CONGENITAL UPPER lid COLOBOMA

Twenty-two patients with congenital upper lid colobomas were assessed Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media A traction test is strongly recommended early in all children with congenital upper lid colobomas A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.     

Congenital upper lid coloboma

Twenty-two patients with congenital upper lid colobomas were assessed. Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media. A traction test is strongly recommended early in all children with congenital upper lid colobomas. A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.     

Congenital upper lid colobomas: management and visual outcome

PURPOSE: Congenital upper lid colobomas may be associated with ocular and systemic anomalies. The ophthalmologist's role involves both the diagnosis and management of their various ocular structural defects and management of the visual development. METHODS: All cases of congenital eyelid colobomas referred to the Singapore National Eye Centre between July 1992 and July 1995 were assessed for the extent of the eyelid defect, associated ocular anomalies, status of the cornea, and any systemic anomalies. RESULTS: Four infants were tested during this period. The mean follow-up was 25 months (range, 16 to 30 months). All required surgical correction of their eyelid defects before 2 years of age. The patients also had refractive errors requiring amblyopia management. Three of the babies also needed other surgical procedures. CONCLUSIONS: Congenital upper eyelid colobomas are a potential threat to vision at an early age and a significant cosmetic blemish later in life. Early surgical intervention is usually required when the defect is larger than one third of the eyelid margin. Close monitoring of the visual development of patients with congenital upper eyelid colobomas is also essential since the risk of amblyopia in these patients is high.     

Atypical oculoplastic surgery in children (author's transl)]

The problems of restorative surgery for inborn eyelid-alterations are indicated here with examples. The following experiences result. 1. Inborn eyelid colobomas without disfigurement of the inner canthus are in general readily correctable. 2. Inborn eyelid colobomas with a disfigured inner canthus and atresia of the canaliculi hardly ever permit the production of a cosmetically satisfactory inner canthus, and never permit a functionally satisfactory one. The use of lacoductorhinostomy, according to L. Jones, is problematic here. 3. The correction of inborn eyelid colobomas in the case of Goldenhar's syndrome is difficult because, due to additional dermoids and fibromas, irregular excisions become necessary. Thus, the lid margin becomes significantly deformed. A considerable temporal displacement of the skin cannot be avoided. 4. Any plastic correction of an inborn, genuine eyelid tumor is difficult, if the important structures of the eyelid--especially the tarsus and levator muscles--are only fragmentarily developed. In the case of the large, soft fibroma of the upper eyelid in neurofibromatosis, only a static eyelid in middle position can be accomplished. 5. Very often, motility problems arise in this connection. Both in Goldenhar's disease and in Recklinghausen's disease, primary dysplasis of the rectus externus muscle occurs.     

Transconjunctival Entropion Repair – The Backdoor Approach

Abstract

Purpose: To present a modified transconjunctival approach for involutional entropion repair.

Methods: This study is a retrospective consecutive single surgeon case series using a transconjunctival approach for involutional lower lid entropion (ILLE) repair.

Results: Eleven eyes were operated for involution entropion with 9 cases of complete resolution. Two patients required further Jones’ retractor plication.

Conclusion: Transconjunctival involutional lower lid entropion repair is a time-efficient, safe, and efficacious technique. The scar free technique described leads to full restoration of lower lid anatomy. In contrast to other reports we found a relatively low rate of recurrence on follow-up.     

Involutional ptosis

Aponeurotic defects and disinsertion of the levator aponeurosis are responsible for acquired involutional ptosis. The typical clinical findings in aponeurotic defects are high or moderate ptosis, good to excellent levator function, thinning of the eyelid above the tarsus, high to absent lid crease, and normal Müller's muscle function. The purpose of the treatment is to repair the defect or to advance the aponeurosis on the tarsus. This surgery can be done via the anterior approach with aponeurotic surgery or via the posterior approach with Müller's muscle conjunctival resection. In all cases, upper lid blepharoplasty is down.     

Rare oculo-rhino-auditive variants of the branchial arch syndrome Report of three cases with two necropsy records

Different kinds of optic disc deformities are considered in this paper. These optic disc deformities include the tilted disc, the morning glory syndrome, the optic pit and the typical coloboma. All of these optic nerve deforrnities are probably typical and atypical optic disc colobomas. A clinical approach of these typical and atypical colomobas included different tests: angiography, electrophysiology and psychophysics. The genetic characteristics of these colobomas are considered.     

Complicated eyelid reconstruction after an unusual glabellar flap repair

Remote flaps may be used for lid reconstruction when tissue loss is extensive and there is insufficient tissue in the adjoining areas. Median forehead flaps are usually used for upper lid, medial canthal or nasal repairs. We describe a complicated reconstruction of the lid and correction of a deformity which resulted from the injudicious use of a glabellar flap for lower lid repair. Improper use of a median forehead flap may interfere with the functioning of the lid, leading to corneal exposure and poor cosmesis. Lower lid defects are better repaired by advancement flaps or techniques like Tenzel's semicircular flap, reverse Cutler Beard, Hughes procedure or Mustarde's repair.     

Congenital iris coloboma repair using a modified McCannel suture technique

PURPOSE: To report a repair of congenital iris coloboma using a modified McCannel suture technique. DESIGN: Interventional case report. METHOS: Retrospective intervention procedure. RESULTS: Postoperative repair resulted in restoration of pupil, anterior support of posterior chamber intraocular lens, and improved appearance. CONCLUSIONS: The modified McCannel suture technique provides acceptable functional and cosmetic repair of congenital iris colobomas.     

Eyelid retractor surgery as an adjunct to cicatricial ectropion repair

Purpose : To evaluate the effectiveness of eyelid retractor repair in cicatricial ectropion of the lower eyelid. Methods : The study design was a prospective case series. One hundred and twenty eight eyelids were operated on in 100 consecutive patients with cicatricial ectropion. All patients underwent lower eyelid retractor repair via a conjunctival approach combined with skin replacement to the anterior lamella with or without a horizontal lid tightening procedure. When only medial ectropion was present, a medial‐based transpositional skin flap was used to repair the anterior lamella (26 eyelids). The remaining eyelids with ectropion involving all or most of the eyelid underwent upper‐to‐lower eyelid lateral‐based transpositional skin flap repair (92 eyelids), or full thickness free skin grafting (10 eyelids). Horizontal lid tightening was performed by lateral canthoplasty in 123 eyelids. Results : Relief of cicatricial ectropion symptoms was reported in 90% of patients overall. A normal punctum position was achieved in 70% of eyelids, overall, and was highest (88%) with a medial‐based transpositional skin flap. Conclusions : Eyelid retractor repair combined with skin replacement and horizontal lid shortening is an effective procedure for cicatricial ectropion.     

Dehiscence and disinsertion of the aponeurotic bundle of the upper eyelid levator in acquired ptosis

Aponeurotic defects and disinsertion of the levator aponeurosis are responsible for many cases of acquired ptosis. The typical clinical findings in aponeurotic defects are: history of prior orbital swelling, injury, ocular surgery, blepharochalasis; good to excellent levator function, thinning of the eyelid above the tarsus, high to absent lid crease, and normal Müller's muscle function. The purpose of the treatment is to repair a defect or advance the aponeurosis onto the tarsus. Levator aponeurosis surgery was used to treat 18 upper eyelids with acquired ptosis. Local anesthesia and surgery from an anterior approach were used in all cases. The advantages of this technique are: The lid height is determined by asking the patient to look in various fields of gaze. A blepharoplasty can be performed when necessary. The lid crease is formed. The exposition of the levator aponeurosis disinsertion is easier to recognize.     

The ophthalmic manifestations and treatment of the amniotic band syndrome

The amniotic band syndrome is an unusual cause of craniofacial deformities. The syndrome, which is initiated by rupture of the amnion, results in an unpredictable combination of compression deformities of the fetus, construction or amputation defects of the extremities, and craniofacial clefting deformities. The type and extent of ophthalmic abnormalities are dependent on the band location and timing. They include a combination of bony orbital clefts or hypertelorism; lid anomalies such as colobomas, ptosis, and ectropion; lacrimal outflow obstruction; and globe involvement. We review the clinical course of 14 patients diagnosed with, or suspected as having, this syndrome and describe the methods of treatment. In most instances, multiple surgical procedures were required to restore function. Satisfactory cosmesis proved more difficult to obtain.     

旋转易位皮瓣及颧颌皮瓣在下睑缺损整复中的应用研究

目的：探讨外伤及肿瘤切除等原因造成的下睑(前层及全层)缺损的Ⅰ期整复及再造方法在功能修复与外观美容等方面的作用。方法：对61例因外伤及下睑良、恶性肿瘤切除所致的下睑前层缺损或下睑全层缺损的患者分别选择旋转易位皮瓣或颧颌皮瓣修复缺损，观察近远期疗效及并发症。结果：术后皮瓣全部成活，色泽良好，活动度满意。结论：上述两种方法对于下睑缺损(不论缺损大小，深浅程度如何)均可完满修复，达到功能与外形的完美结合。     

Involutional entropion of the upper lid

Involutional entropion is an inturning of the eyelid margin caused by changes of lid tissues due to aging. Two patients with the uncommon finding of involutional entropion of the upper lid were treated with surgery based on the principles used to treat common lower lid entropion. The causes of lower lid entropion include increased horizontal and vertical lid laxity, and correcting these same factors in the upper lid resulted in a satisfactory repair of the entropion. Treatment of involutional entropion in the upper lid is compared and contrasted with that of the lower lid.     

对位睑板结膜瓣滑行修复眼睑缺损

目的：评价对位睑板结膜瓣滑行修复眼瞪缺损的效果。方法：对41例眼瞪全层缺损患者,其中上睑10例,下睑31例,切除肿瘤导致缺损者33例。外伤导致缺损者8例,缺损范围在1/3-2/3,年龄24-79岁,采用与缺损眼睑相对应的眼睑睑板结膜瓣滑行至缺损区来修补眼睑缺损。结果：术后随访31例,随访时间3月-5年,除缺损外,1例出现轻度上睑退缩（退缩量为1-2mm),1例出现轻度下睑外翻,余眼睑外形及功能均基本恢复,眼睑活动自如,闭合完全,无严重并发症发生,结论：对位睑板结膜瓣滑行可用于修复眼睑后层缺损,且不受有无睑板替代物的限制。不需另添手术创口,可更好地恢复眼睑的功能及外观。     

下睑缘入路治疗眶内下壁联合骨折

目的评价采用下睑缘切口治疗眶内、下壁联合骨折的效果。设计回顾性病例系列。研究对象18例眶内、下壁联合骨折的患者。方法所有患者均经下睑缘切口行眶壁骨折整复术,术中充分游离、保护泪囊,于眶内、下壁浅面植入复合羟基磷灰石人造骨片,术前、术后行双眶水平及冠状位CT、头面部三维cT检查并进行比较。主要指标临床症状及并发症。结果术后随访3～18个月,所有患者下睑皮肤瘢痕不明显,术后均未出现人造骨片排异或移位,无一例患者术后出现溢泪,复视、眼球内陷等症状均得到改善。结论单独采用下睑缘切口治疗眶内、下壁联合骨折是可行的,但仅适于眶下壁联合眶内壁下份骨折,尤其是伴发眶内、下壁隅角骨折的复合型骨折。     

Aponeurotic ptosis repair under local anesthesia. Prediction of results from operative lid height

The unpredictability of acquired ptosis repair is a difficult problem. Aponeurotic ptosis repair may be performed under local anesthesia, and past reports have suggested that operative lid position may be used to predict the final result. The authors prospectively studied 20 aponeurotic repairs under local anesthesia for patients with acquired ptosis and normal levator function. Photographs were taken during surgery, 1 week after surgery, and 3 months after surgery. Statistical analysis of vertical lid fissure measurements demonstrated a linear relationship between operative lid position and the 3-month result. When operative lid height was significantly greater than 10 mm, then a slight postoperative rise was observed, but when operative lid height was significantly less than 10 mm, then a slight postoperative fall was observed. Lid position at 1 week proved to be an excellent predictor of the 3-month result, establishing a reasonable basis for intervention in cases of overcorrection or undercorrection.     

The Aponeurotic Approach to Eyelid Retraction

A technique for the upper lid retraction that involves an anterior approach similar to aponeurotic ptosis surgery is presented. Instead of advancing the aponeurosis, it is recessed and Moller's muscle is completely extirpated. The lateral horn of the levator must be cut to relieve the marked temporal elevation of the eyelid. Lid height and contour are adjusted intraoperatively with patient cooperation. In the lower lid, the retractors are recessed via a conjunctival approach unless simultaneously performed with orbital decompression. Any amount of lid retraction may be corrected by this technique in the upper lid and up to 3 mm of lower lid retraction can be corrected. Lid height in both the upper and lower lid is lasting and predictable. Thirty-one patients (63 eyelids) have been operated on using this technique with good results. Results in 17 patients (35 eyelids) with follow-up ranging from 8 to 42 months are presented.     

Lid margin split in the surgical correction of epiblepharon

Purpose: To describe the technique of splitting the lid margin combined with the excision of redundant skin and muscle during the surgical correction of epiblepharon and to report its clinical outcome. Methods: A combined procedure that included splitting the lid margin to repair lower eyelid epiblepharon was performed on 31 eyes of 19 consecutive patients. Lid margin splitting was performed along the grey line on the medial third or half of the lower eyelid by making a 1 mm‐deep incision. Having made a transverse subciliary skin incision and a dissection between the tarsus and the orbicularis oculi muscle, the subcutaneous tissue of the superior edge of the incision was secured to the tarsus with interrupted sutures to evert the cilia. An excision of the redundant skin and orbicularis tissue was made and the skin was closed. The patients were followed for direct inspection of the wound, the split lid margin, the direction of the lashes and the status of the cornea. Results: The mean postoperative follow‐up period was 29.4 weeks. Symptoms disappeared in all patients. In 30 eyelids of 19 patients the cilia did not touch the cornea, even in the down‐gaze. In one eyelid the cilium touched the medial conjunctiva, but not the cornea. The cosmetic outcome of the lower lid was satisfactory in all cases and the wounds of the split lid margin healed without scarring. To date, there have been no complications such as wound dehiscence, ectropion or eyelid retraction. Conclusions: The lamellar splitting of the lid margin is a beneficial addition to the repair of prominent lower lid epiblepharon, especially on the medial aspect of the eyelid. This simple technique ensures easier eversion of the cilia in epiblepharon repair, without disturbing the posterior lamella or causing unfavourable results.     

Partial and Total Reconstruction of the Lower Eyelid

Our techniques for reconstruction of the lower lid are based on the maintenance of tarsal support in the reconstructed lid. The surgical approach is dictated by the position and extent of the defect produced by tumor excision. Lysis of the extension of the lateral canthal ligament to the lower lid allows closure of small, full-thickness defects. Mobilization of tarsal remnants by temporal advancement flaps provides for closure of larger defects. An advancement flap of split-thickness upper lid tarsus is combined with a pedicle flap of skin from the upper lid for total lower lid reconstruction.