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Custer PL, Maamari RN. The Hatchet Flap for Eyelid and Midfacial Reconstruction: Experience From 70 Cases. Ophthalmic Plast Reconstr Surg 2024; 40:43-48. [PMID: 37581878 DOI: 10.1097/iop.0000000000002499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
PURPOSE To describe surgical variations of the hatchet flap and a large series of patients in which this procedure was used for eyelid and midfacial reconstruction. METHODS A retrospective review was performed on patients treated with a hatchet flap between March 2016 and March 2023. Patient demographics, defect characteristics, surgical techniques, and outcomes were investigated. RESULTS The hatchet flap was used to repair 70 defects in 69 patients, aged 41.6 to 90.0 years (mean, 66.1). Defects measured 0.6 to 23.6 cm 2 (mean, 4.8) and resulted from Mohs surgery (n = 62), exenteration (n = 2), benign lesion excision (n = 3), or cicatricial ectropion/fistula repair (n = 3). The flap tail was managed with 3 techniques: V-Y plasty (n = 26), transposition (n = 34), and excision (n = 10). Ancillary procedures were often used during reconstructions (skin grafts: 29; double hatchet flap: 2; additional skin flaps: 26; tarsoconjunctival flaps: 6; and other grafts: 7). Small distal eschars healed in 7 flaps without necrosis. Four patients with subcutaneous thickening improved after steroid injections. Mild hatchet flap contracture may have contributed to postoperative cicatricial ectropion in 1 patient. There were no other flap related complications. CONCLUSIONS In selected patients, the hatchet flap is a versatile technique to mobilize vascularized tissue into eyelid/midfacial defects resulting from the excision of lesions or treatment of cicatricial ectropion/fistulas. Individuals without laxity in the plane perpendicular to the flap base may not be good candidates for this procedure. The hatchet flap can be modified by advancing, transposing, or excising the flap tail. Reconstruction is often combined with other flaps/grafts. Few complications were associated with the hatchet flap.
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Affiliation(s)
- Philip L Custer
- John F. Hardesty, MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Douglas RS, Couch S, Wester ST, Fowler BT, Liu CY, Subramanian PS, Tang R, Nguyen QT, Maamari RN, Ugradar S, Hsu K, Karon M, Stan MN. Efficacy and Safety of Teprotumumab in Patients With Thyroid Eye Disease of Long Duration and Low Disease Activity. J Clin Endocrinol Metab 2023; 109:25-35. [PMID: 37925673 PMCID: PMC10735297 DOI: 10.1210/clinem/dgad637] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
CONTEXT Early inflammatory thyroid eye disease (TED) can lead to symptomatic chronic disease, including disabling proptosis. Teprotumumab, an insulin-like growth factor-1 receptor (IGF-1R) inhibitor, previously demonstrated efficacy in acute, high-inflammation TED trials. OBJECTIVE We present data from the first placebo-controlled trial with teprotumumab in chronic/low disease activity TED. METHODS This randomized double-masked, placebo-controlled trial, conducted at 11 US centers, enrolled adult participants with TED duration of 2 to 10 years, Clinical Activity Score (CAS) ≤ 1 or no additional inflammation or progression in proptosis/diplopia for ≥1 year, proptosis ≥3 mm from before TED and/or from normal, euthyroid/mildly hypo/hyperthyroid, no prior teprotumumab, and no steroids within 3 weeks of baseline. Patients received (2:1) intravenous teprotumumab or placebo once every 3 weeks (total 8 infusions). The primary endpoint was proptosis (mm) improvement at Week 24. Adverse events (AEs) were assessed. RESULTS A total of 62 (42 teprotumumab and 20 placebo) patients were randomized. At Week 24, least squares mean (SE) proptosis improvement was greater with teprotumumab (-2.41 [0.228]) than with placebo (-0.92 [0.323]), difference -1.48 (95% CI -2.28, -0.69; P = .0004). Proportions of patients with AEs were similar between groups. Hyperglycemia was reported in 6 (15%) vs 2 (10%) and hearing impairment in 9 (22%) vs 2 (10%) with teprotumumab and placebo, respectively. AEs led to discontinuation in 1 teprotumumab (left ear conductive hearing loss with congenital anomaly) and 1 placebo patient (infusion-related). There were no deaths. CONCLUSION Teprotumumab significantly improved proptosis vs placebo in longstanding/low inflammation TED, demonstrating efficacy regardless of disease duration/activity. The safety profile was comparable to that previously reported.
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Affiliation(s)
- Raymond S Douglas
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Steven Couch
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Sara T Wester
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Brian T Fowler
- Department of Ophthalmology, The University of Tennessee Health Science Center, Hamilton Eye Institute, Memphis, TN 38163, USA
| | - Catherine Y Liu
- Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92037, USA
| | - Prem S Subramanian
- Departments of Ophthalmology, Neurology, and Neurosurgery, UC Health Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Surgery, Division of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rosa Tang
- Eye Wellness Center, Neuro-Eye Clinical Trials, Inc., Houston, TX 77074, USA
| | - Quang T Nguyen
- Department of Endocrinology, Touro University, Henderson, NV 89014, USA
| | - Robi N Maamari
- John F. Hardesty MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Shoaib Ugradar
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Kate Hsu
- Clinical Development, Horizon Therapeutics plc, Deerfield, IL 60015, USA
| | - Michael Karon
- Clinical Development, Horizon Therapeutics plc, Deerfield, IL 60015, USA
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
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Kanakamedala AD, Maamari RN, Couch SM. Tattoo-associated lacrimal gland enlargement and sarcoidosis. Am J Ophthalmol Case Rep 2023; 32:101889. [PMID: 37521806 PMCID: PMC10371775 DOI: 10.1016/j.ajoc.2023.101889] [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: 12/14/2022] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To describe a case of tattoo-associated sarcoidosis presenting with cutaneous findings of tattoo granulomas and ophthalmic manifestation of isolated bilateral lacrimal gland enlargement. Observations A 35-year-old female presented with bilateral upper eyelid swelling for over a year. She reported no associated episodes of ocular pain or visual decline since onset of eyelid edema. On examination, the lacrimal glands were firm and enlarged bilaterally. Slit-lamp examination demonstrated no evidence of active or prior ocular inflammation. Further systemic examination revealed multiple raised papules within a 4-year-old chest/shoulder tattoo. Histopathology from a lacrimal gland biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions and importance The authors report a rare case of a 35-year-old presenting with isolated dacryoadenitis and tattoo granulomas found to be a tattoo-associated sarcoidosis. Although uveitis is a commonly described ocular manifestation in tattoo-associated sarcoidosis, few reports have described lacrimal gland enlargement as a presenting ophthalmic feature in tattoo-associated sarcoidosis.
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Ho TC, Maamari RN, Kossler AL, Sears CM, Freitag SK, Reshef ER, Shinder R, Rootman DB, Diniz SB, Kahana A, Schlachter D, Do TH, Kally P, Turner S, Mokhtarzadeh A, Harrison AR, Hwang CJ, Kim HJ, Avila SA, Thomas DA, Magazin M, Wester ST, Lee WW, Clauss KD, Holds JB, Sniegowski M, Compton CJ, Briggs C, Malik AI, Lucarelli MJ, Burkat CN, Patel LG, Couch SM. Outcomes of Patients With Thyroid Eye Disease Partially Treated With Teprotumumab. Ophthalmic Plast Reconstr Surg 2023; 39:150-155. [PMID: 36095848 PMCID: PMC10771969 DOI: 10.1097/iop.0000000000002267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
PURPOSE In response to the coronavirus (COVID-19) pandemic, teprotumumab production was temporarily halted with resources diverted toward vaccine production. Many patients who initiated treatment with teprotumumab for thyroid eye disease were forced to deviate from the standard protocol. This study investigates the response of teprotumumab when patients receive fewer than the standard 8-dose regimen. METHODS This observational cross-sectional cohort study included patients from 15 institutions with active or minimal to no clinical activity thyroid eye disease treated with the standard teprotumumab infusion protocol. Patients were included if they had completed at least 1 teprotumumab infusion and had not yet completed all 8 planned infusions. Data were collected before teprotumumab initiation, within 3 weeks of last dose before interruption, and at the visit before teprotumumab reinitiation. The primary outcome measure was reduction in proptosis more than 2 mm. Secondary outcome measures included change in clinical activity score (CAS), extraocular motility restriction, margin reflex distance-1 (MRD1), and reported adverse events. RESULTS The study included 74 patients. Mean age was 57.8 years, and 77% were female. There were 62 active and 12 minimal to no clinical activity patients. Patients completed an average of 4.2 teprotumumab infusions before interruption. A significant mean reduction in proptosis (-2.9 mm in active and -2.8 mm in minimal to no clinical activity patients, P < 0.01) was noted and maintained during interruption. For active patients, a 3.4-point reduction in CAS ( P < 0.01) and reduction in ocular motility restriction ( P < 0.01) were maintained during interruption. CONCLUSIONS Patients partially treated with teprotumumab achieve significant reduction in proptosis, CAS, and extraocular muscle restriction and maintain these improvements through the period of interruption.
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Affiliation(s)
- Tiffany C Ho
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Robi N Maamari
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Palo Alto, California, U.S.A
| | - Connie M Sears
- Department of Ophthalmology, Byers Eye Institute, Palo Alto, California, U.S.A
| | - Suzanne K Freitag
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Edith R Reshef
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Alon Kahana
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
- Kahana Oculoplastic & Orbital Surgery, Rochester, Michigan, U.S.A
| | - Dianne Schlachter
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Thai H Do
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Peter Kally
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Sara Turner
- Kahana Oculoplastic & Orbital Surgery, Rochester, Michigan, U.S.A
| | - Ali Mokhtarzadeh
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Andrew R Harrison
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Christopher J Hwang
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Hee Joon Kim
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Sarah A Avila
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Dilip A Thomas
- Department of Ophthalmology, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Maja Magazin
- Department of Ophthalmology, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Sara T Wester
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Wendy W Lee
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Kevin D Clauss
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - John B Holds
- Ophthalmic Plastic and Cosmetic Surgery Inc., Des Peres, Missouri, U.S.A
- Departments of Ophthalmology and Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
| | - Matthew Sniegowski
- Department of Ophthalmology, University of Missouri Kansas City, Kansas City, Missouri, U.S.A
| | - Christopher J Compton
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, U.S.A
| | - Christian Briggs
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, U.S.A
| | - Amina I Malik
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Mark J Lucarelli
- Oculoplastic, Facial Cosmetic & Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Cat N Burkat
- Oculoplastic, Facial Cosmetic & Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Luv G Patel
- Retina Center of Texas, Dallas, Texas, U.S.A
| | - Steven M Couch
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Maamari RN, Farhood Z, Holds JB, Couch SM. Quantitative Analysis of Preoperative and Postoperative Photographs Posted on Social Media by Oculoplastic Surgeons. Ophthalmic Plast Reconstr Surg 2022; 38:571-576. [PMID: 35551417 DOI: 10.1097/iop.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate and quantitatively analyze preoperative and postoperative photographs posted on social media by oculoplastic surgeons. METHODS Pre- and postoperative blepharoplasty photographs posted by oculoplastic surgeons on the social media platform Instagram were identified over a 4-month period. Photographs demonstrating a frontal pose of the periocular region were selected, and image analysis was performed to compare the preoperative and postoperative photographs. Quantitative image analysis was performed with a semiautomated script using ImageJ (v1.52k) software. Image analysis compared magnification, patient position, luminosity, relative color profiles, and edge detection/sharpness. Three oculoplastic surgeons graded these imaging metrics for the same photoset and the consensus grade was assigned to each category. Finally, the quantitative calculations were then compared with the consensus grades to develop receiver operating characteristic curves for further analysis. RESULTS The study included 104 posts from 35 members of ASOPRS. Regarding patient positioning, 9 postings were 5%-10% offset from the patients' center, and 6 postings were more than 10% from the patients' center. The majority of photosets demonstrated less than or equal to 2.5% difference in magnification (69/104), with 7 postings demonstrating a greater than 5% difference, and 3 postings exhibiting greater than 10% difference in magnification. In the periocular region, 17.3% (18/104) of postings were found to have a greater than 10% difference in luminosity (>25.5 pixel-value). A more than 5% difference (>12.75 pixel-value) in pre- and postoperative edge-detection measurements was identified in 12 of 104 postings. In 22 of 104 photosets, the mean absolute deviation in color channel ratios was more than 0.01 and 15 of 104 photosets were found to have a mean absolute deviation more than 0.05. CONCLUSIONS Numerous quantifiable photographic inconsistencies were identified in surgical photographs posted on social media by members of ASOPRS. Adoption of an automated image analysis tool that compares before-and-after surgical photographs could promote standardized oculoplastic surgery photography on social media.
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Affiliation(s)
- Robi N Maamari
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Zachary Farhood
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
| | - John B Holds
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
- Department of Ophthalmology, Saint Louis University, St. Louis, Missouri, U.S.A
- Ophthalmic Plastic and Cosmetic Surgery, Inc., Des Peres, Missouri, U.S.A
| | - Steven M Couch
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Kumar A, Ali FS, Stevens VM, Melo JS, Prajna NV, Lalitha P, Srinivasan M, Bhandari G, Bhandari S, Maamari RN, Fletcher DA, Lietman TM, Keenan JD. Smartphone-based Anterior Segment Imaging: A Comparative Diagnostic Accuracy Study of a Potential Tool for Blindness Prevalence Surveys. Ophthalmic Epidemiol 2022; 29:491-498. [PMID: 34607500 PMCID: PMC8977419 DOI: 10.1080/09286586.2021.1980589] [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] [Received: 05/07/2021] [Revised: 07/07/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine if smartphone photography could be a useful adjunct to blindness prevalence surveys by providing an accurate diagnosis of corneal opacity. METHODS A total of 174 patients with infectious keratitis who had undergone corneal culturing over the past 5 years were enrolled in a diagnostic accuracy study at an eye hospital in South India. Both eyes had an ophthalmologist-performed slit lamp examination, followed by anterior segment photography with a handheld digital single lens reflex (SLR) camera and a smartphone camera coupled to an external attachment that provided magnification and illumination. The diagnostic accuracy of photography was assessed relative to slit lamp examination. RESULTS In total, 90 of 174 enrolled participants had a corneal opacity in the cultured eye and no opacity in the contralateral eye, and did not have a penetrating keratoplasty or missing photographs. Relative to slit lamp examination, the sensitivity of corneal opacity diagnosis was 68% (95%CI 58-77%) using the smartphone's default settings and 59% (95%CI 49-69%) using the SLR, and the specificity was 97% (95%CI 93-100%) for the smartphone and 97% (95%CI 92-100%) for the SLR. The sensitivity of smartphone-based corneal opacity diagnosis was higher for larger scars (81% for opacities 2 mm in diameter or larger), more visually significant scars (100% for eyes with visual acuity worse than 20/400), and more recent scars (85% for eyes cultured in the past 12 months). CONCLUSION The diagnostic performance of a smartphone coupled to an external attachment, while somewhat variable, demonstrated high specificity and high sensitivity for all but the smallest opacities.
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Affiliation(s)
- Ashish Kumar
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital Madurai, India
| | - Ferhina S Ali
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Valerie M Stevens
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - Jason S Melo
- Francis I. Proctor Foundation, University of California, San Francisco, USA
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital Madurai, India
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital Madurai, India
| | - Muthiah Srinivasan
- Department of Cornea and Refractive Surgery, Aravind Eye Hospital Madurai, India
| | | | | | - Robi N Maamari
- Francis I. Proctor Foundation, University of California, San Francisco, USA
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, USA
| | - Daniel A Fletcher
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, USA
| | - Thomas M Lietman
- Department of Ophthalmology, University of California, San Francisco, USA
- Francis I. Proctor Foundation, University of California, San Francisco, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
- Institute for Global Health, University of California, San Francisco, USA
| | - Jeremy D Keenan
- Department of Ophthalmology, University of California, San Francisco, USA
- Francis I. Proctor Foundation, University of California, San Francisco, USA
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Custer PL, Maamari RN, Huecker JB, Gordon MO. Eyebrow Position Before and After Enucleation. Ophthalmic Plast Reconstr Surg 2022; 38:438-443. [DOI: 10.1097/iop.0000000000002145] [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] [Indexed: 11/25/2022]
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Custer PL, Maamari RN, Ho TC, Huecker JB, Couch SM. Lower eyelid margin reconstruction: results of five different techniques. Orbit 2022:1-10. [PMID: 35893769 DOI: 10.1080/01676830.2022.2101128] [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 retrospective study was performed to examine surgical results of five different techniques for lower eyelid margin reconstruction after Mohs surgery: primary closure, semicircular flap, dermal matrix graft, sliding tarsal flap, and tarsoconjunctival flap. METHODS Medical records were reviewed in 178 patients undergoing surgery between 2005 and 2020. Outcomes were evaluated (photographic review) by three oculoplastic observers masked to procedure type, both with and without knowledge of the eyelid defect. RESULTS All patients achieved a good-excellent functional result and 90.4% were asymptomatic after surgery. Tarsoconjunctival flaps were associated with greater need for subsequent interventions (p < .001) and anterior lamellar deformities (p < .001). Semicircular flaps had a higher incidence of lateral canthal deformity (p < .001), but less eyelash disruption than other flap/graft techniques (p < .001). Mean cosmetic ratings (defect masked) were similar for dermal matrix grafts, semicircular, and sliding tarsal flaps; with each grading higher than tarsoconjunctival flaps (p ≤ .05). Among patients with 9-15 mm wide defects, results were better for semicircular and sliding tarsalflaps, than dermal matrix grafts (p ≤ .005) and tarsoconjunctival flaps (p ≤ .02). CONCLUSIONS All patients achieved a good-excellent functional result and 87.1% a good-excellent cosmetic result. The semicircular flap was effective for repairing medium sized wounds that could not be closed primarily, creating a continuous lash line, although with a higher incidence of lateral canthal deformities. The sliding tarsal flap was effective for shallow wounds of varying widths. The single-staged dermal matrix graft provided similar results as the tarsoconjunctival flap. Subsequent interventions were more frequent after the tarsoconjunctival flap than other methods.
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Affiliation(s)
- Philip L Custer
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robi N Maamari
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tiffany C Ho
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julia B Huecker
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Steven M Couch
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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O’Brien KS, Byanju R, Kandel RP, Poudyal B, Gonzales JA, Porco TC, Whitcher JP, Srinivasan M, Upadhyay M, Lietman TM, Keenan JD, Byanju R, Khadka KB, Bista D, Gautam M, Giri P, Kayastha S, Parajuli TP, Shah RK, Sharma N, Sharma P, Shrestha A, Shrestha M, Subedi P, Chaudhary DS, Ghimire R, Adhikari M, Hamal V, Bhandari G, Dahal G, Poudyal B, Bhandari S, Gurung J, Bhattarai D, Bhattarai R, Chapagain D, Chaudhary AK, Gautam SK, Gurau D, Kandel D, Lamichhane PC, Rijal R, Giri G, Upadhyay M, Lietman TM, Acharya NR, Gonzales JA, Keenan JD, McLeod SD, Ramirez DA, Ray KJ, Rose-Nussbaumer J, Whitcher JP, O'Brien KS, Cotter SY, Kim J, Lee S, Maamari RN, Porco TC, Basset K, Chase H, Evans L, Gilbert S, Kandel RP, Moses D, Tenzing C, Choudhary S, Dhakwa P, Fletcher DA, Reber CD. Village-integrated eye workers for prevention of corneal ulcers in Nepal (VIEW study): a cluster-randomised controlled trial. Lancet Glob Health 2022; 10:e501-e509. [PMID: 35303460 PMCID: PMC9814976 DOI: 10.1016/s2214-109x(21)00596-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/14/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Corneal ulcers are a common cause of blindness in low-income and middle-income countries, usually resulting from traumatic corneal abrasions during agricultural work. Antimicrobial prophylaxis of corneal abrasions can help prevent corneal ulcers, but delays in the initiation of therapy are frequent. We aimed to assess whether a community-based programme for corneal ulcer prevention would reduce the incidence of corneal ulceration. METHODS A cluster-randomised trial was performed in village development committees (VDCs) in Nepal. VDCs in the catchment area of Bharatpur Eye Hospital, Nepal with less than 15 000 people were eligible for inclusion. We randomly assigned (1:1) VDCs to either an intervention group or a control group. In the intervention VDCs, existing female community health volunteers (FCHVs) were trained to diagnose corneal abrasions and provide a 3-day course of ophthalmic antimicrobials to their patients. In the control VDCs, FCHVs did not provide this intervention. Participants were not masked given the nature of the intervention. Both groups were followed up for 3 years for photographic evidence of corneal ulceration. The primary outcome was the incidence of corneal ulceration, determined by masked assessment of corneal photographs. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01969786. FINDINGS We assessed 112 VDCs, of which 24 were enrolled. The study was performed between Feb 4, 2014, and Oct 20, 2017. 12 VDCs were randomly assigned to the intervention group and 12 to the control group. 252 539 individuals were included in the study (130 579 in the intervention group and 121 960 in the control group). FCHVs diagnosed and provided antimicrobials for 4777 corneal abrasions. The census identified 289 corneal ulcers among 246 893 person-years in the intervention group (incidence 1·21 cases [95% CI 0·85-1·74] per 1000 person-years) and 262 corneal ulcers among 239 170 person-years in the control group (incidence 1·18 cases [0·82-1·70] per 1000 person-years; incidence rate ratio 1·03 [95% CI 0·63-1·67]; p=0·93). Medication allergy was self-reported in 0·2% of participants. INTERPRETATION We did not detect a reduction in the incidence of corneal ulceration during the first 3 years of a community-based corneal ulcer prevention programme. Further study might be warranted in more rural areas where basic eye care facilities are not available. FUNDING National Eye Institute.
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Affiliation(s)
- Kieran S O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | | | - Ram Prasad Kandel
- Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal,Seva Foundation, Berkeley, CA, USA and Kathmandu, Nepal
| | | | - John A Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - John P Whitcher
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | | | - Madan Upadhyay
- BP Eye Foundation, Children’s Hospital for Eye, Ear, and Rehabilitation Services (CHEERS), Kathmandu, Nepal
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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10
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Desai R, Srienc AI, Maamari RN, Custer PL, Warren DK, Chicoine MR. Removal of a Penetrating Tree Branch in the Orbitofrontal Region-A Unique Application of an Orbitofrontal Craniotomy Through a Supraciliary Brow Approach. Oper Neurosurg (Hagerstown) 2021; 21:E386-E391. [PMID: 34333660 DOI: 10.1093/ons/opab259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/03/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Orbitocranial penetrating injury (OPI) is associated with neurological, infectious, and vascular sequalae. This report describes unique application of an orbitofrontal craniotomy through a supraciliary approach to remove a wooden stick penetrating through the orbit and frontal lobe, postoperative management, and antimicrobial therapy. CLINICAL PRESENTATION A 51-yr-old male presented after a tree branch penetrated beneath his eye. He had no loss of consciousness and was neurologically intact with preserved vision and ocular motility. Computed tomography (CT) and CT angiogram revealed an isodense hollow cylindrical object penetrating though the left orbit and left frontal lobe. The object extended into the right lateral ventricle, abutting the left anterior cerebral artery. There was minimal intraventricular hemorrhage without arterial injury. The patient was treated with broad-spectrum antimicrobial coverage. The foreign body was removed and the dural defect repaired via an orbitofrontal craniotomy through a supraciliary eyebrow incision. He was treated with an extended course of antimicrobial therapy, and after 18 mo remained neurologically intact. CONCLUSION OPI are a subset of penetrating brain injuries with potential for immediate injury to neurovascular structures and delayed complications including cerebrospinal fluid leak and infection. Treatment includes attempted complete removal of the foreign body and antimicrobial therapy. An orbitofrontal craniotomy through a supraciliary eyebrow incision may be effective in selected patients.
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Affiliation(s)
- Rupen Desai
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Anja I Srienc
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robi N Maamari
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philip L Custer
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - David K Warren
- Division of Infectious Disease Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA
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11
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Wong MB, Maamari RN, Couch SM. Contralateral eyelid elevation following unilateral upper eyelid retraction repair. Orbit 2021; 41:452-456. [PMID: 34030599 DOI: 10.1080/01676830.2021.1931352] [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: 10/21/2022]
Abstract
Purpose: To report the influence of unilateral upper eyelid retraction repair on the upper eyelid position of the contralateral, non-operative side.Methods: An IRB-approved retrospective chart review was performed to identify patients who underwent unilateral upper eyelid retraction repair. Patient demographics, etiology of upper eyelid retraction, previous surgeries, and periocular measurements from pre-operative and follow-up visits were reviewed.Results: Thirteen patients who underwent unilateral upper eyelid retraction repair due to thyroid eye disease or iatrogenic retraction secondary to ptosis repair demonstrated an elevation in contralateral eyelid height post-operatively. The mean pre-operative MRD-1 was 6.6 mm in the operative eye and 2.6 mm in the contralateral eye. All patients demonstrated a decreased MRD-1 in the operative eye (mean change: -2.6 mm [-38.4%]; standard deviation [SD]: 1.2 mm) and an increased MRD-1 in the contralateral eye (mean change: +1.3 mm [+62.4%]; SD: 0.6 mm) following unilateral upper eyelid retraction repair. The mean post-operative MRD-1 measurements were 4.0 mm ± 0.5 mm and 3.9 mm ± 0.6 mm in the operative and contralateral eyes, respectively.Conclusions: Unilateral upper eyelid retraction repair may induce an elevation of the contralateral upper eyelid position in some patients. The findings in this report may support unilateral intervention in patients with upper lid retraction, especially in the setting of contralateral blepharoptosis.
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Affiliation(s)
- Michael B Wong
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Robi N Maamari
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven M Couch
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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12
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Nesemann JM, Seider MI, Snyder BM, Maamari RN, Fletcher DA, Haile BA, Tadesse Z, Varnado NE, Cotter SY, Callahan EK, Emerson PM, Margolis TP, Lietman TM, Keenan JD. Comparison of Smartphone Photography, Single-Lens Reflex Photography, and Field-Grading for Trachoma. Am J Trop Med Hyg 2020; 103:2488-2491. [PMID: 33021196 DOI: 10.4269/ajtmh.20-0386] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Conjunctival examination for trachomatous inflammation-follicular (TF) guides public health decisions for trachoma. Smartphone cameras may allow remote conjunctival grading, but previous studies have found low sensitivity. A random sample of 412 children aged 1-9 years received an in-person conjunctival examination and then had conjunctival photographs taken with 1) a single-lens reflex (SLR) camera and 2) a smartphone coupled to a 3D-printed magnifying attachment. Three masked graders assessed the conjunctival photographs for TF. Latent class analysis was used to determine the sensitivity and specificity of each grading method for TF. Single-lens reflex photo-grading was 95.0% sensitive and 93.6% specific, and smartphone photo-grading was 84.1% sensitive and 97.6% specific. The sensitivity of the smartphone-CellScope device was considerably higher than that of a previous study using the native smartphone camera, without attachment. Magnification of smartphone images with a simple attachment improved the grading sensitivity while maintaining high specificity in a region with hyperendemic trachoma.
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Affiliation(s)
- John M Nesemann
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Michael I Seider
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Blake M Snyder
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Robi N Maamari
- Department of Bioengineering, University of California, Berkeley, Berkeley, California.,Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Daniel A Fletcher
- Department of Bioengineering, University of California, Berkeley, Berkeley, California
| | | | | | - Nicole E Varnado
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Sun Y Cotter
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
| | | | | | - Todd P Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Thomas M Lietman
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jeremy D Keenan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
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13
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Abstract
Purpose: To report the clinical outcomes of porcine acellular dermal matrix implants sandwiched between skin and conjunctival flaps for lower eyelid reconstruction following Mohs surgery. Methods: A retrospective review was performed on patients with lower eyelid defects following Mohs surgery treated using a porcine acellular dermal matrix sandwich graft from 2013 to 2018. Patient demographics, defect size and characteristics, and collagen matrix implant dimensions were evaluated. Postoperative course and complications were also reviewed. Results: The dermal matrix sandwich graft was performed in 13 cases (12 patients). Average horizontal marginal defect width was 11.7 mm (range: 6-16 mm). Mean width of the implanted dermal matrix was 7.7 mm (range: 5-9 mm). There were no instances of infection or graft failure. The reconstructed lid had an excellent marginal contour in 11 cases (84.6%), while 2 had minimal irregularities. All patients had an excellent thickness of the reconstructed margin. One patient (7.7%) required cauterization of overgrown marginal conjunctiva after surgery. Two patients (15.4%) experienced symptomatic trichiasis, requiring electrolysis (n = 1) and epilation (n = 1). Conclusions: The dermal matrix sandwich graft is an effective method for marginal defect repair when the remaining conjunctiva and skin are sufficient to develop the necessary flaps. While the resolution of edema and erythema may take several months, an excellent final result is achieved in the majority of cases. Complications are mild, relatively uncommon, and similar to those encountered in other reconstructive procedures. This single-stage, tissue-sparing technique preserves the capability of performing future tarsoconjunctival flaps or lateral canthal procedures, should the need arise.
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Affiliation(s)
- Philip L Custer
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine , St. Louis, Missouri, USA
| | - Robi N Maamari
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine , St. Louis, Missouri, USA
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14
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Johnson ER, Maamari RN, Neimkin MG, Bodnar ZM, Holds JB. Comparison of non-absorbable silk and absorbable polyglactin sutures for external ptosis repair. Orbit 2020; 39:18-22. [PMID: 31057006 DOI: 10.1080/01676830.2019.1594998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The authors compare the outcomes and revision rates for external levator aponeurotic advancement for the treatment of involutional ptosis using non-absorbable silk and absorbable polyglactin sutures.Methods: An IRB-approved retrospective chart review identified 121 patients who underwent external levator advancement for involutional ptosis between 2015 and 2016 by the senior author (JBH). All patients underwent ptosis repair using either 5-0 polyglactin 910 on a S-14 spatulated needle or 6-0 silk on a G-1 reverse cutting needle for the aponeurotic advancement. Ptosis etiologies other than involutional ptosis were excluded. Patients with >0.5 mm of upper lid height asymmetry post-operatively underwent surgical adjustment. Demographics, clinical findings and revision rates were collected and analyzed from follow-up visits.Results: 116 patients (190 eyelids) met inclusion criteria. Fewer ptosis repairs performed using silk sutures necessitated adjustment when compared to those using polyglactin (1/73 [1.4%] vs. 14/117 [12.0%], p = 0.010). Silk direct connection sutures had no better stability than polyglactin direct connection sutures (p = 0.16), but silk hang-back sutures were significantly superior to polyglactin hang-back sutures (p = 0.035). Thirteen out of fifteen (86.7%) revisions were advancements to raise the eyelid, while two (13.3%) were recessions.Conclusion: Non-absorbable silk suture may be superior to absorbable polyglactin, necessitating fewer surgical revisions. Silk demonstrated superiority to polyglactin when a hang-back suture was employed. Since the need to place direct or hang-back sutures cannot be made pre-operatively, the authors modified their technique to utilize silk sutures for external aponeurotic ptosis repair.
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Affiliation(s)
- Erik R Johnson
- Department of Ophthalmology, Saint Louis University, Saint Louis, USA
| | - Robi N Maamari
- Ophthalmic Plastic and Cosmetic Surgery, Inc., Des Peres, USA
- Department of Ophthalmology, Washington University in St. Louis, St. Louis, USA
| | | | - Zachary M Bodnar
- Department of Ophthalmology, Saint Louis University, Saint Louis, USA
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford, USA
| | - John B Holds
- Department of Ophthalmology, Saint Louis University, Saint Louis, USA
- Ophthalmic Plastic and Cosmetic Surgery, Inc., Des Peres, USA
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, USA
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15
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Johnson ER, Maamari RN, Neimkin MG, Bodnar ZM, Holds JB. Response to "Comparison of non-absorbable silk and absorbable polyglactin sutures for external ptosis repair". Orbit 2019; 39:231. [PMID: 31661335 DOI: 10.1080/01676830.2019.1677728] [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: 10/25/2022]
Affiliation(s)
- Erik R Johnson
- Department of Ophthalmology, Saint Louis University, Saint Louis, Missouri, USA
| | - Robi N Maamari
- Ophthalmic Plastic and Cosmetic Surgery, Inc., Des Peres, Missouri, USA.,Department of Ophthalmology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael G Neimkin
- Ophthalmic Plastic and Cosmetic Surgery, Inc., Atlanta, Georgia, USA
| | - Zachary M Bodnar
- Department of Ophthalmology, Saint Louis University, Saint Louis, Missouri, USA.,Byers Eye Institute at Stanford, Stanford, California, USA
| | - John B Holds
- Department of Ophthalmology, Saint Louis University, Saint Louis, Missouri, USA.,Ophthalmic Plastic and Cosmetic Surgery, Inc., Des Peres, Missouri, USA.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA
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16
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Abstract
Fat grafting is effectively used in the lower eyelid and periorbital area for rejuvenation of the aging face. Several complications may occur with fat grafting, including volume undercorrection or overcorrection, contour irregularities, prolonged bruising and swelling, infection, granulomas and inflammation, and vascular embolization with visual loss or stroke. In many cases, complications can be effectively treated, although permanent and serious injury can occur. Appropriate surgical techniques help to prevent most of these complications. An understanding of how and why complications of fat grafting of the lower eyelid occur aids in the avoidance and treatment of these complications.
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Affiliation(s)
- Robi N Maamari
- John F. Hardesty, MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8096, St. Louis, MO 63110, USA.
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, 150 N. Robertson Boulevard, Suite 314, Beverly Hills, CA 90211, USA
| | - John Bryan Holds
- Ophthalmic Plastic and Cosmetic Surgery, Inc.,12990 Manchester Road, Suite 102, Des Peres, MO 63131-1860, USA
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17
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Bamaga AK, Maamari RN, Culican SM, Shinawi M, Golumbek PT. Child Neurology: Brown-Vialetto-Van Laere syndrome: Dramatic visual recovery after delayed riboflavin therapy. Neurology 2019; 91:938-941. [PMID: 30420458 DOI: 10.1212/wnl.0000000000006498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ahmed K Bamaga
- From the Departments of Neurology (A.K.B., P.T.G.) and Ophthalmology and Visual Sciences (R.N.M., S.M.C.) and Division of Genetics and Genomic Medicine, Department of Pediatrics (M.S.), Washington University School of Medicine, St Louis, MO; and Department of Pediatrics (A.K.B.), King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Robi N Maamari
- From the Departments of Neurology (A.K.B., P.T.G.) and Ophthalmology and Visual Sciences (R.N.M., S.M.C.) and Division of Genetics and Genomic Medicine, Department of Pediatrics (M.S.), Washington University School of Medicine, St Louis, MO; and Department of Pediatrics (A.K.B.), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Susan M Culican
- From the Departments of Neurology (A.K.B., P.T.G.) and Ophthalmology and Visual Sciences (R.N.M., S.M.C.) and Division of Genetics and Genomic Medicine, Department of Pediatrics (M.S.), Washington University School of Medicine, St Louis, MO; and Department of Pediatrics (A.K.B.), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marwan Shinawi
- From the Departments of Neurology (A.K.B., P.T.G.) and Ophthalmology and Visual Sciences (R.N.M., S.M.C.) and Division of Genetics and Genomic Medicine, Department of Pediatrics (M.S.), Washington University School of Medicine, St Louis, MO; and Department of Pediatrics (A.K.B.), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul T Golumbek
- From the Departments of Neurology (A.K.B., P.T.G.) and Ophthalmology and Visual Sciences (R.N.M., S.M.C.) and Division of Genetics and Genomic Medicine, Department of Pediatrics (M.S.), Washington University School of Medicine, St Louis, MO; and Department of Pediatrics (A.K.B.), King Abdulaziz University, Jeddah, Saudi Arabia
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18
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Weil LM, Butler C, Howell KR, Sharr S, Paley GL, Huang AJW, Maamari RN, Pawloski LC, Cassiday PK, Acosta AM, Hariri S, Tiwari TSP. Notes from the Field: Conjunctivitis Caused by Toxigenic Corynebacterium ulcerans - Missouri, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:615-616. [PMID: 31295230 PMCID: PMC6741855 DOI: 10.15585/mmwr.mm6827a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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19
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Maamari RN, Custer PL, Neimkin MG, Couch SM. Medial canthoplasty for the management of exposure keratopathy. Eye (Lond) 2019; 33:925-929. [PMID: 30710111 DOI: 10.1038/s41433-019-0347-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/22/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the surgical technique and functional outcomes of the medial canthoplasty for the treatment of exposure keratopathy. PATIENTS/METHODS An IRB approved, retrospective review of patients who underwent medial canthoplasty for exposure keratopathy was performed. Patient demographics, reported symptoms, and clinical examination findings were collected and analyzed from pre-operative and follow-up visits. RESULTS The study included 73 consecutive cases in which the medial canthoplasty was performed in patients with exposure keratopathy. The average follow-up period was 7.9 months (median: 4.7 months; range: 1-150 months). Complete or partial improvement in ocular symptoms (dryness; pain/irritation; tearing) was achieved in 95% (69/73). Clinically, 85% (41/48) of patients demonstrated a post-operative reduction in lagophthalmos and 90% (60/67) showed improvement in ocular surface findings. Complications were rare (1/73) and reversal of medial canthoplasty was not required in any case. CONCLUSIONS The medial canthoplasty appears to be a safe and effective technique to narrow the palpebral fissure, provide lower eyelid support, and improve keratopathy. It is an uncomplicated procedure that may be considered for the treatment of exposure keratopathy caused by facial paralysis and lower eyelid malposition.
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Affiliation(s)
- Robi N Maamari
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Philip L Custer
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael G Neimkin
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA.,Ophthalmic Plastic and Cosmetic Surgery, LLC, Atlanta, GA, Georgia
| | - Steven M Couch
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA.
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20
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Kim TN, Myers F, Reber C, Loury PJ, Loumou P, Webster D, Echanique C, Li P, Davila JR, Maamari RN, Switz NA, Keenan J, Woodward MA, Paulus YM, Margolis T, Fletcher DA. A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging. Transl Vis Sci Technol 2018; 7:21. [PMID: 30280006 PMCID: PMC6166894 DOI: 10.1167/tvst.7.5.21] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 03/13/2018] [Accepted: 08/05/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening.
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Affiliation(s)
- Tyson N Kim
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Frank Myers
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Clay Reber
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - P J Loury
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Panagiota Loumou
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Doug Webster
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Chris Echanique
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Patrick Li
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jose R Davila
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Robi N Maamari
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA.,Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Neil A Switz
- Department of Physics and Astronomy, San José State University, San Jose, CA, USA
| | - Jeremy Keenan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Todd Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel A Fletcher
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA.,Chan-Zuckerberg Biohub, San Francisco, CA, USA
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Maamari RN, Custer PL, Harocopos GJ. Incidentally Discovered Adenoid Cystic Carcinoma of the Lacrimal Gland with Isolated Liver Metastases. Ocul Oncol Pathol 2017; 3:262-266. [DOI: 10.1159/000461585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/05/2017] [Indexed: 11/19/2022] Open
Abstract
<b><i>Aim:</i></b> To report a rare presentation of adenoid cystic carcinoma (ACC) of the lacrimal gland. <b><i>Method:</i></b> This is a case report presenting clinical, radiographic, and histopathologic findings. <b><i>Results:</i></b> A 72-year-old female with no reported ocular symptoms was found to have an incidental right orbital mass on imaging. Additional studies revealed multiple liver lesions, which were biopsied and found to be consistent with ACC. She was then referred to the ophthalmology service, where ocular examination demonstrated 2.5 mm of right proptosis with elevation and abduction deficits. Diplopia could be elicited in extreme upgaze and right lateral gaze. An excisional biopsy of the orbital mass was performed, with histopathology confirming the diagnosis of primary ACC of the lacrimal gland, thereby also supporting the initial suspicion that the hepatic ACC lesions represented metastases. <b><i>Conclusion:</i></b> The authors describe a rare presentation of ACC of the lacrimal gland, initially asymptomatic, with metastatic lesions restricted to the liver at the time of diagnosis. Three previous cases of ACC with isolated metastatic hepatic lesions at the time of diagnosis have been reported; all of these cases localized the primary tumor to the salivary glands.
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Maamari RN, Vemuri S, Tao JP. A Modified Action Sports Camera for High-Quality and Cost–Effective Oculofacial Surgical Videography. Ophthalmic Plast Reconstr Surg 2015; 31:336-7. [DOI: 10.1097/iop.0000000000000468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maamari RN, Ausayakhun S, Margolis TP, Fletcher DA, Keenan JD. Novel telemedicine device for diagnosis of corneal abrasions and ulcers in resource-poor settings. JAMA Ophthalmol 2014; 132:894-895. [PMID: 25010172 PMCID: PMC9360558 DOI: 10.1001/jamaophthalmol.2014.335] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- Robi N. Maamari
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Todd P. Margolis
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Daniel A. Fletcher
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, California
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Breslauer DN, Maamari RN, Switz NA, Lam WA, Fletcher DA. Mobile phone based clinical microscopy for global health applications. PLoS One 2009; 4:e6320. [PMID: 19623251 PMCID: PMC2709430 DOI: 10.1371/journal.pone.0006320] [Citation(s) in RCA: 386] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 06/09/2009] [Indexed: 11/18/2022] Open
Abstract
Light microscopy provides a simple, cost-effective, and vital method for the diagnosis and screening of hematologic and infectious diseases. In many regions of the world, however, the required equipment is either unavailable or insufficiently portable, and operators may not possess adequate training to make full use of the images obtained. Counterintuitively, these same regions are often well served by mobile phone networks, suggesting the possibility of leveraging portable, camera-enabled mobile phones for diagnostic imaging and telemedicine. Toward this end we have built a mobile phone-mounted light microscope and demonstrated its potential for clinical use by imaging P. falciparum-infected and sickle red blood cells in brightfield and M. tuberculosis-infected sputum samples in fluorescence with LED excitation. In all cases resolution exceeded that necessary to detect blood cell and microorganism morphology, and with the tuberculosis samples we took further advantage of the digitized images to demonstrate automated bacillus counting via image analysis software. We expect such a telemedicine system for global healthcare via mobile phone – offering inexpensive brightfield and fluorescence microscopy integrated with automated image analysis – to provide an important tool for disease diagnosis and screening, particularly in the developing world and rural areas where laboratory facilities are scarce but mobile phone infrastructure is extensive.
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Affiliation(s)
- David N. Breslauer
- UCSF/UC Berkeley Bioengineering Graduate Group
- Department of Bioengineering, University of California Berkeley, Berkeley, California, United States of America
| | - Robi N. Maamari
- Department of Bioengineering, University of California Berkeley, Berkeley, California, United States of America
| | - Neil A. Switz
- Biophysics Graduate Group, University of California Berkeley, Berkeley, California, United States of America
| | - Wilbur A. Lam
- Department of Bioengineering, University of California Berkeley, Berkeley, California, United States of America
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel A. Fletcher
- UCSF/UC Berkeley Bioengineering Graduate Group
- Department of Bioengineering, University of California Berkeley, Berkeley, California, United States of America
- Biophysics Graduate Group, University of California Berkeley, Berkeley, California, United States of America
- * E-mail:
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