Objective To evaluate the clinical effect of the eyelid reconstruction using hard palate mucosa graft after resection of malignant tumor of eyelid. Methods From January 1998 to October2003, 18 cases of malignant tumor of eyelid underwent the eyelid reconstruction with local flap grafting and hard palate mucosa autotransplantation. Of 18 cases, there were 10 males and 8 females, aging from 35 to 67 years. The defect was caused by basal cell carcinoma of eyelid in 10 cases, by carcinoma of meibomian glands in 6 cases and by squamous cell carcinoma of eyelid in 2 cases, including 12 cases of complete eyelid defect and 6 cases of 2/3 eyelid defect. Results The appearance and function of the eyelid in all cases were almost normal after the eyelid reconstruction with hard palate mucosa autotransplantation in replacing posterior layer of eyelid. The complete eyelid closure and no entropion were observed in all cases. The infection and contracture of the graft, immunologic rejection were not observed in allcases during the followup period of 6 to 48 months. Conclusion The eyelid reconstruction using autotransplantation with hard palate mucosa in replacing posterior layer of eyelid was easy-to-operate and has satisfactory clinical effect. The hard palate mucosa as substitute of tarsus is superior to the traditional substitute.
OBJECTIVE: To study the clinical effects of allosclera transplant for eyelid reconstruction. METHODS: From May 1986 to January 2001, 45 patients who suffered from partial eyelid defect underwent the allosclera transplant for eyelid reconstruction, There were 31 cases of male and 14 cases of female, 18 cases of the upper eyelid and 27 cases of the lower eyelid, among them, 22 cases were caused by eyelid trauma and 23 cases by eyelid tumor. The length of eyelid defect were less than 1/2 of the whole eyelid. The morphology and function of the eyelid and complications were observed after operation. RESULTS: All 45 cases were followed up for 11 to 38 months, 19.7 months on average. The eyelid morphology and mobility restored well and there was no influence on visual function. CONCLUSION: The xenosclera is an ideal material for eyelid reconstruction.
Eighteen cases of loss or obliteration of eye sockets from trauma or tumour were repaired with various methods: skin graft, postauricle flap with tempopostauricular blood vessel, forehead flap with temporal blood vessel and temporal flap with subcutaneous pedicle. Following 1 to 5 years follwup, the results were good and the improvement on outlooking was remarkable. The skin grafting was a simple and applicable method but it needed a longer time of blepharorrhaphy. The flap transfer was more complicated but suitable for the obliteration of the eye socket accompanied with depression deformity, but it usually would result in a secondary cicatricical malformation at the region around the eye. Thus, it was important to select a best operative method according to the specific condition.
efect of the eyebrow is a common facialdefect. It was resulted from a variety of causes,but the most common was burn. The operationby using free postauricular scalp graft to repairthe defect of eyebrow was intreduced. The var-ious metheds of eyebrow reconstruction werecompared. The treatment of 79 patients with thedefect of eyebrow was summarized. It was notedthat it had the following advantages , such as theoperation being simple and easy, a naturallooking, appropriate density and r...
This paper reported the use of superficial temporal vessels pedicled postauricular island flap for the reconstruction of eye socket. Six cases were treated by this method since 1988 with universal satisfactory results. The disign of the flap was diseribed. The operative procedure was detailed, and the advantages of the flap were evaluated: 1. The donor defect was hidden behind the ear; 2. The flap has a relatively long pedicle, hence easy for distant transfer, and 3. the blood supply was highly reliable.
Ocular ischemic syndrome (OIS) is a disease seen in cardiology, ophthalmology, neurology, and neurosurgery, which can lead to brain and ocular symptoms induced by carotid artery obstruction or stenosis. In local and general manifestation, ocular symptoms usually appear first. Ocular symptoms show the prewarning effect of other ischemic damage. Ophthalmologists should pay attention to the clinical manifestation and damages of OIS. The establishment of multidisciplinary diagnosis and treatment patterns for OIS is a pivotal issue for several disciplines.
Objective To observe the clinical manifestations, therapeutic efficacy and results of bacterial culture of seven patients of scleral buckle (SB) infection after scleral bulking surgery. Methods Seven patients (seven eyes) underwent SB removal for SB infections were enrolled in this study. The patients included four males (four eyes) and three females (three eyes). The patients aged from 12 to 69 years, with a mean age of 42.7 years. There were four right eyes and three left eyes. The duration (interval between primary surgery and SB removal) ranged from two weeks to ten years, with a mean of 47.5 months. Six patients were concurrent with systemic disease. All the patients were examined for visual acuity, slit lamp microscope and indirect ophthalmoscope examination. Some patients also received external eye examination and fundus photography. Whether SB exposure or not and the clinical manifestations were observed. SB removal was performed in all the patients and the SB were sent to the laboratory for bacterial culture. The follow-up time ranged from two weeks to eight months, with a mean of 3.2 months. Whether infections recurrence and retinal detachment or not were observed. Results SB exposure was in three eyes. Obvious ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes; irritation and discharge were in one eye. No SB exposure was in four eyes. Ocular pain and swelling, conjunctival hyperemia and visible yellow-white discharge in the conjunctival sac were presented in two eyes. Repeated subconjunctival hemorrhage and diplopia were presented in one eye. Visual acuity decline, conjunctival sac discharge and total retinal detachment were in one eye. All patients had no intraocular inflammation. The infection was controlled after SB removal and the retina was attached during the follow-up. The bacterial culture were all positive, which included Staphylococcus aureus, Staphylcoccus epidermidis and Erysipelothrix rhusiopathiae, Gram positive corynebacterium, Aspergillus flavus, Kocuria roseus, Streptococcus oralis, Maxwell Corynebacterium. Conclusions The clinical manifestations of SB infection and the pathogenic microorganisms are variable. SB removal can control the infection.
Objective To observe the effect of ophthalmotonus intervention on ocular hemodynamics in patients with ischemic ophthalmopathy (IOP). Methods 106 IOP patients (106 eyes) were enrolled in this study, including 74 eyes with nonarteritic anterior ischemic optic neuropathy (NAION), 20 eyes with retinal artery occlusion (RAO) and 12 eyes with ocular ischemia syndrome (IOS). The patients were randomly divided into ophthalmotonus intervention group and control group. There were 37 NAION eyes, 10 RAO eyes and six IOS eyes in each group. The patients of ophthalmotonus intervention group received lowering intraocular pressure treatment in addition to the basic therapy to reduce the intraocular pressure to le;12 mm Hg (1 mm Hg=0.133 kPa) or decreased by 7-8 mm Hg, or in a 20%-30% reduction. The patients of control group avoided lowering intraocular pressure treatment. The arm-retinal circulation time (A-RCT) and the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) of ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (PCA) before and one week after treatment were comparatively analyzed by fluorescence fundus angiography (FFA) and color Doppler flow imaging. Results The differences of A-RCT before treatment in ophthalmotonus intervention group and control group in NAION, RAO and IOS patients were not statistically significant (t=0.869, 0.119, 0.000; P＞0.05). The differences of PSV (OA:t=0.586, 0.040, 0.067; CRA:t=0.285, 0.057, 0.775; PCA:t=0.658, 0.653, 1.253), EDV (OA:t=0.274, 0.080, 0.093; CRA:t=0.781, 0.077, 0.277; PCA:t=0.200, 0.209, 0.299) and RI (OA:t=0.121, 0.153, 0.138; CRA:t=0.172, 0.242, 0.642; PCA:t=1.053, 1.066, 0.266) of OA, CRA and PCA before treatment in ophthalmotonus intervention group and control group were not statistically significant (P＞0.05). Compared with control group, A-RCT shortened obviously (t=2.573, 2.236, 2.607; P＜0.05) in ophthalmotonus intervention group one week after treatment. Compared with control group, PSV (OA:t=2.367, 2.368, 2.267; CRA:t=0.775, 1.927, 2.775; PCA:t=2.253, 2.353, 2.353) and EDV (OA:t=2.303, 2.236, 2.503; CRA: t=2.277, 2.377, 2.577; PCA:t=2.299, 2.399, 2.299) of OA, CRA and PCA increased obviously (P＜0.05), RI of OA, CRA and PCA decreased obviously (OA:t=2.238, 2.387, 2.228; CRA:t=2.342, 2.442, 2.542; PCA:t=2.266, 2.366, 2.266; P＜0.05) one week after treatment in treatment group. Conclusion Ophthalmotonus intervention can improve the ocular hemodynamics in IOP patients.
Objective To observe the clinical features of primary intraocular lymphoma (PIOL). Methods The clinical data of 13 patients (24 eyes) of PIOL were retrospectively analyzed. In addition to routine ophthalmic examination, auxiliary examination including fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were carried out in patients without opacity of refractive media. All the patients were underwent diagnostic vitreous surgery. Eleven patients were confirmed by cellular pathology analysis, one patient was confirmed by retinal biopsy, and one patient was confirmed by neurology biopsy. The clinical features of these patients were observed. Results There were 16 eyes of nine patients (66.7%) with primary central nervous system lymphoma and PIOL, and eight eyes of four patients (33.3%) with PIOL only. The patients included five males and eight females, with a mean age of (55.7plusmn;12.6) years. Two patients were affected unilaterally and 11 patients affected bilaterally. Their visual acuity ranged from light perception to 1.0. Fourteen eyes (58.3%) were classified as isolated vitreous inflammation type and 10 eyes (41.7%) were classified as vitreous retinal type. FFA results showed that there was no abnormalities in PIOL patients of isolated vitreous inflammation type, but there were extensive lesions of retinal pigment epithelium (RPE) observed in PIOL patients of the vitreous retinal type. OCT results showed that there were no abnormalities in PIOL of patients of isolated vitreous inflammation type, but hyperreflexia between RPE and Bruchprime;s membrane was observed in PIOL patients of vitreous retinal type. Conclusion The clinical manifestation of PIOL are diversified, mostly in bilaterally affected cases. There are extensive lesions of RPE in patients of vitreous retinal type.
The clinical manifestations of infectious retinal diseases are complicated, especially these result from serious infectious diseases such as acquired immune deficiency syndrome (AIDS), tuberculosis and syphilis infections. It is an important issue to differentiate infectious retinal disease from noninfectious intraocular inflammation in the clinic. It is, therefore, highly desirable to follow a proper steps to reach the correct diagnosis. Complete history review and comprehensive ocular examination remains the first step in diagnosing infectious retinal diseases. Although an array of laboratory and serological tests are available to assist in the diagnosis, some situations may require a diagnostic therapy or a tissue biopsy. Identification of the pathogen and histopathologic examination of the ocular specimen remain to be the gold standard of diagnosis. Initiation a specific and appropriate antimicrobial therapy needs multidisciplinary collaborations including ophthalmologists and infectious specialists. Updated knowledge of general medicine and management of infectious diseases, interdisciplinary collaborations and optimization of treatment processes will improve the diagnosis and treatment of retinal infectious diseases in the future.