Publications by authors named "Alan A McNab"

128 Publications

Oculoplastic Abstracts.

Ophthalmic Plast Reconstr Surg 2021 Nov-Dec 01;37(6):607-608

Ain Shams University, Cairo, Egypt.

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http://dx.doi.org/10.1097/IOP.0000000000002080DOI Listing
November 2021

Oculoplastic Abstracts.

Ophthalmic Plast Reconstr Surg 2021 Sep-Oct 01;37(5):509-510

Ain Shams University, Cairo, Egypt.

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http://dx.doi.org/10.1097/IOP.0000000000002035DOI Listing
September 2021

Clinical and Radiological Features of Intramuscular Orbital Amyloidosis: A Case Series and Literature Review.

Ophthalmic Plast Reconstr Surg 2021 Sep 8. Epub 2021 Sep 8.

Sydney Eye Hospital, New South Wales South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide Department of Anatomical Pathology, St. Vincent's Hospital, Fitzroy Royal North Shore Hospital, Sydney, New South Wales Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.

Purpose: Orbital amyloidosis of the extraocular muscles (EOMs) is a rare condition, and its clinicoradiological features are not well elucidated. This study describes the characteristic clinical signs, MRI features, and potential treatment options.

Methods: Retrospective multicenter case series and literature review of EOM amyloidosis.

Results: Five cases were identified for inclusion. Common clinical findings were diplopia, ophthalmoplegia, and proptosis. Systemic amyloidosis was more likely to present with multiple muscle involvement, but no particular pattern was observed with localized disease. On MRI, amyloid deposition was characterized as a heterogeneous intramuscular mass with T2 hypointensity and post contrast enhancement. Management is dependent on the extent of disease and functional impairment; options include surgical debulking and radiation therapy.

Conclusion: EOM amyloidosis is uncommon. The combination of clinical and radiologic findings described in this study should lead to its clinical suspicion.
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http://dx.doi.org/10.1097/IOP.0000000000002061DOI Listing
September 2021

IgG4-related ophthalmic disease in association with adult-onset asthma and periocular xanthogranuloma: a case report.

Orbit 2021 Sep 7:1-6. Epub 2021 Sep 7.

Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Australia.

A 54-year-old male presented with a three-year history of bilateral upper eyelid and peri-orbital swelling and adult-onset asthma. Histopathology of a left orbital biopsy showed lymphoid follicles with foamy macrophages and Touton giant cells. Clinical, histological and radiological features were consistent with adult-onset asthma and periocular xanthogranuloma. Treatment with rituximab led to a complete clinical and radiological remission. Nine years later, his condition relapsed with a biopsy of the left orbit and lacrimal gland demonstrating features of IgG4-related disease and adult-onset asthma and periocular xanthogranuloma. Immunohistochemistry showed increased numbers of IgG4+ plasma cells (290 per high power field) and an elevated IgG4+/IgG+ plasma cell ratio of 480%. Involvement by both disorders in the orbit and ocular adnexa of a single patient has not previously been reported in the literature, to the best of our knowledge, and suggests a possible aetiologic or pathophysiologic association.
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http://dx.doi.org/10.1080/01676830.2021.1973512DOI Listing
September 2021

Referral and diagnostic accuracy in orbital cellulitis.

Emerg Med Australas 2021 10 21;33(5):951-952. Epub 2021 Aug 21.

Orbital, Plastic and Lacrimal Service (OPAL), Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/1742-6723.13852DOI Listing
October 2021

Oculoplastic Abstracts.

Ophthalmic Plast Reconstr Surg 2021 May-Jun 01;37(3):303-304

Watany Eye Hospital, Cairo, Egypt.

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http://dx.doi.org/10.1097/IOP.0000000000001977DOI Listing
May 2021

Re: "Diagnosis and Management of Acute Thrombosis in Venous Dominant Orbital Venolymphatic Malformations".

Ophthalmic Plast Reconstr Surg 2021 May-Jun 01;37(3):297

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1097/IOP.0000000000001967DOI Listing
May 2021

Ptosis, ophthalmoplegia and corneal endothelial disease - ocular manifestations of mitochondrial disease.

Am J Ophthalmol Case Rep 2021 Jun 17;22:101073. Epub 2021 Mar 17.

Department of Orbit, Plastic and Lacrimal Surgery, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria, Australia.

Purpose: To describe two patients with bilateral ptosis, ophthalmoplegia, cataracts and corneal endothelial disease requiring corneal transplantation.

Observations: Histopathological analysis of muscle biopsy samples from both patients identified features consistent with a mitochondrial cytopathy. A single multigenic mitochondrial deoxyribonucleic acid (DNA) deletion was detected in the first patient. Pathogenic mutations in the POLG gene which codes for mitochondrial DNA polymerase, tasked with replicating the mitochondrial genome were identified in the second patient.

Conclusion: The collection of clinical features present in both cases described can be explained by a diagnosis of mitochondrial disease.

Importance: Corneal endothelial disease, in addition to ptosis, ophthalmoplegia, cataract, pigmentary retinopathy and optic atrophy should be recognised as a feature of mitochondrial disease.
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http://dx.doi.org/10.1016/j.ajoc.2021.101073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041719PMC
June 2021

Extraocular Muscle Enlargement and Proptosis Associated with Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

Ophthalmic Plast Reconstr Surg 2021 Sep-Oct 01;37(5):e176-e178

Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, which commonly causes peripheral neuropathy. It has rarely been associated with cranial nerve hypertrophy and neuro-ophthalmic manifestations. Proptosis secondary to cranial nerve hypertrophy has been reported in association with CIDP. The authors present a case of a 67-year-old man with CIDP who presented with bilateral proptosis, strabismus, and episodes of globe subluxation. The proptosis was mainly attributed to significant enlargement of the extraocular muscles, in addition to bilateral enlargement of the trigeminal nerves. There has been no published case of CIDP with associated enlargement of extraocular muscles without a history of underlying hyperthyroidism, inflammation, or malignancy. This may represent a new clinical finding in CIDP and adds to the limited literature on the neuro-ophthalmic and orbital associations of CIDP. The proptosis was managed with an uncomplicated bilateral orbital decompression.
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http://dx.doi.org/10.1097/IOP.0000000000001982DOI Listing
October 2021

Spheno-orbital Lesions-A Major Review of Nonmeningioma Causes.

Ophthalmic Plast Reconstr Surg 2021 Nov-Dec 01;37(6):522-533

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital.

Purpose: To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma.

Methods: We reviewed 32 cases of spheno-orbital lesions involving the GWS from our own practice, as well as 109 published cases (total 141), with emphasis on available imaging features on computerized tomography (CT) and MRI. Features that might assist in differentiating meningioma from its mimics were analyzed for each lesion, including the presence of an osteoblastic or hyperostotic response, bone erosion or osteolysis, homogeneous hypo- or hyperintensity on T2-weighted MRI, leptomeningeal involvement, and the absence of a "dural tail" on contrast-enhanced MRI. The clinical and imaging features were also briefly summarized for each diagnostic group.

Results: The largest diagnostic group was metastasis (67 cases, 47.5%). The most useful imaging features that helped differentiate meningioma from its mimics were the presence of bone erosion and the absence of a "dural tail." Other features were helpful in a small minority of cases only. Metastatic prostate cancer was the largest single group (21 cases), and 18 (85.7%) of these were osteoblastic and most closely mimicked meningioma. Prostate cancer patients were generally older than males with GWS meningioma. Almost all other (44/46, or 95.7%) metastatic lesions showed evidence of bone erosion. Almost half (30 of 61, 49.2%) of patients with metastasis presented without a known diagnosis of malignancy. Among children 16 years of age and less, Langerhans cell histiocytosis (10 cases), dermoid cyst (5), and Ewing's sarcoma (5) were the most common diagnoses.

Conclusions: A combination of a careful history and both CT and MRI gives information, which can best guide the management of patients with spheno-orbital lesions. Metastatic prostate cancer to the GWS most closely mimics GWS meningioma but can in most cases be differentiated on clinical and imaging features. Older males with hyperostotic lesions of the GWS should be investigated for prostate cancer. Other metastatic lesions and primary tumors of the GWS, as well as benign and structural lesions can readily be differentiated from meningioma on clinical and imaging features.
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http://dx.doi.org/10.1097/IOP.0000000000001924DOI Listing
November 2021

Lacrimal gland pleomorphic adenoma with extensive necrosis.

Orbit 2021 Jan 6:1-4. Epub 2021 Jan 6.

Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.

Lacrimal gland pleomorphic adenomas (LGPA) are benign mixed tumors. Diagnosis is based on clinical and radiological findings which usually prompts complete excision of the lesion to minimise recurrence and a cumulative risk of malignant transformation. Necrosis in pleomorphic adenoma has been rarely reported in salivary gland PA, either spontaneously or due to iatrogenic interventions. Necrosis is suggestive of a malignant process and makes interpretation of histology specimens difficult. A 23 year old woman, while awaiting biopsy for a mass in the left lacrimal gland, which had been symptomatic for only several months, presented with acute pain and swelling of the left lateral lid. An incisional biopsy showed an inflamed lacrimal gland with focal necrosis and atypia of adjacent cytology and gland architecture. Subsequent excisional biopsy confirmed an LGPA with some inflammation but no necrosis. Necrosis may occur as an atypical presentation in LGPA.
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http://dx.doi.org/10.1080/01676830.2020.1867194DOI Listing
January 2021

Re: "Morbihan Syndrome, a UK Case Series. What's in a Name?"

Authors:
Alan A McNab

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):98

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, and Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1097/IOP.0000000000001893DOI Listing
April 2021

Reply re: "Orbital Myositis: A Comprehensive Review and Reclassification".

Authors:
Alan A McNab

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):96

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http://dx.doi.org/10.1097/IOP.0000000000001920DOI Listing
April 2021

Cutaneous pleomorphic adenoma of the periocular region - a case series.

Orbit 2020 Dec 8:1-4. Epub 2020 Dec 8.

Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.

Mixed tumour of the skin is a rare entity also known as chondroid syringoma and pleomorphic adenoma. These usually present as slow-growing skin nodules with a smooth surface, clear boundaries, and no ulceration. Case series exist describing pleomorphic adenomas in the periocular region including the lids and orbit, separate to the more familiar lacrimal gland pleomorphic adenoma. These may arise from accessory or ectopic lacrimal gland tissue but in the eyelids are more likely to arise from sweat glands in the skin. Histopathological analysis of these lesions is important to identify complete excision, minimising recurrences and in identifying rare but potential malignant transformation. We describe the clinical features and outcomes in three cases of pleomorphic adenoma with two at the medial canthus (including one recurrence) and one in the brow region.
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http://dx.doi.org/10.1080/01676830.2020.1856884DOI Listing
December 2020

Re: concomitant adult onset xanthogranuloma and IgG4-related orbital disease: A rare occurrence.

Orbit 2021 02 9;40(1):85-86. Epub 2020 Oct 9.

Department of Anatomical Pathology, St Vincent's Hospital , Melbourne, Australia.

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http://dx.doi.org/10.1080/01676830.2020.1832124DOI Listing
February 2021

Diplopia Following the Insertion of a Canalicular Bypass Tube: Etiology, Risk Factors, Management, and Outcomes.

Ophthalmic Plast Reconstr Surg 2021 May-Jun 01;37(3S):S19-S22

Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, United Kingdom.

Purpose: To report the etiology, management, and possible risk factors for diplopia after canalicular bypass surgery.

Methods: A multicenter retrospective, noncomparative case series of patients who developed diplopia following canalicular bypass surgery were assessed.

Results: Twenty-four cases of diplopia were identified across 12 institutions. Tubes were inserted as a primary procedure with external dacryocystorhinostomy (DCR) (1; 4%) or without DCR (10; 42%) or as a secondary procedure after external (8; 33%) or endonasal (5; 21%) DCR. Factors predisposing to local damage were noted in 17 (71%): these factors included preexisting autoimmune/inflammatory condition (7 cases), medial canthal tumor resection (5 cases), preoperative radiotherapy (2 cases), 2 drug treatments (topical and systemic), and 1 local surgery. Horizontal diplopia was due to restriction of abduction and first noted at a median of 3.5 months (mean: 17.8 months, range: 1 day to 112 months) and persisted in 23 (96%) cases with a mean restriction of -2, affecting primary gaze in 4 patients and activities of daily living in 13 (42%). Seventeen patients received various treatments: 10 were operated on resulting in cure in 1 and improvement in 9. A stable degree of diplopia persisted in all but one patient.

Conclusions: Restriction of abduction causing horizontal diplopia is a rare complication with canalicular bypass surgery and a notably high proportion occurred after tube placement without DCR; carunculectomy was not ubiquitous. Although in some the diplopia may be improved with intervention, the chance of cure is low. This complication should probably be included during informed consent for canalicular bypass tubes.
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http://dx.doi.org/10.1097/IOP.0000000000001770DOI Listing
May 2021

Histopathologic Findings in Idiopathic Orbital Myositis.

Ophthalmology 2021 04 11;128(4):609-616. Epub 2020 Sep 11.

Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.

Purpose: To report the histologic and clinical features of idiopathic orbital myositis (IOM) patients who underwent extraocular muscle (EOM) biopsy over 20 years, to provide the first methodical reference to the expected histopathologic findings, and to discuss the histopathologic differences from common differential diagnoses.

Design: Cohort study.

Participants: All patients with a diagnosis of IOM who underwent EOM biopsy from 2000 through 2019 were included. Patients who had a different final diagnosis were excluded.

Methods: Tissue samples of EOM and medical records of all participants were reviewed.

Main Outcome Measures: Histopathologic features of muscle biopsy, including tissue morphologic features and cellular composition.

Results: Thirteen patients met both inclusion and exclusion criteria, and their tissue samples were revisited. Nine patients showed histopathologic findings that suggested a conclusive diagnosis of IOM, and the study focused on them. The average age at presentation was 49 years, and 66.7% of patients were women. The most commonly biopsied EOM was the medial rectus (44.4%). The most common indications for biopsy were nonresolving orbital disease with inadequate response to corticosteroids (44.4%) or a high suspicion of malignancy because of known pre-existing systemic malignancy or the presence of an atypical orbital mass in addition to enlarged muscles (44.4%). The histopathologic findings that suggested a diagnosis of IOM were splaying of muscle fibers by inflammatory infiltrates (n = 9) and mild fibrosis (n = 8) in the endomysium or replacing muscle fibers, with no granulomas or vasculitis. The inflammatory infiltrates identified were of chronic inflammatory cells, consisting of lymphocytes (n = 9), plasma cells (n = 6), and histiocytes (n = 6). Other less commonly identified cells were eosinophils (n = 4), polymorphonuclears (n = 1), and giant cells (n = 1). Muscle fiber degeneration or regeneration was evident in 5 patients. Four patients from the initial cohort showed inconclusive histologic findings on revision and were reassigned as suspected IOM.

Conclusions: The histopathologic features of involved muscles in IOM resemble those seen in idiopathic orbital inflammation and differ from those seen in common differential diagnoses. Extraocular muscle biopsy should be strongly considered whenever the presentation of orbital myositis is not typical or when significant underlying conditions are a possibility.
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http://dx.doi.org/10.1016/j.ophtha.2020.09.012DOI Listing
April 2021

Reply re: "Orbital Myositis: A Comprehensive Review and Reclassification".

Authors:
Alan A McNab

Ophthalmic Plast Reconstr Surg 2020 Sep/Oct;36(5):519

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http://dx.doi.org/10.1097/IOP.0000000000001775DOI Listing
February 2021

Primary Nasocutaneous Fistulae in Granulomatosis With Polyangiitis: A Case Series and Literature Review.

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):55-60

Department of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.

Purpose: To report the presentation, investigation, management, and outcomes of primary nasocutaneous fistulae in granulomatosis with polyangiitis and review the literature of this complication.

Methods: Retrospective series of 5 patients with granulomatosis with polyangiitis and nasocutaneous fistulae and the medical and surgical management strategies employed.

Results: Two cases presented with fistulae as the primary symptom of their systemic disease. Systemic management of granulomatosis with polyangiitis is a primary concern and two cases had inadequate control at presentation such that surgical intervention was deferred. Of the other 3 cases, 2 were closed using a median forehead flap and the other with an orbicularis advancement flap. An endonasal approach was attempted in 1 case but was unsuccessful due to the friable nature of the nasal mucosal tissue.

Conclusions: Nasocutaneous fistulae should alert the clinician to underlying granulomatosis with polyangiitis, which may be a presentation of this condition. Systemic management of disease is often a barrier to surgical management. Myocutaneous flaps may be the most reliable management option to achieve closure.
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http://dx.doi.org/10.1097/IOP.0000000000001678DOI Listing
April 2021

Efficacy of porcine acellular dermal matrix in the management of lower eyelid retraction: case series and review of the literature.

Graefes Arch Clin Exp Ophthalmol 2020 Sep 6;258(9):1999-2006. Epub 2020 Apr 6.

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia.

Purpose: To investigate the efficacy of Permacol™, a decellularized porcine dermal-derived membrane, as a spacer in the management of lower eyelid retraction. The efficacy of sizing and insertion was investigated, as well as complications. The literature was also reviewed to compare this material with other porcine-derived grafts in use for the management of lower eyelid retraction.

Methods: This was a retrospective case series observing all patients who received lower eyelid Permacol implants by the two senior authors (AAM, TGH) for the management of lower eyelid retraction. Patient demographics, indications for surgery, graft size, degree of postoperative lid advancement, and complications were reviewed.

Results: A total of 12 patients (16 eyelids) received Permacol implants for correction of lower eyelid retraction during the study period of 18 months (January 2015 to July 2017). Ten procedures were related to thyroid eye disease, 3 for reconstruction, 2 postcosmetic lower lid blepharoplasty, and one acquired anophthalmic socket. The average preoperative inferior scleral show (ISS) was 1.74 mm, and the average postoperative ISS was 0.82 mm. There was a mean lower eyelid elevation of 0.91 mm (p < 0.005, Wilcoxon signed rank test) and mean ratio of graft height:preoperative ISS was 3.8:1 over a median of 8 months follow-up.

Conclusions: Permacol is a safe and effective alternative to autologous tissues for use as a spacer in patients with lower eyelid retraction of varying etiologies. It does undergo some resorption with time, however this can be predicted and incorporated into surgical planning; we recommend an implant height:ISS ratio of 4:1.
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http://dx.doi.org/10.1007/s00417-020-04660-5DOI Listing
September 2020

Perioperative Prophylactic Antibiotics in 1,250 Orbital Surgeries.

Ophthalmic Plast Reconstr Surg 2020 Jul/Aug;36(4):385-389

Moorfields Eye Hospital, London, England.

Purpose: Intravenous antibiotic prophylaxis is used for many clean-contaminated surgeries or clean surgeries with an implant, but its value for clean orbital surgery has not been determined. This study investigated infection risks and adverse effects related to antibiotics in patients undergoing orbital surgery.

Methods: A prospective, nonrandomized comparative case series of all patients undergoing orbital surgery with participating surgeons between October 1, 2013, and March 1, 2015. Types of surgery, antibiotic regimens, corticosteroid use, antibiotic side effects, and surgical site infections (SSIs) were entered into an electronic database and subsequently analyzed. Cases in which patients received postoperative oral antibiotics were analyzed separately.

Results: Of 1,250 consecutive orbital surgeries, 1,225 met inclusion criteria. A total of 1208 patients were included in the primary analysis: 603 received no antibiotic prophylaxis (group A), and 605 received a single dose of intravenous antibiotic (group B). Five patients (0.42%) developed an SSI, 3 in group A and 2 in group B. The difference in SSI rates was not statistically significant between the 2 groups (p = 0.66). Antibiotic prophylaxis, alloplastic implants, paranasal sinus entry, and corticosteroid use were not associated with differences in SSI rates. All SSIs resolved on a single course of oral antibiotics; an implant was removed in 1 case. There were no complications associated with a single dose of intravenous prophylaxis. However, 12% of 17 patients (group C) who received 1 week of oral postoperative prophylactic antibiotics developed antibiotic-related complications (diarrhea, renal injury), yielding a number needed to harm of 8.5.

Conclusions: In this large series, antibiotic prophylaxis does not appear to have reduced the already low incidence of SSI following orbital surgery. Given the detriments of systemic antibiotics, the rarity of infections related to orbital surgery, and the efficacy of treating such infections should they occur, patients undergoing orbital surgery should be educated to the early symptoms of postoperative infection and followed closely, but do not routinely require perioperative antibiotics.
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http://dx.doi.org/10.1097/IOP.0000000000001565DOI Listing
March 2021

Multiple myeloma manifesting as an ocular salmon patch - a case report.

Orbit 2020 Oct 13;39(5):379-382. Epub 2019 Nov 13.

Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital , Melbourne, Australia.

Multiple myeloma (MM) is the second most prevalent hematologic malignancy after non-Hodgkin lymphoma and is currently considered incurable. Clinical ophthalmic manifestations of MM are rare but at the same time diverse. Ocular surface manifestations of multiple myeloma are uncommon. Conjunctival 'salmon patch' is a typical ocular surface ophthalmological sign with a distinct set of differential diagnoses, including most often ocular adnexal lymphoma. This case report presents a 33-year-old female with a relapse of MM manifesting as a conjunctival 'salmon patch'. The patient initially responded well to medical management including high dose melphalan supported by a third autologous stem cell transplantation (ASCT) and did not require further surgical excision of the ocular lesion. It is suggested that MM should be included in the differential diagnosis of 'salmon patch' conjunctival lesions.
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http://dx.doi.org/10.1080/01676830.2019.1691608DOI Listing
October 2020

Re: Lacrimal gland orbital lobe cysts.

Authors:
Alan A McNab

Orbit 2020 06 12;39(3):230. Epub 2019 Nov 12.

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

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http://dx.doi.org/10.1080/01676830.2019.1683211DOI Listing
June 2020

Clinicopathological Features and Outcomes in Lymphoma of Extraocular Muscles.

Ophthalmic Plast Reconstr Surg 2019 Nov/Dec;35(6):615-618

Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria.

Purpose: To describe the clinicopathological features and report the outcomes of treatment in lymphoma involving the extraocular muscles (EOM), the largest reported case-series.

Methods: A retrospective case series of patients with lymphoma involving the EOM from a single tertiary referral orbital center, between March 1992 and March 2018. Patients with other histopathologic diagnoses or who did not have an EOM biopsy were excluded. The main outcome measures were histologic evaluation and clinical follow-up including tumor response, recurrence, and survival.

Results: Twenty-five patients were included, 16 female; 9 male; median age 64.7 years (range 33.8-92.6 years). Unilateral involvement was present in 23 cases (92%). Lymphoma was found to be primary in 15 patients (60%), and any EOM could be affected by disease. Fourteen patients (56%) displayed impaired duction in the direction of the affected muscle. The commonest histologic type was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in 16 cases (64%) followed by follicular lymphoma in 3 cases (12%), diffuse large B-cell lymphoma in 2 cases (8%), gamma delta T-cell lymphoma in 2 cases (8%), small lymphocytic lymphom and lymphoplasmacytic lymphoma in 1 case each (4%). All 4 patients with high-grade lymphomas (diffuse large B-cell or T cell lymphoma) were found to have systemic disease. Patients were treated with combinations of radiotherapy, chemotherapy, or immunotherapy, with low toxicity. Two patients developed treatment-related complications. With a median follow-up of 26 months (range 3-108 months), there was only 1 recurrence, which was successfully salvaged with Rituximab, and no deaths due to lymphoma.

Conclusions: Lymphoma of the EOM is a rare tumor with good response to treatment, few treatment-related complications and low risk of recurrence or mortality.A retrospective review of 25 patients with lymphoma of the extraocular muscles demonstrates excellent prognosis with a high rate of local remission (96%), 2 treatment-related complications, one recurrence, and no disease-related deaths.
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http://dx.doi.org/10.1097/IOP.0000000000001426DOI Listing
January 2020

Re: warfarin-associated delayed orbital haemorrhage after orbital fracture repair with smooth nylon foil implant.

Authors:
Alan A McNab

Orbit 2019 12 29;38(6):524. Epub 2019 Aug 29.

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital , Melbourne , Australia.

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http://dx.doi.org/10.1080/01676830.2019.1658792DOI Listing
December 2019

Orbital Myositis: A Comprehensive Review and Reclassification.

Authors:
Alan A McNab

Ophthalmic Plast Reconstr Surg 2020 Mar/Apr;36(2):109-117

Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital.

Purpose: Orbital myositis occurs in typical and atypical forms. This review summarizes and updates the current state of knowledge of all forms of inflammation affecting extraocular muscle, excluding thyroid-associated orbitopathy.

Methods: A comprehensive literature review of orbital myositis was performed.

Results: Orbital myositis typically occurs in an idiopathic acute form, with painful diplopia due to inflammation in 1 or more extraocular muscles of young adult females, which usually responds to a course of oral corticosteroids. Atypical forms include idiopathic chronic or recurrent orbital myositis, and myositis related to systemic autoimmune, inflammatory, and infective conditions. The commonest associated autoimmune condition is inflammatory bowel disease. Immunoglobulin G4-related ophthalmic disease often affects extraocular muscle. Drug reactions and rarely paraneoplastic disease may also cause extraocular muscle inflammation.

Conclusions: Orbital myositis occurs in a typical acute steroid responsive form, but atypical forms related to specific autoimmune and inflammatory conditions are increasingly recognized. Orbital myositis has many similarities to uveitis and would benefit from a systematic approach to nomenclature, diagnosis, and treatment.
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http://dx.doi.org/10.1097/IOP.0000000000001429DOI Listing
March 2021

Acquired lacrimal drainage apparatus obstruction in children.

J AAPOS 2019 08 20;23(4):217.e1-217.e5. Epub 2019 Jun 20.

Orbital, Plastics and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, East Melbourne, Victoria, Australia. Electronic address:

Background: Pediatric acquired lacrimal drainage apparatus (LDA) obstruction is much rarer than congenital LDA obstruction. Its etiology and treatment outcomes have not been well defined. Our aim was to examine the etiology and management of acquired LDA obstruction in children and report the results of its management.

Methods: We retrospectively reviewed the medical records of patients ≤16 years of age who presented with acquired epiphora to investigate the causes and describe the management of this condition.

Results: A total of 31 patients (16 males [52%]) were included. Mean age of patients was 10.9 years (range, 3-16). The main causes of acquired LDA obstruction were keratoconjunctivitis, herpes simplex blepharokeratoconjunctivitis, and trauma. Silicone tube intubation, endonasal or external dacryocystorhinostomy, and the insertion of lacrimal bypass tubes were the mainstays of management.

Conclusions: It is important to suspect acquired LDA obstruction in children with acquired, persistent epiphora. Surgical management is similar to that in adults.
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http://dx.doi.org/10.1016/j.jaapos.2019.04.007DOI Listing
August 2019

Lacrimal system obstruction after cataract surgery.

Clin Exp Ophthalmol 2019 09 13;47(7):948-949. Epub 2019 May 13.

Orbit, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/ceo.13521DOI Listing
September 2019

Lacrimal Gland Orbital Lobe Cysts Associated With Lymphoid Hyperplasia or Mucosa-Associated Lymphoid Tissue Lymphoma in Patients With Chronic Autoimmune Disease.

Ophthalmic Plast Reconstr Surg 2019 May/Jun;35(3):e59-e62

The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.

Large cysts in the orbital lobe of the lacrimal gland are rare and are associated with Sjögren syndrome and B-cell mucosa-associated lymphoid tissue lymphoma. The authors describe 4 new cases of large orbital lobe lacrimal gland cysts. The first 2 patients, both with Sjögren syndrome, had unilateral cysts associated with chronic inflammation. Mucosa-associated lymphoid tissue lymphoma was also identified in the cyst wall of the second case and could not be completely excluded in the first case. The third patient, with a history of rheumatoid arthritis, had bilateral cysts, again associated with mucosa-associated lymphoid tissue lymphoma. The fourth patient, with no history of systemic disease, had a unilateral cyst associated with reactive lymphoid hyperplasia. Finally, the authors report the long-term outcomes of 3 previously reported cases.
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http://dx.doi.org/10.1097/IOP.0000000000001344DOI Listing
January 2020
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