摘要:

Nineteen consecutive cases of primary endoscopie potassium titanyl phosphate (KTP) laser-assisted dacryocystorhinostomy (DCR) were retrospectively studied. Follow-up ranged from 10 to 16 months. Patients ranged in age from 18 to 93 years (average 65.6 years). Preoperative epiphora was present in all patients, and associated with mucopyocele in nine patients. Bicanalicular-nasal silicone tubes were placed during surgery in all cases. Timing of tube removal in the office ranged from 5 to 15 weeks (average 8.9 weeks). Prolonged patency through the follow-up period was achieved in 13 of 19 cases (68.4%). The six cases (31.6%) of postoperative failure included three cases with preoperative mucopyocele and three cases without. Failures manifested with recurrent epiphora (three cases) or recurrent dacryocystitis (three cases); the onset of symptom recurrence varied from 7 to 27 weeks postoperatively (average 18.3 weeks). Although success rates will vary between surgeons and study populations, patients should be advised that the success rate of KTP laser-assisted DCR may be lower than that of standard DCR. Generally, indications for choosing laser-assisted DCR include the avoidance of a cutaneous incision and reduced potential for mucosal bleeding. The technique may be considered for use in selected cases of nasolacrimal obstruction. The importance of technical variations remains to be elucidated including rhinostomy size and timing of silicone tube removal. Further studies are needed to help define the role of endoscopy techniques and lasers in DCR surgery.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We studied the relationship between eye dominance (Scobee test) and upper lid level (MRD) in 54 patients with unilateral ptosis or asymmetric bilateral ptosis (±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 $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 present. The preoperative evaluation of unilateral or asymmetrical bilateral ptosis cases should include the Scobee and phenylephrine tests to unmask contralateral upper lid pseudoretraction.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A six-stage approach to the management of the ophthalmic complications of facial palsy was developed to aid the physician in logically organizing therapy and to provide patients with reassuring goals. This step-wise approach was applied prospectively in 120 consecutive facial palsy patients from 1986 to 1990. The six stages included (a) supportive care (with and without tarsorrhaphy), (b) planning facial reanimation, (c) lower eyelid and lateral canthal resuspension, (d) passive upper eyelid reanimation, (e) dynamic eyelid animation (palpebral springs), and (f) soft tissue repositioning including eyebrow lift and blepharoplasty. Each stage was considered in order, although action in each stage was not appropriate for all patients. All 120 patients received supportive care, which was all that was necessary to accomplish the therapeutic goals for 63 (52.5%). Eight patients received temporary tarsorrhaphies (7%) and 14 (12%) permanent. One hundred ten were considered for stage 2. Thirty-five underwent stage 3 procedures, 30 received gold weights in stage 4, 5 had palpebral springs placed in stage 5, and 6 underwent stage 6 procedures. This staged approach was effective in achieving corneal compensation, maintaining vision, and improving the quality of life in all patients.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Quantitative computed tomography (qCT) can be employed to determine the mineral density (MD) of bone or similar mineralized alloplastic materials with high precision. Porous spheres made from coralline hydroxy-apatite are currently used for reconstruction after enucleation procedures. The long-term fate of these implants is unknown. Using qCT, MD was determined in hydroxyapatite spheres prior to implantation. Intersphere MD varied up to 200% with a near Gaussian distribution. Intrasphere MD did not vary significantly when comparing central to peripheral sites. The density of coralline hydroxyapatite spheres was ~400% greater than the density of newly formed endochondral bone. This study demonstrates that qCT data were an invaluable tool for MD determination, detecting a marked variability in hydroxyapatite MDs. Because the long-term fate of these implants is unknown and fibro-vascular ingrowth is an important event in the integration of these implants, monitoring of MDs of coralline hydroxyapatite implants is of interest.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Repair of large full-thickness lower lid defects requires reconstruction of the tarsoligamentous sling. This may necessitate either a tarsus sharing technique or a skin flap with a free cartilage graft. Obtaining tarsus or cartilage in these procedures has the disadvantage of requiring a second surgical site, which may cause further scarring and deformity. Polytetrafluoroethylene (PTFE) is a nonantigenic, inert, highly biocompatible, mechanically strong synthetic material that has been successfully utilized as a vascular and soft tissue patch since the 1970's. PTFE has been used in ophthalmic surgery to wrap orbital implants and as an interpositional graft for the correction of lower lid retraction. We evaluated the usefulness of PTFE in the reconstruction of the tarsoligamentous sling in 24 lids of 12 New Zealand white rabbits. PTFE with internodal spacings of 10 and 30 μm were used initially. Despite a lack of tissue inflammation, the PTFE grafts were uniformly extruded by 2 weeks postoperatively. Four additional lids were reconstructed using PTFE (30 and 60 (μm) coated with a biological substrate. This graft material was also extruded. These results suggest that PTFE material may not be satisfactory for reconstruction of the tarsoligamentous sling.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Several treatments exist for trichiasis, a condition in which misdirected lashes come in contact with the globe. The treatments can be considered in two groups, those that destroy the lash follicle and those that redirect the lashes. No technique is without potential complications, and none is 100% effective. The Ellman Surgitron FFPF offers a new treatment for trichiasis directed at destroying the lash follicle. This instrument utilizes energy at 3.8 MHz in the radiofrequency band of the electromagnetic spectrum, hence the termradiosurgery. This report presents a prospective, non-masked study of 30 eyelids in 26 patients with localized trichiasis treated with the Ellman Surgitron FFPF. Single treatment success rate in patient cure was 67%. Complications included lash recurrence in 8 patients, eyelid notching in 2, granuloma formation in 1, and persistent erythema and tenderness for 1 month in 1 patient. This series demonstrates that the instrument can be effectively used to treat localized trichiasis. A review of the literature reveals that this technique offers potential advantages over some others in use. Further study must determine its efficacy in the treatment of diffuse trichiasis and distichiasis.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A new surgical technique for reconstructing severely contracted sockets using an autogenous buccal mucous membrane-fat graft is presented. The buccal mucosa provides replacement of deficient conjunctival surface area; the fat in the underlying substantia propria of the buccal mucosa replenishes moderate volume deficiency in a single procedure. A custom-designed conformer is used in the immediate postoperative period to maintain reconstructed vertical fornices. We present four consecutive patients with contracted sockets having both a volume deficit and severe conjunctival contracture who were successfully rehabilitated using this technique.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We reviewed the adnexal and orbital findings in a large population with HIV infection followed in one medical center. Around 6% of the series had positive periocular findings. In 1% of the series, the periocular findings were the first manifestation of HIV infection or AIDS. We present the first case of basal cell carcinoma in an HIV-infected individual; the carcinoma involved the eyelid. Orbital findings included lymphoma, cellulitis, Kaposi's sarcoma, and nonspecific inflammatory disease. Adnexal findings included Kaposi's sarcoma, molluscum contagiosum, bacterial folliculitis, madarosis, psoriasis, basal cell carcinoma, and chalazion. Additional opportunistic infections and tumors involving the periocular region are expected to be re- ported in the future.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Malignant eccrine adenocarcinoma of the lower eyelids is described in a 16-year-old girl. This rare tumor has previously been reported only in males, whose average age was 64 years. Our patient remains tumor free 7 years after wide resection of the eyelid and reconstruction.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A spindle cell lipoma developed in the right orbit of a 43-year-old woman whose medical history was only significant for chronic asthma. Sixteen months after nearly complete excision of the tumor, the patient presented with eyelid swelling, orbital pain, and a calcified apical mass as demonstrated by computerized tomography (CT). Recurrent tumor or a second neoplasm was suspected. Histologie examination revealed myositis ossificans. To our knowledge, this is the first reported case of myositis ossificans in the orbit.

ISSN:0740-9303    

出版商:OVID    

年代:1993

数据来源: OVID