摘要:

Summary:Asian upper and lower eyelids are typically characterized by a fuller appearance than the lids of whites. Inferior extension of preaponeurotic fat and brow fat into the Asian upper lid explain the upper lid fullness and its difference from the upper lid of whites. Analogous structures in the Asian lower lid may exist to explain its full appearance. High-resolution magnetic resonance imaging (MRI) of 24 normal Asian and white lower lids was performed to evaluate differences in Asian and white lower lid anatomy. Magnetic resonance images revealed two major differences. First, the orbital fat projected further anteriorly with respect to the orbital rim in all Asian lower lids studied. No analogy with the upper lid exists for this difference. Second, the orbital fat extended further superiorly, to the inferior border of tarsus, in those Asian lower lids that did not have well defined creases. This was analogous to the preaponeurotic fat location of the Asian upper lid and different from the white lower lid. The suborbicularis oculi fat in the lower lid, the analogous structure of the brow fat pad in the upper lid, was not different in location in Asian and white lower lids. Therefore, the Asian lower lid appearance is explained by the difference in orbital fat location, which is only partly analogous to the anatomical differences between the Asian and white upper lids.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:This study was undertaken to establish the detailed vascular architecture of the lacrimal gland. The common carotid arteries of seven fresh human cadaver heads were injected with a compound consisting of a partially polymerized monomer, to which a catalyst and promoter were added to cause hardening. The soft tissue was then digested, using 40% potassium hydroxide, to obtain detailed casts of the lacrimal artery. The authors describe the anatomy of 14 cadaver lacrimal arteries from their entrance into the lacrimal gland to their terminal conjunctival branches. Consistent vascular patterns within the lacrimal gland were observed. A better understanding of the vascular anatomy of the lacrimal gland should allow modification of surgical techniques to reduce bleeding during biopsy or excision of the lacrimal gland.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:To describe eyelid changes in ocular leprosy, 74 patients (148 eyes or 296 eyelids) were examined, focusing on eyelid abnormalities. The adnexal examination included evaluation of the upper eyelid crease pattern, qualitative assessment of the orbicularis oculi muscle function, measurement of the distance between the corneal reflex and the upper eyelid margin (margin reflex distance), and slit-lamp biomicroscopy of the eyelashes and tarsal conjunctiva. Eyelash ptosis was a common finding associated with a multiple upper eyelid crease pattern and trichiasis. In the past, eyelash ptosis has probably been diagnosed as upper eyelid entropion or trichiasis, but in this series entropion was not observed. The distinction between eyelash ptosis, trichiasis, and upper eyelid entropion is important because the surgical management for each is different. Other true leprotic abnormalities of the eyelids are lagophthalmos and lower lid ectropion.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:This article evaluates three generations of synthetic hydroxyapatite implants in a rabbit model. Fourteen New Zealand white rabbits received synthetic hydroxyapatite orbital implants (first, second, and third generation). The rabbits underwent enucleation of one eye and then received a 12-mm synthetic hydroxyapatite implant wrapped in Vicryl (polygalactin 910; Ethicon, Inc.) mesh or sciera. Magnetic resonance imaging was conducted to assess host fibrovascularization of the implant 4 and 12 weeks after implantation. Animals were killed at each of these times and the implant was removed for histopathologic examination. Enhancement on magnetic resonance imaging and extent of fibrovascularization by histopathologic examination were assessed. The first-generation synthetic hydroxyapatite (FCI, Issy-Les-Moulineaux, France) was not 100% hydroxyapatite as is the Bio Eye (Integrated Orbital Implants, Inc., San Diego, CA, U.S.A.). It contained 3.2% calcium oxide. The implant was heavier and much less porous than the original Bio Eye implant. Central vascularization eventually occurred but was not extensive. The second-generation implant was more porous than the first, with rapid central vascularization to the center of the implant by 4 weeks. However, the second-generation implant was very fragile and crumbled easily. The second-generation synthetic implant was chemically identical to the original Bio Eye implant with no calcium oxide. The third-generation implant was more porous than its predecessors. When compared side by side with the Bio Eye, a difference in pore uniformity and interconnectivity seems apparent. However, an early extensive vascularization pattern to the center of the implant is seen histopathologically, similar to that with the Bio Eye. Magnetic resonance imaging also shows extensive enhancement as is the case with the Bio Eye. The third-generation synthetic implant is not fragile as was the second-generation implant, and chemically it is identical to the Bio Eye with no calcium oxide present. The third-generation implant is approximately half the price of the original Bio Eye implant.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Sixty-five patients receiving the FCI synthetic hydroxyapatite implant (FCI3, FCI, Issy-Les-Moulineaux, France) after enucleation, evisceration, or as a secondary implant were studied under human trial guidelines established by Health and Welfare Canada. The implant is chemically identical to the original coralline Bio Eye (Integrated Orbital Implants Inc., San Diego, CA, U.S.A.), is easy to work with, and was implanted without difficulty using a wrap of polygalactin 910 (Vicryl mesh, Ethicon, Inc.) in the majority of patients. Postoperative drilling was carried out at approximately 6 months and found to be much easier than drilling of the Bio Eye. The implant could be hand drilled using drill bits rolled between the thumb and index finger. Postoperatively, patients were followed-up from 7 to 24 months and did not have any problems different from those associated with the original hydroxyapatite implant derived from sea coral (Bio Eye). One case of conjunctival dehiscence occurred at 4 weeks and required a temporalis fascia patch graft to repair. One implant became infected after drilling and had to be removed. The motility obtained with the third-generation FCI implant (FCI3) was similar to that seen with the Bio Eye, in comparable patients. That is, those receiving implants after an evisceration, on the whole, had better motility than those receiving an implant after primary enucleation or secondary implantation. The FCI3hydroxyapatite implant is a viable alternative to the original Bio Eye hydroxyapatite implant. It's advantages are: 1) reduced cost, and 2) ease of drilling (a motorized drill is not required). The implant was given Health and Welfare approval in Canada on February 26, 1997.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Hard palate grafts are commonly used in eyelid reconstructive procedures as a replacement for posterior lamellar defects. Four patients are presented with an unusual complication after placement of a hard palate graft: presumed minor salivary gland secretion. They were experiencing stringy mucous discharge over the graft and along the eyelids, causing visual blurring. Removal of the graft in one patient and cryotherapy to the grafts in the others (presumably causing atrophy of the minor salivary gland tissue found within the grafts) allowed resolution of symptoms. The authors propose the application of cryotherapy to the graft surface to atrophy the salivary glands, prevent any further production of mucus, and return the tear film to a more normal consistency. Alternatively, surgical removal of the grafts can be performed. To our knowledge, this complication (saliva-like mucoid discharge) has not been previously reported.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Congenital ptosis in humans has been associated with anisometropia, myopia, astigmatism, and amblyopia. Scientific evidence has shown that visual deprivation causes axial myopia in animals. This study using chicks was undertaken to investigate an animal model of congenital ptosis and the effects of lid position on ocular development. Eyelid ptosis was surgically induced in one eye each of white leghorn chickens within 48 hours after hatching. The chicks were raised under natural diurnal lighting. Thirty days after inducing ptosis, the chicks were killed and their eyes enucleated and photographed in a sagittal view. Computerized image analysis was used to measure the size of the globe along five axes. Globe size was significantly greater in the superior part of eyes with ptosis compared with control eyes. No other measurement differences were significant (p < 0.01). Thus, this study demonstrates that regional axial myopia is induced by eyelid ptosis in chicks.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:The results of a “modified” levator aponeurotic advancement were reviewed to determine the appropriate indications and optimum timing for office revision after blepharoptosis repair. The levator advancement was modified as follows: 1) elimination of epinephrine from the local anesthetic so as not to stimulate the Müller muscle, 2) use of a 6–0 silk rather than a monofilament nonabsorbable suture to secure the advanced levator to avoid possible cheese-wiring and late recurrence, and 3) excision of a strip of preseptal orbicularis muscle just above the tarsal border to create surgically apposed “raw” surfaces for a firm attachment of the “advanced” levator. Office adjustments were delayed for at least 8 days after surgery and were performed as late as 14 days after surgery. Of the 122 consecutive aponeurotic advancements in 110 patients (12 bilateral cases), five (4.1%) patients were candidates for revision in that the operated eyelid was greater than 1 mm from desired height. All such eyelids were undercorrected by 2.0 mm to 2.5 mm. Four of the five underwent revision at 8, 11, and 14 days (two patients) after surgery. The fifth patient did not undergo revision. Four patients with overcorrections from 2.0 mm to 2.5 mm resolved with eyelid massage. It is concluded that the number of office revisions may be reduced if delayed for at least 8 days after surgery. This delay allows for resolution of postoperative edema and objective prediction of final eyelid position. The advantages of this “modified” levator advancement procedure are discussed.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Schwartz-Jampel syndrome is a rare disorder with prominent palpebral fissure changes. These changes are complex and have been described as ptosis, blepharophimosis, and blepharospasm. Two new cases of the Schwartz-Jampel syndrome and the results of elevating the upper eyelid margin with levator aponeurosis surgery are presented, along with a review of the literature.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Summary:Four patients with orbital apex tumors between the optic nerve and inferior recrus underwent a posterior inferior orbitotomy through the maxillary sinus. Three tumors were removed successfully and the fourth was not located, but the visual function improved after surgery, presumably owing to decompression of the posterior orbital floor. The technique was carried out through a standard Caldwell-Luc approach through the maxillary sinus. The posterior inferior orbital wall was removed and the inferior recrus was retracted either laterally or medially to gain access to the tumor, which was removed microsurgically. The authors believe this approach provides a reasonably safe alternative to remove small, well-circumscribed, inferior posterior orbital apical tumors. It also avoids dissection through the orbit from other directions with the inherent risks of damaging overlying vital structures.

ISSN:0740-9303    

出版商:OVID    

年代:1998

数据来源: OVID