Reconstruction of Orbital Exenteration Defect With Cheek or Combined Cheek and Forehead Advancement Flaps.

PURPOSE: To review the outcomes of orbital exenteration defect reconstruction using cheek or combined cheek-forehead advancement flap. METHODS: Charts of 14 patients who underwent reconstruction of the exenterated orbit with cheek advancement flap were reviewed. In surgery, a cheek flap elevated via a nasofacial sulcus incision, and preperiosteal dissection was advanced over the defect. The upper orbital defect, if necessary, was covered with a forehead flap, which was dissected through an incision in the midline or temporal forehead and advanced inferiorly. RESULTS: In all patients (7 women, 7 men; mean age, 65 years), total (n = 7) or extended (n = 7) exenteration was performed for a malignant tumor. In 12 patients (86%), the defect was primarily closed with cheek flap alone (n = 6) or cheek plus forehead (n = 6) advancement flaps. Eight patients received radiotherapy before and after surgery. Four patients (29%) had a total of 6 postoperative complications (skin graft infection, orbital cavitary abscess, osteomyelitis, chronic skin ulcer, and 2 sino-orbital fistulae). The mean follow-up duration was 43 months (range, 11-79 months). CONCLUSIONS: Cheek advancement flap can be used alone or together with a forehead advancement flap to cover the orbital defects after total or extended exenteration. This repair may be resistant to radiotherapy-related complications in some cases.

Comparison of conjunctival autograft and conjunctival transposition flap techniques in primary pterygium surgery.

PURPOSE: To investigate and compare the efficacy of conjunctival autograft and conjunctival transpositional flap for the treatment of primary pterygium surgery. DESIGN: Retrospective, interventional case series analysis. MATERIALS AND METHODS: Medical records of 48 patients who underwent pterygium surgery by conjunctival autograft or conjunctival transpositional graft for primary pterygium surgery were reviewed. The conjunctival defects after pterygium excision were repaired in 21 eyes with conjunctival autograft and in 27 eyes with conjunctival transpositional flaps. All operations were performed under subconjunctival anesthesia using 8.0 vicryl sutures. Two groups were compared in terms of pterygium size, surgery time, complications and pterygium recurrence. RESULTS: Mean pterygium size was 2.8 mm in conjunctival transpositional flap group, and 3.4 mm in conjunctival autograft group (p < 0.01). Mean surgery time in conjunctival transpositional flap and conjunctival autograft groups was 15.9 and 21.7 min, respectively. The haematoma formation under the graft was observed postoperatively in one eye of conjunctival autograft group. The only one case of recurrence was observed in both conjunctival autograft and conjunctival transpositional flap groups (3.7% and 4.7%, respectively). Mean follow up time was 11.78 months in conjunctival transpositional flap group and 14.95 months in conjunctival autografting group (p < 0.01). CONCLUSION: Both conjunctival transpositional flap and conjunctival autograft techniques have same results in terms of pterygium recurrence and surgery complications in the treatment of primary pterygium. Surgery time in conjunctival transpositional flap technique is significantly shorter. Conjunctival transpositional flap technique may be a good alternative method for primary pterygium surgery.

Melanocytic Nevus of the Tarsal Conjunctiva.

BACKGROUND: Melanocytic nevus is a rare occurrence in the tarsal conjunctiva and only 7 well-described cases have been reported previously in the English literature. CASE REPORT: The medical records of 4 patients with tarsal conjunctival melanocytic nevus were reviewed, together with the relevant literature. All patients (3 women and 1 man; age range: 17 - 40 years) had been referred with a suspicion of melanoma. There was one tarsal nevus in the lower eyelid in 3 patients and 2 nevi in the upper eyelid in 1 patient. All lesions were darkly pigmented with irregular borders and were associated with a history of a recent growth in size. An intralesional cyst was present in 1 nevus only. After surgical excision, no recurrence or complication occurred during the follow-up period (range: 7 - 48 months). CONCLUSION: Tarsal melanocytic nevus has been described in detail in 11 cases, including these 4 cases, in the English literature. The lesion arose from the lower eyelid in all cases except one. Tarsal melanocytic nevi may frequently display clinical features suggesting melanoma, such as advanced patient age, recent growth, dark and irregular pigmentation, nodularity, hypervascularity, and the absence of an intralesional cyst. After total excision, nevus recurrence or malignant transformation has not been reported.

Reconstruction of orbital exenteration defects with bilobed forehead flap.

To describe the use of bilobed forehead flap for reconstruction of orbital exenteration defect. The medical records of 2 patients in whom orbital exenteration defect repair was performed with bilobed forehead flap were reviewed. In both patients (male, ages 74 and 65 years), extended exenteration was performed because of basal cell carcinoma infiltrating the upper and lower eyelids and orbit. One patient had a history of multiple eyelid surgeries and periorbital radiotherapy. In the other, the tumor also involved the maxillary and ethmoid sinuses and nasal dorsum. The bilobed flap was combined with a cheek advancement flap in 1 patient. The excisional defect could be primarily covered in both patients. In 1 patient, a skin graft was needed to cover the forehead donor area defect. In both patients, transient, distal flap ischemia developed after surgery and, in 1 patient, eyebrow malposition required surgical correction at the late period. No other complication developed during follow-up (18 and 26 months). The bilobed forehead flap can be effectively used to reconstruct total or extended orbital exenteration defects.

Lacrimal Punctal Occlusion With Conjunctival Flap.

PURPOSE: To describe a technique of punctal occlusion with conjunctival flap and present its surgical results in a group of patients. METHODS: The records of 30 patients who underwent punctal occlusion with a conjunctival flap due to dry eye were reviewed. A medial segment of the eyelid margin, including the punctum, was superficially excised. The canalicular opening was closed with suturing, and then the margin defect was covered with a conjunctival transposition flap. RESULTS: Sixty-nine puncti (41 lower and 28 upper puncti) in 52 eyes were occluded with a conjunctival flap. During the follow-up period (mean, 4.8 months; range, 2-13 months), 65 puncti (94%) remained occluded and 4 puncti reopened. Because of postoperative epiphora, the procedure was surgically reversed in 2 lower puncti. No complication was encountered during or after surgery. CONCLUSION: Conjunctival transposition flap may be an alternative surgical method for effective and reversible occlusion of the lacrimal punctum in eyes with severe dry eye.

Congenital cranio-orbital myofibroma.

A 1-day-old female newborn presenting with a severe left proptosis was found, on imaging, to have a cranial mass extending in both orbits and ethmoid sinuses. Tumor debulking and biopsy were performed through a lateral orbitotomy. Based on histologic findings, a diagnosis of infantile myofibroma was made. No involvement was found in other areas of the body. The patient died because of respiratory arrest after intracranial surgery that was performed 45 days after the orbital surgery. To the authors' knowledge, only one similar case of cranio-orbital myofibroma has been reported previously. This tumor should be considered in the differential diagnosis of congenital proptosis and cranio-orbital tumor. In such cases, tumor debulking can be performed through orbitotomy.

Visual acuity and contrast sensitivity function after accommodative and multifocal intraocular lens implantation.

PURPOSE: To evaluate visual acuities and contrast sensitivities (CS) after accommodative, refractive, and diffractive multifocal intraocular lens (IOL) implantations. METHODS: After cataract extractions, in 20 eyes accommodative IOL (group 1), in 30 eyes refractive IOL (group 2), and in 20 eyes diffractive multifocal IOL (group 3) implantations were performed. CS were measured with the stereo optical functional acuity contrast test. Uncorrected distance (UCDVA) and distance corrected near visual acuities (DCNVA) and refractive values were determined. RESULTS: The mean UCDVA (0.99+/-0.03) and DCNVA (0.98+/-0.04) of group 3 were significantly better than the other IOL groups. The mean DCNVA of group 2 (0.71+/-0.14) was significantly better than group 1 (0.5+/-0.08). One month after the operations CS, values of group 2 were significantly lower than the 2 other IOL groups. Photopic CS values of group 1 at 12 and 18 cycles per degree (cpd) were significantly higher than group 3. Three months after the operations, CS values of group 1 and 3 were significantly higher than that of group 2 at 3, 6, 12, and 18 cpd and in all spatial frequencies respectively. There was no difference between groups 1 and 3 with respect to photopic CS values. Mesopic CS values of group 3 were significantly higher than that of group 1 at 1.5, 3, and 6 cpd. At the 6th and 12th month, CS values of group 3 were similar or better compared to the values of the 3rd month. CONCLUSIONS: The diffractive multifocal IOL resulted in more favorable visual acuities and higher CS values than accommodative and refractive multifocal IOL.