Correlation between clinical outcomes and patients' satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects.

Aim To examine and quantify patients' satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique. Methods A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17 patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients' satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed. Results Pearson correlation coefficient between patients' satisfaction and clinical presentation was 0.534. Out of 510 (the highest summed score for patients' satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones. Conclusion Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.

Diagnostics and treatment of orbital myositis.

Objective: Orbital myositis is a rare clinical condition that involves idiopathic inflammation mostly of extraocular muscles. The purpose of this study was to present a diagnostic and treatment plan of orbital myositis. Methods: A 60-year-old female presented with decreased visual acuity on her left eye, ocular hypertension, restricted and painful left abduction, diplopia, swollen eyelids, and orbital discomfort. MRI, as well as ultrasound, showed enlargement in width of medial rectus muscle. After other diagnoses were excluded, the diagnosis of left orbital myositis was established. Results: She was started on systemic corticosteroid treatment, but each time the steroid dose was tapered she experienced a relapse. Immunosuppressive therapy was introduced and the steroid dose was gradually tapered and excluded. One year after immunosuppressive therapy, the clinical findings improved. Conclusion: The diagnosis of orbital myositis requires detailed examination, laboratory testing and MRI scans of the orbits in order to exclude other diseases with similar clinical findings. The first line treatment option is systemic corticosteroid therapy with additional immunosuppressive therapy if needed. Abbreviations: MRI = magnetic resonance imaging, BCVA = best corrected visual acuity, ENT = ear, nose, throat specialist, CBC = complete blood count, WBC = white blood cell, ESR = erythrocyte sedimentation rate, CRP = C reactive protein, HM = hand motion, TED = thyroid eye disease, SLE = systemic lupus erythematosus, ECG = electrocardiogram, CT = computed tomography.

Case report of Wolfe grafting for the management of bilateral cicatricial eyelid ectropion following severe burn injuries.

INTRODUCTION: Eye lid reconstruction followed by severe, extensive body and facial burns represents a surgical challenge due to difficulties to obtain proper, healthy skin graft, tissue ischemia and necrosis. PRESENTATION OF CASE: We present a reconstructive lid surgery of cicatricial bilateral lower eyelid ectropion in a case of 31-year-old man who sustained thermal injuries, affecting more than 60% of total body surface area, causing severe, deep dermal burns. Reconstruction was made using the technique of skin cantus-to-cantus incision, contracture release, orbicularis liberation and lid elevation; and oversizing free full-thickness skin graft (FTSG) (Wolfe technique) from the left inguinal region, as the only healthy skin on the entire body surface. Residual lower left lid laxity was addressed by pentagonal wedge resection, not interrupting marginal arcade vessels, thus minimizing ischemia. DISCUSSION: Method of choice of the graft type has been much debated question; however, significantly less reoccurrence rate of ectropion was observed using FTSG. Time of grafting should be balanced to avoid excess granulation and, thus scaring caused by delayed grafting time, or poor graft adherence caused by premature grafting. An interruption of the marginal arcade vessels should not be performed due to already severe ischemic process and increased risk for lid necrosis. CONCLUSION: Major issues when addressing cicatricial ectropion followed by severe burns are: right donor site selection, appropriate graft thickness with the least possible disturbance of the affected place vascularisation, followed by immediate grafting after debridement of scaring and unhealthy tissue, with generous preservation of the orbicularis muscle.

Occurrence and morphological characteristics of cataracts in patients treated with general steroid therapy at Cantonal Hospital Zenica.

AIM: To determine the occurrence and morphological characteristics of cataracts and the impact of general steroid therapy on its occurrence. METHODS: A retrospective/prospective study was conducted on 90 patients who had been treated at the Cantonal Hospital Zenica with general steroid therapy. There were 30 patients whose general steroid therapy lasted shorter than 4 years and 30 patients on steroid therapy for more than 4 years. The remaining 30 patients were the control group. An examination of lens transparency and morphological characteristics of cataract was made by slit lamp with previously achieved mydriasis. RESULTS: A significant (p less than 0.05) occurrence of cataracts in patients taking general steroid therapy > 4 years and significantly more frequent occurrence of cataract in patients aged 60 years and over was found. Iatrogenic diabetes affects the occurrence of cataracts in addition to age and duration of therapy, especially in those who were on steroid therapy for more than 4 years. Steroid cataract was of subcapsular type according to its morphological characteristics. CONCLUSION: A possibility of cataract occurrence during or after the treatment with corticosteroids therapy should not be ignored. Subcapsular location of cataracts reduces work ability, normal daily activities and requires surgery. Ophthalmic examination should be an obligatory part of the preparation of patients for corticosteroids treatment. Control examinations should be repeated every six months during the therapy, and even more frequently if required.

Risk factors and diabetic retinopathy.

The aim of the study was to determine the correlation between risk factors and diabetic retinopathy, which is the leading cause of blindness in developed countries for patients aged 20 to 65. We compared risk factors between patients without retinopathy, with non-proliferate and with proliferate retinopathy (p<0.05). Duration of diabetes is most important for the development of retinopathy. Hyperglycaemia and high blood pressure are important for progression. Better control of blood sugar and elevated blood pressure can reduce progression of retinopathy and risk of vision loss.