Issues of rehabilitation of the patients with symblepharon using oral mucosal autografts.

PURPOSE: To systematize clinical variants of symblepharon and to analyze rehabilitation availability boundaries in patients with different forms of symblepharons. METHODS: Retrospective analysis of clinical cases included 26 patients with local, subtotal, and total symblepharon (ankyloblepharon) with a normal or anophthalmic orbit. In all patients, symblepharon was operated using split- or full-thickness oral mucosal autografts and their fixation with U-shaped stitches and compression plates. Preoperatively and postoperatively, best-corrected visual acuity, IOP, extraocular motility, results of Schirmer I test, and tear break-up time with slit-lamp biomicroscopy were analyzed, as well as additional ultrasound and electrophysiological studies were performed in some cases. Follow-up period lasted from 1.5 to 6 years. RESULTS: The proposed surgical technique using mucosal autografts in all patients allowed complete anatomical restoration of conjunctival fornices and cavity. It resulted in improvement of visual function in patients with local symblepharon, full restoration of ocular motility in patients with a presence of the eye and provided an opportunity to wear artificial eye in patients with anophthalmia. Nonetheless, loss of conjunctival Krause's and Wolfring lacrimal glands, goblet cells, meibomian glands, and limbal stem cells prevents from further optic keratoplasty in patients with total or subtotal symblepharon on potentially sighted eye. CONCLUSION: The most difficult patients for visual rehabilitation were the ones with subtotal or total symblepharon (ankyloblepharon) on potentially sighted eye due to the loss of conjunctival goblet cells, meibomian glands, and limbal stem cells.

A Novel Method for Complex Diagnostics of Globes' Position.

Spiral computed tomography is a gold standard in diagnostics of intraorbital pathological changes. Modern software provides great opportunities at viewing and analyzing DICOM files. Earlier, the authors introduced a method of computed exophthalmometry for precise measurement of globes' position even in the cases of lateral orbital rim fracture. However, eye proptosis is known to be depending on the eye length (ocular component), retrobulbar volume (orbital component), as well as anatomy of neurocranium and brain (cerebral component). Nevertheless, conventional Hertel exophthalmometry and other proposed methods do not specify the component, involved in the pathogenesis of enophthalmos or exophthalmos, that is why additional examinations are required. In this article, the authors propose a novel approach, which can complement and/or substitute instrumental methods used for differential diagnostics of enophthalmos or exophthalmos.

Computed exophthalmometry is an accurate and reproducible method for the measuring of eyeballs' protrusion.

PURPOSE: The aim of this study was to assess reproducibility of the repeated measurements from proposed computed exophthalmometry and to make a comparison with the Hertel exophthalmometer. METHODS: Computed tomography scans of patients with pathological (group 1) and intact orbits (group 2) were included in this retrospective study. In both groups, a single investigator measured a difference of eyeballs' protrusion using the proposed method of computed exophthalmometry. Briefly, the distances from the corneal apices of the left and right eyeballs to the line placed through the styloid processes of the temporal bones were measured and compared to each other three times independently. RESULTS: In some patients with intact lateral orbital rims the results of computed exophthalmometry correlated with the measurements from the Hetrel exophthalmometer. The analysis of the triple measurements with computed exophthalmometry revealed no significant difference in the value of standard deviation of the results in patients with intact and pathological orbits. In comparison with the Hertel-type exophthalmometry, the proposed method demonstrated very low variability and high repeatability of the measurements. The difference of 0.10-0.87 mm in the eyeballs protrusion should be considered as normal. Computed exophthalmometry is an accurate and reproducible method, which can be used for the measurements of eyeballs' protrusion.