[Fatty degeneration of upper tarsal muscle as etiological factor of acquired upper eyelid ptosis]. / Zhirovaia distrofiia verkhnei tarzal'noi myshtsy kak étiologicheskii faktor priobretennogo ptoza verkhnego veka.

PURPOSE: To study the histological structure of the upper tarsal muscle (Müller's muscle of the upper eyelid) in patients with acquired ptosis and to confirm the presence of its fatty degeneration as an understudied etiological factor of upper eyelid ptosis. MATERIAL AND METHODS: A retrospective analysis was performed covering 79 biopsy samples of Müller's muscle of the upper eyelid obtained intraoperatively. Histological examination was performed with samples prepared by waxing. Planning the surgery included determination of basic parameters and the 'transparency' symptom; the Müller's muscle projection area was examined in the inverted upper eyelid, and ultrasound biomicroscopy (UBM) of the upper eyelid structures was performed. RESULTS: Among the study subjects, a group of 11 patients with isolated fatty infiltration of the upper tarsal muscle was identified. At the preoperative stage, in the group of patients with upper eyelid eversion, visibly thickened Müller's muscle advancing on the tarsus could be observed, as well as negative 'transparency' symptom; UBM showed thickened 'conjunctiva - Müller's muscle' complex, and a large number of hypoechogenic inclusions in the muscle in comparison with the intact eye. The removed muscle was thickened, yellow, with increased density and rigidity. Microsection of the histological preparations revealed fat cells located among bundles of smooth muscle fibers of the upper tarsal muscle and dispersion of smooth myocytes on the background of fat infiltration. CONCLUSION: The presence of dystrophic changes in the upper tarsal muscle is proved with clinical, macromorphological and pathohistological methods; they can be one of the independent causes of acquired upper eyelid ptosis.

[Ultrasonography in normal eyelids assessment].

The article presents the results of a complex study on ultrasonography which included high-resolution grey scale B-scan, color Doppler imaging, and ultrasonic density measurement of eyelids and periorbital tissues. A total of 48 patients were enrolled. Echographic anatomy of eyelid layers, i.e. skin, orbicularis oculi muscle, tarsus, and orbital fat, is described in detail. Depth and ultrasonic density values for all layers are provided. The authors suggest performing an ultrasound examination of eyelids prior to reconstructive and plastic surgery in order to facilitate the choice of surgical tactics.

[Posterior approach for foreign body removal from optic nerve head. Case report].

A technique of foreign body removal from optic nerve head performing an external approach and optic nerve transection is described. After 3 months of follow-up cosmetic result is satisfactory and there are no surgery related complications.

[Reconstructive surgery of cranio-orbital injuries].

The aim of study was to optimize evaluation and surgery of cranioorbital injuries in different periods after trauma. Material and methods. We analyzed 374 patients with cranioorbital injuries treated in Burdenko Neurosurgery Institute in different periods after trauma from January 1998 till April 2010. 288 (77%) underwent skull and facial skeleton reconstructive surgery within 24 hours - 7 years after trauma. Clinical and CT examination data were used for preoperative planning and assessment of surgery results. Stereolithographic models (STLM) were applied for preoperative planning in 89 cases. The follow-up period ranged from 4 months up to 10 years. Results. In 254 (88%) of 288 patients reconstruction of anterior skull base, upper and/or midface with restoration of different parts of orbit was performed. Anterior skull base CSF leaks repair, calvarial vault reconstruction, maxillar and mandibular osteosynthesis were done in 34 (12%) cases. 242 (84%) of 288 patients underwent one reconstructive operation, while 46 (16%)--two and more (totally 105 operations). The patients with extended frontoorbital and midface fractures commonly needed more than one operation--in 27 (62.8%) cases. Different plastic materials were used for reconstruction in 233 (80.9%) patients, of those in 147 (51%) cases split calvarial bone grafts were preferred. Good functional and cosmetic results were achieved in 261 (90.6%) of 288 patients while acceptable were observed in 27 (9.4%). Conclusion. Active single-stage surgical management for repair of combined cranioorbital injury in acute period with primary reconstruction optimizes functional and cosmetic outcomes and prevents the problems of delayed or secondary reconstruction. Severe extended anterior skull base, upper and midface injuries when intracranial surgery is needed produced the most challenging difficulties for adequate reconstruction. Randomized trial is required to define the extent and optimal timing of reconstructive surgery in patients with severe traumatic brain injury and craniofacial injury in acute period of trauma.

[Role of primary and stepwise prosthetic replacement in the rehabilitation of subjects with anophthalmos].

The study covered 1980 patients with anophthalmos and a cosmetically poor blind eye, who were followed up in the ocular prosthesis room, Helmgoltz Institute of Eye Diseases. The optimal periods of primary and stepwise prosthetic replacement are defined and standard ocular prostheses of the most appropriate shape and size are recommended depending on the specific features of the conjunctival cavity and stump in this period. Recommendations are given on the application of ocular prostheses in congenital pathology and subatrophy.

[Rehabilitation of patients with burn injury to the eye].

Based on the analysis of the results of treatment in patients with severe and particularly severe burn injuries to the eye, the authors developed principles in the rehabilitation of such patients. The rehabilitation period was divided into 4 stages: 1) treatment of burn injury (removal of necrotic tissues; revascularization of the outer membrane of the eyeball; prevention of cicatricial deformity of the eyelids); 2) treatment of burn disease complications (blood blepharorrhaphy, soft contact lenses, maximum antihypertensive therapy, treatment of cataract and glaucoma); 3) reconstruction of the eyelids, conjunctival vaults, eyeball surface (transplantation of autologous skin flaps, oral mucosa, fixation of leukoma with the automucosa, autocartilage); 4) functional rehabilitation (limbic transplantation, keratoplasty, keratic replacement with a Fedorov-Zuyev prosthesis). The use of the scheme in clinical practice can achieve a considerable reduction in the time of rehabilitation and the rate of functional and anatomic death of the injured eye and improve the functional outcomes of treatment in patients with severe and especially severe burn injury to the eye.

[Surgical treatment policy for concomitant burn injury to the eye in patients admitted to burn units].

The investigation was undertaken to study the causes of ocular complications in patients with extensive body surface burns. Ninety-five patients with concomitant eye burn injury and its consequences, of them 50 victims who had been first admitted to the unit after long-term treatment in burn centers and 45 patients observed jointly with the combustiologists of the Moscow City Burn Center were followed up. The frequency and pattern of destructive complications and, a result, eye burns were ascertained to be associated with the possibility of delivering a specialized ophthalmic care, its period, and nature.

[Exposure of orbital implants: causes and treatment].

The paper provides the results of a 15-year following-up of 91 patients with exposed orbital implants made from synthetic and biological materials. Surgery was made in the patients treated at different health care facilities. The authors analyze the causes of implant exposure in different periods. Early after surgery the most common causes of implant exposure are surgical equipment failure (inadequate implant coating with adjacent tissues), a too large implant arching the tissues, and mismatch of an artificial eye. In the late period, the more common cause is secondary infection or the toxic properties ofa material itself, which cause a persistent chronic inflammatory reaction. Moreover, the authors consider the mechanism of implant exposure and rejection depending on the material of an implant. The paper describes medical and surgical treatments in patients of this group.

[Childhood ophthalmoplasty].

The paper lays down the basic principles of ophthalmoplastic treatment on the basis of an analysis of the results of treatment and follow-ups of 2300 patients aged 6 months to 18 years who have abnormalities of the orbit and appendages of the eye. Emphasis is laid on the preference of methods for plastic repair, using local tissues, and free autologous grafting of the skin and mucosa. A soft material that is to be easy grown through, such as Carbotextim-carbonic felt, is recommended when contour plastic repair of the orbit is required. For hanging, a mersilene mesh should be employed in case of blepharoptosis. To achieve the better cosmetic results, it is better to operate at the age of more than 4 years; however, treatment should be initiated at the age of 1 year when there are available functional indications (symblepharon, ablepharia, or cryptophthalmus).

[Histological studies of carbon felt (carbotextim M) in late periods after its orbital implantation].

The authors performed histological studies of a grown carbon felt implant and its adjacent tissues in late postoperative studies. During planned operations (cavity or stump correction), pieces of a grown implant with its adjacent tissues were taken for examination from 25 patients in whom carbon had been earlier implanted during enucleation and delayed stump plastic repair. Morphological studies indicated that mature connective tissue had grown between the fibers of the implant, that a connective tissue capsule had formed around the whole implant, and that there was no inflammatory reaction in both the implant itself and its adjacent tissues. By taking into account the fact that there is a good tissue basis and vascularity, the authors present the results of additional simulation of an implant in late postoperative periods and those of additional correction of the implant's volume.

[Orbital fractures: diagnosis and treatment policy].

The present paper generalizes the tactical principles of the examination and treatment of patients with orbital fractures. The clinical signs of a fracture are evaluated, with emphasis laid on the significant and insignificant symptoms. Routine X-ray study is regarded as an inadequate diagnostic technique, computed tomography is presented as a basic procedure for detecting and detailing the specific features of the fracture. The cases (n = 161) are divided into 5 groups according to the types of fracture. The treatment sequence is defined, by taking into account the severity of injury. The time of reparative operations (early or late) is recommended in terms of the risk for ocular dysfunction. The principles of reparative and compensatory surgical techniques for different types of injuries, mainly by applying bony autografts and Carbotextim, are given.

[Current approaches to surgical treatment for cranioorbital injuries].

A hundred and two victims (120 reconstructive operations) with cranioorbital injuries were operated on at the N. N. Burdenko Institute of Neurosurgery in different periods after injury in 2000 to 2005. In 69 (67.6%) of the 102 patients (82 operations) bone autografts, mainly calvarial ones (61 operations in 55 victims), were used. The operations were performed, by utilizing both neurosurgical and ophthalmoplastic techniques and up-to-date craniofacial surgical procedures. The basic principle of surgical treatment for cranioorbital injuries was three-dimensional orbital anatomy restoration, such as the stabilization and repair of the orbital rim and one-stage reconstruction of the afflicted walls. Computed tomography provides main information for the efficient planning of a surgical intervention. Optimal cosmetic and functional results are attained when primary reconstructive surgery is made in the acute or early (10-14 days) periods after injury. Secondary cranioorbital reconstructive surgery may be performed in one or several steps in relation to the severity and signs of bone structural injuries and to the state of soft tissues. A bone autograft is the material of choice for repair of all portions of the cranioorbital region.

[Clinical presentation, diagnosis and treatment of strabismus combined with ptosis].

On the basis of examination of 172 patients with strabismus concomitant with ptosis, different clinical forms of the former were defined and their clinical variations were classified. Symptomatology was described for each form. An independent type of false positive ptosis was pointed out. The notion of "positive and negative fixation tests" was introduced. A proper interpretation of the origin of true and false ptosis was presented. Finally, a sequence and tactics of surgical and functional treatment of different clinical presentations of squint concomitant with ptosis are lain down.

[Dependence of mobility of an eye prosthesis on the method of rectus muscle fixation]. / Zavisimost' podvizhnosti glaznogo proteza ot sposoba fiksatsii priamykh myshts.

The relationship between the mobility of eye prosthesis and method of musculus rectus fixation was investigated. The results indicate that fixation of the muscles to subconjunctival tissues allows the best mobility of the eye prosthesis. This method of musculus rectus fixation is most similar to anatomical fixation. In addition, fixation of musculus rectus is essential for configuration and mobility of the conjunctival cavity. Hence, the optimal method for fixation of musculus rectus in order to attain the best mobility of the eye prosthesis and therefore the best cosmetic result can be chosen during enucleation.

[New methods of measuring the mobility of ocular prosthesis in anophthalmia and their comparative study]. / Novye sposoby izmereniia podvizhnosti glaznogo proteza pri anoftal'me i ikh sravnitel'naia otsenka.

Methods for measuring the mobility of ocular prostheses in patients with anophthalmia were developed and compared between each other and with the traditional Forster method for measuring the prosthesis mobility along perimeter. The most accurate method is measurement of the angle tangent (method No. 3), while Forster measurement is the least accurate and most subjective. The most rapid method is making use of millimeter pattern, which can be used in early terms after surgery in adults and children. All methods are convenient, simple, and require no special training.

[Potentialities of conservative and surgical treatment of patients with congenital microphthalmia and anophthalmia]. / Vozmozhnosti konservativnogo i khirurgicheskogo lecheniia patsientov s vrozhdennym mikroftal'mom i anoftal'mom.

Congenital anophthalmia and microphthalmia were responsible for 1.7-1.8% cases of all cases treated at laboratory of plastic surgery and ocular prostheses. Clinical picture of the condition is described. The philosophy of rehabilitation of patients with congenital anophthalmia and microphthalmia is as follows: 1) no operations during the first years of life; 2) early staged fitting with prostheses; 3) surgical treatment in older age, when the resources of conservative extension of the cavity are exhausted. The authors emphasize that active conservative treatment should be preferred. Method for nonsurgical extension of the conjunctival cavity by staged insertion of prostheses is described. Positive and negative aspects of surgical treatments are discussed. The authors emphasize that surgical activity in early age is extremely harmful. Results of surgical treatment of 27 patients are presented. The patients were divided into 2 groups differing by the tasks of surgery: repair of consequences of previous operations (59.2% cases) and typical correction of the eye lids (40.8%). Clinical examples are offered.

[Postradiation atrophy of anophthalmic orbit after treatment of retinoblastoma. System of surgical rehabilitation]. / Postluchevaia atrofiia anoftal'micheskoi orbity posle lecheniia reinoblastomy. Sistema khirurgicheskoi reabilitatsii.

A system of surgical treatment of patients with radiation atrophy of orbital tissues has been developed in order to attain a stable position of the prosthesis in the cavity and improve the patients' appearances. A total of 366 interventions were performed in 242 patients. The operations were as follows: formation of conjunctival cavity by autotransplants of the mucosa from the lips (242), delayed plasty of the stump (81), contour plasty of the temple and external edge of the orbit (32), correction of eyelids (11). Single-stage treatment was carried out in 156 patients and 2-7 stages in 86 patients. Positive results were attained in all cases: the depth of the vault increased, lagophthalmos decreased, falling-in defect of prosthesis, eyelids, and temple were reduced, and stable position of the prosthesis in the cavity was attained. Surgical treatment of this condition differs greatly from plastic repair for other diseases because of changes in tissues after radiotherapy. Functional and cosmetic rehabilitation of patients with postradiation atrophy of orbital tissues after treatment of retinoblastoma with good effect can be attained only by staged surgical treatment.