Publications by authors named "Andrea A Tooley"

40 Publications

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

Ophthalmic Plast Reconstr Surg 2021 Jul 22. Epub 2021 Jul 22.

Department of Ophthalmology, New York University Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, New York Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota Hansjorg Wyss Department of Plastic Surgery, New York University, New York, New York, U.S.A.

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.
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http://dx.doi.org/10.1097/IOP.0000000000002032DOI Listing
July 2021

Natural killer T-cell lymphoma causing bilateral recurrent recalcitrant dacryocystitis.

Orbit 2021 May 11:1-5. Epub 2021 May 11.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.

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.
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http://dx.doi.org/10.1080/01676830.2021.1925931DOI Listing
May 2021

Atypical presentation of invasive myoepithelioma in a pediatric patient.

Orbit 2021 Apr 27:1-4. Epub 2021 Apr 27.

Columbia University Irving Medical Center - NewYork-Presbyterian Hospital, New York, New York, USA.

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.
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http://dx.doi.org/10.1080/01676830.2021.1918724DOI Listing
April 2021

Orbital cavernous venous malformation with partial bone encasement.

Orbit 2021 Mar 16:1-2. Epub 2021 Mar 16.

Department of Ophthalmology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA.

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http://dx.doi.org/10.1080/01676830.2021.1893345DOI Listing
March 2021

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

J Neuroophthalmol 2021 Feb 19. Epub 2021 Feb 19.

Department of Ophthalmology (LD, AQT, AT, IB), New York University, New York, New York; Department of Ophthalmology (AQT, AT), Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, New York; and Department of Ophthalmology (VIE), New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

Abstract: 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.
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http://dx.doi.org/10.1097/WNO.0000000000001174DOI Listing
February 2021

Complete Tarsal Ectropion in a Young Patient with Junctional Epidermolysis Bullosa.

Ophthalmology 2021 02;128(2):233

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

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http://dx.doi.org/10.1016/j.ophtha.2020.09.030DOI Listing
February 2021

Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair.

Craniomaxillofac Trauma Reconstr 2020 Sep 21;13(3):211-214. Epub 2020 May 21.

Department of Plastic and Reconstructive Surgery, Weill Cornell Medical College, New York, NY, USA.

Extraocular muscle (EOM) entrapment with resulting reduction in motility and diplopia is a known complication of orbital fractures. Less commonly, transection of the EOMs due to trauma, iatrogenic injury, or intentional myotomy may lead to persistent diplopia. The inferior oblique (IO) is often encountered during orbital surgery along the medial wall and floor, and may be disinserted to aid in visualization. The authors present a case of IO entrapment which occurred during zygomaticomaxillary fracture reduction. Intraoperatively, an IO transection was performed and the muscle was reattached within the orbit. Postoperatively, the patient did not develop diplopia or motility disruption. This technique may provide a useful solution to an unusual problem during orbital fracture repair.
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http://dx.doi.org/10.1177/1943387520928652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797970PMC
September 2020

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

J Neuroophthalmol 2021 Jan 11. Epub 2021 Jan 11.

Department of Ophthalmology (CLG, AAT, AQT, CO, KJG), Weill Cornell Medical College, New York, New York; Weill Cornell Medical College (AYJL), New York, New York; and Departments of Neurological Surgery (AP) and Radiology (AP), Weill Cornell Medical College, New York, New York.

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http://dx.doi.org/10.1097/WNO.0000000000001178DOI Listing
January 2021

Elephantiasis in a patient with thyroid eye disease.

Orbit 2020 Dec 22:1-2. Epub 2020 Dec 22.

Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.

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http://dx.doi.org/10.1080/01676830.2020.1862249DOI Listing
December 2020

Atypical Cogan Syndrome Featuring Orbital Myositis and Dacryoadenitis.

Ophthalmic Plast Reconstr Surg 2021 May-Jun 01;37(3S):S160-S162

Edward S. Harkness Eye Institute.

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.
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http://dx.doi.org/10.1097/IOP.0000000000001835DOI Listing
May 2021

Social media in ophthalmology: An analysis of use in the professional sphere.

Health Informatics J 2020 12 18;26(4):2967-2975. Epub 2020 Sep 18.

Bascom Palmer Eye Institute, USA.

To characterize how ophthalmologists are using social media in their practice. A survey regarding ophthalmologists' personal and professional use of social media was distributed online through a university alumni listserv. Data collection occurred over 4 weeks from January to February 2020. In total, 808 ophthalmologists opened the survey email, and 160 responded (19.8%). Of 160 respondents, 115 (71.9%) participated in social media for personal use. Professional use of social media was noted by 63 (39.4%) respondents. Age >40 years old correlated with less personal ( = 5.06,  = 0.025) but not professional use ( = 0.065). Private practice was associated with more use of social media professionally compared to those in an academic or Veteran's Affairs hospital ( = 6.58,  = 0.037). A majority of respondents (58.7%) were neutral regarding the effect of social media on their practice. The present survey showed that nearly 40% of respondents are involved in social media in a professional context. Private practice correlated with increased use of social media professionally, but providers were most commonly neutral regarding the impact of social media on their practice. This finding suggests further avenues of research including how providers using social media professionally are defining and assessing successful use.
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http://dx.doi.org/10.1177/1460458220954610DOI Listing
December 2020

Orbital Osteomas: Report of 3 Rapidly Progressive Cases in Adolescents and Systematic Literature Review.

Ophthalmic Plast Reconstr Surg 2021 Mar-Apr 01;37(2):118-124

Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.

Purpose: The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital osteomas in the pediatric age group, and compare these to osteomas managed in the adult population.

Methods: A retrospective review of 3 cases of rapidly progressive orbital osteomas in young patients was performed. In addition, a systematic review of the literature following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted to describe the clinical characteristics, management, and outcomes of orbital osteomas in the pediatric age group. The PubMed/MEDLINE database was searched in December 2019 for studies reporting data on patients with orbital osteomas.

Results: Fifty-nine patients were included in this pediatric review, 39 male patients (68%), 18 female patients (32%), and 2 cases with unreported genders. Average age was 15.9 years with a range of 4-21 years. Average osteoma size measured 30.7 mm with a range of 9-60 mm. Adult osteoma size for comparison was smaller than 10 mm in majority of cases. The most common location of pediatric osteomas was the ethmoid sinus. The frontal sinus was the most common location in adult patients. Ninety-seven percent of reported pediatric cases required surgical intervention, compared with only 6.5% in adults.

Conclusions: Orbital osteomas in younger patients are larger when identified, grow faster, are more likely to be symptomatic, and more likely to require surgical intervention compared with those identified in older patients. We recommend close monitoring of osteomas identified in young patients as well as counseling regarding the potential need for future resection.
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http://dx.doi.org/10.1097/IOP.0000000000001755DOI Listing
April 2021

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

Ophthalmic Plast Reconstr Surg 2021 May-Jun 01;37(3S):S58-S61

Columbia University Edward S. Harkness Eye Institute.

Purpose: 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.
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http://dx.doi.org/10.1097/IOP.0000000000001809DOI Listing
May 2021

Basaloid follicular hamartoma of the eyelid in a pediatric patient.

Am J Ophthalmol Case Rep 2020 Sep 2;19:100855. Epub 2020 Aug 2.

Edward S. Harkness Eye Institute Columbia University College of Physicians and Surgeons, New York, NY, USA.

Purpose: We report a case a pediatric patient with an eyelid lesion found to be a basaloid follicular hamartoma.

Observations: A six-year-old female with juvenile diabetes who presented with a benign eyelid lesion harboring an aberrant eyelash.

Conclusions And Importance: Basaloid follicular hamartoma is a rare benign neoplasm arising from hair follicles. These lesions can resemble basal cell carcinomas and require complete excision.
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http://dx.doi.org/10.1016/j.ajoc.2020.100855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417745PMC
September 2020

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

Ophthalmic Plast Reconstr Surg 2021 May-Jun 01;37(3S):S33-S38

Department of Ophthalmology, Columbia University Medical Center.

Purpose: 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.
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http://dx.doi.org/10.1097/IOP.0000000000001785DOI Listing
May 2021

Adjustable Ptosis Correction via Posterior Levator Advancement With Minimal Superior Tarsectomy.

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):86-90

Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York.

Purpose: To report the surgical technique and outcomes for adjustable ptosis correction using a posterior levator advancement with minimal superior tarsectomy.

Methods: A retrospective single-center study was conducted on patients who underwent adjustable ptosis repair via posterior levator advancement with minimal superior tarsectomy by a single surgeon from 2002 to 2018. Patients with greater than 1 mm asymmetry between eyes or contour abnormalities underwent nonsurgical adjustment in the office within 6 days of surgery.

Results: A total of 79 patients (146 eyelids) were included in this study. The patients were female (67%), underwent bilateral surgery (87%) with mean age of 63 years (range, 20-92). The mean improvement in marginal reflex distance 1 at postoperative month 1 was 2.56 ± 1.04 mm (p ≤ 0.0001). Postoperative symmetry of 1 mm or less between eyes was achieved in 96.6% of patients. Only 8 eyes (5.4%) underwent in-office adjustment postoperatively. No demographic or clinical differences were noted in eyes that required adjustments. Postoperative complications included dry eyes that resolved by 3 months (13.6%), suture cyst (1.4%), corneal abrasion (1.4%), and persistent eyelid edema (1.4%). Surgical revision was required in 2.8% of eyes.

Conclusions: The adjustable posterior levator advancement with minimal superior tarsectomy is an effective surgical technique for ptosis repair with the added benefit of in-office adjustability to correct minor asymmetries.
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http://dx.doi.org/10.1097/IOP.0000000000001772DOI Listing
April 2021

and endogenous panophthalmitis: clinical and histopathological features.

Am J Ophthalmol Case Rep 2020 Sep 11;19:100738. Epub 2020 May 11.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA.

Purpose: To report an unusual case of endogenous panophthalmitis involving and describe its clinical and histopathological features.

Findings: A 30 year-old man with history of human immunodeficiency virus, polysubstance abuse, syphilis, and recently treated pneumonia presented with polymicrobial endogenous panophthalmitis. Two separate ocular specimens confirmed simultaneous and involvement. Histopathological analysis demonstrated fulminant polymorphonuclear infiltration of all ocular tissue layers. Despite aggressive management including two intravitreal injections and enucleation, the patient died, ultimately after receiving care at four neighboring urban medical centers.

Conclusions And Importance: has been a recently and increasingly described pathogen leading to mortality in metropolitan hospitals worldwide. To the authors' knowledge, has not previously been reported with endophthalmitis or panophthalmitis. Future cases may be expected with the reported rise in . A high suspicion of its contribution to panophthalmitis could be warranted early in the evaluation and management of profoundly immunocompromised patients, particularly those who have had sequential care at multiple neighboring metropolitan hospitals.
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http://dx.doi.org/10.1016/j.ajoc.2020.100738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240712PMC
September 2020

Comparing Image Segmentation Techniques for Determining 3D Orbital Cavernous Hemangioma Size on MRI.

Ophthalmic Plast Reconstr Surg 2020 Nov/Dec;36(6):569-574

Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.

Purpose: To measure orbital cavernous hemangioma size using 3 segmentation methods requiring different degrees of subjective judgment, and to evaluate interobserver agreement using these methods.

Methods: Fourteen patients with orbital cavernous hemangiomas were included in the study. Pretreatment T2-weighted MRIs were analyzed by 2 observers using 3 methods, including 1 user-dependent image segmentation method that required high degrees of subjective judgment (ellipsoid) and 2 parameter-dependent methods that required low degree of subjective judgment (GrowCut and k-means clustering segmentation). Interobserver agreement was assessed using Lin's concordance correlation coefficients.

Results: Using the ellipsoid method, the average tumor sizes calculated by the 2 observers were 1.68 ml (standard deviation [SD] 1.45 ml) and 1.48 ml (SD 1.19 ml). Using the GrowCut method, the average tumor sizes calculated by the 2 observers were 3.00 ml (SD 2.46 ml) and 6.34 ml (SD 3.78 ml). Using k-means clustering segmentation, the average tumor sizes calculated by the 2 observers were 2.31 ml (SD 1.83 ml) and 2.12 ml (SD 1.87 ml). The concordance correlation coefficient for the ellipsoid, GrowCut, and k-means clustering methods were 0.92 (95% CI, 0.83-0.99), 0.12 (95% CI, -0.21 to 0.44), and 0.95 (95% CI, 0.90-0.99), respectively.

Conclusions: k-means clustering, a parameter-dependent method with low degree of subjective judgment, showed better interobserver agreement compared with the ellipsoid and GrowCut methods. k-means clustering clearly delineated tumor boundaries and outlined components of the tumor with different signal intensities.
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http://dx.doi.org/10.1097/IOP.0000000000001651DOI Listing
March 2021

Orbital marginal cell lymphoma and mantle cell lymphoma subclone in patient with monoclonal gammopathy of unknown significance.

Orbit 2021 Jun 3;40(3):247-251. Epub 2020 May 3.

Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.

Indolent lymphomas have the potential to transform into more aggressive phenotypes. This phenomenon is best exemplified by the transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma into diffuse large B-cell lymphoma. However, it is less common to find multiple small cell lymphomas in the orbit, particularly mantle cell lymphoma. We present a case of an extranodal marginal zone lymphoma arising in the orbit that acquired a subclonal t(11;14) (q13;32) translocation, giving rise to a subclone of mantle cell lymphoma. The management of this tumor was targeted towards the more aggressive mantle cell subclone. The tumor exhibited an incomplete response to rituximab alone. To the best of the authors' knowledge, this represents the first such case to be described irrespective of site of origin.
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http://dx.doi.org/10.1080/01676830.2020.1760312DOI Listing
June 2021

Orbital and Eyelid Inflammation With "Muciphages" and Extravasated Mucin From an Ethmoido-orbital Mucocele.

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):e1-e3

Department of Ophthalmology.

A 22-year-old woman presented with an acute compressive optic neuropathy due to a ruptured ethmoido-orbital mucocele. She underwent urgent orbital decompression and drainage of the mucocele via an endoscopic approach. Postoperatively, her course was complicated by an orbital compartment syndrome supervened, exhibiting severe eyelid edema caused by infiltration with mucin and mucin-containing macrophages ("muciphages"). Biopsy of the eyelid showed infiltration with "muciphages," macrophages laden with extravasated mucinous material. This is the first report that documents the clinical and histopathologic course of orbital inflammation following mucocele extravasation into the orbit and eyelids.
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http://dx.doi.org/10.1097/IOP.0000000000001685DOI Listing
April 2021

Acute angle plication of optic nerve glioma as a mechanism of rapidly progressive visual loss.

Orbit 2021 Feb 24;40(1):30-33. Epub 2020 Feb 24.

Department of Ophthalmology, Harkness Eye Institute, Columbia University , New York, New York, USA.

: The majority of pediatric patients with optic nerve gliomas (ONG) remain asymptomatic; however, a subset of patients suffer rapid, irreversible visual loss. The purpose of this study was to determine anatomic differences of ONG noted either by imaging or by intra-operative observation between patients with gradual visual dysfunction and those with rapid visual loss. : A retrospective review was performed in patients with visual loss secondary to ONG. The clinical records, pathology, and radiographic images were reviewed for all patients. The degree of folding or plication of the optic nerve (ON) was determined by analyzing the most acute angle present in the course of the ON. : The primary outcome measure was the angle of plication or folding of the ON and the relationship of this to the course of visual dysfunction. : Six patients with ONG were included in the study. A structural difference in the ON was identified in four patients with rapid vision loss compared with two patients with more gradual visual dysfunction. In patients with rapid progressive visual loss, the ONG had a 90-degree or more acute plication of the ON. Those with more gradual visual loss had more obtuse bends in the ONG. : We have identified that the intrinsic structure of the ONG may contribute to the rare but devastatingly rapid progression of visual dysfunction in some patients. Recognizing these changes may guide clinicians to intervene prior to the development of irreversible visual loss.
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http://dx.doi.org/10.1080/01676830.2020.1733027DOI Listing
February 2021

Clinical and histopathological findings of patients with orbital granulomatosis with polyangiitis cases refractory to rituximab.

Can J Ophthalmol 2019 12 26;54(6):682-687. Epub 2019 Jun 26.

Department of Ophthalmology, Mayo Clinic, Rochester, MN; Division of Anatomic Pathology, Mayo Clinic, Rochester, MN.. Electronic address:

Objective: Rituximab, a monoclonal antibody that targets CD20 receptors on mature B lymphocytes, is used in various diseases, including granulomatosis with polyangiitis (GPA) and difficult-to-treat orbital inflammatory diseases. We aimed to describe clinical and histopathologic findings in patients treated with rituximab refractory GPA who had post-rituximab orbital biopsies.

Design: Retrospective review.

Participants: Patients with orbital GPA refractory to rituximab.

Methods: We examined the clinical outcomes, imaging results, and histopathological findings of all patients from September 1, 1994, through July 1, 2017, with a diagnosis of orbital GPA who, after treatment with rituximab, required an orbital excisional biopsy for refractory orbital disease.

Results: Among the 7 patients included the clinical indication for biopsy was pain (n = 3), new mass lesion despite treatment (n = 2), and persistent lesion despite treatment (n = 2). Post-rituximab biopsies showed marked collagenized fibrous tissue, with areas of concentric fibrosis resembling the framework of pre-existing lymphoid follicles, and minimal residual lymphocytic infiltrates (n = 7). Three patients had entrapped nerves. Four biopsies showed active inflammation; clinically, all patients were not responding to treatment.

Conclusions: This study highlights the clinical and histopathological changes seen in patients with orbital GPA refractory to rituximab therapy. The post-rituximab biopsies show marked fibrosis in all patients. Four patients had active inflammation without evidence of entrapped nerves, whereas 3 patients had entrapped nerves and no active inflammation on their biopsies. Knowledge of the histopathology may guide future management decisions in patients with orbital GPA refractory to rituximab treatment.
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http://dx.doi.org/10.1016/j.jcjo.2019.05.004DOI Listing
December 2019

Trans-septal suture retraction for endoscopic orbital surgery.

Orbit 2020 Oct 18;39(5):336-341. Epub 2019 Nov 18.

Oculoplastic and Orbital Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital , New York, NY, USA.

Purpose: We describe a novel technique for endonasal endoscopic orbital surgery. Previously described strategies for minimally invasive orbital surgery include mobilization of the medial rectus muscle and cryosurgical retraction of the pathologic lesion. Herein we describe endoscopic trans-septal suture retraction of an orbital cavernous hemangioma to facilitate intra-orbital dissection from an external approach.

Methods: A 36-year-old male presented with blurred vision in his left eye for several years, along with several months of progressive left proptosis and decreasing visual acuity. Imaging revealed a 2.5 cm orbital mass consistent with a cavernous hemangioma. The patient underwent a combined transconjunctival and endoscopic approach for resection.

Results: Following left medial orbital wall and floor decompression, endoscopic trans-septal suture retraction facilitated dissection of the lesion from intraorbital structures. A complete extracapsular resection of the lesion was achieved. The inferomedial orbit was reconstructed with a synthetic implant.

Conclusion: Trans-septal suture retraction is an effective adjunctive technique for endonasal endoscopic orbital tumor surgery. This technique facilitates safe retraction and dissection of soft tissue lesions from critical intraorbital structures.
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http://dx.doi.org/10.1080/01676830.2019.1692040DOI Listing
October 2020

Extraocular muscle enlargement in retinoencephalofacial angiomatosis.

Orbit 2020 Jun 28;39(3):221-223. Epub 2019 Oct 28.

Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.

A 22-year-old female presented for evaluation of five years of progressive left exophthalmos and intermittent blurred vision. She had previously received laser treatment for peripheral retinal neovascularization and had undergone lip reconstruction for a left-sided congenital vascular facial malformation. Magnetic resonance imaging demonstrated diffuse enlargement of the left extraocular and temporalis muscles, with prominent vessels in the temporalis muscle and intraconal fat. Left fundoscopic examination revealed grossly enlarged, tortuous retinal vessels extending from the optic disc to the peripheral retina and an abnormal network of capillaries. On the basis of these findings, a diagnosis of retinoencephalofacial angiomatosis was established. Retinoencephalofacial angiomatosis is a rare, non-hereditary disorder associated with ipsilateral retinal, brain, and facial arteriovenous malformations. This is the first report, to the authors' knowledge, of retinoencephalofacial angiomatosis presenting with exophthalmos secondary to extraocular muscle enlargement.
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http://dx.doi.org/10.1080/01676830.2019.1677727DOI Listing
June 2020

Renal Medullary Carcinoma With Metastasis to the Temporal Fossa and Orbit.

Ophthalmic Plast Reconstr Surg 2019 Nov/Dec;35(6):e149-e151

Department of Ophthalmology, Columbia University Medical Center.

A 22-year-old Hispanic man with sickle cell trait presented with blurred vision, double vision, and pain with OD movement. MRI demonstrated an extra-axial mass centered around the temporal bone with extension into the middle cranial fossa and lateral aspect of the extra-conal right orbit, and mass effect on the lateral rectus muscle. Biopsy of the lesion was consistent with renal medullary carcinoma. CT chest/abdomen/pelvis confirmed a primary tumor in the right kidney. No additional metastases were found. Renal medullary carcinoma is a rare, highly aggressive malignancy, which almost exclusively affects young men of African descent with sickle cell trait or sickle cell disease. The authors present the second confirmed case of renal medullary carcinoma metastatic to the orbit, with ocular symptoms prior the typical presenting symptoms of flank pain and hematuria.Renal medullary carcinoma is a highly aggressive malignancy, most commonly seen in African American patients with sickle cell disease. Involvement of the orbit is rare and visual symptoms may precede systemic diagnosis.
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http://dx.doi.org/10.1097/IOP.0000000000001478DOI Listing
January 2020

Bipedicle Dermis Fat Graft for Orbital Volume Augmentation and Repair of Lower Eyelid Retraction in an Anophthalmic Socket With Prior Orbital Implant Placement.

Ophthalmic Plast Reconstr Surg 2019 Mar/Apr;35(2):e39-e41

Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, U.S.A.

Buphthalmos can create treatment challenges for socket rehabilitation following enucleation due to compression atrophy and mechanical stretching of adnexal tissues. The authors report a case demonstrating a surgical technique for simultaneous volume augmentation of the anophthalmic socket, expansion of the conjunctival fornix, and repair of lower eyelid retraction in a patient with history of buphthalmos and a previously placed 22 mm orbital implant at the time of enucleation. The authors utilized a single-stage, bipedicle dermis fat graft. Postoperatively, the patient demonstrated improvement in lower eyelid position, lower eyelid volume, improved prosthesis fit, improved three-dimensional projection of the ocular prosthesis, and an improvement in the superior sulcus deformity. Bipedicle dermis fat grafts are an option for surgical rehabilitation of the anophthalmic socket when orbital volume deficiency, conjunctival fornix contracture, and eyelid retraction are present and an adequately sized orbital implant has previously been placed.
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http://dx.doi.org/10.1097/IOP.0000000000001309DOI Listing
December 2019

Pre-aponeurotic Fat Prolapse Following Levator Resection for Congenital Ptosis.

J Pediatr Ophthalmol Strabismus 2019 Feb 8;56:e1-e4. Epub 2019 Feb 8.

The authors describe three children who developed excess overhanging upper eyelid tissue following unilateral levator resection for congenital ptosis. This was thought to be pre-aponeurotic fat herniation. A second procedure, a variation of sulcoplasty, was performed at a mean 4.3 months later and all three children showed improved sulcus and crease symmetry. [J Pediatr Ophthalmol Strabismus. 2019;56:e1-e4.].
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http://dx.doi.org/10.3928/01913913-20181017-02DOI Listing
February 2019
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