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Singh S, Malhotra R, Watson SL. Mucous membrane grafting for cicatricial entropion repair: review of surgical techniques and outcomes. Orbit 2023:1-10. [PMID: 37155333 DOI: 10.1080/01676830.2023.2204498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Mucous membrane graft (MMG) is used for moderate-to-severe cicatricial entropion repair either in primary or recurrent cases. We conducted a review to comprehensively summarize the various surgical techniques, outcomes, and complications of using MMG for cicatricial entropion. Though the comparison between different techniques is limited by multiple factors like small numbers of cicatricial entgropion patients, variable severity and success criteria across studies, and different underlying cicatricial entropion etiologies, the author has brought forth the nuances of the use of MMG for cicatricial entropion repair along with its outcomes and complications. MMG use in moderate-to-severe cicatricial entropion gives favourable outcomes. The shortened tarsoconjunctiva is lengthened using MMG, which is used either with terminal tarsal rotation or anterior lamellar recession (ALR) or tarsotomy alone. Non-trachomatous entropion has poor outcomes compared to trachomatous entropion. The most common source of MMG is labial or buccal mucosa and the exact size of MMG harvested is variable according to the defect, and very few prefer oversizing the graft by 10-30%. The outcomes of ALR+MMG appear similar to tarsal rotation and MMG for severe cicatricial entropion. The recurrences of trichiasis or entropion can occur for up to one year after surgery, irrespective of the technique used. Factors affecting the outcomes of cicatricial entropion repair are not well known. There is a non-uniformity in data reporting across literature; hence, future studies with details on severity of entropion, ocular surface changes, forniceal depth and ocular surface inflammation, and the degree of dry eye disease would be informative.
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Affiliation(s)
- Swati Singh
- Ocular Surface & Adnexa Services, LV Prasad Eye Institute, Hyderabad, India
| | - Raman Malhotra
- Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, India
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Shree N, Das S, Arya D, Srivastava A, Singh A, Sangwan V. Single-Staged Surgical Correction of Eyelid Sequelae Along With Lid Margin Mucous Membrane Grafting in Stevens-Johnson Syndrome and Other Cicatricial Ocular Surface Diseases. Cornea 2023; 42:404-411. [PMID: 35543574 DOI: 10.1097/ico.0000000000003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to study the outcome of single-staged entropion surgery along with lid margin mucous membrane grafting for cicatrizing ocular surface disease. METHODS Retrospective review of medical records of patients who underwent single-staged surgical correction of cicatricial entropion along with lid margin mucous membrane grafting for lid margin keratinization. RESULTS Twenty-six eyes of 19 patients were studied. The mean age of patients was 42.5 years (standard deviation, SD-17.67), of which 7 patients were male and 12 were female. The most common disorder was Stevens-Johnson syndrome (SJS) sequelae (83.33%, n = 20), followed by mucous membrane pemphigoid (n = 4, 16.67%). The most common eyelid changes observed were cicatricial entropion in all 26 eyes (100%, n = 26), followed by trichiasis in 13 eyes (50%, n = 13). Lid margin keratinization was noted in all eyes. Postoperative improvement in corneal surface staining was noted in 70% of the patients (n = 13), no change in 20% of the patients (n = 4), and worsening of corneal surface staining in 10% of the patients (n = 2). Postoperative visual acuity improvement was noted in 50% of the eyes (n = 13), no improvement in 39% of the eyes (n = 10), and vision worsened in 12% of the eyes (n = 3). An entropion recurrence rate of 25% (n = 6) was observed over an average 10-month follow-up, whereas 75% (n = 20) reported no recurrence. CONCLUSIONS Single-staged correction of eyelid cicatricial entropion with a lid margin mucous membrane graft (MMG) has promising outcomes in ocular surface diseases. It can decrease the need for multiple surgeries and provide symptomatic relief in patients with chronic cicatricial surface changes.
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Affiliation(s)
- Neha Shree
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; and
| | - Sima Das
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; and
| | - Deepanjali Arya
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; and
| | - Ankit Srivastava
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India; and
| | - Aastha Singh
- Cornea and Anterior Segment Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender Sangwan
- Cornea and Anterior Segment Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
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3
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Zhang S, Shao C, Chen J, Yao Q, Lu Y, Li J, Fu Y. Ophthalmic features and management of 86 patients with cryptophthalmos-A refined classification to assist in surgical planning. J Plast Reconstr Aesthet Surg 2022; 75:2259-2265. [PMID: 35305918 DOI: 10.1016/j.bjps.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/23/2021] [Accepted: 02/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS This study aimed to describe a cohort of patients with cryptophthalmos (CO), characterize associated oculofacial abnormalities, and expand the classification to summarize surgical strategies for managing CO. METHODS A retrospective, interventional case series was conducted on 86 patients (124 eyes) with CO. The study proposed further classifying complete and incomplete CO into cyst, microphthalmia, anophthalmia, and normal eyeball based on globe structures and then modifying surgery accordingly. The demography, ophthalmic features, systemic anomalies, operation methods, and treatment outcomes were reviewed. RESULTS CO was complete in seven eyes (5.6%) and incomplete in eight eyes (6.5%). A total of 109 eyes (87.9%) of abortive CO were encountered. Among 15 eyes (13 patients) of complete and incomplete types, 9 (60.0%) eyeballs were identified as cysts, 3 (20.0%) as microphthalmia, 1 (6.7%) as anophthalmia, and 2 (13.3%) as normal eyeballs. Cyst reduction was performed in eight eyes and one patient underwent enucleation with hydroxyapatite implantation. The socket was fit with an ocular prosthesis or a conformer after fornix and eyelid reconstruction. Microphthalmia was enucleated, and hydroxyapatites were implanted; patients were fit with ocular prosthesis or conformer after fornix and eyelid reconstruction. A complete CO with normal eyeball was reported with the eyesight of hand movement after ocular surface reconstruction. The upper eyelid contour and adequate fornix were maintained after coloboma repair and fornix reconstruction in all patients with abortive CO. CONCLUSION This study demonstrates the clinical manifestations of different types of CO and expands the manifestation spectrum, proposing a refined classification of CO and modifying surgical strategies accordingly.
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Affiliation(s)
- Siyi Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Chunyi Shao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Junzhao Chen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qinke Yao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yang Lu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jin Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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4
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Kam AW, Go CZ, He G, Veivers D, O'Donnell B. Nasal turbinate mucosal graft for management of contracted anophthalmic socket. Orbit 2021; 42:323-326. [PMID: 34847840 DOI: 10.1080/01676830.2021.2005633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 67-year-old Caucasian male presented with severe contraction of socket lining 8 years after enucleation, dermis fat graft and successful ocular prosthesis fitting. Following two failed attempts at using amniotic membrane grafts to reform the socket lining, a total socket reconstruction was attempted using a novel nasal turbinate mucosal graft technique. This was performed in a staged fashion with lower fornix reconstruction followed by upper fornix reconstruction 3 months later. The patient was stable at 12 months review, with a satisfactory cosmetic outcome. Nasal turbinate mucosa was used as it was surgically accessible, provided natural socket lubrication due to its mucosal surface, and avoided oral mucosa and its associated morbidity. This case report suggests that nasal turbinate mucosa is a suitable autologous grafting material for total socket reconstruction in contracted anophthalmic sockets.
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Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Christopher Zq Go
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - George He
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - David Veivers
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Brett O'Donnell
- Department of Ophthalmology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Ma Y, Tang M, Kikkawa DO, Lu W. Correction of lower eyelid retraction combined with entropion in thyroid eye disease patients of East Asian ancestry. Eur J Ophthalmol 2021; 32:2475-2480. [PMID: 34334010 DOI: 10.1177/11206721211035613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study evaluates causes and treatment of lower eyelid retraction with co-existing entropion in Thyroid Eye Disease (TED) patients of East Asian ancestry. METHODS The medical records for 25 eyelids from 15 TED patients with lower eyelid retraction and entropion who had undergone combined orbital decompression and lower eyelid retraction correction surgery at the Second Hospital of Dalian Medical University from January 2017 to December 2018 were prospectively reviewed. We build a numerical model of biomechanics to analyze von Mises stress and displacement at the lower eyelid. RESULTS The mean follow-up duration was 6 ± 2 months. The difference of mean exophthalmos was 5.16 ± 1.21 mm (t = 21.26, p = 4.479E-17 < 0.05). The difference of mean MRD2 was 1.9 ± 0.14 mm (t = 67.57, p = 6.751E-29 < 0.05). About 2 of 25 eyelids entropion recurred postoperatively; the overall success rate was 92%. The biomechanical analysis results reveal that the eyelid margin is given more stress and caused more displacement in East Asian ancestry under the same force of pressure. CONCLUSIONS This study shows that the lower eyelid retraction with coexistent entropion is attributable to the unique anatomical features of patients of East Asians ancestry. We corrected the lower eyelid retraction and entropion during the orbital decompression operation. The results show that this method is safe and effective. It can simultaneously improve the symptoms of TED patients such as exophthalmos, lower eyelid retraction, and entropion, with minimal complications.
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Affiliation(s)
- Yue Ma
- Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Meiting Tang
- Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | | | - Wei Lu
- Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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Singh S, Narang P, Mittal V. Labial mucosa grafting for lid margin, anterior lamellar, and posterior lamellar correction in recurrent cicatricial entropion. Orbit 2020; 40:301-305. [PMID: 32586179 DOI: 10.1080/01676830.2020.1782439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To report a novel modified technique for severe recurrent cicatricial entropion correction based on anterior lamellar recession (ALR) and grafting. METHODS Six eyelids of five patients (9-48 years; three females) with severe cicatricial entropion (three upper and three lower eyelids) had surgical correction using ALR and labial mucosal grafting for spacing the ciliary margin away from the lid margin and reconstruction of the lid margin and posterior lamella. The modified technique included using mucous membrane as a single unit for anterior lamella, lid margin, and posterior lamella reconstruction employing a different suturing technique. RESULTS The indications for surgery included Stevens-Johnson syndrome (3), chemical injury (2), and post-surgical scarring in congenital distichiasis with lymphedema (1). Entropion resolved in all patients with restoration of eyelid margin and reduction in ocular discomfort. Trichiasis was present in all six eyelids (100%) preoperatively and resolved completely in all but one case (83% success rate) with three residual focal trichiatic lashes in the temporal area, which was successfully managed with radiofrequency ablation. There were no recurrences of trichiatic or distichiatic lashes at a median follow-up duration of 16 months (range, 12-18 months). CONCLUSION Successful resolution of the recurrent cicatricial entropion can be achieved with the use of labial mucosa as one solution for spacing the anterior lamella and reconstruction of the lid margin and posterior lamella with minimal recurrence rate.
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Affiliation(s)
- Swati Singh
- Ophthalmic Plastic Surgery Services, LJ Eye Institute, Ambala, India
| | - Purvasha Narang
- Ophthalmic Plastic Surgery Services, LJ Eye Institute, Ambala, India.,Cornea Services, LJ Eye Institute, Ambala, India
| | - Vikas Mittal
- Ophthalmic Plastic Surgery Services, LJ Eye Institute, Ambala, India.,Cornea Services, LJ Eye Institute, Ambala, India
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7
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Chen L, Yan D, Wu N, Zhang W, Yan C, Yao Q, Zouboulis CC, Sun H, Fu Y. 3D-Printed Poly-Caprolactone Scaffolds Modified With Biomimetic Extracellular Matrices for Tarsal Plate Tissue Engineering. Front Bioeng Biotechnol 2020; 8:219. [PMID: 32269990 PMCID: PMC7109479 DOI: 10.3389/fbioe.2020.00219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
Tarsal plate regeneration has always been a challenge in the treatment of eyelid defects. The commonly used clinical treatments such as hard palate mucosa grafts cannot achieve satisfactory repair effects. Tissue engineering has been considered as a promising technology. However, tarsal plate tissue engineering is difficult to achieve due to its complex structure and lipid secretion function. Three-dimensional (3D) printing technology has played a revolutionary role in tissue engineering because it can fabricate complex scaffolds through computer aided design (CAD). In this study, it was novel in applying 3D printing technology to the fabrication of tarsal plate scaffolds using poly-caprolactone (PCL). The decellularized matrix of adipose-derived mesenchymal stromal cells (DMA) was coated on the surface of the scaffold, and its biofunction was further studied. Immortalized human SZ95 sebocytes were seeded on the scaffolds so that neutral lipids were secreted for replacing meibocytes. In vitro experiments revealed excellent biocompatibility of DMA-PCL scaffolds with sebocytes. In vivo experiments revealed excellent sebocytes proliferation on the DMA-PCL scaffolds. Meanwhile, sebocytes seeded on the scaffolds secreted abundant neutral lipid in vitro and in vivo. In conclusion, a 3D-printed PCL scaffold modified with DMA was found to be a promising substitute for tarsal plate tissue engineering.
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Affiliation(s)
- Liangbo Chen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Dan Yan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Nianxuan Wu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Weijie Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Chenxi Yan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qinke Yao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Hao Sun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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8
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Avisar I, Nahum Y, Mimouni M, Kremer I, Malhotra R. Oculoplastic aspects of ocular surface disease and their management. Surv Ophthalmol 2019; 65:312-322. [PMID: 31837384 DOI: 10.1016/j.survophthal.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
The normal structure and function of the eyelids, eyelashes, conjunctival fornices, and lacrimal system are essential for the health of the ocular surface, and abnormalities of these structures accompany many cases of ocular surface disease. We describe the role of oculoplastic intervention in the context of ocular surface disease, focusing on blink disorders, lagophthalmos, entropion, lid scarring and keratinization, trichiasis, and punctal and lacrimal sac disease.
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Affiliation(s)
- Inbal Avisar
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Israel Kremer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raman Malhotra
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Abstract
PURPOSE Mucous membrane grafts are used for various indications in oculoplastics. The authors report the use of nasal floor mucosa as a new donor site for mucous membrane grafts. METHODS Following adequate anesthesia and vasoconstriction, the nasal floor is visualized with a 30° endoscope. Next, the interior turbinate is medialized, and the nasolacrimal duct is identified and preserved. Anterior, posterior, medial, and lateral incisions are made through the nasal mucosa to the nasal bone. The mucosa is dissected off the nasal bone with a periosteal elevator. Nasal saline irrigation is used postoperatively to aid healing. Histologic analysis of the harvested graft and mucosa from the inferior and middle turbinates were analyzed histologically for the number of mucin-producing cells per high power field and compared. RESULTS Nasal floor mucosa provides ample tissue for grafting with little donor site morbidity. The surgery is technically easy to learn and perform. There is less risk for blood loss compared with harvesting tissue from the turbinates and less postoperative discomfort compared with buccal mucosal grafts. The grafts have been used in 9 different patients for a variety of ocular indications. Histologically, the nasal floor mucosa contains statistically more mucin-secreting cells than other nasal site, which can be helpful especially in cases of ocular surface disease. In 1 case, biopsy of the grafted tissue at postoperative year 2 showed survival of the respiratory mucin-secreting cells under histologic examination. CONCLUSIONS Nasal floor mucosa should be considered a donor site when a mucous membrane graft is needed. The surgery is safe, easy to perform, and has less morbidity than either a nasal turbinate graft or a buccal mucosal graft.
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Long-Term Results for Entropion Repair by Tarsal Margin Rotation With Posterior Lamella Superadvancement. Ophthalmic Plast Reconstr Surg 2016; 33:434-439. [PMID: 27861402 DOI: 10.1097/iop.0000000000000815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the long-term stability of tarsal margin rotation and posterior lamellar superadvancement (TMR PLS) for the repair of upper eyelid cicatricial entropion. METHODS A retrospective chart review was performed from January 2000 through December 2014 to identify all patients who had TMR PLS at the authors' institution. Charts were reviewed for demographic information, recurrence of entropion or trichiasis, and surgical complications. Failure was defined as return of entropion. Patients with greater than 24 months of follow up were included. RESULTS A total of 30 TMR PLS procedures were performed during the review period. Nineteen cases from 14 patients were included in the final analysis. None of the 19 cases demonstrated recurrence of entropion over an average follow-up period of 78.3 months. Eight cases demonstrated trichiasis after TMR PLS, 5 of which required treatment. CONCLUSION This case series suggests that TMR PLS for the treatment of upper eyelid cicatricial entropion has excellent long-term stability.
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Chi M, Kim HJ, Vagefi R, Kersten RC. Modified tarsotomy for the treatment of severe cicatricial entropion. Eye (Lond) 2016; 30:992-7. [PMID: 27101749 DOI: 10.1038/eye.2016.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 02/25/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo analyze the efficacy of modified tarsotomy for the management of severe cicatricial entropion.MethodsTwenty-seven eyelids of 18 patients who underwent modified tarsotomy between March 2011 and July 2013 were retrospectively assessed. The data collected included patient demographics, etiology of cicatricial entropion, and surgical history. Outcome measures included surgical success rate, preoperative and postoperative eyelid position, and surgery-related complications.ResultsMean follow-up time was 13.2 months (range, 6-25.4 months), and the success rate was 81.8% (22 of 27 eyelids). Complications included eyelid margin notching (n=1) and blepharoptosis secondary to avascular necrosis of the distal marginal fragment (n=1), both were corrected by minor surgical intervention.ConclusionsThe study findings suggest modified tarsotomy is effective for the correction of severe cicatricial entropion.
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Affiliation(s)
- M Chi
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - H J Kim
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, Permanente Medical Group, Hayward, CA, USA
| | - R Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - R C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Kerr T, Mancini R. Shared buccal mucosal graft for simultaneous repair of severe upper and lower eyelid cicatricial entropion. Orbit 2015; 35:24-8. [PMID: 26710260 DOI: 10.3109/01676830.2015.1099693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cicatricial entropion is typically an acquired condition that can affect the upper and lower eyelids. The purpose of this prospective study is to examine the effect of shared buccal mucosal grafts for simultaneous repair of severe upper and lower eyelid cicatricial entropion on eyelid position. METHODS Patients at the University of Texas-Southwestern Medical Center Aston Ophthalmology clinic were identified who were diagnosed with cicatricial entropion. Patients found to have severe upper and lower eyelid cicatricial entropion were included in the study if they had undergone or were scheduled to undergo simultaneous upper and lower eyelid repair through the use of a shared mucosal graft. Pre-operative exams which included pre-operative photos and description of eyelid position were performed. Shared mucosal graft surgery was performed. At post-operative week 1, the patients had splitting of their shared mucosal grafts. Post-operative photos as well as post-operative description of eyelid position were made at 6 weeks, 3 months, and 6 months. RESULTS At 6 months after surgical repair of severe upper and lower eyelid cicatricial entropion by shared mucosal grafts, patients were found to have resolution of entropic eyelid position as well improvement in ocular surface irritation. No adverse events were found and no graft failures occurred. CONCLUSIONS The use of a shared mucosal graft for the repair of severe upper and lower eyelid entropion, when sufficient tarsal structural support is present, is effective for the correction of eyelid malpositions and ocular surface irritation.
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Affiliation(s)
- Trevor Kerr
- a Stephenville Medical and Surgical Clinic , Stephenville , Texas , USA
| | - Ronald Mancini
- b Oculoplastic & Orbital Surgery, Department of Ophthalmology , UT Southwestern Medical Center , Dallas , Texas , USA
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13
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Ocular surface, fornix, and eyelid rehabilitation in Boston type I keratoprosthesis patients with mucous membrane disease. Ophthalmic Plast Reconstr Surg 2015; 31:43-9. [PMID: 24911535 DOI: 10.1097/iop.0000000000000172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To understand the efficacy of various approaches for ocular surface reconstruction in eyes with implanted Boston Type I keratoprosthesis. METHODS All eyes implanted with a Boston Type I keratoprosthesis over a 9-year period by a single surgeon were reviewed. Any case in which mucosal rehabilitation was performed was included in the study sample. The type, number, approach, and outcome for all eyelid and ocular surface procedures were assessed. RESULTS A total of 22 mucosal surface surgeries were performed before, concurrent with, and after implantation of 11 keratoprostheses and 1 penetrating keratoplasty (after keratoprosthesis removal) in 9 eyes of 9 patients. Most of the ocular surface reconstructive surgeries (81.8%; 18/22) were performed at the time of or following keratoprosthesis implantation, with the most common indication being corneal stromal necrosis (44.4%; 8/18). Free grafting and simple advancement resulted in graft retraction for each case, and pedicle or bucket handle flaps resulted in a stable vascularized graft for half of the cases. Graft retraction occurred in 6 of the 9 eyes in this study, including in all 5 eyes of patients with Stevens Johnsons syndrome (SJS). CONCLUSIONS Free grafting and simple advancement flaps do not appear to be effective for rehabilitation in these eyes. However, even vascularized pedicle and bucket handle flaps retracted 50% of the time. Individuals with SJS were more likely to both require conjunctival rehabilitation after keratoprosthesis surgery and develop graft retraction in the course of management.
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A hammock flap: A modified backflip flap for the surgical correction of cicatricial entropion. J Plast Reconstr Aesthet Surg 2015; 68:738-40. [PMID: 25694396 DOI: 10.1016/j.bjps.2014.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/18/2014] [Accepted: 12/28/2014] [Indexed: 11/21/2022]
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Ko YJ, Kim HC. Quickert Suture Using Nonabsorbable Suture Material for Lower Lid Entropion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.12.1739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Youn Joo Ko
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ho Chang Kim
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea
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Outcomes of lower eyelid cicatricial entropion with grey-line split, retractor recession, lateral-horn lysis, and anterior lamella repositioning. Ophthalmic Plast Reconstr Surg 2012; 28:134-9. [PMID: 22410661 DOI: 10.1097/iop.0b013e3182467c11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report indications and outcomes of a technique for the correction of lower eyelid cicatricial entropion using a lower eyelid gray-line split, inferior retractor recession, lateral-horn lysis, and anterior lamella repositioning. PATIENTS AND METHODS Retrospective, 5-year, single-center, consecutive case series of patients with lower eyelid cicatricial margin entropion undergoing the above procedure. Patients with significant inferior fornix contraction or symblepharon undergoing concurrent fornix reconstruction with buccal mucosal grafts at the same time as lamella repositioning were excluded. Outcomes were assessed based on the review of medical case notes and clinical photographs assessed independently. Success was defined by: 1) improvement in eyelid position and 2) improvement in lower eyelid retraction. RESULTS Twenty-one eyelids of 19 patients (mean age 57.7 ± 22.6 years, range 5-95 years, 8 men and 11 women) were included. The mean follow up was 27.4 ± 16.8 (range 3.2-59.6) months. The causes of cicatricial entropion were as follows: ocular cicatricial pemphigoid (6), Stevens-Johnson syndrome (3), previous eyelid reconstruction (2), socket scarring (2), thermal burn (1), chemical burn (3), postradiotherapy (1), and meibomian gland dysfunction (1). A second procedure was carried out in 38% (8/21) of eyelids within 1 year. Within 3 years, 10% (2/21) and 5% (1/21) of eyelids required a third and fourth procedure, respectively. The most common lower eyelid revision procedures included anterior lamellar repositioning. Other procedures required included buccal mucous membrane grafts, everting sutures, and lateral tarsorrhaphy. Three patients with loss of >50% inferior fornix depth were included. Two had previously undergone mucosal grafts and 2 required subsequent mucosal grafts. Overall, 90% (19/21) of eyelids eventually achieved improvement in lower eyelid position following repeat surgery, including mucosal grafts in 3 eyelids. Mid-pupil lower eyelid elevation was 1 mm in 6 of 19 (32%) patients and lower eyelid lateral retraction significantly improved in 9 of 19 (47%) patients. CONCLUSION Based on the principles of lamella repositioning and posterior middle lamella release with formal retractor recession through a gray-line incision, this technique is of value as a lash-preserving procedure in moderate-to-severe cicatricial lower eyelid entropion, particularly where tarsoconjuctival contraction or eyelid margin distortion exists.
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Technique for autologous nasal mucosa transplantation in severe ocular surface disease. Eur J Ophthalmol 2011; 21:545-51. [PMID: 21319140 DOI: 10.5301/ejo.2011.6336] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the detailed surgical technique used for harvesting and transplantation of autologous nasal mucosa grafts for ocular surface reconstruction, to evaluate the clinical results and utility of autologous nasal mucosa grafts in ocular surface diseases. METHODS Autologous nasal mucosa was harvested from either the middle or inferior turbinate. It was transplanted on 11 eyes with severe ocular surface diseases including 4 eyes with chemical burns, 2 eyes with thermal burns, 1 eye with Stevens-Johnson syndrome, 1 eye with erythema multiforme major, and 3 eyes with extensively recurred pterygiums. Clinical outcomes were assessed based on ocular manifestation, epithelization, and visual acuity. RESULTS The mean follow-up period was 19.9 months (range 13-32 months). Nasal mucosal tissues were safely excised, and their mucosal harvest sites were completely healed in 2 weeks without postoperative complications. All nasal mucosa autograft survived successfully with rapid epithelization, well-developed horizontal vascularization, and abundant mucin secretion. Clinical success, intact ocular surface epithelium without epithelial erosion more than 4 weeks, was achieved in all eyes. There was no recurrence of significant ulceration, conjunctivalization, fibrovascularization, symblepharon, or pterygium. CONCLUSIONS Goblet cell transplantation using autologous turbinate nasal mucosa presents a promising treatment method in patients with severe ocular surface disorders.
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Oral mucosal graft to correct lid margin pathologic features in cicatricial ocular surface diseases. Am J Ophthalmol 2011; 152:600-608.e1. [PMID: 21683334 DOI: 10.1016/j.ajo.2011.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 03/13/2011] [Accepted: 03/14/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the efficacy of oral mucosal graft to correct not only lid margin keratinization and trichiasis or distichiasis, but also incomplete closure in severe cicatricial ocular surface diseases. DESIGN Retrospective, noncomparative, interventional case series. METHODS Twenty-two eyes (39 eyelids) of 19 patients received an oral mucosal graft during lid margin reconstruction from September 2007 through February 2010. Relief of symptoms, conjunctival inflammation, corneal epithelial abnormalities, and visual acuity were compared before and after surgeries as outcome measures. RESULTS Among 22 eyes, 10 eyes (45.5%) had lid margin keratinization, trichiasis or distichiasis, or both, resulting in blink-related microtrauma. The oral mucosal graft resulted in successful correction in 6 eyes; in the remaining eyes, trichiasis in 3 eyes and distichiasis in 1 eye were away from the corneal surface. Incomplete closure present in 12 (54.5%) eyes was completely corrected in 9 eyes and was much improved in the remaining 3 eyes. During a mean follow-up of 16.2 months, reports of foreign body sensation, photophobia, pain, burning, tearing, and discharge were relieved significantly in 17 (77.3%) of 22 eyes. The visual acuity was improved in 13 eyes (59.1%) and was maintained in 8 eyes. Conjunctival inflammation was reduced markedly in 19 eyes (86.4%). Corneal epithelial defect and superficial punctate keratopathy were healed rapidly or improved in 14 eyes, and regression of superficial vascularization was noted in 1 eye. CONCLUSIONS Oral mucosal graft can reduce not only blink-related microtrauma caused by lid margin keratinization and trichiasis or distichiasis, but also exposure caused by cicatricially induced incomplete closure, thus preventing further deterioration of the ocular surface.
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Takeda K, Nakamura T, Inatomi T, Sotozono C, Watanabe A, Kinoshita S. Ocular surface reconstruction using the combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery for severe ocular surface disease. Am J Ophthalmol 2011; 152:195-201.e1. [PMID: 21652025 DOI: 10.1016/j.ajo.2011.01.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 01/14/2011] [Accepted: 01/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the surgical combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery used to treat patients with severe ocular surface disease and entropion. DESIGN Observational case series. METHODS Three patients with severe thermal and chemical injury were treated by the surgical combination of autologous cultivated oral mucosal epithelial transplantation and everting sutures to correct entropion. Their clinical outcomes and the efficacy of this surgical procedure were assessed. RESULTS The ocular surfaces were successfully reconstructed with autologous cultivated oral mucosal epithelial sheets and everting sutures without any complications during the operations. In the course of a mean follow-up period of 30 months their clinical outcomes were assessed. Postoperative follow-up showed that the simultaneous everting sutures caused no problems with the cultivated oral mucosal epithelial sheet, and there were no severe complications such as infection or inflammation. During the follow-up period, in 2 of the 3 eyes the ocular surface and eyelid remained stable with no recurrence of entropion. CONCLUSION This case series presents a surgical approach to treat severely scarred ocular surfaces using the combination of autologous cultivated oral mucosal epithelial transplantation and everting sutures. Clinical outcomes suggest that this combined surgical procedure is a safe and useful method for the treatment of patients with severe ocular surface disease and entropion.
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A backflip flap: a new surgical correction for severe cicatricial entropion. Plast Reconstr Surg 2010; 126:179e-180e. [PMID: 20885209 DOI: 10.1097/prs.0b013e3181ea91f7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The use of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) scaffolds for tarsal repair in eyelid reconstruction in the rat. Biomaterials 2010; 31:7512-8. [DOI: 10.1016/j.biomaterials.2010.06.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 06/28/2010] [Indexed: 11/18/2022]
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Ocular surface reconstruction with autologous nasal mucosa in cicatricial ocular surface disease. Am J Ophthalmol 2010; 149:45-53. [PMID: 19875092 DOI: 10.1016/j.ajo.2009.07.030] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the possibility of replacing the metaplastic ocular surface with nasal mucosa, and to evaluate the results of autologous nasal and oral mucosal transplantation in cicatricial ocular surface diseases. DESIGN Retrospective interventional case series. METHODS We studied 6 eyes in 6 patients with chemical burns, which were characterized by a cicatricial ocular surface. After removal of cicatricial tissues and symblepharolysis, autologous nasal mucosa was transplanted in all patients. In 3 patients with extensive damage, oral mucosal autografting was performed concurrently. The nasal and oral mucosa was evaluated using immunohistochemical analysis for p63, K3, MUC5AC, and CD34. Clinical outcomes were assessed based on visual acuity, ocular manifestations, and liquid-based cytology. RESULTS Immunohistochemical analysis revealed a plentitude of p63 and K3 in nasal mucosal epithelium. Goblet cells and MUC5AC expression were only observed in nasal mucosal epithelium, not in oral mucosal epithelium. Well-developed parallel vasculature was demonstrated in the nasal mucosa. In contrast, perpendicular vasculature was demonstrated in the oral mucosa. This vascular feature remained after transplantations. In all patients, ocular surface stability recovered with no major complications and increased goblet cells were observed on ocular surface. However, delayed epithelialization and ischemic thinning were seen at oral mucosal graft sites. CONCLUSIONS Nasal mucosa, which has the advantage of well-developed parallel vasculature, enriched goblet cells, and plenty of stem cells, may be an ideal substitute for a cicatricial ocular surface. Transplantation of autologous nasal mucosa is a very effective method for achieving ocular surface reconstruction in cicatricial ocular surface diseases.
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Anterior Lamellar Recession With Buccal Mucous Membrane Grafting for Cicatricial Entropion. Ophthalmic Plast Reconstr Surg 2009; 25:180-4. [DOI: 10.1097/iop.0b013e3181a13f0e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Posterior Lamellar Eyelid Reconstruction With Acellular Dermis Allograft in Severe Cicatricial Entropion. Ann Plast Surg 2009; 62:268-74. [DOI: 10.1097/sap.0b013e31817d8814] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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deSousa JL, Daya S, Malhotra R. Adnexal Surgery in Patients Undergoing Ocular Surface Stem Cell Transplantation. Ophthalmology 2009; 116:235-42. [DOI: 10.1016/j.ophtha.2008.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 08/26/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022] Open
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Kang IB, Tae K, Lee YJ. Ocular Manifestations of Paranasal Sinus Malignancies. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.10.1455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Il Bong Kang
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Kyung Tae
- Department of Otolaryngology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yoon Jung Lee
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Hong SM, Kim SD. The Correction of Cicatricial Entropion of Upper Eyelid by Tarsal Fracture and Anterior Lamellar Reposition. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.12.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seong Min Hong
- Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea
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Swamy BN, Benger R, Taylor S. Cicatricial entropion repair with hard palate mucous membrane graft: surgical technique and outcomes. Clin Exp Ophthalmol 2008; 36:348-52. [DOI: 10.1111/j.1442-9071.2008.01697.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee S, Goldberg RA, Ben Simon GJ. Postoperative complications in ophthalmic plastic and reconstructive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.6.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Soares OE, Cruz AAV. Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin. Braz J Med Biol Res 2004; 37:669-74. [PMID: 15107928 DOI: 10.1590/s0100-879x2004000500007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery.
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Affiliation(s)
- O E Soares
- Federação das Organizações dos Indios do Rio Negro, Sao Gabriel da Cachoeira, AM, Brazil
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Goldberg RA, Kim JW, Shorr N. Orbital exenteration: results of an individualized approach. Ophthalmic Plast Reconstr Surg 2003; 19:229-36. [PMID: 12918560 DOI: 10.1097/01.iop.0000066699.53489.88] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors report and evaluate their experience with an individualized approach to orbital exenteration. METHODS Retrospective chart review was performed on a consecutive series of 25 orbital exenteration patients at a tertiary care center. The cases were classified into two groups for the retrospective analysis: Total exenteration procedures involved the removal of the entire orbital contents including the periorbita (13 cases), and subtotal procedures preserved at least a quadrant of the orbit or the orbital tissues posterior to the globe (12 cases). RESULTS The total exenteration group had a lower rate of clear surgical margins and a higher rate of systemic metastasis, whereas patients in the subtotal exenteration group had fewer surgical complications and better functional and aesthetic results. CONCLUSIONS The surgical planning for orbital exenteration should take into account the location, extent, and biological behavior of the orbital disease process and the reconstructive and prosthetic options for the exenterated socket. When an individualized approach to orbital exenteration is used, subtotal procedures can offer improved functional and aesthetic results while still maximizing the chances for a surgical cure.
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Affiliation(s)
- Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095, USA.
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Affiliation(s)
- Phillip H Choo
- Department of Ophthalmology, University of California, Davis Medical Center, Sacramento 95817, USA
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