Publications by authors named "Eleni Drakonaki"

52 Publications

Effective orbital volume and eyeball position: an MRI study.

Orbit 2010 Oct 2;29(5):244-9. Epub 2010 Sep 2.

Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece.

Purpose: Previous studies have examined factors affecting the position of the eyeball to the orbit. This study examined the role of effective orbital volume (EOV), defined as the difference between orbital and eyeball volume, as a determinant of eyeball position, using MRI scans.

Methods: Forty-six patients were recruited from the Department of Ophthalmology of the University Hospital of Heraklion, Crete Greece. Patients with a history of orbital disease were excluded. Distances between eyeball poles and orbital landmarks were measured in T1 weighted transverse, sagittal and coronal orbital images. The protrusion of the eyeball in the sagittal and transverse planes was recorded. The volume of the eyeball and bony orbit, the EOV, the volume of the extraocular muscles as well as clinical information (age, gender, Hertel exophthalmometry) were also recorded.

Results: EOV was significantly associated with orbital volume but not with eyeball volume. EOV was also significantly associated with transverse and sagittal globe protrusions. Females displayed significantly lower orbital and eyeball volumes as well as EOV than males but higher transverse globe protrusion than males.

Conclusions: Variations in EOV are associated with orbital volume rather than with eyeball volume. EOV is associated with globe protrusion and may be taken into account in the planning of various procedures, including orbital decompression, treatment of enophthalmos or the size of orbital implants following enucleation.
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http://dx.doi.org/10.3109/01676831003664319DOI Listing
October 2010

Watery eye following patent external DCR: an MR dacryocystography study.

Orbit 2010 Oct 2;29(5):239-43. Epub 2010 Sep 2.

Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece.

Purpose: To examine patients with persistent watery epiphora following patent external dacryocystorhinostomy (DCR) with magnetic resonance imaging dacryocystography (MR-DCG).

Methods: Patients with unobstructed nasolacrimal irrigation following external DCR were included. Five patients with watery epiphora constituted the study group (SG). Five patients without epiphora constituted the control group (CG). All patients underwent MR-DCG following the instillation of artificial tears in the conjunctival fornix. The osteotomy site was identified in T1-weighted coronal images. Lacrimal flow was assessed with modified T2-weighted (True Fast Imaging Steady State Pulse, "TrueFISP") coronal images before and 10 min after repeated blinking. Signal intensities at three regions of interest (ROIs), corresponding to the eyeball (ROI-1), conjunctival sac (ROI-2), and anastomotic site (ROI-3) were measured.

Results: Differences in the diameter of both osseous and soft tissue ostia between SG and CG were statistically not significant. A post-blink increase in signal intensity at ROI-3 was noted in both groups, whereas differences in signal intensity for ROI-1 and ROI-2 were statistically not significant. The post-blink signal intensity increase in ROI-3 was significantly more pronounced in the CG, compared with the SG.

Conclusions: The fact that signal intensity increase at ROI-3 was less pronounced in the SG, compared with CG, implies a compromised "lacrimal pump" mechanism in the former group. The methodology presented may be used for the evaluation of post-DCR epiphora.
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http://dx.doi.org/10.3109/01676831003660697DOI Listing
October 2010

Acute abdomen caused by a small bowel perforation due to a clinically unsuspected fish bone.

Diagn Interv Radiol 2011 Jun 3;17(2):160-2. Epub 2010 Aug 3.

Department of Radiology, Venizeleion General Hospital, Heraklion, Greece.

We report the case of a 78-year-old woman with a three-day history of abdominal pain and vomiting. An abdominal plain film showed a distended small bowel loop and no signs of free intra-abdominal gas. An abdominal ultrasound revealed a mass containing a linear, hyperechoic structure. The mass was connected through a sinus tract to an adjacent aperistaltic small bowel loop. A laparotomy revealed a jejunal perforation and an omental granuloma containing a fish bone. Accidentally ingested foreign bodies should always be suspected in cases of acute abdomen, and ultrasonography remains a firstline examination tool for preoperative diagnoses of unsuspected foreign bodies and their complications.
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http://dx.doi.org/10.4261/1305-3825.DIR.3236-09.1DOI Listing
June 2011

Sonographic diagnosis of a clavicular fracture in a neonate with upper limb pseudoparalysis.

J Ultrasound Med 2010 Apr;29(4):671-2

Department of Radiology, Venizeleio Hospital, Knossou Avenue, Heraklion, Crete 71107, Greece.

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http://dx.doi.org/10.7863/jum.2010.29.4.671DOI Listing
April 2010

Intratesticular varicocele.

Postgrad Med J 2010 Apr;86(1014):256

Venizeleio General Hospital, Heraklion, Crete, Greece.

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http://dx.doi.org/10.1136/pgmj.2009.089755DOI Listing
April 2010

Magnetic resonance imaging, ultrasound and real-time ultrasound elastography of the thigh muscles in congenital muscle dystrophy.

Skeletal Radiol 2010 Apr;39(4):391-6

Radiology Department, University of Crete, Heraklion, Greece.

Congenital muscle dystrophy includes a range of genetic disorders characterized by muscle weakness and contractures. We report the magnetic resonance (MR), ultrasound (US) and real-time sonoelastography (RTE) imaging findings of the thigh muscles of a 15-year-old boy with Bethlem myopathy diagnosed with clinical, electromyographic and histopathological criteria. Ultrasound and MR showed hyperechoic appearance and high signal intensity on T1- and T2-weighted sequences respectively at the periphery of the vastus lateralis and the long head of the biceps femoris muscles, and at a central area within the rectus femoris muscles. RTE was employed to examine the elastic properties of the muscle. The elastograms were presented as colour-coded maps superimposed on the B-mode images and revealed that the elastographic pattern correlated with the MR and US pattern of involvement. The abnormal muscle areas were stiffer (blue) than the normal-appearing areas (green), a finding that probably correlates with the presence of dystrophic collagen at the affected areas. This report suggests that RTE could be used as an additional imaging tool to evaluate the pattern of muscle changes in congenital myopathy. Further studies are needed to investigate the specificity and clinical value of RTE in the diagnosis and monitoring of neuromuscular disease.
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http://dx.doi.org/10.1007/s00256-009-0861-0DOI Listing
April 2010

Metatarsal stress fracture diagnosed with high-resolution sonography.

J Ultrasound Med 2010 Mar;29(3):473-6

Department of Radiology, Venizeleio Hospital, Heraklion, Crete, Greece.

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http://dx.doi.org/10.7863/jum.2010.29.3.473DOI Listing
March 2010

Real-time ultrasound elastographic imaging of ocular and periocular tissues: a feasibility study.

Ophthalmic Surg Lasers Imaging 2010 Jan-Feb;41(1):135-41

Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece.

Background And Objective: This study examines the value of ultrasound elastography for the examination of ocular and periocular structures.

Subjects And Methods: Five patients, aged 22 to 75 years, who each had one blind eye were included. Patients underwent ultrasound elastography of their blind eye and periocular tissues using a 7-13 MHz probe. Strain grayscale and color-coded elastographic maps were recorded. In the former, a quantitative assessment of signal intensity (corresponding to elastic properties) for specific anatomical structures was performed.

Results: Anterior vitreous displayed intermediate elasticity, whereas posterior vitreous displayed low elasticity. Medial and lateral rectus muscle elasticity was higher in primary position than in adduction or abduction.

Conclusion: The pattern of elastic imaging in the vitreous cavity could be attributed to posterior vitreous detachment, whereas that of medial and lateral rectus muscles may be related to the level of muscle fiber strain.
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http://dx.doi.org/10.3928/15428877-20091230-24DOI Listing
March 2010

Deferoxamine versus combined therapy for chelating liver, spleen and bone marrow iron in beta-thalassemic patients: a quantitative magnetic resonance imaging study.

Hemoglobin 2010 ;34(1):95-106

Department of Radiology, University of Crete, Heraklion, Greece.

We used magnetic resonance imaging (MRI) to compare the effect of iron chelation on liver, spleen and bone marrow. We examined 21 beta-thalassemic patients undergoing deferoxamine (DFO) (9/21) or combined therapy [DFO and deferiprone (L1), 12/21] with two abdominal MRI studies using T1-w/Pd-w/T2*-wGRE and T1-wTSE sequences. Changes in serum ferritin (DF%), and liver, spleen and marrow to paraspinous muscles signal intensity ratios (SI) in T1-wTSE sequence were calculated as D%=[(2(nd)value-1(st) value)/1(st) value] x100%. Negative DF% and positive D(SI)% indicated reduction of iron. Although 17/21 (80.9%) patients demonstrated reduction in ferritin, only 8/21 (38%), 7/21 (33.3%) and 7/21 (33.3%) patients had decreased liver, spleen and marrow iron. Patients undergoing combined therapy showed significantly greater reduction (Student's t-test, p < 0.05) or less increase (t-test, p <0.05) in iron stores. Combined therapy is more effective than DFO for removing and preventing liver, spleen and bone marrow iron accumulation in beta-thalassemic patients. Magnetic resonance imaging is valuable for organ-specific monitoring of chelation therapy.
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http://dx.doi.org/10.3109/03630260903546445DOI Listing
May 2010

Hematocolpometra due to an imperforate hymen presenting with back pain: sonographic diagnosis.

J Ultrasound Med 2010 Feb;29(2):321-2

Venizeleion General Hospital, Knossou Avenue, Heraklion, Crete 71107, Greece.

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http://dx.doi.org/10.7863/jum.2010.29.2.321DOI Listing
February 2010

MRI evaluation of lacrimal drainage after external and endonasal dacryocystorhinostomy.

Ophthalmic Plast Reconstr Surg 2009 Jul-Aug;25(4):289-92

Departments of Ophthalmology, University Hospital of Heraklion, Crete, Greece.

Purpose: External and endonasal dacryocystorhinostomy (EX-DCR and EN-DCR, respectively) affect the tear drainage mechanism. This study evaluates the preservation of "lacrimal pump" function in both procedures.

Methods: Cases of successful EN-DCR (4 patients) and EX-DCR (4 patients) were included. All patients underwent MRI of the rhinostomy areas, at least 6 months postoperatively. The vertical diameter of rhinostomy (both osseous and soft-tissue apertures) was measured in T1-oriented images, whereas the signal intensity levels were examined for 3 regions of interest (ROIs) in T2-oriented (true fast imaging steady state pulse) images with instillation of normal saline to the conjunctival fornices, both before and after blinking (activation of the "lacrimal pump"). ROI 1 corresponded to the globe (control), ROI 2 corresponded to the inferior conjunctival fornix, and ROI 3 corresponded to the rhinostomy site.

Results: Signal intensity in ROI 3 (rhinostomy) was significantly increased after blinking in both EX-DCR and EN-DCR cases. The increase was significantly higher in the latter. Signal intensity changes in ROI 3 were significantly correlated with rhinostomy size in both groups, whereas the respective correlations with the postoperative interval were not statistically significant.

Conclusions: Findings imply that the "lacrimal pump" is active following DCR and may be better preserved in the EN-DCR than in the EX-DCR group. Persistent epiphora after patent DCR may thus be attributed to a defective "pump" function and treated accordingly.
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http://dx.doi.org/10.1097/IOP.0b013e3181ac5320DOI Listing
September 2009

High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience.

Ann Plast Surg 2008 Sep;61(3):259-64

Department of Radiology, Selly Oak and Royal Orthopaedic Hospitals, Birmingham, UK.

The purpose of this study is to determine the reliability of high-resolution ultrasound (HRUS) in the diagnosis of upper limb disorders compared with the initial clinical opinion. We prospectively studied 178 patients referred for HRUS examination (47.2% hand, 34.8% wrist, and 18% elbow examinations) by recording the clinical opinion, the specific ultrasound diagnosis, and the final diagnosis, as established by surgery (79.9%) or follow-up (20.1%). HRUS examination was highly reliable in diagnosing cystic lesions, synovial disease, ligament injury and foreign bodies (100%), and slightly less reliable for solid lesions (82.1%) and nerve, bone, and tendon disorders (97%, 91.7%, 86.5%, respectively). HRUS examination resulted in significantly more correct diagnoses (92.1%) than the clinical opinion (70.8%) (McNemar test, P = 0.001). The agreement between the HRUS diagnosis and the clinical opinion was slight (Kappa test, k = 0.16). HRUS examination is more reliable than clinical examination in diagnosing upper limb disorders.
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http://dx.doi.org/10.1097/SAP.0b013e31815bfe68DOI Listing
September 2008

Migratory azygos vein: a case report.

J Comput Assist Tomogr 2008 Jan-Feb;32(1):99-100

Department of Radiology, University Hospital of Heraklion, Medical School of Crete, Heraklion, Crete, Greece.

We report a case of a "migrating" azygos vein developing after an abrupt spinal deformity adjacent to the azygos arch. A woman with a previously identified azygos lobe had a follow-up chest computed tomography that demonstrated the azygos vein dislocated medially to the fissure in its usual mediastinal position. The azygos lobe was intact. The woman had developed kyphosis angled at the level of the T4 vertebra, where the azygos vein arches anteriorly.
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http://dx.doi.org/10.1097/RCT.0b013e3180593111DOI Listing
March 2008

Selective removal of sebaceous gland carcinoma of the lower eyelid with orbital infiltration.

Ophthalmic Surg Lasers Imaging 2007 Sep-Oct;38(5):413-6

Department of Ophthalmology, Democritus University of Thrace, Greece.

A 74-year-old woman presented with a nodule on the right lower eyelid. An incisional biopsy was significant for sebaceous gland carcinoma, whereas magnetic resonance imaging revealed infiltration of the ipsilateral orbit, including the medial and lower rectus muscles. The lesion was selectively excised, including the infiltrated part of the lower lid and the intraorbital part of the tumor. Two years postoperatively, no recurrence or metastasis have been noted. Preoperative orbital imaging is mandatory in cases of sebaceous gland carcinoma because it can reveal clinically silent orbital invasion. In such cases, selective surgical excision may be used, avoiding orbital exenteration.
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http://dx.doi.org/10.3928/15428877-20070901-12DOI Listing
November 2007

Bone marrow changes in beta-thalassemia major: quantitative MR imaging findings and correlation with iron stores.

Eur Radiol 2007 Aug 16;17(8):2079-87. Epub 2006 Dec 16.

Radiology Department, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece.

The purpose of this study is to describe the MR imaging features of bone marrow in beta-thalassemia major and investigate their relation to ferritin, liver and spleen siderosis. Spinal bone marrow was prospectively assessed on abdominal MR studies of 40 transfused beta-thalassemic patients and 15 controls using T1-w, Pd, T2*-w Gradient Echo (GRE) and T1-w turbo Spin Echo (TSE) sequences. Signal intensity (SI) ratios of liver, spleen and bone marrow to paraspinous muscles (L/M, S/M, B/M respectively) and the respective T2 relaxation rates (1/T2) were calculated. Serum ferritin levels were recorded. Bone marrow hypointensity in at least T2*-w GRE sequence was noted in 29/40 (72.5%) patients. Eleven/40 patients exhibited normal B/M on all MR sequences. Five/40 patients had normal B/M and low L/M. B/M correlated with L/M in T1-w TSE sequence only (r = 0.471, p = 0.05). B/M correlated with S/M and mean ferritin values in all sequences (r > 0.489, p < 0.01 and r > - 0.496, p < 0.03 respectively). Marrow 1/T2 did not correlate with ferritin values or liver and spleen 1/T2. B/M in transfused beta-thalassemic patients is related to splenic siderosis and ferritin levels. Although marrow is usually hypointense, it may occasionally display normal SI coexisting with liver hypointensity, a pattern typical of primary hemochromatosis.
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http://dx.doi.org/10.1007/s00330-006-0504-yDOI Listing
August 2007

Hemodynamic evaluation of the posterior ciliary circulation in exfoliation syndrome and exfoliation glaucoma.

Graefes Arch Clin Exp Ophthalmol 2007 Apr 17;245(4):516-21. Epub 2006 Nov 17.

Department of Ophthalmology, Democritus University of Thrace, Alexandroupolis, Greece.

Background: Previous studies have reported impaired blood flow in the ophthalmic artery (OA) and central retinal artery (CRA) in exfoliation syndrome and exfoliation glaucoma. This study evaluates blood flow at the long and short posterior ciliary arteries (LPCA and SPCA, respectively) in these conditions.

Methods: Consecutively examined candidates for cataract surgery were included. Only one eye (OD) was included in the analyses for consistency. Patients were classified into non-glaucoma and non-exfoliation (controls), primary open angle glaucoma (POAG), exfoliation syndrome and exfoliation glaucoma groups, based on the findings of the OD. Sixty-eight patients (41 males, 60.3%) were included. Color Doppler imaging (CDI) of the nasal and temporal branches of LPCA and SPCA was performed using a 7.5 Mhz probe. The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI) were recorded for the examined vessels.

Results: EDV at the LPCA was significantly lower in exfoliation syndrome and glaucoma, compared with controls and POAG respectively. EDV was significantly lower and RI was significantly higher at the SPCA in exfoliation glaucoma, compared with exfoliation, whereas respective differences were statistically not significant between controls and POAG.

Conclusions: The hemodynamic impairment at the LPCA in exfoliation syndrome and glaucoma supports an association between exfoliation and ischemic stress at the anterior ocular segment.
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http://dx.doi.org/10.1007/s00417-006-0439-7DOI Listing
April 2007

Lower eyelid laxity in functional acquired epiphora: evaluation with quantitative scintigraphy.

Ophthalmic Plast Reconstr Surg 2006 Jan-Feb;22(1):25-9

Department of Ophthalmology, University Hospital of Alexandroupolis, Greece.

Purpose: The examination of lacrimal drainage is often based on qualitative criteria. This study uses quantitative scintigraphy to evaluate "functional" epiphora.

Methods: Thirty-two patients with functional epiphora (no morphologic abnormalities of the conjunctiva and eyelids, a patent nasolacrimal duct on irrigation, and no anatomical stenosis on dacryocystography) were studied (study group, SG). Twenty-two individuals without epiphora were also examined (control group, CG). Fifty microliters of Technetium-99m was instilled into the conjunctival cul-de-sac. Time-activity curves were then constructed, and conjunctival lacrimal clearance (CLC) at 2.5, 5, 7.5, and 10 minutes was calculated. Differences in CLC between the SG and the CG and correlations between CLC and horizontal and median tendon laxity and eyelid length in the SG were examined.

Results: The SG had significantly reduced CLC at 2.5 and 5 minutes, compared with the CG (p = 0.01 and p = 0.04, respectively), whereas respective differences at 7.5 and 10 minutes were not statistically significant. In the SG, CLC at 2.5 and 5 minutes was significantly correlated with horizontal and median tendon laxity. The respective correlation with eyelid length was not statistically significant. Furthermore, in the SG, CLC at 2.5 and 5 minutes was significantly correlated with patient age (p = 0.03 and p = 0.04, respectively). Differences in CLC between men and women were not statistically significant at all intervals.

Conclusions: The correlation between eyelid laxity and CLC supports the role of the eyelid "pump" in lacrimal drainage. CLC at 2.5 and 5 minutes may be used to decide treatment methods for functional epiphora.
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http://dx.doi.org/10.1097/01.iop.0000192652.17317.83DOI Listing
March 2006

Adrenal glands in beta-thalassemia major: magnetic resonance (MR) imaging features and correlation with iron stores.

Eur Radiol 2005 Dec 16;15(12):2462-8. Epub 2005 Aug 16.

Department of Radiology, University Hospital of Heraklion, Stavrakia, P.O. Box 1325, 71110, Heraklion, Crete, Greece.

This study aimed at describing the magnetic resonance (MR) imaging features of the adrenal glands in beta-thalassemic patients and at investigating the relation between adrenal and hepatic siderosis. Adrenal signal intensity (SI) was retrospectively assessed on abdominal MR studies of 35 patients with beta-thalassemia major undergoing quantification of hepatic siderosis and 12 healthy controls, using T1-(120/4/90), intermediate-(120/4/20), and T2*-(120/15/20) weighted GRE sequences. Adrenal SI was graded as grade 0 (normal SI on all sequences), grade 1 (hypointensity on T2* alone), or grade 2 (hypointensity on at least T2*). Adrenal size was measured in the thalassemic patients and compared with normative data. Liver-to-muscle (L/M) SI ratios, expressing hepatic siderosis, were estimated on each sequence. Serum ferritin levels were recorded. Adrenal hypointensity (grades 1 and 2) was noted in 24/35 (68.6%) patients. L/M ratios correlated significantly with adrenal SI in all sequences. Patients with grade 1 and grade 2 adrenal SI had significantly decreased L/M ratios compared with grade 0. Serum ferritin correlated significantly with L/M values but not with adrenal SI. Adrenal size was within normal limits. Diffuse hypointensity in normal-sized adrenals is a common MR finding in beta-thalassemic patients and correlates with the degree of hepatic siderosis.
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http://dx.doi.org/10.1007/s00330-005-2855-1DOI Listing
December 2005

Ethmoidal osteoma with intraorbital extension: excision through a transcutaneous paranasal incision.

Acta Ophthalmol Scand 2005 Jun;83(3):392-4

Department of Ear, Nose and Throat Diseases, University Hospital of Alexandroupolis, Thrace, Greece.

Purpose: To describe a case of conjunctival hyperaemia and proptosis of the right eye.

Methods: Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach.

Results: The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively.

Discussion: Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures.
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http://dx.doi.org/10.1111/j.1600-0420.2005.00459.xDOI Listing
June 2005

Late isolated brain metastasis following enucleation for choroidal melanoma.

Ophthalmic Surg Lasers Imaging 2005 Mar-Apr;36(2):151-4

Department of Ophthalmology, 492 General Army Hospital, Alexandroupolis, Greece.

Brain metastases from choroidal melanoma are rare and usually have a grave prognosis. A case of successfully treated late isolated brain metastasis from choroidal melanoma is described. A 35-year-old man presented with epileptic seizures of recent origin, 9 years following enucleation for choroidal melanoma. Imaging studies revealed a lesion of the right frontal lobe that was surgically removed. Results of pathologic examination were compatible with metastatic choroidal melanoma. The patient is asymptomatic 5 years postoperatively. Late isolated brain metastases from uveal melanoma may be treatable by local resection. Close, lifelong follow-up is required to diagnose and aggressively treat metastatic disease.
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April 2005

Processed fascia lata as an alternative implant material in evisceration.

Ophthalmic Plast Reconstr Surg 2005 Mar;21(2):133-7

Department of Ophthalmology, University Hospital of Alexandroupolis, Thrace, Greece.

Purpose: To examine the use of processed fascia lata strips as an implant material in evisceration.

Methods: This is a prospective, interventional, noncomparative case series. Eight patients underwent standard evisceration of an eye with subsequent primary insertion of processed fascia lata strips in the scleral shell. They were clinically examined at regular postoperative intervals (up to 20 months) and had computed tomography and magnetic resonance imaging scans of the orbits at the 12-month interval. The development of vascularity of the scleral shell contents was assessed with the intravenous administration of a contrast-enhancing agent.

Results: The fascia lata strips were incorporated without significant complications in all cases. The maintenance of adequate volume and position of the eviscerated globe was confirmed by both computed tomography and magnetic resonance imaging scans. T1-weighted magnetic resonance imaging studies with intravenous administration of contrast-enhancing agent and fat-saturation sequences revealed the development of vascularity of the scleral shell contents.

Conclusions: Processed fascia lata may be a useful alternative implant material in evisceration. Possible advantages of its use may include protection against extrusion, custom volume selection and easy intraoperative manipulation.
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http://dx.doi.org/10.1097/01.iop.0000155855.99932.68DOI Listing
March 2005

Pneumocephalus and presumed meningitis following inconspicuous penetrating periocular trauma.

Acta Ophthalmol Scand 2004 Oct;82(5):603-5

Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, California, USA.

Purpose: To report a case of serious intracranial complications in an adolescent youth following a seemingly trivial periocular injury.

Methods: An adolescent youth was examined and discharged after a small penetrating injury to his left medial canthus. He later presented with blurred vision, nausea and mild pyrexia and underwent a computed tomography (CT) scan of the head and orbits as well as a lumbar puncture.

Results: The CT scan revealed a fracture in the cribriform plate of the ethmoid bone and the medial orbital wall, as well as pneumocephalus. The lumbar puncture revealed 3000 white cells/mm3 in the cerebrospinal fluid (CSF). After treatment with meningitic doses of intravenous antibiotics, a significant improvement was noted.

Conclusions: A CT scan, instead of an ordinary head radiograph, may be considered as a first-choice mode of diagnosis in evaluating even inconspicuous penetrating periocular wounds. Early administration of meningitic doses of antibiotics may significantly improve prognosis.
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http://dx.doi.org/10.1111/j.1600-0420.2004.00334.xDOI Listing
October 2004
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