Publications by authors named "Catherine Y Liu"

61 Publications

Lateral Wall Implant as an Adjunct to Lateral Wall Orbital Decompression in Severe Thyroid Eye Disease.

Ophthalmic Plast Reconstr Surg 2021 Jul 21. Epub 2021 Jul 21.

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, U.S.A.

Purpose: To describe the use of a lateral wall implant as an adjunct in lateral orbital wall decompression in severe thyroid eye disease.

Methods: This study is a retrospective review of 6 patients who underwent prior orbital decompression but had persistent proptosis. These patients underwent lateral wall decompression with adjunct lateral wall implant placement with a manually vaulted 0.6-mm polyethylene-coated titanium mesh implant. Data collection included: visual acuity, intraocular pressure, exophthalmometry, ocular motility, eyelid position, and complication rates.

Results: Eight orbits in 6 patients underwent maximal lateral wall decompression and reconstruction using the polyethylene-coated titanium implant. Four males and 2 females were included with ages ranging from 25 to 73 years. Visual acuity improved an average of 2.4 lines (range 0-5 lines). Intraocular pressure improved an average of 7.5 mm Hg (2-13 mm Hg). There was reduction of proptosis by 3.4 mm on average (1-7 mm). Upper eyelid retraction improved on average by 1.8 mm (0-5 mm). Horizontal eye movements improved by 11% on average (-3.1% to +25%). Excellent cosmesis was achieved with no visible temple deformity, trismus, conjunctival scarring, orbital hemorrhage, or vision loss.

Conclusions: The amount of volume created in lateral wall decompression is limited by the amount of native bone present and the temporalis muscle. In severe or recalcitrant cases, the authors propose the placement of a lateral wall implant as an adjunct to laterally displace the temporalis muscle and create additional volume. This technique accomplishes further reduction of proptosis in patients who have undergone prior orbital decompression.
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http://dx.doi.org/10.1097/IOP.0000000000002007DOI Listing
July 2021

Giant Deep Orbital Dermoid Cyst Presenting in Infancy.

J Craniofac Surg 2021 Jul 7. Epub 2021 Jul 7.

Viterbi Family Department of Ophthalmology, UC San Diego, San Diego Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, CA.

Abstract: Orbital dermoid cysts are benign choristomas that are very common in children and occur most often as a lateral or medial mass associated with the frontozygomatic or frontoethmoidal suture line. The authors present an unusual case of an occult giant deep orbital dermoid cyst in infancy that initially presented with a small, benign appearance and central upper eyelid location on clinical exam. Orbitotomy with complete excision prevented further ocular sequelae in this 11-month-old.
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http://dx.doi.org/10.1097/SCS.0000000000007860DOI Listing
July 2021

Cytomegalovirus Blepharitis and Keratitis Masquerading as Eyelid Malignancy.

Ophthalmic Plast Reconstr Surg 2021 Jun 4. Epub 2021 Jun 4.

UC San Diego Viterbi Family Department of Ophthalmology Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, U.S.A.

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http://dx.doi.org/10.1097/IOP.0000000000001992DOI Listing
June 2021

Outcomes of Single Suture Mueller's Muscle Conjunctival Resection: Ethnic Considerations.

Ophthalmic Plast Reconstr Surg 2021 Jun 4. Epub 2021 Jun 4.

Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Gyeonggido, Korea Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A. Division of Plastic Surgery, UC San Diego, La Jolla, California, U.S.A.

Purpose: To compare outcomes of Mueller's Muscle Conjunctival Resection (MMCR) between 2 groups of patients with different anatomy due to ethnic heritage.

Methods: The medical records of patients who underwent MMCR between 2013 and 2018 were retrospectively reviewed. Patients who underwent additional procedures, such as upper blepharoplasty and browplasty, were excluded from the study. Patients were divided in 2 groups based on self-identified ethnic groups (Asian and Caucasian). Image J software was used to calculate MRD1 from digital images. The improvement of MRD1 (net MRD1) after surgery was evaluated and compared between 2 groups.

Results: Eighty-three eyes of 68 patients were included in this study. The Asian group consisted of 41 eyelids from 28 patients. The Caucasian group consisted of 42 eyelids from 40 patients. The average age was 52.18 (SD 20.176) in the Asian group compared with the 66.45 years (SD 9.22, p< 0.005) in the Caucasian group. The mean improvement of MRD1 was 1.96 ± 0.75 mm in Asian group and 2.05 ± 0.72 mm in Caucasian group, which was not statistically significant (p = 0.62). The incidence of ptosis overcorrection and undercorrection between the groups was also not statistically significant.

Conclusions: There was no statistically significant difference in the surgical outcomes among the 2 study groups. Despite differences in the anatomy of Caucasian and Asian eyelids, MMCR is a successful procedure in patients self-identified from both ethnic groups.
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http://dx.doi.org/10.1097/IOP.0000000000001980DOI Listing
June 2021

Teprotumumab for chronic thyroid eye disease.

Orbit 2021 Jun 1:1-8. Epub 2021 Jun 1.

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA.

: To describe the treatment of nine patients with chronic, low clinical activity score thyroid eye disease with teprotumumab.: A retrospective series of patients with chronic thyroid eye disease (TED) and low clinical activity score (CAS) treated with teprotumumab infusion therapy. Inclusion criteria: adults over 18 years of age with TED for greater than 9 months and CAS of 1 or less. All patients included in the analyses completed a full series of eight infusions. Primary outcome measures included proptosis and eyelid retraction in both eyes. Secondary outcomes included CAS, reported adverse effects, and surgery post-treatment.: Nine patients met all inclusion criteria, seven females and two males with mean age of 50.2 years and TED diagnosis of 6.25 years. Three patients had a baseline CAS of 1 and 6 had a CAS of 0. Mean proptosis reduction in the worse eye was 4.0 ± 2.4 mm immediately post-treatment ( = .02). Five out of nine patients had extended follow-up (average 16.8 ± 5.1 weeks) with mean proptosis reduction of 4.2 ± 2.8 mm at last follow-up ( = .03). Mean reduction in eyelid retraction in the worse eye was 0.3 ± 1.6 mm post-treatment ( = .58) and 0.5 ± 0.9 mm at last follow-up ( = .30). Three patients reported infusion-related myalgias, two hair thinning, one exacerbated chronic tinnitus, and one hyperglycemia.: We report clinically and statistically significant proptosis reduction in nine patients with chronic, low CAS TED treated with teprotumumab. Teprotumumab may be an effective treatment option for these patients.
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http://dx.doi.org/10.1080/01676830.2021.1933081DOI Listing
June 2021

Minimal Dissection Direct Frontalis Muscle Advancement Flap for Congenital Ptosis Repair.

J Craniofac Surg 2021 May 28. Epub 2021 May 28.

Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology School of Medicine, University of California San Diego, Division of Plastic and Reconstructive Surgery, University of California San Diego Department of Surgery, La Jolla, CA.

Background: Frontalis flap advancement is an alternative means of congenital ptosis repair from frontalis suspension utilizing autologous fascia or allogenic implants. Variations in technique, including flap division, location and number of skin incisions, and dissection planes, are described in the literature.

Materials And Methods: A retrospective case series of patients with congenital myogenic ptosis treated with simplified, minimal dissection frontalis flap advancement involving a single upper eyelid crease incision with dissection in the preseptal and subcutaneous planes without division to mobilize the frontalis flap. Inclusion criteria: pediatric patients age < 18 years with either primary or recurrent congenital ptosis following previous surgical repair. Exclusion criteria: ptosis of neurogenic etiology or postoperative follow-up < 3 months. Primary outcome measures were postoperative margin-reflex distance 1 (MRD1), the difference in MRD1 between surgical and nonsurgical eyelids in unilateral ptosis, and lagophthalmos. Secondary outcome measures included recurrence and complications.

Results: Twenty-six patients met inclusion criteria, 24 males and 2 females. Mean postoperative MRD1 at last follow-up was 2.9 ± 1.2 mm and the mean difference in MRD1 between surgical and nonsurgical eyelids at last follow-up was 1.1 ± 1.0 mm. Average lagophthalmos at postoperative month 2 to 5 was 0.6 ± 0.7 mm. One patient demonstrated postoperative lid retraction that required re-operation. Four of 31 eyelids (12.9%) demonstrated ptosis recurrence at 5, 12, or 24 months.

Conclusions: In this retrospective series, the authors report clinically and statistically significant surgical eyelid height improvement and symmetry between nonsurgical and surgical eyelids in congenital ptosis patients treated with minimal dissection direct frontalis flap advancement.
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http://dx.doi.org/10.1097/SCS.0000000000007761DOI Listing
May 2021

Secondary infection with rhino-orbital cerebral mucormycosis associated with COVID-19.

Orbit 2021 Mar 23:1-4. Epub 2021 Mar 23.

Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA.

We report two fatal cases of rhino-orbital-cerebral mucormycosis associated with COVID-19 infection. Both patients had pre-existing diabetes mellitus type 2, were treated with corticosteroids, and developed ketoacidosis. Both patients rapidly declined owing to rapid extension of the infection into the intracranial cavity. We postulate that additional risk factors for opportunistic fungal infection exist in COVID-19 patients including mechanical ventilation and Sars-CoV-2 induced immunosuppression. The ophthalmologist's role is particularly important in the early diagnosis of mucormycosis associated with COVID-19.
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http://dx.doi.org/10.1080/01676830.2021.1903044DOI Listing
March 2021

Corneal neurotization for neurotrophic keratopathy: Review of surgical techniques and outcomes.

Ocul Surf 2021 04 26;20:163-172. Epub 2021 Feb 26.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA.

Neurotrophic keratopathy is a degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia. Injuries to neurotrophic corneas are notoriously difficult to treat and have traditionally been approached with supportive management. However, recent progress in the field of corneal neurotization has given new direction for addressing nerve loss directly by stimulating new nerve growth onto the cornea from nearby sensory nerves transferred to the perilimbal region. Herein, we review the surgical techniques utilized in corneal neurotization, including direct transfers and the use of nerve grafts. Considerations in surgical approach, as well as factors that influence prognosis and outcomes of the surgical intervention are also discussed.
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http://dx.doi.org/10.1016/j.jtos.2021.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113161PMC
April 2021

A case of mistaken identity: of the orbit.

Orbit 2021 Dec 30;40(6):521-524. Epub 2020 Aug 30.

Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA.

The authors describe a rare presentation of invasive fungal rhino-orbital cellulitis caused by in an immunocompetent child. The patient was initially diagnosed and treated as , which has a high mortality rate and is primarily seen in immunocompromised patients. Though of the same order, Mucorales, the families and , may be difficult to differentiate on histologic examination and must be distinguished by fungal culture and speciation. Our patient responded well to sino-orbital debridement and systemic treatment with amphotericin and posaconazole.
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http://dx.doi.org/10.1080/01676830.2020.1814354DOI Listing
December 2021

Colorectal carcinoma presenting in the orbit: mass effect from an uncommon cause.

Orbit 2021 Aug 9;40(4):338-341. Epub 2020 Jul 9.

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA.

An 84-year-old male with previously documented poor medical follow-up presented with progressive painless proptosis of the right eye. Right upper eyelid ptosis, limited motility, proptosis, and inferomedial displacement of the right globe were noted on the exam. Computed tomography (CT) imaging revealed a right retrobulbar extraconal heterogenous mass with ill-defined borders. Biopsy revealed a malignant adenocarcinoma with tumor markers suggestive of a colorectal primary. A rectal mass was identified during a systemic workup. After biopsy, the patient was diagnosed with stage IV metastatic rectal adenocarcinoma. He began palliative radiation therapy shortly following diagnosis.
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http://dx.doi.org/10.1080/01676830.2020.1787466DOI Listing
August 2021

Canalicular laceration repair using a self-retaining, bicanalicular, hydrophilic nasolacrimal stent.

Orbit 2021 Jun 20;40(3):239-242. Epub 2020 May 20.

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, CA, USA.

: To evaluate outcomes of primary eyelid and canalicular laceration repair using a self-retaining bicanalicular hydrophilic nasolacrimal stent.: This study is a retrospective review of seven patients with canalicular laceration primarily repaired with a self-retaining bicanalicular nasolacrimal stent within 72 hours of initial injury. After lacrimal intubation, repair was performed by reapproximation of the lacerated tissues. Data collection included ophthalmic examination, mechanism of injury, involvement of upper/lower/common canaliculi, symptoms of epiphora, operative time, stent extrusion and canalicular irrigation.: Seven patients with monocanalicular laceration were repaired using the self-retaining bicanalicular nasolacrimal stent. The stent was left in place an average of 5 months. The average operative time was 29.3 minutes. None of the stents extruded prior to removal. After 5 months, the stent was removed successfully without difficulty. All patients reported subjective improvement in epiphora, with complete resolution of symptoms. Anatomic success was confirmed with irrigation in all cases. There were no complications associated with usage of the self-retaining bicanalicular nasolacrimal stent.: Primary repair of canalicular lacerations can be successfully performed with a self-retaining bicanalicular nasolacrimal stent. This stent has several advantages, including potentially faster operative times, no need for intranasal fixation or retrieval, easier intubation in the lacrimal system, and improved anatomic reapproximation of lacerated tissues.
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http://dx.doi.org/10.1080/01676830.2020.1768559DOI Listing
June 2021

Characterization of Facial Trauma Associated with Standing Electric Scooter Injuries.

Ophthalmology 2020 07 14;127(7):988-990. Epub 2020 Feb 14.

Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; Division of Oculofacial Plastic and Reconstructive Surgery, University of California, San Diego, La Jolla, California; Division of Plastic Surgery, University of California, San Diego, La Jolla, California. Electronic address:

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http://dx.doi.org/10.1016/j.ophtha.2020.02.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703691PMC
July 2020

Severe Progressive Bilateral Vision Loss With Headaches.

JAMA Ophthalmol 2020 05;138(5):582-583

Shiley Eye Institute, Division of Oculofacial Plastic and Reconstructive Surgery, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.0362DOI Listing
May 2020

The CAIDE Dementia Risk Score and the Honolulu-Asia Aging Study.

Dement Geriatr Cogn Disord 2019 22;48(3-4):164-171. Epub 2020 Jan 22.

Pacific Health Research and Education Institute, Honolulu, Hawaii, USA.

Introduction: The CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) dementia risk score is based on demographic, genetic, and modifiable risk factors in midlife and has been shown to be predictive of later-life dementia.

Objective: To test the predictive capacity of the CAIDE dementia risk score among a cohort of Japanese-American men.

Methods: Midlife measures were obtained from a sample of 3,582 Japanese-American men in the Honolulu Heart Program (1965-1968, average age = 53.1 years). A follow-up exam in 1991 (average age = 77.8 years) assessed cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). Severe cognitive impairment was defined as a CASI score <60.

Results: In this cohort, the CAIDE dementia risk score demonstrates significant association with later-life severe cognitive impairment (OR = 1.477, 95% CI: 1.39-1.58). However, the area under the receiver-operating characteristic curve c-statistics suggests poor predictive ability (c = 0.645, 95% CI: 0.62-0.67). Using a score cut-point of 10, the accuracy is acceptable (0.82), but the sensitivity is low (0.50).

Conclusion: While the CAIDE dementia risk score at midlife is associated with later development of cognitive impairment in Japanese-American men, its predictive capacity in this population is weak.
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http://dx.doi.org/10.1159/000504801DOI Listing
June 2020

Evaluation of Electronic Health Record Implementation in an Academic Oculoplastics Practice.

Ophthalmic Plast Reconstr Surg 2020 May/Jun;36(3):277-283

UC San Diego Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute and Viterbi Family Department of Ophthalmology.

Purpose: Despite increasing electronic health record (EHR) adoption, perceptions of EHRs are negative among ophthalmologists due to concerns about productivity, costs, and documentation. The authors evaluated the effects of EHR adoption in an oculoplastics practice, which had not been previously studied.

Methods: Clinical volume, documentation time, time spent with patients, reimbursement, relative value units, and patient satisfaction were examined for 2 academic oculoplastics attendings between April 2018 and April 2019, with EHR implementation in September 2018.

Results: The mean number of patients seen in a half-day clinic was 31.8 versus 27.7 (p = 0.018) pre- and post-EHR implementation, respectively. EHR implementation had no effect on total monthly reimbursement (p = 0.88) or total monthly relative value units (p = 0.54). Average reimbursement (p = 0.004) and relative value units (p = 0.001) per patient encounter were significantly greater with EHR use. Patient satisfaction scores improved (p = 0.018). Mean physician time per patient increased from 6.4 to 9.0 minutes (p < 0.001). Mean documentation time per patient increased from 1.7 to 3.6 minutes (p < 0.001). Average patient wait times decreased by 9 minutes (p = 0.03) with EHR use. No scribes were used.

Conclusions: EHR implementation was associated with decreased patient volume without significant differences in total reimbursement. Although EHR adoption was associated with increased physician time devoted to patients and greater time expenditure on documentation, patients experienced decreased wait times. This suggests that EHR use streamlined the overall clinic flow without sacrificing physicians' time with the patient. The author's findings suggest that EHR implementation can be accomplished in an academic oculoplastics setting without negative impact on patient experience or reimbursement considerations.
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http://dx.doi.org/10.1097/IOP.0000000000001531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210068PMC
March 2021

Surgical Intervention of Periocular Infantile Hemangiomas in the Era of β-Blockers.

Ophthalmic Plast Reconstr Surg 2020 Jan/Feb;36(1):70-73

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, La Jolla, CA.

Purpose: To examine the role of adjuvant surgical resection of infantile hemangiomas after systemic β-blocker therapy.

Methods: This is a multicentered retrospective study. Standard protocol for oral propranolol was employed by the referring physicians. Ocular indications for surgery included ptosis obstructing the visual axis, high degrees of astigmatism causing amblyopia, or disfigurement from residual tumor. Patients underwent complete excision or debulking.

Results: Eleven girls and 4 boys were surgically treated with mean operative age of 34.4 months. Patients were followed for a mean of 19.6 months after surgery. Four patients required surgical treatment due to an inability to tolerate medical therapy secondary to drug-related side effects (including bradycardia). The other 11 patients proceeded to surgery due to residual eyelid and orbital lesions despite medical treatment. All 15 patients underwent orbitotomy for residual hemangioma excision. Four patients also underwent simultaneous levator advancement at the time of excision. In all cases, there was resolution of ptosis with clearing of the visual axis. No complications were incurred during the surgical treatment and there were no hemangioma recurrences.

Conclusions: This is the first study to report surgical management of periocular infantile hemangiomas recalcitrant to standard therapy in the β-blocker era. In patients with infantile hemangioma who have failed medical therapy, adjuvant surgical treatment still plays an important role. For patients with persistent tumor causing ocular sequelae, surgical intervention aimed at soft tissue debulking and ptosis repair can be successful in achieving excellent functional and aesthetic outcomes with minimal side effects.For patients with periocular infantile hemangiomas with residual soft tissue deformity following propranolol therapy, surgical treatment plays an important role in improving functional and cosmetic outcomes with minimal side effects.
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http://dx.doi.org/10.1097/IOP.0000000000001466DOI Listing
March 2021

Does Intraoperative Ketorolac Increase Bleeding in Oculoplastic Surgery?

Ophthalmic Plast Reconstr Surg 2020 Jul/Aug;36(4):355-358

Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego School of Medicine, La Jolla, California, U.S.A.

Purpose: To report adverse hemorrhagic outcomes in patients who received intravenous (IV) ketorolac during oculofacial plastic surgical procedures.

Methods: The medical records of 111 consecutive patients who underwent lacrimal or orbital surgery, between the years 2016 and 2018, performed by a single surgeon under general anesthesia were retrospectively reviewed. Patients were excluded if they had history of a bleeding coagulopathy, anticoagulant use prior to surgery, or insufficient follow up. Patients were divided into 2 groups based on whether they received intravenous ketorolac. The primary outcome measure was the occurrence of a major postoperative bleeding event, and the secondary outcome measures were the evaluation of postoperative ecchymosis graded at 1 week after surgery and the incidence of persistent ecchymosis beyond 4 weeks.

Results: A total of 111 patients were analyzed further, including 31 patients who received intraoperative IV ketorolac and 80 control patients who did not. The demographic characteristics between the 2 groups were similar. No major bleeding events occurred in either group. And there was no statistically significant difference between the 2 groups in terms of ecchymosis grade and the incidence of development of persistent ecchymosis. Comparing the subgroups of lacrimal and orbital cases, there was also no significance difference between these groups.

Conclusions: This study suggests that intraoperative ketorolac use does not increase the risk of postoperative bleeding complications in oculofacial procedures. This alternative to opioids may assist with pain control and lessen the narcotic burden.
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http://dx.doi.org/10.1097/IOP.0000000000001549DOI Listing
March 2021

Precision in Oculofacial Surgery: Made-To-Specification Cast-Molded Implants in Orbital Reconstruction.

Ophthalmic Plast Reconstr Surg 2020 May/Jun;36(3):268-271

UC San Diego Division of Oculofacial Plastic and Reconstructive Surgery, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California.

Purpose: To describe the utilization of customized made-to-specification porous polyethylene implants and to evaluate clinical characteristics and outcomes of patients who received these implants for unilateral orbital defects.

Methods: A retrospective review of 9 patients was performed. Three-dimensional surface models were generated from high-resolution computed tomography scans. Orbital constructs were modeled after the normal, contralateral orbits and mirrored across the vertical midline to generate the target orbital implant. Measured outcomes included globe position, extraocular motility, facial symmetry, and diplopia.

Results: Patients ranged 25-56 years old (mean: 37) and included 6 males and 3 females. Cases consisted of 6 orbital floor fractures due to trauma, 1 lateral wall defect after neurofibroma resection, 1 floor/medial wall defect after myxoma resection, and 1 superior orbital rim defect after intraosseous hemangioma resection. Seven patients had ≥1 prior repair. All patients had previous hard and soft tissue defects and varying degrees of restrictive globe motility. Patients exhibited improved ductions after implant placement and improved facial appearance and symmetry. Post-operatively, 1 patient was found to have a small orbital hematoma between the implant and orbital floor, resolving within weeks.

Conclusions: Precision, personalized oculofacial surgery is the next wave in tailoring surgical care to the individual patient. Customizable implants are manufactured to specifically mold to an individual patient's unique bony architecture, which can lead to superior outcomes in reconstructing orbital and craniofacial bony defects. This technique is particularly useful in patients with prior unsuccessful repair.
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http://dx.doi.org/10.1097/IOP.0000000000001529DOI Listing
March 2021

Exposed Scleral Buckle Causing Atypical Mycobacterial Infection.

Ophthalmic Plast Reconstr Surg 2020 May/Jun;36(3):e83

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology.

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http://dx.doi.org/10.1097/IOP.0000000000001458DOI Listing
March 2021

Brain Injury and Later-Life Cognitive Impairment and Neuropathology: The Honolulu-Asia Aging Study.

J Alzheimers Dis 2020 ;73(1):317-325

Pacific Health Research and Education Institute, Honolulu, HI, USA.

Background: Findings are inconsistent regarding the role of traumatic head injury in the subsequent development of neurologic outcomes.

Objective: Examine the relationship between head injury and later cognitive impairment.

Methods: A sample of 3,123 Japanese-American men was assessed for history of head injury and evaluated for cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). For a subsample of 676 respondents, neuropathologic results from those with and without head injury were compared.

Results: Although the crude model showed an association between history of head injury and later severe cognitive impairment, the relationship lost significance in the adjusted model (OR = 1.320, CI: 0.90-1.93), regardless of time between injury and impairment. Similar to cognitive impairment, hippocampal sclerosis was observed significantly more in the brains of respondents with a history of head injury in the crude model, but the relationship weakened in the adjusted model (OR = 1.462, CI: 0.68-3.12). After adjustment, decedents with a head injury demonstrated marginally higher brain weight (OR = 1.003, CI: 1.00-1.01).

Conclusion: We did not find a relationship between head injury and subsequent cognitive decline in this cohort. The neuropathology results also displayed no strong association between history of head injury and specific brain lesions and characteristics. These results support other findings in prospective cohorts. However, they could be influenced by the demographic make-up of the sample (male Japanese-Americans) or by the observation that the majority reported only a single head injury.
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http://dx.doi.org/10.3233/JAD-190053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477789PMC
April 2021

Development of Poliosis Following Checkpoint Inhibitor Treatment for Cutaneous Melanoma.

Ophthalmic Plast Reconstr Surg 2019 Sep/Oct;35(5):e121-e122

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute.

The authors describe a clinical case whereby a patient with metastatic cutaneous melanoma developed eyelash poliosis after undergoing treatment with combination immunotherapy with ipilimumab and nivolumab.
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http://dx.doi.org/10.1097/IOP.0000000000001451DOI Listing
January 2020

A Lazy-T Modification in the Treatment of Medial Ectropion.

Aesthet Surg J 2019 08;39(9):NP398-NP402

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL.

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http://dx.doi.org/10.1093/asj/sjz181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316179PMC
August 2019

Sudden-onset Blindness from a Spontaneous Carotid-cavernous Fistula with Secondary Central Retinal Artery Occlusion and Posterior Ischemic Optic Neuropathy.

Neuroophthalmology 2019 Apr 19;43(2):107-113. Epub 2018 Jul 19.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.

Our case describes a patient diagnosed with a carotid-cavernous fistula (CCF) secondary to a spontaneously ruptured cavernous carotid aneurysm, presenting with sudden vision loss, and a concomitant central retinal artery occlusion as visualized by a cherry-red spot in the macula and posterior ischemic optic neuropathy. Computed tomography of the brain and orbits showed mild hydrocephalus, orbital fat haziness, and proptosis with concern for fluid in the basal cisterns. Cerebral angiography confirmed the suspected diagnosis of CCF. After angiography, a Magnetic resonance imaging of the brain demonstrated abnormal diffusion restriction in the posterior right optic nerve confirmed on the apparent diffusion coefficient map, consistent with ischemia of the optic nerve in this location. Two weeks after discharge, outpatient fundus photography showed resolution of her cherry-red spot, and optical coherence tomography showed thinning of the entire retinal nerve fiber layer as compared to the contralateral eye. In CCFs, congestive symptoms of proptosis, pain, and even central retinal vein occlusion findings are frequently described. However, our patient's no light perception vision and imaging findings suggest associated central retinal artery occlusion and ischemic optic neuropathy. These findings underscore the multitude of serious visual effects of high flow CCFs.
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http://dx.doi.org/10.1080/01658107.2018.1488979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619923PMC
April 2019

Single Suture Müeller Muscle Conjunctival Resection (ssMMCR): A Modified Technique for Ptosis Repair.

Ophthalmic Plast Reconstr Surg 2019 Jul/Aug;35(4):403-406

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California.

Purpose: To evaluate the efficacy in degree of ptosis correction achieved by single suture Müeller muscle conjunctival resection (ssMMCR) when compared with that of traditional MMCR.

Methods: A retrospective chart analysis of patients who underwent either ssMMCR or traditional MMCR at 2 institutions. Single suture MMCR was performed after using a ptosis clamp to imbricate conjunctiva and Müeller muscle. Margin-to-reflex distance 1 was measured pre- and postoperatively, and the change in margin-to-reflex distance 1 was analyzed for both groups. Patients were monitored in follow up for postoperative complications including lagophthalmos, corneal abrasions, and change in visual acuity. Statistical analysis was performed using the Microsoft Excel and Stata software programs.

Results: Twenty-seven and 30 patients underwent single suture and traditional MMCR, respectively. The ssMMCR and MMCR groups were followed postoperatively for approximately 4.2 and 9.7 months, respectively and the average margin-to-reflex distance 1 increased by 2.93 mm and 2.81 mm, respectively. Notably, there was no statistically significant difference in the means identified by t test. Of the 94 eyelid surgeries evaluated, 1 ssMMCR and 3 MMCR eyelids required further surgical revision for persistent ptosis, and 1 ssMMCR developed a transient corneal epithelial abrasion. Surgical revisions were rare with both procedures, and patient satisfaction was high.

Conclusions: Single suture MMCR is an efficient and effective method for ptosis repair. It results in comparable outcomes including elevation in margin-to-reflex distance 1, safety profile, and reoperation rates, when compared with traditional MMCR.
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http://dx.doi.org/10.1097/IOP.0000000000001380DOI Listing
December 2019

Unusual Cause of Ptosis.

JAMA Ophthalmol 2019 03;137(3):320-321

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, Chicago, Illinois.

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http://dx.doi.org/10.1001/jamaophthalmol.2018.5438DOI Listing
March 2019

Self-insertion of foreign bodies into the orbit and periocular tissue.

Orbit 2019 Dec 20;38(6):486-491. Epub 2018 Dec 20.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago , Illinois , USA.

We describe six patients with 12 separate episodes of self-inflicted periocular foreign body injuries, which presented to our institution recently. All patients were male, relatively young (mean 28.5 years old), incarcerated, and had significant underlying psychiatric conditions. The subjects had inserted staples (6), paperclips (2), or other small metallic wire segments (4) into the periocular region. Most cases (9/12) involved concurrent self-inflicted injury to other body parts. Ten cases involved foreign bodies inserted through the palpebral conjunctiva into the upper eyelid, while two cases involved insertion into the orbit. Identification and surgical retrieval of foreign bodies was successful in most cases (9/11) but was not attempted in one case. Self-inflicted periocular injuries, while rare, are challenging cases for which the ophthalmologist should be prepared. A multidisciplinary approach, including psychiatric assessment and treatment, is important for optimal care.
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http://dx.doi.org/10.1080/01676830.2018.1556705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586531PMC
December 2019

Angular Vein Varix Congestion From Chronic Glasses Wear.

Ophthalmic Plast Reconstr Surg 2018 Nov/Dec;34(6):e182-e184

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, U.S.A.

This is a case report of a symptomatic varicose angular vein exacerbated by chronic glasses wear. Compressing the vein in a recumbent position led to increased fullness of the medial canthal region and reproduced his symptoms. Obliteration by cauterization of the vein led to resolution of symptoms.
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http://dx.doi.org/10.1097/IOP.0000000000001220DOI Listing
May 2019

Stable Upper Eyelid after 2 Successive Tarsoconjunctival Flaps.

Plast Reconstr Surg Glob Open 2018 May 14;6(5):e1724. Epub 2018 May 14.

Department of Ophthalmology, University of Illinois at Chicago, Chicago, Ill.

A 70-year-old male with history of multiple cutaneous squamous cell carcinoma throughout the body presented with a left lower lid margin squamous cell carcinoma. The lesion was excised via Mohs surgery elsewhere, and the defect was reconstructed with a tarsoconjunctival flap (Hughes flap). The lesion recurred, and the patient had a second Mohs surgery for excision. For reconstruction, a second tarsoconjunctival flap spanning the entire horizontal distance of the upper lid was done. The remaining 2-3 mm of upper tarsus provided good support of the upper lid. Careful planning may allow for successive tarsoconjunctival flaps if needed in the future.
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http://dx.doi.org/10.1097/GOX.0000000000001724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999439PMC
May 2018
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