[Double intubation technique for the treatment of epiphora in complicated cases]. / Técnica de doble intubación para el tratamiento de la epífora en casos complicados.

PURPOSE: The aim of this study is to present a surgical technique used to treat epiphora secondary to difficult cases of lacrimal pathway obstruction after fractures, previous surgery or anatomic abnormalities. METHODS: From January 2001 to December 2002 we treated 27 patients with complicated lacrimal pathway obstruction secondary to fractures (10 cases), previous nasal surgery (4 cases), failure of a previous ipsilateral dacryocystorhinostomy (DCR; 6 cases), or failure of a previous contralateral DCR (7 cases). A DCR through an external approach was performed by placing a double concentric intubation in the lacrimal sac and nasal fossa, with the additional introduction of an interpositional silicone structure within a third hollow tube anchored to the sac entrance. RESULTS: The results were evaluated according to the absence of tearing, the emptiness of the lacrimal meniscus, and the permeability of the lacrimal system after forced liquid infusion. Globally, the technique was effective in 85 percent of cases. The results were satisfactory in 90% of cases of postraumatic epiphora, in 75% of patients with previous surgery, in 83% of patients with previous ipsilateral DCR, and in 71% of patients with failed DCR in the contralateral eye. CONCLUSIONS: The double intubation technique is a good option in lower lacrimal system obstructions when conventional techniques have a high index of failure.

Técnica de doble intubación para el tratamiento de la epífora en casos complicados / Double intubation technique for the treatment of epiphora in complicated cases

Objetivo: Presentar un sistema para corregir quirúrgicamentela epífora ante obstrucciones del sistemalagrimal que se presentan de difícil resoluciónpor alteraciones en fosa nasal, traumatismos o cirugíaprevia.Métodos: Se realiza una dacriocistorrinostomía(DCR) por vía externa, colocando una doble intubaciónconcéntrica a nivel de saco lagrimal y fosanasal introduciendo un elemento de interposiciónmacizo de silicona en otro cilindro hueco, ancladoen la abertura del saco. Se practicó la técnica en 27casos durante los años 2001 y 2002, en pacientesafectados por traumatismos faciales con fracturaósea que compromete el sistema lagrimal (diezcasos), con cirugía nasal previa (cuatro casos), conDCR fallida previa en el mismo lado (seis casos), ycon DCR previa fallida en ojo contralateral (sietecasos).Resultados: Son valorados según la ausencia delagrimeo, el vaciamiento del menisco lagrimal, y lapermeabilidad objetivable del sistema lagrimalmediante paso forzado de líquido. Los resultadosglobales indican una tasa de eficacia de la técnica de un 85%. El análisis por grupos refleja una eficaciadel 90% en pacientes con traumatismo facialprevio, del 75% en pacientes sometidos a cirugíanasal previa, del 83% en operados de DCR previaen el mismo ojo, y del 71% en operados de DCRcon mal resultado en el ojo contralateral.Conclusiones: El método presentado nos pareceuna buena solución en los casos de obstruccionesbajas del sistema lagrimal de pacientes con patologíaprevia, en los que sospechamos un fracaso alenfrentarnos a la cirugía convencional de repermeabilización

Purpose: The aim of this study is to present a surgical technique used to treat epiphora secondary to difficult cases of lacrimal pathway obstruction after fractures, previous surgery or anatomic abnormalities. Methods: From January 2001 to December 2002 we treated 27 patients with complicated lacrimal pathway obstruction secondary to fractures (10 cases), previous nasal surgery (4 cases), failure of a previous ipsilateral dacryocystorhinostomy (DCR ;6 cases), or failure of a previous contralateral DCR (7 cases). A DCR through an external approach was performed by placing a double concentric intubation in the lacrimal sac and nasal fossa, with the additional introduction of an interpositional silicone structure within a third hollow tube anchored to the sac entrance. Results: The results were evaluated according to the absence of tearing, the emptiness of the lacrimal meniscus, and the permeability of the lacrimal system after forced liquid infusion. Globally, the technique was effective in 85 percent of cases. The results were satisfactory in 90% of cases of pos-traumatic epiphora, in 75% of patients with previous surgery, in 83% of patients with previous ipsilateral DCR, and in 71% of patients with failed DCR in the contralateral eye. Conclusions: The double intubation technique is a good option in lower lacrimal system obstructions when conventional techniques have a high index of failure

[Treatment of palpebral ptosis with frontal suspension: a comparative study of different materials]. / Estudio comparativo de diferentes materiales empleados en la suspensión al frontal en casos de ptosis palpebral.

PURPOSE: The aim of this study was to compare the results of three materials used for frontal muscle suspension in the treatment of palpebral ptosis. METHODS: Sixty-six eyes in 46 patients with palpebral ptosis were operated with a modified Fox technique. The suspension was performed with autologous fascia lata in 18 cases (group 1), cryopreserved fascia lata in 23 cases (group 2), silicone in 15 cases (group 3), and PTFE in 20 cases (group 4). The results were evaluated according to the height symmetry of the palpebral opening and the improvement in visual capacity. RESULTS: The results were considered satisfactory in 16 patients (88%) in group 1, 19 cases (82%) in group 2, 12 cases (80%) in group 3, and 18 cases (90%) in group 4. Complications included the loss of correction with recurrent palpebral ptosis requiring revision surgery, or foreign body granuloma formation. The highest complication rate occurred in group 4 (40%), and the lowest in group 1 (5%). Two thirds of the patients with recurrent ptosis were included in the group of younger patients. CONCLUSIONS: Autologous or homologous fascia lata is superior to silicone or PTFE when used as a suspension material in the treatment of palpebral ptosis.

[The use of a prolene double mesh for orbital wall reconstruction]. / Utilización de doble malla de prolene para reconstrucción de la pared orbitaria.

CASE REPORT: Patient with a recurrent carcinoma of the nasal fossae affecting the internal orbital wall. The intraorbital content was not affected. The orbital wall was reconstructed with a prolene double mesh anchored to the periosteum. DISCUSSION: Prolene mesh as a substitute of the orbital wall. Good stability and isolation of the intraorbital structures were observed. Ocular motility was completely normal after surgery without prolene mesh displacements. The prolene double mesh is a good surgical option to replace missing bone in the reconstruction of the internal orbital wall.

Estudio comparativo de diferentes materiales empleados en la suspensión al frontal en casos de ptosis palpebral / Treatment of palpebral ptosis with frontal suspension: a comparative study of different materials

Objetivo: Realizar un estudio comparativo de los diferentes materiales utilizados en la suspensión al frontal en casos de ptosis palpebral.Métodos: Se intervienen 66 ojos (46 pacientes) mediante la técnica de Fox modificada, en el grupo 1 (18 casos) utilizando fascia lata autóloga, en el grupo 2 (23 casos) utilizando fascia lata criopreservada, en el grupo 3 (15 casos) utilizando silicona y en el grupo 4 (20 casos) utilizando PTFE. Se realiza un seguimiento postoperatorio de al menos dos años, analizando la eficacia del método y las complicaciones.Resultados: La eficacia obtenida, considerando como tal la liberación del eje visual y la simetría en la altura de la hendidura palpebral en el grupo 1 es de un 88% (16 casos), en el grupo 2 de un 82% (19 casos), en el grupo 3 de un 80% (12 casos) y en el grupo 4 de un 90% (18 casos). Las complicaciones, considerando como tales la necesidad de reintervención por descenso de párpado, o la formación de granulomas fue de un 40% (ocho casos) en el grupo 4, de un 33% (cinco casos) en el grupo 3, de un 17% (cuatro casos) en el grupo 2, y del 5% (un caso) en el grupo 1. El 74% de los casos que descendieron pertenecían al grupo de menor edad.Conclusiones: La fascia lata, autóloga o procedente de banco resulta un material superior, para su empleo en la suspensión, a la silicona y al PTFE

Purpose: The aim of this study was to compare the results of three materials used for frontal muscle suspension in the treatment of palpebral ptosis. Methods: Sixty-six eyes in 46 patients with palpebral ptosis were operated with a modified Fox technique. The suspension was performed with autologous fascia lata in 18 cases (group 1), criopreserved fascia lata in 23 cases (group 2), silicone in 15 cases (group 3), and PTFE in 20 cases (group 4). The results were evaluated according to the height symmetry of the palpebral opening and the improvement in visual capacity. Results: The results were considered satisfactory in 16 patients (88%) in group 1, 19 cases (82%) in group 2, 12 cases (80%) in group 3, and 18 cases (90%) in group 4. Complications included the loss of correction with recurrent palpebral ptosis requiring revision surgery, or foreign body granuloma formation. The highest complication rate occurred in group 4 (40%), and the lowest in group 1 (5%). Two thirds of the patients with recurrent ptosis were included in the group of younger patients. Conclusions: Autologous or homologous fascia lata is superior to silicone or PTFE when used as a suspension material in the treatment of palpebral ptosis

Utilización de doble malla de prolene para reconstrucción de la pared orbitaria / The use of a prolene double mesh for orbital wall reconstruction

Caso clínico: Paciente con carcinoma recidivante de fosa nasal que invade pared orbitaria interna, sin afectar al contenido orbitario. Se emplea, para la reconstrucción, una malla doble de prolene anclada a periostio.Discusión: El prolene es un material adecuado para sustituir la pared orbitaria, proporcionando estabilidad a la órbita sin afectar a su contenido. Tras la cirugía la motilidad ocular es normal y la malla no tiene desplazamiento. Ésta es una buena opción para reemplazar el hueso extirpado en los casos en que sea necesario realizar una reconstrucción de la pared orbitaria interna

Case report: Patient with a recurrent carcinoma of the nasal fossae affecting the internal orbital wall. The intraorbital content was not affected. The orbital wall was reconstructed with a prolene double mesh anchored to the periosteum. Discussion: Prolene mesh as a substitute of the orbital wall. Good stability and isolation of the intraorbital structures were observed. Ocular motility was completely normal after surgery without prolene mesh displacements. The prolene double mesh is a good surgical option to replace missing bone in the reconstruction of the internal orbital wall

[Orbital vasculonervous network and orbital surgical compartments by high field magnetic resonance]. / Dotación vasculonerviosa y espacios anatomoquirúrgicos de la órbita por resonancia magnética de alto campo.

PURPOSE: To elucidate the possibilities and indications of high-resolution magnetic resonance imaging (MRI) in the study of the orbit and its contents. METHODS: Orbital anatomy was studied in sliced specimens of fifteen fresh frozen cadavers and the results were compared with those obtained in thirty asymptomatic subjects who underwent a magnetic resonance with 1.5 Tesla equipment. The information obtained was used to interpret the findings in twenty-two patients with various orbital diseases. RESULTS: High-resolution MRI allows visualization of structures difficult to assess previously, like the cerebrospinal fluid (CSF) surrounding the optic nerve, the complete intraorbital route and the exit of the third cranial nerve, the ophthalmic artery and the intraorbital relationships of the sixth cranial nerve, which can be clearly differentiated from the lateral rectus muscle. CONCLUSIONS: High-resolution MRI is a very useful tool for the study of the orbit and its content. It provides accurate diagnoses through non-invasive procedures and facilitates the planning of the surgical approaches by improving the visualization of pathologic orbital structures. lcarlos@correo.uniovi.es

Dotación vasculonerviosa y espacios anatomoquirúrgicos de la órbita por resonancia magnética de alto campo / Orbital vasculonervous network and orbital surgical compartments by high field magnetic resonance

Objetivo: Conocer las posibilidades de la Resonancia Magnética de alto campo en el estudio de la órbita y su contenido. Métodos: Se han realizado cortes anatómicos en 15 cadáveres a fin de analizar las estructuras orbitarias y vecinas, comparando éstas con los hallazgos obtenidos en 30 sujetos sanos a los que fue realizada una Resonancia Magnética (RM) con equipo dotado de 1.5 TESLA. Asimismo se incorporaron al estudio comparativo un grupo de 22 pacientes portadores de patología orbitaria diversa. Resultados: Se pueden identificar con este tipo de sistema de exploración estructuras hasta ahora difícilmente asequibles, tales como el L.C.R. que acompaña al fascículo óptico, la salida y recorrido completos del III par craneal, la arteria oftálmica y las relaciones del VI par craneal en el interior de la órbita, que con este método puede ser bien diferenciable de la estructura del músculo recto externo. Conclusiones: La Resonancia Magnética de alto campo o de alta resolución es un procedimiento de exploración muy útil para el estudio de la órbita y su contenido, lo cual permite avanzar en el diagnóstico por métodos escasamente invasivos y facilita la preparación de los abordajes quirúrgicos, al mostrar con buena nitidez el estado de las diferentes estructuras orbitarias afectadas por patología (AU)

Purpose: To elucidate the possibilities and indications of high-resolution magnetic resonance imaging (MRI) in the study of the orbit and its contents. Methods: Orbital anatomy was studied in sliced specimens of fifteen fresh frozen cadavers and the results were compared with those obtained in thirty asymptomatic subjects who underwent a magnetic resonance with 1.5 Tesla equipment. The information obtained was used to interpret the findings in twenty-two patients with various orbital diseases. Results: High-resolution MRI allows visualization of structures difficult to assess previously, like the cerebrospinal fluid (CSF) surrounding the optic nerve, the complete intraorbital route and the exit of the third cranial nerve, the ophthalmic artery and the intraorbital relationships of the sixth cranial nerve, which can be clearly differentiated from the lateral rectus muscle. Conclusions: High-resolution MRI is a very useful tool for the study of the orbit and its content. It provides accurate diagnoses through non-invasive procedures and facilitates the planning of the surgical approaches by improving the visualization of pathologic orbital structures (AU)

Acerca de las suturas ajustables en cirugía oculoplástica / About the adjustable sutures in ophthalmic plastic surgery

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Acerca de las suturas ajustables en cirugía oculoplástica / About the adjustable sutures in ophthalmic plastic surgery

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[Chronic granulomatous endophthalmitis. Clinical-pathological correlation]. / Endoftalmitis crónica granulomatosa. Correlación clínico-patológica.

CASE REPORT: The authors present the case of a patient with a painful eye secondary to a non-perforating traumatism sustained in the past which, at the time of the injury, had caused a post-traumatic cataract, corneal lesions and a secondary glaucoma. The structural damage of the ocular content, associated with a well preserved size and external shape, made the diagnosis more difficult, requiring additional diagnostic methods. The pathological findings are also presented. DISCUSSION: The authors present the available diagnostic methods for those cases with chronic inflammation in which direct examination of the ocular content is not feasible, and it is mandatory to exclude vital threatening pathologies.

Endoftalmitis crónica granulomatosa. Correlación clínico-patológica / Chronic granulomatous endophthalmitis. Clinical-pathological correlation

Caso clínico: Paciente afectado por un traumatismo no perforante antiguo en su ojo izquierdo que provoca una catarata traumática, lesiones corneales y glaucoma secundario y que presenta años después una evolución tórpida y dolorosa. La desestructuración del contenido ocular con conservación del tamaño y forma del globo obliga a efectuar un diagnóstico mediante medios auxiliares, presentándose los hallazgos anatomopatológicos. Discusión: Presentamos las posibilidades diagnósticas que existen en casos de inflamaciones crónicas en las cuales no sea posible el examen directo del interior del ojo a fin de descartar patología de importancia vital (AU)