CT volumetry study of microfat graft survival from different donor sites in augmenting the enophthalmic socket

PURPOSE

To evaluate autologous fat grafts harvested from the abdomen versus the thigh for treating the enophthalmic socket using CT volumetry.

METHODS

A randomized prospective interventional study including 20 patients suffering from unilateral enophthalmic socket. Pre-operative clinical assessment included photographs, exophthalmometry reading as well as CT volumetry for volume deficit calculations and the harvesting site was randomly allocated (abdomen or thigh). All patients completed 6 months of follow-up. Exophthalmometry change and percentage of retained fat with the globe included and without it at follow-up were measured.

RESULTS

Microfat graft survival showed no statistically significant correlation with sex, age, or donor site. Mean percentage of retained fat with globe and without it were 14.75% and 25.31%, respectively. Difficulty of extraction and degree of volume deficit correlated significantly with percentage of fat retained. Exophthalmometer change correlated significantly with percentage of fat retained.

CONCLUSION

Autologous fat grafting is a safe and effective technique for volume augmentation of enophthalmic sockets regardless of its harvesting site. CT volumetry has an important role in accurately measuring the volume deficit as well as the postoperative results.

Transcutaneous approach for orbital augmentation with alloplastic implants in acquired anophthalmia

Purpose: To report the outcomes of a transcutaneous surgical technique for orbital volume augmentation with secondary alloplastic implants in acquired anophthalmia.Methods: Retrospective case note review of patients who underwent secondary orbital implant insertion through a subciliary incision between January 2006 and December 2017. Collected data included age, gender, type and cause of primary surgery, time interval before secondary implantation, and details of secondary implantation surgery. The main outcome parameters included postoperative appearance, grade of superior sulcus deformity (SSD), implant centration, and prosthesis function.Results: Thirty-eight patients ranging from 2 to 54 years had undergone secondary alloplastic orbital implant placement through the subciliary approach. The mean follow-up was 5.3 years (range: 1-10 years). All the patients showed satisfactory orbital volume with the average SSD was grade 0.74. There were no cases with implant exposure or extrusion. Implant migration occurred in six cases (15.8%). Fitting a prosthesis was possible in all cases.Conclusion: Subciliary secondary orbital implantation is proved to be effective in correcting volume deficiency in acquired anophthalmia with rapid rehabilitation while avoiding anterior surface breakdown and implant exposure.

Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities

AIM

To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion (UCE) correction using anterior lamellar recession (ALR) with addressing the associated conditions including dermatochalasis, brow ptosis, blepharoptosis, and lid retraction.

METHODS

Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed. Success was defined as the lack of any lash in contact with the globe, no need for a second procedure, and acceptable cosmesis at the final follow up.

RESULTS

Sixty eight patients (97 eyelids) were operated by ALR with simultaneous correction of associated lid problems in each case when necessary. The mean follow-up time was 17.8mo (range, 6.0-24.0mo). Concomitantly, levator tucking was performed in 19 eyelids (19.6%), upper lid retractor recession in 18 eyelids (18.6%), and internal browpexy in 31 eyelids (32.0%). In 95.8% of patients (95%CI: 0.85-0.96), satisfactory functional and cosmetic outcome was achieved with a single surgical procedure.

CONCLUSION

Based on the principles of lamellar recession and concurrently addressing the associated lid problems, this approach is an effective and safe treatment of UCE.

Orbital foreign bodies: expect the unexpected

Data of three pediatric patients with orbitofacial trauma were reviewed. Two patients presented with recurrent orbital inflammation with partial remission with antibiotics. One patient presented with diplopia. All patients underwent full opthalmic examination and computed tomography (CT) of the brain and orbit, followed by surgical intervention. The indication for surgery was either abscess evacuation, repair of blowout fracture, or mass excision. All of the patients had intraorbital wood foreign bodies that were not evident on CT and were not suspected from the history given by the parents. All were surgically removed. One patient had multiple wood foreign bodies (more than 10). Chronic or recurrent orbital inflammation, unexplained proptosis, or orbital masses following orbitofacial trauma in children should raise the suspicion of intraorbital foreign bodies even if not detected by CT studies. Presence of other sequelae of trauma such as blowout fracture does not exclude the possibility of associated foreign bodies.

Evaluation of transconjunctival frontalis suspension using nonabsorbable suture

PURPOSE

To evaluate the transconjunctival frontalis suspension technique using nonabsorbable suture (4/0 polypropylene) in patients with severe blepharoptosis and poor levator function.

METHODS

A total of 22 patients (33 ptotic eyelids) were included in a prospective interventional case series study. All had severe ptosis with poor levator function. Transconjunctival frontalis suspension using 4/0 polypropylene suture was done in all patients.

RESULTS

Twelve patients (17 eyelids) had congenital ptosis, 6 patients (12 eyelids) had blepharophimosis, and 4 patients (4 eyelids) had traumatic ptosis. The surgical technique was easy and fast and surgical results in the 3 groups were good functionally and cosmetically. Recurrences in 3 eyelids (9%) happened after 3 years. Follow-up ranged from 1 to 4 years.

CONCLUSIONS

Transconjunctival frontalis suspension technique is simple and time saving for treatment of severe ptosis with poor levator function. It gives good functional and cosmetic results. Healing was normal with no postoperative swelling or infection. 4/0 Polypropylene exhibits satisfactory results and easy manipulation.