Complications of two scleral flaps evisceration technique: analysis of 201 procedures.

PURPOSE: To present data on complications after 2 scleral flaps evisceration technique carried out with placement of a spherical porous implant. MATERIALS AND METHODS: The medical records of all patients who underwent a 2 scleral flap evisceration procedure with placement of a spherical porous implant were retrospectively reviewed. RESULTS: Two hundred one patients were identified. One hundred eleven were men (55.22%) and 90 were women (44.72%). Ages ranged from 3 to 94 years (mean age, 52 years). Mean follow-up was 31.62 months (range, 3-98 months). All patients received a spherical porous implant. The average diameter of the implant was 20.38 mm (range, 18-22). Minor complication occurred in 16 patients, and major complications were observed in 3 patients. CONCLUSION: The 2 scleral flaps evisceration technique is a simple, safe, and useful procedure that enables filling the orbital socket with an adequate orbital implant size.

Botulinum toxin A in the treatment of glabellar lines: scheduling the next injection.

BACKGROUND: A single intramuscular treatment with botulinum toxin A (BoNT-A) into the facial muscles underlying glabellar rhytids has been shown to effectively attenuate or totally erase these lines for at least 3 months. OBJECTIVE: We sought to evaluate the optimal time for a second injection of BoNT-A (Dysport, Ipsen). METHODS: One hundred patients with moderate to severe glabellar rhytids at rest were randomized to a first, double-blind injection of 50 U of BoNT-A (n = 50) divided into 5 intramuscular sites, or placebo (n = 50). At monthly intervals between Month 3 and Month 6, the patient and the investigator consensually decided to repeat the injection with open-label BoNT-A in both groups. The main outcome was the time between the first and second injections. Responder ratings (mild or no glabellar lines) after the first and second injections, patient satisfaction, and safety were also assessed. RESULTS: At Months 3 and 4 after the first injection, the cumulative percentage of patients having a second injection was lower in the BoNT-A group compared to the placebo group, with a significant difference at Month 4. Following the first double-blind injection, responder rates were significantly higher in BoNT-A group (up to 75%) compared to placebo up to Month 4, and a large majority of patients were significantly satisfied with the BoNT-A treatment at Month 4 (75% satisfied and completely satisfied versus 9.1% with placebo) and Month 5 (86.7% versus 0%, respectively). Headache was the most frequent adverse event in the BoNT-A group (10% versus 6% in the placebo group). No blepharoptosis was reported. CONCLUSIONS: The effectiveness of 50 U of BoNT-A was confirmed for the treatment of glabellar lines. A second injection was sought within 3 to 4 months by most patients and investigators. Both injections were safe.

Reinjection of autologous fat in moderately deep upper lid sulci of anophthalmic sockets.

The purpose of this paper is to present the author 's experience with the transplantation of autologous adipose tissue into the moderately deep upper lid sulci of anophthalmic sockets. Coleman's lipostructuring technique may help oculoplastic surgeons with patients requiring cosmetic improvements; however, reinjection of autologous fat can be done only if it is known that the intra-orbital implant is of a suitable size and that there are no orbital volume deficits. In this study, the patient's own adipose tissue is harvested by the technique of liposuction by syringe, without trauma, and then refined and reinjected in an intricate layering of fat tissue via microcannulae. The author describes the technique and results after one year of follow-up.

Auricular cartilage grafting to correct lower conjunctival fornix retraction and eyelid malposition in anophthalmic patients.

PURPOSE: To evaluate the surgical outcomes of auricular cartilage grafts to correct inferior fornix retraction and eyelid malposition in anophthalmic patients. METHODS: We performed a retrospective review of consecutive anophthalmic patients whose posterior lamella was lengthened by an autogenous ear cartilage graft to correct inferior fornix retraction and eyelid malposition. Surgical and postoperative complications, additional procedures, recurrence of fornix retraction, eyelid malposition, and donor-site complications were documented. RESULTS: Fifty-four patients (21 men, 33 women) were included in the study. Ages ranged from 5 to 86 years. Thirty-nine patients had moderate fornix retraction and 15 had severe retraction. The mean length of postoperative follow-up was 19.7 months. Successful correction was achieved in 92.6% of cases in the follow-up period. Conjunctival fornix retraction recurred in 4 patients. Two patients developed mild inferior fornix retraction and were able to wear a cosmetic external prosthesis after surgery. The other 2 patients required additional surgeries and could not be fitted with an external prosthesis. Minor complications were observed in 13 patients and were easily managed without cartilage removal. There was no donor-site complication or cosmetic deformity of the ear in any of the patients. CONCLUSION: Inferior fornix retraction and eyelid malposition in anophthalmic patients can be successfully treated with posterior lamella lengthening using an auricular cartilage graft.

Avaliação de um novo implante intra-orbitário: resultados preliminares / Evaluation of a new intraorbital implant: preliminary results

Objetivo: Apresentar novo tipo de implante orbitário, com formato original, o modo de utilização e os resultados clínicos preliminares. Métodos: Os autores descrevem a técnica cirúrgica utilizada para a inserção do novo implante em 22 pacientes, como implante primário ou secundário. Os pacientes foram avaliados de forma prospectiva quanto aos seguintes aspectos: cosmético (grau de sulco suprapalpebral e enoftalmia), mobilidade, centragem e volume do implante. O tempo de seguimento variou de 3 a 15 meses (média 1 ano). resultados: observou-se resultado cosmético satisfatório, sem caso de enoftalmia ou de sulco suprapalpebral importante, bem como boa mobilidade das próteses adaptadas sobre o novo implante. Não houve casos de infecção, migração ou extrusão do implante. Conclusão: Os resultados pós-operatórios com o novo implante são comparáveis aos implantes com pinos externos. Contudo um estudo multicêntrico, com maior tempo de controle pós-operatório é necessário, para avaliação mais acurada das complicações potenciais.