Faculty Bibliography

Adenoid cystic carcinoma (ACC) is a rare epithelial malignancy, which tends to grow slowly. ACC is an intractable neoplasm due to its ability to invade perineural spaces. Local recurrence after excision is not unusual. ACC most commonly arises in the lacrimal gland. Very rarely, ACC originates from accessory lacrimal gland tissue. Here, we present a patient with a large ACC of the central upper eyelid, which had been misdiagnosed and treated as a chalazion without histological examination. Its origin most likely is an accessory lacrimal gland.

BACKGROUND:Transconjunctival orbital decompression ("swinging eyelid technique") nowadays is the technique of choice for the reduction of proptosis in Graves' orbitopathy. Here, we present the first report of two patients who developed corneal dellen secondary to conjunctival chemosis following swinging eyelid decompression. CASE REPORTS/METHODS:Two female patients, 38 and 52 years old, underwent transconjunctival orbital decompression in 2006. Postoperatively, they developped corneal dellen secondary to conjunctival chemosis. The dellen and the chemosis completely regressed after intensive topical and oral therapy. CONCLUSION/CONCLUSIONS:Corneal dellen represent a potential cause of postoperative pain following transconjunctival orbital decompression.

PURPOSE/OBJECTIVE:In the past few years, the essential role of the homeobox gene Pax6 for eye development has been demonstrated unambiguously in a variety of species including humans. In humans, Pax6 mutations lead to a variety of ocular malformations of the anterior and posterior segment. However, little is known about PAX6 expression in the adult human retina. We have therefore investigated PAX6 levels and localization in the human retina at various ages. METHODS:Adult human eyes of various ages (17-79 years) were obtained from the Zurich Eye Bank. PAX6 expression levels and patterns were analysed by Western blot analysis of total retinal protein and by immunohistochemistry on paraffin sections, respectively. RESULTS:PAX6 expression in the retina was detected up to 79 years of donor age and was predominantly localized to the ganglion cell layer and the inner part of the inner nuclear layer. CONCLUSIONS:PAX6 remains distinctly expressed throughout the lifespan of the human retina suggesting a role for PAX6 in the retina after completion of eye morphogenesis.

PURPOSE/OBJECTIVE:Corneal collagen cross-linking by UVA/riboflavin (X-linking) represents a new method for the treatment of progressive keratoconus and currently is under clinical study. To avoid UVA irradiation damage to the corneal endothelium, the parameters for X-linking are set in a way that effective treatment occurs only in the first 300 microm of the corneal stroma. Here, X-linking not only strengthens the biomechanical properties of the cornea but also induces keratocyte apoptosis. To date, the effectiveness of treatment could be monitored only indirectly by postoperative follow-up corneal topographies or using corneal confocal microscopy. Here we describe a corneal stromal demarcation line indicating the transition zone between cross-linked anterior corneal stroma and untreated posterior corneal stroma. The demarcation line is biomicroscopically detectable in slit-lamp examination as early as 2 weeks after treatment. METHODS:X-linking was performed in 16 cases of progressive keratoconus, and corneas were examined biomicroscopically and by means of corneal topography and pachymetry before and after treatment. RESULTS:In 14 of 16 cases, a thin stromal demarcation line was visible at a depth of approximately 300 microm over the whole cornea after X-linking treatment. CONCLUSION/CONCLUSIONS:This newly observed demarcation line may result from differences in the refractive index and/or reflection properties of untreated versus X-linked corneal stroma and represents an effective tool to biomicroscopically easily monitor the depth of effective X-linking treatment in keratoconus.

In a review of the recent literature, liposuction and tumescent fluid injection are accompanied by hazards of ischemia, flap necrosis, and wound dehiscence at the time of abdominoplasty. The problems that generate complaints from patients and dissatisfaction with tummy tuck surgery are: fullness of flanks and epigastric areas, lack of a posterior lumbar curve, hanging skin over the incision line, and visible scars over the flanks and beyond underwear or swimming suit coverage. The purpose of this article is to introduce modalities to perform liposuctioning of the whole abdomen without confronting the danger of ischemia or flap necrosis. Wide lipoaspiration at the time of abdominoplasty and removing the flanks and epigastric fullness result in a shorter incision line and more natural-looking abdomen. In this article, the authors explain their experience using a new method to omit the complications of classic abdominoplasty surgery in 56 cases performed over a 3-year period (2000-2003).

A bulky nose is a challenging issue to manage, and surgeons have not found the ultimate solution to this problem in the evolution of rhinoplastic surgery. Because of the multiplicity of techniques and controversies published in the literature, it has become confusing for the operating surgeon to find the most appropriate and effective way of solving this frustrating dilemma. The subcutaneous fat is the thickest in the supratip area, and the soft tissue thickness over the tip of the nose varies considerably from patient to patient. The focus of this study was to find a method for reducing the overlying soft tissue of the tip for better re-draping of skin over the nasal skeleton. The hallmark of this technique is to undermine the nasal skin in two layers. We believe that soft tissue trimming in biplane dissection can minimize the thickness of the tip skin in a relatively safe and homogeneous way. With this report we introduce a new method of dissection of nasal soft tissue and of trimming it in different areas of the nose for different purposes. In the authors' opinion, this approach is one of the most effective ways of handling unpliable, thick nasal skin.

BACKGROUND:Repeat operations after refractive surgery have increased in frequency during the past 10 years. The spectrum of the indications for repeat LASIK may have changed. METHODS:All cases of repeat operations after refractive surgery performed between May 1, 2004 and April 30, 2005 at the Institute of Refractive and Ophthalmic Surgery (IROC) were retrospectively investigated regarding indication for repeat surgery and visual and refractive results. The 1-month results were used to estimate the refractive and visual success rate. RESULTS:Of the 76 reoperations, 69 were performed as re-lifts, 3 eyes had new lamellae cut, and 3 cases needed keratoplasties. The reoperations took place 7.5 +/- 13 months after the primary operation (range 0.5 to 60 months). The most frequent indication was residual astigmatism of 0.5 D and more. Visual loss of more than 1 decimal line did not occur and unaided visual acuity increased from 0.64 to 1.05. No complications were reported, however, 3 eyes needed additional enhancement. CONCLUSIONS:Reoperations after LASIK performed as re-lifts appear to be effective and reasonably safe when using the technique described and respecting a residual stromal thickness of 280 microns.

Steep central island (SCI) formation after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) represents a major drawback in the visual rehabilitation of patients after refractive laser surgery. Because of the small size of SCIs, current ablation algorithms are unable to properly calculate an ablation pattern for customized retreatment. We present the use of a new ablation algorithm for the treatment of SCIs that occurred after PRK or LASIK surgery. This algorithm uses a smaller zone of approximation and takes into account the spherical shift induced by removal of the SCI. In all 3 eyes treated, best spectacle-corrected visual acuity increased to 20/16 and remained stable at the 1- and 3-month follow-up, with disappearance of the SCI in corneal topography. This new treatment algorithm may be of benefit to patients experiencing visual side effects due to SCI formation after PRK or LASIK surgery.