Emily J. Ceisler, M.D.

Surgical treatment of capillary hemangiomas causing amblyopia
Levi, Michelle; Schwartz, Shirah; Blei, Francine; Ceisler, Emily; Steele, Mark; Furlan, Louis; Millman, Arthur; Kodsi, Sylvia R
2007 Jun;11(3):230-234, Journal of AAPOS: American Association for Pediatric Ophthalmology & Strabismus
BACKGROUND: Capillary hemangiomas of the eyelids and orbit can cause refractive and occlusive amblyopia. Although oral and intralesional steroid injections are the most common treatment modalities, sometimes they are not successful. There is a paucity of information in the literature on the success of eliminating amblyogenic factors by treating these lesions with surgical resection. METHODS: Retrospective chart review of 10 patients in two pediatric ophthalmology practices who underwent surgical excision of a capillary hemangioma that was causing amblyopia and that had failed to regress with other treatment. RESULTS: Two patients had surgery secondary to pupillary occlusion, which was successful in relieving occlusion. Eight patients had surgery secondary to significant astigmatism. The average preoperative astigmatic difference between the affected and unaffected eye in five of these patients undergoing surgery before the age of 21 months was 2.15 D. The average postoperative astigmatic difference was 0.1 D. The average preoperative astigmatic difference between the affected and unaffected eye in three patients undergoing surgery after 21 months of age was 1.6 D. Surgery completely failed to reduce the astigmatism in two of these patients. The third patient had a decrease of 0.75 D of cylinder but still had a difference of 1.75 D between the two eyes postoperatively. Postoperative complications in this study included wound infection in one patient. CONCLUSIONS: Surgical excision of capillary hemangiomas that were resistant to other modes of treatment was useful in relieving pupillary occlusion and in decreasing the amount of astigmatism if performed before the age of 21 months in our series of patients. Our cases as well as the literature suggest that surgery should be performed at 13 months or earlier to reduce the amount of astigmatism
— id: 71020, year: 2007, vol: 11, page: 230, stat: Journal Article,

Treatment of capillary hemangiomas causing refractive and occlusional amblyopia
Schwartz, Shirah R; Kodsi, Sylvia R; Blei, Francine; Ceisler, Emily; Steele, Mark; Furlan, Louis
2007 Dec;11(6):577-583, Journal of AAPOS: American Association for Pediatric Ophthalmology & Strabismus
PURPOSE: Capillary hemangiomas of the eyelid and orbit are treated when amblyopia secondary to anisometropic astigmatism or pupillary occlusion is present or when rapid growth of the hemangioma threatens to occlude the pupil. The goal of this study was to determine whether treatment of hemangiomas resolves or prevents occlusion or results in decrease in astigmatism. METHODS: The records of 54 patients who underwent treatment for reduction in the size of a capillary hemangioma causing amblyopia or threatened amblyopia in two pediatric ophthalmology practices were reviewed. RESULTS: Twenty-eight patients were treated for amblyopia due to anisometropic astigmatism. The average amount of pretreatment astigmatism was 2.71 D, while the average amount of post-treatment astigmatism was 0.46 D. Fifteen of these patients could be tested for optotype visual acuity and all had vision acuity of 20/40 or better. Only 1 of the 15 patients treated for threatened occlusion of the pupil developed occlusion. Six of these patients cooperated with optotype visual acuity and all had vision acuity of 20/30 or better. Eleven patients were treated for pupillary occlusion. Occlusion resolved in all cases. Of the five patients treated for occlusion who cooperated with optotype visual acuity, two had a vision acuity of 20/100 or worse. CONCLUSIONS: Treatment to reduce the size of capillary hemangiomas results in resolution of occlusion, reduction in astigmatism, and prevention of pupillary occlusion. Those with occlusion are at higher risk for severe residual amblyopia and require prompt and definitive treatment
— id: 75163, year: 2007, vol: 11, page: 577, stat: Journal Article,

Risk factors for amblyopia in children with capillary hemangiomas of the eyelids and orbit
Schwartz, Shirah R; Blei, Francine; Ceisler, Emily; Steele, Mark; Furlan, Louis; Kodsi, Sylvia
2006 Jun;10(3):262-268, Journal of AAPOS: American Association for Pediatric Ophthalmology & Strabismus
Introduction: Capillary hemangiomas are the most common orbital tumors of childhood and can cause amblyopia secondary to occlusion of the pupil, anisometropia, or strabismus. We undertook this study to describe the clinical characteristics of children with capillary hemangiomas and to propose a classification system to guide clinical treatment decisions. Methods: A retrospective review of the records of 129 patients with 132 capillary hemangiomas in two pediatric ophthalmology practices was conducted. Hemangiomas were classified based on size. Presence of aniosometropic astigmatism, ptosis, pupillary occlusion, lid margin change, proptosis, globe displacement, and strabismus was recorded. Results: Thirty-one hemangiomas measured less than 1 cm in greatest dimension and were not associated with amblyogenic factors. Seventy-five patients had hemangiomas that measured greater than 1 cm, 40 of which were associated with amblyopia. Eighteen children had diffuse hemangiomas that could not be measured and 14 of these were associated with amblyopia. Five of seven hemangiomas in six patients with PHACES syndrome were associated with amblyopia. Conclusion: This study is the largest review of capillary hemangiomas of the orbit and eyelids. Our findings suggest that size greater than 1 cm in largest diameter is an important predictor of amblyogenic factors and approximately half of these patients will require treatment. Diffuse hemangiomas and hemangiomas in patients with PHACES syndrome will cause amblyopia in the majority of cases
— id: 66077, year: 2006, vol: 10, page: 262, stat: Journal Article,

Ocular and systemic manifestations of PHACES (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Cardiac defects and coarctation of the Aorta, Eye abnormalities, and Sternal abnormalities or ventral developmental defects) syndrome
Kronenberg, Alaina; Blei, Francine; Ceisler, Emily; Steele, Mark; Furlan, Louis; Kodsi, Sylvia
2005 Apr;9(2):169-173, Journal of AAPOS: American Association for Pediatric Ophthalmology & Strabismus
INTRODUCTION: PHACES syndrome (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Cardiac defects and coarctation of the aorta, Eye abnormalities, and Sternal abnormalities or ventral developmental defects) is a rare neurocutaneous syndrome with only 2 case reports published in the ophthalmic literature. This study was conducted to identify ocular and systemic manifestations of PHACES syndrome. METHODS: A retrospective chart review was performed on 8 children with a diagnosis of PHACES syndrome. Information recorded included age at first visit, length of follow-up, gender, race, vision, need for glasses, strabismus, amblyopia, ptosis, proptosis, anterior and posterior segment abnormalities, need for treatment of the hemangioma, type of treatment of the hemangioma, and systemic manifestations. RESULTS: Periocular and ocular findings in patients with PHACES syndrome included hemangioma involving ocular structures (n = 6), strabismus (n = 4), amblyopia (n = 5), proptosis (n = 2), ptosis (n = 5), anterior polar cataract (n = 1), optic atrophy from optic neuropathy (n = 1), heterochromia (n = 1), and refractive error requiring glasses (n = 2). All patients were treated with steroids for the hemangioma. Systemic manifestations of PHACES syndrome included posterior fossa malformation (n = 4), hemangioma (n = 8), arterial anomalies (n = 3), cardiac abnormalities (n = 3), and sternal or ventral deformities (n = 3). CONCLUSION: Children with PHACES syndrome may have significant ocular and systemic abnormalities and are at increased risk for strabismus and amblyopia. They often require steroid therapy of the hemangioma to prevent and/or treat ocular complications. These patients require careful monitoring by a pediatric ophthalmologist in addition to other subspecialists
— id: 57830, year: 2005, vol: 9, page: 169, stat: Journal Article,

Periocular hemangiomas: what every physician should know
Ceisler, Emily J; Santos, Laura; Blei, Francine
2004 Jan-Feb;21(1):1-9, Pediatric dermatology
Hemangiomas are the most common benign tumor of infancy. Most hemangiomas remain asymptomatic and can be managed by close observation; however, immediate treatment is indicated for hemangiomas that may cause significant complications. Periocular hemangiomas warrant close evaluation and early, active treatment of those with the potential to threaten or permanently compromise vision. Herein we review the clinical features of periocular hemangiomas, differential diagnosis, possible ophthalmologic complications and sequelae, and therapeutic modalities
— id: 44856, year: 2004, vol: 21, page: 1, stat: Journal Article,

Ophthalmic issues in hemangiomas of infancy
Ceisler, Emily; Blei, Francine
2003 ;1(4):321-330, Lymphatic Research & Biology
Hemangiomas are the most common benign tumor of infancy. Although most hemangiomas remain asymptomatic, certain hemangiomas can cause significant morbidity and require treatment. Periocular hemangiomas require close observation and early therapy for those lesions with potential for visual impairment. Hemangiomas typically cause visual morbidity by induction of amblyopia, strabismus, significant refractive error or optic nerve compromise. Diagnosis is typically straightforward but occasionally other entities may cause diagnostic confusion and radiologic evaluation can be helpful. This is particularly important if the hemangioma is one component of the PHACES syndrome. Therapeutic options which may be useful include steroids (oral, intralesional or topical), interferon alpha (usually reserved for life- or sight-threatening lesions due to serious potential side effects), laser, embolization and surgery. Ophthalmic treatment using patching, atropine, glasses and stabismus surgery may be necessary
— id: 48088, year: 2003, vol: 1, page: 321, stat: Journal Article,

Visual outcomes in children with bilateral retinoblastoma
Hall LS; Ceisler E; Abramson DH
1999 Jun;3(3):138-142, Journal of AAPOS: American Association for Pediatric Ophthalmology & Strabismus
BACKGROUND: Retinoblastoma is the most common primary intraocular tumor of childhood. Although studies have explored trends in retinoblastoma management and prognosis, few have addressed visual outcome. METHODS: A retrospective chart review was performed on children in whom bilateral retinoblastoma was diagnosed at New York Hospital-Cornell Medical College. A total of 74 children were included in the study. All children underwent radiation to the eyes that were studied. Fundus drawings done at the time of diagnosis were evaluated to determine the location of tumors on presentation and the Reese-Ellsworth classification. Visual outcome was classified into 3 groups: group 1 represented visual acuity of 20/20 to 20/40; group 2, 20/50 to 20/400, and group 3, <20/400. RESULTS: A total of 74 children were studied. Forty-six (62%) underwent enucleation of 1 eye. The visual acuity of the remaining 102 eyes was divided into groups 1, 2, and 3. Fifty-eight percent of these eyes were in group 1, 31% in group 2, and 9% in group 3. Two percent underwent subsequent enucleation after treatment. The tumors were analyzed on the basis of Reese-Ellsworth classification, location, size, and distance from the macula. Excluding Reese-Ellsworth group VB, there was no correlation between Reese-Ellsworth classification and final visual outcome. Tumors involving the macula were in 7 (78%) of 9 eyes with poor visual outcome (group 3), and 16 (33%) of 48 eyes with excellent vision (group 1) had macular tumors. Paradoxically, 2 (22%) of 9 eyes in group 3 did not have tumors involving the macula. CONCLUSIONS: Children with retinoblastoma now have an excellent prognosis for life. Although correlated with tumor location, visual outcome is not always easily predicted on the basis of the initial presentation. Final acuity is excellent in most cases but may be influenced by multiple factors that must be considered when caring for these children and families
— id: 36211, year: 1999, vol: 3, page: 138, stat: Journal Article,

Juvenile rheumatoid arthritis and uveitis: minimizing the blinding complications
Ceisler EJ; Foster CS
1996 Winter;36(1):91-107, International ophthalmologic clinics
— id: 21590, year: 1996, vol: 36, page: 91, stat: Journal Article,

Complex choristoma
Lucarelli MJ; Ceisler EJ; Talamo JH; Jakobiec FA
1996 Apr;114(4):498-499, Archives of ophthalmology
— id: 21589, year: 1996, vol: 114, page: 498, stat: Journal Article,

Results of Mullerotomy and levator aponeurosis transposition for the correction of upper eyelid retraction in Graves disease
Ceisler EJ; Bilyk JR; Rubin PA; Burks WR; Shore JW
1995 Mar;102(3):483-492, Ophthalmology
BACKGROUND: Upper eyelid retraction in Graves disease may cause functional morbidity and aesthetic deformity. Surgery to correct thyroid-related upper eyelid retraction may result in temporal undercorrection with failure to eliminate lateral eyelid retraction, leading in turn to a poor eyelid contour postoperatively. METHODS: In 1984, one of the authors developed a new procedure for correcting moderate to severe upper eyelid retraction associated with Graves disease. The surgical technique consists of a Mullerotomy and recession of the levator aponeurosis combined with medial transposition of the lateral horn of the levator aponeurosis. The procedure was performed on 37 patients (72 eyelids). Muller's muscle was used as the spacer to set the eyelid height. Transposition of the levator aponeurosis allowed adjustment of eyelid contour. RESULTS: Thirty patients (58 eyelids) had excellent results, six (13 eyelids) had good results, and one (1 eyelid) had a poor result. No patient required re-operation for asymmetry, unacceptable contour, or malposition. Only one eyelid had significant overcorrection, and only one eyelid had significant undercorrection, requiring further surgery. The most frequent unwanted effects were high eyelid crease (24 eyelids) and residual temporal flare (6 eyelids); however, most of these were seen early in the series before the lateral levator transposition modification was added. CONCLUSION: This procedure allows successful and simultaneous correction of both eyelid position and contour in patients with moderate to severe thyroid-related upper eyelid retraction
— id: 21591, year: 1995, vol: 102, page: 483, stat: Journal Article,

Chondroblastoma of the temporal bone. Case report and literature review
Varvares MA; Cheney ML; Goodman ML; Ceisler E; Montgomery WW
1992 Sep;101(9):763-769, Annals of otology rhinology & laryngology
Chondroblastoma is a rare tumor of bone that represents approximately 1% of all primary bone tumors. In the temporal bone, only 33 have been reported. We present a case of chondroblastoma of the temporal bone, followed by a literature review and analysis of reported cases. We conclude that the best chance for a prolonged disease-free interval is total excision using a combined otolaryngologic and neurosurgical approach
— id: 36212, year: 1992, vol: 101, page: 763, stat: Journal Article,