A quality of life survey in patients with long-term silicone oil or phthisis bulbi.

AIM: The aim of this study is to determine whether there is any difference in the quality of life of patients with a blind eye with long-term silicone oil compared to without. METHOD: Patients with either long-term silicone oil in situ (N = 17), defined as a period greater than 6 months duration with no plan for future removal, or those with a phthisical, non oil-filled eye were identified (N = 13). Two validated questionnaires (NEI VFQ-25 and the FACE-Q) that cover indicators for visual function, pain and cosmesis were sent to all patients in the two cohorts. RESULTS: There was no significant difference found in quality of life outcomes between the two groups in terms of visual function, pain or cosmesis. CONCLUSION: The results of this study support a holistic approach to the consent process before vitreoretinal surgery. Patients that may need to undergo multiple vitreoretinal procedures, where the endstage result is a long-term silicone oil fill, should be informed that their functional outcome may be similar to having no surgical intervention.

The Learning Curve in Endoscopic Dacryocystorhinostomy: Outcomes in Surgery Performed by Trainee Oculoplastic Surgeons.

PURPOSE: To report outcomes of endoscopic DCR (En-DCR) performed by oculoplastic trainees and describe factors to improve success rates for trainees. METHODS: Retrospective, single-centre audit of En-DCR procedures performed by three consecutive trainee oculoplastic surgeons, over a 3-year period. Trainees also completed a reflective-learning questionnaire highlighting challenging and technically difficult aspects of En-DCR surgery, with relevant tips. RESULTS: Thirty-eight consecutive independently-performed en-DCR procedures on 38 patients (mean age 58.6 ± 21.4 years) were studied. Mean time spent in the operating-theatre was 95.7 ± 27.3 minutes. Success rate for each year was 15/17(88%), 8/8(100%) and 7/13(54%), respectively, at mean follow-up 12.5 ± 12 months. The lowest success rate year coincided with use of silicone stents in 31% cases compared to 94% and 100% in the previous 2 years. In cases that failed, video-analysis highlighted inadequate superior bony rhinostomy (2 cases), incomplete retroplacement of posterior-nasal mucosal-flaps (3 cases), significant bleeding (1 case). Those who underwent revision surgery (n = 6), were found to have soft-tissue ostium and sac closure requiring flap revision. Two-cases required further bone removal supero-posterior to the lacrimal sac. Trainees-tips that helped improve their surgery related to patient positioning, instrument handling, bone removal and posture. CONCLUSION: Good surgical outcomes are achievable training in en-DCR surgery. Adequate operating time needs to be planned. Failure was primarily due to closure of the soft-tissue ostium, either secondary to inadequate osteotomy and sac-marsupialisation or postoperative scarring. Intra-operative mucosal trauma is higher amongst trainees and adjuvant silicone stenting during the training period may be of value where mucosal adhesions are anticipated.

Orbital compressed air and petroleum injury mimicking necrotizing fasciitis.

BACKGROUND: Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. CASE REPORT: A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management.

Hyaluronidase toxicity: a possible cause of postoperative periorbital inflammation.

BACKGROUND: Periorbital inflammation following regional anaesthesia is commonly attributed to hyaluronidase allergy. This case series suggests an alternative explanation in some patients. DESIGN: Retrospective case series. PARTICIPANTS: Seven patients presenting with postoperative non-infectious periorbital inflammation following peribulbar or sub-tenons anaesthesia, presenting at four different institutions, are described. METHODS: Data on patient demographics, operative data, clinical presentation, treatment and allergy testing were collected among the four institutions. MAIN OUTCOME MEASURES: Response to treatment and allergy testing were noted among the patients included in this study. RESULTS: Seven patients (five female) underwent uneventful phacoemulsification under a peribulbar or sub-tenon's block, all including hyaluronidase with concentrations ranging 50-250 IU/mL. The onset of inflammatory symptoms and signs varied from 12 h to 3 days after the surgery. The most common form of presentation was lid swelling and chemosis. Patients were treated with oral corticosteroids, with good clinical response. Four patients underwent skin prick and intradermal testing to the local anaesthetic used, and to the suspect and a control hyaluronidase batch. The results were all negative, excluding allergy as the aetiology of this toxic periorbital syndrome, in at least these four patients. CONCLUSION: Hyaluronidase toxicity, potentially related to concentration of hyaluronidase, may be a cause of postoperative periorbital inflammation after cataract surgery, rather than hypersensitivity.

Composite septo-retractor recession; a surgical technique for lower-eyelid retraction and review of the literature.

PURPOSE: To report the outcomes of a technique for correcting lower-eyelid retraction with composite recession of the inferior retractor and orbital septum complex, release of the lateral horn of the lower-eyelid retractors, and the orbito-malar ligament (OML) followed by skin, orbicularis, and conjunctival advancement. METHODS: We performed a retrospective, noncomparative review of consecutive procedures performed on patients with lower-eyelid retraction undergoing composite septo-retractor recession for lower-eyelid retraction over a 4-year period, performed or supervised by a single surgeon (RM). Outcomes are based on postoperative standard photographs, including central pupil to lower-eyelid distance, inferior scleral show, and subjective improvement in lower-eyelid lateral flare. RESULTS: We reviewed 26 eyes of 16 patients (12 men, 4 women; mean age, 61.0 ± 14.3 years). Causes of lower-eyelid retraction included involutional (n = 6), thyroid orbitopathy (n = 4), previous lower-eyelid surgery (n = 3), mechanical secondary to proptosis (n = 1), Crouzon syndrome (n = 1), and longstanding facial nerve palsy (n = 1). Mean lower-eyelid elevation achieved was 1.4 mm ± 1.3 mm (range, 0.2 to 6.6 mm; p = 0.001). Scleral show improved by 1.0 ± 0.7 mm (range, 0.0 to 2.9; p = <0.001). Preoperatively, all patients had an altered lower-eyelid contour with lateral flare, 89% cases being graded "significant." Lower-eyelid contour improved postoperatively, with only 19% graded "significant" lateral flare (p = <0.0001). No significant complications occurred, although one patient required excision of a secondary lateral canthal cyst. CONCLUSION: Composite recession of the inferior retractor and orbital septum complex combined with release of the inferior retractor lateral horn and the OML significantly improves lower-eyelid height and contour in cases of lower-eyelid retraction and should be considered a useful option for this condition.

Modified draping technique for topical anaesthesia ophthalmic surgery.

We describe a simple modified technique for draping the eye in cataract surgery under topical anaesthesia. This method minimizes prolapse of the eyelashes into the surgical field without compromising patient comfort and confers several advantages over previously used techniques.