Periumbilical fat auto-graft associated to a porous orbital implant for socket reconstruction after enucleation.

Having to remove the sclera, fat and the optic nerve in patients undergoing an enucleation, translates in a larger volume that needs to be replaced to achieve good motility and aesthetic results. Using a 20 or 22 mm implant can only partially replace the removed volume. We report the results of our enucleation technique, which includes the use of a porous orbital implant combined with a primary fat graft to replace a higher percentage of the removed volume to achieve a better cosmetic outcome and to avoid implant related complications in high risk patients. Prospective, non-randomized study of enucleated patients for whom porous orbital implantation was performed with anterior placement of a fat auto-graft. The development of implant extrusion or exposure was recorded as well as the presence of conjunctival wound dehiscence and infection. Orbital volume was clinically and radiologically evaluated as well. Twenty-eight patients were included, with a postop follow-up of at least 6 months (6-79 months). No cases of migration or extrusion were found. One case of a large exposure resolved completely. All MRI demonstrated proper implant-graft integration and vascularisation. The aesthetic result and the symmetry were very adequate, with Hertel differences of less than 2 mm in all cases and good motility range. The fat graft is well tolerated, showing low incidence of implant-related complications whilst maintaining good volume and motility.

Giant Blue Nevus: A New Association to Nevus of Ota.

Nevus of Ota, also known as oculodermal melanocytosis, is a congenital pigmentary condition that can affect structures in the distribution of the ophthalmic and maxillary divisions of the trigeminal cranial nerve. Malignant transformation, although rare, may occur within nevus of Ota and result in uveal, cutaneous, orbital or even dural melanoma. We present a new association of Nevus of Ota complicated with a giant orbital Blue Nevus in a young white male and the management of this tumor.

Fat transposition with a single subdermal stitch for the treatment of deep tear trough.

GOAL: To describe a fixation technique of the medial and central fat pads in the subperiosteal pocket for transconjunctival fat transposition, using a single subdermal, non-removable, non-absorbable stitch. MATERIALS AND METHODS: Retrospective study of 19 patients with bilateral deep tear through treated by means of transconjunctival fat transposition. Charts and photographic records were reviewed. RESULTS: Photographical and clinical improvement of the deep tear through and fat prolapse was observed in all patients in variable degrees. There were no intraoperative complications. Significant periocular hematoma occurred in 1 patient and solved without complications. Two patients presented transitory fat pedicle hardening and one patient presented a conjunctival inferior fornix granuloma, surgically removed. All patients were satisfied. CONCLUSIONS: Transconjunctival subperiosteal fat transposition with single subdermal stitch to fix the medial and central fat pads, for the treatment of deep tear trough and fat prolapse demonstrated high patient satisfaction, good aesthetic results with no significant or permanent complications.

Periumbilical fat graft: a new resource to replace large volume in the orbit.

GOAL: To describe the technique we use to obtain a fat graft from the periumbilical area to replace volume in our patients requiring total or partial orbital volume restoration or replacement. MATERIALS AND METHODS: Under local anaesthesia a one-piece fat auto-graft is obtained from one of the quadrants of the periumbilical zone through a 10- to 15-mm incision at the umbilicus edge. RESULTS: Excised adipose tissue contains connective tracts, with medium and small vascular vessels with discrete thickened wall and preserved endothelium, with more blood cells, and less dead cells. CONCLUSIONS: Fat grafts are the ideal fillers for patients requiring orbital volume replacement. The periumbilical fat graft technique we describe is simple, safe and fast, the learning slope shallow and the results gratifying in both the replaced volume, and the donor area with an invisible scar. The amount of fat that can be obtained with this technique through a minimal incision can be large enough.

Early frontalis flap surgery as first option to correct congenital ptosis with poor levator function.

UNLABELLED: In congenital blepharoptosis the upper eyelid cannot be lifted normally because of congenital impairment in the levator function. The descended eyelid margin partially or completely obstructs of the visual axis with the consequent risk of amblyopia. Frontalis suspension is the surgery of choice for ptosis with poor levator function creating a linkage between the frontalis muscle and the tarsus; the frontalis muscle is used to elevate the eyelid. Direct transplantation of frontalis muscle to the upper eyelid has been widely described. We report our experience using frontalis flap in congenital ptosis with poor levator function in children. METHODS: Retrospective study of 30 eyes with severe congenital ptosis and poor levator function treated by means of direct frontalis flap. Mean age 2 years. Eyelid measurements were taken at baseline, 1, 3, 12 months postoperatively and last visit. Mean ptosis degree was 5 mm (3-8 mm) and levator function 2 mm (1-5 mm). The presence of complications, flap function and palpebral contour were evaluated. Mean follow up time was 27 months. At last visit, ptosis degree ranged from 0 to 3 mm. DISCUSSION: Direct advancement of the frontalis muscle to treat severe eyelid ptosis is effective and stable in the long term avoiding the use of a linking structure, therefore the risk of foreign-body reaction, absorption, granuloma and late exposure, as well as the need for a second visible incision in the forehead. Patients learn how to control the lid height by means of the frontalis muscle achieving more symmetry.

Thermal damage influences endonasal dacryocystorhinostomy success.

OBJECTIVE: To compare the success rates of two surgical methods of endonasal dacryocystorhinostomy (DCR) at the stage of ostium creation. In procedure 1, a Colorado needle is used to create the mucosectomy, while in procedure 2 no heated instruments are applied to the mucosa. METHODS: A total of 173 patients (218 eyes) underwent endonasal DCR between 2006 and 2009. Efficacy was assessed by a fluorescein endoscopic test at 6 months of follow-up. RESULTS: The success rate in group 2 was higher than in group 1 (91 vs. 81%, p < 0.05). CONCLUSIONS: We have found a significant difference, which supports that a 'cold' surgical technique may be better than the use of heated instruments.

Photodynamic therapy in the management of circumscribed choroidal hemangioma.

OBJECTIVE: To evaluate the efficacy of photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH). DESIGN: A retrospective case series analysis through chart review of patients with CCH treated by means of PDT. PARTICIPANTS: Thirteen patients with circumscribed choroidal hemangioma. METHODS: Through retrospective charts review, the patients' demographics, clinical features, management, and follow-up data were obtained and analyzed. Outcome measures were change in visual acuity, required sessions, and adjunctive treatments. RESULTS: Median follow-up was 26 months. Seven patients (54%) underwent only 1 session, 5 patients (38%) 2 sessions, and 1 received 5 sessions and was finally treated with external beam radiotherapy (EBRT). Visual acuity improved by at least 1 line (1-5) in 11 patients and remained stable in 2. Exudative subretinal fluid was completely resolved in 92% of the cases at the last visit. No major local side effects were found. CONCLUSIONS: PDT of CCH can effectively induce tumor regression and resolution of exudative subretinal fluid, improving, or stabilizing vision.

Spontaneous regression in a case of racemose haemangioma archer's type 2.

BACKGROUND: Racemose hemangioma of the retina is a benign arteriovenous communication that can occur as an isolated solitary lesion or as a component of the Wyburn-Mason syndrome. We report a case of a patient with an Archer's type 2 arteriovenous malformation that spontaneously regressed. METHODS: A retrospective clinical chart review. RESULTS: A 20-year-old woman was diagnosed with racemose hemangioma, Archer's type 2 on her right eye, after a retinal arteriovenous communication located at 6 o'clock was found. She was followed-up for more than 10 years in our service, always remaining asymptomatic. After this time, spontaneous vascular regression and fibrosis was noticed. CONCLUSION: Racemose hemangiomas are usually stationary lesions, but spontaneous asymptomatic regression can occur.