Russ Gonnering
Medical College of Wisconsin, Ophthalmology, Faculty Member
- Russell S. Gonnering, MD, MMM, FACS, CPHQ Brief Biography rsgonnering1@me.com Russell Gonnering took a non-standard... moreRussell S. Gonnering, MD, MMM, FACS, CPHQ
Brief Biography
rsgonnering1@me.com
Russell Gonnering took a non-standard path to medicine. He studied History at Boston College and the University of Vienna, thinking that understanding “starting point” was essential to knowing where one was going. Following graduation from the Medical College of Wisconsin and subsequent post-graduate training there and at the University of Wisconsin, he worked as an Ophthalmic Plastic and Reconstructive Surgeon in both private practice and academic medicine. He served as the Research Advisor to the Fellowship in Ophthalmic Plastic Surgery at the University of Wisconsin for twenty years, and under his mentorship a rich tradition of clinical and basic science research was developed, with numerous awards for quality of clinical and basic-science research.
Over twenty years ago, a realization that quality improvement would play an increasing role in healthcare led to additional education and responsibilities including a Blackbelt in Six Sigma, becoming a Certified Professional in Healthcare Quality, Co-Chair of the Quality Council of a 750 bed tertiary hospital, Technical Advisor to the National Quality Forum and moderator of healthcare presentations at the ASQ’s World Conference on Quality and Improvement.
In 2006, a herniated cervical disc and loss of fine motor skills forced a “change in perspective” for Dr. Gonnering. He obtained a Master of Medical Management from the Marshall School of Business at USC and learned that Organizational Culture was the prime determinant of the performance of an institution. A chance reading of an article on Complexity Theory led Dr. Gonnering to study with David Snowden, learning about Wicked Problems and the tools needed to solve them. This was honed with further study and research into Complexity and its application to organizational performance and healthcare.
Dr. Gonnering is currently Adjunct Professor of Ophthalmology at the Medical College of Wisconsin. He used the tools of both Organizational Culture and Complexity in his past position as quality improvement consultant at the Zablocki VA Medical Center, and has written extensively in the medical and complexity literature and been invited presenter at multiple meetings. One of his current projects of interest is the Electronic Medical Record and how this fits into the larger picture of communicating complex information-in-context. Another is the formulation of agent-based models of performance based upon universal scaling laws. He sees a bright future for those who understand healthcare as a Complex Adaptive System.edit
Research Interests:
Research Interests:
We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average... more
We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average length of intubation was 4.3 months. The final results for both congenital and acquired obstructions combined were good in 52 cases (82.5%), fair in three (4.8%), and poor in eight (12.7%). Complications, with the exception of some with infection, were easily treated or minimal and did not affect the outcome significantly. We recommend silicone intubation as the procedure of choice for congenital or acquired nasolacrimal duct obstructions in children after failure of medical therapy and nasolacrimal duct probings.
Research Interests:
The distinction between benign and malignant cutaneous periocular lesions can be difficult, as the clinical history and appearance are often quite similar. When present, typical cutaneous changes are often helpful in distinguishing... more
The distinction between benign and malignant cutaneous periocular lesions can be difficult, as the clinical history and appearance are often quite similar. When present, typical cutaneous changes are often helpful in distinguishing between benign and malignant neoplasms. However, when tumors lack characteristic epidermal change, histopathologic examination may be necessary to confirm the diagnosis. The authors present their experience in the evaluation and management of two patients with periocular basal cell carcinoma who were initially diagnosed as having benign cysts. The case records for two patients with periocular basal cell carcinoma were reviewed. Preoperative and postoperative photographs were available for comparison in one case. For each patient, the medical history, clinical presentation, histology, and surgical outcome were reviewed. In each case, the periocular mass was initially diagnosed as a benign process. Histopathologic examination following excisional biopsy est...
Research Interests:
Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young... more
Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young adults. In children, infection is spread by direct contact or through fomites, with lesions predominating on the trunk, extremities, and face. In young adults, this disease is spread primarily through sexual contact. Periocular infection can cause secondary chronic follicular conjunctivitis, superficial keratitis, and punctal occlusion. Although many modes of therapy are effective in destruction of the virus, some may have significant side effects when used in the periocular area. We describe treatment by incision and curettage, which we recommend as a simple, effective method of managing this problem.
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The pathophysiologic mechanisms responsible for the clinical features of the anophthalmic socket are poorly understood. Atrophy of orbital fat has been thought to be a major contributing cause of enophthalmos and the superior sulcus... more
The pathophysiologic mechanisms responsible for the clinical features of the anophthalmic socket are poorly understood. Atrophy of orbital fat has been thought to be a major contributing cause of enophthalmos and the superior sulcus deformities that develop after enucleation, but it has never been demonstrated histopathologically or confirmed by scientific analysis. This study was undertaken to investigate the changes that occur in the orbital fat compartment of the anophthalmic socket in an animal model by measuring orbital soft tissue mass and evaluating adipocyte cell size. Instead of reduction in the tissue mass, a statistically significant greater weight of the fat and connective tissue compartment was found in the anophthalmic orbit by nearly 13% compared to the control orbit in the animals in the long-term group. No significant change in the mean maximal diameter of adipocytes developed 7 months after enucleation. These analyses do not support the concept that orbital fat atr...
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A wide variety of complications of the anophthalmic socket develop in patients after enucleation, including enophthalmos, superior sulcus deformities, eyelid malpositions, implant migration and extrusion, poor prosthetic motility, and... more
A wide variety of complications of the anophthalmic socket develop in patients after enucleation, including enophthalmos, superior sulcus deformities, eyelid malpositions, implant migration and extrusion, poor prosthetic motility, and socket contraction. Changes in the orbital blood flow and metabolic activity of the socket tissues and atrophy of the orbital fat occurring after enucleation have been suggested as two theoretical mechanisms that result in the development of these clinical conditions. Lack of scientific evidence and a limited understanding of the pathophysiologic basis of the features of anophthalmos led us to evaluate the validity of these proposed mechanisms in an animal model. Selected parameters of the normal orbits were compared with the contralateral anophthalmic orbits at different time intervals after surgery. Orbital blood flow was studied with selective ophthalmic artery angiography and radioactive microsphere techniques. Ophthalmic arteriography demonstrated...
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Epibulbar osseous choristomas are rare congenital collections of mature compact bone most often located in the superotemporal fornix. Most cases are not recognized preoperatively, as the lesion is usually felt to represent a dermatolipoma... more
Epibulbar osseous choristomas are rare congenital collections of mature compact bone most often located in the superotemporal fornix. Most cases are not recognized preoperatively, as the lesion is usually felt to represent a dermatolipoma or epibulbar dermoid. Although most previous reports have described a loose attachment to the surrounding orbital structures, we report two cases in which intimate scleral incorporation was present. In one case, preoperative computerized tomography and echography allowed the diagnosis and probable scleral involvement to be considered preoperatively, and surgery was deferred. The embryogenesis of these lesions is uncertain, although they seem to correlate with the scleral ossicles seen in avian anatomy, and may represent abnormal activation of embryonic pluripotential mesenchymal cells.
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Orbital dog bites, though statistically uncommon, occur most frequently in children and are associated with severe ocular adnexal injury. Of 16 victims, two-thirds were under 10 and over half under 5 years of age. The wounds consisted of... more
Orbital dog bites, though statistically uncommon, occur most frequently in children and are associated with severe ocular adnexal injury. Of 16 victims, two-thirds were under 10 and over half under 5 years of age. The wounds consisted of numerous periorbital punctures, and in most cases, full-thickness lid lacerations involving the tear system. There were no serious injuries to the globe. Reversible amblyopia occurred in two children under 3 years of age with damage to the levator muscle. One child suffered a naso-orbital fracture. Because of the obvious nature of the injury, most patients present early and can be managed well with meticulous wound care and primary surgical repair. The use of prophylactic antibiotics, though controversial, appears prudent in such cases. Ophthalmologists treating these injuries must be aware of serious potential complications including occult facial fracture or intracranial penetration in young children, septicemia caused by bacillus DF-2 in patients...
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For some anophthalmic patients, the contracted socket is a severe problem that precludes the wearing of a prosthesis. A normal and cosmetically acceptable appearance is dependent on the ability of a socket to retain a prosthesis. The... more
For some anophthalmic patients, the contracted socket is a severe problem that precludes the wearing of a prosthesis. A normal and cosmetically acceptable appearance is dependent on the ability of a socket to retain a prosthesis. The disfigurement and distress caused by the contracted socket and its inability to accommodate a prosthesis may have a profound detrimental effect on the patient's career, self-esteem, and psychosocial interactions. The tissue dynamics at work in the anophthalmic socket and in the contracting socket are not yet understood. There are many unanswered questions regarding the histology and anatomy of the normal, as well as the contracting, socket. The tissue responsible for clinical contraction has not been identified. This thesis, using the cynomolgus monkey socket as an experimental model, investigated healing in both the normal and contracting socket. Qualitative observations of the anatomy and histology of eight sockets were made. Two of the sockets we...
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Lateral displacement at the medial canthus is the most common complication following lacrimal intubation. Current procedures for dealing with this situation involve the removal of the tubing, and are either technically difficult or else... more
Lateral displacement at the medial canthus is the most common complication following lacrimal intubation. Current procedures for dealing with this situation involve the removal of the tubing, and are either technically difficult or else involve retrograde passage of the knotted silicone through one of the canaliculi. By passing both probes of a second intubation set through the same punctum, the loop of the displaced tubing can be captured and gently repositioned without removal. This is particularly useful with early displacement of the tubing following microsurgical repair of a canalicular laceration.
Research Interests:
A 76-year-old male had orbital extension and regional lymph node involvement from an oncocytic carcinoma thought to have arisen in the plica semilunaris of the left eye. Declining early orbital exenteration and radical neck dissection,... more
A 76-year-old male had orbital extension and regional lymph node involvement from an oncocytic carcinoma thought to have arisen in the plica semilunaris of the left eye. Declining early orbital exenteration and radical neck dissection, the patient received radiation therapy. Although initial palliation was achieved, the lesion recurred 1 year later, with massive orbital involvement. Despite exenteration and chemotherapy, the patient expired within 6 months. Oncocytomas arise from transformed epithelial cells, generally in the medial canthal region. Oncocytic carcinoma of the ocular adnexa is extremely rare and no such lesion of the plica semilunaris has been reported.
Research Interests:
We studied the relationship between eye dominance (Scobee test) and upper lid level (MRD) in 54 patients with unilateral ptosis or asymmetric bilateral ptosis (> or = 2 mm difference in MRD) using the phenylephrine test. A... more
We studied the relationship between eye dominance (Scobee test) and upper lid level (MRD) in 54 patients with unilateral ptosis or asymmetric bilateral ptosis (> or = 2 mm difference in MRD) using the phenylephrine test. A contralateral lid drop was measured in 12/54 patients after instillation of 2.5% phenylephrine in the more ptotic eye and occurred in both congenital (3) and acquired (9) ptosis cases. A contralateral lid drop was seen in 7/14 (50%) patients whose ptosis was greater in the dominant eye and in 5/40 (12.5%) patients whose ptosis was greater in the nondominant eye (p = .01). Contralateral lid drops > or = 1 mm were present in 7/54 patients, and 6/14 (43%) of them had greater ptosis on the dominant side and 1/40 (2.5%) on the non-dominant side (p = .001). There was no association between contralateral pseudoretraction and either visual acuity or severity of ptosis. These results suggest that levator muscle tone is influenced by eye dominance when ptosis is prese...
Research Interests:
To identify lymphatic vessels in the human orbit. Lymphatic and blood capillaries were distinguished histochemically by light microscopy using a 5'-nucleotidase (5'-Nase) and alkaline phosphatase (ALPase) double staining method.... more
To identify lymphatic vessels in the human orbit. Lymphatic and blood capillaries were distinguished histochemically by light microscopy using a 5'-nucleotidase (5'-Nase) and alkaline phosphatase (ALPase) double staining method. Identification of lymphatic vessels was based on strict morphologic criteria combined with specific 5'-Nase staining. The presence of conjunctival lymphatics was confirmed and used as a control tissue. Lymphatic vessels were identified in the lacrimal gland and in the dura mater of the optic nerve. Structures demonstrating positive 5'-Nase staining at the orbital apex were highly suggestive of lymphatics but did not meet the morphologic criteria established. Lymphatic vessels were not identified in the extraocular muscles or orbital fat. To the authors' knowledge, this study presents the first evidence for lymphatic capillaries in the dura mater of the human optic nerve and lacrimal gland.
Research Interests:
Page 1. Pharmacology of Botulinum Toxin Russell S. Gonnering, MD Protein toxins are produced by various strains of Clostridium botulinum, Clostridium butyricum, and Clostridium barati [1]. The neurotoxin produced by these ...
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The presence of orbital lymphatics in the primate model is demonstrated using light and electron microscopic enzyme histochemistry. In addition, strictly morphological definitions of lymphatics, such as discontinuous basal lamina, thin... more
The presence of orbital lymphatics in the primate model is demonstrated using light and electron microscopic enzyme histochemistry. In addition, strictly morphological definitions of lymphatics, such as discontinuous basal lamina, thin and irregular walls, anchoring filaments, and attenuated endothelial cell cytoplasm, were applied. This study confirmed the presence of conjunctival lymphatics reported by others. It also clearly demonstrated the presence of orbital arachnoid and lacrimal gland lymphatics that have not been previously described. A few areas of the extraocular muscles and connective tissue at the orbital apex also showed evidence of the presence of lymphatic vessels. Additional work is needed to define the nature and extent of orbital lymphatics as well as their connection to the extraorbital lymphatic system.
Research Interests:
Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the... more
Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the victim. The exact precipitating event is usually unknown. Most victims are treated by a physician soon after injury, and can be reconstructed primarily following meticulous local wound care, including adequate irrigation. Infection is rare, but because of its potentially disastrous consequences, prophylactic treatment with penicillinase-resistant penicillin or cephalosporin seems indicated. Serious, potentially fatal consequences due to underlying intracranial injury in children under aged 2 years, fatal septicemia in splenectomized individuals, tetanus, and rabies must be considered by ophthalmologists who treat such patients.
Research Interests: Adolescent, Medicine, Dogs, Humans, Child, and 9 moreFemale, Animals, Male, Adult, Retrospective Studies, Bites and Stings, Orbit, Child preschool, and Wound infection
To the Editor. —Bicanalicular silicone intubation is a well-accepted and proven surgical technique for treatment of a variety of pathologic states affecting the lacrimal system, particularly congenital nasolacrimal duct obstruction.1 In... more
To the Editor. —Bicanalicular silicone intubation is a well-accepted and proven surgical technique for treatment of a variety of pathologic states affecting the lacrimal system, particularly congenital nasolacrimal duct obstruction.1 In some cases, however, it is impossible to perform because of anatomic variations. Most notably, this occurs in partial lacrimal agenesis. Report of a Case. —A 3¾-year-old boy presented with a history of bilateral tearing and mucopurulent discharge occurring since 3 months of age. Conservative treatment with massage and antibiotics was unsuccessful. Bilateral probing was also unsuccessful in relieving the symptoms. An increased tear lake was present on both sides, with mucoid reflux. Both inferior puncta were present and normal. Although superior lacrimal papillae were present, superior puncta were absent. A cutaneous opening of an anlage duct was present on the left. With the patient under general anesthesia, a size-0 Bowman probe was passed from the inferior puncta through a
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Deformity and contracture of ophthalmic soft tissues and the orbital bones which compose the orbital complex may be the result of mechanical, chemical, thermal, and/or radiation injury. While reconstruction is most commonly necessary... more
Deformity and contracture of ophthalmic soft tissues and the orbital bones which compose the orbital complex may be the result of mechanical, chemical, thermal, and/or radiation injury. While reconstruction is most commonly necessary following traumatic orbital injuries, iatrogenically induced deformities account for a large number of cases as well. Iatrogenic causes range from unavoidable surgically induced deformity resulting from excision of a primary orbital neoplasm or ocular tumor with orbital extension, to contracture resulting from secondary effects of radiation. Radiation-related injury may develop following radiation therapy directed to the globe, orbit, or nasopharynx. Secondary considerations which may exacerbate radiation-induced injury include poor fitting or excessively heavy prostheses in anophthalmic (no globe) patients with orbital volume deficiency, and normal aging changes which may lead to or contribute to socket deformity.
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There is confusion in all of healthcare, including oculofacial surgery, as to what is 'complex' and what is 'merely complicated'. Although in common usage, these terms tend to be interchangeable, the distinction is more... more
There is confusion in all of healthcare, including oculofacial surgery, as to what is 'complex' and what is 'merely complicated'. Although in common usage, these terms tend to be interchangeable, the distinction is more than trivial. A different and somewhat unfamiliar toolset is needed to successfully navigate complex problems. This review will explore a methodology for the physician to understand what is complex in oculofacial surgery, the tools needed to optimize performance in a complex healthcare system and successfully manage patients with complex diseases. A specific understanding of complexity science in oculofacial surgery is only in its nascent beginnings at this point. Nevertheless, recent advances in closely related fields can provide concrete applications. The practice of oculofacial surgery is optimized within a healthcare network of supporting professionals. Moreover, a newer understanding of the 'complex' nature of disease common to oculofacia...
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The formation of epithelial cysts and pseudocysts of the eyelid is an uncommon complication of ptosis surgery. These lesions may originate at the time of surgery from the burying of conjunctival epithelium, from obstruction of the gland... more
The formation of epithelial cysts and pseudocysts of the eyelid is an uncommon complication of ptosis surgery. These lesions may originate at the time of surgery from the burying of conjunctival epithelium, from obstruction of the gland of Krause, or from injury to the main lacrimal gland or duct. Although surgical excision effectively cures lesions stemming from buried conjunctiva or obstruction of the gland of Krause, lacrimal gland pseudocysts must be drained into the conjunctival fornix. These complications are best avoided by a thorough understanding of eyelid anatomy and by meticulous surgical dissection.
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A 72-year-old man had secondary orbital involvement with dermatofibrosarcoma protuberans 36 years after removal of the initial tumor on his forehead. In addition, multiple bilateral inferior orbital masses were present, which on... more
A 72-year-old man had secondary orbital involvement with dermatofibrosarcoma protuberans 36 years after removal of the initial tumor on his forehead. In addition, multiple bilateral inferior orbital masses were present, which on pathologic examination proved to be reactive lymphoid hyperplasia. Serum immunoelectrophoresis revealed polyclonal elevations of IgG and IgA. Dermatofibrosarcoma protuberans is part of the spectrum of fibrohistiocytic tumors that also includes atypical fibroxanthoma and benign and malignant fibrous histiocytoma. The exact cell of origin of dermatofibrosarcoma protuberans is controversial, though immunohistochemical study of our specimen supports the fibroblast. The coexistence of this rare orbital tumor with noncontiguous reactive lymphoid hyperplasia is unique, and points out the fact that multiple orbital masses may indicate more than one underlying disease process.
Research Interests:
The distinction between benign and malignant cutaneous periocular lesions can be difficult, as the clinical history and appearance are often quite similar. When present, typical cutaneous changes are often helpful in distinguishing... more
The distinction between benign and malignant cutaneous periocular lesions can be difficult, as the clinical history and appearance are often quite similar. When present, typical cutaneous changes are often helpful in distinguishing between benign and malignant neoplasms. However, when tumors lack characteristic epidermal change, histopathologic examination may be necessary to confirm the diagnosis. The authors present their experience in the evaluation and management of two patients with periocular basal cell carcinoma who were initially diagnosed as having benign cysts. The case records for two patients with periocular basal cell carcinoma were reviewed. Preoperative and postoperative photographs were available for comparison in one case. For each patient, the medical history, clinical presentation, histology, and surgical outcome were reviewed. In each case, the periocular mass was initially diagnosed as a benign process. Histopathologic examination following excisional biopsy established the diagnosis of basal cell carcinoma in both patients. Following biopsy, residual tumor was removed by the Mohs micrographic technique. There were no surgical complications and no tumor recurrences during follow-up of one year and eight years. Periocular basal cell carcinoma may mimic benign cystic lesions of the central face. Incorrect diagnosis may result in delayed or inappropriate therapy, or failure to submit seemingly benign lesions for histopathologic examination. Definitive treatment requires complete excision with histologic margin control.
Research Interests:
The abundant blood supply normally found in the periorbital region grants the reconstructive surgeon many options for repair. When this blood supply is altered by such factors as thermal damage or scar formation, classic methods of lid... more
The abundant blood supply normally found in the periorbital region grants the reconstructive surgeon many options for repair. When this blood supply is altered by such factors as thermal damage or scar formation, classic methods of lid reconstruction may not suffice. In such situations, treatment with hyperbaric oxygen accelerates the process of primary revascularization of full-thickness skin grafts and large composite grafts. Augmentation of capillary budding occurs because hyperbaric oxygen therapy raises the tissue oxygen tension in hypoxic areas to the level needed for extracellular deposition of collagen, which is needed for support of endothelial cells. Hyperbaric oxygen also appears to improve the survival of ischemic skin flaps of the face, although the exact mechanism of this action is unclear. Since 1982, a total of six patients needing periorbital reconstruction has been treated postoperatively with adjunct hyperbaric oxygen. Although the results have been uniformly favorable, a matched series comparing the results with and without hyperbaric oxygen therapy will be required to prove the efficacy of this treatment regimen.
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Page 1. 479 152 Ten Steps to Making Ptosis Surgery More Predictable Russell S. Gonnering There is many a boy here today who looks on war as all glory, but, boys, it is all hell. General William Tecumseh Sherman August 11, 1880 Columbus,... more
Page 1. 479 152 Ten Steps to Making Ptosis Surgery More Predictable Russell S. Gonnering There is many a boy here today who looks on war as all glory, but, boys, it is all hell. General William Tecumseh Sherman August 11, 1880 Columbus, Ohio Ptosis is hell. ...
ABSTRACT External levator ptosis surgery has a degree of inherent unpredictability. The outcome is a dance with three partners: the patient, the surgeon, and the steps in the process of the procedure itself. It is best thought of as a... more
ABSTRACT External levator ptosis surgery has a degree of inherent unpredictability. The outcome is a dance with three partners: the patient, the surgeon, and the steps in the process of the procedure itself. It is best thought of as a complex procedure, and not one that is merely complicated. While surgical experience helps in improving outcome, variables outside of the control of the surgeon will always be present. The key is to recognize those variables and influence them as much as possible. Complete control of these variables is impossible, and the attempt is even counterproductive. The ten steps outlined in this chapter have proven to be the most effective for me. They are a starting point, not the end.
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Study what health leaders need to do to sense what will happen in the future and prepare for the dramatic changes coming this way.
Research Interests:
External levator ptosis surgery has a degree of inherent unpredictability. The outcome is a dance with three partners: the patient, the surgeon, and the steps in the process of the procedure itself. It is best thought of as a complex... more
External levator ptosis surgery has a degree of inherent unpredictability. The outcome is a dance with three partners: the patient, the surgeon, and the steps in the process of the procedure itself. It is best thought of as a complex procedure, and not one that is merely complicated. While surgical experience helps in improving outcome, variables outside of the control of the surgeon will always be present. The key is to recognize those variables and influence them as much as possible. Complete control of these variables is impossible, and the attempt is even counterproductive. The ten steps outlined in this chapter have proven to be the most effective for me. They are a starting point, not the end.
"In order to maximize effectiveness and productivity, the physician executive must understand the differences between simple, complicated, complex and chaotic... more
"In order to maximize effectiveness and productivity, the physician executive must understand the differences between simple, complicated, complex and chaotic systems."
Research Interests:
Research Interests:
The endotheliums of rabbit corneas were perfused in an in vitro perfusion specular microscope up to 3 hr with solutions varying in pH from 3.5 to 10.0. Corneal thickness was monitored throughout the experiment, and at appropriate times... more
The endotheliums of rabbit corneas were perfused in an in vitro perfusion specular microscope up to 3 hr with solutions varying in pH from 3.5 to 10.0. Corneal thickness was monitored throughout the experiment, and at appropriate times the corneas were prepared for SEM and TEM. Analysis of the corneal thickness data and interpretation of the electron micrographs reveals that outside of the pH range of 6.5 to 8.5, structural and functional alterations occur. Direct cellular damage, as well as disruption of junctional complexes, lead to a breakdown in the barrier function of the corneal endothelium. The extent of this breakdown is dependent upon both the magnitude of the pH change and the exposure time. Further experiments on banked human eyes support this finding.
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"Consider how radical advances in technology or understanding often occur not through entirely new ideas, but through the recombination of existing ideas in new ways."
Research Interests:
Study what health leaders need to do to sense what will happen in the future and prepare for the dramatic changes coming this way.
Research Interests:
Page 1. Electronic copy available at: http://ssrn.com/abstract=1753308 The Seductive Allure of Best Practices Improved outcome is a delicate dance between structure and process Russell S. Gonnering, MD, MMM Department of Ophthalmology... more
Page 1. Electronic copy available at: http://ssrn.com/abstract=1753308 The Seductive Allure of Best Practices Improved outcome is a delicate dance between structure and process Russell S. Gonnering, MD, MMM Department of Ophthalmology and Visual Science ...
Research Interests:
We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average... more
We performed 63 intubations with silicone tubing for nasolacrimal duct obstruction in children in whom nasolacrimal duct probings had failed. Fifty-nine (93.7%) obstructions were congenital and four (6.3%) were acquired. The average length of intubation was 4.3 months. The final results for both congenital and acquired obstructions combined were good in 52 cases (82.5%), fair in three (4.8%), and poor in eight (12.7%). Complications, with the exception of some with infection, were easily treated or minimal and did not affect the outcome significantly. We recommend silicone intubation as the procedure of choice for congenital or acquired nasolacrimal duct obstructions in children after failure of medical therapy and nasolacrimal duct probings.
Research Interests:
Lateral displacement at the medial canthus is the most common complication following lacrimal intubation. Current procedures for dealing with this situation involve the removal of the tubing, and are either technically difficult or else... more
Lateral displacement at the medial canthus is the most common complication following lacrimal intubation. Current procedures for dealing with this situation involve the removal of the tubing, and are either technically difficult or else involve retrograde passage of the knotted silicone through one of the canaliculi. By passing both probes of a second intubation set through the same punctum, the loop of the displaced tubing can be captured and gently repositioned without removal. This is particularly useful with early displacement of the tubing following microsurgical repair of a canalicular laceration.
Research Interests:
A 76-year-old male had orbital extension and regional lymph node involvement from an oncocytic carcinoma thought to have arisen in the plica semilunaris of the left eye. Declining early orbital exenteration and radical neck dissection,... more
A 76-year-old male had orbital extension and regional lymph node involvement from an oncocytic carcinoma thought to have arisen in the plica semilunaris of the left eye. Declining early orbital exenteration and radical neck dissection, the patient received radiation therapy. Although initial palliation was achieved, the lesion recurred 1 year later, with massive orbital involvement. Despite exenteration and chemotherapy, the patient expired within 6 months. Oncocytomas arise from transformed epithelial cells, generally in the medial canthal region. Oncocytic carcinoma of the ocular adnexa is extremely rare and no such lesion of the plica semilunaris has been reported.
Research Interests:
Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the... more
Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the victim. The exact precipitating event is usually unknown. Most victims are treated by a physician soon after injury, and can be reconstructed primarily following meticulous local wound care, including adequate irrigation. Infection is rare, but because of its potentially disastrous consequences, prophylactic treatment with penicillinase-resistant penicillin or cephalosporin seems indicated. Serious, potentially fatal consequences due to underlying intracranial injury in children under aged 2 years, fatal septicemia in splenectomized individuals, tetanus, and rabies must be considered by ophthalmologists who treat such patients.
Research Interests: Adolescent, Dogs, Humans, Child, Female, and 8 moreAnimals, Male, Adult, Retrospective Studies, Bites and Stings, Orbit, Child preschool, and Wound infection
To identify lymphatic vessels in the human orbit. Lymphatic and blood capillaries were distinguished histochemically by light microscopy using a 5'-nucleotidase (5'-Nase) and alkaline phosphatase (ALPase) double staining... more
To identify lymphatic vessels in the human orbit. Lymphatic and blood capillaries were distinguished histochemically by light microscopy using a 5'-nucleotidase (5'-Nase) and alkaline phosphatase (ALPase) double staining method. Identification of lymphatic vessels was based on strict morphologic criteria combined with specific 5'-Nase staining. The presence of conjunctival lymphatics was confirmed and used as a control tissue. Lymphatic vessels were identified in the lacrimal gland and in the dura mater of the optic nerve. Structures demonstrating positive 5'-Nase staining at the orbital apex were highly suggestive of lymphatics but did not meet the morphologic criteria established. Lymphatic vessels were not identified in the extraocular muscles or orbital fat. To the authors' knowledge, this study presents the first evidence for lymphatic capillaries in the dura mater of the human optic nerve and lacrimal gland.
Research Interests:
Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young... more
Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young adults. In children, infection is spread by direct contact or through fomites, with lesions predominating on the trunk, extremities, and face. In young adults, this disease is spread primarily through sexual contact. Periocular infection can cause secondary chronic follicular conjunctivitis, superficial keratitis, and punctal occlusion. Although many modes of therapy are effective in destruction of the virus, some may have significant side effects when used in the periocular area. We describe treatment by incision and curettage, which we recommend as a simple, effective method of managing this problem.
Research Interests:
Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients with facial spasm syndromes. The maximum cumulative toxin dose was 553 units, the maximum number of injections in any given patient was 16,... more
Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients with facial spasm syndromes. The maximum cumulative toxin dose was 553 units, the maximum number of injections in any given patient was 16, and the maximum dosage of any given injection was 52.5 units. Sera from these patients showed no antibody production when measured with a standard mouse lethality bioassay.
Research Interests:
Prior investigations have established that changes in bio-electric potentials accompany the processes of wound creation and healing. In order to investigate these changes in an experimental full-thickness skin graft model, grafts were... more
Prior investigations have established that changes in bio-electric potentials accompany the processes of wound creation and healing. In order to investigate these changes in an experimental full-thickness skin graft model, grafts were harvested from the dorsa of eight albino rabbits. Changes in potential were recorded over a period of 32 days, using silver-silver chloride electrodes and a recording polygraph. The potential measured across the skin graft became increasingly more electropositive until, between days 1 and 2, the potential abruptly reversed polarity. This negative potential lasted until day 4, when the conductivity again became positive, with a slow return to baseline measurements by day 32. Although these observations may indicate a bio-electric counterpart to the cellular events of wound healing, more study is needed.
Research Interests:
Amyloidosis (AL) is a disease characterized by the extracellular deposition of a complex glycoprotein, part of which is derived from light chains of immunoglobulins. The ocular adnexa can be involved in both systemic primary amyloidosis... more
Amyloidosis (AL) is a disease characterized by the extracellular deposition of a complex glycoprotein, part of which is derived from light chains of immunoglobulins. The ocular adnexa can be involved in both systemic primary amyloidosis (AL), usually associated with multiple myeloma or other immunologic disorders, or in a localized form without such systemic implications. We present the case report of a 65-year-old man in whom occult primary systemic amyloidosis (AL), associated with a monoclonal IgG-kappa gammopathy, occurred with presenting signs of ptosis and dermatochalasis secondary to infiltration of the extraocular and orbicularis oculi muscles with amyloid.
Research Interests:
A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic catheter was used to create intranasal dacryocystorhinostomy fistulas in fresh-frozen cadaver heads. The procedure, which we term endonasal laser... more
A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic catheter was used to create intranasal dacryocystorhinostomy fistulas in fresh-frozen cadaver heads. The procedure, which we term endonasal laser dacryocystorhinostomy, is described. Cadaver specimens were examined postoperatively. Laser rhinostomies were found to involve the posteroinferior portion of the lacrimal sac fossa. Tissues surrounding the fistula site showed no signs of damage. We report on the first patient to undergo endonasal laser dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction, with 10 months of follow-up. We believe endonasal laser dacryocystorhinostomy offers the following advantages over standard external dacryocystorhinostomy: (1) Tissue injury is limited to the discrete fistula site. (2) The cutaneous scar and cosmetic blemish of an external dissection are eliminated. (3) Excellent hemostasis is maintained. (4) Minimal operative and postoperative morbidity p...