[Dermal fatty tissue transplant as primary and secondary orbital implant. Complications and results]. / Dermis-Fett-Transplantat als primäres und sekundäres Orbitaimplantat. Komplikationen und Ergebnisse.

In this retrospective study we report the indications, complications and functional and cosmetic results after dermofat grafting into anophthalmic orbits. The method consists of implantation of autogenous dermis with attached subcutaneous fat from the gluteal region into the orbit. Twenty-four primary and 4 secondary grafts were implanted in 28 patients aged 12 to 49 years. In the explantation site one patient showed delayed healing. All implants became integrated, none were lost because of infection or extrusion. Eleven patients developed minor complications like central ulceration in the dermis, hair growth on the dermis or suture granuloma. In the primary implant group the functional and cosmetic outcome was evaluated by measurements of the lid structures, exophthalmometry (Hertel) and measuring the prosthesis motility (Kestenbaum). Three patients showed fair results; all the others had good or very good results. In one case of a secondary implant marked graft atrophy was observed. Despite the more extensive surgery and some minor complications the safety of this method with good functional and cosmetic results makes dermofat grafting an excellent alternative to heterogeneous orbital implants.

[Dermal fat transplant as autologous orbital implant]. / Dermis-Fett-Transplantat als autologes Orbitaimplantat.

BACKGROUND: The use of orbital implants after an enucleation is the pre-condition for an adequate fitting of the prosthesis and gives the best functional and cosmetic results. The autogenous dermofat graft is an alternative to the widely used alloplastic orbital implants. It can be used as a primary implant or as a secondary implant for the correction of a contracted socket or a post enucleation socket syndrome. METHOD: Deepithelialized skin with subcutaneous fat is implanted into the socket. The rectus muscles, Tenon's capsule and conjunctive are fixed to the transplant separately. Surgical technique, possible complications and their therapy are presented. CONCLUSIONS: Disadvantages of the method are the more extensive surgery, some minor complications and the possible shrinkage of the transplant. Advantageous is the fact, that typical complications of all alloplastic implants, like migration and extrusion, can be avoided, heterologous materials like donor sclera are unnecessary and the functional and cosmetic results are very good.

Paraffinoma of the periorbit--a challenge for the oculoplastic surgeon.

Five patients with a history of sinus surgery with nasal packing and postoperative hemorrhage developed nontender, firm tumors of the periorbit. There was no spontaneous regression. Surgical excision was difficult due to diffuse cellular infiltration and intracutaneous deposits, requiring reoperations in all patients. Histology showed a marked lipogranulomatous reaction to dispersed lipid material with fibrosis. Paraffinoma is a known complication of paraffin injection in dermatology and cosmetic surgery. Reports of it in the ophthalmic literature are rare. This series documents a late complication of sinus surgery, very probably due to the intraoperative nasal packing with paraffin-containing ointments.

[Preferred techniques of eyelid reconstruction]. / Bevorzugte Techniken der Lidrekonstruktion.

The trend of lid reconstruction is to use less lid sharing operations. Free tarsoconjunctival or composite grafts in conjunction with covering skin muscle transplants have allowed suitable and cosmetically acceptable methods of full lid repairs. Our preferred surgical techniques are provided. Such methods of reconstructions differ according to the size of the lid sector to be rebuilt. The methods of Tenzel, Cutler-Beard, Landolt-Hughes, McCord, Leone, Hübner, Beyer-Bathrick and Mustardé were described in detail.

[Temporal tarsal strip-plasty for correction of malposition of the lower eyelid]. / Die temporale Tarsalzungenplastik zur Korrektur von Unterlidfehlstellungen.

The lateral tarsal strip procedure has the combined effect of increasing horizontal lid tension and adjusting the level of the lateral canthus. Following a lateral canthotomy a tarsal strip is created from the lateral aspect of the lower lid and sutured to the periosteum at the lateral orbital wall. Indications for this technique include senile and paralytic ectropion, recurrent entropion, congenital malpositions, and lid laxity following trauma or enucleation. The results yielded by this technique in 148 patients at the University Eye Hospital in Munich are presented. These included 53 suffering from paralytic ectropion in whom a medial canthoplasty was added to the lateral tarsal strip procedure. The two techniques combined provided symmetrical adjustment of the level of both lateral and medial canthal angles, a good position of the lacrimal puncta and increased lid tension.

[Oculoplastic therapy in generalized nevus verrucosus]. / Okuloplastische Therapie bei generalisiertem Naevus verrucosus.

The clinical and histopathological picture of a 27-year-old patient with generalized nevus verrucosus is described. The oculoplastic treatment performed in this patient consisted in lid plasties, surgical excision, cauterization and cryotherapy. The different therapeutic techniques were applied over a period of 2 years. Nearly all papillomatous lesions were removed without impairing lid contour or lid function.

Histology of partial thickness double composite eyelid graft.

Double composite grafting is a technique used in the repair of large (greater than 75%) eyelid defects due to tumor resection, trauma, or congenital coloboma. The procedure utilizes two partial thickness composite grafts derived from two unaffected lids. The skin defect is covered by a pedicle skin graft to provide an adequate blood supply. This is thought to be superior to revascularization occurring from the margin of the graft alone. We examined histologically the lid margins of two such grafts 2 and 9 months postoperatively. Each demonstrated scarred tarsus and absent meibomian glands. One of the two grafts had loss of cilia. The architecture of the graft tissue otherwise was preserved.

Dermis fat graft in eviscerated sockets.

Following evisceration, three patients who experienced extrusion of synthetic orbital implant underwent socket reconstruction using an autogenous dermis fat graft. An incision into the fundus of the existing sclera was necessary to provide for an adequate vascular bed for a composite fat graft, although the anterior ring of existing sclera with extraocular muscle attachments was not disturbed. Conjunctival reepithelialization of the dermal surface and enhancement of orbital volume occurred in each case. Furthermore, the autogenous fat graft retained the original excellent globe motility that was present before the socket reconstruction. After an average follow-up of 18 months, the volume restoration, integrity of conjunctival epithelium and fornices, and the graft viability have remained unchanged. As with alloplastic orbital implant extrusions in enucleated sockets, autogeneous dermis fat grafts can be useful in managing extrusions in previously eviscerated sockets.

Acquired ptosis associated with a conjunctival cyst.

A 44-year-old woman with a history of previous ptosis surgery presented with a moderate ptosis of the left upper eyelid and a large cystic mass extending over the length of that lid. The mass was excised completely and histologically found to be a conjunctival ductal cyst. The levator aponeurosis was disrupted by the cyst and required reconstruction. This case demonstrates an acquired ptosis associated with a large conjunctival cyst as a late complication of ptosis surgery.

Fate of primary orbital dermis-fat grafts in guinea pigs.

A year-long study was undertaken to serially evaluate the tissue changes occurring in dermis-fat graft (DFG) after orbital implantation in nine guinea pigs. Methods used to evaluate the DFGs were histology, magnetic resonance imaging, morphometric analysis, and clinical observations. The histology of a 1-year-old failed human dermis-fat graft has been included for completeness. The study reveals that clinically successful DFGs have a fibrous capsule surrounding the DFG. Minimal revascularization was present. The grafts appear to undergo continual histological changes for approximately 9 months before a steady-state condition ensues. Of interest are changes in the deep-orbital fat posterior to the DFG.

The modified Ambos lacrimal stent.

The described silastic intubation method is workable and predictable and is an advisable therapeutic principle in congenital and acquired dacryostenoses. It represents a new method of introducing silastic tubing into the nasolacrimal excretory system.

Eyelid penetration of a hard contact lens, simulating a neoplasm.

A hard contact lens penetrated the right upper lid at the level of the aponeurosis of the levator palpebral superior's muscle. Later tumor-like symptoms developed of a hard movable mass with blepharoptosis.

Osteomyelitis of the orbit. A case report.

With the advent of the antibiotic era, the incidence of osteomyelitis has decreased remarkably. However, cases of trauma-induced orbital cellulitis, abscess, fistula formation, and osteomyelitis may still occur. The following case is illustrative of the chronicity of problems (8-year course) caused by retained orbital wooden foreign bodies.

Histopathologic condition of fascia lata implant 42 years after ptosis repair.

Fascia lata implants have been employed since the early part of this century in the repair of blepharoptosis. Although much has been written concerning surgical techniques and results of implanting different preparations of fascia lata, there are relatively few reports of long-term histopathologic follow-up of recovered tissue. In the case described herein, autogenous fascia lata was recovered at the time of repeated surgery and examined 42 years later. On microscopic examination the tissue was viable but demonstrated significantly more vascularization, fibroblastic infiltration, and incorporation with surrounding structures than previously reported implants.

Double composite lid reconstruction: a new method of upper and lower lid reconstruction.

The double composite grafting technique utilizes two composite lid grafts from an opposing upper and lower lid for reconstruction of extensive lid defects. These two composite grafts are covered by a rotational pedicle advancement skin flap. The skin defect created by such an advancement graft is covered by a free skin graft. The donor areas are closed directly by a layer-by-layer approximation. This new single-stage technique allows reconstruction of large lid defects without covering an affected eye for a prolonged period and without jeopardizing the irreplaceable entity of a "normal" lid margin.

Immunoglobulin deposition in localized conjunctival amyloidosis.

Immunofluorescent studies were performed on tarsus and tarsal conjunctiva from a 30-year-old woman with blepharoptosis secondary to localized nonfamilial amyloidosis. Both kappa and lambda light chains were identified in abundance in the resected tissue. There was no evidence of any systemic disease or of amyloid deposition elsewhere. Six months after the patient underwent surgery, there was no sign of recurrence. The antigenic determinants of the amyloid suggested that the pathogenesis of localized nonfamilial ocular amyloidosis involves the accumulation of proteins similar to immunoglobulin.