Archives of Ophthalmology
Air Reflux After External Dacryocystorhinostomy
Objective: To ascertain the prevalence of air reflux after external dacryocystorhinostomy, its natural history, and its relation to symptomatic cure.
Methods: More than a year after lacrimal surgery, patients were contacted via a structured telephone interview and were questioned about air reflux and lacrimal symptoms.
Results: Interviews were completed by 77 patients (98 operations). Postoperative air reflux had been noted after 46 of 98 operations (47%) and persisted in 36 of 46 eyes (78%), at a mean follow-up of 58 months. Reflux occurred in 36% (8 of 22) of eyes after membranectomy, a rate similar to that without membranectomy (38 of 76 eyes; [50%]); the relative risk of air reflux with membranectomy was 0.7 (95% confidence interval, 0.4-1.3; P = .30). Overall, symptomatic improvement was achieved in 85% of procedures (83 eyes). Reflux was associated with a higher success rate (relative risk, 1.22; P = .02) and was significantly less likely to be associated with unchanged or worse symptoms (relative risk of failure, 0.28; P = .03).
Conclusions: Air reflux is common after external dacryocystorhinostomy, is associated with symptomatic success, and generally persists but is rarely troublesome. Membranectomy does not increase the incidence of reflux, suggesting that the valve of Rosenmüller may not act as a 1-way valve for air flow.
Herbert HM, Rose GE
2007;125(12):1674-1676
Archives of Ophthalmology
Intraorbital Injection of Triamcinolone Acetonide in Patients With Idiopathic Orbital Inflammation
Objective: To present findings of a pilot study on intraorbital corticosteroid therapy in the management of idiopathic orbital inflammation.
Methods: This prospective, noncomparative, interventional case series included patients with clinically, radiologically, and histologically confirmed idiopathic orbital inflammation with an anterior orbital mass. Twenty to 40 mg/mL of triamcinolone acetonide was injected intraorbitally (intralesionally or perilesionally) in all patients. The injection was repeated at 4-week intervals if complete resolution was not achieved. Patients were assessed for local and systemic complications of corticosteroid injection. Visual acuity, fundus examination, intraocular pressure, blood pressure, and serum glucose levels were measured at each visit.
Results: Ten patients (5 men and 5 women; mean age, 49.8 years [age range, 25-82 years]) received treatment. In 4 patients, an orbital mass was noted; in 6 patients, the lacrimal gland was involved (dacryoadenitis). Substantial improvement (1 patient) or complete resolution (8 patients) was noted during a follow-up of 9.8 months (range, 3-24 months).
Conclusion: Intraorbital injection of a corticosteroid is an effective treatment for idiopathic orbital inflammation and may be considered first-line treatment in selected patients.
Leibovitch I, Prabhakaran VC, Davis G, Selva D
2007;125(12):1647-1651
Archives of Ophthalmology
Mechanisms and Treatment of Extruding Intraconal Implants: Socket Aging and Tissue Restitution (the "Cactus Syndrome")
Objective: To investigate the initial features and treatment of 26 consecutive patients referred with extruding orbital implants between January 1991 and December 2004.
Methods: Retrospective medical record review recording the reason for enucleation, primary implant type, infection when initially seen, time to implant exposure, location of conjunctival defect, and time to surgical revision.
Results: Of the 26 eyes, 16 (62%) were removed after trauma, 3 (12%) because of tumor, 3 (12%) because of infection, and 4 (15%) because of painful blind eyes (percentages do not total 100 because of rounding). Of the 26 eyes, 8 (31%) were right eyes and 15 (58%) were hemispheric implants; 8 implants (31%) were acrylic or glass spheres, and 1 (4%) each was a hydroxyapatite, porous polythene, or bone sphere. Hemisphere extrusion occurred at a mean of 16 years after implantation, significantly later than with spheres (mean, 10 years after implantation; P = .05). The conjunctiva was breached medially in only 1 (sphere) (4%), centrally in 13 (50%), and laterally in 12 (46%). Lateral erosion occurred solely with hemispheres, in contrast to central erosions, in which 10 of 13 (77%) were spheres (P < .001). Twelve patients (46%) underwent surgical revision within a year of extrusion, 7 (27%) within 2 years, and the remaining 7 (27%) at 2 to 21 years.
Conclusions: Exposure of hemispheres occurred later, from pressure erosion at their prominent lateral edge. In contrast, central erosion (in spheres) occurred earlier, because of gradual tissue restitution after forced-ball implantation ("cactus syndrome"). This may be avoided by implantation through a polythene glide.
Sagoo MS, Rose GE
2007;125(12):1616-1620
Archives of Ophthalmology
Use of Radiopaque Intraorbital Catheter in the Treatment of Sino-Orbito-Cranial Mucormycosis
Sino-orbital mucormycosis, especially with intracranial involvement, is a devastating infection affecting mostly immunocompromised patients. When combined with systemic therapy and surgical debridement, intraorbital amphotericin B infusion can be an important adjunctive therapy for orbital mucormycosis. Correct placement of the intraorbital catheter can be critical to proper drug delivery. We describe a technique using a barium-embedded neurosurgical catheter for intraorbital drug delivery. Intraoperative fluoroscopy can also be used to assess and adjust catheter tip placement to achieve optimal results.
Kahana A, Lucarelli MJ
2007;125(12):1714-1715
Archives of Dermatology
Smoking and Skin Aging in Identical Twins
Background: A twin pair can provide a rare opportunity to control for genetic susceptibility and exposure variables, which often serve as major confounders in population-based studies on the relationship between smoking and skin aging.
Observations: We describe a unique twin pair who spent not only their first 2 decades of life together but also in their later decades had the same type of job at the same latitude, resulting in well-matched levels of significant sun exposure. However, the twins differed markedly in regard to smoking history; the twin with an approximately 52.5–pack-year smoking history showed more severe skin aging than did the nonsmoking twin.
Conclusion: The difference in skin aging illustrated by this twin pair may serve as a motivator for smoking cessation.
Doshi DN, Hanneman KK, Cooper KD
2007;143(12):1543-1546
