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Surgical Management of Advanced Ocular Adnexal Amyloidosis

Surgical Management of Advanced Ocular Adnexal Amyloidosis Abstract • Ocular adnexal amyloidosis is characterized by amyloid deposition within the deep connective tissue layers of the eyelids, conjunctiva, and anterior orbit. Management of advanced cases has traditionally been unsatisfactory, with either no surgery offered because of fear of hemorrhage or an en bloc resection performed of the entire involved area. We present two cases of advanced periorbital amyloidosis successfully managed by preserving the anatomic planes of the eyelids and meticulously debulking the deposits with a spooned curette. Lax eyelid tendons and aponeuroses were simultaneously repaired, and no sacrifice of eyelid tissues was necessary. One patient remained asymptomatic for 2 years after surgery before developing early reaccumulation in the lower eyelids. The other patient required additional eyelid debulking and ptosis revision 8 months after surgery, but was in stable condition at follow-up 2 years after surgery. This technique offers safe, easily repeatable, nondestructive treatment for advanced periocular amyloidosis. References 1. Doughman DJ. Ocular amyloidosis . Surv Ophthalmol . 1969;13:133-142. 2. Knowles DM II, Jakobiec FA, Rosen M, Howard G. Amyloidosis of the orbit and adnexae . Surv Ophthalmol . 1975;19:367-384. 3. Lemke BN, Woog JJ, Stasior OG, Dortzbach RK. Amyloidosis of the orbit and adnexa . In: Hornblass A, ed. Oculoplastic, Orbital and Reconstructive Surgery: Orbit and Lacrimal System . Baltimore, Md: Williams & Wilkins; 1990;2:907-914. 4. Halasa AH. Amyloid disease of the eyelid and conjunctiva . Arch Ophthalmol . 1965;74:298-301.Crossref 5. Borodic GE, Beyer-Machule CK, Millin J, Conte J, Foster CS. Immunoglobulin deposition in localized conjunctival amyloidosis . Am J Ophthalmol . 1984;98:617-622. 6. Fett DR, Putterman AM. Primary localized amyloidosis presenting as an eyelid margin tumor . Arch Ophthalmol . 1986;104:584-585.Crossref 7. Orentreich DS, Orentreich N. Dermatology of the eyelids (excluding neoplasms) . In: Smith BC, Della Rocca RC, Nesi FA, Lisman RD, eds. Ophthalmic Plastic and Reconstructive Surgery . St Louis, Mo: Mosby—Year Book; 1987;2:876. 8. Rootman J. Degenerations and depositions . In: Rootman J, ed. Diseases of the Orbit . Philadelphia, Pa: JB Lippincott; 1988:569-576. 9. Levin PS, Dutton JJ. Polytef (polytetrafluroethylene) alloplastic grafting as a substitute for mucous membrane . Arch Ophthalmol . 1990;108:282-285.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Surgical Management of Advanced Ocular Adnexal Amyloidosis

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1992.01080180154045
Publisher site
See Article on Publisher Site

Abstract

Abstract • Ocular adnexal amyloidosis is characterized by amyloid deposition within the deep connective tissue layers of the eyelids, conjunctiva, and anterior orbit. Management of advanced cases has traditionally been unsatisfactory, with either no surgery offered because of fear of hemorrhage or an en bloc resection performed of the entire involved area. We present two cases of advanced periorbital amyloidosis successfully managed by preserving the anatomic planes of the eyelids and meticulously debulking the deposits with a spooned curette. Lax eyelid tendons and aponeuroses were simultaneously repaired, and no sacrifice of eyelid tissues was necessary. One patient remained asymptomatic for 2 years after surgery before developing early reaccumulation in the lower eyelids. The other patient required additional eyelid debulking and ptosis revision 8 months after surgery, but was in stable condition at follow-up 2 years after surgery. This technique offers safe, easily repeatable, nondestructive treatment for advanced periocular amyloidosis. References 1. Doughman DJ. Ocular amyloidosis . Surv Ophthalmol . 1969;13:133-142. 2. Knowles DM II, Jakobiec FA, Rosen M, Howard G. Amyloidosis of the orbit and adnexae . Surv Ophthalmol . 1975;19:367-384. 3. Lemke BN, Woog JJ, Stasior OG, Dortzbach RK. Amyloidosis of the orbit and adnexa . In: Hornblass A, ed. Oculoplastic, Orbital and Reconstructive Surgery: Orbit and Lacrimal System . Baltimore, Md: Williams & Wilkins; 1990;2:907-914. 4. Halasa AH. Amyloid disease of the eyelid and conjunctiva . Arch Ophthalmol . 1965;74:298-301.Crossref 5. Borodic GE, Beyer-Machule CK, Millin J, Conte J, Foster CS. Immunoglobulin deposition in localized conjunctival amyloidosis . Am J Ophthalmol . 1984;98:617-622. 6. Fett DR, Putterman AM. Primary localized amyloidosis presenting as an eyelid margin tumor . Arch Ophthalmol . 1986;104:584-585.Crossref 7. Orentreich DS, Orentreich N. Dermatology of the eyelids (excluding neoplasms) . In: Smith BC, Della Rocca RC, Nesi FA, Lisman RD, eds. Ophthalmic Plastic and Reconstructive Surgery . St Louis, Mo: Mosby—Year Book; 1987;2:876. 8. Rootman J. Degenerations and depositions . In: Rootman J, ed. Diseases of the Orbit . Philadelphia, Pa: JB Lippincott; 1988:569-576. 9. Levin PS, Dutton JJ. Polytef (polytetrafluroethylene) alloplastic grafting as a substitute for mucous membrane . Arch Ophthalmol . 1990;108:282-285.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 1992

References