ABSTRACT
PURPOSE: To asses the functional results and complications of Mersilene mesh as an alternative to autogenous fascia lata in the management of low function ptosis. METHODS: In a randomized clinical trial, 31 eyelids with poor levator function were operated on. In 16 eyelids Mersilene mesh (Group A) and in 15 eyelids autogenous fascia lata were used for frontalis suspension procedure (Group B). RESULTS: Nine patients with congenital unilateral and 11 patients with bilateral ptosis underwent sling procedure. There were no differences between the two groups with regards to functional (lid fissure height stability) and cosmetic (lid margin contour) results. Eyelid fissure increase was 4.00-/+1.46 mm in Group A and 3.13-/+1.72 mm in Group B. Change in eyelid fissure in both groups was significant (p=0.00, paired t-test), but intergroup difference was not significant (p=0.141, independent sample t-test). Follow-up for Group A was 14.2 (range 6-26) months and for Group B was 15.1 (range 9-29) months. Dermatochalasis was seen more in Group B (B/A = 10/2) and extrusion of Mersilene mesh was seen in two cases of Group A and none of Group B. Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the two groups. CONCLUSIONS: Mersilene mesh with long-term functional results and low rate of complications is a suitable alternative to autogenous fascia lata as a suspensory material in ptosis surgery.
Subject(s)
Blepharoptosis/surgery , Eyelids/surgery , Fascia Lata/transplantation , Polyethylene Terephthalates , Surgical Mesh , Adolescent , Adult , Blepharoplasty/methods , Blepharoptosis/congenital , Blepharoptosis/physiopathology , Child , Child, Preschool , Eyelids/physiopathology , Female , Humans , Intraoperative Complications , Male , Oculomotor Muscles/surgery , Postoperative Complications , Prospective Studies , Transplantation, Autologous , Young AdultABSTRACT
PURPOSE: Polycarbonate peg has been customarily used for pegging of hydroxyapatite for years. For better movement, tissue tolerance, and to decrease the complications of pegging, titanium peg system has been used. This study compares the two systems. METHODS: Complications associated with pegging (polycarbonate: Bio-Eye or titanium: Dr-Perry new P-K) were retrospectively reviewed from the charts of 153 patients admitted to the Labbafinejad Medical Center, Tehran, Iran, for over 5 years from 1997 to 2003. RESULTS: A total of 153 cases were studied. Ninety-six (62.3%) were male and 57 (37.7%) were female, and the mean age was 27.7 years (6-59 years). In 88 cases pegs were poly-carbonate and sleeve system and in 65 cases pegs were titanium. Forty-one (46%) of cases with polycarbonate and 18 (27%) of cases with titanium had at least one or more complications (p=0.018). The most common complications were granulation tissue, discharge, overgrowth of conjunctiva, and peg falling out in 25%, 23%, 13%, and 8% in polycarbonate peg and 15%, 5%, 1.5%, and 0% in titanium peg group. The prevalence of the last three complications was statistically lower in titanium peg compared with polycarbonate. Twenty-five cases (35%) with polycarbonate peg and 5 cases (7.5%) with titanium peg had two or more complications (p=0.03). Peg removal was done in 11 cases of polycarbonate but only two cases of titanium peg in order to treat the complication. CONCLUSIONS: Both pegging systems had some complications, although these were less severe and prevalent in titanium peg. More studies on complications due to titanium pegs are recommended.
Subject(s)
Durapatite , Orbital Implants , Polycarboxylate Cement/adverse effects , Surgical Fixation Devices/adverse effects , Titanium/adverse effects , Adolescent , Adult , Child , Eye Enucleation , Eye, Artificial , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
PURPOSE: To report the results of a newly devised two-stage surgical technique for management of large hydroxyapatite exposure defects. METHODS: Eight patients with exposed hydroxyapatite orbital implant were treated in two stages. The exposed hydroxyapatite anterior surface was burred down and the defect was directly closed 3 to 13 months after the primary procedure. Then a mucous membrane or dermis-fat graft was added for socket reconstruction. RESULTS: Trauma was the primary cause of enucleation in all patients. Hydroxyapatite exposures occurred 1 to 2 weeks after implantation. Mean defect size was 15 mm in the greatest dimension (range 10-21 mm). Socket reconstruction was done in seven patients with mucous membrane graft and in one patient with dermis fat graft 3 to 13 months after direct repair of the defects. All eight patients maintained closure of the defects during a mean follow-up of 13 months (range 9-19 months). CONCLUSIONS: Management of hydroxyapatite exposures, especially those with large defects, can be difficult. Based on our experience, optimal results can be obtained after direct closure of the defect under minimal tension at the expense of foreshortening the fornices after which the socket can be reconstructed with a mucous membrane or dermis fat graft as a secondary procedure.
Subject(s)
Durapatite/adverse effects , Foreign-Body Migration/surgery , Ophthalmologic Surgical Procedures/methods , Orbital Diseases/surgery , Orbital Implants/adverse effects , Adipose Tissue/transplantation , Adult , Biocompatible Materials , Child , Female , Foreign-Body Migration/etiology , Humans , Male , Middle Aged , Mucous Membrane/transplantation , Orbital Diseases/etiologyABSTRACT
Incision site tissue necrosis (ISTN) after surgical procedures of the facial area is rare. In this article, two patients who have suffered from ISTN after dacryocystorhinostomy (DCR) are reported. No known causes have been found for this complication; however, over-cauterization could be considered a contributing factor in at least one of our cases.
