Efficient Type-II Heterojunction Nanorod Sensitized Solar Cells Realized by Controlled Synthesis of Core/Patchy-Shell Structure and CdS Cosensitization

Here, we report the successful application of core/patchy-shell CdSe/CdSe _xTe_{1- x} type-II heterojunction nanorods (HNRs) to realize efficient sensitized solar cells. The core/patchy-shell structure designed to have a large type-II heterointerface without completely shielding the CdSe core significantly improves photovoltaic performance compared to other HNRs with minimal or full-coverage shells. In addition, cosensitization with CdS grown by successive ionic layer adsorption and reaction further improves the power conversion efficiency. One-diode model analysis reveals that the HNRs having exposed CdSe cores and suitably grown CdS result in significant reduction of series resistance. Investigation of the intercorrelation between diode quality parameters, diode saturation current density ( J₀) and recombination order (β = (ideality factor)^-1) reveals that HNRs with open CdSe cores exhibit reduced recombination. These results confirm that the superior performance of core/patchy-shell HNRs results from their fine-tuned structure: photocurrent is increased by the large type-II heterointerface and recombination is effectively suppressed due to the open CdSe core enabling facile electron extraction. An optimized power conversion efficiency of 5.47% (5.89% with modified electrode configuration) is reported, which is unmatched among photovoltaics utilizing anisotropic colloidal heterostructures as light-harvesting materials.

Photoresist Contact Patterning of Quantum Dot Films

Scalable and cost-effective protocols to pattern and integrate colloidal quantum dots (QDs) with high resolution have been challenging to establish. While their solubility can facilitate certain processes such as spin-casting into thin films, it also makes them incompatible with many conventional patterning techniques including photolithography that require solution processing. In this work, we present "photoresist (PR) contact patterning", a dry means to pattern QD films over large areas with high resolution while maintaining desired properties. Here, a PR layer on an elastomer substrate is patterned by conventional photolithography and used as a dry contact stamp to selectively peel off QDs in the contact regions, leaving behind a QD film with the negative of the PR pattern. Once patterned, QD films are readily transferred and integrated on foreign substrates by subsequent transfer printing processes. Patterned PR layers can also be transferred from elastomer substrates onto QD films and used as masking layers for subsequent deposition and patterning of additional materials, e. g., patterned metal electrodes or charge transport layers for QD-based devices. The study of the interfacial mechanics and energy of materials associated with PR contact patterning reveals why a lithographically patterned PR is superior for high-resolution QD film patterning. Applicability of PR contact patterning is demonstrated through the fabrication of red, green, and blue (RGB) QD light-emitting diode pixels. PR contact patterning presented in this work not only allows dry patterning of QD films but also enables high-resolution integration of functional multistack structures for future QD-based electronic and optoelectronic devices.

Route to Improving Photovoltaics Based on CdSe/CdSexTe1-x Type-II Heterojunction Nanorods: The Effect of Morphology and Cosensitization on Carrier Recombination and Transport

One-dimensionally elongated nanoparticles with type-II staggered band offset are of potential use as light-harvesting materials for photovoltaics, but only a limited attention has been given to elucidate the factors governing the cell performance obtainable from such materials. Herein, we describe a combined strategy to enhance charge collection from CdSe/CdSe_xTe_1-x type-II heterojunction nanorods (HNRs) utilized as light harvesters for sensitized solar cells. By integrating morphology- and composition-tuned type-II HNRs into solar cells, factors that yield interfaces favorable both for the electron injection into TiO₂ and hole transfer to electrolyte are examined. Furthermore, it is shown that a more efficient photovoltaic system results from cosensitization with CdS quantum dots (QDs) predeposited on a TiO₂ scaffold, which improves charge collection from HNRs. Electrochemical impedance spectroscopy (EIS) analysis suggests that such a synergistically enhanced system benefits from the decreased recombination within HNRs and facilitated charge transport through the cosensitized TiO₂ electrode, even with the activation of a recombination path presumably related to the photogenerated holes in CdS QDs.

Solvent-Free Patterning of Colloidal Quantum Dot Films Utilizing Shape Memory Polymers

Colloidal quantum dots (QDs) with properties that can be tuned by size, shape, and composition are promising for the next generation of photonic and electronic devices. However, utilization of these materials in such devices is hindered by the limited compatibility of established semiconductor processing techniques. In this context, patterning of QD films formed from colloidal solutions is a critical challenge and alternative methods are currently being developed for the broader adoption of colloidal QDs in functional devices. Here, we present a solvent-free approach to patterning QD films by utilizing a shape memory polymer (SMP). The high pull-off force of the SMP below glass transition temperature (T_g) in conjunction with the conformal contact at elevated temperatures (above T_g) enables large-area, rate-independent, fine patterning while preserving desired properties of QDs.

Edge profile analysis of Joint European Torus (JET) Thomson scattering data: Quantifying the systematic error due to edge localised mode synchronisation

The Joint European Torus (JET) high resolution Thomson scattering (HRTS) system measures radial electron temperature and density profiles. One of the key capabilities of this diagnostic is measuring the steep pressure gradient, termed the pedestal, at the edge of JET plasmas. The pedestal is susceptible to limiting instabilities, such as Edge Localised Modes (ELMs), characterised by a periodic collapse of the steep gradient region. A common method to extract the pedestal width, gradient, and height, used on numerous machines, is by performing a modified hyperbolic tangent (mtanh) fit to overlaid profiles selected from the same region of the ELM cycle. This process of overlaying profiles, termed ELM synchronisation, maximises the number of data points defining the pedestal region for a given phase of the ELM cycle. When fitting to HRTS profiles, it is necessary to incorporate the diagnostic radial instrument function, particularly important when considering the pedestal width. A deconvolved fit is determined by a forward convolution method requiring knowledge of only the instrument function and profiles. The systematic error due to the deconvolution technique incorporated into the JET pedestal fitting tool has been documented by Frassinetti et al. [Rev. Sci. Instrum. 83, 013506 (2012)]. This paper seeks to understand and quantify the systematic error introduced to the pedestal width due to ELM synchronisation. Synthetic profiles, generated with error bars and point-to-point variation characteristic of real HRTS profiles, are used to evaluate the deviation from the underlying pedestal width. We find on JET that the ELM synchronisation systematic error is negligible in comparison to the statistical error when assuming ten overlaid profiles (typical for a pre-ELM fit to HRTS profiles). This confirms that fitting a mtanh to ELM synchronised profiles is a robust and practical technique for extracting the pedestal structure.

Allergic fungal sinusitis involving the lacrimal sac: a case report and review

BACKGROUNd: We report a case of allergic fungal sinusitis (AFS) involving the lacrimal sac and review the current English literature. A literature search for AFS involving the lacrimal sac revealed two reports with only one of the two cases demonstrating histological evidence of fungal elements. This is just the third such case and only the second reported case with histopathologic confirmation of fungal elements by Gomori methenamine silver (GMS) stain.

MATERIALS AND METHODS

A PubMed database search was performed using combinations of the following key words: allergic fungal sinusitis, lacrimal sac, nasolacrimal duct, ophthalmology, epiphora, orbit. A 70-year-old white man with a history of chronic conjunctivitis and nasal polyps presenting with chronic epiphora was found to have dacryostenosis on the left side. A CT scan of the orbits revealed mucoperiosteal thickening completely obliterating the frontal, ethmoid and sphenoid sinuses.

RESULTS

A left external dacryocystorhinostomy (DCR) was performed and the lacrimal sac contents were studied histopathologically. Microscopic examination of the lacrimal sac contents disclosed allergic mucin with laminated aggregates of eosinophils in various stages of degeneration, Charcot-Leyden crystals and rare noninvasive fungal hyphae confirming the diagnosis of AFS. Fungal elements stained positively with Gomori methenamine silver stain.

CONCLUSION

Although rarely reported, AFS can affect the lacrimal sac. AFS should be suspected in patients with a history of recurrent refractory sinusitis, recurrent dacryocystitis and nasal polyposis. Early diagnosis is important for adequate treatment and prevention of recurrence.

Postoperative eyelid infection in a patient taking etanercept

Postoperative eyelid infections are a rare complication of eyelid surgery. The authors present a case of an eyelid infection occurring within the first week following surgery in a patient taking etanercept--a biologic anti-TNF-α agent used in the treatment of rheumatoid arthritis. The authors urge caution regarding the use of steroid/antibiotic combination ointments and systemic steroids in patients undergoing elective eyelid surgery who are on such medications. Perioperative discontinuation of etanercept in consultation with the prescribing physician may also be considered. Eyelid infections following eyelid surgeries such as blepharoplasty and ptosis correction are uncommon.( 1 , 2 ) A review of a large series of blepharoplasty procedures estimated the rate of postoperative infection at 0.2%.( 3 ) However, patients who are relatively immunosuppressed may be at a higher risk of developing skin and eyelid infections. We present a case of postoperative infection in a patient who was taking etanercept (Enbrel, Immunex Corporation, Thousand Oaks, CA) for rheumatoid arthritis.

Dacryocystorhinostomy: History, evolution and future directions

Dacryocystorhinostomy (DCR) is a procedure of choice for nasolacrimal duct obstruction and chronic dacryostenosis in the setting of patent canaliculi and a functional lacrimal pump. Two major approaches are utilized: external, via a transcutaneous incision and endonasal endoscopically guided. The surgery has a high success rate via both approaches. We review the history, evolution, current techniques, complications and future directions of DCR.

Enhancement of the JET edge LIDAR Thomson scattering diagnostic with ultrafast detectors

The edge light detection and ranging (LIDAR) Thomson scattering diagnostic at the Joint European Torus fusion experiment uses a 3 J ruby laser to measure the electron density and temperature profile at the plasma edge. The original system used a 1 GHz digitizer and detectors with response times of approximately 650 ps and effective quantum efficiencies <7%. This system has recently been enhanced with the installation of a new 8 GHz digitizer and four new ultrafast GaAsP microchannel plate photomultiplier tube detectors with response times of <300 ps and effective quantum efficiencies in the range of approximately 13%-20% (averaged over lambda=500-700 nm). This upgrade has enabled the spatial resolution to be reduced to approximately 6.3 cm along the laser line of sight for a laser pulse of 300 ps full width at half maximum, which is close to the requirements for the ITER core LIDAR. Performance analysis shows that the new system will have an effective spatial resolution of up to 1 cm in the magnetic midplane via magnetic flux surface mapping.

Incidence of postblepharoplasty orbital hemorrhage and associated visual loss

PURPOSE

Orbital hemorrhage, especially when associated with visual loss, is a significant complication of cosmetic eyelid surgery. We investigated the incidence of this complication among cases handled by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. We also reviewed the length of time between surgery and the onset of bleeding and sought any factors that may contribute to these cases.

METHODS

A 2-page questionnaire was sent to all American Society of Ophthalmic Plastic and Reconstructive Surgery members. Responses were tabulated as to total numbers of cases performed, the incidence of postoperative orbital hemorrhage, treatments, and incidence of permanent visual loss. Comorbidities were also reviewed.

RESULTS

Two hundred thirty-seven responses were received from American Society of Ophthalmic Plastic and Reconstructive Surgery members, collectively representing 269,433 cases. Among these cases, there were 149 orbital hemorrhages, 48 cases associated with temporary visual loss, and 12 cases associated with permanent visual loss. The majority of these cases occurred within the first 3 hours of surgery, and the risk decreased significantly after 24 hours after surgery. Common comorbidities were hypertension, perioperative aspirin use, postoperative vomiting, and increased physical activity. Treatment commonly consisted of wound drainage with cauterization of active bleeders, lateral canthotomy, intravenous steroids, and intraocular pressure-lowering drugs. Orbital decompression was infrequently used; anterior chamber paracentesis was not used. This study is limited by recall biases regarding the number of cases performed by each responding surgeon and the number of relevant cases of orbital hemorrhage.

CONCLUSIONS

The incidence of orbital hemorrhage associated with cosmetic eyelid surgery is 0.055% (1:2,000), and orbital hemorrhage with permanent visual loss is 0.0045% (1:22,000) [corrected] Development of orbital hemorrhage is most common within the first 24 hours after surgery, especially within the first 0 to 3 hours, but can occur as late as several days after surgery.

Ocular surface, ocular adnexal, and lacrimal complications associated with the use of systemic 5-fluorouracil

PURPOSE

To determine the prevalence rates and associated characteristics of patients who have ocular surface, ocular adnexal, and lacrimal complications associated with the systemic use of the cancer chemotherapeutic agent 5-Fluorouracil (5-FU).

METHODS

An exposure-based cohort study was designed. Adult patients who had completed at least 3 months of systemic 5-FU therapy within the past 5 years were eligible for enrollment. Study subjects had a detailed medical history taken with emphasis on preexisting conditions known to be associated with the development of ocular surface, ocular adnexal, and lacrimal complications. An ocular examination was then performed. A complete nasolacrimal system evaluation was performed if symptoms or findings were identified. The prevalence was then determined for each ocular symptom and each ocular finding identified that was not present pretreatment. An exploratory analysis was then performed to identify patient characteristics that might influence the likelihood of developing any of the above complications.

RESULTS

Fifty-two patients were enrolled in the study. The prevalence rates of the following ocular abnormalities were calculated: ocular irritation, 5.8%; blepharitis, 3.8%; conjunctivitis, 3.8%; keratitis, 3.8%; eyelid dermatitis, 5.8%; cicatricial ectropion, 1.9%; tearing, 26.9%; punctal-canalicular stenosis, 5.8%; and blurred vision, 11.5%. Blacks had tearing at a significantly higher rate when compared with whites (P = 0.022, 2-sided Fisher exact test). Three patients had permanent complications that will require surgery for correction. Of the 7 patients who had a single abnormality, 6 had tearing and one had eyelid dermatitis. All of the 8 patients who had multiple findings had tearing as one of their abnormalities.

CONCLUSIONS

Ninety-three percent of the patients who had an ocular abnormality had tearing as one of the complications. Patients who are receiving systemic 5-FU and begin to tear should have an ocular examination, looking for ocular surface, ocular adnexal, and lacrimal complications.

Tarsorrhaphy: clinical experience from a cornea practice

PURPOSE

To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients.

METHODS

In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up.

RESULTS

Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 +/- 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 +/- 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant ( p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid.

CONCLUSION

Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.

Complications associated with silicone intracanalicular plugs

PURPOSE

To assess American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) member physicians' experiences with complications associated with silicone intracanalicular plugs and publicize risks associated with this device.

METHODS

Two case reports are presented. A survey was sent to 420 ASOPRS member physicians, questioning them on their experiences with complications associated with silicone intracanalicular plugs.

RESULTS

We present two case reports of complications associated with migration of intracanalicular plugs. In the first case, a 41-year-old man underwent serial insertion of seven intracanalicular plugs in one eye over several years, he had a 3-month relapsing course of Nocardia asteroides canaliculitis, dacryocystitis, and cellulitis requiring systemic antibiotics and multiple surgeries. In the second case, a 72-year-old woman had acute dacryocystitis, eventually necessitating dacryocystorhinostomy; at surgery, an intracanalicular plug was discovered in the lacrimal sac. One hundred fifty-nine usable survey responses were obtained. Sixty-one percent of respondents reported various complications including tearing, canaliculitis, and dacryocystitis. Fifty-one percent of respondents performed surgery to treat complications associated with silicone intracanalicular plugs.

CONCLUSIONS

Silicone intracanalicular plugs may be difficult to remove and may be associated with significant lacrimal complications.

Plasmacytoma of the eye and orbit

BACKGROUND

Plasmacytomas of the ocular and adnexal tissue are rare. The variation in their clinical manifestations and potential association with multiple myeloma are not well appreciated.

METHODS

We reviewed the clinical features and laboratory data of five cases of plasmacytoma involving the eye and orbit.

RESULTS

Plasmacytomas involved the conjunctiva in one case, the orbit in three cases, and the iris in one case. Plasmacytoma was the solitary plasma cell neoplasm in a patient with a conjunctival lesion and another patient with an orbital lesion. Two other patients who developed plasmacytomas of the orbit and iris, respectively, had a known history of multiple myeloma. An orbital plasmacytoma preceded the onset of systemic plasma cell neoplasia in the final patient.

CONCLUSION

Plasmacytomas of the eye and orbit are rare. They may or may not be associated with multiple myeloma.

Eye injuries from merchandise display hooks

PURPOSE/METHODS

Four patients had ocular or ocular adnexal injuries, which resulted from store merchandise display hooks.

RESULTS/CONCLUSIONS

Ocular and periocular injuries from display hooks include conjunctival, eyelid, and canalicular lacerations, as well as penetrating brain injury. Display hooks are commonly used in retail establishments and pose a high risk when placed below eye level.

Benign mixed tumor arising from an accessory lacrimal gland of Wolfring

We report a 59-year-old man who had a slowly enlarging mass of the central upper eyelid that proved histopathologically to be a benign mixed tumor (pleomorphic adenoma) arising from an accessory lacrimal gland of Wolfring. The tumor was totally separate from the main lacrimal gland, and its deep location in the lid excluded origin from dermal sweat glands. Benign mixed tumors of the accessory lacrimal glands are exceedingly rare tumors of the ocular adnexa.

Squamous cell carcinoma of the eyelid

A total of 24 patients (12 men and 12 women) with squamous cell carcinoma of the eyelid were identified from pathology records at Wills Eye Hospital from 1978 through 1987. Squamous cell carcinoma accounted for 24 of 648 (3.7%) malignant eyelid lesions submitted during the 10-year study period. The median age of patients at the time of diagnosis was 72 years (range, 55 to 96 years). Initial therapy of all tumors involved surgical excision. Four patients developed clinical recurrence of squamous cell carcinoma in a median of 7.5 months after surgery. There were no tumor recurrences when frozen section techniques were applied during the initial surgical excision. The data suggest that the risk of persistence or recurrence of tumor was increased for patients who delayed seeking medical care after the lesion was first noticed and when frozen section control was not used during surgery. None of the patients were known to have developed metastases, and there were no tumor-related deaths.

Lacrimal sac tumors

This is a clinicopathologic study of 115 lacrimal sac neoplasms in adults (mean 52 years). The most common presenting signs and symptoms were epiphora (53%), recurrent dacryocystitis (38%), and/or lacrimal sac mass (36%). The tumors were divided into epithelial (82 cases) and nonepithelial (33 cases) neoplasms. Benign epithelial tumors included squamous and transitional cell papillomas (32), oncocytomas (4), and benign mixed tumors (2). The malignant epithelial neoplasms included squamous cell carcinoma (22), transitional cell carcinoma (5), adenocarcinoma (4), mucoepidermoid (3), adenoid cystic (3), and poorly differentiated carcinoma (1). The nonepithelial tumors consisted of fibrous histiocytoma (13), lymphoid lesions (10), malignant melanoma (6), hemangiopericytoma (1), lipoma (1), granulocytic sarcoma (1), and neurofibroma (1). Review of the literature, including our own series, discloses a 55% malignancy rate for tumors originating in the lacrimal sac. Malignant epithelial neoplasms, especially invasive transitional cell carcinoma, often recur locally and can metastasize and be fatal. Epithelial malignancies tend to grow along the epithelium of the lacrimal drainage system, and thus cure is dependent on a wide surgical excision of the tumor and of the entire lacrimal drainage system (canaliculi, sac, and nasolacrimal duct) combined with a lateral rhinostomy and radiation therapy.

Ocular motility disorders secondary to sinus surgery

Sinus surgery has multiple potential ocular complications including visual loss, diplopia, infection, hemorrhage, and epiphora. We report six patients with ocular motility problems secondary to sinus surgery, review the literature on ocular motility disorders secondary to sinus surgery, and propose an approach for management of those ocular motility problems following sinus surgery. Intranasal sinus surgery was found to be the most common procedure resulting in injury to an extraocular muscle and the ethmoid sinus the most common structure being operated on when injury occurred. The medial rectus was the muscle most commonly injured and it had the poorest prognosis for recovery of functional vision free of diplopia. Optimal timing for repair depends on the structure injured, but early recognition and management appear to be a key to the best outcome for these injuries.

Severe orbital infection as a complication of orbital fracture

Orbital fractures secondary to blunt trauma, and their complications, have been the subject of numerous reports, with little mention of an association with severe orbital infection. Conversely, studies of severe (postseptal) orbital infections rarely make reference to orbital fractures as being a significant pathogenetic factor. In a retrospective study of 130 orbital infections, three cases of severe orbital infection were identified as being associated with an orbital fracture, and are thus presented. In the literature, only anecdotal reports and inconclusive studies address this problem, and its possible prevention. The consequences of a pathologic communication between the paranasal sinuses and the orbit secondary to blunt facial trauma are discussed, along with recommendations for prophylactic management.

Gaze-induced amaurosis from central retinal artery compression

Color Doppler imaging was used to evaluate a patient with gaze-induced amaurosis caused by an intraconal orbital mass. The time-velocity waveform demonstrated abnormally high vascular resistance in the central retinal artery of the affected eye in the primary position. Abduction of the affected eye resulted in transient visual loss with an unreactive pupil. This same maneuver during color Doppler imaging resulted in a dramatic reduction of blood flow in the central retinal artery. Two months after surgical excision of the mass, the gaze-evoked amaurosis was no longer present, and color Doppler imaging demonstrated normal blood flow in the central retinal artery. This suggests that impaired retinal and optic nerve blood flow are responsible for gaze-induced amaurosis from compressive orbital lesions.

The Carney complex with ocular signs suggestive of cardiac myxoma

We treated a patient who had ophthalmic findings of the Carney complex that led to a search for and the discovery of asymptomatic cardiac myxoma. Substantial morbidity and mortality are associated with the complex because of the occurrence of cardiac myxoma. Facial and eyelid lentigines, conjunctival and caruncle pigmentation and eyelid pigmentation may precede signs or symptoms of cardiac myxoma. A study of the patient's primary relatives disclosed manifestations of the complex transmitted in a manner consistent with mendelian autosomal dominant inheritance.

Analysis of indications for referral to a multidisciplinary medical genetics clinic: implications for training programs in obstetrics and gynecology

Clinical genetics has become an integral component of obstetric training. Advances in prenatal screening (particularly maternal serum alpha-fetoprotein) and the clinical applications of molecular technologies have broadened the indications for referral to geneticists. During the study period, 1237 patients were referred for genetics consultation. A total of 596 (48%) were referred because of cytogenetic indications (576 for genetic amniocentesis); 252 (20%) because of multifactorial-developmental abnormalities; 204 (17%) because of risk of diseases attributable to single-gene mutations; 58 (5%) because of antenatal teratogen exposure(s); and 127 (10%) because of other reasons. Herein we summarize our experience as a multidisciplinary genetics unit and offer recommendations for broadening resident training curricula to meet current clinical needs. These data will be useful for enhancement of health care use and more effective direction of limited resources.

Treatment of blepharospasm with botulinum toxin

Many therapeutic modalities, including medications, excision of the muscles used in closure of the eyelids (myectomy), and selective extirpation of branches of the facial nerve (neurectomy), have been used for the management of blepharospasm. Because of limited effectiveness and undesirable side effects, none of these treatments has been completely satisfactory. Recent reports about injection of botulinum toxin indicate that it is safe and effective for most patients. Relief from blepharospasm, however, is usually transient, and repeated injections are usually necessary. The current availability of effective therapy for blepharospasm emphasizes the importance of prompt diagnosis and referral of affected patients to physicians knowledgeable in the use of botulinum toxin and other therapeutic approaches.

Pseudotumor and lymphoid tumor: distinct clinicopathologic entities

Although in the past some have considered lymphoid tumor to be a form of pseudotumor, clinical, radiologic and pathologic features show them to be distinct entities. Acute pseudotumor presents with abrupt, painful onset, and CT scan shows a diffuse process with no distinct mass to biopsy. Chronic or recurrent pseudotumor leads to a mass of fibrosis apparent on CT scan, which should be biopsied. Lymphoid tumor presents without pain, and orbital CT scan shows a homogenous mass that should be biopsied. Acute pseudotumor usually responds to steroids, but patients with chronic or recurrent pseudotumor may require low-dose radiation or immunosuppressive therapy. Lymphoid tumors that are classified as reactive lymphoid hyperplasia initially may be treated with steroids, followed by low-dose radiation if steroids are ineffective. Orbital lymphomas are treated with higher dose radiation and, perhaps, chemotherapy, if systemic disease is present. Reports of representative cases of acute and chronic pseudotumor and lymphoid tumor illustrate the distinguishing clinical, radiologic and pathologic characteristics of each type of tumor, and recommendations for management of each type are outlined.

Maternal serum alpha-fetoprotein (MSAFP) screening: the Keesler experience

Maternal serum alpha-fetoprotein (MSAFP) screening is rapidly becoming a standard of practice in all regions of the United States and Canada. This paper will review the initial results of MSAFP screening in 761 patients at USAF Medical Center Keesler, and offer recommendations for Department of Defense hospitals offering such testing.

Breast carcinoma metastatic to the orbit

Breast carcinoma metastatic to the orbit presented in four patients as a diffuse mass lesion. Clinical findings included restricted ocular motility, palpable mass, enophthalmos, and ptosis. The delay in diagnosis in three cases was due to subtle early findings, the long time interval from the primary breast lesion, lack of other metastases, and, in each of the four cases, the patient's reluctance to disclose any history of breast disease. Pathologic examination of the orbital breast metastases revealed two types: an adenocarcinomatous pattern with nests of pleomorphic malignant appearing cells and a histiocytoid variant with bland, large cells similar to histiocytes.

The association of congenital ptosis and congenital heart disease

Congenital ptosis and congenital heart disease are known to occur simultaneously in the presence of several well-recognized clinical syndromes. We report seven cases of documented, structural congenital heart defects found among 156 consecutive congenital ptosis patients operated at the Wills Eye Hospital. The possibility that the concurrence found in the patients was a manifestation of a dysmorphic syndrome was carefully excluded by observers skilled in the recognition of such anomalies. The observed rate of congenital heart disease, in otherwise normal congenital ptosis patients, was five times the expected rate in the pediatric population at large. This should alert ophthalmologists examining pediatric ptosis patients to the possibility of a coexisting structural heart defect.

Ocular motility disturbances following cosmetic blepharoplasty

Five patients developed diplopia following cosmetic blepharoplasty. While temporary diplopia and visual disturbances are known to occur following this type of surgery, the persistence of diplopia with demonstrable muscle imbalance is not common. We encountered ocular motility complications involving the inferior or oblique muscle, inferior rectus muscle, and superior oblique tendon.

Pediatric dacryocystorhinostomy

Dacryocystorhinostomy (DCR) often has uncertain results in the pediatric age group. Poorly defined and rapidly changing anatomy, along with a tendency toward vigorous growth of scar tissue, may alter surgical results. We report our experience with 29 primary pediatric dacryocystorhinostomies and five reoperations. Strict attention to surgical anatomy allows attainment of success results (83%) comparable with those in adults in both traumatic and nontraumatic cases. Our results, surgical technique, and evaluation of failures are discussed. Meticulous suturing of anterior and posterior flaps is not necessary for good surgical results. Dacryocystorhinostomy is a successful therapeutic modality in childhood dacryostenosis with chronic dacryocystitis when medical therapy, probing, and silicone intubation have been unsuccessful.

The histopathology of involutional ectropion

Twenty eyelid specimens from patients with involutional ectropion, obtained by full-thickness horizontal shortening procedures, were examined histopathologically by light and electron microscopy and compared with six normal eyelids from exenteration specimens. Paralytic, cicatricial, and congenital ectropions were excluded from the study. The main histopathologic features included: (1) collagen degeneration and elastosis of the tarsal plate; (2) increased amounts of adipose tissue in the distal tarsus and capsulopalpebral fascia; (3) subacute inflammation and epidermidalization of the tarsal conjunctiva; (4) focal degeneration, fibrosis and elastosis of pretarsal orbicularis, and occasionally minimal change in the muscle of Riolan; and (5) arteriosclerosis of the marginal artery. The combination of these histopathologic changes characterize and may contribute to the development of ectropion of the eyelid associated with aging.

Classification and incidence of space-occupying lesions of the orbit. A survey of 645 biopsies

Six hundred forty-five consecutive biopsies of orbital lesions performed at a major ophthalmic hospital during a 20-year period were used to develop a comprehensive classification of orbital tumors and pseudotumors, excluding thyroid orbitopathy. Although this series has certain bias, it probably closely parallels the incidence of orbital lesions that would prompt a biopsy in an ophthalmic practice. It is hoped that this review, combined with a familiarity of the signs and symptoms of various orbital lesions, will aid the clinician in the diagnostic evaluation of the patient with an orbital mass.

Management of orbital inflammatory disease. A protocol

A step-by-step practical approach to orbital inflammatory disease is presented. In our hands, this proposed protocol has been useful. In any patient with orbital inflammatory disease, the ophthalmologist must initially rule out a life-threatening bacterial orbital cellulitis. Because the orbital disease presentation may be part of a systemic process, a good history and appropriate systemic work-up are mandatory. If any suspicion of bacterial orbital cellulitis exists, we recommend that intravenous antibiotics be instituted. Concurrently, orbital computerized tomographic scan may be extremely helpful in the work-up. Specifically, three findings--presence of an orbital-mass lesion without sinus involvement or bone erosion, presence of an orbital-mass lesion with sinus involvement or bone changes, or thickened extraocular muscles on CT scan--lead to the differential diagnosis, decision to biopsy, and appropriate treatment.

Treatment of congenital ptosis with frontalis suspension: a comparison of suspensory materials

One hundred forty-five consecutive frontalis suspension procedures performed during the years 1976 to 1982 at the Wills Eye Hospital for the repair of congenital ptosis were reviewed. Results with nylon polyfilament cable-type suture ( Supramid Extra) as the suspensory material were compared to results with allogenic fascia lata. Forty-nine of the 121 polyfilament cable-type suture procedures (40.5%) were considered failures either because of ptosis recurrence (28.1%) or granuloma formation (12.4%). Only two of 24 (8.3%) of the fascia lata cases failed. No granuloma was associated with the use of fascia lata. The clinical and pathologic characteristics of ptosis recurrence and suture-rejection granuloma formation are discussed. Available preparations of allogenic fascia lata are reviewed and suggested as alternatives to the use of nylon polyfilament cable-type sutures for the repair of congenital ptosis.

An unusual late complication of orbital floor fracture repair

Three patients developed unilateral proptosis 13, 16, and 20 years after repair of blow-out fracture with orbital floor Teflon implants. In one patient trauma preceded the onset of proptosis. In all three cases, the cause of the proptosis was probably hemorrhage of the capillaries in a fibrous capsule that surrounded the implant and that was evident on orbital CT scan. In two cases on CT scan, a retrobulbar cyst-like structure surrounded the implant, which was confirmed on ultrasonography. In the third case, an irregular soft-tissue density surrounded the implant. Histologically, a fibrous capsule surrounded the implant in all three cases, and in one case, the inner lining of the fibrous capsule was respiratory epithelium. The contents of the cyst-like structure, in two cases, were fresh blood and disintegrating red blood cells and blood products. In the third case, no cyst-like structure or "cyst" contents were identified; however, fibrous tissue containing hemosiderin-laden macrophages suggested the presence of an organized hemorrhage. The patients' proptosis resolved almost completely after surgical removal of the implant, decompression of the "cyst," and partial removal of the "cyst" wall in two cases. The same result followed removal of the implant and part of the fibrous capsule in the third case.

Conjunctivodacryocystorhinostomy with mucous membrane graft

Eleven patients with obstructed lacrimal canaliculi underwent conjunctivodacryocystorhinostomy modified by lining the fistula with buccal mucosa at the time of surgery. Four patients had the tube removed after six months. All four have parent mucous membrane lined fistulas with follow-up ranging from ten to 13 months. One patient removed his tube on the second post-operative day. His fistula closed immediately. For comparison, the remaining six patients retain their tubes. They are free from epiphora but suffer from some of the complications of the tube itself, namely tube extrusion, tube migration, and chronic conjunctival irritation and discharge. The surgical technique is described, histopathologic material is presented, and the initial results are discussed.

Retrobulbar anesthesia and retinal vascular obstruction

The cases of three patients who developed combined central retinal artery/vein obstruction secondary to retrobulbar anesthesia are presented. In one case the obstruction was presumably present immediately after surgery, while in the other two it was observed to evolve over a period of several days. A dilated optic nerve sheath was demonstrated by contact B-scan ultrasonography in two cases and by computerized tomography in the third case, suggesting intravaginal sheath hemorrhage as a common underlying pathophysiologic process. Partial return of vision was evident in the latter case following orbitotomy with optic nerve sheath decompression.

Complications of orbital roof fractures

A spectrum of complications of orbital roof fractures is discussed. The authors have had cooperation with the neurosurgical service in treating nine cases. Careful ocular and neurologic examination of the patient is emphasized in an attempt to avoid ocular complications, orbital deformities, ocular muscular imbalance, enophthalmos, blepharoptosis, and intracranial complications. With intracranial involvement, a combined neurosurgical and ophthalmologic approach is indicated. A superior orbitomy is indicated if there is a simple fracture of the orbital roof without involvement of the inner table of the skull.

Experience with dermis-fat grafting: an analysis of early postoperative complications and methods of prevention

During the past 18 months at Wills Eye Hospital we have performed autogenous dermis-fat grafts to anophthalmic orbits in 16 patients. Six early postoperative complications of dermis-fat grafting are presented and discussed, as are the modifications of surgical technique that we feel may minimize early postoperative complications.