Aims: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. Methods: A r etrospective case note review of 86 patients who presented...Aims: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. Methods: A r etrospective case note review of 86 patients who presented with inferior break r etinal detachments was carried out. An inferior break was defined as a horseshoe tear present between 4 and 8 o’clock. Patients were analysed in two groups; gr oup A consisted of 41 patients who underwent a vitrectomy and gas, group B consi sted of 45 patients who underwent a vitrectomy, gas, and scleral buckle. The fea tures of the retinal detachment, peroperative and postoperative complications, a nd outcomes of treatment were recorded for each patient. Results: The primary an atomical success rate at 3 months was 89%in group A versus 73%in group B (P= 0 .11). There was no statistical difference in the complication rate between the t wo groups (P=0.819). The most common cause of treatment failure was proliferativ e vitreoretinopathy, 20%(n=9) in group B compared with 5%(n=2) in group A and this reached statistical significance (P=0.0159). There was a higher rate o f epiretinal membrane development in group B (P=0.000 4). The final attachment r ate was not statistically different between the two groups, 95%(39) in group A and 93%(42) in group B (P=1.0). Conclusion: Vitrectomy and gas without the appl ication of a scleral buckle may be used to safely treat inferior break retinal d etachments. It may be used as an alternative to vitrectomy, gas, and buckle whic h has an increased risk of choroidal haemorrhage, requires a longer operating ti me, and has all the associated complications of a scleral buckle.展开更多
Objective: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or ...Objective: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or fellow) and specialist oculoplastic surgeons (attending supervising physician). Design: Prospective, interventional, comparative, clinical case series. Participants: Adult patients with involutional entropion. Methods: Lateral tarsal strip and everting sutures (LTS+ES) by residents, fellows, or attending supervising physician. A minimum of 12 months of postoperative follow-up was required. Main Outcome Measures: Patients’symptoms and clinical examination to confirm a normal eyelid position (no entropion or secondary ectropion) at rest and with forced orbicularis contraction with the topical amethocaine (tetracaine) test. This test is described. Results: Fifty-five consecutive patients, aged 57 to 91 years (mean, 77 years) underwent LTS+ES surgery on 62 eyelids. Surgery was performed by a consultant ophthalmic oculoplastic surgeon (attending supervising physician) in 8 eyelids and by 20 different trainees, residents, and fellows in 54 eyelids. Six patients died (11%) within 6 months of surgery and 2 patients (3.5%) were lost to follow-up, resulting in 47 evaluable patients (54 eyelids). The follow-up period was 12 to 34 months (mean, 18 months). Fifty-three of 54 eyelids (98%)-had a successful outcome with no recurrence. The surgery was effective when performed by different grades of surgeon (P > 0.4). Conclusions: The LTS+ES is a simple operation for the correction of involutional entropion that can be performed effectively by both residents and fellows.展开更多
Objective: Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, i...Objective: Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, including lateral tarsal strip (LTS) or a lateral tarsorrhaphy. We modified the LTS to differentially shorten and elevate the lower lidmore than the upper: an augmented LTS tarsorrhaphy (aug-LTS-T). This study aimed to evaluate the technique. Design: Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture (PA), lagophthalmos, and corneal findings were recorded. The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data. Participants: Fourteen consecutive adult patients (15 eyelids) with chronic lagophthalmos and paralytic ectropion. Methods: Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm) that is attached to the outer temporal orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough. Main Outcome Measures: Improvementof symptoms, reduction of lower margin reflex distance, lagophthalmos, and improvement of corneal signs. Results: Minimum followup was 6 months. There was a significant reduction in PA (P =0.005) and lagophthalmos (P=0.0002) with improvement of corneal signs (14 of 15 eyelids=93%). Surgery was successful anatomically in 14 of 15 eyelids (93%) with low morbidity. Conclusions: We describe the augmented LTS tarsorrhaphy and find it effective in the treatment of severe lower eyelid ectropion resulting from facial palsy.展开更多
Background.Mersilene mesh(polyester fibre)is commonly used in ptosis surgery for frontalis suspension as it is readily available and cheap.Management of extrusion can be challenging.We report three case s of extrusion...Background.Mersilene mesh(polyester fibre)is commonly used in ptosis surgery for frontalis suspension as it is readily available and cheap.Management of extrusion can be challenging.We report three case s of extrusion where extremely thick mesh or extremely th in tissue may have contributed to the extrusion.Methods.Retrospective case note study of three adult patients who developed chronic mesh extrusion.Results.Extrusion and chronic infection occured 5-12months after surgery.Despite systemic an-tibiotics,all three patients requi red surgical excision of mesh from the eyelid up to the brow,which was curative.Conclusion.These cases illustrate the need for a systematic approach and the need in some cases to excise the mesh to prevent recurrent infection.展开更多
文摘Aims: To compare the success rates of vitrectomy and gas with vitrectomy, gas, and buckle in the treatment of inferior break retinal detachments. Methods: A r etrospective case note review of 86 patients who presented with inferior break r etinal detachments was carried out. An inferior break was defined as a horseshoe tear present between 4 and 8 o’clock. Patients were analysed in two groups; gr oup A consisted of 41 patients who underwent a vitrectomy and gas, group B consi sted of 45 patients who underwent a vitrectomy, gas, and scleral buckle. The fea tures of the retinal detachment, peroperative and postoperative complications, a nd outcomes of treatment were recorded for each patient. Results: The primary an atomical success rate at 3 months was 89%in group A versus 73%in group B (P= 0 .11). There was no statistical difference in the complication rate between the t wo groups (P=0.819). The most common cause of treatment failure was proliferativ e vitreoretinopathy, 20%(n=9) in group B compared with 5%(n=2) in group A and this reached statistical significance (P=0.0159). There was a higher rate o f epiretinal membrane development in group B (P=0.000 4). The final attachment r ate was not statistically different between the two groups, 95%(39) in group A and 93%(42) in group B (P=1.0). Conclusion: Vitrectomy and gas without the appl ication of a scleral buckle may be used to safely treat inferior break retinal d etachments. It may be used as an alternative to vitrectomy, gas, and buckle whic h has an increased risk of choroidal haemorrhage, requires a longer operating ti me, and has all the associated complications of a scleral buckle.
文摘Objective: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or fellow) and specialist oculoplastic surgeons (attending supervising physician). Design: Prospective, interventional, comparative, clinical case series. Participants: Adult patients with involutional entropion. Methods: Lateral tarsal strip and everting sutures (LTS+ES) by residents, fellows, or attending supervising physician. A minimum of 12 months of postoperative follow-up was required. Main Outcome Measures: Patients’symptoms and clinical examination to confirm a normal eyelid position (no entropion or secondary ectropion) at rest and with forced orbicularis contraction with the topical amethocaine (tetracaine) test. This test is described. Results: Fifty-five consecutive patients, aged 57 to 91 years (mean, 77 years) underwent LTS+ES surgery on 62 eyelids. Surgery was performed by a consultant ophthalmic oculoplastic surgeon (attending supervising physician) in 8 eyelids and by 20 different trainees, residents, and fellows in 54 eyelids. Six patients died (11%) within 6 months of surgery and 2 patients (3.5%) were lost to follow-up, resulting in 47 evaluable patients (54 eyelids). The follow-up period was 12 to 34 months (mean, 18 months). Fifty-three of 54 eyelids (98%)-had a successful outcome with no recurrence. The surgery was effective when performed by different grades of surgeon (P > 0.4). Conclusions: The LTS+ES is a simple operation for the correction of involutional entropion that can be performed effectively by both residents and fellows.
文摘Objective: Patients with paralytic ectropion and lagophthalmos may experience keratitis and may pose a functional and aesthetic surgical challenge. Various methods are used to reduce the vertical palpebral aperture, including lateral tarsal strip (LTS) or a lateral tarsorrhaphy. We modified the LTS to differentially shorten and elevate the lower lidmore than the upper: an augmented LTS tarsorrhaphy (aug-LTS-T). This study aimed to evaluate the technique. Design: Prospective noncomparative surgical trial in which preoperative and postoperative symptoms, margin reflex distances, vertical palpebral aperture (PA), lagophthalmos, and corneal findings were recorded. The data were analyzed at 6 months after surgery using the Wilcoxon sign-rank test for nonparametric data. Participants: Fourteen consecutive adult patients (15 eyelids) with chronic lagophthalmos and paralytic ectropion. Methods: Patients underwent aug-LTS-T. This consisted of a long strip (10-15 mm) that is attached to the outer temporal orbital rim, at a point higher than a conventional LTS. It included removal of a small part of the upper eyelid anterior lamella laterally to pass the long strip up high enough. Main Outcome Measures: Improvementof symptoms, reduction of lower margin reflex distance, lagophthalmos, and improvement of corneal signs. Results: Minimum followup was 6 months. There was a significant reduction in PA (P =0.005) and lagophthalmos (P=0.0002) with improvement of corneal signs (14 of 15 eyelids=93%). Surgery was successful anatomically in 14 of 15 eyelids (93%) with low morbidity. Conclusions: We describe the augmented LTS tarsorrhaphy and find it effective in the treatment of severe lower eyelid ectropion resulting from facial palsy.
文摘Background.Mersilene mesh(polyester fibre)is commonly used in ptosis surgery for frontalis suspension as it is readily available and cheap.Management of extrusion can be challenging.We report three case s of extrusion where extremely thick mesh or extremely th in tissue may have contributed to the extrusion.Methods.Retrospective case note study of three adult patients who developed chronic mesh extrusion.Results.Extrusion and chronic infection occured 5-12months after surgery.Despite systemic an-tibiotics,all three patients requi red surgical excision of mesh from the eyelid up to the brow,which was curative.Conclusion.These cases illustrate the need for a systematic approach and the need in some cases to excise the mesh to prevent recurrent infection.
