Surgical approaches used in the reconstruction of the eyelids after excision of malignant tumors

The choice of reconstructive technique for eyelid defects after malignant tumors was based on tumor location and defect size after tumor excision. Treatments included direct closure for defects measuring less than 25%, Tenzel flap for defects measuring 25–50%, lid-sharing procedures for defects measuring more than 50%, skin grafts for tumors affecting the inner canthus advancement flap for outer canthus tumors, and orbital exenteration for malignant tumors demonstrating orbital invasion. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacture or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or diveces.     

眼睑恶性肿瘤的临床分析

目的 :探讨眼睑恶性肿瘤的发病特点和治疗效果。方法 :按病理诊断对我院近 10年手术摘除的眼睑肿瘤做一回顾性分析。结果 :总计眼睑恶性肿瘤 5 2例 5 3眼 ,占全部眼睑肿瘤的 2 1 1%。男性 3 0例 ,女性 2 2例 (约 1 3∶1)。年龄 44～ 81岁 ,平均60 5岁。病程 3个月～ 2 0年。发生在下睑者为多 (2 8眼 ,5 2 8% )。其中居前三位者为基底细胞癌 (2 4眼 ,45 3 % )、睑板腺癌(14眼 ,2 6 4% )、鳞状细胞癌 (11眼 ,2 0 7% )。平均发病年龄依次为 63岁、 60岁和 5 6岁 ,平均病程依次为 6年、 2 0个月和1年。其中基底细胞癌发生在左下睑 13眼 (5 4 2 % ) ,睑板腺癌上睑 11眼 (68 8% ) ,鳞状细胞癌左下睑 7眼 (63 6% )。随观3 8眼 ,复发 5眼 ,死亡 3例。结论 :上述三种主要恶性眼睑肿瘤均以老年发病为主 ,其发病年龄依次下降 ,病程依次缩短。发病部位各有特点 ,治疗以手术为主。     

Treatment of eyeball and ocular appendages malignant tumors]

Based on the results of her observations, the author demonstrates the advantages of organ-sparing treatment.     

Surgical management of deep chemical burns of the eyelids

Chemical burns of the eyelids are common, and this may lead to ocular damage. A direct insult of the eyes that result in permanent damage, is rare in facial burns. The majority of the chemical burns of eyelids are partial-thickness that heal spontaneously in 1 week. Whereas, 10 percent are full-thickness burns that require release of contractures and grafts. Wound contracture can cause ectropion of the eyelid, resulting in exposure keratitis, conjunctivitis, corneal ulcers, perforation, and even blindness. At our departments, thirteen patients with 28 chemical burns of eyelids of third-degree, were reviewed. The eyelids had burns wounds with granulation and necrotic tissue. All patients had severe cicatrical ectropion. The eyelids were released with incisions running along the eyelid margin, down to the orbicularis muscle, including the distal part of the levator palpebrae superioris muscle, when necessary. To cover the resulting defects, we use generous full-thickness skin grafts, if available, for both the upper and lower eyelids. Rarely has a tarsorrhaphy been required, and properly constructed dressing provides satisfactory eyelid margin immobilization and conjunctival hygiene. Eighteen full-thickness grafts in 10 patients are reported 8 to 12 weeks after grafting. In seven eyelids, 3 patients developed ectropion and required reconstruction of the eyelids. Our series demonstrates that the early grafting of eyelid burns with full-thickness grafts, can prevent the development of recurrent cicatrical ectropion. Split-thickness grafting should be limited to cases where we can not find the hairless donor site for full-thickness skin grafts.     

眼睑恶性肿瘤切除术后异体巩膜移植的眼睑再造

目的：探讨眼睑恶性肿瘤切除术后异体巩膜移植的眼睑再造手术效果。方法：采用保存的异体巩膜代替睑板，对28例眼睑恶性肿瘤切除术后进行眼睑再造术，6例皮肤除较大，行皮瓣转位及游离植皮，4例外眦韧带切除者，将巩膜移植片外侧延长固定于眶骨缘以代替外眦韧带，术后随访3－72月，平均37．5月。结果：28例术后均未见排异反应，眼睑外观满意；运动自如，闭合良好，结论：较大的眼睑恶性肿瘤切除的患者采用异体巩膜移植眼睑再造术，能达到保持眼睑功能和美容的效果。     

Long-term results of xenoscleroplasty of the posterior pole of the eyeball in the treatment of patients with progressive myopia

The study deals with the development of an effective, atraumatic and easy-to-use treatment for patients with progressive myopia, by using a discoid xenograft. The treatment involves implantation of a discoid xenograft to the episclera of the posterior pole of the eye. The xenograft is a white disk prepared from the treated bovine pericardium and it has 2 mm in thickness and a diameter of 13 mm. Clinical studies were performed in 89 patients (161 eyes) operated on by the proposed procedure, by evaluating the stabilized progression of myopia 4 years later. In the late period of a follow-up, the stabilization effect was 88.3 to 92.6% in relation to the degree of myopia. There was evidence for increases in the thickness of the sclera (and its acoustic density) on the posterior pole of the eye, for improved regional hemodynamics and better electrophysiological functions of the retina in the postoperative period. Xenoscleroplasty of the posterior pole of the eye with a bovine pericardial xenograft is an easy-to-use, pathogenetically oriented, highly effective, and safe treatment in patients with progressive myopia.     

Long-term outcome after treatment with 5% topical imiquimod cream in patients with basal cell carcinoma of the eyelids

Background  

Basal cell carcinoma (BCC) is the most common malignancy of the skin and of the eyelid in the Caucasian population. Our study evaluated the long-term results of 5% imiquimod cream therapy for nodular BCC of the eyelid as an alternative to surgical approaches.     

儿童眼球穿孔伤咪唑安定滴鼻辅助麻醉临床观察

目的　探讨避免儿童眼球穿孔伤术前恐惧及哭闹不安 ,导致眼压增高和眼内容脱出的麻醉方法。方法　 40例儿童眼球穿孔伤随机分成 2组 :A组经鼻滴咪唑安定 (midazolam) ,3 0分钟后肌注氯氨酮 5mg/kg ;B组直接肌注氯氨酮 5mg/kg。结果　咪唑安定滴鼻组 ,患儿肌注氯胺酮时哭闹发生率为 2 5 %,B组为 95 %,两组之间差异有非常显著意义 (P <0 0 1)。咪唑安定滴鼻 ,还可减少术中氯胺酮用量 ,不影响术中SpO2 、不延长术后苏醒时间。结论　儿童眼球穿孔伤 ,肌注氯氨酮前经鼻滴入咪唑安定 ,镇静效果好 ,患儿哭闹少 ,可有效地减少和避免眼压增高引起的眼内容脱出 ,且可减少术中麻醉用药     

Lacrimal duct treatment with ring intubation in injuries of the upper and lower eyelids

Background. Treating injuries of the lacrimal system with a silicon intubation is an approved method to prevent post-traumatic epiphora. Materials and methods. Between 1990 and 1999, operations were carried out on 44 patients with injuries of the canaliculi with silicon ring intubations. Interesting for us were the age distribution, causes of injuries, localisation and mid- to long-term postoperative complications. Results. The age of the patients was between 1.75 and 74 years, 48% of the injuries were caused by household accidents, 23% by violence, 20% by traffic accidents and 9% by job-related accidents. The canaliculus inferior was injured in 68% of all patients. We found 10 postoperative complications, e.g. ectropia, a too long silicon ring or granuloma. We found a positive anatomical readapted lacrimal system in 88% and 12% of our patients complained of distinct to severe epiphora. Conclusions. The treatment of lacrimal laceration with a silicon intubation is an excellent method but special care should be taken with correct positioning of the lid margin.     

Histological findings in the eyelids of AIDS patients.

PURPOSE: The eyelids of 15 AIDS patients (17 specimens) were examined histologically at postmortem. METHODS: Formalin-fixed, paraffin-embedded and haematoxylin-eosin stained sections were examined by conventional light microscopy. The presence of calcific deposits was confirmed by special stains and elemental analysis (X-ray energy dispersive spectroscopy). RESULTS: 6 cases had abnormal microscopical findings. In two cases deposits of calcium oxalates were observed in the wall of dermal blood vessels and in epithelial cells of sweat and sebaceous glands, respectively. Precipitates of calcium phosphate were observed in the superficial substantia propria of the palpebral conjunctiva in an additional patient. Other histological findings in the remaining three patients included flat warts, an unusual elastotic degeneration of the forniceal palpebral conjunctiva and more common lesions (chalazion, Demodex folliculorum infestation of the eyelashes, trichilemmal cyst). CONCLUSION: The presence of microscopical lesions in nearly half of this small series demonstrates that the eyelids may be affected subclinically in AIDS patients.     

A new pyrimidine-series preparation in the treatment of experimental chemical eye burns

The effectiveness of a substance of a group of pyrimidine derivatives LUS-3 has been studied in 87 rabbits (174 eyes) with chemical burns of the cornea of degree III. In parallel series of experiments, its action was compared with one of traditional methods of treatment of eye burns using sodium sulfacetamide in combination with subconjunctival injections of autologous blood with penicillin as well as with a pyrimidine derivative--methyluracil. The assessment of the effectiveness of the preparations was made by the picture of the clinical course as well as by data of histologic investigations. The results obtained have shown a pronounced effectiveness of the preparation LUS-3: it accelerated regenerative processes, prevented development of secondary infection, and, as a result, conditioned formation of low-intensive opacifications of the cornea.