The Effect of Autologous Dermis-fixation to Orbital Periosteum in Superior Sulcus Deformity

PURPOSE: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity. METHODS: From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries. RESULTS: Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed. CONCLUSIONS: The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity.

Evisceration Using Scleral Capping Technique for Severe Phthisis Bulbi

PURPOSE: To introduce a new technique, involving the creation of a circumferential 360 degrees scleral relaxing incision, using an implant as large as 20 mm in diameter, and report on the surgical results in the treatment of severe phthisis bulbi, which are not indicated for classic evisceration. METHODS: The medical records of 20 patients with 20 phthisis bulbi who had undergone evisceration and placement, using the scleral capping technique, of porous polyethylene orbital implants as large as 20 mm in diameter between September 2002 and February 2006 were reviewed. For each patient, after evisceration, a circumferential 360 degrees equatorial scleral relaxing incision was made posterior to insertion of 4-recti muscles, and a porous polyethylene orbital implant was implanted. Each circumferential scleral relaxing incision wound was loosely sutured in the mattress fashion, using 5-0 braided polyester (Ethibond). RESULTS: The average of preoperative axial length, obtained using A scan and orbital computed tomography scan, was 16.8 mm. Orbital implants of 20 mm in diameter were implanted in all patients. The average of postoperative follow-up interval was 29.1 months. Orbital implant showed good motility to the satisfaction of all of patients. And the scleral capping technique could prevent complications, such as exposure of orbital implant, enophthalmos, and superior sulcus deformity. CONCLUSIONS: Scleral capping technique is safe and useful for evisceration in patients with severe phthisis bulbi. This technique can provide adequate space for the placement of and implant as large as 20 mm in diameter without generating any tension on wound. Consequently, this technique provided cosmesis and prosthesis motiliy, even without the use of a Medor coupling peg, with which patients were satisfied.

Correction of Superior Sulcus Deformity and Enophthalmos with Porous High-density Polyethylene Sheet in Anophthalmic Patients

PURPOSE: Superior sulcus deformity is the main cosmetic problem in anophthalmic patients. Many methods of correcting enophthalmos have been reported, especially in patients with orbital wall fracture. The purpose of this study is to review the long term results of effectiveness in superior sulcus deformity correction by subperiosteal Medpor (R) sheet implantation in anophthalmic patients. METHODS: Subperiosteal Medpor (R) sheets were used in 11 eyes of 11 anophthalmic patients. To estimate the effectiveness, photographs were taken and exophthalmometric value with their own prosthesis using Hertel exophthalmometer was measured in all patients before and after surgery. RESULTS: The overall cosmetic results in superior sulcus deformity were 'excellent' in 3 (27.3%), 'good' in 6 (54.5%), 'fair' in 2 (18.2%). The overall results in enophthalmos were 'excellent' in 3 (27.2%), 'markedly improved' in 4 (36.4%), 'slightly improved' in 4 (36.4%). Most patients had a marked increase in orbital volume, except two patients. They received irradiation treatment in early childhood so showed unsatisfactory results in both superior sulcus deformity and enophthalmos. CONCLUSIONS: Subperiosteal Medpor (R) sheet implantation is considered to be a reliable and safe procedure without serious complication and with an excellent cosmetic results.

The Effect of Perlane(R) Injection on Superior Sulcus Deformity

PURPOSE: This study evauated the effect of Perlane(R) injection into the subcutaneous tissue on six patients with superior sulcus deformity. METHODS: From August 2001 to September 2003, Perlane(R) was injected on the six eye lids of six patients with superior sulcus deformity caused by orbital varix, blow-out fracture, or anophthalmos. RESULTS: Superior sulcus deformity of all six patients was completely corrected with Perlane(R), bilateral symmetry was achieved for all six. Ocular pain and superior sulcus deformity disappeared after Perlane(R) injection in two patients with orbital varices. Ptosis developed temporarily in one patient at two weeks after injection, was resolved spontaneously at 8 months. The average duration of correction was 12 months. CONCLUSIONS: Although Perlane(R) is not a permanent material, the Perlane(R) injection is an effective and easy way to correct superior sulcus deformity especially for those who do not want to undergo surgery or have the deformity undercorrected. A larger series of patients and longer follow-up might be necessary to obtain further information on Perlane(R) injection for patients with superior sulcus deformity caused by various etiologies.

Clinical Efficacy of Dermis-Fat Graft vs. Posterior Tenon's Capsule Suturing in Anophthalmic Orbit

The anatomic and physiologic changes of the anopthalmic orbit affect cosmetic appearance of the patient and function of the socket and the prosthesis. During the past three years, the authors studied 13 cases of dermis-fat graft and 27 cases of posterior Tenon's capsule suturing with a plastic implant, and compared the post'operative effects of the two procedures. Dermis-fat graft produced good fornix formation with no remarkable fat atrophy after both primary and secondary proceddure. Posterior Tenon's capsule suture technique showes good effect to keep implant from migration or extrusion. Size of the plastic implant and fixation of the extraocular muscles were important factors also for good cosmesis and implant motility. There revealed no significant difference between the two procedures in EOM motility, enophthalmos, deep superior sulcus deformity, implant migration or prolapse etc.