Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: To describe and evaluate the efficacy and safety of lacrimal sac to conjunctiva reconstructive ostomy for proximal lacrimal system reconstruction.

Methods: This retrospective study included 41 patients (32 cancer and 9 trauma; 36 primary and 5 secondary) who underwent lacrimal sac to conjunctiva reconstructive ostomy. The technique involves creating a direct connection between a surgical opening in the lacrimal sac, which maintains its bony attachments to prevent ostomy occlusion, and the medial conjunctiva (medial fornix, bulbar, and palpebral). Interrupted 7-0 polyglactin 910 sutures were used to form a 3- to 5-mm-diameter lined conduit. Stenting was not employed. When necessary, oral mucosa or mucoperiosteal grafts and local flaps were utilized for reconstruction. Outcomes were assessed by epiphora prevention, the functional patency of the lacrimal ostomy, and the patient-reported nasolacrimal duct obstruction symptom score.

Results: On examination, all patients demonstrated canalization of the lacrimal sac to the conjunctival reconstructive ostomy, as evidenced by unobstructed tear drainage. Complications occurred in 17% of cases, including periorbital edema, chemosis, diplopia, and conjunctival granuloma. The average nasolacrimal duct obstruction symptom score for lacrimal-ocular symptoms was 3.1/10 and for nasal symptoms was 2.3/10 (0 best, 10 worst). Tearing was the least prominent complaint (0.8/10), with 1 patient reporting permanent tearing (6/10).

Conclusion: Lacrimal sac to conjunctiva reconstructive ostomy proves to be a valuable procedure for immediate and delayed proximal lacrimal system reconstruction in cancer and trauma cases due to its straightforward and stent-free approach and its favorable 8-year outcomes.

A 59-year-old female patient presented with a purple, fluid-filled lesion on her left upper eyelid that contained a solid component. Excisional biopsy revealed a diagnosis of mucinous adenocarcinoma. Extensive oncological workup was negative for a distant primary tumor or metastasis and confirmed a diagnosis of primary mucinous adenocarcinoma. Further excision and eyelid reconstruction were required. One year later, another suspicious, fluid-filled lesion was excised from the patients' left lower eyelid. Biopsy and subsequent oncological workup confirmed a mucinous adenocarcinoma in situ, a known precursor of primary mucinous adenocarcinoma. This case contributes to the limited literature reporting multicentric primary mucinous adenocarcinoma of the eyelids and suggests that there may be underlying factors that heighten a patient's risk for developing these tumors.

Purpose: To report the experience with an alternative to the upper eyelid pentagonal wedge resection technique which results in improved cosmesis due to a greater alignment of incisions with relaxed skin tension lines.

Methods: A retrospective review of all patients who underwent the T-shaped wedge resection by the authors from 2009 to 2017. A horizontal eyelid crease incision is made across the upper eyelid skin. A rectangular full-thickness excision extending to the eyelid crease anteriorly, with an additional superior triangle of posterior lamellar excision is performed. The anterior lamella above the eyelid crease is left intact and the eyelid crease incision is used to distribute the relative excess anterior lamellar tissue above the eyelid crease to the horizontally shortened tissue below the crease.

Results: One hundred and four eyelids of 102 patients were included. The mean patient age was 57 and the procedure was performed on 49 right upper eyelids and 55 left upper eyelids. The indications for eyelid resection were benign lesions (n = 57), basal cell carcinoma (n = 27), trichiasis (n = 15), and squamous cell carcinoma (n = 3). Two patients experienced mild postoperative lagophthalmos, which did not require surgical repair. All patients were satisfied with their postoperative appearance. No patients required reoperation related to their procedure.

Conclusion: The T-shaped wedge resection is an alternative to the traditional pentagonal wedge resection of the upper eyelid. This technique uses the natural upper eyelid crease to redistribute the relative excess skin above the defect, rather than extending the excision superior to the eyelid crease which can alter the contour of the crease and potentially create a vertical scar above the crease.

Purpose: To review the long history of wound management, including the methods of skin closure, asepsis, and anesthesia. Periocular techniques will be emphasized.

Methods: Literature searches and cross-referencing were used to identify historic reports addressing the management of wounds. Foreign language manuscripts were translated using online resources.

Results: The first written description of suturing dates to around 3000 BC and involved the repair of an eyebrow wound. A wide variety of materials have since been used as ligatures or stitches, including animal intestines, tendons, hair, silk, linen, plant fibers, and metal wire. For much of recorded history, sutures were a primary cause of wound infection and morbidity. There was a time when the resultant drainage was viewed as being beneficial (laudable pus). Many of the discoveries that ultimately led to the practice of asepsis were coincidental. Prior to the development of infiltrative anesthesia in 1894, patients had to endure the discomfort of surgery, occasionally with the sedative effects of wine or cannabis.

Conclusions: The history of wound closure is a fascinating tale. While there has been a constant evolution, silk and catgut sutures, ligatures, surgical knots, and layered closure have been used for several millennium. Advances in asepsis, in addition to the development of anesthesia, antibiotics, and synthetic sutures, ushered in the modern age of surgery. A knowledge of the past will give us, as oculofacial surgeons, a greater understanding and appreciation of the techniques we use today.

Purpose: This study aimed to analyze demographic, clinical, socioeconomic, and facility-specific factors affecting the survival outcomes of patients diagnosed with eyelid melanoma (EM) between 2004 and 2017 using data from the National Cancer Database.

Methods: Cases of EM diagnosed between 2004 and 2017 were identified using the National Cancer Database. Patient demographic data, tumor stage (American Joint Committee on Cancer TNM classification), treatment modalities, and socioeconomic variables were collected. Facility-specific variables included patient volume and academic status. Kaplan-Meier survival analyses and multivariate Cox regression models were used to assess 10-year survival and identify significant predictors of mortality.

Results: A total of 3,235 patients with EM were eligible for demographic analysis. The majority of patients were over 60 years of age and predominantly male. Kaplan-Meier analysis showed a significant decrease in 10-year overall survival with increasing age at diagnosis (p < 0.001), T clinical stage (p < 0.001), and male sex (p = 0.001). Additionally, patients with higher income (p = 0.01), private insurance (p < 0.001), and those treated at high-volume (p = 0.006) and academic facilities (p = 0.005) had improved 10-year overall survival. Multivariate Cox regression identifying independent predictors of EM mortality corroborated these findings.

Conclusions: Eyelid melanoma survival outcomes were significantly influenced by age, tumor stage, socioeconomic status, and facility characteristics. Treatment at high-volume centers confers a survival advantage, emphasizing the importance of specialized care. These findings underscore the need for early detection and equitable access to improve EM outcomes.

Eyelid malpositions as a complication of pregnancy, in the absence of associated trauma or injury, are rarely encountered. There are limited published reports on this phenomenon or subsequent surgical repair. We present the case of a 38-year-old female who experienced 3 separate episodes of eyelid malpositions, each occurring independently during 3 otherwise uncomplicated pregnancies, which persisted until surgical correction. Histological analysis of the patient's conjunctiva and tarsus revealed degeneration and loss of elastic tissue, crucial for eyelid anatomy. Surgical repair was performed in each instance, resulting in excellent cosmetic, anatomic, and visual outcomes.

Oncocytic carcinoma is a rare malignant neoplasm of oncocytic cells, such cells being characterized by abundant granular eosinophilic cytoplasm, invasive growth, and pronounced cellular pleomorphism. It may arise de novo, or through malignant transformation of a pre-existing benign oncocytoma. Oncocytic carcinoma most commonly occurs in the salivary glands, with rare involvement of the ocular adnexa where it mainly affects caruncle, conjunctiva, and lacrimal sac, and only very arises in the lacrimal gland. This report presents a unique case of a 77-year-old male with lacrimal gland oncocytic carcinoma that probably arose from a pre-existing pleomorphic adenoma; local tumor control was achieved with local excision and adjuvant radiotherapy, but he developed metastasis and died 3 years later. Together with a literature review, this case underlines the aggressive biological behavior of lacrimal gland oncocytic carcinoma, with its high propensity for local and distant recurrence.

Purpose: To examine microscopically the progress of baggy eyelid formation in the lower eyelid.

Methods: Histological evaluation of 17 central lower eyelids (11 right and 6 left) from 13 Japanese cadavers (age range: 36-97 years, average: 73.0 years) was performed. The specimens were fixed in 10% formalin and stained with Masson's Trichrome. The following characteristics were examined: 1) presence of baggy eyelid, 2) thickness of the orbital septum, 3) presence of anterior protrusion of fat and/or orbicularis oculi muscle (OOM), 4) thickness of OOM and subcutaneous tissue at the widest anterior protrusion, and 5) skin thickness.

Results: The findings were divided into 4 stages: stage 0 (2 eyelids in 1 specimen) absent baggy eyelid, all tissues normal, stage 1 (1 eyelid in 1 specimen) absent baggy eyelid, intermediate orbital septum, anterior dome-like protrusion of fat but minimal OOM projection, thick OOM, subcutaneous tissue, and skin, stage 2 (9 eyelids in 7 specimens) absent or minimal baggy eyelid, intermediate orbital septum, anterior dome like protrusion of fat and OOM, intermediate OOM, with thick subcutaneous tissue and skin, stage 3 (5 eyelids in 4 specimens) with present baggy eyelid, thin orbital septum, severe anterior dome like protrusion of fat and OOM, with thin OOM, subcutaneous tissue and thick skin in mild type, with thin skin in severe type.

Conclusions: Baggy eyelid appears to be triggered by the anterior protrusion of fat, followed by thinning of the orbital septum, OOM, and subcutaneous tissue in order. Thinner skin may promote severe entity.

Purpose: The study aimed to assess the efficacy and recurrence rate of everting sutures as a sole procedure in entropion repair, its impact on quality of life during the coronavirus disease pandemic, and to determine if this procedure remains an option to offer after the pandemic.

Design: Retrospective clinical cohort study.

Methods: Retrospective study of 58 patients who had everting sutures for entropion repair over a 1-year period. Patients who had everting sutures combined with another procedure were excluded from the study. The study evaluated the effectiveness of the procedure by examining eyelid positioning during follow-up, complication rate, and the 1-year recurrence rate. Patients were also contacted to describe their symptoms before and after surgery and to complete The European Quality of Life questionnaire.

Results: The mean age was 79 years and 68.9% were male. The immediate success rate was 95.3% with a complication rate of 1.5%. The 1-year recurrence rate was 23.4%. After surgical intervention, 95.1% of patients experienced symptom relief. An improvement in quality of life was reported in 76.2%, which was predominantly attributed to a reduction in eye pain or discomfort (p < 0.05).

Conclusions: Everting sutures are a quick and safe procedure that can be performed by any general ophthalmologist. This procedure is effective and improves the quality of life; however, it is associated with a higher recurrence rate compared with other entropion repair surgeries. Nonetheless, it remains an attractive option for older patients who want to avoid long and invasive procedures.

Loss of periocular skin due to cancer, trauma, or surgery is a major reconstructive challenge; resultant tissue contracture can cause eyelid malposition with poor functional and aesthetic outcomes. We describe the successful use of cryopreserved umbilical cord amniotic membrane as a wound covering and scaffold for periorbital anterior lamellar defects. This is a retrospective case series of 4 patients (mean 21 years, range 9-30 years, 3 male) who underwent periocular reconstruction with umbilical cord amniotic membrane of 9 different sites. Follow-up time ranged from 10 to 22 months. All wounds healed successfully with a good functional eyelid position. Umbilical cord amniotic membrane is readily available, has antibacterial and anti-inflammatory properties, provides a structural scaffold for cell adhesion and growth, and contains biological factors that promote cell proliferation/remodeling. We demonstrate that the umbilical cord amniotic membrane is an effective substitute for full-thickness skin grafting in the periocular area, particularly with skin loss secondary to burns and/or trauma.