Vertical lid split approach for optic nerve sheath decompression

We describe a vertical lid split orbitotomy approach to perform optic nerve sheath fenestration which was done in a patient with idiopathic intracranial hypertension. A vertical lid split incision was used to enter the superomedial orbit and approach the optic nerve sheath. This approach resulted in a successful nerve sheath fenestration, with improvement in the patient''s symptoms. The vertical lid split incision provides access to the optic nerve sheath with minimal morbidity and may be an option for optic nerve sheath decompression.     

Modified split level lid resection in ptosis

10 patients of congenital simple ptosis having 3 to 5 mm of ptosis with variable levator action were operated. All the patients showed a good response of lid lift after instillation of phenyl ephrine drops showing the activity of Muller's muscle. With this technique the lagophthalmos was minimal and good lid folds were formed in all cases. The skin muscle lamina was not excised and was utilized for formation of lid folds which were equal in depth and dynamic in nature. However, the lid lag which is an unavoidable complication of any ptosis surgery was present in the present technique also.     

Lesion-oriented orbitotomy

The surgical approach to orbital tumor removal is a matter of surgical strategy and preference. Different procedures have been developed, each with its pros and cons. The frontal selective orbitotomy for removal of orbital tumors is a versatile technique with physiologic cuts, relatively small incisions, lesion orientation, fast repair, and minimal trauma. Six case reports demonstrate the use of this technique and its advantages.     

Modified grey line split with anterior lamellar repositioning for treatment of cicatricial lid entropion

To determine the success rate of surgery of modified grey line split with anterior lamellar repositioning in patients with cicatricial lid entropion and to determine the risk factors of failure of the procedure, 40 patients (84 lids) with either lid involvement caused by cicatricial lid entropion of different etiologies were enrolled in this study. All the lids were operated on using the technique of modified grey line split and anterior lamellar repositioning. The success of the procedure was assessed by restoration of anatomical and physiological functioning of the lid without any residual symptom to the patient. Patients were examined initially at weekly intervals for 1 month and subsequently followed up at 2, 3, and 12 months following surgery. Among the various causes for cicatricial lid entropion, infectious etiology (72/84 lids) was found to be the most common one. A success rate of modified grey line split with anterior lamellar repositioning was 88.09% (74/84 lids). The underlying etiology of cicatricial lid entropion was the sole predictor of failure of surgery. Those with the etiology of infection had more than 6 times the odds of surgery failure (OR: 6.73; 95% CI: 2.79-16.73) as compared to a patient without infectious etiology. The role of other factors such as the age of the patient, degree of entropion, previous entropion surgery, the lid (upper or lower) involved, irregular lid margin, and defective lid closure were statistically insignificant. The underlying etiology of cicatricial lid entropion is the only risk factor that significantly influences the outcome of surgery with this technique. Otherwise, this procedure gives good results with fewer complications in patients with cicatricial lid entropion.     

現代外側開眶術

目的外側開眶術是治療眼眶中、後部腫瘤及泪腺腫瘤的一種標準術式,本文主要討論現代外側開眶術手術方法及適應癥.方法采用標準外側開眶,"S"形外側開眶和外側結合内側開眶術三種術式共做70例眼眶腫瘤.結果采用標準外側開眶適合于視神經以下腫瘤的切除(38例),"S"形外側開眶適合于視神經以上腫瘤的切除(28例),外側結合内側開眶適合于視神經周圍廣泛腫瘤的切除(4例).均獲較好效果.結論根據腫瘤的性質,位置和範圍采用不同術式的外側開眶.包括眶上、下緣的外側開眶使術野明顯擴大,提高J手術的成功率.     

外侧开眶术的临床疗效观察

目的：观察外侧开眶术的临床疗效。方法：采用标准外侧开眶、改良外侧开眶及外侧结合内侧开眶3种术式对武警总医院眼科1999年7月至2001年4月球后肌锥内及泪腺区肿瘤患者70例进行治疗,并观察其临床疗效。结果：标准外侧开眶术切除视神经及视神经下方肿瘤38例;改良外侧开眶术切除视神经上方及泪腺区肿瘤28例（包括眶上、下缘的切除）;外侧结合内侧开眶术切除视神经周围广泛肿瘤4例。术中全切肿瘤63例,3例行眼眶减压,3例血管畸形大部切除,1例眶尖海绵状血管瘤部分切除;眼球突出度：术后残余2mm眼球突出者3例,均为血管畸形。眼球内陷2－3mm者7例,均为体积较大肿瘤切除后所致,如海绵状血管瘤、血管畸形及泪腺肿瘤等。视力提高＞2行者31例,视力下降或丧失者6例,无变化者24例,失访9例未记录。眼球运动永久性障碍者7例,上睑下垂者2例。结论：应根据眼眶肿瘤的性质、位置及范围采取不同术式的外侧开眶术,包括眶上、下缘的骨瓣切除使术野扩大,并可明显提高眶内上和眶外上深部和眶尖肿瘤切除的成功率。     

Transconjunctival orbitotomy for orbital cavernous hemangiomas

BACKGROUND: Orbital cavernous hemangiomas, particularly those within the retrobulbar space, are approached by neurosurgeons as well as by ophthalmic surgeons. Several surgical techniques have been applied over the past decades. Less traumatic approaches in this functionally and cosmetically important region are desirable. We describe a transconjunctival approach in 39 patients with orbital cavernous hemangiomas. METHODS: Thirty-nine patients with orbital cavernous hemangiomas were treated with transconjunctival orbitotomy. The clinical and radiologic characteristics of orbital cavernous hemangiomas were analyzed in the course of their appropriate treatment. RESULTS: In all patients, cavernous hemangiomas were just behind the globe or were compressing it. Computed tomography and magnetic resonance imaging showed orbital cavernous hemangiomas as round, well-defined intraconal masses. In 37 cases, the tumors were removed intact, and only 1 patient suffered permanent vision loss as a result of intraoperative hemorrhage. In the other 2 cases, the tumor fragments were incompletely removed. Visual acuity increased in 6 of the 9 cases with primary visual impairment. Thirty-two patients with primary proptosis were resolved completely. Six patients with visual field defect were also improved. INTERPRETATION: Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach. However, if the tumor is close to, or touching, the orbital apex, adhering tightly to retrobulbar tissue, or combined with large draining veins, operation through other approaches must be considered.     

Lateral lid lysis for medial lid and medial canthus lacerations

Techniques are now being used to provide adequate healing time for medial lid and medial canthal full-thickness lacerations. Lateral upper and lower lid lysis allows the needed extended period of healing.     

开眶术后斜视的手术治疗

目的 分析开眶术后斜视的临床特点及手术治疗效果.方法 回顾性病例研究.回顾分析中山大学中山眼科中心自1998年3月至2003年7月期间住院行开眶术后斜视的诊治病例9例.其中男性5例,女性4例;年龄12～柏岁,平均26.4岁;右眼4例,左眼5例.全部病例随访1～3年(平均1.4年).常规行远、近标准E视力表检查.眼前后节行裂隙灯显微镜和眼底镜检查.眼位检查包括角膜映光法、同视机检查法和视野弧检查法等.结果 开眶术后发生的斜视需手术矫正者共9例.大部分为瘢痕粘连引起的限制性斜视,占66.7%.9例患者均采用手术治疗,术式包括受累肌瘢痕松解术、后徙术+缩短术、Jensen术等.术后眼位完全矫正6例,轻度欠矫2例,明显欠矫1例.4例术前有复视者,术后2例自觉复视消失,2例仅向某个方位有轻微复视,可耐受.所有患者眼球运动均较术前明显好转.结论 眼眶术后发生的斜视需手术治疗者多为瘢痕粘连引起的限制性斜视,松解并后退粘连的眼外肌联合对抗肌缩短术或直肌联结术或肌移位术,术终用固定缝线将眼位固定于过矫位可获得理想的矫正效果.     

A case of primary lid tuberculosis after upper lid blepharoplasty

Primary lid tuberculosis after lid surgery is a very rare condition and is likely caused by the introduction of bacilli through epithelial injury. Secondary infection, due to direct hematogenous spread or contiguous spread from adjacent structures are more common presentations of lid tuberculosis. The authors experienced a case of primary lid tuberculosis occurring in a 19 year old female after blepharoplasty for making a eyelid crease. Her upper lid skin showed a reddish and non-tender mass lesion measured 3x1 cm, which was diagnosed as the tuberculosis through typical histopathological findings (caseous necrosis), acid-fast bacilli stain and PCR, and treated with anti-tuberculosis medications.     

Nonpseudomonal ecthyma gangrenosum of the upper lid treated with lid reconstruction

Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2-year-old Asian Indian female presented to us with right upper lid edema with a large necrotic area. The child received intravenous cefotaxime for a week and the necrotic area turned to a well-defined eschar. Escharotomy with wound debridement and skin grafting was done. The present case highlights the importance of surgical intervention to prevent the sequelae of scarring of upper lid.     

Repair of an avulsed upper lid and partially severed lower lid.

We present a case in which trauma from a broken glass resulted in complete amputation of the upper lid and severe lacerations to the lower lid but with an intact and functioning globe. The avulsed upper lid was repaired as a composite autograft. The possible management of such an unusual case is discussed.     

The lateral triangle flap--a new approach for lateral orbitotomy

Lateral orbitotomy with or without removal of the lateral wall enables access to the extraconal and intraconal spaces of the orbit lateral to the optic nerve. We present the lateral triangle flap technique using an upper eyelid skin crease incision and skin incision from the lateral canthal angle joining together laterally at the outer margin of the lateral orbital rim, just beyond the lateral orbital margin. A triangular skin muscle flap is raised medially, based at the canthal angle, providing maximal exposure of the lateral and superolateral orbital wall. The deep lateral orbital wall can be burred away for lateral orbital decompression, or a bone flap removed for exposure of deep intraconal or extraconal lesions. The lateral triangle flap provides excellent exposure and postoperative cosmetic results.