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Azzam DB, Vagefi MR, Vuong LN. Cranio-Orbital Fibrous Dysplasia Manifesting as Contralateral Optic Neuropathy. Ophthalmology 2024:S0161-6420(24)00205-7. [PMID: 38661614 DOI: 10.1016/j.ophtha.2024.03.024] [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: 01/21/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Daniel B Azzam
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - M Reza Vagefi
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; Division of Oculofacial Plastic Surgery, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Laurel N Vuong
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; Division of Neuro-Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
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Ruan MZC, Meer E, Kaur G, Namiri NK, Ashraf DC, Winn BJ, Kersten R, Vagefi MR, Grob S. Eye and Orbit Injuries Caused by Electric Scooters and Hoverboards in the United States. Clin Ophthalmol 2024; 18:809-816. [PMID: 38504934 PMCID: PMC10949383 DOI: 10.2147/opth.s452750] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/09/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction To evaluate eye and orbital injuries in non-powered scooter, electric-scooter (e-scooter), and hoverboard riders in the United States (US) between 2014 and 2019. Methods The National Electronic Injury Surveillance System (NEISS) was queried for head and neck injuries by body part codes related to non-powered scooters and powered scooters/hoverboards from 2014 to 2019. The NEISS complex sampling design was used to obtain US population projections of injuries and hospital admissions. Keywords were queried in case narratives to analyze trends in location, type, and mechanism of eye and orbit injuries. Results Since their introduction, a 586% (p=0.01) increase in e-scooter injuries and 866% (p<0.001) increase in hoverboard injuries were observed with an increase in hospital admissions seen in young adults (18-34) in urban areas (e-scooter: 5980% and hoverboard: 479%). Descriptive narratives of the trauma noted eye injuries in 242 unweighted NEISS cases with only 30 cases appropriately documented under body part code 77: eyeball. Eye injuries increased 96.9% during the study period (p=0.23). Specifically, the most common ophthalmic injuries reported included eyebrow (40.9%) and eyelid (11.3%) lacerations, periorbital contusions (18.7%), orbit fractures (6.6%), and corneal abrasions (5.1%). Conclusion There was a significant increase in both head and neck injury cases and hospital admissions related to e-scooters. Eye and orbit injuries similarly increased but were underreported by body part code compared to injury narratives. Orbital fractures were reported more frequently in injuries from e-scooters than non-powered scooters.
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Affiliation(s)
- Merry Z C Ruan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elana Meer
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gurbani Kaur
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nikan K Namiri
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Davin C Ashraf
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Oregon Health & Sciences University, Portland, OR, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Robert Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Division of Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
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Smith LD, Ahmad M, Ashraf DC, Kersten RC, Winn BJ, Grob SR, Vagefi MR. Cutaneous Mucormycosis of the Eyelid Treated With Subcutaneous Liposomal Amphotericin B Injections. Ophthalmic Plast Reconstr Surg 2024; 40:e42-e45. [PMID: 37995143 PMCID: PMC10922450 DOI: 10.1097/iop.0000000000002545] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Cutaneous mucormycosis is a rare, opportunistic fungal infection that typically affects immunocompromised hosts. Current treatment consists of systemic antifungal therapy, surgical debridement, and when applicable, restoration of immune function. Despite intervention, the morbidity and mortality of invasive fungal disease remains high. There are few reports of primary or secondary cutaneous mucormycosis involving the ocular adnexa. The authors describe the course of 2 children with cutaneous mucormycosis of the eyelid treated with subcutaneous liposomal amphotericin B (LAmB) injections (3.5 mg/ml) in an off-label application as an adjunct to debridement and systemic antifungal therapy. To the authors' knowledge, these are the first 2 cases of invasive fungal disease involving the eyelid treated with subcutaneous LAmB injections, and the first reported case of disseminated fungal infection with secondary cutaneous involvement of the eyelid.
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Affiliation(s)
- Loreley D Smith
- The Pacific Center for Oculofacial and Aesthetic Plastic Surgery, San Francisco, California, U.S.A
- California Pacific Medical Center, San Francisco, California, U.S.A
- University of California San Francisco, San Francisco, California, U.S.A
| | - Meleha Ahmad
- University of California San Francisco, San Francisco, California, U.S.A
| | - Davin C Ashraf
- University of California San Francisco, San Francisco, California, U.S.A
- Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Robert C Kersten
- University of California San Francisco, San Francisco, California, U.S.A
- University of Utah, Salt Lake City, Utah, U.S.A
| | - Bryan J Winn
- University of California San Francisco, San Francisco, California, U.S.A
| | - Seanna R Grob
- University of California San Francisco, San Francisco, California, U.S.A
| | - M Reza Vagefi
- University of California San Francisco, San Francisco, California, U.S.A
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
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Wang L, Ashraf DC, Deiner M, Idowu OO, Grob SR, Winn BJ, Vagefi MR, Kersten RC. Evaluating for unrecognized deficits in perimetry associated with functional upper eyelid malposition. Adv Ophthalmol Pract Res 2024; 4:39-44. [PMID: 38406664 PMCID: PMC10891280 DOI: 10.1016/j.aopr.2024.01.007] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
Objective To investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing. Methods In this retrospective pre-post study, an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020. Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses. As part of routine practice, glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition; taped examinations were excluded from analysis. Clinical and demographic characteristics, mean deviation, and pattern standard deviation were evaluated within a two year period before and after eyelid surgery. Results The final analysis included 60 eyes of 38 patients. Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses. Among patients with ptosis, the margin reflex distance-1 was not associated with change in mean deviation after surgery (Pearson R2 = 0.0061; P = 0.700). Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery. Conclusions Functional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields. Unreliable visual fields could be a sign of eyelid interference in this population.
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Affiliation(s)
- Linyan Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Oregon Health and Science University, Portland, USA
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, San Francisco, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Tufts Medical Center, Boston, USA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California, San Francisco, USA
- Department of Ophthalmology, Tufts Medical Center, Salt Lake City, USA
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5
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Chang CC, Saifee M, Ton L, Ashraf D, Winn BJ, Kersten R, Vagefi MR, Deiner M, Grob SR. Eye Trauma in Mixed Martial Arts and Boxing. Ophthalmic Plast Reconstr Surg 2024; 40:75-87. [PMID: 37656909 PMCID: PMC10926996 DOI: 10.1097/iop.0000000000002510] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN Retrospective cohort study. METHODS Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.
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Affiliation(s)
- Chih-Chiun Chang
- University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Murtaza Saifee
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Lauren Ton
- University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Davin Ashraf
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, Oregon Health & Sciences University, Portland, Oregon, U.S.A
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert Kersten
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- F.I. Proctor Foundation, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
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Tao JP, Shen JF, Aakalu VK, Foster JA, Freitag SK, McCulley TJ, Vagefi MR, Kim SJ, Wladis EJ. Thermal Pulsation in the Management of Meibomian Gland Dysfunction and Dry Eye: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:1336-1341. [PMID: 37642619 DOI: 10.1016/j.ophtha.2023.07.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To review the literature to determine the efficacy and safety of thermal pulsation technologies in improving signs or symptoms of meibomian gland dysfunction (MGD) and dry eye compared with no therapy or with conventional warm compress therapy or eyelid hygiene. METHODS A literature search was conducted in the PubMed database in June 2022 and again in March 2023 to identify all studies in the English language on the use of thermal pulsation to treat MGD or dry eye. The search yielded 59 citations, and 11 articles met all of the inclusion criteria. The panel methodologist then assigned a level of evidence rating for each study; 8 studies were rated level I evidence and 3 studies were rated level II evidence. RESULTS All included studies evaluated a single 12-minute session using the LipiFlow automated thermal pulsation system (TearScience, Inc, or Johnson & Johnson). Improvements were detected in subjective and objective metrics of MGD or dry eye in patients within 1 to 12 months of thermal pulsation treatment compared with nontreatment. Most of the studies (9/11) reported greater efficacy with thermal pulsation than with standard warm compress therapy and eyelid hygiene. Four of these studies showed relevant industry conflicts of interest. Two of the 4 level I studies without direct industry participation concluded that thermal pulsation treatment was not significantly different from conventional hygiene or warm compress therapy control treatments (in symptoms in one of the studies and in objective findings in the second study). No serious adverse events were reported in any of the 11 studies. CONCLUSIONS According to the current literature, a single thermal pulsation session may improve subjective or objective parameters of MGD and dry eye safely. However, industry support and participation were present in 4 of the 8 level I studies. The durability beyond several months and cost efficacy remain uncertain. Because the inclusion parameters of this assessment captured only the LipiFlow system, the conclusions are limited to that product. High-quality independent studies are needed to assess the long-term benefits of this intervention. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
| | | | - Vinay K Aakalu
- Department of Ophthalmology and Visual Sciences University of Michigan, Ann Arbor, Michigan
| | - Jill A Foster
- Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
| | - Suzanne K Freitag
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Timothy J McCulley
- Department of Ophthalmology, John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - M Reza Vagefi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
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Freitag SK, Aakalu VK, Foster JA, McCulley TJ, Tao JP, Vagefi MR, Yen MT, Kim SJ, Wladis EJ. Use of Mitomycin C in Dacryocystorhinostomy: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:1212-1220. [PMID: 37656088 DOI: 10.1016/j.ophtha.2023.06.024] [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: 05/15/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To review the literature on the adjuvant use of mitomycin C (MMC) during dacryocystorhinostomy (DCR) in adults with primary nasolacrimal duct obstructions (NLDOs) to determine the efficacy in improving functional and anatomic outcomes with an acceptable level of risk. METHODS A literature search conducted in November 2020 and updated in November 2022 yielded 137 articles. Twenty-four articles met the inclusion criteria and were rated for level of evidence by the panel methodologist. Inclusion criteria required controlled studies on the effect of MMC on outcomes of external, endoscopic endonasal, or diode laser-assisted transcanalicular DCR in adults with primary acquired nasolacrimal obstruction with 6 months minimum follow-up and at least 10 participants. RESULTS Six of the 24 articles were rated level I evidence, 15 level II , and 3 level III. In primary external DCR, MMC significantly improved functional outcomes in 3 of 9 series. In primary endoscopic endonasal DCR, MMC significantly improved functional outcomes in 1 of 9 series. In revision endoscopic endonasal DCR, MMC significantly improved functional success in 1 of 3 series. The use of MMC did not improve outcomes statistically in any diode laser-assisted transcanalicular DCR studies. Concentrations of MMC ranged from 0.05 to 1 mg/ml, with 0.2 mg/ml used most frequently in 12 series, with duration of application ranging from 2 to 30 minutes. Ostium size was significantly larger in MMC groups than in control groups at 6 months after surgery in 4 of 5 reporting studies. However, these larger ostia did not confer higher functional success rates. Reporting of adverse events related to MMC were rare, with delayed cutaneous wound healing reported in 1 of 750 patients. CONCLUSIONS Intraoperative use of MMC in external and endoscopic endonasal DCR has been shown to improve functional and anatomic outcomes compared with controls in some series, but there is no agreement on the recommended concentration or application time for MMC in DCR. The data support that MMC use can result in a larger ostium size, decreased granulation tissue formation, and a decreased number of postoperative nasal debridements compared with controls, but this does not translate into improved functional success. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Suzanne K Freitag
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Vinay K Aakalu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Jill A Foster
- Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
| | - Timothy J McCulley
- Department of Ophthalmology, John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
| | - M Reza Vagefi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Michael T Yen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
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Idowu OO, Soderlund KA, Ashraf DC, Vagefi MR. Reply. Ophthalmology 2023; 130:e37-e38. [PMID: 37380130 DOI: 10.1016/j.ophtha.2023.06.022] [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: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Genentech, Inc., South San Francisco, California
| | - Karl A Soderlund
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California; Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts.
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9
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Bernier M, Miller A, Leung V, Vagefi MR, Kersten RC, Kalin-Hajdu E. Dacryoscintigraphy as a guide for surgery in patients with functional epiphora. Can J Ophthalmol 2023:S0008-4182(23)00169-2. [PMID: 37290488 DOI: 10.1016/j.jcjo.2023.05.007] [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] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 01/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate how dacryoscintigraphy (DSG) may benefit surgical planning for functional epiphora. METHODS A retrospective multicentred case series was performed on patients with symptomatic tearing despite no identified external cause and normal lacrimal probing and irrigation (i.e., functional epiphora). All patients had preoperative DSG testing. Patients were excluded if DSG testing failed to detect a tear flow abnormality. Those with delayed tear flow prior to entering the lacrimal sac (presac) on DSG underwent surgery aimed at improving flow into the lacrimal sac. Those with delayed tear flow after the lacrimal sac (postsac) on DSG underwent dacryocystorhinostomy. Surgical success was defined as complete resolution of the epiphora, significantly improved, or partially improved. Surgical failure was defined as epiphora being unchanged or worse than at the preoperative timepoint. RESULTS A total of 77 cases (53 patients) of DSG-guided surgery were included. A presac delay was observed in 14 cases (18.2%) and post-sac delay in 63 (81.8%). Overall surgical success was 83.1% across the cohort. Success was 100% in the presac group and 79.4% in the postsac group (p = 0.06). Mean follow-up time was 22 months (SD = 21 months). CONCLUSION A role was demonstrated for DSG in the planning of surgery for patients with functional epiphora. The DSG-guided approach, when compared with empirical lacrimal intubation or dacryocystorhinostomy, may be especially useful in cases of functional epiphora that are presac in nature.
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Affiliation(s)
- Mikaël Bernier
- Department of Ophthalmology, University of Montreal, Montreal, Que
| | - Amanda Miller
- Department of Ophthalmology, University of California-San Francisco, San Francisco, Calif
| | - Victoria Leung
- Department of Ophthalmology, William Osler Health System, Brampton, Ont
| | - M Reza Vagefi
- Department of Ophthalmology, University of California-San Francisco, San Francisco, Calif
| | - Robert C Kersten
- Department of Ophthalmology, University of California-San Francisco, San Francisco, Calif
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Que..
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Stallworth JY, Hoffman WY, Vagefi MR, Indaram M. Superior oblique palsy after facial feminization surgery. J AAPOS 2023; 27:165-166. [PMID: 37031917 DOI: 10.1016/j.jaapos.2023.03.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/18/2023] [Accepted: 03/05/2023] [Indexed: 04/11/2023]
Abstract
Facial feminization surgery (FFS), or gender-affirming facial surgery, is a common procedure for patients with gender dysphoria. One goal of FFS involves extensive contouring of the frontal and nasal bones to reduce supraorbital bossing. Ophthalmic complications after FFS have been rarely reported. We report 2 cases of superior oblique palsy after FFS producing persistent vertical and torsional diplopia. One case was successfully treated with prism spectacles; the other required surgical management. Both cases likely involved surgical trauma to or disinsertion of the trochlea during orbital bony reshaping.
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Affiliation(s)
| | - William Y Hoffman
- Department of Plastic and Reconstructive Surgery, University of California San Francisco
| | - M Reza Vagefi
- Department of Ophthalmology, University of California San Francisco
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco
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Lussier C, Leung VC, El-Khazen Dupuis J, Ashraf DC, Idowu OO, Massicotte E, Vagefi MR, Kersten RC, Kalin-Hajdu E. Prevalence and Predictors of Hering's Response in Müller's Muscle-conjunctival Resection. Ophthalmic Plast Reconstr Surg 2023; 39:237-242. [PMID: 36700873 DOI: 10.1097/iop.0000000000002297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Determine the prevalence and predictors of Hering's response following Muller's muscle-conjunctival resection (MMCR). METHODS Seventy-five consecutive patients undergoing unilateral MMCR were recruited in this prospective, multicenter, cohort study. Margin-reflex distance-1 (MRD1) of both eyelids was recorded preoperatively and postoperatively. One hundred forty-three variables were investigated as potential predictors of a late postoperative (≥3 months) Hering's response using regression analyses. Main outcome measures were Hering's response (≥0.5 mm descent of the unoperated eyelid from baseline), and a clinically relevant Hering's response (descent of the unoperated from baseline to a MRD1 ≤ 2.0 mm, or descent from baseline such that the MRD1 of the unoperated eyelid became >1 mm lower than the operated eyelid). RESULTS Twenty-four (32.0%) patients had a late postoperative Hering's response, but only 6 (8.0%) responses were clinically relevant. A Hering's response at the immediate (OR 16.24, p = 0.02) and 1-week postoperative (OR 8.94, p = 0.04) timepoints predicted a late postoperative response. However, the presence (OR 7.84, p = 0.07) and amplitude (OR 8.13, p = 0.06) of a preoperative phenylephrine Hering's response did not predict a late postoperative response. Of the 10 patients with a clinically relevant phenylephrine Hering's response, only 1 demonstrated a clinically relevant response late postoperatively. CONCLUSION Unilateral MMCR induces a clinically relevant Hering's response in 8% of patients. A preoperative phenylephrine Hering's response does not predict a late postoperative Hering's response. Therefore, when unilateral phenylephrine testing unmasks contralateral blepharoptosis, only the side with blepharoptosis at baseline should be operated.
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Affiliation(s)
- Charlotte Lussier
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Victoria C Leung
- Department of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada
| | | | - Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Erika Massicotte
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Leung VC, Dupuis JEK, Ashraf DC, Idowu OO, Massicotte E, Vagefi MR, Kersten RC, Kalin-Hajdu E. Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success. Ophthalmic Plast Reconstr Surg 2023; 39:226-231. [PMID: 36356179 DOI: 10.1097/iop.0000000000002292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE This is a multicenter prospective cohort study investigating Müller muscle conjunctival resection success rates based on marginal reflex distance-1 (MRD1) and symmetry criteria. A secondary objective was to identify predictors of success. METHODS One hundred fifty-two patients with unilateral or bilateral blepharoptosis (229 eyelids) undergoing Müller muscle conjunctival resection were consecutively recruited from 2015 to 2020 at the Université de Montréal and University of California San Francisco. Ptosis was defined as MRD1 ≤ 2.0 mm or MRD1 > 1 mm lower than the contralateral eyelid. Patients were selected for Müller muscle conjunctival resection surgery if they demonstrated significant eyelid elevation following phenylephrine 2.5% testing. MRD1 success (operated eyelid achieving MRD1 ≥ 2.5 mm) and symmetry success (patient achieving an intereyelid MRD1 difference ≤ 1 mm) were evaluated for the patient cohort. Predictors of MRD1 and symmetry success were analyzed using multivariate regression analysis. RESULTS MRD1 success was achieved in 72.1% (n = 165) of 229 operated eyelids. Symmetry success was achieved in 75.7% (n = 115) of 152 patients. MRD1 before phenylephrine testing was the only statistically significant predictor of MRD1 success (odds ratio [OR] 2.69, p = 0.001). Symmetry following phenylephrine testing was the only variable associated with increased odds of symmetry success (OR 2.71, p = 0.024), and unilateral surgery (OR 0.21, p = 0.004), the only variable associated with reduced odds of symmetry success. CONCLUSIONS Müller muscle conjunctival resection effectively achieves postoperative MRD1 and symmetry success. MRD1 before phenylephrine testing is the strongest determinant of MRD1 success. Neither a large rise in MRD1 with phenylephrine nor increasing tissue resection length adequately counterbalance the effect of a low MRD1 before phenylephrine. Unilateral surgery and the absence of symmetry following phenylephrine predict greater odds of symmetry failure.
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Affiliation(s)
- Victoria C Leung
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | | | - Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Erika Massicotte
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
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Vagefi MR, Idowu OO, Miller A, Doan T, Chen C, Hinterwirth A, Zhong L, Ahmad M, Ashraf DC, Grob SR, Kersten RC, Winn BJ. Metagenomic Deep Sequencing for Orbital Inflammatory Disease. Ocul Immunol Inflamm 2023:1-4. [PMID: 37068263 PMCID: PMC10579447 DOI: 10.1080/09273948.2023.2199061] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Orbital inflammatory disease (OID) is a heterogeneous group of immunologic disorders whose etiology is often non-specific despite routine investigation. In this proof-of-concept study, metagenomic deep sequencing (MDS) is applied to examine host gene expression in two subtypes of OID. METHODS Prospectively collected lacrimal gland tissue from patients with OID was processed for MDS. Differential gene expression analysis was performed to evaluate for host transcriptome signatures. Proof-of-concept comparison was made between histologically confirmed samples of idiopathic dacryoadenitis and IgG4-related disease (IgG4-RD). RESULTS Twelve genes were identified to be differentially expressed between idiopathic dacryoadenitis and IgG4-RD. Differences in innate humoral immunity gene expression were observed. Several additional genes of interests were also found to be upregulated in idiopathic dacryoadenitis. CONCLUSIONS A unique transcriptome signature was found when comparing idiopathic dacryoadenitis to IgG4-RD. This suggests that MDS can identify differentially expressed genes in OID. Such insight could potentially provide a better understanding of host gene expression and the inflammatory pathways involved in OID.
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Affiliation(s)
- M. Reza Vagefi
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Amanda Miller
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Thuy Doan
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Cindi Chen
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Meleha Ahmad
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Davin C. Ashraf
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Seanna R. Grob
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Robert C. Kersten
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California San Francisco, San Francisco, CA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121
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Kinde B, Ahmad M, Vagefi MR. Concurrent Mucocele and Silent Sinus Syndrome after Orbital Fracture Repair. Ophthalmology 2023; 130:344. [PMID: 35973853 DOI: 10.1016/j.ophtha.2022.06.039] [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: 06/21/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- Benyam Kinde
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Idowu OO, Soderlund KA, Laguna B, Ashraf DC, Arnold BF, Grob SR, Winn BJ, Russell MS, Kersten RC, Dillon WP, Vagefi MR. Magnetic Resonance Imaging Prognostic Findings for Visual and Mortality Outcomes in Acute Invasive Fungal Rhinosinusitis. Ophthalmology 2022; 129:1313-1322. [PMID: 35768053 DOI: 10.1016/j.ophtha.2022.06.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To identify initial, preintervention magnetic resonance imaging (MRI) findings that are predictive of visual and mortality outcomes in acute invasive fungal rhinosinusitis (AIFRS). DESIGN Retrospective cohort study. PARTICIPANTS Patients with histopathologically or microbiologically confirmed AIFRS cared for at a single, tertiary academic institution between January 2000 and February 2020. METHODS A retrospective review of MRI scans and clinical records of patients with confirmed diagnosis of AIFRS was performed. For each radiologic characteristic, a modified Poisson regression with robust standard errors was used to estimate the risk ratio for blindness. A multivariate Cox proportional hazards model was used to study AIFRS-specific risk factors associated with mortality. MAIN OUTCOME MEASURE Identification of initial, preintervention MRI findings associated with visual and mortality outcomes. RESULTS The study comprised 78 patients (93 orbits, 63 with unilateral disease and 15 with bilateral disease) with AIFRS. The leading causes of immunosuppression were hematologic malignancy (38%) and diabetes mellitus (36%). Mucormycota constituted 56% of infections, and Ascomycota constituted 37%. The overall death rate resulting from infection was 38%. Risk factors for poor visual acuity outcomes on initial MRI included involvement of the orbital apex (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1-3.8; P = 0.026) and cerebral arteries (RR, 1.8; 95% CI, 1.3-2.5; P < 0.001). Increased mortality was associated with involvement of the facial soft tissues (hazard ratio [HR], 4.9; 95% CI, 1.3-18.2; P = 0.017), nasolacrimal drainage apparatus (HR, 5.0; 95% CI, 1.5-16.1; P = 0.008), and intracranial space (HR, 3.5; 95% CI, 1.4-8.6; P = 0.006). Orbital soft tissue involvement was associated with decreased mortality (HR, 0.3; 95% CI, 0.1-0.6; P = 0.001). CONCLUSIONS Extrasinonasal involvement in AIFRS typically signals advanced infection with the facial soft tissues most commonly affected. The initial, preintervention MRI is prognostic for a poor visual acuity outcome when orbital apex or cerebral arterial involvement, or both, are present. Facial soft tissues, nasolacrimal drainage apparatus, intracranial involvement, or a combination thereof is associated with increased mortality risk, whereas orbital soft tissue involvement is correlated with a reduced risk of mortality.
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Affiliation(s)
- Oluwatobi O Idowu
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Karl A Soderlund
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Benjamin Laguna
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Davin C Ashraf
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Benjamin F Arnold
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Seanna R Grob
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Bryan J Winn
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Matthew S Russell
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Robert C Kersten
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - M Reza Vagefi
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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Ashraf DC, Miller A, Ahmad M, Smith LD, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Augmentation of telemedicine post-operative follow-up after oculofacial plastic surgery with a self-guided patient tool. Orbit 2022:1-11. [PMID: 35920583 DOI: 10.1080/01676830.2022.2104325] [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] [Indexed: 10/16/2022]
Abstract
PURPOSE This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery. METHODS Adult, English-speaking patients undergoing periocular surgery with telemedicine follow-up were studied prospectively in this interventional case series. Participants submitted visual acuity measurements and photographs via a web-based tool prior to routine telemedicine post-operative visits. An after-visit survey assessed patient perceptions. Surgeons rated photographs and live video for quality and blurriness; external raters also evaluated photographs. Images were analyzed for facial centration, resolution, and algorithmically detected blur. Complications were recorded and graded for severity and relation to telemedicine. RESULTS Seventy-nine patients were recruited. Surgeons requested an in-person assessment for six patients (7.6%) due to inadequate evaluation by telemedicine. Surgeons rated patient-provided photographs to be of higher quality than live video at the time of the post-operative visit (p < 0.001). Image blur and resolution had moderate and weak correlation with photograph quality, respectively. A photograph blur detection algorithm demonstrated sensitivity of 85.5% and specificity of 75.1%. One patient experienced a wound dehiscence with a possible relationship to inadequate evaluation during telemedicine follow-up. Patients rated the telemedicine experience and their comfort with the structure of the visit highly. CONCLUSIONS Augmented telemedicine follow-up after oculofacial plastic surgery is associated with high patient satisfaction, rare conversion to clinic evaluation, and few related post-operative complications. Automated detection of image resolution and blur may play a role in screening photographs for subsequent iterations of the web-based tool.
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Affiliation(s)
- Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Amanda Miller
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Loreley D Smith
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Ophthalmology Section, Surgical Service, San Francisco Veterans' Affairs Health Care System, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Maru JA, Carvajal ND, de Alba Campomanes AG, Parikh N, Ashraf DC, Kersten RC, Winn BJ, Vagefi MR, Grob SR. Perceived Barriers to Increasing Diversity within Oculofacial Plastic Surgery. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0042-1758561] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose Physician diversity is limited in ophthalmology and oculofacial plastic surgery. Determination of barriers within the application process for oculofacial plastic surgery may help target efforts to improve the recruitment of underrepresented groups. This study aimed to illuminate perceived barriers to increasing diversity in oculofacial plastic surgery trainees, according to the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellows and fellowship program directors (FPDs).
Methods During the month of February 2021, we sent surveys out to 54 current oculofacial plastic surgery fellows and 56 FPDs at 56 oculofacial plastic surgery programs recognized by the ASOPRS nationwide using a 15-question Qualtrics survey.
Results Sixty-three individuals (57%) responded to the survey: 34 fellows (63%) and 29 FPDs (52%). Eighty-eight percent of fellows and 68% of FPDs identified as non-underrepresented in medicine (UiM). Forty-four percent of fellows and 25% of FPDs identified as men. FPDs most commonly noted, “Not enough minorities applying to our program” and “The objective data (Ophthalmic Knowledge Assessment Program score, United States Medical Licensing Examination Step scores, clinical honors, Alpha Omega Alpha status, letter of recommendation) for minority applicants often do not meet the threshold required to offer an interview or to be ranked to match” as barriers. Among fellows, the lowest-rated considerations when applying to oculofacial plastic surgery were “Racially/ethnically diverse faculty” and “Perceptions of minority candidates by fellowship programs,” whereas “Likelihood of matching in program of choice” was ranked highest in considerations. Fellows identifying as men indicated greater concern for “Financial factors related to fellowship (e.g., loans, salary, cost of living, or cost of interviewing)” compared to fellows identifying as women who noted greater concern for “Program or preceptor acceptance of starting or having a family during fellowship.”
Conclusion Responses from FPDs suggest that efforts focused on recruiting and supporting diverse students to medicine and ophthalmology, mentoring applicants interested in oculofacial plastic surgery, and restructuring the application process to decrease bias, may improve diversity within the subspecialty. The lack of UiM representation in this study, 6% fellows and 7.4% FPDs identified as UiM, shows both the stark underrepresentation and the need for further research into this topic.
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Affiliation(s)
- Johsias A. Maru
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Nicole D. Carvajal
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Neeti Parikh
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Robert C. Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Bryan J. Winn
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Seanna R. Grob
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Ashraf DC, Idowu OO, Hirabayashi KE, Kalin-Hajdu E, Grob SR, Winn BJ, Vagefi MR, Kersten RC. Outcomes of a Modified Treatment Ladder Algorithm Using Retrobulbar Amphotericin B for Invasive Fungal Rhino-Orbital Sinusitis. Am J Ophthalmol 2022; 237:299-309. [PMID: 34116011 DOI: 10.1016/j.ajo.2021.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess whether a modified treatment ladder algorithm incorporating transcutaneous retrobulbar amphotericin B (TRAMB) for invasive fungal rhino-orbital sinusitis can reduce the risk of exenteration without compromising survival. DESIGN Retrospective, comparative clinical study with historical control subjects. METHODS Fifty consecutive patients with biopsy-proven invasive fungal sinusitis and radiographic evidence of orbital involvement were evaluated at a single tertiary institution from 1999-2020. TRAMB was incorporated as part of the treatment algorithm in 2015. Demographics, underlying immune derangement, infective organism, ophthalmic examination, surgical care, and survival were compared in a quasiexperimental pre-post format, dividing patients into a pre-2015 group and a post-2015 group. Risk of exenteration and mortality were the primary outcomes. RESULTS Baseline characteristics did not differ significantly between the 2 groups. Nearly all patients underwent a surgical intervention, most commonly functional endoscopic sinus surgery with debridement. TRAMB was administered to 72.7% of the post-2015 group. Exenteration was more common in the pre-2015 group (36.4% vs 9.1% [95% confidence interval {CI} 5.2-48.8]; P = .014), while mortality was similar (40.0% vs 36.7% [95% CI -22.1 to 29.3]; P = .816). After adjusting for potential confounders, patients treated after 2015 were found to have lower risk of exenteration (relative risk 0.28 [95% CI 0.08-0.99]; P = .049) and similar risk of mortality (relative risk 1.04 [95% CI 0.50-2.16]; P = .919). CONCLUSION Compared with historical control subjects, patients with invasive fungal rhino-orbital sinusitis who were treated with a modified treatment ladder algorithm incorporating TRAMB had a lower risk of disfiguring exenteration without an apparent increase in the risk of mortality.
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Affiliation(s)
- Davin C Ashraf
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Oluwatobi O Idowu
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Kristin E Hirabayashi
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology (E.K-H.), Université de Montréal, Montreal, Quebec, Canada
| | - Seanna R Grob
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Bryan J Winn
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - M Reza Vagefi
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA
| | - Robert C Kersten
- From the Department of Ophthalmology (D.C.A., O.O.I., K.E.H., S.R.G., B.J.W., M.R.V., R.C.K.), University of California San Francisco, San Francisco, California, USA.
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Kinde B, Smith LD, Vagefi MR. Exuberant Scleral Calcification from Secondary Hyperparathyroidism. Ophthalmology 2022; 129:413. [DOI: 10.1016/j.ophtha.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 10/18/2022] Open
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Alsoudi AF, Ton L, Ashraf DC, Idowu OO, Kong AW, Wang L, Kersten RC, Winn BJ, Grob SR, Reza Vagefi M. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye Contact Lens 2022; 48:162-168. [PMID: 35296627 PMCID: PMC8931268 DOI: 10.1097/icl.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate whether use of an antibiotic improves the efficacy of care for a chalazion or hordeolum. METHODS A cross-sectional retrospective review was performed. All patients treated for a newly diagnosed chalazion or hordeolum at the University of California, San Francisco from 2012 to 2018 were identified. Patients were excluded when clinical notes were inaccessible or there was inadequate documentation of treatment modality or outcome. Patient demographics, setting of initial presentation, treatment modalities, antibiotic use, and outcomes were analyzed. RESULTS A total of 2,712 patients met inclusion criteria. Management with an antibiotic was observed in 36.5% of patients. An antibiotic was 1.53 times (95% confidence interval [CI], 1.06-2.22, P=0.025) more likely to be prescribed in emergency or acute care setting for a chalazion. Older age was associated with a higher risk of receiving an antibiotic for a hordeolum (adjusted RR 1.07 per decade, 95% CI, 1.05-1.11, P<0.001). The addition of an antibiotic to conservative measures for a chalazion (adjusted RR, 0.97, 95% CI, 0.89-1.04, P=0.393) or hordeolum (adjusted RR, 0.99, 95% CI, 0.96-1.02, P=0.489) was not associated with an increased likelihood of treatment success. CONCLUSION Although frequently prescribed, an antibiotic is unlikely to improve the resolution of a chalazion or hordeolum.
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Affiliation(s)
- Amer F. Alsoudi
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Alan W. Kong
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Linyan Wang
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
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21
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Pongsachareonnont P, Hemarat K, Panjaphongse R, Liu W, Vagefi MR, Stewart JM. Factors associated with the development of blepharoptosis after pars plana vitrectomy surgery. Semin Ophthalmol 2021; 37:509-514. [PMID: 34957908 DOI: 10.1080/08820538.2021.2006240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the incidence and risk factors for developing blepharoptosis after vitrectomy surgery. METHODS This prospective observational study conducted in patients who had vitrectomy surgery at the University of California, San Francisco. The patients' eyelids were photographed before, surgery and follow-up visits at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. Levator excursion (LE), palpebral fissure (PF) height and marginal reflex distance 1 (MRD1) changes from baseline were evaluated. Operative parameters associated with lid parameter changes were analyzed. RESULTS Thirty-eight eyes were enrolled in the study. Multivariate analysis performed for PF changes from pre-operative were -0.47 mm, 0.33 mm, and 0.09 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.1, 0.2, and 0.8). The mean change of LE from preoperative was -0.44 mm, -0.15 mm, and 0.35 mm at 1 week, 1 month and 6 months after surgery, respectively (p-value 0.3, 0.7 and 0.4). The reduction of MRD1 at 1 week, 1 month and 6 months after surgery were -0.08 mm, -0.13 mm and -0.01 mm, respectively (p = .003, p = .6 and 0.9). Triamcinolone usage was associated with reduction of MRD1 and LE. CONCLUSION Blepharoptosis presents most during the first week after surgery. The possibility of developing transient changes in eyelid position after vitrectomy surgery should be discussed with patients.
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Affiliation(s)
- Pear Pongsachareonnont
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornwipa Hemarat
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Ronakorn Panjaphongse
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Department of Ophthalmology, Royal Thai Air Force, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Weifeng Liu
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Department of Ophthalmology, The Third Affiliated Hospital of Nanchang University, Nanchang, China
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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22
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Smith LD, Ashraf DC, Vagefi MR. Schwannoma of the Lacrimal Gland Fossa. Ophthalmology 2021; 129:87. [PMID: 34930553 DOI: 10.1016/j.ophtha.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Loreley D Smith
- Department of Ophthalmology; University of California, San Francisco; San Francisco, California; Department of Ophthalmology; California Pacific Medical Center; San Francisco, California
| | - Davin C Ashraf
- Department of Ophthalmology; University of California, San Francisco; San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology; University of California, San Francisco; San Francisco, California
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23
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Sobel RK, Aakalu VK, Vagefi MR, Foster JA, Tao JP, Freitag SK, Wladis EJ, McCulley TJ, Yen MT. Orbital Radiation for Thyroid Eye Disease: A Report by the American Academy of Ophthalmology. Ophthalmology 2021; 129:450-455. [PMID: 34895729 DOI: 10.1016/j.ophtha.2021.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/27/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the current literature on the safety and efficacy of orbital radiation for the management of thyroid eye disease (TED). METHODS A literature search was conducted last in February 2021 of the PubMed database to identify all articles published in the English language on original research that assessed the effect of orbital radiation on TED. The search identified 55 articles, and 18 met the inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study, and all of them were rated level III. RESULTS Two large retrospective studies demonstrated the efficacy of radiation treatment, with or without corticosteroid use, in preventing or treating compressive optic neuropathy (CON). Three studies highlighted the role of orbital radiation therapy (RT) to facilitate the tapering of corticosteroids. Several other studies showed a possible role for RT to improve diplopia and soft tissue signs. CONCLUSIONS Although no level I or level II evidence exists, the best available evidence suggests that orbital radiation, used with or without corticosteroids, is efficacious in preventing CON, improving motility restriction, and decreasing clinical activity in TED. Orbital radiation also may facilitate a corticosteroid taper. Together, these studies show that RT seems to modify the active phase of TED. Short-term risks of orbital radiation are minor, but long-term outcome data are lacking.
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Affiliation(s)
- Rachel K Sobel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - M Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Jill A Foster
- Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
| | - Suzanne K Freitag
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
| | - Timothy J McCulley
- Ruiz Department of Ophthalmology and Visual Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Michael T Yen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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24
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Kinde B, Idowu OO, Ashraf DC, Chen RM, Hirabayashi KE, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Quality-of-Life Outcomes for Excision and Reconstruction of Periocular Nonmelanoma Skin Cancer. Facial Plast Surg Aesthet Med 2021. [PMID: 34227877 DOI: 10.1089/fpsam.2020.0647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding how periocular nonmelanoma skin cancer (NMSC) impacts quality of life (QoL) provides insight into the patient experience. Objective: To prospectively measure QoL of individuals with surgically treated periocular NMSC. Methods: Responses to the skin cancer index (SCI) and FACE-Q questionnaires were obtained at preoperative (PRE), postoperative week 1 (POW1), and postoperative month 3 (POM3) visits. Statistical analysis was performed using paired t-test and stepwise linear regression. Results: Forty-five patients participated in the study. Improved QoL as reflected in an increased mean difference of the total SCI score at PRE and POM3 visits (25.8, 95% confidence interval [CI 20.0 to 31.6]) and FACE-Q early life impact of treatment score at POW1 and POM3 visits (19.0, 95% CI [14.9 to 23.0), and a decreased mean difference of the FACE-Q adverse effects score at POW1 and POM3 visits (-1.3, 95% CI [-2.4 to -0.1]) was observed. Linear regression of the SCI and FACE-Q scores using demographic and clinical attributes revealed several predictors of postoperative QoL. Conclusions: Surgical management of periocular NMSC results in improved QoL, demonstrated at the final postoperative visit.
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Affiliation(s)
- Benyam Kinde
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Davin C Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Kristin E Hirabayashi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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25
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Kinde B, Vagefi MR, Seitzman GD. Inside-out: Infectious Endophthalmitis with Secondary Corneal Perforation. Ophthalmology 2021; 128:1038. [PMID: 34154723 DOI: 10.1016/j.ophtha.2021.01.008] [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: 12/29/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benyam Kinde
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California
| | - Gerami D Seitzman
- Department of Ophthalmology, University of California - San Francisco, San Francisco, California; Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California
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26
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Radmall BR, Idowu OO, Vagefi MR, Carter KD, Shriver EM. Challenging the current treatment of residual postoperative ptosis: safety and efficacy of repeat Müller's muscle conjunctival resection. Can J Ophthalmol 2021; 57:247-252. [PMID: 34058146 DOI: 10.1016/j.jcjo.2021.04.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine if repeat Müller's muscle conjunctival resection (MMCR) is a viable approach in the treatment of recurrent or residual eyelid ptosis. METHODS A retrospective review of patients who underwent repeat MMCR was performed using external photos obtained preoperatively, postoperatively, and at last follow-up. The marginal reflex distances (MRD1 and MRD2), brow position (BP), and tarsal platform show (TPS) were evaluated with digital image analysis. The change in upper eyelid height (MRD1) and TPS following repeat ptosis repair were the outcome measures. RESULTS Repeat MMCR was performed on 12 eyelids of 11 patients. Mean MRD1 elevation after initial MMCR was 1.6 mm (standard deviation [SD] = 1.0mm, p < 0.00001). Mean decrease in TPS was 1.9 mm (p = 0.04). There was no significant change in MRD2 (p = 0.36) or BP (p = 0.33) with initial MMCR. Mean interval between procedures was 12.8 months (range 2.3-48.0) and follow-up after repeat MMCR was 2.3 months. Total average follow-up after initial MMCR was 15.1 months. Mean elevation in MRD1 after repeat MMCR was 1.0 mm (SD = 0.8 mm, p < 0.002). Mean decrease in TPS was 1.0 mm (p = 0.03). There was no difference in MRD2 (p = 0.90) or BP (p = 0.53). There were no complications of repeat MMCR noted clinically or spontaneously reported, including no entropion, fornix foreshortening, or development of dry eye signs or symptoms. CONCLUSION Repeat MMCR significantly improves recurrent or residual ptosis after initial MMCR without significant adverse consequences. The degree of elevation with repeat MMCR was diminished when compared with initial MMCR.
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Affiliation(s)
- Bryce R Radmall
- Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, Calif
| | - M Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, Calif
| | - Keith D Carter
- Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Erin M Shriver
- Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
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27
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Mekonnen ZK, Ashraf DC, Jankowski T, Grob SR, Vagefi MR, Kersten RC, Simko JP, Winn BJ. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthalmic Plast Reconstr Surg 2021; 37:e40-e80. [PMID: 33229953 PMCID: PMC7927902 DOI: 10.1097/iop.0000000000001889] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
Acute invasive fungal rhinosinusitis is a rare, although highly morbid, infection primarily affecting immunosuppressed individuals. The same population is at particularly high risk of complications and mortality in the setting of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. The authors present a case of acute invasive fungal rhino-orbital mucormycosis in a patient with COVID-19 and discuss the prevalence, diagnosis, and treatment of fungal coinfections in COVID-19. Prompt recognition, initiation of therapy, and consideration of the challenges of rapidly evolving COVID-19 therapy guidelines are important for improving patient survival.
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Affiliation(s)
| | | | - Tyler Jankowski
- Department of Pathology, University of California, San Francisco
| | | | | | | | - Jeffry P. Simko
- Department of Pathology, University of California, San Francisco
| | - Bryan J. Winn
- Department of Ophthalmology
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, U.S.A
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28
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Ashraf DC, Idowu OO, Wang Q, YeEun T, Copperman TS, Tanaboonyawat S, Arnold BF, Oldenburg CE, Vagefi MR, Kersten RC. The Role of Topical Antibiotic Prophylaxis in Oculofacial Plastic Surgery: A Randomized Controlled Study. Ophthalmology 2020; 127:1747-1754. [PMID: 32698033 PMCID: PMC7686086 DOI: 10.1016/j.ophtha.2020.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The usefulness of topical antibiotic prophylaxis for routine oculofacial plastic surgery is not well established. Given concerns such as contact dermatitis, antibiotic resistance, and healthcare costs in conjunction with a low baseline rate of surgical site infections, the investigators sought to determine the frequency of infection with and without the use of topical antibiotic prophylaxis. DESIGN Randomized, controlled, unmasked clinical trial. PARTICIPANTS Adult patients undergoing routine periocular surgery without prior history of periocular surgical site infection, need for perioperative oral or parenteral antibiotics, or allergy to all study medications. METHODS Participants were randomized before surgery to receive either antibiotic or placebo (mineral oil and petrolatum-based) ointment after surgery. Outcomes were measured at the first postoperative visit. The 2-tailed Fisher exact test was used to compare outcomes between groups. MAIN OUTCOME MEASURES The primary outcome was the incidence of surgical site infections. The secondary outcomes included stratification of infections by patient risk characteristics, incidence of allergic contact dermatitis, and incidence of wound complications. RESULTS Four hundred one participants were enrolled and randomized, and 13 participants did not proceed with surgery or were lost to follow-up. High-risk features for infection were identified in 24% of the placebo group and 21% of the antibiotic group. Surgical site infections were more common in the placebo group (2.7% vs. 0.0%; P = 0.025). The rate of contact dermatitis was similar (0.5% vs. 0.5%; P = 1.00), as was the rate of wound dehiscence (2.7% vs. 3.5%; P = 0.77). Among the placebo group, the incidence of infections in the low- and high-risk participants was 2.9% and 2.2%, respectively. Infections were treated with oral or topical antibiotics and resolved without complication, except in 1 patient who required 2 subsequent surgeries to address the sequelae. CONCLUSIONS After routine oculofacial plastic surgery, patients treated with a topical antibiotic ointment showed a lower risk of surgical site infection compared with patients treated with a nonantibiotic ointment.
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Affiliation(s)
- Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Qinyun Wang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Tak YeEun
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Thomas S Copperman
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Sombat Tanaboonyawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Benjamin F Arnold
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Catherine E Oldenburg
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Abstract
Purpose: To review and summarize the epidemiology, clinical presentations, histopathologic characteristics and management of dacryops.Methods: A comprehensive PubMed, Embase and Google Scholar search of all articles written in English and non-English language articles with abstract translated to English on dacryops were reviewed. Data reviewed included epidemiology, etiology, pathogenesis, clinical presentations, histopathologic characteristics and management of dacryops.Results: Lacrimal ductal cysts or dacryops are classified based on locations: palpebral lobe cysts (simple dacryops); orbital lobe cysts; cysts of the accessory lacrimal glands of Krause and Wolfring; and cysts of ectopic (choristomatous) lacrimal glands. The exact etiology of dacryops remains unknown. Dacryops is usually asymptomatic but can present with varied symptoms depending on the type and associated complications. While complete excision of dacryops is generally recommended, marsupialization is also a safe and effective method for the treatment of dacryops in the palpebral lobe of lacrimal gland. Complete surgical excision via orbitotomy is required for deep orbital lesions.Conclusion: Dacryops is an uncommon benign cystic lacrimal gland tissue neoplasm. Dacryops can be classified into four types based on locations. Lesions could be either superficial that can be seen through the fornix or deep into the orbit. Observation is also an option for small or asymptomatic lesions. Surgery remains the mainstay of treatment for symptomatic cases, but approaches are different depending on the location of the lesions.
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Affiliation(s)
- Sombat Tanaboonyawat
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thomas S Copperman
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
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30
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Dalle Ore CL, Magill ST, Rodriguez Rubio R, Shahin MN, Aghi MK, Theodosopoulos PV, Villanueva-Meyer JE, Kersten RC, Idowu OO, Vagefi MR, McDermott MW. Hyperostosing sphenoid wing meningiomas: surgical outcomes and strategy for bone resection and multidisciplinary orbital reconstruction. J Neurosurg 2020; 134:711-720. [PMID: 32114535 DOI: 10.3171/2019.12.jns192543] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 09/15/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperostosing sphenoid wing meningiomas cause bony hyperostosis that may extend into the orbit, resulting in proptosis, restriction of extraocular movements, and/or compressive optic neuropathy. The extent of bony removal necessary and the optimal reconstruction strategy to prevent enophthalmos is debated. Herein, the authors present their surgical outcomes and reconstruction results. METHODS This is a retrospective review of 54 consecutive patients undergoing resection of sphenoid wing meningiomas associated with bony hyperostosis. The majority of cases were operated on by the senior author. Extent of tumor resection, volumetric bone resection, radiographic exophthalmos index, complications, and recurrence were analyzed. RESULTS The median age of the cohort was 52.1 years, with women comprising 83% of patients. Proptosis was a presenting symptom in 74%, and 52% had decreased visual acuity. The WHO grade was I (85%) or II (15%). The median follow-up was 2.6 years. On volumetric analysis, a median 86% of hyperostotic bone was resected. Gross-total resection of the intracranial tumor was achieved in 43% and the orbital tumor in 27%, and of all intracranial and orbital components in 20%. Orbital reconstruction was performed in 96% of patients. Postoperative vision was stable or improved in 98% of patients and diplopia improved in 89%. Postoperative complications occurred in 44% of patients, and 26% of patients underwent additional surgery for complication management. The most frequent complications were medical complications and extraocular movement deficits. The median preoperative exophthalmos index was 1.26, which improved to 1.12 immediately postoperatively and to 1.09 at the 6-month follow-up (p < 0.001). Postoperatively, 18 patients (33%) underwent adjuvant radiotherapy after subtotal resection. Tumors recurred/progressed in 12 patients (22%). CONCLUSIONS Resection of hyperostosing sphenoid wing meningiomas, particularly achieving gross-total resection of hyperostotic bone with a good aesthetic result, is challenging and associated with notable medical and ocular morbidity. Recurrence rates in this series are higher than previously reported. Nevertheless, the authors were able to attain improvement in proptosis and visual symptoms in the majority of patients by using a multidisciplinary approach.
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Affiliation(s)
| | | | | | | | | | | | | | - Robert C Kersten
- 3Ophthalmology, University of California, San Francisco, California
| | | | - M Reza Vagefi
- 3Ophthalmology, University of California, San Francisco, California
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31
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Kang JM, Kalin-Hajdu E, Idowu OO, Vagefi MR, Kersten RC. Nasolacrimal Obstruction Following the Placement of Maxillofacial Hardware. Craniomaxillofac Trauma Reconstr 2020; 13:32-37. [PMID: 32642029 DOI: 10.1177/1943387520906004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/15/2022] Open
Abstract
Purpose This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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Copperman T, Idowu OO, Kersten RC, Vagefi MR. Subcutaneous Tocilizumab for Thyroid Eye Disease: Simplified Dosing and Delivery. Ophthalmic Plast Reconstr Surg 2020; 35:e64-e66. [PMID: 30865069 DOI: 10.1097/iop.0000000000001346] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intravenous tocilizumab has been demonstrated to be an effective disease modifying agent in the treatment of moderate to severe active thyroid eye disease. The authors describe 2 patients treated with tocilizumab using home subcutaneous administration over an accelerated, biweekly course. Both patients exhibited improvement in thyroid eye disease clinical activity and proptosis.
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Affiliation(s)
- Thomas Copperman
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
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Idowu OO, Oldenburg CE, Vagefi MR. Oculoplastic surgical services in Nigeria: status and challenges. Int Ophthalmol 2020; 40:109-116. [PMID: 31440936 PMCID: PMC9982647 DOI: 10.1007/s10792-019-01163-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/21/2019] [Accepted: 08/14/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the status and challenges of oculoplastic surgical services in Nigeria. METHODS An IRB-exempt, web-based survey was distributed to Ophthalmological Society of Nigeria members via e-mail. Information regarding demographics, type and location of practice, subspecialization training, availability and barriers of oculoplastic surgical services, pattern of oculoplastic diseases and surgical procedures was obtained. Responses were analyzed using standard statistical methods. RESULTS Forty-four percent (155/356) of ophthalmologists invited completed the online survey. Of these respondents, 104 (67.1%) do provide oculoplastic surgical services with 8 (5.2%) trained in oculoplastic surgery. Respondents reported most commonly treating eyelid trauma (98.1%), orbital inflammatory diseases (92.1%) and lacrimal system disorders (86.5%) with globe removal procedures (98.1%), eyelid reconstruction (92.1%) and lacrimal drainage procedures (84.5%) being the most common procedures performed in their practices. Barriers to availability of oculoplastic surgical services identified by respondents were few trained oculoplastic surgeons (92.9%), lack of training centers (70.3%) and accessibility of services (60%). On multivariable analysis, predictors of availability of oculoplastic surgical services were greater number of years in practice (P < 0.001) and subspecialty training (P < 0.001). CONCLUSIONS The availability and geographical distribution of oculoplastic surgical services in Nigeria are suboptimal with training deficiencies identified as the main challenge. Strategies to improve availability of oculoplastic care should entail a sustainable training program for this emerging subspecialty and physician deployment to under-resourced areas of the country.
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Affiliation(s)
- Oluwatobi O. Idowu
- Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA 94143, USA
| | - Catherine E. Oldenburg
- Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA 94143, USA,Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA 94143, USA
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Kersten R, Vagefi MR, Bartley GB. Reply. Ophthalmology 2018; 125:e88. [PMID: 30343940 DOI: 10.1016/j.ophtha.2018.06.031] [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: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert Kersten
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - M Reza Vagefi
- Division of Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - George B Bartley
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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Affiliation(s)
- Eugene A Lowry
- Department of Ophthalmology, University of California, San Francisco
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of California, San Francisco
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco
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Bregman JA, Vakharia KT, Idowu OO, Vagefi MR, Grumbine FL. Outpatient Surgical Management of Orbital Blowout Fractures. Craniomaxillofac Trauma Reconstr 2018; 12:205-210. [PMID: 31428245 DOI: 10.1055/s-0038-1661355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/04/2018] [Accepted: 04/29/2018] [Indexed: 10/28/2022] Open
Abstract
There is ample investigation into the optimal timing and approach to orbital blowout fracture (OBF) repair; however, less attention has been directed toward postoperative care. This is a multicenter IRB-approved retrospective review of patients with OBF presenting to our study sites between November 2008 and August 2016. Those with isolated OBF, over 18 years of age, and who had not suffered additional facial injuries or globe trauma were included. A total of 126 surgical cases of isolated OBF repair were identified that met our inclusion and exclusion criteria; 42.1% were outpatient repairs while the remaining 57.9% were admitted for overnight monitoring. Time elapsed prior to repair differed between the two groups at a mean of 8.4 days versus 5.2 days for the outpatient and inpatient cohorts, respectively ( p = 0.001). A majority of inpatient cases underwent immediate repair, while a majority of outpatient cases were delayed. There were two cases of RBH in the outpatient cohort resulting in an overall incidence of 1.6%. In both instances, a significant change in clinical exam including decreased visual acuity, diplopia, and eye pain prompted repeat evaluation and immediate intervention for hematoma evacuation. Estimated hospital charges to the patient's insurance for key components of an inpatient versus outpatient isolated OBF repair amounted to a total cost of $9,598.22 for inpatient management and $7,265.02 for outpatient management without reflexive postoperative imaging. Reflexive postoperative CT scans were obtained in 76.7% of inpatient cases and only two led to a reoperation. No outpatient repairs included reflexive postoperative imaging. Outpatient OBF repair is an attractive alternative to inpatient management. The potential cost savings of outpatient management of OBF, which do not detract from quality or safety of patient care, should not be ignored. Our results will hopefully contribute to updated shared practice patterns for all subspecialties that participate in the surgical management of OBF.
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Affiliation(s)
- Jana A Bregman
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland
| | - Kalpesh T Vakharia
- Department of Otolaryngology - Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - F Lawson Grumbine
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland
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Kersten RC, Vagefi MR, Bartley GB. Orbital “Blowout” Fractures: Time for a New Paradigm. Ophthalmology 2018; 125:796-798. [DOI: 10.1016/j.ophtha.2018.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 11/16/2022] Open
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Kalin-Hajdu E, Colby JB, Idowu O, Grumbine FL, Kang JM, Hirabayashi KS, Glastonbury CM, Vagefi MR, Kersten RC. Diagnosing Distensible Venous Malformations of the Orbit With Diffusion-weighted Magnetic Resonance Imaging. Am J Ophthalmol 2018; 189:146-154. [PMID: 29458038 DOI: 10.1016/j.ajo.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the diffusion-weighted imaging of nonthrombosed distensible venous malformations of the orbit with that of other histologically-proven orbital tumors. DESIGN Retrospective case-control study. METHODS Patients with nonthrombosed distensible venous malformations of the orbit and patients with other histologically-proven orbital tumors were selected for chart review. The main outcome measure was the apparent diffusion coefficient of these lesions. RESULTS Sixty-seven patients qualified for chart review; 9 patients had nonthrombosed distensible venous malformations and 58 patients had other histologically-proven tumors. Three of the 9 patients with nonthrombosed distensible venous malformations were initially misdiagnosed as having had solid orbital tumors. The mean apparent diffusion coefficient of distensible venous malformations was 2.80 ± 0.48 × 10-3 mm2/s, whereas the mean apparent diffusion coefficient of other histologically-proven tumors was 1.18 ± 0.39 × 10-3 mm2/s (P < .001). The mean apparent diffusion coefficient ranged from 2.42 to 3.94 × 10-3 mm2/s in the distensible venous malformation group, whereas other histologically-proven tumors ranged from 0.53 to 2.08 × 10-3 mm2/s. Therefore, in this single-institution series, a threshold value of 2.10 × 10-3 mm2/s was 100% sensitive and 100% specific for distensible venous malformations. CONCLUSION Certain nonthrombosed distensible venous malformations can evade diagnostic suspicion and mimic solid orbital tumors on standard magnetic resonance imaging sequences. In this single-institution series, diffusion-weighted imaging effectively distinguished these nonthrombosed distensible venous malformations from other orbital tumors.
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Alsberge JB, Kalin-Hajdu E, Vagefi MR. Intraorbital Bullet. JAMA Ophthalmol 2018; 136:295-296. [PMID: 29192308 DOI: 10.1001/jamaophthalmol.2017.4050] [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] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph B Alsberge
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, San Francisco
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Idowu OO, Kalin-Hajdu E, Grumbine FL, Kersten RC, McDermott M, Vagefi MR. Restrictive Strabismus Following Frontotemporal-orbitozygomatic Craniotomy. Cureus 2017; 9:e1937. [PMID: 29464144 PMCID: PMC5807026 DOI: 10.7759/cureus.1937] [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] [Indexed: 11/05/2022] Open
Abstract
The frontotempotal-orbitozygomatic craniotomy (FTOZ) is a standard approach for large sphenoid wing meningiomas (SWMs). Nevertheless, resection of these tumors is not without ophthalmologic risks. This series presents two patients with acute postoperative restrictive strabismus following tumor resection and orbital wall reconstruction. Forced duction testing and postoperative imaging revealed impingement of the lateral rectus muscle caused by an alloplastic implant and/or residual bone, prompting immediate orbitotomy and restoration of normal extraocular muscle function. This report highlights the intricacies of orbital reconstruction, as well as the need for intraoperative forced duction testing.
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Affiliation(s)
| | | | | | | | - Michael McDermott
- Department of Neurological Surgery, University of California, San Francisco
| | - M Reza Vagefi
- Ophthalmology, University of California, San Francisco
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Alsberge JB, Grumbine FL, Bloomer MM, Vagefi MR, Kersten RC. Primary hepatoid adenocarcinoma of the orbit. Am J Ophthalmol Case Rep 2017; 5:38-40. [PMID: 29503944 PMCID: PMC5757757 DOI: 10.1016/j.ajoc.2016.10.006] [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: 04/18/2016] [Revised: 09/30/2016] [Accepted: 10/12/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report a case of primary hepatoid adenocarcinoma of the orbit. OBSERVATIONS An adult patient was referred for evaluation of an orbital mass. Histopathology of the orbital biopsy indicated a carcinoma with hepatoid features. Laboratory studies revealed normal liver function tests, elevated serum alpha-fetoprotein, and whole-body positron emission tomography/computed tomography scan showed no evidence of liver involvement or an alternative primary origin. CONCLUSIONS AND IMPORTANCE To the authors' knowledge, this is the first reported case of primary hepatoid adenocarcinoma of the orbit.
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Affiliation(s)
| | | | | | | | - Robert C. Kersten
- Department of Ophthalmology, University of California, San Francisco, USA
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Affiliation(s)
- Evan Kalin-Hajdu
- Department of Ophthalmology, University of California–San Francisco, San Francisco
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California–San Francisco, San Francisco
| | - Marc H. Levin
- Department of Ophthalmology, University of California–San Francisco, San Francisco
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44
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DeParis SW, Bloomer M, Han Y, Vagefi MR, Shieh JTC, Solomon DA, Grenert J, de Alba Campomanes AG. Uveal Ganglioneuroma due to Germline PTEN Mutation (Cowden Syndrome) Presenting as Unilateral Infantile Glaucoma. Ocul Oncol Pathol 2016; 3:122-128. [PMID: 28868283 DOI: 10.1159/000450552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/26/2016] [Revised: 09/01/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Uveal ganglioneuroma is a rare tumor that usually occurs in association with neurofibromatosis type 1. Here, we present a rare case of a uveal ganglioneuroma leading to a diagnosis of the tumor predisposition condition Cowden syndrome. PROCEDURES A 5-year-old girl with unilateral refractory glaucoma secondary to diffuse iris and choroidal thickening developed a blind, painful eye. Enucleation was performed, and histopathology revealed infiltration of the entire uveal tract by neoplastic spindle cells containing admixed ganglion cells diagnostic of uveal ganglioneuroma. Targeted next-generation sequencing of 510 cancer-associated genes was performed on tumor tissue and peripheral blood. RESULTS A germline nonsense mutation in the PTEN gene was found, accompanied by loss of heterozygosity in the tumor. A diagnosis of Cowden syndrome was made, for which the family sought genetic counseling and initiated the recommended cancer screening. CONCLUSIONS A novel association is found between uveal ganglioneuroma and Cowden syndrome, emphasizing the value of genetic tissue testing in managing patients with rare ocular tumors.
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Affiliation(s)
- Sarah W DeParis
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Michele Bloomer
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Joseph T C Shieh
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA, USA
| | - James Grenert
- Department of Pathology, University of California, San Francisco, CA, USA
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Affiliation(s)
- Ferhina S Ali
- Department of Ophthalmology, University of California, San Francisco
| | - Joseph B Alsberge
- Department of Ophthalmology, University of California, San Francisco
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco
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Desai SJ, Pruzan NL, Geske MJ, Jeng BH, Bloomer MM, Vagefi MR. Local and Regional Spread of Primary Conjunctival Squamous Cell Carcinoma. Eye Contact Lens 2016; 44 Suppl 1:S312-S315. [PMID: 27058828 DOI: 10.1097/icl.0000000000000264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two cases of biopsy-proven conjunctival squamous cell carcinoma (SCC) that developed local and regional spread are described. The cases involved a 65-year-old woman and a 79-year-old man who were initially treated at outside institutions for SCC of the conjunctiva. The patients did not have a history of immune compromise. The female patient presented with direct extension into the lacrimal gland but deferred recommended exenteration. Despite eventual exenteration, she developed metastasis to a neck node 6 months later, which was treated with radiotherapy. The male patient presented with local recurrence and a parotid node metastasis treated with exenteration, parotidectomy, selective neck dissection, and postoperative radiotherapy. Review of the outside pathology of both cases revealed positive tumor margins at the time of original resection. Local control of conjunctival SCC is of critical importance to reduce the risk of orbital extension and regional spread.
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Affiliation(s)
- Shilpa J Desai
- Department of Ophthalmology (S.J.D., N.L.P., M.J.G., M.M.B., M.R.V.), University of California, San Francisco, CA; Department of Ophthalmology (S.J.D., N.L.P., M.J.G., M.M.B., M.R.V.), San Francisco General Hospital, San Francisco, CA; and Department of Ophthalmology and Visual Sciences (B.H.J.), University of Maryland School of Medicine, Baltimore, MD
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DeParis SW, Grumbine FL, Vagefi MR, Kersten RC. Persistent Upgaze Restriction after Orbital Floor Fracture Repair. Craniomaxillofac Trauma Reconstr 2016; 9:268-70. [PMID: 27516846 DOI: 10.1055/s-0035-1570076] [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] [Received: 05/21/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022] Open
Abstract
Here we present two cases of marked postoperative upgaze restriction after successful repair of orbital floor fracture and release of inferior rectus entrapment. In both cases, follow-up imaging showed enlargement of the inferior rectus, and gradual resolution of gaze limitation was observed over several months of conservative management. Thus, in patients with postoperative findings suggestive of residual inferior rectus entrapment, follow-up imaging is indicated prior to returning to the operating room. With a markedly swollen inferior rectus muscle but no radiographic evidence of residual muscle entrapment in the fracture, a trial of conservative management may be warranted.
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Affiliation(s)
| | - F Lawson Grumbine
- Department of Ophthalmology, University of California, San Francisco, California
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California
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Eftekhari K, Choe CH, Vagefi MR, Eckstein LA. The last ride of Henry II of France: orbital injury and a king's demise. Surv Ophthalmol 2015; 60:274-8. [PMID: 25890627 DOI: 10.1016/j.survophthal.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/13/2014] [Revised: 08/27/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022]
Abstract
Jousting was a popular pastime for royalty in the Renaissance era. Injuries were common, and the eye was particularly at risk from the splinters of the wooden lance. On June 30, 1559, Henry II of France participated in a jousting tournament to celebrate two royal weddings. In the third match, Gabriel de Montgomery struck Henry on the right shoulder and the lance splintered, sending wooden shards into his face and right orbit. Despite being cared for by the prominent physicians Ambroise Paré and Andreas Vesalius, the king died 10 days later and was found to have a cerebral abscess. The wound was not explored immediately after the injury; nevertheless, wooden foreign bodies were discovered in the orbit at the time of autopsy. The dura had not been violated, suggesting that an infection may have traveled from the orbit into the brain. Nostradamus and Luca Guarico, the astrologer to the Medici family, had prophesied the death of Henry II of France, but he ignored their warnings and thus changed the course of history in Renaissance Europe.
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Affiliation(s)
| | | | - M Reza Vagefi
- Division of Oculoplastic, Orbital and Reconstructive Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Lauren A Eckstein
- Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, California, USA
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Abstract
Periocular and orbital hemorrhage are rare complications of blepharoplasty, with a reported incidence of 0.055%. These complications are even less common more than 48 h after surgery. The authors report 2 cases of postoperative hemorrhage 5 and 8 days following uncomplicated upper blepharoplasty in which the initiating factor seems to have been uncontrolled hypertension. Details of the presentation, management and follow-up of each patient are described. These cases serve as an important reminder that patients must be appropriately counseled regarding the postoperative implications of their systemic conditions.
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Affiliation(s)
- F Lawson Grumbine
- Department of Ophthalmology, University of California , San Francisco, California , USA
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McClintic SM, Yoon MK, Bidar M, Dutton JJ, Vagefi MR, Kersten RC. Tissue necrosis following diode laser-assisted transcanalicular dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2015; 31:e18-22. [PMID: 24807803 PMCID: PMC4919112 DOI: 10.1097/iop.0000000000000045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advantages of transcanalicular laser-assisted dacryocystorhinostomy (TCDCR) over conventional, external, and endonasal dacryocystorhinostomy (DCR) have been purported to include decreased operating time, reduced morbidity, enhanced cosmesis, avoidance of general anesthesia, and a shorter recovery time. However, 1 case of skin necrosis has recently been reported to have occurred following diode laser-assisted TCDCR, and the authors now report 3 additional cases that were evaluated by the Ophthalmic Plastic Surgery services at the University of North Carolina, North Carolina, and the University of California, San Francisco. Three patients developed full-thickness tissue necrosis over the medial canthus following TCDCR, and 2 of these patients experienced persistent tissue breakdown at the site following reconstructive repair.
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Affiliation(s)
- Scott M McClintic
- *Department of Ophthalmology, University of California, San Francisco, San Francisco, California; †Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; ‡California Eye Institute, Fresno, California; and §Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, U.S.A
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