Abstract Listings (Video presentations)

Müller’s muscle-conjunctival resection in chronic progressive external ophthalmoplegia

Category: Aesthetic, Eyelid
Author: Mehmet Serhat Mangan

Purpose

Chronic progressive external ophthalmoplegia (CPEO) is a type of eye disorder characterized by slowly progressive inability to move the eyes and eyebrows. This video demonstrates a Müller’s muscle-conjunctival resection with tarsectomy to treat a bilateral ptosis.

Methods

A 59-year-old lady with chronic bilateral severe blepharoptosis of 14 years duration is presented, whose detailed ophthalmic and neurological investigations excluded myasthenia gravis and the other causes. She has a ophthalmoplegia without diplopia. Pupilla was not affected bilaterally. Partial response was achieved to topical 2.5% phenylephrine.

Results

Increased upper marginal reflex distance was achieved postoperatively. Lagophthalmos and exposure keratopathy was not seen.

Conclusion

In conclusion, posterior approach may be preferred as an alternative in cases with weak Bell’s phenomenon and high risk of exposure keratopathy.

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Eyelid trauma reconstruction

Category: Eyelid, Lacrimal
Author: Ayşe Çetin Efe

Purpose

A 45-year-old woman had a car accident 20 days ago. Corneal perforation and lid laceration repair of the right eye was performed at an referral center. She was referred for canaliculus repair. Visual acuity is 20 ⁄ 25000 on the right eye, 20 ⁄ 20 on the left eye. Biomicroscopic examination revealed sutured horizontal full thickness corneal perforation, epithelial defect in the lower half of the cornea, traumatic cataract and nearly total traumatic iridodialysis in the right eye. Fundus was not visible in the right eye, globe was stable on ocular usg.

Methods

We planned a revision surgery. We opened all eyelid layers one by one and excised the scar areas. There was a lower canalicular laceration close to the common canaliculus. We performed annular silicone intubation with pigtail probe. We sutured the laceration on the eyelids layer by layer from deep to surface.We examined the patient at two-week intervals and applied subcutaneous 5-fu injection to the areas required for scar rehabilitation, targeting the deep subcutaneous tissues from the tissue next to the scar tissue, towards the center of the scar tissue, until clinical whitening was achieved. And we continued this injection at two-week intervals until the desired healing was achieved.

Results

The appearance of the eyelids became better and more acceptable. There was a decrease in the stiffness and tension of the scar and an increase in its ability to stretch. The patient’s nasolacrimal canal passage is open, no complaint of epiphora.

Conclusion

The aim of repair is to achieve anatomical and functional reconstruction. To assess the extent of lid injury, we need to know the anatomy and restore it layer by layer, putting the puzzle in place in the three-dimensional eyelids. We should consider applying 5 fluorosil for the rehabilitation of eyelid scarring.

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Orbital foreign body removal: a surgical challenge

Category: Orbit
Author: Arnaud Martel

Purpose

To demonstrate how difficult it is to remove a deep orbital foreign body, even when removing the eyeball. And to demonstrate the need for each orbital surgeon to have a dedicated orbital magnet.

Methods

Surgical video with presentation of the case, surgery, outcomes and conclusion

Results

A young patient was referred for an apical bullet foreign body associated with eye loss and chronic eye pain. We planned to perform an enucleation with an on the table evisceration followed by foreign body removal. Despite using a specifically designed orbital magnet, removal of the foreign body was a failure. The patient had no eye pain anymore. The postoperative course was unremarkable. We also present a magnet that we specifically designed for metallic orbital foreign bodies.

Conclusion

Several conclusions can be drawn:
1. Removal of apical foreign body is challenging, even when removing the eyeball.
2. The vegetal orbital foreign bodies should be systematically removed, even when located at the orbital apex
3. Bullets are usually not ferromagnetic
4. Every orbital surgeon should have a specific orbital magnet to help removal of metallic foreign bodies

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Müller’s Muscle Conjunctival Resection Ptosis Repair: Double Pass- Temporal Buried Suture Technique using Polyglaktin 910

Category: Eyelid
Author: Ayse Dolar Bilge

Purpose

To present Müller’s muscle conjunctival resection technique with double pass-temporal subconjunctival burried knot technique using polyglaktin 910 suture.

Methods

Lidocaine-bupivacaine mixture was infiltrated on upper eyelid skin and under the conjunctiva superior to the tarsal border. After placing upper eyelid traction suture, eyelid was everted using desmarres retractor. Half of the preoperatively planned resection length was marked from the superior border of the tarsus and three 5.0 silk traction sutures were passed from conjunctiva and Müller’s muscle. Conjunctiva and Müller’s muscle was clamped and temporal conjunctival stab insicion was made to bury the knot. Polyglaktin 910 suture was passes in a running horizontal matress pattern starting from temporal stab insicion to nasal and nasal to temporal. Entrapped tissue was excised with a no:15 Bard-Parker blade and sutures integrity was controlled, tied and secured under the conjunctival stab insicion. Eyelid height was controlled, antibiotic oinment was placed.

Results

Patients were controlled 1st day, 1st week and 1st month after the surgery. As the suture was buried under the conjunctiva, post op corneal pain or epitheliopathy did not happened.

Conclusion

Double pass, buried knot technique using polyglaktin 910 suture for Müller’s muscle conjunctival resection is an easy and safe method. The most important advantage of the method is that it does not require suture removal and the soft structure of the suture does not cause any corneal damage. In addition, double pass of the suture provides adequate tensil strength during the healing period.

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Drop down the anchor: Fixation of the medial canthal tendon using the Mitek Anchor System

Category: Eyelid
Author: Catarina Monteiro

Purpose

This video aims to present a case in which the Mitek Anchor System was used for medial canthal tendon fixation and angular restoration of the palpebral fissure.

Methods

We present the case of a 56 year old man that suffered trauma in his right eye with a grinding wheel and was submitted to medial canthal reconstruction by the maxillofacial team. Two years after the first surgery, the patient still presented with traumatic telecanthus and palpebral angle distortion. This resulted in both aesthetic and functional complaints (epiphora). Therefore, the patient was submitted to a new surgical intervention using the Mitek Anchor System. This canthoplasty technique consisted of fixation of the soft tissue of the medial canthal tendon to the nasomaxillary process in the maxilla. In addition, we used the Burow’s triangle technique for the skin.

Results

Five years after the surgery the patient still presents with a satisfactory eyelid position and symmetry between both eyes. The interpalpebral angle was restored with resolution of the traumatic telecanthus.

Conclusion

The Mitek Anchor System offers a new and exciting alternative to conventional techniques for medial canthal tendon reattachment. Our surgery was complex due to the nature of the trauma and the previous surgical interventions. However, the anchor placement was fast and simple, and it provided a very pleasing aesthetic and functional longlasting result.

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Lower eyelid hard palate graft: tips for the extraction and suture

Category: Eyelid
Author: Constanza Barrancos

Purpose

Hard palate grafts are very useful to lengthen the posterior lower eyelid lamella.

Methods

In the video, we present ten pearls to optimize this surgical technique.

Results

These tips will facilitate the extraction and suture of this graft.

Conclusion

Hard palate grafts extraction and suture can be tricky. This pearls will flatten the learning curve for this technique.

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Preoperative embolization for hypervascular solitary fibrous tumor orbit: The thrilling Tale of a bloody orbit

Category: Orbit
Author: Dr. Anasua Kapoor

Purpose

Solitary fibrous tumours (SFT) is an encompassing terminology comprising of tumours with proliferating CD34 positive specialized fibroblasts. Orbital SFTs are rare slowly progressive highly vascular neoplasms. Complete surgical excision is considered the mainstay treatment. Incomplete resection is a known risk factor for recurrence and malignant transformation. However, excessive bleeding on table many a times hinders complete surgical excision.

Methods

Pre-operative embolization of SFT has shown promising results in reducing the vascularity of these tumours rendering them amenable to complete surgical excision. Less than ten cases of embolization of orbital solitary fibrous tumours have been described in literature.

Results

Our patient underwent an attempted surgical excision elsewhere with significant intraoperative hemorrhage which precluded its complete excision when he was referred to our ocular oncology clinic for appropriate management.

Conclusion

This video will highlight the procedure of preoperative embolization using onyx as an embolizing agent in a case of a hypervascular orbital tumour followed by removal of the tumour through minimally invasive technique of inferior transconjunctival orbitotomy with cryoextraction followed by adjuvant radiotherapy.

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Dacryocystorhinostomy – osteotomy techniques.

Category: Lacrimal
Author: Maria Araujo

Purpose

Dacryocystorhinostomy is a surgical technique aimed at creating a bypass between the lacrimal sac and the nose. The performance of osteotomy has evolved according to the emergence of new technologies, surgeon preference, or the economic capacity of the country or patient. Kerrison punches, Citelli punches, Arruga trephines, lasers, and ultrasonic instruments can be used separately or in combination for osteotomy during dacryocystorhinostomy.

The authors present a video demonstrating various technical options for performing osteotomy in dacryocystorhinostomy.

Methods

In this study, the authors present a video demonstrating the latest osteotomy techniques used in dacryocystorhinostomy, including the utilization of diode laser and ultrasonic aspirator.

Results

The success rate, learning curve, risks to surrounding tissues, and costs associated with dacryocystorhinostomy depend on the chosen technique and the approach route, which can be cutaneous, endonasal, or diode laser-assisted.

Laser diode osteotomy is the fastest and leaves no cutaneous scar, but it yields poorer results and is expensive. The external approach with an Arruga trephine or punches is the most cost-effective, provides good results, and is relatively fast, but it carries risks of nasal mucosa injury, especially with the Arruga trephine, and leaves a cutaneous scar. Ultrasonic aspirator osteotomy is slower and more expensive, but it poses fewer risks to soft tissues, including the inflammatory process.

Conclusion

The choice of instruments for osteotomy varies depending on the technique used. However, in endonasal and cutaneous dacryocystorhinostomy, there are more options available for performing osteotomy, which can be complementary. In transcanalicular cases, the use of LASER is generally the preferred method.

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Autologous pericranium graft in reconstructing the contracted socket

Category: Socket
Author: Nuria Ibañez Flores

Purpose

Insufficient orbital volume in an anophthalmic socket is a significant problem for the placement of an ocular prosthesis. This video shows the use of an autologous pericranium graft in association with an orbital implant in a patient with a contracted socket and a large orbital volume deficit.

Methods

We present a video of a patient previously eviscerated that suffered severe loss of intraorbital volume.

Results

This video presents the surgical technique performed under general anaesthesia. The first step is the pericranium graft harvest from the scalp region. Starting at the center of the parietal region toward the occipital area, the skin was marked and a vertical incision was made along the mark up to the glabella. A 3 × 3 cm tissue patch was obtained using a periosteum dissector, closed by layers.Then, the socket is opened, followed by a conjunctival peritomy and careful tissue dissection. The orbital implant is placed in the empty sclera. The implant used was 20-mm diameter porous polyethylene implant. The smoother graft surface (in contact with the scalp bone) was positioned face upwards to promote the growth of conjunctiva and complete epithelialization of the graft. We sutured the graft using 6-0 Vicryl suture and left the central pericranium graft bare for its subsequent epithelialization. Finally, an antibiotic ointment was instilled, and a conformer was placed in the conjunctival sac.

Conclusion

The goal of anophthalmic socket surgery is to restore the lost volume of the orbit.The volume deficit is usually restored in these patients using a large orbital implant in a second surgical intervention. However, the conjunctiva is often insufficient to cover the new implant surface, with consecuent high rates of implant exposure. The benefits of using pericranium tissue are barely visible donor site scars in the parieto-occipital zone, minimal postoperative pain and donor site morbidity.This report describes successful outcomes in patients with insufficient orbital volume undergoing a large orbital implant placement in association with an autologous pericranium graft in a one-stage surgical procedure.

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A tooth rooted from orbital floor

Category: Orbit
Author: Sertaç Argun Kıvanç

Purpose

Dentigerous cysts are rare structures. It is seen together with ectopic tooth development. In this case, surgery for a maxillary dentigerous cyst with an ectopic tooth originating from the orbital floor is shown.

Methods

The patient, who was referred to an Ear Nose and Throat (ENT) physician by the dentist, was referred to Bursa Uludag University, Oculoplastic, Orbita and Lacrimal System Diseases Department by ENT doctors due to the tooth in the orbital floor in his radiological imaging. Otorhinolaryngology and Ophthalmology Departments performed a joint operation.

Results

The patient had an uneventful surgery. Ophthalmologists intervened in the tooth root from within the orbit with orbitotomy, while otorhinolaryngologists intervened in the maxillary sinus with Caldwell-Luc approach.

Conclusion

Although ectopic teeth are rare conditions, they are more often found in the sinus and their extension into the orbit is very rare. The multidisciplinary approaches of ophthalmologists and otorhinolarigologists to surgery will be beneficial in order not to damage the orbital structures and orbital floor during the extraction of ectopic teeth extending into the orbit from the sinus.

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Minimally invasive micro-endoscopy asisted periorbital mass surgery

Category: Aesthetic, Eyelid, Orbit
Author: Sertaç Argun Kıvanç

Purpose

Dermoid cysts are one of the most common periorbital masses in childhood. Dermoid cysts may be tightly adhered to the periosteum and their capsules may rupture during surgery. In order to avoid this complication, it is possible to make a wide surgical incision in order to see the mass better and to perform the dissection, but in this case, a significant scar may occur. In this video, we show the surgery that we define as minimally invasive periorbital mass surgery with micro-endoscope assisted through a 5mm incision.

Methods

The endoscopy probe used for endoscopic cyclophotocoagulation in glaucoma surgery has been used as both endoscopic imaging and light source.

Results

Dermoid cyst, 13x18x6 mm in size, was successfully visualized by endoillumination from the 5 mm incision area through the skin incision. The dermoid cyst was removed without rupture of its capsule.

Conclusion

In minimally invasive small incisions, using additional illumination through the wound lips can provide good illumination and can ensure the surgery to be completed very successfully. However, since the endoscopic image quality is not high with these probes, it may be preferable to perform the surgery under a microscope or with a loop rather than looking at the endoscopy screen.

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Direct Brow Lift Technique

Category: Aesthetic
Author: nathalia kassis

Purpose

Demonstrate how I perform the brow lift technique with a satisfactory arch and good scar.

Methods

Design, incision at medium depth, internal suture taking the orbital orbicularis and intradermal suture with continuous suture to reduce tension.

Results

In my experience, the use of this technique has enabled me to attain longterm stable aesthetic results.

Conclusion

The traditional open approach for the brow lift remains a fundamental skill in the arsenal of the oculoplastic surgeon, because it has several positive points such as: presenting a low rate of complications and promoting a satisfactory arching of the eyebrow.

Additional Authors

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