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Di Maria A, Barone G, Gaeta A, Confalonieri F, Vinciguerra P, Vinci V, Klinger M, Ferraro V. Persistent Conjunctival Chemosis after Lower Lid Blepharoplasty: A Comparison of Different Surgical Techniques. J Clin Med 2024; 13:2093. [PMID: 38610858 PMCID: PMC11012893 DOI: 10.3390/jcm13072093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Conjunctival chemosis, a complication of lower blepharoplasty, can cause persistent discomfort and functional disturbances with worsening in the postoperative period following surgery. Methods: A review of the records of the lower blepharoplasty procedures carried out at the Humanitas Research Hospital, Rozzano, Milan, Italy was performed. Patients were categorized into two groups depending on the procedure performed: (1) transconjunctival blepharoplasty with the removal of the fatty lodges with canthopexy and (2) transcutaneous blepharoplasty with the removal of the fatty lodges with lateral canthoplasty. Each group was further divided into two more groups based on the surgical method used, that is either (a) cold blade and disposable cautery or (b) radiofrequency cut and coagulation and colorado tip (respectively 1a, 1b, 2a and 2b). All patients underwent a postoperative follow-up up to 24 months, which included an evaluation of cosmetic appearance, eyelid scarring and the severity of chemosis. The aim of the study was to investigate which of the surgical procedures causes a lower incidence of persistent type 3 conjunctival chemosis. Results: A total of 1047 patients who underwent lower lid blepharoplasty were included in the study. A total of 512 patients underwent transcutaneous blepharoplasty and 535 underwent the transconjunctival procedure. Among the first group of patients, 266 belong to group 1a and 246 to group 1b. In the second group, 264 were categorized as group 2a and 271 as group 2b. The incidence of type 3 chemosis in the transcutaneous blepharoplasty procedure with lateral canthoplasty was statistically significantly higher than in the transconjunctival approach, considering both the cold blade and the radiofrequency (p = 0.012, 0.010, 0.006, 0.004, respectively). Conclusions: A higher incidence of persistent type 3 conjunctival chemosis is associated with lateral canthus surgery and with the use of radiofrequency.
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Affiliation(s)
- Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.D.M.); (G.B.); (F.C.); (P.V.)
| | - Gianmaria Barone
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.D.M.); (G.B.); (F.C.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genova, Italy;
| | - Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.D.M.); (G.B.); (F.C.); (P.V.)
| | - Paolo Vinciguerra
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.D.M.); (G.B.); (F.C.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Plastic Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Marco Klinger
- Plastic Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
- Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, 20089 Milan, Italy
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (A.D.M.); (G.B.); (F.C.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
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Catania F, Vinciguerra P, Di Maria A. Low Rate of Postoperative Pterygium Recurrence in Patients under Treatment with Low-Dose Oral Doxycycline for Chronic Blepharitis: A First Report. Diagnostics (Basel) 2024; 14:715. [PMID: 38611627 PMCID: PMC11012025 DOI: 10.3390/diagnostics14070715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/02/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Low doses of systemic doxycycline (LD-SD) inhibit angiogenesis and the expression of matrix metalloproteases, which are determinants of pterygium progression. This study aimed to compare the recurrence rate and visual outcome of pterygium excision in patients undergoing chronic treatment with LD-SD for chronic refractory blepharitis and LD-SD-naive patients. METHODS A retrospective analysis of patients that underwent surgical excision and conjunctival graft apposition was conducted. Patients were divided in a TETRA group (under LD-SD treatment at the moment of surgery) and a control group. The main outcome was the rate of recurrence at 1 year postoperatively. Secondary outcomes were the comparisons of surface regularity, visual quality, and dry-eye symptoms at 6-week, 6-month, and 1-year follow-up in the two groups. RESULTS The TETRA group showed a significantly lower rate of 1-year recurrence both in primary (p = 0.034) and recurrent (p < 0.001) pterygia. The best corrected visual acuity (BCVA), astigmatic error, corneal total root mean square (RMS), and ocular surface disease index (OSDI) significantly reduced during the follow-up in both groups. The surface asymmetry index and high-order aberrations (HOAs) significantly reduced only in the TETRA group. The final BCVA was significantly higher, while the OSDI score and total RMS and HOAs were significantly lower in the TETRA group compared to the control. CONCLUSIONS Patients under treatment with LD-SD showed a lower rate of recurrence at 1-year follow-up compared to controls. These patients also experienced higher BCVA and surface regularity and less dry-eye symptoms.
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Affiliation(s)
- Fiammetta Catania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Italy;
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Italy;
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Pace GM, Giombi F, Muci G, Giunta G, Pirola F, Serra E, Zuppardo J, Ferreli F, Vinciguerra P, Mercante G, Maria AD, Spriano G, Malvezzi L. Outcomes of Endoscopic Endonasal Dacryocystorhinostomy in Glaucoma Patients. J Pers Med 2024; 14:348. [PMID: 38672975 PMCID: PMC11050967 DOI: 10.3390/jpm14040348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. We aimed to assess whether these effects may impair the effectiveness of endoscopic endonasal dacryocystorhinostomy (EE-DCR). METHODS This is a single-center observational retrospective study on EE-DCR via a posterior approach. Resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). RESULTS Twenty patients (32 sides) were enrolled. Preoperatively, 93.75% (n = 30/32) presented severe (Munk 3-4) epiphora and 68.75% (n = 22/32) recurrent dacryocystitis. At T1, 50.0% (n = 16/32) were referred with residual epiphora (Munk ≥ 1) and 18.75% (n = 6/32) dacryocystitis. At T2, 31.25% (n = 10/32) still complained of epiphora (Munk ≥ 1) and 6.25% (n = 2/32) dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted in statistical significance (p < 0.05). At T2, 22 (68.75%) complete, 8 (25.0%) anatomical successes and 2 (6.25%) surgical failures were observed. CONCLUSIONS Despite the chronic uptake of anti-glaucoma eye drops, EE-DCR guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis.
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Affiliation(s)
- Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Giovanna Muci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
| | - Gianmarco Giunta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
| | - Francesca Pirola
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Egidio Serra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Jessica Zuppardo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.M.P.); (G.M.); (G.G.); (E.S.); (J.Z.); (F.F.); (P.V.); (G.M.); (A.D.M.); (G.S.); (L.M.)
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
- Otorhinolaryngology Head and Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
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Confalonieri F, Ferraro V, Barone G, Di Maria A, Petrovski BÉ, Vallejo Garcia JL, Randazzo A, Vinciguerra P, Lumi X, Petrovski G. Outcomes in the Treatment of Subretinal Macular Hemorrhage Secondary to Age-Related Macular Degeneration: A Systematic Review. J Clin Med 2024; 13:367. [PMID: 38256501 PMCID: PMC10816885 DOI: 10.3390/jcm13020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Subretinal macular hemorrhage (SRMH) secondary to age-related macular degeneration (AMD) is a relatively rare condition in ophthalmology characterized by blood collection between the neurosensory retina and the retinal pigment epithelium (RPE). Without prompt treatment, visual prognosis is poor. A plethora of treatment approaches have been tried over the past years ranging from intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy to direct subretinal surgery, with no conclusive superiority of one over the other. Materials and Methods: We conducted a systematic review of the outcomes and treatment modalities of SRMH from inception to 14 June 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The level of evidence was assessed for all included articles according to the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: A total of 2745 articles were initially extracted, out of which 1654 articles were obtained after duplicates were removed and their abstracts screened. A total of 155 articles were included for full-text review. Finally, 81 articles remained that fulfilled the inclusion criteria. Conclusions: Even though there are solid results supporting a variety of treatments for SRMH, the best treatment modality has still not been conclusively demonstrated and further research is needed.
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Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Gianmaria Barone
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Beáta Éva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
| | - Josè Luis Vallejo Garcia
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandro Randazzo
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.F.); (G.B.); (A.D.M.); (J.L.V.G.); (P.V.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Xhevat Lumi
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
- Eye Hospital, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (X.L.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000 Bitola, North Macedonia
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Di Maria A, Ferraro V, Trenti N, Morenghi E, Gaeta A, Vinciguerra P, Confalonieri F. Ten-Year Follow-Up of Orbital Volume Augmentation With Calcium Hydroxyapatite Filler in Postenucleation Socket Syndrome. Ophthalmic Plast Reconstr Surg 2024; 40:49-54. [PMID: 37581879 PMCID: PMC10795969 DOI: 10.1097/iop.0000000000002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To describe the efficacy and persistence of injectable calcium hydroxyapatite (CAHY) to correct orbital volume deficit in postenucleation socket syndrome. METHODS An observational study was conducted as a clinical review of all patients in the authors' practice who received injectable CAHY placed in the extraconal and intraconal space to increase orbital volume with a 10-year follow up. The amount of CAHY to be injected was defined according to the degree of orbital volume deficit. Patients previously treated with radiotherapy or with a conjunctival fornix insufficient to accommodate the external prosthesis were excluded. All the patients with at least 10 years of follow up were included in the study. RESULTS Thirty-one postenucleation socket syndrome patients received injectable CAHY for orbital volume augmentation, with a 10-year follow up. The mean amount of preoperative relative enophthalmos measured by Hertel's exophthalmometry was 14.16 ± 2.15. An increase in the mean orbital volume of 3.35 ± 0.91 at 6 months and 2.97 ± 1.35 at 10 years was obtained. The mean follow-up was 219 ± 18 months (range, 184-240). Patients demonstrated clinical and cosmetic improvement that was observed to continue for 10 years. The complications were peribulbar ecchymosis, 2 extrusions of the internal prosthesis, and 2 ptosis. CONCLUSIONS Injectable CAHY provides safe, simple, repeatable, and cost-effective technique to treat volume deficiency in the enophthalmic orbit in the long term. The volume augmentation obtained with this semipermanent filler demonstrated a lasting effect in the orbit with negligible loss of volume at 10 years.
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Affiliation(s)
- Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nicoletta Trenti
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genova GE, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Ophthalmology, Center for Eye Research and Innovative Diagnostics, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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Confalonieri F, Barone G, Ferraro V, Ambrosini G, Gaeta A, Petrovski BÉ, Lumi X, Petrovski G, Di Maria A. Early versus Late Pars Plana Vitrectomy in Vitreous Hemorrhage: A Systematic Review. J Clin Med 2023; 12:6652. [PMID: 37892789 PMCID: PMC10607253 DOI: 10.3390/jcm12206652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/14/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Vitreous hemorrhage (VH) is a common vitreoretinal condition causing impairment of vision due to various etiologies. No consensus exists on the best timing for performing pars plana vitrectomy (PPV) in fundus-obscuring VH. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, we conducted a systematic review of the timing of PPV in VH. We assessed the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for all the included publications, in accordance with the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. Results: A total of 1731 articles were identified. Following the removal of duplicates and screening of abstracts, 1203 articles remained. Subsequently, a comprehensive full-text review of 30 articles was conducted. Ultimately, 18 articles met the predefined inclusion criteria. Conclusions: Despite the small number of studies on the timing of treatment for VH, the advantage of early over late PPV seems to be a reasonable approach in selected cases, and it might be considered modern standard care.
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Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (G.P.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Gianmaria Barone
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Giacomo Ambrosini
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 16132 Genova, Italy;
| | - Beáta Éva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (G.P.)
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (B.É.P.); (G.P.)
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (G.B.); (V.F.); (A.D.M.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
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Di Maria A, Barone G, Ferraro V, Tredici C, Manara S, De Carlo C, Gaeta A, Confalonieri F. Recurrence of Basal Cell Carcinoma Treated with Surgical Excision and Histopathological Analysis with Frozen Section Technique with Complete Margin Control (CMC-FS): A 15-Year Experience of a Reference Center. Cancers (Basel) 2023; 15:3840. [PMID: 37568656 PMCID: PMC10417263 DOI: 10.3390/cancers15153840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common type of eyelid malignancy and it is considered to be dangerous due to its proximity to functionally essential organs. Early diagnosis and complete excision of the primary lesion are crucial to prevent infiltration and metastasis. The study aims to evaluate the extent of recurrence in subjects affected by BCC of the upper third of the face treated with surgical eradication and the frozen section technique with complete margin control (CMC-FS), in comparison with the gold standard Mohs micrographic surgery (MMS). MATERIALS AND METHODS The study included 111 patients with 111 biopsy-proven eyelid BCCs. On clinical examination, all lesions were removed with 2 mm margins clinically free of neoplasm. Prior to reconstruction, CMC-FS analysis of all surgical margins was performed on each tumor for histopathologic confirmation. Subsequently, all margins were presented for the permanent paraffin sections. RESULTS There were 69 primary carcinomas and 42 secondary carcinomas among the 111 samples. No recurrence occurred in 109 tumors followed-up for at least 5 years, with a total recurrence rate of 1.8%. The median time between lesion excision and diagnosis of recurrence was 20 months. CONCLUSIONS at 5-year follow-up, CMC-FS guided excision of BCCs of the eyelids resulted in recurrence rates equivalent to MMS. Intraoperative microscopic control of all margins reduced the recurrence rate of the upper third of the facial BCCs, correlating with easier reconstruction with better esthetic and functional outcome.
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Affiliation(s)
- Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.D.M.); (G.B.); (C.T.); (F.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
| | - Gianmaria Barone
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.D.M.); (G.B.); (C.T.); (F.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.D.M.); (G.B.); (C.T.); (F.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
| | - Costanza Tredici
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.D.M.); (G.B.); (C.T.); (F.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
| | - Sofia Manara
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
- Department of Pathology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Camilla De Carlo
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
- Department of Pathology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, 16132 Genova, Italy;
| | - Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (A.D.M.); (G.B.); (C.T.); (F.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (S.M.); (C.D.C.)
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8
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Klinger M, Vinci V, Romeo MA, Battistini A, Klinger F, Bandi V, Maione L, Vinciguerra P, Di Maria A. Surgical Tips for Aesthetic Lower Lid Blepharoplasty: Prevention of Round Eye. Plast Reconstr Surg Glob Open 2023; 11:e5092. [PMID: 37404781 PMCID: PMC10317483 DOI: 10.1097/gox.0000000000005092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/05/2023] [Indexed: 07/06/2023]
Abstract
In the present study, we highlight surgical tips based on our experience in lower eyelid blepharoplasty. These have been shown to be crucial in the prevention of several complications, specifically lateral lower-lid displacement. Methods A series of bilateral lower-lid blepharoplasties were performed on 280 patients at Humanitas-Research-Hospital (Milan, Italy) between January 2016 and January 2020. Patients with a history of lower-lid blepharoplasty and patients requiring canthopexy/canthoplasty were excluded. Needing to singularly evaluate and correct several lower-eyelid structures to obtain a harmonic result, we preoperatively assessed the amount of skin excess, the eyelid margin malposition relative to the globe, and the presence/absence of herniated fat-pads. Pre- and postoperative standard photographs were collected. Patients were evaluated by measuring scleral show, snap-back test, and distraction test. Blinded-fashioned photograph analysis was performed by independent plastic and oculoplastic surgeons who did not execute the procedures. A visual analogue scale was administered to all patients to assess satisfaction. Results In total, 280 patients underwent successful lower blepharoplasty, with satisfactory results of scleral show, snap-back test, and distraction test. Of the 280 patients, four presented postoperative complications. At 10-month follow-up visit, we achieved a mean patient visual analogue scale satisfaction score of 8.4. Postoperative surgeon's photographs mean score was 4.5. Conclusions Without the use of muscle flaps, our technique averts tarsal ligament misposition, preserves orbicularis-muscle innervation, and limits thermal spread, assuring excellent stability of results and high patient and surgeon satisfaction. Cosmetic outcome in terms of symmetry, appearance, and lower lid line definition revealed high satisfaction with the result over time, with a remarkably low complication rate.
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Affiliation(s)
- Marco Klinger
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Aesthetic Plastic and Reconstructive Surgery, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | | | - Andrea Battistini
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Francesco Klinger
- University of Milan, Department of Health Sciences, Ospedale San Paolo, Milan, Italy
| | - Valeria Bandi
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Luca Maione
- From the Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Ophthalmology, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Ophthalmology, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
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Confalonieri F, Ferraro V, Di Maria A, Gaeta A, Vallejo-Garcia JL, Vinciguerra P, Lumi X, Petrovski G. Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review. Life (Basel) 2023; 13:1362. [PMID: 37374144 DOI: 10.3390/life13061362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Antiplatelets and anticoagulants have substantially influenced contemporary vitreoretinal surgical practices. The availability of new oral blood thinners has recently spurred a renewed interest in the clinical approach to vitreoretinal surgical conditions since it may be difficult for the surgeon to collect sufficient evidence-based data to decide whether to discontinue or continue such medications. Materials and Methods: We conducted a systematic review on the use of antiplatelets and/or anticoagulants in the perioperative setting in vitreoretinal surgery and their possible complications, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence, according to the Oxford Centre for Evidence-Based Medicine (OCEM) 2011 guidelines, and the quality of evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, were assessed for all included articles. Results: In total, 2310 articles were initially extracted, out of which 1839 articles were obtained after duplicates were removed and their abstracts were screened. A total of 27 articles were included in the full-text review. Finally, a remaining 22 articles fulfilled the inclusion criteria. Conclusions: Even though there is just a small number of studies with solid results, the advantage of using antiplatelets and/or anticoagulants in vitreoretinal surgery seems to outweigh the disadvantages, which are mainly related to postoperative hemorrhagic complications.
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Affiliation(s)
- Filippo Confalonieri
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Vanessa Ferraro
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandro Gaeta
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Josè Luis Vallejo-Garcia
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Xhevat Lumi
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Eye Hospital, University Medical Centre Ljubljana, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
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10
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Di Maria A, Tredici C, Cozzupoli GM, Vinciguerra P, Confalonieri F. Effects of prostaglandin analogues on epiphora persistence after EN-DCR: A hypothesis-generating study. Eur J Ophthalmol 2023; 33:182-187. [PMID: 35668621 PMCID: PMC9834318 DOI: 10.1177/11206721221106138] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose: To explore the relationship between topical antiglaucoma therapy, both prostaglandin and non-prostaglandin based eyedrops, and persistence of epiphora in glaucoma patients who underwent EN-DCR surgery for PANDO. Methods: prospective observational cohort study of all over 65 years-old patients with a dacryo-CT documented diagnosis of PANDO who underwent EN-DCR, were affected by glaucoma and treated with either topical monotherapy prostaglandin eyedrops or other antiglaucoma molecules, up to 12-month postoperative follow-up. Patients were assessed with Fluorescein Dye Disappearance Test and Munk scale. Results: Fifteen right eyes from 15 PG-group patients and 15 eyes right eyes from 15 non-PG-group patients were considered. Epiphora occurred in 1/15 (7%) of PG-group patients at 3 months, in 8/15 (53%) at 6 months, and in 11/15 (73%) at one year. In comparison, only 1/15 of non-PG-group patients developed epiphora at 6 months. The relative risk of epiphora in PG-group patients versus non-PG-group patients was 3.00 (95% CI, 0.13-68.1; p = 0.99) at 3 months, 8.00 (95% CI, 1.14-56.3; p = 0.014) at 6 months, and 11.0 (95% CI, 1.62-74.9; p < 0.001) at 12 months. Conclusion: Based on our results, we speculate that prostaglandin eye drops may affect the outcome of EN-DCR in terms of increasing epiphora recurrence from early to late postoperative follow up. The toxicity of antiglaucoma eye drops might damage spiral fibers of the mucous membrane of the lacrimal system inducing fibrosis by a proinflammatory mechanism.
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Affiliation(s)
- Alessandra Di Maria
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Costanza Tredici
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | | | - Paolo Vinciguerra
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Filippo Confalonieri
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy,Dr Filippo Confalonieri, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milan, Italy.
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11
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Pirola F, Spriano G, Ferreli F, Russo E, Di Bari M, Giannitto C, De Virgilio A, Mercante G, Vinciguerra P, Di Maria A, Malvezzi L. Clinical outcome and quality of life of lacrimal sac mucocele treated via endoscopic posterior approach. Am J Otolaryngol 2022; 43:103244. [PMID: 34563801 DOI: 10.1016/j.amjoto.2021.103244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Dacryocystorhinostomy (DCR) is the surgical treatment for lacrimal sac mucoceles (LSM), yet variants of the procedure are several. Since LSM causes bone remodeling and thinning, especially of the lacrimal bone, osteotomy at that site is reasonably the easiest. The aim of the study is to support treatment of LSM via a posterior DCR approach, in a large cohort of cases, and report patients' quality of life after the procedure with validated questionnaires. METHODS Single-center observational retrospective study on a specific methodology (endoscopic-DCR via posterior approach). Consecutive patients with LSM were enrolled in 2008-2020; CT scans were reviewed, bone thickness was measured bilaterally and compared. Resolution of mucocele, epiphora and infection were analyzed after 6-months. Patients were administered the Munk Score and Lacrimal Symptom Questionnaire (Lac-Q). Statistical analysis was done to compare bone thickness between the two sides; descriptive analysis of the questionnaires results was presented. RESULTS Forty-four patients with LSM were enrolled. The LSM side showed frontal process thickness of 4.00 ± 1.06 mm (vs 3.90 ± 1.03 on the unaffected side; p = 0.23) and a lacrimal bone of 0.32 ± 0.12 mm (vs 0.41 ± 0.12; p < 0.001). Resolution of infection was achieved in 97.4% cases, anatomical patency in 87.2%. After 5 years, 84.6% of patients reported no relevant epiphora (Munk score 0-1). Social impact (Lac-Q) due to lacrimal malfunctioning was still noted in 30.8% patients. CONCLUSIONS Adult LSM is a rare condition and DCR remains the mainstay of treatment. LSM physiopathology may support a preferred surgical choice via a posterior approach. Despite objective patency, some lacrimal way malfunctioning may be experienced in a minority of cases.
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Affiliation(s)
- Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy.
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Matteo Di Bari
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Ophthalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele - Milan, Italy; Department of Otolaryngology and Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano - Milan, Italy
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12
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Maione L, Vinci V, Costanzo D, Battistini A, Lisa A, Di Maria A. Upper eyelid blepharoplasty following hyaluronic acid injection with improved facial aesthetics and eye symptoms: a case report. J Med Case Rep 2021; 15:248. [PMID: 33926525 PMCID: PMC8086306 DOI: 10.1186/s13256-020-02641-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dermatochalasis of the upper eyelids (blepharochalasis) is a typical age-related change in the upper third of the face and a major concern for facial aesthetics. Nowadays both surgical and nonsurgical interventions are available for patients complaining of upper eyelid dermatochalasis. Although nonsurgical treatments are often easier to perform, if they are not performed correctly, complications may ensue and worsen the condition. CASE PRESENTATION We describe the case of a Caucasian patient presenting with bilateral upper eyelid dermatochalasis, previously treated with multiple injections of hyaluronic acid filler. Following these procedures, the patient reported nonspecific eye symptoms (such as a sense of heaviness and asthenopia) and cosmetic concerns. We decided to perform an upper eyelid blepharoplasty. During the procedure we found a ribbon of hard, fibrous material, which was carefully removed. The patient reported resolution of functional eye symptoms owing to the reduction of upper lid heaviness, which also resulted in subjective improvement of the visual field. Patient satisfaction was assessed preoperatively and 3 months postoperatively using the Blepharoplasty Outcomes Evaluation (BOE), which showed an overall satisfaction rate of 95.8 %. CONCLUSIONS Blepharoplasty not only treated the patient's blepharochalasis but also allowed us to correct the previous nonsurgical intervention by removing the excessive amount of injected hyaluronic acid. Both aesthetic and functional results were successfully achieved.
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Affiliation(s)
- Luca Maione
- Plastic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Rozzano, Milan, Italy.,Plastic Surgery Unit, Clinica San Carlo, Via Ospedale 21, 20037, Paderno Dugnano, Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Andrea Battistini
- Plastic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy. .,Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Rozzano, Milan, Italy.
| | - Andrea Lisa
- Plastic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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13
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Pirola F, De Virgilio A, Di Maria A, Russo E, Di Bari M, Costantino A, Ferreli F, Mercante G, Colombo G, Spriano G, Malvezzi L. Applying the Exoscope to Lacrimal Surgery: Preliminary Experience. ORL J Otorhinolaryngol Relat Spec 2021; 83:381-386. [PMID: 33735886 DOI: 10.1159/000513529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR). MATERIALS AND METHODS In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as "good" = 2, "acceptable" = 1, and "not acceptable" = 0). A questionnaire score of 24 out of 24 was valued as "completely approved," score 20-23 as "moderately approved," and score ≤19 as "weakly approved." Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained. RESULTS No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20' vs. 23', respectively, p = 0.091). The exoscope was valued by surgical team members as "completely approved" in 55.5% of cases, "moderately approved" in 39.7%, and "weakly approved" in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively). CONCLUSIONS The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.
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Affiliation(s)
- Francesca Pirola
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy, .,Department of Biomedical Sciences, Humanitas University, Milan, Italy,
| | - Armando De Virgilio
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandra Di Maria
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Ophthalmology, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Elena Russo
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Matteo Di Bari
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Costantino
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Fabio Ferreli
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mercante
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Colombo
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Spriano
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Malvezzi
- Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Borgia A, Manara S, Balzarotti M, Vinciguerra P, Di Maria A. Small lymphocytic lymphoma in true trilineage hematopoietic tissue within heterotopic ossification in an enucleated blind painful eye: a case report. J Med Case Rep 2020; 14:92. [PMID: 32635936 PMCID: PMC7341667 DOI: 10.1186/s13256-020-02430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background The finding of hematological malignancies within bone marrow in heterotopic ossification has been reported only a handful of times previously in the literature. We described a case of true trilineage hematopoiesis in an excised area of heterotopic ossification from an enucleated blind painful eye. Case presentation A 70-year-old Caucasian man, positive for asymptomatic lymphoplasmacytic lymphoma, presented with a blind painful right eye in our ophthalmology department to evaluate enucleation bulbi. After enucleation, a histopathologic examination revealed the presence of intertrabecular infiltration in the metaplastic bone marrow of non-Hodgkin B lymphoma, with small lymphocytes, with similar characteristics to the already known disease. Conclusion This uncommon case reveals the possibility of the localization of malignant cells within bone metaplasia of intraocular ossification in an enucleated blind painful eye. From a practical point of view, a careful systematic histopathological examination of all resected tissues in patients with a history of malignant neoplastic pathology is necessary to confirm the diagnosis and exclude occult malignancies.
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Affiliation(s)
- Alfredo Borgia
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy.
| | - Sofia Manara
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano (Mi), Italy
| | - Monica Balzarotti
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano (Mi), Italy
| | - Paolo Vinciguerra
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
| | - Alessandra Di Maria
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
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Sindoni A, Famà F, Vinciguerra P, Gioffrè-Florio M, Di Maria A. Orbital metastasis in a male patient after seven years from breast cancer diagnosis. Breast J 2020; 26:2060-2062. [PMID: 32542858 DOI: 10.1111/tbj.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Fausto Famà
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, Humanitas Research Hospital - IRCCS, Rozzano/Milano, Italy
| | - Maria Gioffrè-Florio
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, Humanitas Research Hospital - IRCCS, Rozzano/Milano, Italy
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Sindoni A, Di Maria A, Fama' F. Orbital metastases in infiltrating lobular carcinoma of the breast. J Surg Oncol 2020; 122:569. [PMID: 32476134 DOI: 10.1002/jso.26045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Fausto Fama'
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
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Sindoni A, Fama' F, Vinciguerra P, Dionigi G, Manara SAAM, Gaeta R, Gioffre'-Florio M, Di Maria A. Orbital metastases from breast cancer: A single institution case series. J Surg Oncol 2020; 122:170-175. [PMID: 32297325 DOI: 10.1002/jso.25927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Among orbital tumors, metastatic lesions have a prevalence of 1% to 13%; on the other hand, breast cancer is the most common malignancy causing orbital metastases. The aim of this study is to present our experience dealing with orbital metastases caused by breast cancer, to assess characteristics and clinic-pathological data of patients suffering from this rare occurrence and to find indexes related with their prognosis and survival. METHODS Records of 28 patients diagnosed with orbital metastases from breast cancer at the Department of Ophthalmology, Humanitas Clinical and Research Centre of Milano over a 27-year period (1992-2018) were retrieved and analyzed. RESULTS Mean patients' age at breast cancer diagnosis was 56.29 ± 14.63 years. Mean time interval between breast cancer diagnosis and orbital metastasis occurrence was 5 ± 4.17 years. All lesions were estrogen receptor-positive; 79% of patients harbored progesterone receptor-positive lesions. Interestingly, the majority of deceased patients presented orbital lesions with MIB-1 index >50% (P = .0265) and had concomitant lung metastases (P = .0452). CONCLUSIONS The occurrence of orbital metastasis from breast cancer represents a challenging finding. Patients' clinical picture can include exophthalmos, edema, tumefaction, proptosis and/or diplopia. Significant symptomatic improvement can be achieved through surgery and other adjuvant treatments, such as radiation therapy and chemotherapy.
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Affiliation(s)
- Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Fausto Fama'
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, Humanitas Research Hospital - IRCCS, Rozzano/Milano, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy
| | | | - Roberto Gaeta
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University Hospital of Messina, Italy
| | - Maria Gioffre'-Florio
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, Humanitas Research Hospital - IRCCS, Rozzano/Milano, Italy
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Fama' F, Di Maria A, Cicciu' M, Buccheri G, Gioffre'-Florio M, Benvenga S, Sindoni A. Intraoperative sonography for nonpalpable breast lesions: Additional indications for a consolidate technique. Breast J 2019; 26:479-483. [PMID: 31524310 DOI: 10.1111/tbj.13575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/29/2022]
Abstract
This prospective study evaluated the intraoperative ultrasound scan (IUSS) for nonpalpable breast lesions' detection. A total of 108 consecutive female patients underwent surgery using IUSS: Frozen sections demonstrated clear margins in 95.5% of neoplastic patients. Only four (4.5%) patients underwent local re-excision in the same operation. IUSS demonstrated to be quick, accurate, useful, effective, and safe for the intraoperative management of neoplastic nonpalpable breast lesions when performed by a surgeon who has undergone US training, particularly for people in whom alternative approaches can show some limitations due to contraindications or because of scheduling constraints, costs, and patient discomfort.
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Affiliation(s)
- Fausto Fama'
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, Humanitas Clinical and Research Center, Rozzano/Milano, Italy
| | - Marco Cicciu'
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University Hospital of Messina, Italy
| | - Giancarlo Buccheri
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy
| | - Maria Gioffre'-Florio
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Klinger F, Maione L, Vinci V, Lisa A, Barbera F, Balia L, Caviggioli F, Di Maria A. Autologous fat graft in irradiated orbit postenucleation for retinoblastoma. Orbit 2018; 37:344-347. [PMID: 29303387 DOI: 10.1080/01676830.2017.1423358] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/29/2017] [Indexed: 06/07/2023]
Abstract
Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.
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Affiliation(s)
- Francesco Klinger
- a Reconstructive and Aesthetic Plastic Surgery School-MultiMedica Holding S.p.A.- Plastic Surgery Unit-Sesto San Giovanni , University of Milan , Milan , Italy
| | - Luca Maione
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Valeriano Vinci
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Andrea Lisa
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Federico Barbera
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Laura Balia
- c Ophthalmology Unit , Humanitas Research Hospital , Milan , Rozzano , Italy
| | - Fabio Caviggioli
- a Reconstructive and Aesthetic Plastic Surgery School-MultiMedica Holding S.p.A.- Plastic Surgery Unit-Sesto San Giovanni , University of Milan , Milan , Italy
| | - Alessandra Di Maria
- c Ophthalmology Unit , Humanitas Research Hospital , Milan , Rozzano , Italy
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Piscopo R, Romano M, Maria AD, Vinciguerra R, Vinciguerra P. Ocular Onset of Paraneoplastic Pemphigus Presenting as Hyperemic Conjunctivitis and Massive Bilateral Eyelid Ulceration: A Case Report and Literature Review. Ocul Immunol Inflamm 2016; 26:265-268. [PMID: 27537424 DOI: 10.1080/09273948.2016.1203958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Paraneoplastic clinical signs are characterized by a large and heterogeneous variety of manifestations due to several possible underlying neoplasms. Paraneoplastic pemphigus (PNP) is a particular paraneoplastic variety that usually primarily affects the dermic and/or oral mucosa and is characterized by a high rate of mortality (90%). Therefore, it is important to recognize its possible signs early. This report describes a case of ocular paraneoplastic pemphigus (PNP) presenting with recalcitrant eyelid ulceration and hyperemic conjunctivitis caused by an undiagnosed prostate cancer. METHODS A 77-year-old man was admitted to our department because of recalcitrant hyperemic conjunctivitis in both eyes, complicated with large ulceration of both upper eyelids in spite of topical therapy. After 3 weeks, oral mucositis and bullous dermatitis on the chest and arms developed. RESULTS Complete slit lamp ocular study, conjunctival swabs, routine hematologic tests, serum neoplasm markers, indirect immunofluorescence study, immunoblotting, and oral mucose biopsy with direct immunofluorescence were performed under the hypothesis of a paraneoplastic sign. Total body computed tomography scan and ultrasound-guided needle prostate biopsy completed the diagnostic process and confirmed the diagnosis of prostate PNP. Complete remission of ocular clinical signs was achieved by treatment of the prostate malignancy with systemic immunosuppressive therapy and chemotherapy.
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Affiliation(s)
- Raffaele Piscopo
- a Department of Ophthalmology , Humanitas Clinical and Research Institute , Rozzano , Milan , Italy
| | - Mary Romano
- b Department of Ophthalmology , Second University of Naples , Napoli , Italy
| | - Alessandra Di Maria
- a Department of Ophthalmology , Humanitas Clinical and Research Institute , Rozzano , Milan , Italy
| | - Riccardo Vinciguerra
- a Department of Ophthalmology , Humanitas Clinical and Research Institute , Rozzano , Milan , Italy
| | - Paolo Vinciguerra
- a Department of Ophthalmology , Humanitas Clinical and Research Institute , Rozzano , Milan , Italy
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Balia L, Vinciguerra P, Di Maria A, Piscopo R, Romano M. Paraneoplastic syndrome--unresponsive systemic hypertension and fever as expression of primitive ciliary body carcinoma in a blind painful eye: a case report. J Med Case Rep 2016; 10:5. [PMID: 26776954 PMCID: PMC4716645 DOI: 10.1186/s13256-015-0782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to present a case of paraneoplastic systemic hypertension and fever in an undiagnosed primary ciliary body carcinoma arising in a painful blind eye. Case presentation A 37-year-old white man with a history of blindness since childhood was enucleated for neovascular glaucoma because of intractable pain in his right eye. A histopathological examination revealed a ciliary body carcinoma. One year later, an invasive recurrence of his orbit and ethmoid was detected and a debulking procedure was performed. He had untreatable fever and multidrug-resistant systemic hypertension for 3 months before the neoplasm diagnosis. He recovered from fever and systemic hypertension only after tumor excision and relapsed 1 year later when synchronous tumor dissemination was shown through a computed tomography scan. Tumor metastases, despite surgery and chemotherapy, caused his death. Conclusions Paraneoplastic symptoms such as fever and hypertension may be due to unrecognized ocular malignancy. This case report intends to emphasize the importance of histopathological examination of an enucleated phthisical painful blind eye.
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Affiliation(s)
- Laura Balia
- Department of Ophthalmology, Istituto Clinico Humanitas, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Paolo Vinciguerra
- Department of Ophthalmology, Istituto Clinico Humanitas, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Alessandra Di Maria
- Department of Ophthalmology, Istituto Clinico Humanitas, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Raffaele Piscopo
- Department of Ophthalmology, Istituto Clinico Humanitas, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Mary Romano
- Department of Ophthalmology, Istituto Clinico Humanitas, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. .,Department of Ophthalmology, Second University of Neaples, Naples, Italy.
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Abstract
BACKGROUND. Merkel cell tumor is an uncommon, aggressive neoplasm of the skin, now regarded as a neuroendocrine carcinoma. Eyelids are among the sites where it can develop, often mimicking a benign process. The purpose of this report is to describe two new cases and to discuss briefly the problems of diagnosis and treatment. METHODS. Two patients with Merkel cell tumor of the eyelids are described. In both cases, the original clinical diagnosis was chalazion. Progressive growth of the lesion identified it as a tumor some 2-7 months after it was first noticed. The patients were treated by surgical excision of the tumor tissue, and only one by a course of local radiotherapy. The visual acuity was measured with Snellen fractions. The dose of local radiotherapy is given in cGy. RESULTS. Histopathological and immunohistochemical studies identified the lesion as a neuroendocrine carcinoma, consistent with Merkel cell tumor. The natural history was marked by aggressive behavior in one case, and by a delayed recurrence in the other, requiring different therapeutic approaches. CONCLUSION. Merkel cell carcinoma of the eyelid is a tumor that ophthalmogists should be aware of, as early diagnosis is a prerequisite for successful treatment. Rapid recurrence of any chalazion in a middle-aged or elderly patient should therefore prompt its histological examination to exclude the possibility of a malignant tumor.
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Affiliation(s)
- Alessandra Di Maria
- Ophthalmic Clinic, IRCCS-Policlinico San Matteo, University of Pavia, Pavia, Italy
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Dunn D, Newell ML, Ades T, Peckham C, Maria AD. CD4 T cell count as predictor of Pneumocystis carinii pneumonia in children born to mothers infected with HIV. BMJ 1994. [DOI: 10.1136/bmj.308.6926.437] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gilgenkrantz JM, Larcan A, Laprevotte MC, Maria AD, Faivre G. [Pre-hospital resuscitation and transport of cardiac patients. Apropos of 107 cases of primary transport]. Arch Mal Coeur Vaiss 1975; 68:459-65. [PMID: 816302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Report of 107 cases of primary transportation in ambulances especially equipped for coronary patients monitoring. The various delays of admission were studied and the complications occuring during transportation were analyzed, together with the various therapeutic methods applied. On the basis of this personal experience, and to attempt at diminishing the mortality at the acute stage of myocardial infarction, it was advised: --a careful information of the public, --a systematic training of the physicians, --a logic organization of emergency care. Only a coherent set up of fixed and mobile units might result in improvement of the prognosis of the first hours after myocardial infarction.
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