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Acute Orbital Compartment Syndrome After Coil Embolization of a Contralateral Carotid Cavernous Fistula

Gandy, Christiana L; Tooley, Andrea A; Lee, Andrew Y J; Tran, Ann Q; Oliveira, Cristiano; Patsalides, Athos; Godfrey, Kyle J
PMID: 33449493
ISSN: 1536-5166
CID: 4747352

Double Frost Suture Technique for Simultaneous Skin Grafting of the Upper and Lower Eyelids

DeMaria, Lauren N; Tran, Ann Q; Tooley, Andrea A; North, Victoria S; Flores, Roberto L; Lisman, Richard D; Belinsky, Irina
The double Frost suture is a useful supplement to the reconstruction of ipsilateral upper and lower eyelid defects with full-thickness skin grafts. This technique involves silk traction sutures that overlap the upper and lower eyelids to place them on maximal stretch after placement of 2 full-thickness skin grafts. It has the added benefit of protecting the cornea and compressing both grafts under 1 bolster. The authors illustrate this technique in 2 pediatric cases-a congenital melanocytic kissing eyelid nevus and a periocular burn. Each case resulted in large upper and lower anterior lamellar defects, which were reconstructed with supraclavicular and retroauricular free skin grafts. The double Frost sutures counter vertical cicatricial forces during graft healing, obviating the need for staged procedures. Both described cases resulted in excellent graft survival with minimal contracture.
PMID: 34297708
ISSN: 1537-2677
CID: 4948712

Partial Vision Loss After Orbital Decompression in a Patient With Thyroid Eye Disease, Chorioretinal Folds, and Disc Edema

DeMaria, Lauren N; Tran, Ann Q; Tooley, Andrea A; Elmalem, Valerie I; Belinsky, Irina
ABSTRACT/UNASSIGNED:Concomitant chorioretinal folds with disc edema can be seen in cases of thyroid eye disease presenting with compressive optic neuropathy and may portend optic nerve ischemia. We describe an unusual case of a 64-year-old man who developed partial vision loss after orbital decompression.
PMID: 33630776
ISSN: 1536-5166
CID: 4794842

Cadaveric simulation improves ophthalmology resident confidence and preparedness for emergent ophthalmic procedures [Letter]

Tooley, Andrea A; Hur, Min Jun; Lachman, Nirusha; Barkmeier, Andrew J
PMID: 33741361
ISSN: 1715-3360
CID: 4821892

Natural killer T-cell lymphoma causing bilateral recurrent recalcitrant dacryocystitis

Mechel, Elzbieta; Tran, Ann Q; North, Victoria S; Moen, Farnoush M; Tooley, Andrea A
A 35-year-old female with a history of chronic extensive rhinosinusitis, previously treated twice with functional endoscopic sinus surgery, presented with recurrent dacryocystitis despite prior dacryocystorhinostomy. Histopathological specimens taken at the most recent sinus surgery demonstrated a lymphocytic inflammatory reaction without evidence of angiodestruction or necrosis. Flow cytometry was normal. Over the following 9 months, the patient developed worsening hypertelorism and bilateral recurrent acute dacryocystitis with a fistula tract to the skin. Neuroimaging revealed a hyperintense enhancing soft tissue expansion into the periorbital regions, invading the nasolacrimal canals, and obstructing the paranasal sinuses. A skin biopsy at the fistula site revealed natural killer T-cell lymphoma. Metastatic work-up disclosed lung, spleen, and bone marrow involvement. The patient underwent chemotherapy with mixed clinical response, and ultimately passed away from metastatic disease. The authors present a rare case of natural killer T-cell lymphoma involving the nasolacrimal sac, presenting as recurrent dacryocystitis and diagnosed by skin biopsy of the fistula site.
PMID: 33975510
ISSN: 1744-5108
CID: 4867332

Atypical Cogan Syndrome Featuring Orbital Myositis and Dacryoadenitis

Zhou, Henry W; Tran, Ann Q; Tooley, Andrea A; Miyauchi, Jeremy T; Kazim, Michael
A 39-year-old male presented with bilateral hearing loss and progressive left eye vision loss over a 14-month period. The development of systemic symptoms including arthralgias, enlarged lymph nodes, and profound leg weakness, prompted a workup for lymphoproliferative disease, infection, and autoimmune inflammatory conditions which was unrevealing. Subsequently, the right visual acuity declined from 20/25 to 20/70 and the left to hand motions due to corneal interstitial keratitis. There was limitation of left infraduction. Neuroimaging revealed dural thickening of the internal auditory canals, cavernous sinuses, cerebellum, and along the optic nerves. There was fusiform enhancing enlargement of the left inferior and medial rectus muscles and pathologic enlargement of the left lacrimal gland. Biopsy of the left lacrimal gland and left inferior rectus revealed fibrosis and lymphocytic infiltration. The patient was diagnosed with atypical Cogan syndrome and treated with oral prednisone, with improvement in visual acuity of the right eye, motility of the left eye, and systemic weakness.
PMID: 32991499
ISSN: 1537-2677
CID: 4616732

Reliability of 3 Strategies of Orbital Tumor Volume Measurement Using Phantom Modeling

Tooley, Andrea A; Maher, Mary; Cooper, Cathleen; Godfrey, Kyle J; Tran, Ann Q; Kazim, Michael
PURPOSE/OBJECTIVE:The reliability of 3 volume measurement strategies was investigated using MRI and a simple method for creating phantom orbit tumors. METHODS:Water-based starch was molded into orbital "tumors" of 3 shapes (sphere, ovoid, diffuse); water displacement was used to calculate volume. "Tumors" were placed into 3D-printed orbit phantoms, MRIs were obtained and volume analysis was performed. Observers measured tumor volume using ellipsoid volume (EV), manual segmentation, and semi-automated segmentation strategies. Intraclass correlation coefficients were calculated comparing observer measurements to true volumes. The coefficient of repeatability determined the percentage of tumor volume change required for each method to detect tumor growth. RESULTS:Intraclass correlation coefficients comparing measured volumes to true volumes using EV, manual segmentation, and semi-automated segmentation were 0.61, 0.98, and 0.99 for spherical, 0.64, 0.97, and 0.98 for ovoid, and 0.18, 0.82, and 0.87 for diffuse tumors. Semi-automated segmentation followed by manual segmentation had the highest correlation between measured and true tumor volume for all 3 tumor geometries. EV had low correlation with true volume for all tumor geometries. Diffuse tumors had high variability and low correlation for all 3 measurement techniques. CONCLUSIONS:This study shows the reliability of 3 strategies to measure orbital tumor volume with MRI based on tumor geometry, using a simple phantom model. EV, the most commonly employed strategy in clinical practice, had low correlation and high variability across tumor shapes. Using manual segmentation and semi-automated segmentation, a measured change in volume greater than 25% may be considered true growth, while the EV strategy required a 40%-400% change in volume to reliably measure tumor growth.
PMID: 32732541
ISSN: 1537-2677
CID: 4540552

Prospective Correlation of Risk of Obstructive Sleep Apnea With Severe Clinical Features of Thyroid Eye Disease

Godfrey, Kyle J; Schmuter, Gabriella; Hu, Bo; Tooley, Andrea A; Dunbar, Kristen E; Basner, Robert C; Kazim, Michael
PURPOSE/OBJECTIVE:To evaluate the association between risk of obstructive sleep apnea (OSA) and severity of thyroid eye disease (TED) using a validated OSA screening tool. METHODS:A prospective, observational cohort study was performed. New adult TED patients were offered OSA screening with the Snoring Tired Observed Pressure (STOP)-Bang survey during their initial evaluation. Clinical examination and treatment for TED were standard of care and utilized the International Thyroid Eye Disease Society Vision Inflammation Strabismus Appearance system. At the conclusion of the study period, analysis was performed correlating maximum severity of TED signs and symptoms between high- and low-risk OSA groups. Multivariate logistic and linear regression analyses were also performed to analyze the association between the numerical STOP-Bang score and maximum severity of the potentially actionable clinical features of TED (compressive optic neuropathy, vertical prism deviation, horizontal prism deviation, exophthalmos, vertical fissure height). RESULTS:Eighty-five patients met inclusion criteria. Twenty-eight percent were at high risk of OSA (STOP-Bang score of 3 or higher). When comparing the low- and high-risk cohorts, increased risk of OSA was significantly associated with the development of TED compressive optic neuropathy (p = 0.014), conjunctival injection (p = 0.027), chemosis (p = 0.013), upper eyelid edema (p = 0.024), lower eyelid edema (p = 0.003), eyelid erythema (p = 0.037), and vertical strabismus (p = 0.047). In the multivariate regression analyses, higher STOP-Bang scores correlated with increased risk of TED compressive optic neuropathy (p = 0.006), vertical strabismus (p = 0.019), and higher subjective diplopia scores (p = 0.045). CONCLUSIONS:Increased risk of OSA, as determined by the STOP-Bang survey, is associated with increased severity of multiple clinical features of TED, including TED compressive optic neuropathy and strabismus.
PMID: 32852372
ISSN: 1537-2677
CID: 4575812

Gender Distribution and Rates of Publication of Abstracts Presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery Meeting Over a 25-Year Period

Tooley, Andrea A; Tran, Ann Q; Rebhun, Carl B; Paulose, Sefy; Kim, Eleanore; Belinsky, Irina; Lisman, Richard
PMID: 34011913
ISSN: 1537-2677
CID: 4877372

Atypical presentation of invasive myoepithelioma in a pediatric patient

Chang, Angela Y; Tran, Ann Q; Plum, William; Tooley, Andrea A; Purushothaman, Sonya; Kazim, Michael
A 15-year-old girl presented with a mobile lesion with yellowish hue on the posterior lamella of the right lower eyelid adjacent to the punctum. Four years prior, a lesion thought to be a chalazion was excised from the same location. There was subsequent progressive painless enlargement. The patient ultimately underwent an internal excision of the mass. Histopathology demonstrated infiltrative nests and cords of epithelioid and plasmacytoid cells with abundant eosinophilic myxoid-collagenous stroma along with focal infiltration of skeletal muscle with immunohistochemical staining consistent with an invasive myoepithelioma of mixed-cell type. Given concern for invasive disease, the patient underwent subsequent Mohs resection resulting in a 25% full thickness eyelid defect, which was repaired with direct closure of the wedge defect. There has been no recurrence of the disease for 7 months since the Mohs resection. This case illustrates the atypical presentation of an invasive myoepithelioma of the eyelid in a pediatric patient.
PMID: 33906572
ISSN: 1744-5108
CID: 4853242