ABSTRACT
BACKGROUND: Coralline hydroxyapatite has been used since 1983 as volume replacement. Through 2001, a total of 200 hydroxyapatite implants were used in our department. OBJECTIVE: This prospective study was undertaken to measure the subjective and objective long-term tolerance of this implant. MATERIALS AND METHODS: In 2012, a total of 20 patients were examined, who were enucleated or eviscerated between 1993 and 2001 (average follow-up 16.2 years) and had an hydroxyapatite implant placed with a scleral sheath. We evaluated the subjective tolerance and measured the motility, the prominence of the globe, lid positions, changes of the conjunctiva and postoperative complications. RESULTS: The subjective long-term tolerance was reported to be good. All patients had a ptosis; an ectropion was found in 50% of patients. In 40% of the patients additional surgery was performed. The motility was better in primary than in secondary placed implants. Volume replacement was successful in 10 patients, 9 patients had a retraction and 1 patient a prominent prosthesis. DISCUSSION: Hydroxyapatite implants with sclera sheathing were well tolerated and showed good motility on long-term follow-up over more than 16 years. Lid malpositions such as ptosis or ectropion are common but might be due to mechanical stress through the prosthesis and atrophy of the orbital fat.
Subject(s)
Orbital Implants , Ceramics , Eye Enucleation , Humans , Hydroxyapatites , Prospective Studies , Prostheses and ImplantsABSTRACT
Rejuvination of the lower lid is a challenging procedure. Lower lid malposition and ectropion are serious postoperative complications. Therefore presurgical assessment of the lower lid function and laxity are a must before performing a blepharoplasty. Lateral canthopexy is an effective procedure to minimise the risk of postsurgical ectropion. Its necessity increases with rising age of the patients. The canthopexy supports the lower lid postion in the case of increasing vertical tension.
Subject(s)
Blepharoplasty/methods , Ectropion/prevention & control , Ectropion/surgery , Eyelids/surgery , Plastic Surgery Procedures/methods , Blepharoplasty/adverse effects , Combined Modality Therapy/methods , Ectropion/etiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: The aim of this study was to evaluate the long-term success rates of a multimodal concept for treating functional nasolacrimal duct obstruction (FNLDO) consisting of minimally invasive lacrimal duct surgery and additional treatment of the conjunctiva, the puncta or the lids if necessary. METHODS: Clinical outcomes and subjective symptoms of 118 consecutive patients with the main diagnosis FNLDO were studied in a retrospective design. RESULTS: Of the 118 cases 64â% were treated by microendoscopy and microdrill only while 36â% needed additional treatments. In 76â% of all cases (82â% in the group of patients who were treated by microdrill only) the patients reported their symptoms to have "improved" after a median follow-up of 14 months. Up to the age of 70 years more women were affected by FNLDO, while it was more common among male patients above this age. In older patients additional treatment especially tightening of the lids was required more frequently. CONCLUSION: Transcanalicular microendoscopy of the lacrimal duct alone or in combination with additional treatments, if needed, showed satisfactory long-term outcomes in patients suffering from FNLDO and can be considered a valuable and minimally invasive option for these patients.