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Vivekanandan Ramakrishnan VR, Venugopal A, Benzy M, Venkatesh R, Ravindran M. A novel transconjunctival, intrascleral, ab-externo, knotless, and double-flanged technique with 6-0 Prolene for iridodialysis repair. Indian J Ophthalmol 2023; 71:2257-2259. [PMID: 37202964 PMCID: PMC10391415 DOI: 10.4103/ijo.ijo_2879_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Small traumatic iridodialysis (ID) may be asymptomatic, but large ones usually cause polycoria and corectopia, leading to symptoms like diplopia, glare, and photophobia. The management of ID, including medical and surgical methods, depends upon the patient's symptoms. Mild glare and diplopia can be treated either with atropine, antiglaucoma medications, tinted spectacles, colored contact lens, or corneal tattooing, but extensive IDs require surgical options. The surgical techniques are challenging due to the iris texture and the damage encountered during the primary surgery, the narrow anatomical workspace for repair, and the associated surgical complications. Numerous techniques have been described by several authors in the literature; each has its advantages and disadvantages. All the procedures described previously involve conjunctival peritomy, scleral incisions, and suture knots and are time consuming. Here, we report a novel transconjunctival, intrascleral, knotless, and ab-externo, double-flanged technique for repair of large ID with a 1-year follow-up.
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Affiliation(s)
| | - Anitha Venugopal
- Cornea, Cataract and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Merlin Benzy
- Cataract and IOL Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Soliman LB, Lerner JL, Gong JH, Paiva M, Sobti N, Rao V, Woo AS. Operative technique for a combined transcaruncular- transconjunctival approach to double-walled orbital fractures. Plast Aesthet Res 2023; 10:13. [PMID: 37125218 PMCID: PMC10139735 DOI: 10.20517/2347-9264.2022.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma. Operative intervention is indicated in the presence of persistent diplopia, significant enophthalmos, or muscle entrapment. Surgical repair of these injuries may be challenging due to large fracture sizes or loss of bony supports. The transconjunctival and transcaruncular approaches have been popularized to reconstruct isolated floor and medial wall fractures, respectively. However, surgical approaches for fractures involving both these walls have not been well described in the literature. In this technical note, we detail a combined transcaruncular-transconjunctival approach that is safe, effective, and aesthetically sensitive.
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Affiliation(s)
- Luke B Soliman
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Julia L Lerner
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Jung Ho Gong
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Marcelo Paiva
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Nikhil Sobti
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Vinay Rao
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
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Ozturker C, Sari Y, Ozbilen KT, Ceylan NA, Tuncer S. Surgical Repair of Orbital Blow-Out Fractures: Outcomes and Complications. Beyoglu Eye J 2022; 7:199-206. [PMID: 36185982 DOI: 10.14744/bej.2022.88156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
Objectives The purpose of this study is to evaluate the demographics of patients with orbital blow-out fractures, as well as the success and complications of surgical repair with porous polyethylene membrane sheet implants through transconjunctival technique and to compare the results to previously published studies. Methods This retrospective study included 57 patients diagnosed with orbital blow-out fractures referred to our clinic between 2018 and 2022. Seventeen patients (29.8%) underwent orbital fracture repair through a transconjunctival technique employing porous polyethylene membrane sheets. The indications for surgery were enophthalmos >2 mm and persistent ocular motility restriction, diplopia, and strabismus. The success criteria were <2 mm of enophthalmos and complete correction of eye motility, diplopia, and strabismus. Results The study group consisted of ten females and 47 males with a mean age of 31.12 years. The most common cause of injury was assaults (50.9%), followed by falls (38.6%), traffic accidents (5.3%), and accidental impacts (5.3%). The inferior wall (61.4%) was the most common fracture site, followed by the medial wall (21.1%) and a combination of the inferior and medial walls (21.1%). The surgically treated group showed a significant improvement in ocular motility restriction (88.2-23.5%, p=0.002), diplopia (70.6-23.5%, p=0.008), and enophthalmos (1.41 mm to 0.82 mm, p=0.012) after surgery. The surgery was successful in ten of 17 cases (58.8%), and the success rate was higher in patients who were treated early (77.8% vs. 37.5%), but the difference was not statistically significant (p=0.092). Conclusion Orbital blow-out fracture repair using porous polyethylene membrane sheets through a transconjunctival approach is a safe and effective surgical technique for orbital blow-out fracture repair. Although patients who had early surgery had a higher success rate in our study group, larger study groups are needed to assess the effect of surgical timing on success.
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Borghol K, Turton N, Sharp I. Experience of orbital floor fractures in a UK level one trauma centre: a focus on the surgical approach and lid-related complications. Br J Oral Maxillofac Surg 2021; 60:482-487. [PMID: 34952743 DOI: 10.1016/j.bjoms.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
The two surgical approaches to access orbital fractures are transconjunctival and transcutaneous. The aim of this study was to assess the outcomes of orbital repairs with a focus on lid-related complications and their management. A retrospective analysis was carried out over a five-year period (January 2015 to January 2020) to assess all consecutive orbital repairs in our unit. Data were collected for variables including demographics, fracture pattern, surgical approach, and details of postoperative complications. A total of 111 patients were included in the study, 94 were male (85%), the majority being between 16 and 45 years of age. A total of 46 (41%) had isolated orbital floor fractures, 31 (28%) zygomaticomaxillary complex, and 18 (16%) Le Fort pattern fractures. Eighty per cent (n = 91) received a transconjunctival approach as first choice. In the transconjunctival group, six (6.6%) had entropion and increased scleral show, four (4.4%) had ectropion, and none had canthal malposition. In the transcutaneous group (n = 20) there was a higher rate of ectropion (25%, n = 5), a lower rate of entropion (n = 1, 5%) and higher rate of increased scleral show (n = 2, 10%). Factors associated with a higher rate of complications included complex fractures, use of conjunctival sutures, and increased length of time to surgery. Seventy-two per cent of patients who suffered entropion required further surgical treatment. The most common complication of the transconjunctival approach was entropion, and clinicians should have a low threshold for early surgical management. We feel that this should be part of the consenting process, especially in high-risk cases.
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Affiliation(s)
- Khaled Borghol
- Oral & Maxillofacial Department, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Natalie Turton
- Oral & Maxillofacial Department, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Ian Sharp
- Oral & Maxillofacial Department, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
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Trevisiol L, D’Agostino A, Gasparini S, Bettini P, Bersani M, Nocini R, Favero V. Transconjunctival and Subciliary Approach in the Treatment of Orbital Fractures: A Study on Oculoplastic Complication. J Clin Med 2021; 10:jcm10132775. [PMID: 34202783 PMCID: PMC8268694 DOI: 10.3390/jcm10132775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor fractures, associated to the subciliary vs transconjunctival approaches. (2) Materials and Methods: A retrospective comparative study of patients who underwent surgery for orbital fractures by means of a transconjunctival or a subciliary approach at the Clinic of Dentistry and Maxillofacial Surgery of the University of Verona from January 2013 through September 2018 was designed. Data related to the trauma and to surgical procedures were retrieved, as well as a series of anthropometric parameters extrapolated from standardized photographs. Statistical analysis was performed on the outcomes. (3) Results: 33 patients underwent surgery by means of a transconjunctival approach and 36 patients by means of a subciliary approach. Ectropion was observed to a greater extent in the subciliary group, however the difference resulted to be not statistically significant. Patients in which osteosynthesis devices were used presented with a greater incidence of scleral show with respect to the remaining patients. No statistically significant difference was observed for any of the parameters taken into account. (4) Conclusions: Since the two approaches does not seem to be associated with remarkable differences in terms of outcomes, the choice of technique should be tailored to the patient’s features and the surgeon’s experience.
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Affiliation(s)
- Lorenzo Trevisiol
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; (L.T.); (S.G.); (M.B.); (V.F.)
| | - Antonio D’Agostino
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; (L.T.); (S.G.); (M.B.); (V.F.)
- Correspondence: ; Tel.: +39-04-5812-4251; Fax: +39-04-5802-7437
| | - Silvia Gasparini
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; (L.T.); (S.G.); (M.B.); (V.F.)
| | - Pierfrancesco Bettini
- Unit of Otolaryngology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy;
| | - Massimo Bersani
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; (L.T.); (S.G.); (M.B.); (V.F.)
| | - Riccardo Nocini
- Unit of Otolaryngology, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy;
| | - Vittorio Favero
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; (L.T.); (S.G.); (M.B.); (V.F.)
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Majidian Ba M, Kolli Bs H, Moy Md RL. Transconjunctival lower eyelid blepharoplasty with fat transposition above the orbicularis muscle for improvement of the tear trough deformity. J Cosmet Dermatol 2021; 20:2911-2916. [PMID: 33538121 DOI: 10.1111/jocd.13978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/30/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The tear trough is the hollow concavity of the medial lower eyelid. Surgery can address tear trough deformities and reverse visible signs of periorbital aging. The previous methods of transconjunctival blepharoplasty with fat transposition were first described with subperiosteal placement of fat (Plast Reconstr Surg, 125, 2010,699, Aesthetic Surg J, 32, 2012, 426). This was followed by techniques with submuscular transposition of fat, which overcame certain difficulties associated with the subperiosteal methods (Clin Plast Surg, 20, 1993, 393, Arch Facial Plast Surg, 2, 2000, 16). OBJECTIVES We present a detailed description, evaluate the efficacy, safety, and advantages of transconjunctival blepharoplasty with fat pedicle transposition above the orbicularis muscle for lower eyelid rejuvenation and improvement of the tear trough deformity. METHODS Forty-one patients underwent lower eyelid blepharoplasty with fat transposition above the orbicularis muscle. Clinical and photographic documentation along with patient satisfaction ratings were evaluated for a minimum of 44 months postoperatively. RESULTS Significant improvements of lower eyelid aesthetics and correction of tear trough abnormalities were observed in most patients. At 44 months postoperatively, surgical correction was maintained in all patients with a high satisfaction and long-term survival. No contour irregularities or significant long-term complications were detected in any of the patients. CONCLUSION Transconjunctival blepharoplasty with the fat pedicle transposition placed above the orbicularis muscle is a safe and effective technique for lower eyelid rejuvenation. Compared to previously described techniques of repositioning fat into the subperiosteal or submuscular plane, this technique of transposing fat above the orbicularis muscle is an alternative technique resulting in long-term improvement of tear trough abnormalities with no major complications.
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Affiliation(s)
- Mandy Majidian Ba
- Tulane University School of Medicine, New Orleans, LA, USA.,Research Department, Moy-Fincher-Chipps Facial Plastics and Dermatology, Beverly Hills, CA, USA
| | - Hiren Kolli Bs
- Research Department, Moy-Fincher-Chipps Facial Plastics and Dermatology, Beverly Hills, CA, USA.,Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Ronald L Moy Md
- Research Department, Moy-Fincher-Chipps Facial Plastics and Dermatology, Beverly Hills, CA, USA
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7
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Abstract
Transcaruncular and transconjunctival approaches are commonly used by ophthalmic plastic surgeons to access various orbital compartments. These approaches are versatile and may be combined with transnasal or transcranial approaches to the orbit to gain optimal access to challenging locations. A major advantage of the transcaruncular and transconjunctival approaches is the lack of a visible skin incision with excellent postoperative cosmesis. As with all orbital surgery, an in-depth knowledge of orbital anatomy and physiology, as well as meticulous hemostasis, is needed to prevent complications including globe injury, permanent vision loss, diplopia, and retrobulbar hemorrhage. This article reviews the surgical steps of these approaches. The indications for each approach and case examples are illustrated.
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Affiliation(s)
- Natalie Wolkow
- Department of Ophthalmology, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Suzanne K Freitag
- Department of Ophthalmology, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
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8
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Palella Gómez A, Mazzucchelli S, Scurrell E, Smith K, Pinheiro de Lacerda R. Evaluation of partial tarsal plate excision using a transconjunctival approach for the treatment of distichiasis in dogs. Vet Ophthalmol 2020; 23:506-514. [PMID: 32083378 DOI: 10.1111/vop.12748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/03/2020] [Accepted: 01/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical outcome, possible complications, and recurrence rate of distichiasis in dogs treated with partial tarsal plate excision (PTPE) technique using a transconjunctival approach. METHODS Retrospective study including 17 client-owned canine patients affected with distichiasis and presenting with associated clinical signs (ie, blepharospasm, epiphora, chronic keratoconjunctivitis, or corneal ulceration) that underwent surgical removal of the aberrant lashes using a PTPE technique between January 2018 and February 2019. Data collected included breed, age, sex, affected eyelid(s), number of distichia, and tear film breakup time (TBUT). Resected cilia-bearing tarsoconjunctival strips were submitted for histopathological analysis. RESULTS Thirty eyes (52 eyelids) from 17 dogs were included in the study. The median age was 688 days (range 118-4243 days). A successful outcome, defined as complete resolution of clinical signs attributable to the distichia, occurred in all eyes after a single procedure, with a mean follow-up time of 239 days (range 69-480 days). Appearance of new distichia occurred in 14/30 eyes (46.3%), and of these, three eyes needed a new PTPE procedure. Recurrence of the distichia only occurred in one eye (3.3%) which was asymptomatic. Following surgery, TBUT decreased below the normal value in 7/24 eyes (29.1%) although none developed clinical signs of qualitative tear film deficiency. Post-operative complications included trichiasis and cicatricial entropion, which developed in two eyes (6.6%), and these were successfully managed with corrective eyelid surgery. CONCLUSIONS Partial tarsal plate excision, using a transconjunctival approach, had an excellent clinical outcome with a low incidence of complications.
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Affiliation(s)
| | | | | | - Kinley Smith
- Willows Veterinary Centre & Referral Service, Solihull, UK
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Abou-Al-Shaar H, Krisht KM, Cohen MA, Abunimer AM, Neil JA, Karsy M, Alzhrani G, Couldwell WT. Cranio-Orbital and Orbitocranial Approaches to Orbital and Intracranial Disease: Eye-Opening Approaches for Neurosurgeons. Front Surg 2020; 7:1. [PMID: 32118028 PMCID: PMC7025513 DOI: 10.3389/fsurg.2020.00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/10/2020] [Indexed: 01/01/2023] Open
Abstract
Orbital approaches for targeting intracranial, orbital, and infratemporal disease have evolved over the years in an effort to discover safe, reliable, effective, and cosmetically satisfying surgical corridors. The surgical goals of these approaches balance important factors such as proximity of the lesion to the optic nerve, the degree of anticipated manipulation and required space for surgical maneuverability, and the type of disease. The authors provide a comprehensive review of the most commonly used periorbital approaches in the management of intra- and extracranial disease, with emphasis on the advantages and limitations of each approach.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States.,Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Khaled M Krisht
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States.,Neurosurgery & Spine Associates, Montgomery, AL, United States
| | - Michael A Cohen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Abdullah M Abunimer
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jayson A Neil
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States.,Midwest Neurosurgery Associates, Kansas City, MO, United States
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Gmaan Alzhrani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States.,Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
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Veith M, Stranak Z, Pencak M, Vranova J, Studeny P. 25-gauge vitrectomy and gas for the management of rhegmatogenous retinal detachment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:80-84. [PMID: 29967564 DOI: 10.5507/bp.2018.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022] Open
Abstract
AIMS To evaluate the anatomical and functional results in patients with rhegmatogenous retinal detachment (RRD) who underwent 25-gauge pars plana vitrectomy (PPV) with gas tamponade. MATERIALS AND METHODS A retrospective evaluation of 126 eyes of 126 patients (79 men, 47 women) with RRD who underwent 25-gauge PPV with gas tamponade (13% C3F8 in 87 eyes, 20% SF6 in 39 eyes). 113 patients (89.7%), were operated on under local anaesthesia, 13 patients (10.3%) under general anaesthesia. Macula was detached in 85 eyes (67.5%). 53 eyes had pseudophakic RRD, 73 eyes were phakic. Anatomical success of the primary intervention, change in best corrected visual acuity (BCVA) and incidence of complications were assessed. An average follow-up period is 7.2 months (6-15). RESULTS With single operation, retinal attachment was achieved in 125 eyes (99.2%); the final anatomical success was 100%. The initial mean BCVA was 0.89 logMar (2.00 to 0.00); at the end of the follow-up period, it improved to 0.23logMAR (1.00 to -0.10), P < 0,0001. During the first post-intervention day, hypotony of the eye below 10 mmHg was observed in 1 patient (0.8%); on the contrary, intraocular pressure was temporarily increased to 25 mmHg and more in 36 patients (28.6%). CONCLUSION The surgical treatment of RRD using 25-gauge PPV with expansive gas tamponade renders excellent anatomical results and improvement in BCVA. The incidence of complications and necessity of sclerotomy suturing are low.
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Affiliation(s)
- Miroslav Veith
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Zbynek Stranak
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Martin Pencak
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Jana Vranova
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Pavel Studeny
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
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11
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Bonawitz S, Crawley W, Shores JT, Manson PN. Modified Transconjunctival Approach to the Lower Eyelid: Technical Details for Predictable Results. Craniomaxillofac Trauma Reconstr 2015; 9:29-34. [PMID: 26889345 DOI: 10.1055/s-0035-1556051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/31/2015] [Indexed: 10/23/2022] Open
Abstract
The transconjunctival approach to the lower orbit is well described in the literature and has been used for both cosmetic and reconstructive purposes. When properly performed, it allows access to the orbital floor and inferior orbital rim with minimal lower lid morbidity and an inconspicuous scar. Many variations of this approach have been described and these can lead to confusion and uncertainty regarding the surgical technique including when and how to best utilize this approach in the traumatized eyelid. Residents and less experienced attendings employing this approach often fail to fully understand the technical and anatomic details that can make this a very fast and simple way to gain complete access to the inferior, medial, and lateral orbit while minimizing complications such as postoperative lid malposition and canthal deformities. We describe our method for transconjunctival access to the inferior orbital rim and orbital floor with specific attention to several precise surgical aspects that make this a fast and reliable technique with low morbidity and predictable architecture of closure.
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Affiliation(s)
- Steven Bonawitz
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - William Crawley
- Department of Surgery, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul N Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Abstract
AIM To analyze the ease and surgical outcome of using sutureless transconjunctival approach for repair of infra-orbital fractures. DESIGN Prospective clinical case series. MATERIALS AND METHODS Totally 5 patients with infra-orbital rim or orbital floor fractures were selected and the fractures were accessed through a pre-septal transconjunctival incision. After reduction and fixation, the conjunctiva was just re-approximated and re-draped into position. Incidence of post-operative complications such as diplopia, lid retraction, eyelid dystopia, foreign body granuloma and poor conjunctival healing was assessed at intervals of 1 week, 15 days and a month post-operatively. RESULTS No complications were observed in any of the 5 patients. Healing was satisfactory in all patients. CONCLUSION The sutureless technique appears to be a time saving and technically simpler viable alternative to multilayered suturing in orbital trauma with minimal post-operative complications.
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Affiliation(s)
- Vaibhav Nagaraj
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Abhishek Ghosh
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Madan Nanjappa
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
| | - Keerthi Ramesh
- Department of Oral and Maxillofacial Surgery, V. S. Dental College and Hospital, Bengaluru, Karnataka, India
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13
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Davies BW, Hink EM, Durairaj VD. Transconjunctival inferior orbitotomy: indications, surgical technique, and complications. Craniomaxillofac Trauma Reconstr 2014; 7:169-74. [PMID: 25136405 DOI: 10.1055/s-0034-1374063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 08/07/2013] [Indexed: 10/25/2022] Open
Abstract
Surgical access to the inferior orbit can be accomplished through either a transcutaneous or transconjunctival incision. The preferred approach should provide adequate surgical exposure with the fewest adverse effects. The purpose of this article is to review the literature on the transconjunctival incision and to discuss the indications and complications of the approach. The authors also discuss their preferred technique and provide a step-by-step instruction. The transconjunctival approach provides good surgical access with a low incidence of complications and a better aesthetic outcome than transcutaneous approaches.
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Affiliation(s)
- Brett W Davies
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric M Hink
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Vikram D Durairaj
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado ; Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado ; Texas Oculoplastic Consultants, Austin, Texas
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Shen YD, Paskowitz D, Merbs SL, Grant MP. Retrocaruncular approach for the repair of medial orbital wall fractures: an anatomical and clinical study. Craniomaxillofac Trauma Reconstr 2014; 8:100-4. [PMID: 26000079 DOI: 10.1055/s-0034-1375168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/29/2013] [Indexed: 10/25/2022] Open
Abstract
The aim of this article is to investigate a retrocaruncular approach for repairing medial orbital wall fractures. A total of 10 fresh cadaver orbits were dissected to investigate a transconjunctival approach to the orbit posterior to the caruncle. Medical records of consecutive patients with medial orbital wall fractures repaired via a retrocaruncular incision at Wilmer Eye Institute over a 10-year period were retrospectively reviewed. The study was approved by the Johns Hopkins Medical Institution's Institutional Review Board. Feasibility of this approach was clearly demonstrated on all cadavers. Horner muscle was observed to be directly attached to the caruncle and remained undisturbed throughout the retrocaruncular approach. For each of the 174 patients reviewed, this approach allowed successful access to the fracture and proper implant placement. The origin of the inferior oblique muscle was divided in only 19 patients. Sutures were not used for conjunctival incision closure in any patient. For 120 patients who underwent acute repair, the percentage with enophthalmos (≥ 2 mm) decreased from 34% preoperatively to 4% postoperatively; extraocular motility deficit decreased from 41 to 11%. Postoperative complications included recurrence of the preexisting retrobulbar hemorrhage, conjunctival granuloma, and temporary torsional diplopia, each in one patient. The retrocaruncular transconjunctival incision is an effective and safe approach for repairing medial orbital wall fractures with minimal complications. The retrocaruncular incision offers advantages over dividing the caruncle because Horner muscle is left undisturbed, and the incision heals well without suturing.
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Affiliation(s)
- Yun-Dun Shen
- Division of Oculoplastic Surgery, Johns Hopkins University School of Medicine, Wilmer Ophthalmological Institute, Baltimore, Maryland
| | - Daniel Paskowitz
- Division of Oculoplastic Surgery, Johns Hopkins University School of Medicine, Wilmer Ophthalmological Institute, Baltimore, Maryland
| | - Shannath L Merbs
- Division of Oculoplastic Surgery, Johns Hopkins University School of Medicine, Wilmer Ophthalmological Institute, Baltimore, Maryland
| | - Michael P Grant
- Division of Oculoplastic Surgery, Johns Hopkins University School of Medicine, Wilmer Ophthalmological Institute, Baltimore, Maryland
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Lim JH, Sardesai MG, Ferreira M, Moe KS. Transorbital neuroendoscopic management of sinogenic complications involving the frontal sinus, orbit, and anterior cranial fossa. J Neurol Surg B Skull Base 2012; 73:394-400. [PMID: 24294556 DOI: 10.1055/s-0032-1329617] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 07/06/2012] [Indexed: 10/27/2022] Open
Abstract
Transnasal endoscopic surgery has remained at the forefront of surgical management of sinogenic complications involving the frontal sinus, orbit, and anterior skull base. However, the difficulty in accessing certain areas of these anatomical regions can potentially limit its use. Transorbital neuroendoscopic surgery (TONES) was recently introduced to transgress the limits of transnasal endoscopic surgery; the access that it provides could add additional surgical pathways for treating sinogenic complications involving the frontal sinus, orbit, and anterior cranial fossa. We describe a prospective series of 13 patients who underwent TONES for the management of various sinogenic complications, including epidural abscess, orbital abscess, and fronto-orbital mucocele or mucopyocele, as well as subperiosteal abscess presenting with orbital apex syndrome. The primary outcome measurement was the efficacy of TONES in treating these pathologies. TONES provided effective access to the frontal sinus, orbit, and the anterior cranial fossa. All patients demonstrated postoperative resolution of initial clinical symptoms with well-hidden surgical scars. There were no ophthalmologic complications or recurrence of pathology. Based on our experience, TONES appears to provide a valuable addition to the current surgical armamentarium for treating selected complications of sinusitis.
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Affiliation(s)
- Jae H Lim
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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16
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Issa SA, Connor A, Habib M, Steel DH. Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy. Clin Ophthalmol 2011; 5:109-14. [PMID: 21339803 PMCID: PMC3037038 DOI: 10.2147/opth.s16414] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To assess the rate and type of retinal break formation in patients undergoing 23 gauge transconjunctival vitrectomy surgery for complications of proliferative diabetic retinopathy compared with 20 gauge vitrectomy surgery. METHODS Retrospective case notes review of two consecutive series of patients who had primary pars plana vitrectomy for complications of proliferative diabetic retinopathy by a single surgeon. The control group had standard 20 gauge vitrectomy surgery whilst the second group had 23 gauge transconjunctival vitrectomy surgery. RESULTS Eighty-five eyes were included in the 20 gauge group and 85 eyes in the 23 gauge group. The groups were well matched for surgical complexity and indications for surgery, as well as a variety of other preoperative variables. There was a significant reduction in the incidence of peripheral sclerotomy-related retinal breaks and lesions suspicious for breaks (4/85 [5%] 23 gauge versus 14/85 [16%] 20 gauge, P = 0.02) and posterior retinal breaks (3/85 [4%] 23 gauge versus 12/85 [14%] 20 gauge, P = 0.03). Six eyes (7%) in total had definite new retinal breaks of any type detected in the 23 gauge group compared with 16 (18.8%) in the 20 gauge group (P = 0.04). One patient in each group experienced a retinal detachment postoperatively related in both cases to a posterior retinal break associated with recurrent traction. CONCLUSION In this series of patients, 23 gauge transconjunctival vitrectomy surgery was associated with a lower rate of retinal break formation than 20 gauge vitrectomy for proliferative diabetic retinopathy.
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Affiliation(s)
- Sharif A Issa
- Department of Ophthalmology, Sunderland Eye Infirmary, Sunderland, UK
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Kiss S, Vavvas D. Intraoperative switch to a temporal surgical approach in 23- and 25-gauge microcannula-based sutureless transconjunctival vitrectomy. Open Ophthalmol J 2010; 4:12-4. [PMID: 21270948 PMCID: PMC3027078 DOI: 10.2174/1874364101004010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 01/22/2010] [Accepted: 03/25/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose: To illustrate a surgical method in which the infusion port during a three-port pars plana vitrectomy is moved intraoperatively from the traditional infra-temporal location and placed supra-nasally, thus permitting a temporal surgical approach to better tackle superior and inferior vitreoretinal pathology. Methods: Description of surgical technique. Results: When the location of the vitreoretinal pathology and/or the patient's anatomy prevents adequate visualization or surgical access and/or the instrument flexibility precludes sufficient maneuvering of the eyeball, a temporal approach to the vitrectomy may be employed by utilizing the interchangeable microcannulas of 23- and 25-gauge vitrectomy systems. The infusion port is dis-inserted from the traditional infra-temporal microcannula and reaffixed in the supra-nasal microcannula. The surgeon, the operating microscope, and the foot pedals are then adjusted to a temporal orientation, and the instruments inserted through the temporally placed microcannulas. Conclusions: The flexibility of interchangeable microcannulas in 23- and 25-gauge PPV systems permits intraoperative switching between superior and temporal surgical sites to better manage posterior segment pathology.
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Affiliation(s)
- Szilárd Kiss
- Retina Service, Weill Cornell Medical College, Department of Ophthalmology, 1305 York Ave, 11th Floor, New York, New York 10021, USA
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