multidisciplinary resection and reconstruction of SOM via frontotemporal orbitozygomatic craniotomy at a single institution are evaluated.

Methods:

A retrospective chart review was performed of all patients with SOM who underwent joint neurosurgical and oculofacial plastic resection via frontotemporal orbitozygomatic craniotomy between January 1999 and December 2018. Demographic data, clinical presentation, risk factors for meningioma, radiographic imaging, pathology results, postoperative outcomes, and surgical complications were reviewed. The outcome measures assessed included visual acuity, pupillary function, color vision, ocular motility, visual fields, and proptosis.

Results:

A total of 48 patients were identified having had multidisciplinary frontotemporal orbitozygomatic craniotomy for SOM of which 43 met inclusion criteria. A mean follow-up period of 23.9 ± 20.4 months (range 1–60) was observed. There were 35 patients who underwent primary resection and 8 patients who had prior surgical resection. The main presenting complaints were proptosis (88%), headache (44%), and reduced vision (12%). Gross total resection was achieved in 15 patients (35%) while near-total or subtotal resection was achieved in the remainder. Histologic analysis revealed World Health Organization grade I meningioma in 72% of tumors, grade II in 23%, and grade III in 5%. Mean visual acuity (Logarithm of the Minimum Angle of Resolution) improved from 0.24 ± 0.46 preoperatively to 0.09 ± 0.13 postoperatively (p = 0.03). Surgery improved proptosis, with a reduction in mean Hertel exophthalmometry from 22.37 ± 3.78 mm to 17.91 ± 3.84 mm (p < 0.001), of which 80% had no residual proptosis or developed subsequent recurrence. Exophthalmic index calculated by radiologic evaluation also improved from a mean preoperative value of 1.32 ± 0.19 to 1.12 ± 0.13 at the 6-month interval after surgery (p < 0.001). Before surgery, 19 (45%) patients had a relative afferent pupillary reaction with improvement in 9 (24%) after surgery. Of the 14 (33%) patients with preoperative ocular motility deficit, 7 (16%) had resolution of ocular motility deficit postoperatively. The most common surgical complications were temporalis muscle atrophy with temporal hollowing (14%), wound infection (7%), neurogenic strabismus secondary to trochlear nerve palsy (5%), restrictive strabismus (5%), and aponeurotic blepharoptosis (5%).

Conclusions:

Multidisciplinary frontotemporal orbitozygomatic for resection of SOM is a safe and effective means of tumor removal. It can provide improved visual acuity and proptosis metrics, as well as relief of optic neuropathy and ocular motility deficits.

https://journals.lww.com/op-rs/Abstract/2021/01000/Multidisciplinary_Frontotemporal_Orbitozygomatic.3.aspx

Journal : OPRS

Ref : Ocular Oncology Orbit Spheno-Orbital Meningioma

Postoperative Quality of Life in Oculoplastic Patients

25 Jan 2021

Seo, Shin Tien; Sundar, Gangadhara; Young, Stephanie Ming

Journal : OPRS

Ref : Oculoplastics QOL

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