[Reconstruction of eyelid defect using periosteal stripe from lateral orbital rim as substitute of tarsus].

OBJECTIVE: To evaluate the results of eyelid defect reconstruction using periosteal stripe of the lateral orbital rim. METHODS: This was a retrospective analysis of eyelid defects reconstruction in 13 patients with lateral canthus eyelid defect following the excision of the eyelid tumors including: seven patients with basal cell carcinoma, four patients with sebaceous cell carcinoma and two patients with squamous cell carcinoma. All eyelid defects were reconstructed with zygoma periosteal stripe as the posterior layer of the eyelid. The anterior layer of the eyelid was reconstructed by myocutaneous flap. RESULTS: After follow-up at 8 to 56 months, all reconstructed eyelids showed a normal appearance with good function and without deformities, e.g. eyelid notch, entropion and ectropion. There was no relapse of the eyelid tumor. All patients were satisfied with the results. CONCLUSIONS: This method is good for repairing lateral eyelid defect involving 1/3 to 2/3 eyelids and without the tumor invasion of lateral orbit rim. This procedure obtains satisfactory results, especially for simultaneous reconstruction of upper and lower eyelids defects.

[Evaluation of photodynamic therapy in idiopathic choroidal neovascularization].

OBJECTIVE: To evaluate the effectiveness of photodynamic therapy (PDT) in the treatment of idiopathic choroidal neovascularization (CNV). METHODS: Sixty-one cases (61 eyes) of CNV were treated with PDT and the fundus appearance, visual acuity, retina thickness as well as the fundus angiographic imaging were observed before and after the therapy. PDT was performed 1.2 times in average and the follow-up period was 6 - 36 months (mean 19 months). RESULTS: At the last follow up, the visual acuity was improved in 41 eyes (67.2%), unchanged in 15 eyes (24.6%) and slightly decreased in 5 eyes (8.2%). Macular hemorrhage and exudation reduced in all cases after PDT. Fundus angiography showed complete closure of CNV in 38 eyes (62.3%), partial closure in 4 eyes (6.6%), incomplete closure in 14 eyes (23.0%) and recurrence in 5 eyes (8.2%). In 6 eyes CNV was complete closed after single PDT with diminish of macular edema and neuronal retinal epithelial detachment. No recurrent CNV was observed during three years' follow-up and the visual acuity remained stable. Our results also demonstrated that the therapeutic effect decreased with patient's age (t = 0.476, P = 0.016). The decrease of visual acuity averaged 0.008 per year. CONCLUSION: Photodynamic therapy is a potential treatment for idiopathic CNV and better outcomes are achieved in younger patients.

Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage.

PURPOSE: To evaluate the efficacy of autologous limbal transplantation (ALT) combined with deep lamellar keratoplasty (DLK) for ocular surface reconstruction and corneal clarity recovery in eyes with severe late-stage chemical or thermal burns. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-nine eyes of 39 patients with a history of severe chemical or thermal burns over 6 months (mean, 47 +/- 28.7 months) exhibiting corneal vascularization, conjunctivalization, and heavy corneal scarring were treated at two university hospitals. METHODS: Surgical procedures included excising epibulbar fibrous tissue, clearing the fibrovascular membrane over the cornea, deep removal of corneal stroma 7.5 to 8.0 mm in diameter, exposing Descemet's membrane in the pupillary area, grafting a corneal button, transplanting autologous limbal and conjunctival epithelial grafts, and making a temporary tarsorrhaphy. MAIN OUTCOME MEASURES: Integrity of ocular surface recovery, postoperative corneal epithelial stability, optical corneal clarity, and best-corrected visual acuity were the outcome measurements. RESULTS: Thirty-four of 39 eyes that received ALT combined with DLK met the criteria of the study. Of 34 operated eyes, full corneal epithelialization was achieved in 19 eyes (55.9%) within 5 days and in 32 eyes (94.1%) within 7 days after surgery. Delayed epithelial healing occurred in two eyes (5.9%). The reconstructed corneal surface remained stable, and the renewed epithelium was characterized cytologically by nonkeratinized squamous cells without goblet cells. After surgery in 11 of 34 eyes, fluid was identified between Descemet's membrane and the donor corneal graft, resulting in a pseudochamber that completely resolved in 10 eyes within 30 days. In one patient, a persistent pseudochamber was present for 28 months. After surgery, transparent cornea especially in the pupillary area was accomplished in 29 eyes, whereas mild cornea clouding, nebulomacular corneal opacity, and heavy corneal scarring were observed, respectively, in three eyes. In addition, corneal endothelial decompensation was identified in two eyes and demonstrated persistent corneal epithelial and stromal edema. Remarkable improvement of postoperative vision was achieved in 30 eyes. Four eyes without postoperative improvement in vision were regrafted by penetrating keratoplasty at least 6 months after the original ALT and DLK surgery. CONCLUSIONS: Autologous limbal grafting combined with DLK simultaneously can restore a normal and stable ocular surface, create clear central cornea, and remarkably enhance visual acuity after severe chemical or thermal burns.