Complications of the Superior Eyelid Endoscopic Transorbital Approach to the Skull Base: Preliminary Experience With Specific Focus on Orbital Outcome.

BACKGROUND: The endoscopic superior eyelid approach is a relatively novel mini-invasive technique that is currently investigating for skull base cancers. However, questions remain regarding specific approach-related complications when treating different skull base tumors. This study aims to analyze any surgical complications that occurred in our preliminary consecutive experience, with specific focus on orbital outcome. METHODS: A retrospective and consecutive cohort of patients treated via a superior eyelid endoscopic transorbital approach at the Division of Neurosurgery of the Hospital Clinic in Barcelona was analyzed. Patients features were described in detail. Complications were divided into 2 groups to analyze separately the approach-related complications, and those resulting from tumor removal. The ocular complications were subdivided into early ocular status (<3 weeks), late ocular status (3-8 weeks), and persistent ocular complications. The "Park questionnaire" was used to determine patient's satisfaction related to the transorbital approach. RESULTS: A total of 20 patients (5 spheno-orbital meningiomas, 1 intradiploic Meningioma, 2 intraconal lesions, 1 temporal pole lesion, 2 trigeminal schwannoma, 3 cavernous sinus lesions, and 6 petroclival lesions) were included in the period 2017-2022. Regarding early ocular status, upper eyelid edema was detected in all cases (100%) associated with diplopia in the lateral gaze in 30% of cases, and periorbital edema in 15% of cases. These aspects tend to resolve at late ocular follow-up (3-8 weeks) in most cases. Regarding persistent ocular complications, in one case of intraconal lesion, a limitation of eye abduction was detected (5%). In another patient with intraconal lesion, an ocular neuropathic pain was reported (5%). In 2 cases of petroclival menigioma, who were also treated with a ventriculo-peritoneal shunt, slight enophthalmus was observed as a persistent complication (10%). According to the Park questionnaire, no cosmetic complaints, no head pain, no palpable cranial irregularities, and no limited mouth opening were reported, and an average of 89% of general satisfaction was encountered. CONCLUSIONS: The superior eyelid endoscopic transorbital approach is a safe and satisfactory technique for a diversity of skull base tumors. At late follow-up, upper eyelid edema, diplopia, and periorbital edema tend to resolve. Persistent ocular complications are more frequent after treating intraconal lesions. Enophthalmus may occur in patients with associated ventriculo-peritoneal shunt. According to patient's satisfaction, fairly acceptable results are attained.

Pillar tarsoconjunctival flap: An alternative approach for the management of refractory corneal ulcer.

PURPOSE: To report the effectiveness of the surgical procedure of the tarsoconjunctival flap (FTC) in patients with severe ocular surface impairment refractory to previous conventional treatments. METHODS: A retrospective, noncomparative, consecutive case series. RESULTS: Pillar tarsoconjunctival flap (PTCF) was performed in eight eyes of eight patients. Three patients had neurotrophic corneal ulcer (NCU), three had exposure keratopathy and two had corneal melting. Seven of them had satisfactory postoperative results, showing total corneal re-epithelialization that lasted throughout the postoperative follow-up (mean 10.33 ± 2.65 months [SD], range 6 to 12 months). Mean time for the re-epithelization was 11.28 ± 8.97 days [SD] (range 4 to 30 days). CONCLUSION: This study suggest PTCF is a valid alternative to tarsorrhaphy in cases of persistent epithelial defect (PED) or NCU resistant to conventional treatments. Notwithstanding, prospective comparative trials comparing PTFC with conventional and/or novel therapies in PED or NCU are needed to corroborate these findings.

Endoscopic superior eyelid transorbital approach: how I do it.

BACKGROUND: The endoscopic transorbital approach to the skull base is currently growing in popularity, and it is nowadays progressively used as a skull base approach. Clinical experience, along with detailed anatomical knowledge, makes this technique safe and effective. METHOD: We present a step by step description of our technique based on the most recent anatomic references, and clinical experience. In order to better understand every phase of the procedure, we propose to keep on the following scheme, that is (1) skin phase; (2) working space; (3) lesion removal; (4) reconstruction. Hence, alone or in combination with the well-known endonasal pathway, the transorbital avenue seems to be a useful approach for selected skull base lesions. We present our technique, along with an anatomic analysis on cadaveric specimens. CONCLUSIONS: Detailed knowledge of surgical anatomy, and a specific stepwise analysis of each part of the surgical procedure, is notably useful in order to safely and effectively perform a superior eyelid endoscopic transorbital surgery to the skull base.

Long-term stability of transconjunctival midface lift surgery for postblepharoplasty lower eyelid retraction.

Lower eyelid retraction occurring as a complication of lower eyelid blepharoplasty may give rise to symptoms of exposure keratitis as well as cosmetic considerations. This retrospective longitudinal study describes our clinical experience with 74 patients with bilateral lower eyelid retraction postblepharoplasty (148 eyes) undergoing a transconjunctival subperiosteal midface lift with the implantation of a hard palate spacer graft over the period 2002 to 2019. All patients had a forced-up traction test result of less than or equal to 2 mm, indicating a significant fibrosis of the middle lamellae. Margin reflex distances (MRD2) were examined at follow-up visits scheduled for 2 weeks, 1 month, and 1, 3, 6, 9, and 12 years. Mean follow-up duration was ± 102 months (range 6 to 144 months). In all patients, MRD2 varied up until 1-year postsurgery and stabilized thereafter. Last follow-up MRD2 values indicated retraction improvements of 1.4, 2.4, and 3.2 mm, respectively, for those with mild: MRD2 6.3 mm [5.5 - 6.6], moderate: 7.0 mm [6.7 - 7.8], and severe retraction: 8.5 mm [7.9 - 9]. This improvement was statistically significant in patients with severe baseline retraction (p = 0.04). This approach proved to be safe and functional, and cosmetic results were excellent and remained stable over time.

Retroauricular myoperiosteal autograft for orbital implant exposure: 11 years of experience.

PURPOSE: To describe our experience with retroauricular myoperiosteal autograft for surgical coverage of exposed orbital implants. METHODS: This was a single-center, retrospective, observational cohort study, in which demographic and clinical data were compiled by reviewing the clinical records of anophthalmic patients with implant exposure treated with an autogenous retroauricular myoperiosteal graft at the Instituto de Microcirugía Ocular (IMO, Barcelona, Spain) over the period January 2007 to December 2017. Main outcome was the long-term coverage of implant after retroauricular myoperiosteal autograft; secondary outcome was the rate of post-surgical complications and management. RESULTS: Over the 11-year period, 27 eyes of 27 patients with implant exposure received a retroauricular myoperiosteal autograft. Mean participant age was 47.3 ± 17.9 years (range 9-78, median 45). Primary surgery was enucleation in 8 eyes (29.6%) and evisceration in 19 (70.4%). Implant materials were porous polyethylene in 17 (63%), hydroxyapatite in 3 (11.1%), and bioceramics in 4 (14.8%). In the remaining three patients (11.1%), the implant material and size were unknown. Implant exposure was diagnosed after a mean of 98 ± 111.7 months. Mean exposure diameter was 5.9 ± 3.1 mm. Mean follow-up duration after graft surgery was 37.5 ± 39 months. In four patients (14.8%), implant re-exposure was recorded and in two of these patients a re-graft using the same technique was performed. In the last follow-up session, all patients showed good implant coverage. CONCLUSIONS: Myoperiosteal graft could be a valid option for the long-term management of implant exposure irrespective of primary surgery, exposed area, and implant material.

Subconjunctival Orbital Fat Prolapse: An Update on Diagnosis and Management.

Subconjunctival prolapse of orbital fat is an uncommon clinical entity in which intraconal orbital fat herniates into the subconjunctival space. Its diagnosis is mainly clinical in character and usually based on palpation, patient clinical history, and lesion features along with a slit lamp examination. Its pathophysiology remains unclear. Although frequently asymptomatic, clinical features may simulate conditions such as a prolapsed lacrimal gland, orbital lymphoma or dermolipoma and may worsen over time. In such cases, surgical removal or repositioning of the herniated fat may be necessary. While several surgical techniques have been described, no reports exist of a customized approach to manage this condition. This paper reviews the diagnosis and management of subconjunctival orbital fat prolapse.

Type A lymphomatoid papulosis presenting as an eyelid ulcer in a young man.

We present the case of an ulcerative lesion of the eyelid as first presentation of type A lymphomatoid papulosis (LP) in a young adult. LP is a rare cutaneous lymphoproliferative disease with a risk of associated systemic or cutaneous lymphoma.

Platelet-rich plasma to rescue an ulcerated orbital dermal fat graft.

INTRODUCTION: Central graft ulceration is a rare complication of an orbital dermal fat graft caused by diminished blood supply to the implant. This study reports on the efficacy and safety of the use of a single subconjunctival injection of autologous platelet-rich plasma to rescue an ulcerated orbital dermal fat graft. METHODS: Three patients, who had undergone autologous dermal fat graft to treat their anophthalmic socket, were given a 2-mL subconjunctival platelet-rich plasma injection in the exposed graft margins. Demographic and clinical features, treatment protocol, clinical course, complications and follow-up time are reported. In the preoperative examination, all the patients presented a primary epithelial defect of the dermal fat graft. RESULTS: There were no major complications such as necrosis or infection. One patient presented a small conjunctival granuloma at 1-month follow up. Mean postoperative follow-up duration was 13 (range: 10-16) months. By 1 month, the chronic epithelial defect had resolved with the graft integrated within the orbital tissues in all cases. All patients were referred for artificial prosthesis placement. CONCLUSION: Although further work is needed, our findings suggest that a single subconjunctival platelet-rich plasma injection could be an effective, safe and economic alternative to surgery to rescue an ulcerated orbital dermal fat graft.

Primary Intraocular Malignant Rhabdoid Tumor Without Extrascleral Compromise.

Primary intraocular malignant rhabdoid tumor is classified as a malignant extrarenal rhabdoid tumor. It is extremely rare, highly aggressive, and, so far, only one case (in a newborn) has been described in the medical literature. The authors report a second case of primary intraocular malignant rhabdoid tumor, this time without extrascleral involvement and in a teenager, and describe its histological, immunohistochemical, and radiological characteristics along with clinical correlations. [J Pediatr Ophthalmol. 2018;55:e7-e9.].

Desarrollo de una PCR para la detección y cuantificación de la parasitación por Demodex folliculorum en biopsias de neoplasias cutáneas del área periocular / Development of a PCR for the detection and quantification of parasitism by Demodex folliculorum infestation in biopsies of skin neoplasms periocular area

Objetivo. Estandarizar la cuantificación relativa por masa de tejido de la parasitación por Demodex folliculorum procedente de biopsias neoplásicas cutáneas de la zona periocular mediante técnicas de amplificación molecular con el objetivo de poder estudiar la posible relación de la aparición de carcinoma basocelular palpebral con la presencia y densidad del ácaro en trabajos posteriores. Material y métodos. Se desarrolló una PCR cuantitativa a tiempo real con sondas TaqMan. La PCR se probó en una serie piloto de 46 muestras reales de biopsias de carcinoma basocelular de tipo nodular. Resultados. La sensibilidad se situó con un límite de detección de entre 1 y 10 copias/μl. El 50% (23/46) de las biopsias fueron positivas a D. folliculorum. La especificidad fue del 100% confirmado mediante secuenciación. Conclusión. La técnica muestra buenos resultados de sensibilidad y especificidad que la pueden hacer útil como herramienta para estudios causa-efecto de D. folliculorum y basalioma (AU)

Objective. To standardize the relative quantification by mass of tissue parasitism by Demodex folliculorum infestation from neoplastic skin biopsies periocular using molecular amplification to study the possible relationship of the appearance of eyelid basal cell carcinoma with the presence and density of the mite in later works. Methods. A quantitative PCR was developed real-time probes TaqMan. PCR was tested in a pilot 46 actual biopsy samples nodular basal cell carcinoma series. Results. The sensitivity was placed with a detection limit of between 1 and 10 copies / μl. 50% (23/46) of the biopsies were positive for D. folliculorum. The specificity was 100% confirmed by sequencing. Conclusion. The technique shows good results for sensitivity and specificity that can make it useful as a tool for studies of cause and effect D. folliculorum and basal cell carcinoma (AU)