LATERAL TARSAL STRIP TECHNIQUE IN CORRECTION OF EYELID ECTROPION AND ENTROPION.

BACKGROUND: Ectropion and entropion are eyelid malpositions associated with a number of unpleasant symptoms. One of several surgical methods that can correct these problems is referred to as the lateral tarsal strip technique. In this paper, we evaluate the postoperative results and quality of this technique. We also examine the complications associated with this surgical method. METHODS: The study took place from April 2018 to April 2020 at the Military University Hospital in Prague. The operation was performed by two surgeons. The study included 43 eyes of 33 patients (17 women and 16 men), average age was 79 years. Before the operation, 23 eyes were affected by ectropion and 20 eyes affected by entropion, 35 of the 43 were cases of involutional origin. The study does not include patients who underwent other surgical techniques. RESULTS: There were no perioperative or postoperative complications in the entropion surgery group. Successful correction was achieved, and adverse symptoms disappeared in 91.3% of cases. Correct position of the eyelid was not achieved in two cases. For patients with ectropion, surgical correction was successful in 95% of cases. Ectropion persisted after surgery only in one patient. CONCLUSION:   The lateral tarsal strip technique is a safe, reliable and highly effective surgical technique. Correction of eyelid malposition was achieved in more than 90% of cases. The vast majority of patients were satisfied and reported relief from preoperative symptoms.

Cyanoacrylate tissue adhesive in blepharoplasty.

This article reports the results of an animal study designed to evaluate the usefulness of butyl 2-cyanoacrylate (Histoacryl) in blepharoplasty skin closure. Bilateral upper and lower lid blepharoplasty skin incisions were made on seven pigs. We compared the wounds closed with 6.0 nylon to those closed with Histoacryl at 1, 2, 4, and 9 weeks postoperatively. The tensile strength of the "glued" incisions was significantly greater than that of the sutured incisions only at the 9-week postoperative interval (p < 0.05). There was no significant difference in bond strength, however, between the two methods at 1, 2 and 4 weeks postoperatively. Histopathologic analyses of sutured and glued wounds were compared at the same designated postoperative periods. No deleterious effects were found in the overall healing of the cutaneous wounds closed with Histoacryl.

Hertel exophthalmometry without orbital rim contact.

BACKGROUND: The Hertel exophthalmometer is the most widely used instrument for the measurement of globe malposition, but an absent or damaged lateral orbital rim will preclude its application. To circumvent this shortcoming, the authors have developed a fixation adapter that attaches to a standard Hertel instrument and transfers fixation to the forehead and nasion from the lateral orbit. METHODS: The adapter design is presented and discussed, along with illustrative clinical cases. A study of 30 healthy patients was performed to assess the validity of the adapter with respect to the Hertel standard. The agreement was then evaluated by comparing the Hertel adapter measurements from each patient with that of the adapter. A Wilcoxon statistic was performed to assess differences in the paired values from each patient for both techniques. RESULTS: Analysis on a sample (n = 30) of a healthy adult population does not show a statistical difference between the Hertel adapter and the adapter data (P > 0.05). In addition, more than 90% of the differences fall within +/- 1 mm (standard deviation = 1.02 mm) of the means for both eyes, which is within the accepted variance for the Hertel instrument. CONCLUSION: The new fixation adapter promises to become useful in assessing trauma and surgical cases where the lateral orbital rim has been violated and will expand the application of Hertel exophthalmometry to these situations.

Dacryocystorhinostomy in elderly patients: regional anesthesia without cocaine.

Elderly patients with nasolacrimal obstruction who are in poor health often pose a special anesthetic and surgical risk. General anesthesia and the use of cocaine packs may be contraindicated because of potentially dangerous side effects. Regional block dacryocystorhinostomy has gained popularity in all adult patient groups, but specifically it appears to be the procedure of choice in elderly patients. It is well suited for either hospital-based or ambulatory care. We describe our experience with the procedure in 25 consecutive patients (28 procedures), with emphasis on modification of our standard technique to suit regional blockade. Mechanisms of cocaine toxicity in the surgical setting are reviewed, and a method of local anesthesia without cocaine nasal packing is presented.

Tests for contralateral pseudoretraction in blepharoptosis.

Pseudoretraction of the contralateral upper eyelid has long been recognized as a clinical phenomenon in certain patients with unilateral ptosis. In this prospective study of 30 patients with ptosis, we used two commonly used tests for pseudoretraction, the digital "lift" and "closure" tests. We also describe two new adaptations, the "lift and release" and "closure and release," which enhance these basic tests. The incidence of pseudoretraction in unilateral ptosis was found to be 66.7% and the test with the highest positive yield was the "closure test" (66.7%). The use of clinical tests for pseudoretraction, including the "release" maneuvers, are recommended as part of routine preoperative assessment of blepharoptosis.

Dog and human bites of the eyelid repaired with retrieved autogenous tissue.

Two cases of traumatic avulsion of the upper eyelid were surgically repaired with retrieved autogenous tissue. Both injuries were caused by bites, canine in one case and human in the other. Surgical repair consisted of débridement of the retrieved tissue and layered closure of the wound 17 and 40 hours after the injury occurred. Good functional results were obtained in both cases. In both patients mild lid retraction and loss of cilia were noted. One of the patients underwent a secondary lid-lengthening procedure with scleral grafting for optimal cosmesis.

Modified Tessier flap for reconstruction of the upper eyelid.

We present a modification of the Tessier or orbitonasojugal flap for use in upper eyelid reconstruction. It is suitable for repairing full-thickness defects involving 60% or more of the lid margin and has the advantage of being a one-step procedure.

Orbital compartment syndrome. Direct measurement of orbital tissue pressure: 1. Technique.

Many disorders of the orbit produce an increase in intraorbital pressure, which may result in the development of an orbital compartment syndrome and visual loss. Traditionally, orbital tension is assessed clinically by indirect means based on retrodisplacement of the globe. The authors describe their experience with the "slit-catheter" technique for direct tissue pressure measurement as applied to the orbit. The preliminary results indicate that normal orbital pressure ranges from 3.0 to 6.0 mm Hg. In patients with Graves' orbitopathy the values ranged from 7.0 to 15.0 mm Hg. The results suggest that the technique may have many exciting possibilities as a clinical research tool in orbital disease, and its use will result in better understanding of orbital compartment syndromes.

[Metabolic and acid-base changes in intensive diuretic therapy in heart failure]. / Nekteré metabolické a acidobazické zmeny pri intenzívní diuretické lécbe srdecní slabosti.

A group of 65 patients with advanced heart failure was examined with the aim to disclose changes in serum glucose, creatinine, potassium, chloride, and acid-base balance under the influence of intensive diuretic therapy. 50 patients were treated with ordinary furosemide and amiloride combination (average observation time 25 days), in 15 cases amiloride was replaced by captopril 75-150 mg/day (average observation 15.5 days). The results are as follows: 1. We found no rise of glycaemia in non-diabetics with either ordinary diuretic therapy or captopril. On the contrary: stress hyperglycaemia in the beginning of the therapy normalized in the course of it. 2. There was a significant rise of serum creatinine during the first two weeks of therapy with furosemide and amiloride. Reversal of this trend followed after captopril. 3. There was no fall in the average serum chloride concentration during ordinary diuretic therapy. Adding captopril to the regime brought about a rise in serum chloride. 4. Serum potassium had no tendency to fall either after furosemide and amiloride or furosemide and captopril. 5. The acid-base balance showed no shift towards metabolic alkalosis during an intensive but rational diuretic regime either with or without captopril. On the contrary: mild initial metabolic alkalosis had a tendency to normalize with proceeding cardiac compensation.

Avulsion of the canalicular system.

Avulsion of the common canaliculus from its attachment to the lacrimal sac should be suspected in cases involving either deep lacerations on the lateral side of the nose or traumatic telecanthus in midfacial trauma. Blunting of the canalicular angle and rounding of the inner canthus are confirming signs. A canaliculodacryocystorhinostomy can be performed to reanastomize the lacrimal drainage pathways and relieve epiphora.

Effect of extracapsular cataract extraction on intraocular pressure.

Intraocular pressure (IOP) was measured in 27 normotensive patients scheduled to undergo uncomplicated extracapsular cataract extraction with insertion of a posterior chamber intraocular lens implant. The measurements were recorded the day before surgery, 3, 6 and 9 hours after surgery and the following morning. Fourteen of the patients had a substantial increase in IOP, to more than 30 mm Hg, on the evening of surgery. Most had normal IOP values the next morning. Ophthalmologists should be aware of this possible effect of extracapsular cataract extraction on IOP.

Stereochronoscopy of the optic disc with stereoscopic cameras.

Goldmann's chronoscopy, a form of time-based photogrammetry of the optic disc, can be accomplished by repeated simultaneous stereophotography. The variations in centration and image orientation are nulled by azimuthal rotation and fusion of two pairs of stereophotographs taken at separate times.

[Urinary Staphylococcus epidermidis: a pathogen or contamination?]. / Staphylococcus epidermidis im Harn: ein Pathogen oder eine Kontamination?

The alleged pathogenity of Staphylococcus epidermidis for the human urinary tract has been investigated statistically. The finding of this microbe in the urinary bladder punctate (678 suprapubic bladder aspirations) or in conventional urine sampling in the concentration greater than or equal to 10(4) microbes/ml (416 urine samples) shows no statistically significant correlation with the clinical signs of urinary tract disease.