Comparison of scleral bulkling surgery for retinal detachment under microscope and under indirect ophthalmoscope / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To compare the effects of external approach microsurgery and conventional external approach surgery for retinal detachment ( RD) .METHODS: From January 2010 to January 2013, 60 patients (60 eyes) in our hospital were randomly divided into experimental group (29 cases, 29 eyes) and control group ( 31 cases, 31 eyes ) , the external approach microsurgery and conventional external approach surgery were performed respectively ( by the same skilled doctor ) . Retinal reattachment rate, visual acuity improvement rate and operative time were compared between two groups.RESULTS:lt cost shorter time for the external approach microsurgery than that of conventional external approach surgery ( P = 0. 0087 ). The once successful retinal reattachment rate in experimental group was 93% ( 27 cases ) , which was higher than that in control group (90%, 28 cases), there was no statistical difference. The vision improvement rate in control group was 86% ( 25 cases ) , compare to 90% ( 28 cases ) in experimental group, there was no statistical differences. CONCLUSlON: No statistical differences showed in visual acuity improvement and the once retinal reattachment rate between the two groups for rhegmatogenous retinal detachment. However, it is believed that external approach microsurgery could be faster, easier to learn with satisfactory effect.

Comparison of Approaches for the Removal of Metallic Intraocular Foreign Bodies

PURPOSE: To review the management of posterior segment metallic intraocular foreign bodies (IOFB) and to compare the use of an external approach using a large electromagnet and an internal approach using vitrectomy and its tools for their removal. METHODS: A retrospective review was performed on 49 eyes of 49 patients who underwent surgical removal of metallic IOFBs with either an internal or an external approach at a single institution between January 2003 and December 2006. We divided 49 eyes into two groups based on the type of approach: 26 external (n=26) and 23 internal (n=23). Visual acuity and the presence of any complications occurring with the two approaches were the main outcome measures studied. RESULTS: Thirty of 49 eyes (61%) showed improvements in visual acuity. When we compared patients treated with an external versus an internal approach, we found no statistically significant difference in regard to visual outcome. Preoperative vitreous hemorrhage and endophthalmitis were more common in the internal approach group. A trend toward a higher rate of reoperation was more common in the external approach group, but they were not statistically significant. Postoperative complications found to be significantly different between the two groups were the rate of postoperative endophthalmitis and retinal detachment, which were more common in the external approach group. CONCLUSIONS: Surgical removal of metallic IOFBs results in significant visual improvement regardless of the approach method. The internal approach by vitrectomy is recommended as the first choice in preoperative conditions such as severe cataracts, vitreous hemorrhage and endophthalmitis, as well as in groups at high risk for postoperative endophalmitis and retinal detachment.

Short Scar Incision Using Modified Z-Incision For Restoration of Medial Orbital Blow-Out Fracture

Blow-out fracture is frequently encountered in facial bone trauma. And the frequency of medial orbital wall fracture in Asia is high. Various approaches have been reported for medial orbital wall fractures. The field of medial orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital wall, susceptibility of injury of orbital structures. Recently, endoscopic reduction of orbital wall was provided good fuctional and cosmetic results. In order to address this shortcoming we have explored the use of endoscopic external short scar approach in medial orbital wall dissection to allow direct visualization of orbital content and nearly whole fracture components. In this study a direct local approach through a 2cm, modified Z-shaped incision on superior medial orbital area was used as a consistent method to reconstruct medial blow-out fractures. The incision line consist 3 limbs. The angle of the limbs is to 110 degrees. First, 1cm sized line exsists frontonasal line. Second, 5mm sized 2 limbs of the incision line were placed parallel or oblique to the relaxed skin tension line. During the follow-up period of 6 to 12 months, excellent functional and cosmetic results were observed with an inconspicuous scar. Therefore, a direct external short scar incision approach with endoscope on the superior medial orbit may be a consistent method to gain the surgical goal in treatment of blow-out fractures of the medial orbital wall.

The Surgical Efficacy of External Lacrimal Surgery without Nasal Mucosal Flap

PURPOSE: To evaluate the surgical result of lacrimal surgery with total removal of the nasal mucosal flap. METHODS: Lacrimal surgery was performed in 30 eyes of 26 patients, by external approach without the nasal mucosal flap from February 2001 to August 2002. The surgical method was similar to conventional dacryocystorhinostomy, but the nasal mucosa of the osteotomy site was removed with a No.11 Bard-Parker blade and Westcott scissors. After insertion of a silicone tube, the anterior flap of the lacrimal sac was sutured to the soft tissues around the osteotomy site. Surgical efficacy was evaluated after a follow-up period of 7 22 months (average, 11.5 months). RESULTS: The primary success rate was 96.7% (29/30 eyes). We performed revision of mucosa ostium in the one failed eye, thereby raising the final success rate to 100%. The size of mucosa ostium was 0.7 3.0 mm (average 1.17 mm). CONCLUSIONS: Satisfactory surgical results were obtained without anastomosis of the lacrimal sac or the nasal mucosa during external approach, lacrimal surgery. We suggest that this method is a good surgical procedure in external approach, lacrimal surgery.

Clinical Study of Inverted Papilloma of the Nose and Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND: Inverted papilloma is a benign sinonasal tumor which is locally aggressive and has a significant malignant potential. Complete en bloc excision via lateral rhinotomy and medial maxillectomy has been the mainstay in the treatment in majority of patients. OBJECTIVES: The aim of this study is to evaluate clinical features and outcomes of surgical treatment according to various surgical approaches(external approach vs transnasal endoscopic approach) in the treatment of inverted papilloma of the nose and paranasal sinuses. MATERIALS AND METHOD: We retrospectively examined 24 cases of inverted papilloma of the nose and paranasal sinuses treated in our department from January 1990 to April 1995. We reviewed clinical features, radiologic findings, operative findings, association with malignancy, and outcomes of various surgical approaches. RESULTS: Fifteen patients underwent surgical excision. Of this patients followed up for at least 18 months, lateral rhinotomy was performed in 10 patients, midfacial deglobing in 1 patient and endoscopic surgery in 3 patients. The most common symptoms were nasal obstruction(93.3%) and nasal discharge(80.0%). Ten cases(66.7%) had history of previous nasal surgery. The lateral nasal wall was most frequent site of tumor involvement and concurrent involvement of the adjacent paranasal sinuses was observed in 11 cases. No recurrence was observed both external approach and transnasal endoscopic surgery. CONCLUSION: The optimal management of inverted papilloma of nose and paranasal sinuses is complete excision of tumor and choice of adequate surgical approach(external approach or transnasal endoscopic approach).

Rhinoplasty through the External Approach / 대한이비인후과학회지

BACKGROUND: Rhinoplasty surgeons have a choice of several approaches to the nose. The approaches can conveniently be divided into external and intranasal techniques. We prefer the external approach to the intranasal approach because the former provides better operative fields and more complete correction. OBJECTIVES: The purpose of this report is to analyze the experiences of rhinoplasty through the external approach. MATERIALS AND METHODS: A retrospective study was performed in 119 patients who underwent rhinoplasty using the external approach from January of 1994 through March of 1997. RESULTS: This procedure has been used in all kinds of deformities even though most of them overlapped: 54 cases of crooked nose, 57 cases of saddle nose, 5 cases of hump nose and 3 cases of tip surgery. CONCLUSION: The exact procedures of cosmetic nasal tip surgery can be performed more easily by the external approach. The disadventages of this procedure, which is the columellar scar, longer operation time and post-operative edema, are neglible.