Vitreous hemorrhage from the persistent hyaloid artery.

J AAPOS 2000;4:190–1.     

Vitreous haemorrhage associated with persistent hyaloid artery

IntroductionHaemorrhage from an entire persistent hyaloid artery (PHA) is an uncommon anomaly.Case reportA 52 year old female presented with blurred vision in her amblyopic eye. Biomicroscopy revealed a blood filled PHA which was inserted in the posterior crystalloid. Ophthalmoscopy showed a mild vitreous haemorrhage. A tubular structure showing a hypo-reflexivity inside the PHA was able to be analysed using optical coherence tomography (OCT). However, Doppler ultrasound did not detect the presence of active blood flow within it.ConclusionsThe performance of non-invasive imaging tests such as the OCT and Doppler ultrasound may be useful in the study of vitreous haemorrhage associated with PHA.     

带滑车上动脉前额部皮瓣修复上睑缺损

目的 探讨采用带滑车上动脉前额部皮瓣法修复上睑缺损的效果.方法 7例上睑全层缺损采用带滑车上动脉前额部皮瓣进行修复,术后随访6 ～ 24个月观察其临床效果.结果 皮瓣全部成活,颜色、质地与周围皮肤相近,上睑部无明显臃肿,睁眼、闭眼活动自如,无眼部不适感.皮瓣蒂部及额部植皮区无明显瘢痕增生.结论 在上睑缺损的修复中使用带滑车上动脉的前额部皮瓣对于功能和外形都有良好的改善作用.     

Cranio-orbital injury with internal carotid artery laceration and a missing eyelid

A 37-year-old man presented to the emergency department with a visor impacted in the left orbit after a motorbike accident. His initial injury appeared to be limited to the orbit. Because the bleeding appeared disproportionate to the orbital injury, an intracranial injury was suspected. Subsequently, on hemicraniotomy, the tip of the visor was found at the bifurcation of the internal carotid artery. The avulsed upper eyelid was found under the frontal lobe. The patient underwent the clipping of internal carotid artery and middle and anterior cerebral artery with replantation of the upper eyelid. Neurologic damage was limited to loss of vision, right foot drop, and bowel and bladder incontinence. This case of penetrating orbital trauma demonstrates that the absence of focal neurologic deficit and radiologic signs suggestive of intracranial injury may not rule out life-threatening intracranial injury.     

Syndrome of the flaccid eyelid (floppy eyelid syndrome

Three patients with increasing swelling of the lateral half of the upper lid associated with chronic papillary conjunctivitis which did not respond to therapy were observed. The history, clinical findings, keratinized epithelial cells in the scrapings and the therapeutic success with a protective shield over night suggested the diagnosis of floppy eyelid syndrome.     

Ultrastructure of vitreomacular traction syndrome associated with persistent hyaloid artery

AIM: To demonstrate the ultrastructure of vitreomacular traction associated with persistent hyaloid artery. METHODS: Pars plana vitrectomy was performed in a 66-year-old man with progressive vitreomacular traction associated with a persistent hyaloid artery. Epimacular tissue was peeled and processed for transmission electron microscopy. RESULTS: Ultrastructural analysis revealed multiple sheets of cellular and collagenous components. Myofibroblasts and newly formed collagen were the predominant features. Fibrous astrocytes, fibroblasts, macrophages, and basement membrane were also present. CONCLUSION: The cellular composition of the epimacular tissue and high cellular activity suggest that persistence of the hyaloid artery may contribute to the development of vitreomacular traction.     

颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损

目的探讨颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损的适应证、安全性和有效性。方法根据颞浅血管的解剖分布,制备以颞浅动脉为蒂形成的顺行岛状皮瓣,通过皮下隧道移转至缺损区,修复各种原因所致的重度眼睑及眶周组织缺损患者18例（18眼）。术后随访6个月,观察皮瓣存活、眼睑功能恢复情况和手术效果。结果16例皮瓣完全存活,皮瓣颜色与受区皮肤相近,质地柔软,皮瓣感觉功能良好,睑裂闭合良好,外观满意。1例术后早期出现静脉回流障碍,经积极处理,皮瓣远端有小片表皮坏死。1例皮瓣因严重静脉淤滞坏死,术后3个月行游离植皮术,植皮存活。6例患者因皮瓣肿胀,行Ⅱ期修整术。结论颞浅动脉顺行岛状皮瓣具有血供丰富、色泽质地与受区相近等优点,是修复重度眼睑及眶周组织缺损并重建眼睑功能和外观理想的皮瓣。     

Poroma of the eyelid

A 71-year-old white woman sought treatment for poroma of the right lower eyelid. Excisional biopsy was performed, and the specimen had histologic features consistent with poroma. One year after excision, there has been no recurrence of the lesion. Clinicians should be aware that poroma can occur in regions other than the hands and feet.     

Trichoblastoma of the eyelid

A 50-year-old woman developed a slow-growing tumor of the right medial canthus. Excisional biopsy and histologic examination showed a trichoblastoma. This nodule was excised using Mohs micrographic and reconstructive surgery. Trichoblastoma is a rare, slow-growing neoplasm derived from the hair follicle. Though rarely undergoing malignant transformation, these nodules histologically resemble basal cell carcinoma and generally require complete excision.     

Anthrax of the eyelid

Anthrax is a rare infection that is transmitted to humans from animals or animal products. In its cutaneous form it may produce lesions of the eyelids which can lead to cicatricization and ectropion. Exophthalmos, optic atrophy and panophthalmitis have also been reported. A case of anthrax affecting the eyelid of a patient seen by the author in Kabul, Afghanistan, is presented.     

Malakoplakia of the eyelid

A 35-year-old white man, on immunosuppressive medications for 3 1/2 years following a renal transplant, presented with a whitish-yellow mass at the medial end of the left lower eyelid. An initial incisional biopsy was performed that was misinterpreted as granular cell myoblastoma. The mass was subsequently excised and histopathologic examination revealed malakoplakia. A more extensive recurrent lesion was excised one year later. About two years after the resection of the original lesion the patient died of complications of chronic renal failure. At autopsy there was no evidence of malakoplakia either of the eyelid-or systemically. This is the first case reported of eyelid involvement by malakoplakia, a histiocytic disorder with pathognomonic histopathologic features.     

Osteolipoma of the eyelid

A 50-year-old woman presented with a nodular swelling on her right upper eyelid. The tumour was diagnosed as osteolipoma histologically after resection. Osteolipoma is a very rare variant of lipoma and only a few cases affecting the head and neck are reported in literature. To the best of the author's knowledge this is the first reported case of osteolipoma of the eyelid.     

Myolipoma of the eyelid

Background: This report describes the pathology of a myolipoma which occurred in the eyelid. Myolipoma is a benign hamartomatous tumour in which smooth muscle cells are interspersed with adipocytes. · Patient details: an irregular yellowish tumour (30×25 mm) with ill-defined borders had been present for 50 years in the medial part of the left lower eyelid of a 67-year-old woman. The tumour was excised and studied by conventional histology, immunohistochemistry and transmission electron microscopy. · Results: The tumour was formed by bundles of spindle-shaped cells with cigar-shaped nuclei intermingled with multiloculated clear cells containing small eccentric nuclei. By immunohistochemistry, positive staining of the spindle cells was restricted to smooth muscle actin and desmin; the clear cells were non-reactive with the immunohistochemical panel, but fat was identified within the cytoplasm. The ultrastructural features of the spindle cells were those of a leiomyoma, while the clear cells were classified as adipocytes. · Conclusion: This tumour was considered to originate from the media of blood vessels within the tumour. Received: 2 June 1997 Revised version received: 6 October 1997 Accepted: 15 October 1997     

颞浅动脉岛状皮瓣修复眼睑及眶周缺损的临床应用

随着对颞浅血管解剖学研究的进展,以颞浅动脉为基础的顺流岛状皮瓣及以颞浅动脉为基础的反流轴型岛状皮瓣应用日益广泛,本文查阅了近年来国内外相关的文献和综述,旨在探讨和总结颞浅动脉顺行和逆行岛状皮瓣在修复眼睑及眶周缺损中的临床应用。     

Tricholemmoma of the eyelid

Tricholemmoma is a benign cutaneous tumor that shows differentiation characteristic of the outer hair sheath. The usual site of occurrence is the face, including the nose and eyelid. Four cases of tricholemmoma involving the eyelid margin to a variable extent are presented and the clinical and pathologic findings are reviewed. In three of the four cases, a histopathologic misdiagnosis of squamous cell carcinoma was initially made. In one case, this resulted in a greater sacrifice of normal lid tissue than was necessary, although the reconstruction yielded a good result. In the subsequent cases, the entity of tricholemmoma was well appreciated before definitive oculoplastic surgery and the referring diagnosis of squamous cell carcinoma was refuted.     

Angiosarcoma of the eyelid

Background: Angiosarcomas are uncommon malignant tumours of vascular endothelium. They frequently affect the face and scalp, but to our knowledge there are only three reports of eyelid involvement.
Methods/results: We report a case of angiosarcoma arising from the eyelid skin in a 79-year-old woman. Treatment was surgical with wide excision and staged reconstruction of the defect. Systemic oncological work-up for metastatic disease was negative. Adjuvant systemic chemotherapy and radiotherapy were considered but were not felt to be of proven benefit and were not used. The patient died seven months after presentation from a myocardial infarct.
Conclusion: Angiosarcoma should be considered in the differential diagnosis of unusual or atypical eyelid lesions. Management is wide surgical excision, although adjuvant systemic therapy should be considered in selected cases in consultation with an oncologist.