Archives of Dermatology
Predictors of Skin-Related Quality of Life After Treatment of Cutaneous Basal Cell Carcinoma and Squamous Cell Carcinoma
Objective: To identify predictors of skin-related quality of life (QOL) after treatment of nonmelanoma skin cancer (NMSC).
Design: Prospective cohort study of consecutive patients with NMSC diagnosed in 1999 and 2000.
Setting: University-affiliated private practice and a Veterans Affairs clinic.
Patients: A total of 633 patients who responded to a questionnaire before treatment.
Main Outcome Measure: Skin-related QOL, measured with the 16-item version of Skindex-16, a validated measure. Skindex-16 scores vary from 0 (best QOL) to 100 (worst QOL) and are reported in 3 domains: symptoms, emotional effects, and effects on functioning.
Results: Controlling for treatment group, the strongest independent predictor of skin-related QOL after treatment of NMSC was pretreatment skin-related QOL. Other patient characteristics that predicted better QOL included less comorbidity and better mental health status. No tumor or care characteristic (including location of tumor, size of tumor, site of therapy, or training level of treating clinician [attending physician, resident, or nurse practitioner]) was found to predict better skin-related QOL after treatment of NMSC.
Conclusions: Patients with better pretreatment skin-related QOL, less comorbidity, and better mental health status had better skin-related QOL after treatment of NMSC. These findings may be useful for pretreatment assessment and counseling.
Chen T, Bertenthal D, Sahay A, Sen S, Chren M-M
2007;143(11):1386-1392
Archives of Ophthalmology
Effect of Upper Eyelid Surgery on Corneal Topography
Objective: To compare the effects of different upper eyelid procedures on corneal topography.
Methods: Eighty-two eyes of 43 patients with various degrees of dermatochalasis or ptosis underwent computed corneal topography before surgery and at 3 months after surgery. Patients were divided into groups depending on the extent of surgery. In addition, the thickness of the central cornea was correlated with the change in astigmatism.
Results: There were mean changes in total astigmatism of 0.25 diopter (D) after ptosis surgery (P = .02) and 0.21 D after blepharoplasty with reduction of large fat pads (P = .04) compared with 0.09 D in patients after skin-only blepharoplasty. In addition, there was a correlation between corneal thickness and change in astigmatism of more than 0.2 cylinders after ptosis surgery (P < .05). Postoperative astigmatic axis changes were not systematic.
Conclusions: We found a statistically significant correlation between the severity of upper eyelid abnormality and topographical corneal changes after surgery. These findings emphasize the importance of advising patients, especially those with ptosis and severe dermatochalasis, that upper eyelid repositioning procedures may induce vision changes.
Zinkernagel MS, Ebneter A, Ammann-Rauch D
2007;125(12):1610-1612
Lash Ptosis in Congenital and Acquired Blepharoptosis
Objective: To determine the prevalence of lash ptosis (LP) in eyes with congenital and acquired blepharoptosis.
Methods: We retrospectively graded photographs of 228 eyes from 174 patients with congenital or acquired blepharoptosis for LP. We used a 4-point rating scale for LP, in which 0 indicates no LP; 1, minimal; 2, moderate; and 3, severe. A prospective evaluation of LP in 30 eyes from 15 patients without blepharoptosis (control eyes) was also performed.
Results: A total of 107 eyes (in 87 patients) demonstrated congenital blepharoptosis and 121 eyes (in 87 patients) had acquired blepharoptosis. A moderate to severe rating of LP (rating, 2) occurred in 60.7% of eyes with congenital blepharoptosis, 28.9% of eyes with acquired blepharoptosis, and 6.7% of control eyes. Lash ptosis (rating, 1) was present in 91.6% of eyes with congenital blepharoptosis, 83.5% of eyes with acquired blepharoptosis, and 33.3% of control eyes. The mean LP rating was 2.1 for eyes with congenital blepharoptosis, 1.3 for eyes with acquired blepharoptosis, and 0.6 for control eyes.
Conclusions: Lash ptosis was common in the patients with blepharoptosis. Moderate to severe LP occurred more commonly in all forms of blepharoptosis compared with normal eyes, with more frequent and more severe LP demonstrated in eyes with congenital blepharoptosis.
Malik KJ, Lee MS, Park DJJ, Harrison AR
2007;125(12):1613-1615
Cerebrospinal Fluid Leaks Complicating Orbital or Oculoplastic Surgery
Objectives: To report cerebrospinal fluid (CSF) leakage as an unusual complication following orbital or oculoplastic procedures and to describe its diagnosis and management.
Methods: Retrospective case review.
Results: Three cases of CSF leaks are described in patients following orbital or oculoplastic procedures. Two patients developed CSF leaks after orbital decompression surgery for compressive optic neuropathy and 1 patient had a CSF leak following endonasal dacryocystorhinostomy. In the first case, high-resolution computed tomography confirmed the site of the leak that required surgical repair. In the second case, a β2-transferrin test result confirmed the presence of CSF in the nasal drip, and coronal computed tomography identified a small fracture near the fovea ethmoidalis, but the leak resolved within 2 days of bed rest. In the third case, the patient reported several days of nasal dripping, but the problem had already resolved at the first follow-up appointment.
Conclusions: A CSF leak following certain orbital and oculoplastic procedures is a rare but well-recognized complication. This case report reviews the mechanisms, diagnostic techniques, and staged management of CSF leaks.
Badilla J, Dolman PJ
2007;125(12):1613-1634
