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Shani Golan, Gilad Rabina, Shimon Kurtz, Igal Leibovitch Division of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Purpose and design: The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed.Participants: All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial.Methods: The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period.Main outcome measure: In this study, the prevalence of glaucoma in individuals withectropion or entropion was the main outcome measure.Results: A total of 227 patients (57% men, mean age: 79.2years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications.Conclusion: An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients. Keywords: cicatricial, lamella, review

Roy Schwartz,1 Ran Ben Cnaan,1 Ophir Schein,2 Michael Giladi,3 Michal Raz,4 Igal Leibovitch11Oculoplastic and Orbital Institute, Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Department of Plastic Surgery, Assaf Harofeh Medical Center, Tzrifin, Israel; 3Infectious Disease Unit, 4Pathology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelAbstract: A 44-year-old woman, who had undergone gold-weight implantation due to facial palsy and lagophthalmos, arrived at the ophthalmology ward with eyelid swelling and erythema, which rapidly deteriorated under intravenous antibiotics to a necrotic process involving the periocular tissues, the eye, and the anterior orbit. Despite prompt removal of the gold weight, the patient's ocular and systemic condition continued to deteriorate, necessitating evisceration and debridement of necrotic tissue. Cultures showed growth of Staphylococcus epidermidis, Staphylococcus capitis, Candida glabrata, and Candida albicans, and histopathology demonstrated an acute nonspecific necrotizing panophthalmitis. Later on, the patient was admitted to a plastic surgery ward with recurrent severe burns of her thigh, which were highly suggestive of being self-induced, raising the possibility of self-induced damage.Keywords: evisceration, factitious disorder, lagophthalmos

Uri Soiberman,1,2 Ran Levy,1,2 Igal Leibovitch1,2 1Department of Ophthalmology, Tel Aviv Medical Center, 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Background: "Graves' ophthalmopathy" (GO), is an inflammatory disease of the orbit, with extensive adipose tissue involvement. Previous studies of orbital fat derived from such patients have demonstrated overexpression of the adiponectin gene and messenger RNA. Aim: The study reported here aimed to measure the protein concentration of orbital adipose tissue adiponectin in GO patients, in comparison to healthy controls. Methods: This was a prospective study. Orbital samples from ten healthy controls undergoing blepharoplasty and five patients with GO undergoing orbital fat decompression for proptosis were analyzed by enzyme-linked immunosorbent assay. Results: The mean adiponectin concentration in samples from GO patients was 121.9 ± 29.5 ng/mL (mean ± standard deviation), versus 107.9 ± 26.6 ng/mL in the control group (P=0.20). Conclusion: This study was unable to demonstrate a statistically significant difference in adiponectin protein concentrations between the two studied groups. Keywords: Graves' disease, Graves' orbitopathy, ELISA

Uri Soiberman,1 Hirohiko Kakizaki,2 Dinesh Selva,3 Igal Leibovitch11Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel; 2Department of Ophthalmology, Aichi Medical University, Nagakute, Japan; 3South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, AustraliaAbstract: Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.Keywords: acquired punctal stenosis, definition, epiphora, etiology, treatment

Hirohiko Kakizaki1, Yasuhiro Takahashi1, Akihiro Ichinose2, Masayoshi Iwaki1, Dinesh Selva3, Igal Leibovitch41Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Plastic Surgery, Kobe University, Kobe, Hyogo, Japan; 3South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, Australia; 4Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, IsraelPurpose: To evaluate the surgical outcome of deep lateral orbital decompression with or without rim removal.Design: Retrospective case series.Methods: Thirty-two patients (47 orbits) with Graves’ orbitopathy who underwent simple deep lateral decompression or balanced lateral plus medial decompression. Of the 14 patients (24 orbits) who underwent simple deep lateral decompression, 8 (13 orbits) had temporary rim removal and in 6 (11 orbits) the rim was left intact. Of the 18 patients (23 orbits) who underwent a balanced decompression, 7 (9 orbits) had temporary rim removal and in 11 (14 orbits) the rim was left intact. The amount of postoperative reduction in proptosis was compared among these four groups.Results: The average reduction in proptosis in the simple deep lateral decompression group was 5.73 mm (range: 4.0–8.0 mm) in the rim removal group and 4.09 mm (range: 2.5–6.0 mm) in the intact rim group (P = 0.005). The average reduction in proptosis in the balanced decompression group was 6.39 mm (range: 5.0–8.5 mm) in the rim removal group and 5.07 mm (range: 3.0–8.0 mm) in the intact rim group (P = 0.039). There was no statistically significant difference in proptosis reduction between the simple deep lateral decompression with rim removal group and the balanced decompression with an intact rim group (P = 0.220).Conclusion: The rim removal approach allows a more effective decompression than the intact rim approach. Simple deep lateral decompression with rim removal approach has a similar effect to balanced decompression through an intact rim.Keywords: deep lateral decompression, balanced decompression, rim removal, intact rim, Graves’ orbitopathy, proptosis

Renal fossa heterotopic splenic tissue is characteristically asymptomatic and is usually an incidental finding that has been reported to mimic renal or adrenal tumors. However, symptoms related directly to the splenic tissue do occur. We present an unique case with simultaneous occurrence of an accessory spleen and splenosis which were diagnosed following intentional radiological investigations conducted to evaluate flank pain which was probably related to the presence of the heterotopic spleens. CT complemented by isotopic liver-spleen scan is the radiological modality of choice in the diagnosis of renal fossa splenosis. However, MRI may significantly contribute to the evaluation by accurate delineation of blood supply and surgical separation planes.

To verify whether bladder dysfunction detected by urodynamic studies prior to radical prostatectomy can predict postoperative continence status.Twenty patients diagnosed with prostate cancer had multichannel subtracted filling and voiding videocystometry before undergoing radical retropubic prostatectomy. Postoperatively, all patients had periodic clinical assessment of continence status.On preoperative filling cystometry, detrusor instability with a maximal detrusor pressure greater than 15 cm H2O was demonstrated in 12/20 patients (60%). Postoperatively, 11/20 patients (55%) were continent, 4 (20%) had mild stress incontinence and 5 (25%) complained of episodic urge incontinence. However, only 5 of the 12 patients with preoperatively diagnosed detrusor instability manifested clinical urge incontinence after surgery (positive predictive value = 41.6%).The incidence of preoperative detrusor instability in our series was high, but little correlation was found between this finding and postoperative incontinence.

Extensive necrosis is rare in primary renal cell carcinoma. This finding may reflect the biological characteristics of the carcinoma and therefore could be of prognostic and clinical value.To assess the incidence of necrosis in renal cell carcinoma and its potential prognostic value.We conducted a consecutive retrospective study of 173 patients after radical nephrectomy for renal cell carcinoma. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database.Extensive necrosis was found in 31 tumor specimens (17.9%). Univariate analysis showed that the specimens with extensive necrosis were significantly larger and manifested more perirenal and venous extension than the tumors without necrosis. The size of the renal tumor was the only parameter that remained significant in multivariate analysis (P = 0.0001). Overall disease-free survival did not differ significantly between patients with necrotic tumors and those without (68% and 66% respectively).The finding of extensive necrosis in renal cell carcinoma specimens does not seem to be related to tumor biology but rather may reflect the relation between size and vascularity of the tumor.