Temporalis muscle transfer: a vascular bed for autogenous dermis-fat orbital implantation

Nine patients with contracted avascular sockets who were unable to wear prostheses, and whose prospects for maintaining viable autogenous dermis-fat grafts were diminished, underwent temporalis muscle transfer into the orbit through a window in the lateral orbital wall. The temporalis transposition was used as a vascular bed for dermis-fat orbital implantation. Postoperatively, seven of nine patients were able to wear satisfactory prostheses and four of nine patients had amelioration of their superior sulcus deformities.     

Single-stage socket reconstruction with vascularised temporalis muscle flap following total orbital exenteration: Description of 3 surgical approaches

We describe the techniques and outcome of three different approaches to transfer the posterior 2/3^rd temporalis muscle pedicle flap for orbital socket reconstruction following total orbital exenteration. A retrospective interventional series of 9 patients operated between February of 2000 and 2006. We describe three different techniques, namely supraorbital, transorbital and transorbitectomy approach. All patients were followed for minimum of 3 years and muscle trophism with periorbital contour was clinically studied for outcome. There were 6 males and 3 females with a mean age of 42 years. Three patients each underwent the three mentioned approaches of socket reconstruction following total orbital exenteration performed mainly for oculo-adenexal malignancies with orbital extension (77.78%). Intraoperative, tumor-free histopathological margins were ensured. Postoperatively, bulky lateral orbital rim was noticed in all 3 patients of supraorbital approach, while progressive temporalis flap atrophy was noticed in all with transorbital approach over a period of 6 months. No such complications were observed in transorbitectomy approach and reasonably good periorbital cosmetic appearance with optimum preservation of muscle trophism was obtained. The mean follow-up period was 7 years. Temporalis muscle flap provides adequate orbital volume restoration in an exenterated socket. It also helps in better skin graft uptake, socket health and appearance. The transorbitectomy approach appeared as a reliable one stage surgical technique with reasonably acceptable anatomical and cosmetic outcome over a long-term follow-up. The choice of posterior portion of temporalis muscle as a flap offers satisfactory temporal fossa appearance.     

硅油继发青光眼的发病相关因素及治疗的初步探讨

探讨硅油继发青光眼的发病相关因素及治疗。方法对行玻璃体切割,硅油注入术的２７５例患者术后随访结果进行回顾性研究。结果硅油继发青光眼的发病率为１１．３％,随着硅油在眼内存留时间的延长,其发病率增高。     

硅油填充术后视网膜再脱离的分析与处理

目的探讨硅油填充术后视网膜再脱离的特点及处理方式。设计回顾性病例系列。研究对象55例(55眼)硅油填充术后视网膜再脱离患者。方法分析硅油填充术后视网膜再脱离患眼的临床表现,并分别采取硅油取出联合玻璃体视网膜手术、硅油下视网膜复位手术及单纯巩膜扣带术复位治疗,术后随访3个月。主要指标视网膜再脱离临床表现、视网膜复位情况及视力。结果硅油填充术后视网膜再脱离的特点为下方脱离为主,范围常小于2个象限,多伴有再增生及裂孔。50眼再次行手术治疗,39眼行硅油取出联合玻璃体视网膜手术,9眼行硅油下视网膜复位手术,2眼行单纯巩膜扣带术。随访期间,完全复位41眼(78％),部分复位7眼,未复位2眼。结论硅油填充术后视网膜再脱离较为复杂,需根据视网膜再脱离的特点,针对性地选择手术方法。     

上睑下垂双"V"形硅胶带额肌悬吊矫正术的设计

目的：探讨双“V”形硅胶带额肌悬吊矫正上睑下垂的手术方法。方法：33例（41眼）重度上睑下垂采用2条“V”形硅胶带将睑板与额肌相连接,利用额肌力量提起上睑。结果：术后上睑睑缘位于角膜上缘下1mm者36眼;2mm者5眼。术后早期上睑鼻侧1／3部分内翻10眼,自然恢复7眼,二次手术矫正3眼。结论：本法矫正上睑下垂,取材方便,手术时间短,损伤小,排斥反应,效果确切。     

Use of silicone oil in the management of complex retinal detachment -- an Indian experience

Background and objective: In the management of complicated retinal detachments (RD), temporary silicone oil tamponade has been increasingly used. This study reports results and complications of temporary silicone oil tamponade that was used to treat complicated RD associated with multiple etiologies. Materials and methods: Between 1988 and 1998, a total of four thousand four hundred and eighty-eight (4488) eyes underwent vitreous surgery and silicone oil tamponade. Outcome measures were: anatomic and functional success and postoperative complications such as cataract, corneal changes, hypotony, and glaucoma. An eye was considered an anatomic success if there was a complete retinal reattachment or macular attachment. Functional success was defined as attainment of visual acuity of 5/200 or better. Multiple logistic regression analysis was performed to elucidate the relationship between various pre- and postoperative variables and outcome measures. Mean follow-up was 17months, and median, 8months. Results: Overall, anatomic success was achieved in 73% of the eyes, and functional success, in 47%. After removal of silicone oil, recurrence of retinal detachment was observed in 9% of the eyes; a high percentage (70%) of eyes attained functional success. Postoperative cataract was observed in 65.3%, abnormal corneas in 21.3%, hypotony in 16.9%, and glaucoma in 16.4% of the eyes. Conclusions: Despite the onset of complications related to silicone oil usage, a high rate of reattachment of the retina was observed following vitrectomy and silicone oil tamponade in the management of complex RD associated with multiple etiologies.Address for correspondence: T. Sharma, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai 600 006, India. Phone: +91-44-2827-1616/9435/1036; Fax: +91-44-2821-0117; E-mail: drts@sankaranethralaya.org; tarusharma@eth.net     

Comparison of Densiron 68 and 1 000 cSt silicone oil in the management of rhegmatogenous retinal detachment with inferior breaks

AIM:To compare success rates and complications of Densiron 68 and 1000cSt silicone oil (SO) in the management of rhegmatogenous retinal detachment (RRD) with inferior breaks (IBs).METHODS:Totally 61 eyes of 61 consecutive patients with RRD with IBs were assigned to pars plana vitrectomy (PPV) with Densiron (n=31) or PPV with SO (n=30) in order of presentation. SO and Densiron removal was performed 3 months after initial surgery. Follow up visits were terminated 6 months after SO removal.RESULTS:With a single operation, the Densiron group showed 84% and SO 74% reattachment. With further surgery, both groups showed 90% re-attachment. Complications such as cataract, raised intraocular pressure (IOP), inflammatory reaction, macular epiretinal membranes, and emulsification of SO were seen in both groups.CONCLUSION:Densiron and SO are found to have similar success rates and complications.     

硅油填充治疗外伤感染性眼内炎伴视网膜脱离

目的 探讨硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的效果和影响因素。方法 回顾性分析1995年1月至2002年12月，我院眼科行硅油填充治疗外伤性感染性眼内炎伴视网膜脱离的16例16眼临床资料。结果 感染性眼内炎均得到控制。视网膜完全复位11眼(68．8％)，限局性视网膜脱离3眼(18．8％)，完全脱离2眼(12．5％)。术后视力光感-0．04者11眼，≥0．05者5眼。结论 应用硅油填充术能够有效地治疗外伤性感染性眼内炎伴视网膜脱离，术后并发症主要是视网膜脱离复发和增生性玻璃体视网膜病变(PVR)。     

两种类型泪道引流管治疗儿童泪小管断裂的临床观察

目的:观察RS-1型泪道引流管与常规硅胶泪道引流管治疗儿童泪小管断裂的临床疗效。方法:回顾性分析2015-01/2018-06河北省眼科医院眼外伤科儿童泪小管断裂患者48例48眼,按治疗方法分成两组:A组(常规硅胶泪道引流管组)25例25眼,B组(RS-1型泪道引流管组)23例23眼;两组患者均在全身麻醉下行泪小管断裂吻合术,术后3mo拔管,比较两组患者手术时间、临床疗效及并发症。结果:A组手术时间为44.92±14.45min,B组为31.78±7.40min(t=4.02,P<0.01);A组:20眼治愈(80%),2眼好转(8%),3眼未愈(12%),治疗有效率为88%;B组:19眼治愈(82%),2眼好转(9%),2眼未愈(9%),治疗有效率为91%(χ2=0.14,P>0.05)。并发症情况:A组下泪点及眼睑轻度外翻1眼(4%),泪小管撕裂2眼(8%),泪道置管脱落2眼(8%),鼻黏膜损伤3眼(12%),并发症总发生率32%;B组:下泪点及眼睑轻度外翻1眼(4%),泪小管撕裂1眼(4%),并发症总发生率9%(χ2=3.94,P<0.05)。结论:RS-1型泪道引流管与常规硅胶泪道引流管在儿童泪小管断裂吻合术中应用效果均良好,但RS-1型泪道引流管操作更简便,手术时间更短,并发症更少,更容易拔管。     

再次玻璃体手术治疗硅油填充眼视网膜脱离

目的:探讨再次玻璃体手术治疗硅油填充眼视网膜脱离的效果。方法:对12例硅油填充眼视网膜脱离患眼行再次玻璃体手术,其中下方视网膜脱离10例,黄斑裂孔复发2例。结果:12例术后视网膜全部复位,10例3～6mo取出硅油。最佳矫正视力提高4行1例,提高3行4例,提高2行3例,提高1行3例,不提高1例。结论:再次玻璃体手术是治疗硅油填充眼视网膜脱离的有效方法,早期手术有重要意义。     

Comparison of the antimicrobial effect of heavy silicone oil and conventional silicone oil against endophthalmitis-causing agents

Purpose:

To conduct an in vitro experimental study comparing the effectiveness of conventional silicone oil and heavy silicone oil against endophthalmitis-causing agents.

Materials and Methods:

The antimicrobial activity of conventional silicone oil (RS OIL 5000) and heavy silicone oil (heavySil 1500) was tested. The antimicrobial effects of both silicone oils were determined by the growing capability of the microorganism.

Results:

The number of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans decreased to zero levels at the second day of inoculation in heavy silicone oil. In conventional silicone oil, the microorganisms survived longer than in heavy silicone oil.

Conclusion:

Heavy silicone oil seems to be more effective than conventional silicone oil against endophthalmitis-causing agents.     

Surgical management of silicone oil migrated into suprachoroidal space after vitrectomy

AIM: To report a successful surgical management of silicone oil migrated into suprachoroidal space after the repair of the retinal detachment with hemorrhagic choroidal detachment. METHODS: Retrospective observational case report. A 30-year-old man with retinal detachment and hemorrhagic choroidal detachment due to severe corneal penetrating injury, underwent a pars plana lensectomy and vitrectomy, endolaser, and silicone oil tamponade followed by transscleral suprachoroidal hemorrhage drainage in the right eye. One week later, a localised temporal choroid elevation was noted. This persistent elevation was confirmed by operation research to be silicone oil migration into suprachoroidal space. RESULTS: The migrated silicone oil was drained via trans-scleral cut down, and the intravitreal silicone oil was removed and replaced by 16% C2F6. Over the next 2 weeks, the elevation vanished and the choroid became completely flat. CONCLUSION: The migration of silicone oil into suprachoroidal space is a rare complication of vitrectomy. The pathway of the migration is most likely through internal orifice of sclerotomy sites. Trans-scleral drainage surgery is an effective method to remove the migrated silicone oil from suprachoroidal space.     

硅油填充眼的白内障超声乳化术

目的:评价硅油填充眼的白内障超声乳化手术的治疗效果。方法:对30例(30眼)玻璃体切割术后硅油填充眼患者实施白内障超声乳化联合人工晶状体植入术,观察术后视力、并发症等。结果:术后3mo最佳矫正视力≥0.1共22眼,视力增进2行以上者22眼,占73%,术后2例再次出现视网膜脱离。结论:硅油填充眼并发白内障的治疗中,超声乳化手术虽然手术难度较大,但仍是最安全有效的方法,能使患者达到或接近玻璃体切割术后的最佳视力。     

新型硅胶管逆行置管治疗少儿泪小管断裂的疗效分析

目的：观察新型硅胶(RS-1型)泪道引流管逆行置管治疗少儿泪小管断裂的临床效果。

方法：回顾性分析于2016-03/2019-11邯郸市眼科医院及邯郸市中心医院收治的37例37眼泪小管断裂患者的临床资料。所有患者术中逆行植入新型硅胶管,8-0可吸收缝线吻合泪小管断端,6-0可吸收缝线间断吻合“内眦韧带-眼轮匝”复合体,间断缝合肌肉、皮下组织、皮肤伤口及结膜面伤口。术后2～3mo拔管,随访6～12mo,观察泪道通畅情况及溢泪症状。

结果：泪小管断裂37眼中,临床治愈31眼(84%),好转5眼(14%),无效1眼(3%),总有效率达97%。所有患者均未发生泪小点撕裂、泪小点位置异常、成角畸形等相关并发症,无效1眼(3%)为合并骨性泪小管骨折,无明显溢泪症状。

结论：新型硅胶管逆行置管具有操作简便、术后刺激轻、置管状态安全、吻合效果显著等特点,逆行置管能较好保护泪小点。     

硅油眼复发性视网膜脱离的特点及临床处理

目的 探讨硅油眼复发性视网膜脱离的特点及手术方法的选择.方法 回顾性分析本院2012年1月至2015年12月硅油填充术眼复发视网膜脱离者134例(134眼),采用玻璃体切割联合硅油置换术或巩膜外加压术治疗,术后随访6个月,评价手术效果.结果 101眼采用玻璃体切割联合硅油置换治疗,术后79眼视网膜复位,22眼视网膜复位失败者再次行玻璃体切割手术,成功率为78.2％ (79/101);视力提高者16眼,不变者56眼,下降者29眼;眼压升高超过25 mmHg(1 kPa=7.5mmHg)者31眼.33眼采用巩膜外加压治疗,23眼视网膜复位,10眼术后随访中发现视网膜未复位而改行玻璃体切割联合硅油置换术,成功率为69.7％ (23/33);视力提高者5眼,不变者16眼,下降者12眼;眼压升高超过25 mmHg者14眼.结论 对于下方或较周边的裂孔导致的局限性视网膜脱离,增生性玻璃体视网膜病变处于A或B级,屈光介质不影响眼底检查的病例,可选巩膜外加压术;对于裂孔位于后极部或较大裂孔导致的大范围视网膜脱离,并有较广泛的视网膜增殖或视网膜固定皱襞形成,建议选玻璃体联合硅油置换手术,松解牵拉,填充硅油.     

硅油填充术后继发青光眼的原因分析及治疗

目的 统计经睫状体平坦部玻璃体切除术联合硅油填充治疗复杂性视网膜脱离患者出现高眼压的发生率,并分析其病因,探讨其治疗方法。方法 对56例（56眼）行玻璃体切除术联合硅油填充患者进行随访观察。结果 56眼中的21眼（占37.5%）出现了眼压升高。其中,6眼仅用抗青光眼药物治疗,用药后眼压为6.0～38.5mmHg;15眼行青光眼手术治疗,术后眼压为6.0～19.5mmHg。结论 本组硅油术后继发青光眼发病率为37.5%,其中一部分可以用抗青光眼药物治疗,而对药物无效的患者经手术治疗,病情均能得到良好控制。     

下斜肌部分切除术治疗先天性上斜肌麻痹

目的探讨下斜肌部分切除术治疗先天性上斜肌麻痹的效果。方法观察17例接受下斜肌部分切除术治疗的先天性上斜肌麻痹术前术后9方位眼位，歪头试验及代偿头位的变化。结果垂直眼位变化小于15^△的先天性上斜肌麻痹患者术后眼位及代偿头位均恢复，大于15^△的仍残留部分眼位异常及代偿头位。结论下斜肌部分切除术对垂直眼位变化小于15^△的先天性上斜肌麻痹有效。