Evaluation of patient comfort with outpatient orbital surgery.

PURPOSE: To evaluate patient comfort with outpatient orbital surgery. DESIGN: Prospective, non-randomized study. METHODS: The experience of 34 consecutive outpatient orbital procedures in 30 patients was evaluated. The data obtained included subjective postoperative pain and discomfort at 3 time intervals (immediate, postoperative day 1 and 1 week) using a 100 mm visual analogue scale (VAS). Patients were also asked to rate the overall experience after one week of follow-up. RESULTS: The average pain and discomfort scores in the immediate postoperative period measured 13.95 and 12.61, respectively. Overnight scores of 5.91 and 7.25 were determined for pain and discomfort, and at the one-week follow-up these were 0.91 and 3.42, respectively. All 30 patients reported that they were "satisfied with their overall experience." The highest VAS score for pain at any time was 50. The highest VAS score for discomfort at any time was also 50. All 30 patients had recovered or improved their visual acuity at week one. There was no incidence of retrobulbar hemorrhage, significant loss of vision (greater than two lines), increased intraocular pressure or pupillary defects in any of the patients. None of the study patients required re-hospitalization. CONCLUSIONS: This study suggests that outpatient orbital surgery, in the hands of an experienced orbital surgeon, is safe and well tolerated by the patients regardless of the type of anesthesia or type of procedure.

Treatment of trichiasis and distichiasis by eyelash trephination.

PURPOSE: To describe the methods and results of a new technique of eyelash trephination for treatment of trichiasis and distichiasis. METHODS: The medical records of all patients who underwent eyelash trephination by the authors to treat trichiasis or distichiasis were reviewed. Gender, diagnosis, number of eyelids treated, follow-up time, and surgical outcome were recorded. The technique involves boring of the affected lash follicle with a microtrephine, followed by removal of the follicle. RESULTS: The procedure was performed on 41 eyelids of 26 patients (15 females and 11 males). Patients were followed for 6 to 51 months after surgery. No recurrence was observed in 16 patients (62%) during this period. There were no adverse effects of the therapy. CONCLUSIONS: Eyelash trephination is a safe, quick, and effective method of treatment for trichiasis and distichiasis.

Autologous allogeneic amniotic membrane grafting in Stevens-Johnson syndrome.

We describe the use of autologous allogeneic amniotic membrane in ocular surface reconstruction. A 28-year-old woman with cicatricial entropion from Stevens-Johnson syndrome had recurrent keratinization of the tarsal conjunctiva. Amniotic membrane from the patient's own conceptus was stored and successfully used in ocular surface reconstruction with improvement of ocular symptoms. Disease transmission is an important risk inherent in all human tissue transplantation. Use of carefully prepared autologous allogeneic amniotic membrane grafts should be considered in pregnant patients in need of ocular surface reconstruction.

Prosthetic motility in pegged versus unpegged integrated porous orbital implants.

PURPOSE: To objectively measure and compare prosthetic motility in pegged versus unpegged orbital implants and to determine subjective patient assessment of motility after the pegging procedure. METHODS: A prospective case series of 10 patients with integrated porous orbital implants, who had secondary motility peg placement procedure, were studied. Infrared oculography was used to quantitatively assess pegged and unpegged prosthetic eye motility in horizontal and vertical excursions. RESULTS: For horizontal excursions, prosthetic motility in unpegged implants retained an average of 49.6% of measured motility of the contralateral normal eye, which increased to 86.5% with peg placement (P<0.05). For vertical excursions, prosthetic motility in unpegged implants retained an average of 51.3% of measured motility of the contralateral normal eye, which increased to 54.3% with peg placement (P>0.3). Nine of 10 patients judged their motility as "significantly improved," and 1 patient gave a rating of "some improvement" after peg placement. Four of 10 patients had granulomas around the peg sites. CONCLUSIONS: Objective assessment of prosthetic motility shows a significant increase in horizontal gaze after motility peg placement.