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Pitak-Arnnop P, Nimitwongsakul O, Sirintawat N, Subbalekha K, Stoll C, Meningaud JP. A stepwise approach to chainsaw kickback injury of the nasoorbital complex: a case-based meta-narrative review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:e1-e12. [PMID: 38582707 DOI: 10.1016/j.oooo.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE This article outlines the management of a rare and severe nasoorbital injury resulting from a chainsaw kickback accident in a 60-year-old male. A meta-narrative review of English, French, and German literature indexed in PubMed, Embase, and the Cochrane Library up to January 8, 2024, accompanies the case report. METHODS This was a case report combined with a comprehensive review based on the 2011 Oxford Centre for Evidence-Based Medicine's highest and most recent level of evidence (LoE) and highest recommendation grade (RG). Rigorous selection criteria were applied. RESULTS The patient had an open nasal fracture, complex lacerations, and avulsion of the left eyelid, lateral orbital wall and lateral rectus muscle. Staged surgical interventions comprised repositioning and fixation of the fractured nose, buccal mucosal grafting for nasal mucosa and conjunctiva repair, titanium mesh and polydioxanone sheet for lateral orbital wall reconstruction, and subsequent muscle and eyelid repair. The second intervention 3 months postsurgery addressed lateral ectropion, nasal dorsal hump, and nasolacrimal system issues. Despite the rarity of such injuries, evidence-based discussions were conducted. CONCLUSIONS Complex nasoorbital trauma resulting from chainsaw kickback necessitates a meticulous, staged surgical approach. The inside-out technique proved effective in addressing various challenges. This article concludes with evidence-based recommendations, highlighting the importance of adapting established principles to unique nature of these injuries.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany; Department of Oral, Craniomaxillofacial and Plastic Surgery, University Hospital Ruppin-Brandenburg, Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
| | - Ornvenus Nimitwongsakul
- Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Mettapracharak Eye Hospital Nakorn Prathom and Metta Prosthetic Eye Center, Bangkok, Thailand
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Christian Stoll
- Department of Oral, Craniomaxillofacial and Plastic Surgery, University Hospital Ruppin-Brandenburg, Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Esthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris Est, Créteil, France
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2
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Topcu H, Serefoglu Cabuk K, Cetin Efe A, Ulas MG, Poslu Karademir F, Kandemir Besek N, Aydin Arslan R, Ahmet S. The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM). Int Ophthalmol 2024; 44:274. [PMID: 38916687 DOI: 10.1007/s10792-024-03232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. METHODS The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. RESULTS cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. CONCLUSIONS cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.
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Affiliation(s)
- Husna Topcu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Kubra Serefoglu Cabuk
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ayse Cetin Efe
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Goksel Ulas
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Poslu Karademir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Nilay Kandemir Besek
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Rukiye Aydin Arslan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Sibel Ahmet
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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3
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Wu KY, Khan S, Liao Z, Marchand M, Tran SD. Biopolymeric Innovations in Ophthalmic Surgery: Enhancing Devices and Drug Delivery Systems. Polymers (Basel) 2024; 16:1717. [PMID: 38932068 PMCID: PMC11207407 DOI: 10.3390/polym16121717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/30/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
The interface between material science and ophthalmic medicine is witnessing significant advances with the introduction of biopolymers in medical device fabrication. This review discusses the impact of biopolymers on the development of ophthalmic devices, such as intraocular lenses, stents, and various prosthetics. Biopolymers are emerging as superior alternatives due to their biocompatibility, mechanical robustness, and biodegradability, presenting an advance over traditional materials with respect to patient comfort and environmental considerations. We explore the spectrum of biopolymers used in ophthalmic devices and evaluate their physical properties, compatibility with biological tissues, and clinical performances. Specific applications in oculoplastic and orbital surgeries, hydrogel applications in ocular therapeutics, and polymeric drug delivery systems for a range of ophthalmic conditions were reviewed. We also anticipate future directions and identify challenges in the field, advocating for a collaborative approach between material science and ophthalmic practice to foster innovative, patient-focused treatments. This synthesis aims to reinforce the potential of biopolymers to improve ophthalmic device technology and enhance clinical outcomes.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada; (K.Y.W.); (M.M.)
| | - Sameer Khan
- Department of Biology, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Zhuoying Liao
- Department of Biology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Michael Marchand
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrook, QC J1G 2E8, Canada; (K.Y.W.); (M.M.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Chernova UV, Varakuta EY, Koniaeva AD, Leyman AE, Sagdullaeva SA, Plotnikov E, Melnik EY, Tran TH, Rutkowski S, Kudryavtseva VL, Buznik VM, Bolbasov E. Piezoelectric and Dielectric Electrospun Fluoropolymer Membranes for Oral Mucosa Regeneration: A Comparative Study. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 38607352 DOI: 10.1021/acsami.4c01867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Wound healing of the oral mucosa is an urgent problem in modern dental surgical practice. This research article presents and compares the findings of the investigations of the structural, physicochemical, and biological characteristics of two types of polymeric membranes used for the regeneration of oral mucosa. The membranes were prepared from poly(tetrafluoroethylene) (PTFE) and a copolymer of vinylidene fluoride and tetrafluoroethylene (VDF-TeFE) and analyzed via scanning electron microscopy, atomic force microscopy, X-ray diffraction analysis, and Fourier transform infrared spectroscopy. Investigation results obtained indicate that both types of membranes are composed of thin fibers: (0.57 ± 0.25) μm for PTFE membranes and (0.43 ± 0.14) μm for VDF-TeFE membranes. Moreover, the fibers of VDF-TeFE membranes exhibit distinct piezoelectric properties, which are confirmed by piezoresponse force microscopy and X-ray diffraction. Both types of membranes are hydrophobic: (139.7 ± 2.5)° for PTFE membranes and (133.5 ± 2.0)° for VDF-TeFE membranes. In vitro assays verify that both membrane types did not affect the growth and division of mice fibroblasts of the 3T3-L1 cell line, with a cell viability in the range of 88-101%. Finally, in vivo comparative experiments carried out using Wistar rats demonstrate that the piezoelectric VDF-TeFE membranes have a high ability to regenerate oral mucosa.
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Affiliation(s)
- Ulyana V Chernova
- School of Nuclear Science & Engineering, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Elena Yu Varakuta
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Anastasiia D Koniaeva
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Arina E Leyman
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Sofia A Sagdullaeva
- The Human Anatomy Department, Siberian State Medical University, I-634050 Tomsk, Russian Federation
| | - Evgenii Plotnikov
- Research School of Chemistry and Applied Biomedical Sciences, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Evgeniy Yu Melnik
- Research School of Chemistry and Applied Biomedical Sciences, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Tuan-Hoang Tran
- Research School of Chemistry and Applied Biomedical Sciences, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Sven Rutkowski
- Weinberg Research Center, School of Nuclear Science & Engineering, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
| | - Valeriya L Kudryavtseva
- School of Engineering and Materials Science, Queen Mary University of London, E14NS London, United Kingdom
| | - Vyacheslav M Buznik
- Faculty of Chemistry, Tomsk State University, I-634050 Tomsk, Russian Federation
| | - Evgeniy Bolbasov
- School of Nuclear Science & Engineering, National Research Tomsk Polytechnic University, I-634050 Tomsk, Russian Federation
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Parikh AO, Conger JR, Li J, Sibug Saber M, Chang JR. A Review of Current Uses of Amniotic Membrane Transplantation in Ophthalmic Plastic and Reconstructive Surgery. Ophthalmic Plast Reconstr Surg 2024; 40:134-149. [PMID: 38427832 DOI: 10.1097/iop.0000000000002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE To review and summarize the existing literature on the clinical applications of amniotic membrane transplantation (AMT) in ophthalmic plastic and reconstructive surgery. METHODS A literature review was conducted on the PubMed database using the following search terms: "amniotic membrane" and "eyelid" or "orbit" or "fornix" or "socket" or "lacrimal". RESULTS In total 516 articles resulted from the search, of which 62 were included. Numerous cases and case series have been published on the use of amniotic membrane transplantation for ocular surface reconstruction, eyelid and forniceal reconstruction, and cicatricial eyelid abnormalities. Surgical methods of securing the graft vary. Few comparative studies exist; some show a similar or improved result when compared to oral mucous membrane grafting for certain indications. CONCLUSIONS Amniotic membrane transplantation can be a useful tool for the oculoplastic surgeon when faced with a case requiring reconstruction of the posterior lamellae, particularly in patients without other graft donor sites available, and uses of AMT continue to expand. Additional studies directly comparing AMT to other reconstructive techniques would be helpful in choosing between the available surgical techniques and standardizing best practices.
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Affiliation(s)
- Alomi O Parikh
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Jordan R Conger
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Joy Li
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Maria Sibug Saber
- Department of Pathology, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, U.S.A
| | - Jessica R Chang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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Reddy JK, Tara VS, Sundaram V, Patro S, Dani SS. Scleral patch graft with mucous membrane overlay for scleral perforation. Oman J Ophthalmol 2024; 17:150-152. [PMID: 38524321 PMCID: PMC10957064 DOI: 10.4103/ojo.ojo_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 03/17/2023] [Accepted: 01/02/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Jagadeesh Kumar Reddy
- Department of Cornea and Refractive Surgery, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
| | - V Shruthi Tara
- Department of Oculoplasty, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Vandhana Sundaram
- Department of Cornea and Refractive Surgery, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Shweta Patro
- Department of Cornea and Refractive Surgery, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Samruddhi Sarang Dani
- Department of Cornea and Refractive Surgery, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
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7
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Yan Y, Ji Q, Fu R, Liu C, Yang J, Yin X, Li Q, Huang R. Biomaterials and tissue engineering strategies for posterior lamellar eyelid reconstruction: Replacement or regeneration? Bioeng Transl Med 2023. [DOI: 10.1002/btm2.10497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- Yuxin Yan
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Qiumei Ji
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Rao Fu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chuanqi Liu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Jing Yang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiya Yin
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Department of Plastic and Burn Surgery West China Hospital, Sichuan University Chengdu China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ru‐Lin Huang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
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8
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Management of scleral melt. Ocul Surf 2023; 27:92-99. [PMID: 36549583 DOI: 10.1016/j.jtos.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
Scleral melting, while rare, can lead to significant ocular morbidity. Several possible risk factors for scleral melt have been identified, such as infection, autoimmune disease, trauma, and post-surgical state, and these may act in combination with each other. Treatment should be tailored according to the etiology and severity of the scleral melt. Medical management may be indicated, especially in cases of autoimmune-related melt; however, surgical procedures are often necessary due to compromised ocular integrity and limited penetration of medications into the avascular sclera. An understanding of the surgical options available and their operative outcomes is particularly important when choosing the appropriate treatment protocol for each patient.
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9
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Spaniol K, Borrelli M, Menzel-Severing J, Geerling G. [Conjunctival reconstruction-State of the art of regenerative treatment forms beyond the limbus]. DIE OPHTHALMOLOGIE 2022; 119:902-909. [PMID: 35925338 DOI: 10.1007/s00347-022-01673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The demands on conjunctival replacement tissues are high: they need to be elastic, clinically compatible, surgically feasible and support goblet cell growth. OBJECTIVE This article provides an overview of currently applied conjunctival replacement tissues and those under investigation. METHOD Current publications on clinically applied conjunctival replacement tissues and substrates which are the subject of scientific research and those already tested in animal models are presented and discussed. RESULTS Replacement tissues in clinical use are autologous and allogenic conjunctiva, nasal and oral mucous membranes, amniotic membrane and decellularized tissues. Autologous conjunctiva shows good results but is not suitable for large defects due to limited availability. In these cases autologous nasal and oral mucous membranes can be used; however, success is limited in cases of autoimmune diseases. Amniotic membranes are frequently applied clinically but goblet cell growth is limited. Different decellularized tissues are used clinically and goblet cell growth was found in vivo. Robust comparative studies are not yet available. Biological matrices such as fibrin, collagen, elastin, gelatin or hyaluronate and synthetic tissues from the group of polyesters are being investigated in the laboratory and in animal models. These studies show good epithelialization and goblet cell growth in vivo. CONCLUSION Transplantation of conjunctiva, nasal and oral mucous membranes and amniotic membranes show satisfactory clinical results but exhibit individual weaknesses. Further studies in animal models and clinical settings are required to further evaluate the benefits of other matrices, such as cell-free tissues or other biological and synthetic matrices.
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Affiliation(s)
- Kristina Spaniol
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Maria Borrelli
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Johannes Menzel-Severing
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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10
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Miotti G, Zeppieri M, Rodda A, Salati C, Parodi PC. How and when of eyelid reconstruction using autologous transplantation. World J Transplant 2022. [DOI: doi.org/10.5500/wjt.v12.i7.175] [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: 02/06/2023] Open
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11
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Miotti G, Zeppieri M, Rodda A, Salati C, Parodi PC. How and when of eyelid reconstruction using autologous transplantation. World J Transplant 2022; 12:175-183. [PMID: 36051449 PMCID: PMC9331409 DOI: 10.5500/wjt.v12.i7.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Reconstructive surgery of the eyelid after tumor excision, trauma or other causes can be challenging, especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes. The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction. Surgical procedures are various, based on the use of both flaps, pedicled or free, and grafts, in order to guarantee adequate tissue reconstruction and blood supply, which are necessary for correct healing. Common techniques normally include the use of local tissues, combining non-vascularized grafts with a vascularized flap for the two lamellae repair, to attempt a reconstruction similar to the original anatomy. When defects are too wide, vast, deep, and complex or when no adjacent healthy tissues are available, distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction. With regards to the anterior lamella, full thickness skin grafts are commonly preferred. With regards to the reconstruction of posterior lamella, there are different graft options, which include conjunctival or tarsoconjunctival, mucosal or palatal or cartilaginous grafts usually combined with local flaps. Free flap transplantation, normally reserved for rare select cases, include the use of the radial forearm and anterolateral flaps combined with mucosal grafts, which are surgical options currently reported in the literature.
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Affiliation(s)
- Giovanni Miotti
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Agostino Rodda
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
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12
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Alkhairy S, Baig MM, Pasha UA. Unilateral Anophthalmic Socket Reconstruction With Dermis Fat Graft. Cureus 2021; 13:e18834. [PMID: 34804689 PMCID: PMC8592800 DOI: 10.7759/cureus.18834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 11/05/2022] Open
Abstract
A 15-year-old girl presented with the complaint of a cosmetically disfigured right eye since birth. The initial assessment was carried out by way of a history and physical examination. The patient's history revealed no significant findings. Physical examination revealed that the right ophthalmic socket was seemingly devoid of an identifiable globe and ocular tissue, which is described as an anophthalmic socket. The conjunctival fornices appeared short, a finding which was more noticeable in the inferior conjunctival fornix. The patient's orbital volume was decreased. To increase the orbital volume, a dermis fat graft (DFG) was carefully taken from the gluteal region. The graft was then transposed to the anophthalmic socket and sutured to the conjunctiva and Tenon's capsule. A prosthetic eye was placed in the socket. Later, a second surgical intervention was performed to deepen the inferior fornix, for which a mucous membrane graft was taken from the lower lip. As a result of these interventions, all cosmetic and medical concerns of the patient regarding the anophthalmic socket were addressed. The success of this procedure speaks to the efficacy of DFGs in the repair of an anophthalmic socket.
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Affiliation(s)
- Saba Alkhairy
- Ophthalmology, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Mahad M Baig
- Ophthalmology, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Usman A Pasha
- Ophthalmology, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
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13
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Grossmann T, Darnhofer B, Birner-Gruenberger R, Kirsch A, Gugatschka M. Descriptive proteomics of paired human vocal fold and buccal mucosa tissue. Proteomics Clin Appl 2021; 16:e2100050. [PMID: 34792860 PMCID: PMC9286793 DOI: 10.1002/prca.202100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/28/2021] [Accepted: 11/14/2021] [Indexed: 11/22/2022]
Abstract
The vast majority of voice disorders is associated with changes of the unique, but delicate, human vocal fold mucosa. The ability to develop new effective treatment methods is significantly limited by the physical inaccessibility and the extremely rare occasions under which healthy tissue biopsies can be obtained. Therefore, the interest in laryngological research has shifted to human oral (buccal) mucosa, a similar and more easily available tissue. The harvesting process is less invasive and accompanied with faster healing and less scarring, compared to vocal fold mucosa. Here we report a descriptive proteomic comparison of paired human buccal and vocal fold mucosa by high‐resolution mass spectrometry (CID‐MS/MS). Our study identified a total of 1575 proteins detected within both tissues that are highly consistent in several crucial biological processes, cellular components, and molecular functions. Hence, our proteomic analysis will provide a fundamental resource for the laryngological research community.
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Affiliation(s)
- Tanja Grossmann
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Barbara Darnhofer
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center of Molecular Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, The Omics Center Graz, Graz, Austria
| | - Ruth Birner-Gruenberger
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center of Molecular Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, The Omics Center Graz, Graz, Austria.,Institute of Chemical Technologies and Analytics, Vienna University of Technology, Vienna, Austria
| | - Andrijana Kirsch
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
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14
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Martinez-Osorio H, Schellini SA, Marin-Muñoz LS. Long-term follow up of oral mucosa autograft sutured to the sclera in severe symblepharon. Am J Ophthalmol Case Rep 2021; 23:101099. [PMID: 34124409 PMCID: PMC8175267 DOI: 10.1016/j.ajoc.2021.101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/25/2021] [Accepted: 04/12/2021] [Indexed: 10/25/2022] Open
Abstract
Purpose To evaluate the clinical outcomes and complications of oral mucosa autograft (OMAU) sutured to the sclera to treat symblepharon after severe chemical or fireworks burn. Methods Our surgical technique for OMAU sutured to the sclera is presented along with clinical data and outcomes of 7 symblepharon carriers. Our surgical technique was performed unilateral in all cases. An OMAU with a mean length of 3 cm and 2 cm wide was sutured to the bare sclera 1-3 mm behind the limbus. Amniotic membrane transplant was placed covering the rectus muscles and bare sclera proximal to the limbus. The fornix was secured into the skin with deepening bolster sutures. A temporary tarsorrhaphy was performed, and a symblepharon ring was placed on top of a bandage contact lens. Results There were no cases of intraoperative complications. Three years postoperatively, all patients had perfect integration of the OMAU and there were no cases of symblepharon's recurrence. Two patients developed mild superior entropion and 2 patients developed mild strabismus (one esotropia and another exotropia). Conclusion and Importance OMAU sutured to the sclera after symblepharon release caused by severe ocular burns, results in excellent cosmetic and anatomical outcomes with no recurrence.
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Diplopia Following the Insertion of a Canalicular Bypass Tube: Etiology, Risk Factors, Management, and Outcomes. Ophthalmic Plast Reconstr Surg 2021; 37:S19-S22. [PMID: 33009327 DOI: 10.1097/iop.0000000000001770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the etiology, management, and possible risk factors for diplopia after canalicular bypass surgery. METHODS A multicenter retrospective, noncomparative case series of patients who developed diplopia following canalicular bypass surgery were assessed. RESULTS Twenty-four cases of diplopia were identified across 12 institutions. Tubes were inserted as a primary procedure with external dacryocystorhinostomy (DCR) (1; 4%) or without DCR (10; 42%) or as a secondary procedure after external (8; 33%) or endonasal (5; 21%) DCR. Factors predisposing to local damage were noted in 17 (71%): these factors included preexisting autoimmune/inflammatory condition (7 cases), medial canthal tumor resection (5 cases), preoperative radiotherapy (2 cases), 2 drug treatments (topical and systemic), and 1 local surgery. Horizontal diplopia was due to restriction of abduction and first noted at a median of 3.5 months (mean: 17.8 months, range: 1 day to 112 months) and persisted in 23 (96%) cases with a mean restriction of -2, affecting primary gaze in 4 patients and activities of daily living in 13 (42%). Seventeen patients received various treatments: 10 were operated on resulting in cure in 1 and improvement in 9. A stable degree of diplopia persisted in all but one patient. CONCLUSIONS Restriction of abduction causing horizontal diplopia is a rare complication with canalicular bypass surgery and a notably high proportion occurred after tube placement without DCR; carunculectomy was not ubiquitous. Although in some the diplopia may be improved with intervention, the chance of cure is low. This complication should probably be included during informed consent for canalicular bypass tubes.
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Abstract
Purpose: To review the surgical management options in ocular chemical burn, including newer advances.Methods: Online literature search of published articles over last 5 years on surgical management of ocular chemical burn and newer advances were performed on December 30, 2020.Results: Following literature search and screening using adequate filters, 67 review articles on surgical management of ocular chemical burns were retrieved. The review talks about the surgical management options starting from Debridement in acute stage to various visual rehabilitative procedures in the chronic stage. The review also highlights the evolving surgical advances in this field.Conclusion: It is imperative to choose adequate surgical tool wherever applicable; current review discusses the role of each surgical option at different clinical stages in detail.
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Affiliation(s)
- Priyanshi Awasthi
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Prabhakar Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
| | - Amit Raj
- Department of Ophthalmology, All India Institute of Medical Sciences, Patna, India
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17
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Trinh T, Mimouni M, Santaella G, Cohen E, Chan CC. Surgical Management of the Ocular Surface in Neurotrophic Keratopathy: Amniotic Membrane, Conjunctival Grafts, Lid Surgery, and Neurotization. Eye Contact Lens 2021; 47:149-153. [PMID: 33196502 DOI: 10.1097/icl.0000000000000753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the surgical modalities available to treat Mackie stage 2 and stage 3 neurotrophic keratopathy. METHODS Literature review and technique descriptions. RESULTS The following procedures are described in detail with accompanying videos: temporary, permanent, and botox-assisted tarsorrhaphy; amniotic membrane transplant; keratoplasty with amniotic membrane and tarsorrhaphy augmentation; Gunderson and conjunctival pedicle flaps; buccal graft transplantation; and neurotization. CONCLUSION A variety of surgical options exist to manage neurotrophic keratopathy when medical treatments alone fail to resolve epitheliopathy. Ongoing protection and optimization of the ocular surface health remains crucial to prevent recurrent epithelial breakdown.
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Affiliation(s)
- Tanya Trinh
- Department of Ophthalmology and Vision Sciences, the University of Toronto, Toronto, ON, Canada
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Shanbhag SS, Singh S, Koshy PG, Donthineni PR, Basu S. A beginner's guide to mucous membrane grafting for lid margin keratinization: Review of indications, surgical technique and clinical outcomes. Indian J Ophthalmol 2021; 69:794-805. [PMID: 33727438 PMCID: PMC8012968 DOI: 10.4103/ijo.ijo_1273_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The posterior lid margin, where the mucocutaneous junction (MCJ) between the eyelid skin and tarsal conjunctiva is located, plays a critical role in maintaining the homeostasis of the ocular surface. Posterior migration of the MCJ leads to lid-margin keratinization (LMK), which has a domino effect on the delicate balance of the ocular surface microenvironment. This occurs most commonly following Stevens-Johnson syndrome/toxic epidermal necrolysis and is not known to regress spontaneously or with medical therapy. Over time, LMK causes blink-related chronic inflammatory damage to the corneal surface which may have blinding consequences. Lid-margin mucous membrane grafting (MMG) is the only definitive therapy for LMK. Timely MMG can significantly alter the natural course of the disease and not only preserve but even improve vision in affected eyes. Literature searches were conducted on PubMed, using the keywords "mucous membrane grafts," "lid margin keratinization," "Stevens-Johnson syndrome," "toxic epidermal necrolysis," "lid related keratopathy," and "lid wiper epitheliopathy". This review, which is a blend of evidence and experience, attempts to describe the indications, timing, surgical technique, postoperative regimen, and clinical outcomes of MMG for LMK. The review also covers the possible complications and pearls on how they can be effectively managed, including how suboptimal cosmetic outcomes can be avoided. The authors hope that this review will aid ophthalmologists, including cornea and oculoplasty specialists, to learn and perform this vision-saving surgery better, with the aim of helping their patients with chronic ocular surface disorders, relieving their suffering, and improving their quality of life.
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Affiliation(s)
- Swapna S Shanbhag
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swati Singh
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | - Sayan Basu
- The Cornea Institute; Center for Ocular Regeneration (CORE); Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
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19
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Dereli Can G, Akcan G, Can ME, Akdere ÖE, Çaylı S, Şimşek G, Gümüşderelioğlu M. Surgical and Immunohistochemical Outcomes of Scleral Reconstruction with Autogenic, Allogenic and Xenogenic Grafts: An Experimental Rabbit Model. Curr Eye Res 2020; 45:1572-1582. [PMID: 32366164 DOI: 10.1080/02713683.2020.1764976] [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: 01/08/2023]
Abstract
Purpose: Choukroun's platelet-rich fibrin (PRF), a second-generation platelet concentrate, has unique morphological and chemical features and may be considered as a scaffold for scleral reinforcement and regeneration. The purpose of this study was to compare the use of xenogenic human-derived amniotic membrane (HAM), allogenic sclera, and autogenic PRF in rabbit lamellar scleral defect model with respect to both anatomical and immunohistochemical improvement. Methods: A total of 45 adult New Zealand rabbits were randomized into five groups: normal control; without surgical procedure, negative control; scleral defect model (SDM), xenogenic HAM; SDM+HAM graft, allogenic sclera; SDM+allogenic sclera graft, autogenic PRF; SDM+autogenic PRF graft. Clinical findings, Hematoxylin&Eozin (HE), Masson Trichrome, Verhoeff Acid Fuchsin, Transforming Growth Factor β Receptor 1, Fibroblast Growth Factor, Bone Morphogenetic Protein 2, collagen type 1, aggrecan, and Matrix Metalloproteinase 2 were evaluated. Results: Ocular surface inflammation was significantly lower in normal control and autogenic PRF groups (p < .001). Graft was avascular and not integrated to scleral wound area in 25% rabbits of allogenic sclera group (p = .02), was out of the scleral wound in 33.3% rabbits of xenogenic HAM group (p > .05), all the grafts were at the normal location and viable in autogenic PRF group. The inflammation and vascularization in autogenic PRF group was significantly lower than negative control and xenogenic HAM groups in HE (p < .001). The collagen score of negative control and xenogenic HAM groups were significantly lower than normal control (p < .001) and autogenic PRF (p < .001) groups. There were insignificant differences between allogenic sclera and autogenic PRF groups (p > .05). For immunohistochemistry, the closest values to normal control group were detected in autogenic PRF group for all immunomarkers. Conclusion: Autogenic PRF showed superior features via its excellent anatomical and chemical composition for scleral regeneration when compared to single-layered xenogenic HAM and allogenic sclera grafts.
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Affiliation(s)
- Gamze Dereli Can
- Department of Ophthalmology, Bursa Yüksek Ihtisas Training and Research Hospital , Bursa, Turkey
| | - Gülben Akcan
- Department of Histology and Embryology, Ankara Yıldırım Beyazıt University, Medical Faculty , Ankara, Turkey
| | - Mehmet Erol Can
- Department of Ophthalmology, Bursa City Hospital , Bursa, MD, Turkey
| | - Özge Ekin Akdere
- Department of Bioengineering, Hacettepe University Institute of Science and Engineering , Ankara, Turkey
| | - Sevil Çaylı
- Department of Histology and Embryology, Ankara Yıldırım Beyazıt University, Medical Faculty , Ankara, Turkey
| | - Gülçin Şimşek
- Department of Pathology, Keçiören Training and Research Hospital , Ankara, MD, Turkey
| | - Menemşe Gümüşderelioğlu
- Department of Bioengineering, Hacettepe University Institute of Science and Engineering , Ankara, Turkey.,Department of Chemical Engineering, Hacettepe University Faculty of Engineering , Ankara, Turkey
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Pilger D, von Sonnleithner C, Bertelmann E. Assessing full thickness oral mucosal grafting: complications and postoperative outcomes in a broad collective of patients. BMJ Open Ophthalmol 2020; 5:e000337. [PMID: 32154368 PMCID: PMC7045019 DOI: 10.1136/bmjophth-2019-000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/29/2019] [Accepted: 12/24/2019] [Indexed: 11/03/2022] Open
Abstract
Background Conjunctival defects can be repaired with several mucosal tissues. The simplicity of harvesting oral mucosa and its wide availability makes it the preferred graft tissue for all indications requiring mucosal grafting. Through analysing the postsurgical outcomes and rate of revisions, this study explores the suitability of oral mucosa grafts, depending on the initial diagnosis. Methods We reviewed all the files of patients with a history of oral mucosal graft surgery, performed at our clinic between 2012 and 2018, focusing on complications and revision rates. Results In total, we analysed 173 oral mucosa grafts in 131 patients. The most common initial diagnosis was tumour resection, followed by surgical complications, postenucleation socket syndrome, trauma and ocular surface disorders. Complication and revision rates depended highly on the initial diagnosis. Revision rates were highest if the initial diagnosis included ocular surface disorders or chemical trauma. Conclusions Oral mucosa grafting (OMG) is the most effective treatment for a wide range of ocular conditions involving conjunctival defects. Conjunctival defects that result from trauma or cicatricial surface diseases seem less suitable for OMG and may benefit from alternative graft tissue or treatment options.
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Affiliation(s)
- Daniel Pilger
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Eckart Bertelmann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Sheth T, Attzs M, Tambe K. A new perspective in oculoplastic surgical management of symptomatic distichiasis in lymphedema-distichiasis syndrome. Orbit 2019; 38:424-427. [PMID: 30516410 DOI: 10.1080/01676830.2018.1546749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
Lymphedema-distichiasis syndrome (LDS) is an autosomal dominant condition associated with FOXC2 mutations. Patients with distichiasis are mostly symptomatic, and efforts to deal with their ocular complaints comprise of electrolysis, cryotherapy and a variety of surgical techniques. We describe an enhanced surgical technique for a case of symptomatic distichiasis of the right eye with scarred, irregular eyelid margins secondary to initial cryotherapy, whereby the distorted tarsus was excised to remove the aberrant hair follicles, the levator palpebrae superioris was released to extend the upper lid and prevent lagophthalmos and a mucous membrane graft was used to cover the exposed portion of the tarsal plate. At 14 months follow up, the lid cosmesis and position remained satisfactory, with no infection or rejection of the mucous membrane graft. Therefore, this surgical technique provides a sound option for symptomatic distichiasis, where cryotherapy can cause lid irregularity and keratinization.
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Affiliation(s)
- Twishaa Sheth
- Department of Ophthalmology, University Hospital Nottingham NHS Trust , Nottingham , UK
| | - Michelle Attzs
- Department of Ophthalmology, University Hospital Nottingham NHS Trust , Nottingham , UK
| | - Katya Tambe
- Department of Ophthalmology, University Hospital Nottingham NHS Trust , Nottingham , UK
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22
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Oliphant H, Rajak SN. Dried amniotic membrane in fornix reconstruction. Clin Exp Ophthalmol 2019; 47:1090-1091. [PMID: 31170326 DOI: 10.1111/ceo.13566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Huw Oliphant
- The Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
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