Good anesthetic for good esthetic: Blocks in oculoplasty

Background: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon carry out each step of the surgery precisely and beautifully. The art of giving a good local anesthesia is to be learnt and practiced not only by anesthetists, but also by the practicing ophthalmologists. Purpose: This video gives an overview of anatomy in terms of the nerve supply of the orbit, the surface marking, and the techniques of giving regional and nerve blocks. Synopsis: In this video, we describe the anatomy, the surface marking, the technique of regional anesthesia including peribulbar, retrobulbar, and subtenon blocks and of nerve blocks, specifically of facial, frontal nerve and its branches, infraorbital, nasociliary, infratrochlear, and dorsal nasal nerves, with their application in ocular plastic surgery. Highlights: This video highlights the essence of providing appropriate and good anesthesia so that the surgeon works in an optimal field with maximum comfort to the patients.

Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature

Blepharoplasty is one of the most commonly performed aesthetic procedures. Surgical complications are rare, but can have severe consequences, such as permanent vision loss. In this report, we describe a patient who developed primary angle-closure glaucoma (ACG) with associated vision loss after a oculoplastic procedure using local anesthesia. So far, six similar cases have been described in the literature. It is believed that acute ACG is triggered by the surgical procedure in patients with predisposing risk factors such as a cataract. Surgical triggering factors include the use of buffered lidocaine/xylocaine with adrenaline/epinephrine, stress, and coverage of the eyes postoperatively. Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay. Acute ACG should therefore be excluded in each patient with postoperative complaints by assessing pupillary reactions. If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss.

Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center.

Aim: The study aims to report a single trainee’s experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En‑DCR). Settings and Design: This study was a retrospective, interventional case series. Subjects and Methods: Fifty‑four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin‑C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora. Results: Fifty‑four eyes of fifty patients were operated, and three cases were lost to follow‑up after surgery. The mean age at presentation was 34 (4–75) years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD) obstruction in 72% (39/54), acute dacryocystitis in 15% (8/54), failed DCR in 7% (4/54), and persistent congenital NLD obstruction in 5% (3/54). The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05). Anatomical and functional success rate was 94% (48/51) at 6 months follow‑up period. Conclusions: Endoscopic En‑DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn and perform En‑DCR with acceptable success rates.

A case series of Tessier 3, 4, 7 and combined 4, 7 craniofacial clefts

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case series<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Subjects:</strong> Five patients<br /><strong>RESULTS:</strong> Five  patients aged 3 to 14-years-old with Tessier 3, 4 (2  cases), 7  and combined 4,7 were included in this study: Tessier 3 - medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 - median orbitomaxillary cleft traversing  vertically  through  the  inferior  eyelid,  infraorbital rim and  orbital  floor extending  to the lip between the philtral crest and the oral commissure  (2 cases), Tessier 7 - macrostomia and cleft oral commissure and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while one declined.<br /><strong>CONCLUSION:</strong> Five  craniofacial  clefts  were  presented.  Because  of  the  varying  patterns of craniofacial  deformities,  a  series of surgical  procedures,  tailor-made  for  each  individual  were performed  on  four. Otolaryngologists who perform maxillofacial and cosmetic surgery  should have good background knowledge about craniofacial defects and be familiar with the  surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts.</p>

Desarrollo de las consultas oculoplastia y cirujía implanto-refractiva del Sistema alas BQO / Development of the consultations oculoplasty and implanto-refractive surgery of System alas BQO

En la actualidad, la gestión de la información en las consultas oftalmológicas de Oculoplastia y Cirugía Implanto-Refractiva se realiza de forma manual. Esto ha provocado duplicidad de datos, acumulación de la información y deterioro de registros médicos, incidiendo como una vulnerabilidad a la hora de procesar la información. La presente investigación tiene como meta, la informatización de los procesos correspondientes a estas consultas, guiada durante todo el ciclo de vida por el Proceso Unificado de Desarrollo (RUP), con el propósito de garantizar un medio para el almacenamiento seguro de la información y de su procesamiento. Se utiliza Visual Paradigm como herramienta de modelado. Para la implementación de las funcionalidades se emplea la plataforma .NET mediante el lenguaje de programación C#, auxiliado por el Framework 2.0 y Postgres SQL como gestor de bases de datos. Como resultado de su implementación se espera proporcionar al usuario una forma viable de gestionar la información en las consultas oftalmológicas, brindado una mayor confiabilidad y seguridad tanto al personal de la institución como a los pacientes que requieren de dichos servicios. Por otra parte, los especialistas contarán con una Historia Clínica Electrónica única, que permitirá el seguimiento de la salud del paciente y la disponibilidad de la información para que puedan ser examinados los diagnósticos emitidos de estos con anterioridad(AU)

Currently, the information management in the ophthalmological queries of Oculoplasty and Refractive Implant Surgery is performed manually. This has resulted in duplication of data, accumulation of information and deterioration of the medical records, becoming an invulnerability when processing of information occurs. The present research is intended to the computerization of the processes of this consultations, guided throughout the life cycle by the Rational Unified Process (RUP), in order to guarantee a means for the safe storage and processing of the information. The Visual Paradigm is employed as a modeling tool. For the implementation of the functionalities we used the platform .NET, through the programming language C#, helped by the Framework 2.0 and the Postgres SQL as a database manager. As a result from its implementation, it is expected to provide the user with a viable way of managing the information on the eye care consultations, providing also a better reliability and safety to both, the institution staff and the patients requiring that system. Moreover, the specialists will have a single electronic health record that will allow monitoring the patient´s health and the availability of the information so that the latest diagnoses can be examined. better reliability and safety to both, the institution staff and the patients requiring that system. Moreover, the specialists will have a single electronic health record that will allow monitoring the patient´s health and the availability of the information so that the latest diagnoses can be examined(AU)

Rehabilitación quirúrgico-protésica de pacientes con cavidades anoftálmicas atípicas / Surgical-prosthetic rehabilitation of patients with atypical anophthalmic cavities

Se realizó estudio descriptivo y transversal de 377 pacientes con cavidades anoftálmicas atípicas, atendidos en el Departamento de Oculoplastia del Hospital General "Dr. Juan Bruno Zayas Alfonso" y la Clínica de Rehabilitación de Prótesis Bucomaxilofacial del Hospital Provincial Docente "Saturnino Lora" en Santiago de Cuba, desde enero de 2004 hasta septiembre de 2010, con vistas a evaluar su rehabilitación quirúrgica protésica. Del total de cavidades, 13 eran congénitas y 364 adquiridas: 75 con globos oculares no estéticos y 289 sin ellos; en estos últimos se efectuaron 189 evisceraciones, 98 enucleaciones y 2 exenteraciones. En la casuística, 170 pacientes recibieron implantes orbitarios con hidroxiapatita porosa coralina cubana (HAP 200): 125 primarios y 45 secundarios. La rehabilitación quirúrgica protésica fue buena en 86,0 % de los pacientes sin implante orbital y en la totalidad de los que sí lo recibieron, de donde se concluyó que la rehabilitación quirúrgica no puede separarse de la protésica.

A descriptive and cross-sectional study of 377 patients with atypical anophthalmic cavities, attended in the Oculoplasty Department from "Dr Juan Bruno Zayas Alfonso" General Hospital and the Rehabilitation Clinic of Oral Maxillofacial Prosthesis from "Saturnino Lora" Teaching Provincial Hospital in Santiago de Cuba was carried out from January 2004 to September 2010, aimed at evaluating their surgical prosthetic rehabilitation. From the total of cavities, 13 were congenital and 364 were acquired: 75 with non-aesthetic eyeballs and 289 without them; in the last group 189 eviscerations, 98 enucleations and 2 exenterations were carried out. One hundred and seventy patients had orbital implants with Cuban coral porous hydroxyapatite (HAP 200): 125 primary and 45 secondary in the case material. Surgical prosthetic rehabilitation was good in 86,0% of the patients without orbital implants and in all those who received it, from which it was concluded that surgical rehabilitation cannot be separated from the prosthetic one.

Pay more attention to the selection of proper surgical timing and method for oculoplasty in the pediatric / 眼科

The pediatric population with the orbital and eyeball malformations has been an important part in ophthalmic plastic surgery.The pediatric is with great difference from adult in physiology and anatomy.Besides,visual function,orbit and face during childhood are still under development.The orbital deformityes during the childhood,especially for some congenital abnormalities,are always associated with or a cause of visual disfunction.And the congenital or acquired anophthalmia or microphthalm may lead to the retardation of orbital growth and overall of the face afterwards,so it is not only a simple cosmetic surgery for the oculoplastic surgery in the pediatric population,but also the reconstruction of function.Thus we should pay special attention for the oculoplastic surgery to the effect of development of visual function and orbit in the pediatric.Accordingly,it is crucial to select a proper surgical timing and method for ophthalmic plastic surgery in the pediatric.

The Morphological and Functional Characteristics of Eyelid in Korean Children

PURPOSE: To investigate the morphological and functional characteristics and degree of abnormal lid and help for a decision to a proper diagnosis and treatment by morphologic and functional study of normal children's eyelid. METHODS: One hundred twenty children under 15 years old were sampled. Inter rim distance, inter canthal distance, fissure length, fissure height, lid height, height of lid fold, carnuncle size, corneal size, MRD1, MRD2, MLD, and LFT were measured and the morphology of epicanthal fold was classified. We classified samples into three groups by age and made a significant test using a ANOVA test. RESULTS: There were no significant difference between male and female samples except the inter rim distance. Inter rim distance, inter canthal distance, fissure length, fissure height, frequency of lid fold, carnuncle size and MLD increased significantly. Length of lid fold / length of lid in closed eye remained in a consistent ratio regardless of age. 54 children of 120 children(45%) have epicanthal fold. CONCLUSIONS: Considering the fact that there is a morphological change of eyelid according to the age in children, knowing the anatomic average value of eyelid in different age group would be useful in oculoplasty in children.