Objectives: To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. Design: Interventional case report. Methods: An 80-year-oldman underwent a prolonge...Objectives: To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. Design: Interventional case report. Methods: An 80-year-oldman underwent a prolonged lumbar decompression laminectomy for spinal stenosis, under general anesthesia in the prone position. Several hours later, the patient complained of left periocular pain and reduced vision. Examination revealed significant facial edema, left proptosis, and a tight orbit, as well as no light perception and elevated intraocular pressure in the left eye, with complete internal and external ophthalmoplegia. Main Outcome Measures: Clinical course, imaging findings, management, and final outcome. Results: Magnetic resonance imaging confirmed the clinical diagnosis of a compartment syndrome with elevated intraorbital tension. A lateral canthotomy and cantholysis were performed, and high-dose IV steroids were started. The proptosis and facial swelling subsided gradually, but no improvement was noted in left visual acuity or left ocular movements. Conclusion: It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively and to intervene surgically and medically once the diagnosis of orbital compartment syndrome is established.展开更多
Objectives: To report a patient with a rare case of orbital eosinophilic angiocentric fibrosis (EAF) and to review the literature. Design: Interventional case report. Methods: A 61-yearold man presented with a 6-week ...Objectives: To report a patient with a rare case of orbital eosinophilic angiocentric fibrosis (EAF) and to review the literature. Design: Interventional case report. Methods: A 61-yearold man presented with a 6-week history of right periorbital edema and painless proptosis. Examination revealed a nonaxial proptosis, lateral globe displacement, and mild limitation in right eye adduction. Main OutcomeMeasures: Clinical course and radiological and histological findings. Results: Orbital imaging revealed a right medial orbital mass with involvement of middle ethmoidal air cells. An orbital biopsy of the mass demonstrated an inflammatory infiltrate with a marked eosinophilic component, onion skinning of vessels, and surrounding fibrosis. The diagnosis of orbital EAF was made. There was no response to a 3-month treatment course with systemic steroids, but the patient did not want any further surgical interventions. Conclusion: Although orbital EAF is rare, ophthalmologists need to be aware of this entity, as it may invade the orbit from the sinonasal tract or present as a localized orbital mass. The presence of even minimal sinus involvement and the characteristic histopathology are useful in establishing the correct diagnosis.展开更多
Objectives: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior...Objectives: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material. Design: Retrospective, comparative, interventional case series. Patients: Thirty-one consecutive patients who were operated in 2 oculoplastics centers between July 2000 and January 2005. Methods: All patients’ clinical records were reviewed. Main Outcome Measures: Postoperative upper eyelid contour and viability, ocular discomfort, keratopathy, and corneal edema, as well as assessment for donor site complications and final graft dimensions. Results: There were 31 patients who underwent upper lid surgery (15 HPGs, 16 FTGs). The complications in the HPG group included corneal edema or transient keratopathy (13.3% ), partial graft dehiscence (13.3% ), upper lid retraction (13.3% ), and necrosis of the overlying skin flap (6.7% ). There were no significant postoperative complications in the FTG group during a mean follow-up period of 13.5± 5 months. Donor site complications included 2 cases of mild upper lid retraction and central peaking. There were an average of 17% decrease in FTG vertical height and a 24% decrease in HPG vertical height during the follow-up period. Conclusion: Hard palate grafts may be associated with a higher rate of complications in upper lid surgery relative to FTGs, although most complications are temporary. Graft contraction could be reduced by oversizing.展开更多
Background:Bowen’s disease (BD), also known as squamous intraepidermal carcinoma, is a malignant skin tumor with a potential to progress to invasive carcinoma. Objective:We sought to report a large series of patients...Background:Bowen’s disease (BD), also known as squamous intraepidermal carcinoma, is a malignant skin tumor with a potential to progress to invasive carcinoma. Objective:We sought to report a large series of patients with BD treated with Mohs micrographic surgery (MMS). Methods:This prospective, multicenter, case series included all patients in Australia treated with MMS for BD, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. Results:There were 270 cases; the majority (93.4%) were located in the head and neck area. In 50.7%of cases it was a recurrent tumor. In 20%the tumor was initially misdiagnosed as basal cell carcinoma or squamous cell carcinoma. No cases with perineural invasion were diagnosed. There were 6 cases of recurrence (6.3%) of 95 patients who completed a 5-year follow-up period after MMS. Conclusion:The low 5-year recurrence rate of BD with MMS emphasizes the importance of margin-controlled excision, especially in the head and neck area where tissue preservation is essential.展开更多
文摘Objectives: To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. Design: Interventional case report. Methods: An 80-year-oldman underwent a prolonged lumbar decompression laminectomy for spinal stenosis, under general anesthesia in the prone position. Several hours later, the patient complained of left periocular pain and reduced vision. Examination revealed significant facial edema, left proptosis, and a tight orbit, as well as no light perception and elevated intraocular pressure in the left eye, with complete internal and external ophthalmoplegia. Main Outcome Measures: Clinical course, imaging findings, management, and final outcome. Results: Magnetic resonance imaging confirmed the clinical diagnosis of a compartment syndrome with elevated intraorbital tension. A lateral canthotomy and cantholysis were performed, and high-dose IV steroids were started. The proptosis and facial swelling subsided gradually, but no improvement was noted in left visual acuity or left ocular movements. Conclusion: It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively and to intervene surgically and medically once the diagnosis of orbital compartment syndrome is established.
文摘Objectives: To report a patient with a rare case of orbital eosinophilic angiocentric fibrosis (EAF) and to review the literature. Design: Interventional case report. Methods: A 61-yearold man presented with a 6-week history of right periorbital edema and painless proptosis. Examination revealed a nonaxial proptosis, lateral globe displacement, and mild limitation in right eye adduction. Main OutcomeMeasures: Clinical course and radiological and histological findings. Results: Orbital imaging revealed a right medial orbital mass with involvement of middle ethmoidal air cells. An orbital biopsy of the mass demonstrated an inflammatory infiltrate with a marked eosinophilic component, onion skinning of vessels, and surrounding fibrosis. The diagnosis of orbital EAF was made. There was no response to a 3-month treatment course with systemic steroids, but the patient did not want any further surgical interventions. Conclusion: Although orbital EAF is rare, ophthalmologists need to be aware of this entity, as it may invade the orbit from the sinonasal tract or present as a localized orbital mass. The presence of even minimal sinus involvement and the characteristic histopathology are useful in establishing the correct diagnosis.
文摘Objectives: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material. Design: Retrospective, comparative, interventional case series. Patients: Thirty-one consecutive patients who were operated in 2 oculoplastics centers between July 2000 and January 2005. Methods: All patients’ clinical records were reviewed. Main Outcome Measures: Postoperative upper eyelid contour and viability, ocular discomfort, keratopathy, and corneal edema, as well as assessment for donor site complications and final graft dimensions. Results: There were 31 patients who underwent upper lid surgery (15 HPGs, 16 FTGs). The complications in the HPG group included corneal edema or transient keratopathy (13.3% ), partial graft dehiscence (13.3% ), upper lid retraction (13.3% ), and necrosis of the overlying skin flap (6.7% ). There were no significant postoperative complications in the FTG group during a mean follow-up period of 13.5± 5 months. Donor site complications included 2 cases of mild upper lid retraction and central peaking. There were an average of 17% decrease in FTG vertical height and a 24% decrease in HPG vertical height during the follow-up period. Conclusion: Hard palate grafts may be associated with a higher rate of complications in upper lid surgery relative to FTGs, although most complications are temporary. Graft contraction could be reduced by oversizing.
文摘Background:Bowen’s disease (BD), also known as squamous intraepidermal carcinoma, is a malignant skin tumor with a potential to progress to invasive carcinoma. Objective:We sought to report a large series of patients with BD treated with Mohs micrographic surgery (MMS). Methods:This prospective, multicenter, case series included all patients in Australia treated with MMS for BD, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. Results:There were 270 cases; the majority (93.4%) were located in the head and neck area. In 50.7%of cases it was a recurrent tumor. In 20%the tumor was initially misdiagnosed as basal cell carcinoma or squamous cell carcinoma. No cases with perineural invasion were diagnosed. There were 6 cases of recurrence (6.3%) of 95 patients who completed a 5-year follow-up period after MMS. Conclusion:The low 5-year recurrence rate of BD with MMS emphasizes the importance of margin-controlled excision, especially in the head and neck area where tissue preservation is essential.
