ABSTRACT
PURPOSE: We present a technique modification for enucleation surgery that may decrease implant exposure or extrusion by using native tissue to reinforce the implant at the most susceptible area, specifically the anterior-most aspect. METHODS: An enucleation procedure is performed, and an implant is placed into the orbit. The horizontal rectus muscles are attached to the implant, and the vertical rectus muscles are attached directly to the horizontal muscles. The inferior oblique muscle is then spread over the anterior implant surface and sutured to the superior rectus and lateral rectus muscles. RESULTS: 15 patients underwent this procedure, with implantation of an SST porous polyethylene implant. The mean follow-up interval was 18 months with a range of 4-33 months. One patient suffered an implant exposure, and one experienced a post-operative orbital hemorrhage. Two patients required blepharoptosis surgery to achieve eyelid symmetry. CONCLUSIONS: This retrospective series demonstrates the potential usefulness of the inferior oblique muscle to augment coverage of the orbital implant. Reinforcement of the anterior surface of the implant with vascularized tissue may improve the integrity and strength of the tissues anterior to the implant, and thereby reduce the likelihood of implant exposure.
Subject(s)
Eye Enucleation/methods , Oculomotor Muscles/surgery , Orbital Implants , Postoperative Complications/prevention & control , Prosthesis Implantation/methods , Biocompatible Materials , Eye, Artificial , Follow-Up Studies , Humans , Polyethylenes , Retrospective Studies , Suture TechniquesABSTRACT
The white-eyed orbital floor blowout fracture is most commonly seen in children and adolescents. The orbital floor is the most common fracture location with entrapment of inferior orbital contents and/or the inferior rectus muscle in a "trapdoor" fashion. Other sites may also be fractured either simultaneous to the floor or in isolation. The authors describe an isolated orbital medial wall fracture with entrapment of the medial rectus muscle in an adolescent and discuss treatment options.
Subject(s)
Diplopia/etiology , Ocular Motility Disorders/etiology , Oculomotor Muscles/injuries , Orbital Fractures/etiology , Wrestling/injuries , Adolescent , Diplopia/surgery , Eye Movements/physiology , Humans , Male , Ocular Motility Disorders/physiopathology , Ocular Motility Disorders/surgery , Orbital Fractures/surgery , Visual Acuity/physiologyABSTRACT
PURPOSE: To describe a technique for performing a bolsterless temporary tarsorrhaphy. DESIGN: Retrospective analysis and surgical technique description. METHODS: Temporary suture tarsorrhaphy (TST), which consists of a suture through the upper and lower eyelid posterior lamella, was performed after eyelid or socket surgery. RESULTS: Over 15 years, >1000 patients in the practice of one of the authors (R.L.A.) had TST that successfully maintained corneal coverage without complications in all but four eyes. In two patients, replacement was required because of tissue erosion; in two patients, the suture was placed too posteriorly and caused corneal irritation that required replacement. CONCLUSION: The TST is functionally equivalent to, or superior to, traditional bolster temporary tarsorrhaphy. The TST is faster and simpler, requires fewer materials, and avoids the risks of bolsters, which include eyelid margin necrosis, irregularities, and lash loss from vascular compromise.
