Traumatic phacocele

We report a case of traumatic phacocele in a 42-year-old patient with a history of congenital glaucoma and bilateral goniotomies as an infant. Her left eye had little vision and poorly controlled intraocular pressure but was comfortable until her presentation after blunt trauma. Phacocele or subconjunctival dislocation of the crystalline lens is a rare consequence of blunt trauma, particularly in a patient whose only previous ocular surgery was goniotomy more than 40 years ago.     

A rare case of traumatic posterior phacocele with retinal detachment

Dislocation of crystalline lens into the anterior subconjunctival or subtenon''s space is a rare but known complication of blunt trauma. Dislocation into the posterior subtenon''s space is even rarer and can be associated with a complication such as occult scleral tear and retinal detachment. We report a case of traumatic posterior subtenon''s dislocation of crystalline lens after blunt trauma and its successful surgical management.     

Traumatic phacocele: review of eight cases

Blunt trauma can result in indirect scleral rupture with subsequent dislocation of the crystalline lens in the subconjunctival or subtenon space. This retrospective review of eight patients with traumatic phacocele highlights the clinical presentation, management and visual outcome. This study provides evidence that timely and effective intervention can ensure good visual recovery.     

Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens

PURPOSE: To report treatment of persistent corneal epithelial defects unresponsive to other therapies by extended wear of a fluid-ventilated gas-permeable scleral contact lens.METHODS: In this retrospective study, 14 eyes of 13 consecutive patients referred for the treatment of persistent corneal epithelial defects that failed to heal with conventional therapies or developed epithelial defects after penetrating keratoplasty for persistent corneal epithelial defects were fitted with an extended-wear gas-permeable scleral lens. These included seven eyes of six patients with Stevens-Johnson syndrome and seven eyes of seven patients who did not have Stevens-Johnson syndrome. Twelve eyes had undergone recent penetrating keratoplasty. All 14 eyes were fitted with a gas-permeable scleral contact lens designed to avoid the intrusion of air bubbles under its optic. An antibiotic and corticosteroid were added to the lens fluid reservoir or instilled before each lens insertion in 12 of 14 eyes. The lenses were worn continuously except for brief periods of removal for purposes of cleaning, replacement of the lens fluid reservoir, and examination and photography of the cornea.RESULTS: Five of the seven persistent corneal epithelial defects associated with Stevens-Johnson syndrome healed. The persistent corneal epithelial defects of four of these eyes re-epithelialized within 7 days, and a fifth healed in 27 days of gas-permeable scleral lens extended wear. A sixth persistent corneal epithelial defect that failed to heal initially re-epithelialized after a subsequent penetrating keratoplasty and gas-permeable scleral lens extended wear. The seventh eye healed after 3 days of gas-permeable scleral lens extended wear, but the persistent corneal epithelial defect subsequently recurred. Three of seven non-Stevens-Johnson syndrome persistent corneal epithelial defects re-epithelialized within 36 hours, 6 days, and 36 days, respectively. Of the six (six of 14) persistent corneal epithelial defects that failed to heal with a gas-permeable scleral lens extended wear, one subsequently healed after multiple amniotic membrane grafts. Microbial keratitis occurred in four eyes (four of 14) and graft failure in one eye, all of which required repeat penetrating keratoplasty.CONCLUSION: Extended wear of an appropriately designed gas-permeable scleral contact lens was effective in promoting the healing of persistent corneal epithelial defects in some eyes that failed to heal after other therapeutic measures. Re-epithelialization appears to be aided by a combination of oxygenation, moisture, and protection of the fragile epithelium afforded by the scleral lens. However, microbial keratitis represents a significant risk.     

Management of giant retinal tears without scleral buckling

Giant retinal tears have been repaired in six consecutive patients without the use of a scleral buckle. By using preoperative laser photocoagulation, pars plana vitrectomy with light choroidal cryopexy, pure C3F8 gas injection followed by postoperative positioning and supplemental laser, excellent anatomic and visual results have been achieved. The risk of proliferative vitreoretinopathy may be minimized using this technique.     

Evisceration with scleral modification

PURPOSE: To describe an evisceration technique that combines scleral modification with optic nerve release for coverage of any sized orbital implant. METHODS: The medical records of 70 patients who underwent the described evisceration procedure were reviewed. RESULTS: The average implant was 20 mm in diameter, with 50 patients (71%) receiving a solid polymethylmethacrylate sphere. Fifty-eight patients (83%) had a history of at least one previous ocular surgery, and 12 patients (17%) had phthisical eyes preoperatively with moderate to severe scleral cicatrization. Postoperatively, there were two cases of new or worsened ptosis, no cases of worsened motility, and no cases of implant extrusion. CONCLUSION: Evisceration with scleral modification is a simple and effective procedure that allows placement of any size orbital implant. Surgical results are excellent with few complications.     

Defect closure with scleral grafts

BACKGROUND: Excessively draining fistulas may lead to enucleation when primary suture closure is not effective. In these cases preserved cadaver tissues such as sclera, fascia lata, dura mater and peritoneum have been used for patch graft repair with variable results. In this study, the clinical outcomes after transplantation of scleral patch grafts have been investigated. METHOD: Twenty-eight eyes of twenty-seven patients underwent surgery with homologous scleral patch grafts for repair of excessively draining scleral fistulas after cataract surgery (n = 2), leaking filtering blebs following full-thickness filtration surgery (n = 7), large scleral perforations due to trauma (n = 7), corneo-scleral ulcerations due to severe eye burns (n = 9) or after radiotherapy of malignant melanoma (n = 3). The mean size of the rectangular grafts was 8.6 x 6.7 mm (+/- 2.8/3.1 mm). Clinical follow-up was up to 73 months (median 30 months). RESULTS: Twenty-three of 28 eyes (82.1 %) showed functional closure after initial surgery without any wound complication such as patch retraction or leakage and without evidence of inflammation. In five eyes surgical revision was necessary. Two of these eyes had to be enucleated due to uncontrollable dehiscence after the second operation. Two eyes were enucleated at the patient's demand due to pain. The fifth eye showed effective closure after the second operation. CONCLUSION: In our study scleral patch grafts were useful in adequately closing large corneo-scleral defects in 24 of 28 eyes (85.7 %). The antigen load and, therefore, the rejection of the scleral grafts is minimized due to the denaturation of proteins during the alcohol treatment before storage.     

转位皮瓣联合异体巩膜植入治疗外伤性下睑缺损

目的 探讨不同转位皮瓣联合异体巩膜植入在外伤性下睑缺损的临床效果.方法 选择因外伤致下睑全层缺损程度大于1/2,导致眼睑闭合不全,下睑呈退缩状态＞2mm的8例,采用不同部位的转位皮瓣代替下睑前层,异体巩膜植入和分离的残留穹窿结膜代替下睑后层,从而矫正缺损的下睑.结果 随访12 ～24个月,全部病例异体巩膜血管化,无溶解和排斥现象,皮肤活性好,下睑缘位于角膜下缘或稍高,无巩膜暴露,l例轻度下睑外翻,外观形态基本正常.结论 对于外伤所致大于1/2的下睑全层缺损,异体巩膜植入联合转位皮瓣治疗是一种有效方法.     

异体巩膜移植治疗眼睑恶性肿瘤术后睑板缺损的临床观察

目的：探讨异体巩膜移植在眼睑恶性肿瘤切除术后睑板缺损重建手术中的临床效果。

方法：对24例24眼眼睑恶性肿瘤术后睑板缺损长度大于1/2睑板的患者实施眼睑重建, 利用异体巩膜替代睑板,异体巩膜材料取自眼库。

结果：术后3～12mo随访,眼睑重建术后形态良好,未出现明显的异体巩膜溶解或排斥反应; 巩膜脉络膜面均被结膜细胞移行覆盖,异体巩膜与皮肤粘连紧密,缺损区修复完整。4眼出现睑缘轻、中度内翻后行眼睑内翻矫正。2眼出现不同程度睑球粘连,行睑球粘连分离手术。

结论：异体巩膜具有材质稳定性好、组织相容性佳、取材保存方便、手术操作简单易行等优点。术后眼睑功能良好、外观满意,是理想的睑板替代材料。     

Repair of scleral perforation with preserved scleral and amniotic membrane in Marfan's syndrome.

To describe the surgical technique used in the repair of a large scleral perforation in a patient with Marfan's syndrome and a past history of various surgical interventions in both eyes. Scleral homograft and amniotic membrane transplant were used to reconstruct the large scleral defect present in his left eye. One month after surgical intervention, the patient showed excellent restoration of the scleral perforation without signs of inflammation or infection. The combination of scleral homograft and amniotic membrane transplant constitute an effective alternative to autologous scleral and conjunctival grafts when these cannot be used.     

The efficacy of modified posterior scleral reinforcement with round scleral patches in Chinese children with high myopia

Graefe's Archive for Clinical and Experimental Ophthalmology - To observe the efficacy of modified Snyder-Thompson posterior scleral reinforcement with round scleral patches in Chinese children...