Marco Sales‐Sanz

Hospital Universitario Ramón y Cajal

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Hae‐Ryung Won‐Kim

Hospital Universitario de La Princesa

Andrea Sales‐Sanz

Clínica Rementería

Constanza Barrancos

Instituto Cajal

Francisco J. Muñoz‐Negrete

Hospital Universitario Ramón y Cajal

Carolina Arruabarrena

Hospital Universitario Príncipe de Asturias

Gema Rebolleda

Universidad de Alcalá

Miguel A. Teus

Hospital Universitario Príncipe de Asturias

Alicia Galindo‐Ferreiro

Hospital Universitario Río Hortega

Ana Rosa Albandea

Instituto Ramón y Cajal de Investigación Sanitaria

Cristina Ye‐Zhu

Hospital Universitario Ramón y Cajal

Cooperative Institutions

Hospital Universitario Ramón y Cajal

Instituto Cajal

Instituto Ramón y Cajal de Investigación Sanitaria

Universidad de Alcalá

Universidad Autónoma de Madrid

Universidad Complutense de Madrid

Universidade de São Paulo

Hospital Universitario de La Princesa

Clínica Rementería

Hospital Universitario Río Hortega

Author Statistics

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Anterior versus posterior retractor reinsertion with a lateral tarsal strip for involutional entropion repair: A multicentric experience

European Journal of Ophthalmology (2023)

Milagros Mateos-Olivares Minal Belani-Raju H. Sánchez-Tocino Cristina Ye‐Zhu Marco Sales‐Sanz

Purpose The aim was the comparison of two different approaches to re-insert the inferior eyelid retractors within addition to lateral tarsal strip at lower eyelid involutional entropion (LEIE) surgical correction. Method This multicentric retrospective case series involved 233 consecutive patients (195 eyelids) who underwent LEIE repair. All the lids had a lateral tarsal strip (LTS) in addition to the reinsertion of retractors onto the tarsal plate via the anterior approach (group 1) or the posterior approach (group 2). The desired normal position of the eyelids at 6-month follow-up was considered ‘surgical successes, while entropion recurrence and overcorrection (ectropion) were considered ‘surgical failures’. Results One-hundred ninety-one (82%) surgeries were included in group 1 and 42 (18%) in group 2. The success rate was 92.1% (176 lids) in group 1 and 85.7% (36 lids) in group 2 (p = 0.188). The recurrence rate was statistically higher for group 2 (14.3%) than for group 1 (3.7%) (p = 0.016). Overcorrection only described in group 1 (3.1%). Both groups had a similar complication rate (p = 0.268), with trichiasis being the most frequent (14, 6%). Ten eyelids (47.6%) from the 21 overall failures were satisfactorily reoperated, and the remaining ones were treated conservatively. Conclusion The anterior or posterior approach to reinsert lower eyelid retractors to tarsal plate in addition to LTS to correct LEIE can provide a similar outcome. However, the anterior approach achieves a slightly higher success rate with fewer recurrences but with a higher overcorrection rate.

Retractor

Entropion

10.1177/11206721231155665

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Citations (0)

Müllerotomy with anterior graded Müller muscle disinsertion for Graves upper eyelid retraction: validation of surgical outcomes using Bézier curves

Graefe s Archive for Clinical and Experimental Ophthalmology (2022)

Marco Sales‐Sanz Fernando J. Huelin Cristina Ye‐Zhu Antonio A. V. Cruz Francisco J. Muñoz‐Negrete

10.1007/s00417-022-05853-w

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Citations (4)

Carcinoma sebáceo simulando un chalazión en paciente joven

Archivos de la Sociedad Española de Oftalmología (2017)

C. Fuente García Ignacio Pinilla-Pagnon Ana Albandea Jiménez Marco Sales‐Sanz

Ulipristal acetate

10.1016/j.oftal.2017.11.001

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Citations (1)

Nerve Sheath Myxoma Involving the Medial Rectus Muscle: A Case Report

Ophthalmic Plastic and Reconstructive Surgery (2020)

Arnau Mora-Cantallops Hae‐Ryung Won‐Kim Antonia Navarro‐Cantero Juan Martínez San Millán Marco Sales‐Sanz

A 63-year-old man reported a 2-year history of painless OS proptosis. The first MRI, performed in the institution of origin, resulted in a diagnosis of hemangioma versus orbital pseudotumor. Examination revealed proptosis and mild chemosis. Ancillary tests were normal, and oral prednisone was initiated without remarkable changes. Later, an incisional biopsy identified the lesion as an intramuscular myxoma of the left rectus, and a new MRI was ordered. It described a fusiform thickening of the medial rectus with and exophytic growth below the inferior rectus and upward toward the superior oblique. Due to the localization of the lesion, a combined transcaruncular and swinging eyelid approach with a lateral orbitotomy was performed. Histopathological examination revealed a proliferation of stromal origin composed of myxoid matrix with fusocellular and stellate-shaped cells. Cells were S-100, CD34, and CD56 positive and negative for epithelial membrane antigen, CD68, CD10, actin, and desmin. Results were consistent with a left medial rectus nerve sheath myxoma.

Inferior rectus muscle

Medial rectus muscle

Superior rectus muscle

Orbit (dynamics)

Lateral rectus muscle

10.1097/iop.0000000000001766

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Citations (3)

Upper Eyelid Contour Changes After Orbital Decompression in Graves Orbitopathy

Ophthalmic Plastic and Reconstructive Surgery (2021)

Antônio Augusto Velasco e Cruz Bruna S. N. Equitério Stefânia B. Diniz Denny Marcos Garcia Daniel B. Rootman

To evaluate the effect of orbital decompression on the upper eyelid contour.A paired cross-sectional analysis of the upper eyelid contour was performed for 103 eyes of 66 patients who underwent orbital decompression. A control group of 26 normal subjects was also included. The eyelid contour of all participants were measured with Bézier lines adjusted to the eyelid contour and 9 midpupil eyelid margin (MPD) distances from a horizontal line bisecting the pupil. One central, corresponding to the margin reflex distance (MRD 1), and 8 equally distributed medially and laterally at 20% of the interval between the lines. Patients were classified as with flare if the height of the most lateral MPD relative to the MRD 1 was above the upper limit of the controls.Preoperatively 63 of the 103 contours were classified as flare + (F+). After decompression MRD1 showed a mean decrease of 0.4 mm and the location of the contour shifted 0.8 mm medially. These changes were not correlated with proptosis reduction. Orbital decompression decreased the lateral curvature of the contours especially for the F+ lids. In 40% of the F+ eyelids the flare sign disappeared after decompression.Orbital decompression affects the lateral eyelid contour and diminishes the amount of lateral eyelid retraction surgery necessary to correct the flare sign. In 40% of the patients, the eyelid contour is normalized with proptosis reduction only.

Orbit (dynamics)

10.1097/iop.0000000000002093

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Citations (11)

Bilateral Simultaneous Ancient Schwannomas of the Orbit

Ophthalmic Plastic and Reconstructive Surgery (2007)

Marco Sales‐Sanz Andrea Sanz-López Jose Antonio Canto Romero

In Brief An unusual case of purely cystic bilateral ancient schwannomas of the orbit is reported. Complete ophthalmologic examination and CT was performed. Diagnosis was established by excisional biopsy of both tumors, including clinicopathologic study. Histologic examination showed a bilateral purely cystic ancient schwannoma. This case underlines the importance of considering neural tumors, including schwannomas, in the differential diagnosis of both cystic and bilateral orbital tumors. As far as we know, no other case has been previously reported. The authors describe a case of bilateral simultaneous schwannoma of the orbit with pure cystic degeneration that was managed by bilateral inferior orbitotomy.

Orbit (dynamics)

10.1097/iop.0b013e31802d97dd

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Citations (15)

Evisceration

Gijsbert J. Hötte Marco Sales‐Sanz Dion Paridaens

Evisceration involves the removal of ocular contents (lens, uvea, vitreous, retina, and cornea) with preservation of the conjunctiva, sclera and extraocular muscles. For patients with a blind painful and or cosmetically disturbing eye, evisceration is favoured over enucleation provided that intraocular malignancy has been ruled out. Despite a very low risk of sympathetic ophthalmia, evisceration provides superior outcomes with less complications, cheaper cost and easier learning. Pre-operatively, the patient's medical history (including general health and previous ocular surgery) should be reviewed, as well as any risk factors, such as scleral or conjunctival abnormalities. If adequate evaluation of the fundus is not possible, B-scan ultrasonography should be performed to rule out intraocular malignancy. Less invasive treatment options, including lubricants and cosmetic contact lenses or shells, should also be considered. Currently, a surgical technique with scleral modification (for example, a two-flap or four-flap technique with disinsertion of the optic nerve) is preferred, allowing placement of a larger implant, which improves cosmetic results by limiting enophthalmos and superior sulcus deformity. Implants of 18–22 mm diameter are commonly used, depending on the volume of the contralateral eye, orbital size, and the availability of adequate conjunctival lining. Although porous implants are still widely used, silicone spheres may be preferred due to low rate of exposure and extrusion and acceptable rate of implant migration. Silicone implant motility is similar to non-pegged porous implants. Pegging of the porous implants can improve motility, however it has a high complication rate and is rarely performed.

Evisceration (ophthalmology)

10.1007/978-3-031-39638-0_2

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Primary periocular squamous cell carcinoma in central Spain: Factors related to recurrence

European Journal of Ophthalmology (2021)

Alicia Galindo‐Ferreiro H. Sánchez-Tocino Cecilia Díez-Montero Minal Belani-Raju Raquel García-Sanz

To describe the characteristics and recurrence rates of primary periocular squamous cell carcinoma (SCC) in Spain.This retrospective study investigates the characteristics of primary periocular SCC at two tertiary centers in Spain from 2000 to 2020. Data were collected on demographics, skin phenotype, location, clinical and histological diagnosis, the commitment of surgical margins, recurrence, and risk factors. Multivariate analysis and risk factors were used to investigate recurrence rates, considering p < 0.05 as statistically significant.Over the 20-year studied period, 107 patients with primary periocular SCC were assessed. The mean age of SCC was 76.8 ± 12.8 years, 55 (50.9%) were females, and 105 (98.1%) had Fitzpatrick skin phenotype type II or III. SCC lesions affected less than 1/3 of the eyelid (56/52.3% cases), mainly the lower lid (42/39.3% lesions). Sixty (56.1%) cases were SCC differentiated, 76 (71%) had clear margins. Clinical diagnosis of SCC corroborated with histological in 84 (78.5%) cases and orbital involvement occurred in 18 (16.8%) cases. Recurrence was observed in 13 (12.1%) cases, occurring more in large tumors and undifferentiated subtype (53.8%), with committed margins (69.2%) (p = 0.001), being the commitment of margins a significant predictor for recurrence, although thickness was an independent predictor.Periocular SCC in Spain showed a similar pattern as in the world. The risk of recurrence is increased in undifferentiated and large periocular SCC, partially removed with committed margins.

Demographics

10.1177/11206721211035629

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Citations (4)

Bézier curves as a total approach to measure the upper lid contour: redefining clinical outcomes in palpebral surgery

British Journal of Ophthalmology (2021)

Fernando J. Huelin Marco Sales‐Sanz Cristina Ye‐Zhu Antônio Augusto Velasco e Cruz Francisco J. Muñoz‐Negrete

To define and quantify the upper lid contour by adapting Bézier curves with a newly developed software in normal subjects, assessing their reliability.Fifty eyes of 50 healthy patients with no ocular pathology were included in this study from October 2020 to November 2020. All measurements were performed on Bézier curves adjusted to the upper lid contour. An original software was used to measure the radial and vertical midpupil-to-lid margin distances (MPLD), temporal-to-nasal (T/N) ratios, contour peak location and grade of superposition (GS) and asymmetry (GA) indexes. We calculated differences in the variables measured regarding age, gender or the side of the eye being assessed.The mean Bézier curve showed an excellent level of inter-rater reliability (intraclass correlation coefficient of 0.99). The median GS index of each eyelid to the mean Bézier curve was 95.4%, 8.5 IQR, and the median GA index was 3%, 3.4 IQR. The mean contour peak location was -0.35 mm, SD 0.45. Overall, the mean central MPLD was 4.1 mm, SD 0.6. No significant differences were found between male and female patients in variables derived from Bézier curves.Bézier curves may become a very useful tool for the assessment of upper lid contour, contour peak and symmetry. GS and GA indexes, along with the T/N area ratio are potential outcomes for this purpose. All current variables can be obtained just from one single Bézier curve measurement. Our results offer an in-depth exhaustive description of these variables and their distribution in the normal population.

10.1136/bjophthalmol-2021-319666

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Citations (7)

Thyroid orbitopathy

Expert Review of Ophthalmology (2013)

Jade S. Schiffman Marco Sales‐Sanz Gema Rebolleda Anastas F. Pass Roberto Alejandro Cruz

Thyroid orbitopathy is a complex disease that can produce severe functional and cosmetic complications. Prompt diagnosis and treatment during the active inflammatory phase is essential to decrease late sequels. Corticosteroids remain the main pillar in the treatment of the active phase. Other possibilities when steroids fail are radiotherapy, cyclosporine or new biological agents such as rituximab. Rehabilitative surgery can be performed to treat the functional and disfiguring sequels in the inactive phase. A review of the clinical manifestations, classifications and treatment, both medical and surgical, is presented.

Graves' ophthalmopathy

10.1586/eop.13.4

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Citations (1)