Filler-induced blindness "seen" by ophthalmologists: Case presentation and treatment algorithm.

PURPOSE: Filler-induced blindness (FIB) is the most threatening complication following periocular injection. To date, no standard of care has been established. The goal of this study is to report a new case of FIB with partial visual recovery and present our personalized algorithm for treatment based on fluorescein angiography findings. MATERIALS AND METHODS: Case report with 24 months follow-up and treatment algorithm. RESULTS: Our patient experienced complete vision loss to no light perception following forehead lipofilling. Retinal angiography identified a posterior ciliary artery occlusion. Antiplatelet medication, steroids and intraocular pressure lowering medications were administrated, followed by hyperbaric oxygen treatment (HBOT). Visual acuity improved to +0.8 logMar. The HBOT treatment was monitored by fluorescein angiogram. Based on this case and on the ophthalmic literature on retinal and ciliary artery occlusion, we established a personalized FIB protocol guided by fluorescein angiography. CONCLUSION: Although prevention remains the best treatment, all physicians should be prepared to manage FIB. Prompt management at the office guided by written protocols, as well as emergency kits, are essential. In referral centers, personalized treatment should be undertaken based on fluorescein angiography findings.

[Palpebral malformations in children]. / La paupière malformative chez l'enfant.

Palpebral malformations can be isolated or associated with a craniofacial disorder. Their assessment is based on clinical examination; additional investigations are mainly done to characterize craniofacial syndromes. In case of extrapalpebral lesions or complex craniofacial pathology, genetic testing must be performed. Some isolated malformations will only need a simple follow-up; others must have specific treatment, undertaken following a precise timing, taking into account child and anatomical structures' growth and the possible consequences of the malformation on the eye and child's sight (degree of urgency). When dealing with these malformations, there are two main risks to be taken into consideration: corneal irritation due to lagophtalmos and amblyopia owing to visual axis obstruction, anisometropia or strabismus.

[Management of oculo-palpebral consequences in facial paralysis]. / Prise en charge des atteintes orbito-palpébrales secondaires à une paralysie faciale.

Facial paralysis prognostic depends on eye lesion. In this pathology, lacrymal and palpebral functions will be modified: bad eye closure and leak of tears secretions. It can leads to corneal complications from keratitis to corneal abcedation and visual dysfonction. This chapter details different procedures and their indications to avoid this kind of complications.

[Cosmetic eyelid surgery]. / Chirurgie esthétique des paupières.

Cosmetic eyelid surgery is becoming increasingly popular. It can rejuvenate the patient's appearance with relatively minor side effects. Its risk/benefit ratio is one of the best in facial cosmetic surgery. However, the patient does not always accurately assess the aesthetic appearance of his or her eyelids. This underscores the importance of clinical examination in order to determine the patient's wishes, and then make an accurate diagnosis and potential surgical plan. We currently oppose, in general, surgical techniques involving tissue removal (skin-muscle and/or fat) in favor of those involving tissue repositioning and grafting (autologous fat pearl transposition, obtained by liposuction, and lipostructure). Furthermore, the place of adjuvant therapies to blepharoplasty is steadily increasing. They mainly include surface treatments (peels and lasers), dermal fillers and anti-wrinkle botulinum toxin injections. They are also increasingly used in isolation in novel ways. In all cases, a perfect knowledge of anatomy and relevant skills and experience remain necessary.

[Aesthetic aspects of eyelid reconstruction]. / Aspects esthétiques de la reconstruction des paupières.

In eyelid reconstruction, filling the defect is not sufficient. In young patients, the aim is to obtain a reconstructed eyelid, as normal as possible. In elderly patients, the large amount of available skin and the good quality of scars seem to be favorable. But weakening and stretching of the connective tissue and eyelid structures and deficient production of tears may compromise the functional result. In every case, restoring aspect and function are going together. The purpose of this chapter is to show how different techniques may be used in eyelid reconstruction with good cosmetic result. Different cases are carefully described and illustrated.

[Ethmoidal mucocele after transpalpebral bony orbital decompression]. / Mucocèle ethmoïdale après décompression orbitaire osseuse transpalpébrale.

We report a case of a late ethmoidal mucocele occurring after transpalpebral bony orbital decompression. A 39-year-old man presented with a recurrence of a right-sided proptosis without signs of orbital inflammation. The patient had undergone bilateral transpalpebral bony orbital decompression for dysthyroid orbitopathy 2 years prior. Orbital CT scan showed a large mucocele in the supero-lateral right ethmoidal sinus with lateral extension to the medial rectus. The patient was therefore referred to an ear, nose and throat (ENT) surgeon, who performed an anterior ethmoidectomy with marsupialization and drainage of the mucocele via an endoscopic approach. A complete postoperative resolution of proptosis was observed without recurrence of the mucocele to date, approximately 6 months postoperative. Sinus complications occurring after orbital decompression may include sinusitis, hematoma, imploding antrum syndrome and mucoceles. Recurrent proptosis secondary to an ethmoidal mucocele is a rare event after bony orbital decompression surgery, with only two cases reported in the international literature. Management requires ophthalmologic diagnosis and collaboration between the ophthalmologist and otorhinolaryngologist.

Mycobacterium abscessus infection in a case of recurrent orbital implant exposure.

Exposure is one of the most frequent complications of porous orbital implants, while infection is rarely observed. Atypical mycobacteria are ubiquitous germs of mostly variable pathogenicity. A patient with recurrent orbital implant exposure is described, in whom a final diagnosis of Mycobacterium abscessus infection was made on culture of the orbital implant remnant at its removal. In orbital implant exposure, infection with unexpected organisms should be considered and in these cases only the complete removal of the implant may allow the socket to settle.

[Complications of transpalpebral osseous orbital decompressions in thyroid orbitopathies]. / Complications des décompressions orbitaires osseuses transpalpébrales pour orbitopathie thyroïdienne.

INTRODUCTION: Complications of bony orbital decompression (BOD) are rather unreported and often neglected. The aim of this study was to assess the risks of this surgery. MATERIAL AND METHODS: 44 patients (76 orbits) were studied. There were 19 malignant orbitopathies and 57 cosmetic rehabilitations. All side-effects and true complications were reported. A questionnaire was send to the patient and to his ophthalmologist. RESULTS: Infra-orbital hypoesthesia, oculomotor disorders, entropion, changes of lid position were the most frequent complications. A case of hypoglobus, a case of lacrimal stenosis, a case of decreased visual acuity were reported. DISCUSSION: Side-effects of BOD are frequent. Higher rates are even found in the literature. These effects tend to decrease spontaneously or can be treated by adequate medical or surgical care. Some measures are proposed to perform surgery safer. CONCLUSION: More precise information should be given to the patients before surgery and a better prevention can be afforded.

Clinical and scintigraphic comparison of silicone and polyvinylpyrrolidone coated silicone perforated plugs.

BACKGROUND/AIM: Isolated stenosis of the lacrimal punctum is a frequent cause of epiphora. Treatment relies on surgical opening or dilatation with bi- or monocanalicular prosthesis. Recently, silicone perforated punctum plugs (PPP) were proposed. The drawback with these silicone PPP was that secretions accumulate in the central orifice blocking the spontaneous flow of tears. A modification of the surface of the PPP using polyvinylpyrrolidone (PVP) was thus proposed. The aim was to compare silicone PPP with new PVP surface treated PPP. METHODS: A prospective study was conducted of 20 patients with dilatable stenosis of the lacrimal puncta who developed epiphora. Epiphora, tolerance, implantation of the PPP, and lacrimal drainage were evaluated using scintigraphy of the lacrimal ducts. RESULTS: The raw data and statistical analysis showed evidence of a superior performance of PVP surface treated PPP. CONCLUSION: Long term evaluation of the advantages or risks of PVP plugs and comparison with microsurgical punctoplasty are warranted.

[Bicanaliculonasal intubation tubes covered with and without polyvinylpyrrolidone. Comparative study]. / Sondes d'intubation bicanaliculonasales recouvertes de polyvinylpyrrolidone (PVP) ou non recouvertes. Etude comparative.

PURPOSE: To compare the efficacy and tolerance between silicone tube and treated polymer surface (PVP) tube of the bicanalicular intubation. METHODS: A randomized prospective study was performed in 50 patients (coated between March 96 and July 97) with chronic tearing. 25 classic intubations (silicone) and 25 with PVP was used. Intubations were performed for 2 months. Functional signs and objectives parameters at the medial canthus and the nasal mucous membrane were compared. RESULTS: There was no difference about functional signs between the 2 groups of patients. Objective signs (hyperemia, secretions) observed in the medial canthus and the nasal mucous membrane were less pronounced with the treated polymer surface tube. CONCLUSION: This study confirms the great potential of treated polymer surface tube.

Anatomic study of the distal supraorbital nerve.

This investigation was designed to extend our present knowledge of the supraorbital n. (SO n.) distal to the supraorbital notch. It is based on 40 dissected hemi-faces and the position of the notch and the periosteal and frontalis cutaneous branches of the SO n. were studied. The notch was 33.05 mm from the midline on the right side and 30.70 mm on the left. The periosteal branch arises from the lateral frontalis cutaneous branch. Its ascends in an oblique direction laterally and ends in two terminal branches. The frontalis cutaneous branch, after a very short trunk, divides into two branches, medial and lateral. The medial or deep branch enters the corrugator supercilii m. between its fibers. Most frequently, it passes under the inferior fasciculus and superficial to the middle and superior ones. Leaving the corrugator m., it ascends medially into the frontalis m., supplying the median cutaneous frontalis region. The lateral or superficial branch crosses superficial to the corrugator supercilii m. to penetrate the frontalis m. in an ascending and lateral direction, supplying the lateral frontalis region. The two branches enter the frontalis m., displaying a zigzag pattern in order to adapt its length during expressive movements. They cross the frontalis region together with the SO a. and two veins supplying the nerve and the frontalis m. These anatomic data may explain some of the complications after surgery for ptosis and blepharospasm.

[Unusual facial clefts]. / Les fentes faciales rares.

After briefly review facial morphogenesis, the authors define facial clefts, distinguishing primary clefts, secondary clefts, and residual clefts. They discuss the uncertainties surrounding the embryology and clinical features of palpebral colobomas. The various pathogenetic concepts are analysed: amniotic hypothesis, vascular hypothesis, fusion defect. The various classifications of rare facial clefts are reviewed, with particular emphasis on Tessier's classification and the so-called Milan classification. The general principles of surgical treatment are described together with the various skeletal and soft tissues procedures.

[Effects of external orbital radiotherapy on the oculomotor muscle in Graves disease]. / Effets de la radiothérapie orbitaire externe sur le muscle oculomoteur dans l'ophtalmopathie thyroïdienne.

PURPOSE: Orbital radiotherapy is recognised to be effective in the treatment of acute Graves' disease. The effect on the oculomotor muscles is still controversial. MATERIAL AND METHODS: To assess this effect, we conducted a prospective study on 15 patients with acute Graves' ophthalmopathy. Patients were investigated before radiotherapy, 3 months later and at long term (mean = 2 years). To study the extent of the ophthalmopathy we chose the following criteria: class IV in the NOSPECS classification system, amplitude of gaze, measurement of the thickness of oculomotor muscles (CT-scan). RESULTS: Improvement of the amplitude of gaze and reduction of the thickness of oculomotor muscles were not statistically significant. The oculomotor disorder was unchanged 3 months after radiotherapy. After a long term follow up (mean: 2 years), only 5 patients, among those who complained of diplopia before radiotherapy, had to be operated, especially large deviations. CONCLUSION: Orbital radiotherapy does not appear as a direct treatment for oculomotor disorder in active thyroid related ophthalmopathy, however favorable indirect effects may be effective due to reduction of inflammation. As it is a harmless treatment, orbital radiotherapy may be proposed as primary treatment in active thyroid related ophthalmopathy.

[Synchronous bilateral cancer of the kidney in the adult. Apropos of a case]. / Cancer du rein bilatéral synchrone chez l'adulte. A propos d'un cas.

Following a case of synchronous bilateral renal cancer, we carried out a review of the literature and defined the specific therapeutic and prognostic characteristics of this clinical condition. Conservative surgery should be proposed as first line treatment. Results in terms of survival depend on the histological characteristics of the more affected kidney. The prognosis is relatively good in general and better than that of unilateral cancer.

[Post-traumatic hemarthrosis of the knee and arthroscopy. Review of 161 cases]. / Hémarthroses post-traumatiques du genou et arthroscopie. Revue de 161 cas.

In a prospective study, 161 traumatic hemarthrosis of the knee had clinical, radiological and arthroscopic examination. The anatomical lesions were diagnosed clinically and radiologically in 78%, but was incomplete every other time. Arthroscopy allowed us to confirm, to complete or to do the exact diagnosis in 98%. Anatomical lesions were never benign: ligaments ruptures (65%), patella dislocations (20.5%), chondral lesions (41%), meniscal lesions (31%). The main interest of arthroscopy is to precise associated lesions and thus, to use these data for a rational treatment program. Most often, the treatment has been performed by arthroscopic techniques, avoiding arthrotomy and shortening post operative rehabilitation. No complication due to arthroscopy has been noted. This study confirms: (1) that a traumatic hemarthrosis indicates a serious knee injury, and (2) the important contribution of arthroscopy for diagnosis and treatment of these traumatic knees.