摘要:

Reconstruction of full thickness eyelid defects requires the correction of posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Various tarsal substitutes—conchal and nasal cartilage, banked sclera, hard palate, irradiated homologous tarsal plates, periosteum, temporalis fascia, and composite grafts from the opposite eyelid—have been used for posterior lamellar replacement over the years. Eyelid-sharing procedures and full thickness flaps have also been described. At times, because of extensive tissue loss, the eyelid reconstruction can be particularly challenging because of the shortage of tissue. We describe a new posterior lamellar technique using irradiated homologous aorta. The experimental surgical procedure in rabbits, the clinical response, and the histological fate of the donor aorta are described in Part 1 followed by our experience with four patients in Part 2.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Involvement of the eyebrow fat pad in Graves' disease has never been reported. We noted that Graves' orbitopathy patients had bulkier eyebrows due to a larger eyebrow fat pad not associated with the preaponeurotic fat. A cadaver model was used to show that the eyebrow fat could be identified with magnetic resonance imaging (MRI) scans. Then, a series of Graves' orbitopathy patients were sent for orbital MRI scans, and the eyebrow fat was measured with maximum lengths and widths. The averages were compared to two groups of patients, one without orbital pathology, and one with orbital pathology causing proptosis but not due to Graves' disease. Graves' patients with early orbitopathy and incipient optic neuropathy or congestive orbits where optic neuropathy had to be ruled out had statistically significant larger eyebrow fat pads than either comparison group. This has clinical significance: The eyebrow fat may need to be debulked during operations such as blepharoplasty. Furthermore, periorbital fat may play a larger role in the disease process than previously thought.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although the histologic anatomy of the lower eyelid retractors is well defined, the physiology of the lower retractors has been determined only by inference based on anatomic and clinical findings. In this study, in five normal subjects we investigated the physiology of the lower eyelid retractors utilizing dynamic high resolution magnetic resonance imaging (MRI) with a custom designed surface coil. Measurements of the excursion of the cornea, lower eyelid margin, and anterior edge of the inferior oblique muscle were made from scans taken in upgaze and downgaze. We found that the corneal movement was substantially greater than the movement of the eyelid margin, a finding that can readily be made clinically. A more important result was that the movement of the eyelid margin and the movement of the inferior oblique margin were similar in all cases. Thus, the length of the anterior Capsulopalpebral fascia between the tarsus and inferior oblique muscle remains constant in downgaze, and the source of the stretch in the lower eyelid retractors lies in the posterior Capsulopalpebral system, at the Capsulopalpebral head. High resolution eyelid MR has great potential to allow investigation of essential aspects of normal and pathologic eyelid anatomy and physiology.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Four kinds of ichthyosiform dermatoses have been described. Only lamellar ichthyosis or ichthyosis congenita is associated with the development of ectropion and subsequent eye symptoms. Conservative treatments have been tried but surgical correction of the ectropion was ultimately required for symptomatic relief. Autografts have been used successfully, provided an available donor site can be found. Grafts taken from the arm, eyelids, postauricular skin, and groin have been used with success. An uncircumcised youth with total body involvement from ichthyosis developed bilateral upper and lower ectropion. The penile foreskin was the only possible suitable donor site because it seemed unaffected by the disease. A circumcision was performed and the foreskin divided into four separate full-thickness skin graft triangles to treat the four-lid ectropion. There was successful resolution of the eye symptoms and a watertight closure. To our knowledge, this is a unique case in which penile foreskin has been used to correct cicatricial ectropion.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Two porous orbital implants available for clinical use in the anophthalmic socket are hydroxyapatite (HA) and porous polyethylene (PP). We examined the rate and the extent of fibrovascular ingrowth into these implants using histopathologic criteria in a rabbit model. Thirty-two New Zealand white rabbits underwent a unilateral enucleation with placement of a 14-mm spherical orbital implant. Twelve rabbits received HA, 12 small-pore PP, and 8 large-pore PP. The implants inserted were wrapped either in autologous sclera with and without anterior fenestrations or as unwrapped spheres. The implants were harvested at 6 and 12 weeks. The extent of fibrovascular ingrowth was assessed by determining the percentage of the cross-sectional area penetrated by fibrovascular tissue. On gross inspection, 12 implants (37.5%) were found to be exposed at harvesting; however, only two were grossly infected. The highest rate of exposure was found among the unwrapped implants. Wrapped versus unwrapped and fenestrated versus unfenestrated implants did not result in significant differences in the extent of vascularization. Hydroxyapatite implants were vascularized most rapidly. The small-pore PP implants did not become fully vascularized during the study, and yet complete vascularization was found in the large-pore PP at 12 weeks. The most intense areas of microscopic fibrovascular ingrowth were in the region where the extraocular muscles were in direct contact with the implant and at the posterior opening. Exposure of the implant was accompanied by chronic and acute inflammation. Both HA and large-pore PP spherical implants are capable of complete vascularization in this animal model. Increasing the interstitial pore size resulted in more complete vascularization of the PP. Vascularization of the implants is limited by exposure, secondary inflammation, and infection.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Ophthalmologists continue to search for the ideal orbital implant for the anophthalmic socket. The successful long-term clinical performance of an implantable prosthesis is highly dependent on the materials from which the device is fabricated. Among the materials issues are chemistry, surface texture, and porosity. Polyethylene, a polymer comprised of simple hydrocarbon chains, is highly resistant to biological degradation and possesses mass and fabrication properties that would be favorable in an orbital implant. In this report, our early experimental experience with porous polyethylene orbital enucleation implants is reported. Our findings are sufficiently encouraging to warrant further exploration and refinement of the polyethylene device examined.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A case of a coral orbital enucleation implant that exposed and failed two closure attempts, by scleral patch grafting and by simple tissue advancement, is presented. The method used to overcome this problem is detailed. This unique case sheds light on the factors that are etiologically important in coral implant exposure and those relevant to covering that exposure successfully.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Lacrimal ultrasonography (echography) evaluates lesions in that drainage system in a painless, noninvasive way in the office. The technique complements other imaging methods and can be correlated with histological results. The authors survey the principles and technique and describe the normal ultrasound, indications, applications, and limitations. Lacrimal ultrasound, whose potential has just lately been recognized, only reveals gross anatomic abnormalities and cannot evaluate the functional integrity of the lacrimal excretory system.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective confirmation of nasolacrimal patency following dacryocystorhinostomy is a desirable postoperative goal for both the surgeon and the patient. The authors describe a simple method to demonstrate dacryocystorhinostomy patency and present a study comparing the effectiveness of this novel test with Jones fluorescein testing in 32 cases seen consecutively at postoperative follow-up. The test consists of demonstrating reflux of air through the dacryocystorhinostomy as the patient performs the Valsalva maneuver. This reflux is most easily seen as bubbles rising through a drop of saline placed in the medial canthus. A high correlation was found between this test and Jones testing. The Valsalva dacryocystorhinostomy bubble test (VBT) appears to be a fast, safe, and accurate method of confirming dacryocystorhinostomy patency.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A 41-year-old white woman presented with a 1-month history of epiphora and a painless medial canthal mass on the left that was unresponsive to antibiotic treatment. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans delineated a soft tissue mass with bony destruction originating in the area of the left lacrimal sac with extension into the maxillary and ethmoid sinuses and inferomedial orbit. Open biopsy of the mass revealed adenoid cystic carcinoma (ACC). On surgical exploration, the tumor was found to originate from the lacrimal sac wall. Radical surgery with wide excision of surrounding bone and periorbital tissue was performed in light of the histological diagnosis and tumor extension. Orbital exenteration was not performed in order to preserve the patient's left eye. A 6-week course of adjunctive radiotherapy was applied without complication. The patient was clinically and radiologically free of tumor at 1-year follow-up. This case represents only the third time that primary ACC arising from the lacrimal sac has been reported.

ISSN:0740-9303    

出版商:OVID    

年代:1994

数据来源: OVID