[The orbital implant after exenteration of the orbit with the preservation of the eyelids and the conjunctival sac]. / Orbitální protéza po exenteraci ocnice se zachováním vícek a spojivkového vaku.

In ophthalmology, the orbital exenteration presents the most mutilating surgical procedure. The surgical technique presented by authors, preserves the eyelids and conjunctival sac. This surgical procedure was suggested and repeatedly performed in adult patients with extensive benign tumors (mostly meningeomas) by J. Otradovec and J. Safár. The enucleation of the eyeball preceded this type of surgery. The final state made it possible to put the prosthesis into the conjunctival sac. Today we inform about further development of this surgical technique and according to our own experiences we widen its indications to some malignant tumors (rhabdomyosarcoma and metastases of the retinoblastoma, etc.) in children. The initial cutaneous incision starts in the eyebrow area and is directed toward the bone of the orbital rim. The preparation of the tissue underneath the intact conjunctival sac to the lower aspect of the bone orbital rim follows. After folding the conjuctival-cutaneous sac back, the real content of the orbit is exenterated in the classical manner. After the hemostasis in the orbital apex, the flap is returned to its primary position and suturing of the primary incision in anatomical layers terminates the surgery. The authors refer about a boy, now 17 years old, who underwent at the age of three years the exenteration of the orbit in this manner due to a rhabdomyosarcoma. The authors also refer about the development and application of a special type of prosthesis made from silicone rubber--implant grade--filling out the orbital space and forming the anterior segment of the eye. The prosthesis was created from a classical orbital implant, regularly used in enucleation surgery and a conjunctival implant, a convex-concave plate with diameter of 20 mm. Both parts are made from the same type of silicon rubber and were connected together by vulcanization. The orbital implant was eliptically extended according to the measurements of the orbital casting made from dental impression matter. The cosmetic part, simulating the colored iris and the pupil, was prepared from a polyester sheet, painted with acrylic paint. It was fixated on the conjunctival prosthesis and covered with a transparent silicone foil. For the first time, the prosthesis was applied at the age of seven years, and during the next ten-years period, it was three times exchanged mostly for a bigger model. This procedure guaranteed proper growing of the orbital area and symmetrical development of the face. The prosthesis also carries out the prosthetic role and cosmetically it looks similarly like after the enucleation without the implant.

[Duane's retraction syndrome--overview and diagnosis of clinical types]. / Duanuv retrakcní syndrom--prehled a diagnostika klinických forem.

The author presents a postgraduate review of the problem. In the introduction he reviews typical features of Duane's retraction syndrome (DS) and its main symptoms and reminds of the main approaches to classification: (1) Malbrane s (Duane I, II and III), (2) Huber's which is based on EMG findings in ZOS and (3) Kaufman's which classifies DS according to the enforced position of the head. The author maintains that even according to the above many atypical rare pictures cannot be classified or explained pathogenetically. Some are mentioned: (1) "Inverse" DS, which was recorded and documented by Chytilová-Divisová (1949) in a girl with congenital paralysis of abduction on both eyes retraction of the bulbus developed and narrowing of the palpebral aperture when attempting abduction (1) of the eye, (2) Bilateral acquired DS in a female patient with a tumour of the brain stem confirmed by EMG records of both horizontal muscles. (3) Unilateral DS in a child from a family with familial incidence of congenital ZOS fibrosis with an obscure ratio of the neurogenic and myogenic and fibrous component of the two pictures. In another member of this family the Marcus Gunn phenomenon was present. The latter findings support the idea that in the development of the fairly uniform picture of DS a combination of neurogenic, myogenic and connective tissue changes participate.