Comprehensive Evaluation of Visual Function in Patients With Orbital Fracture by Visual Electrophysiology and Visual Field Examination.

OBJECTIVE: At present, the effect of the visual electrophysiology and vision field examination in patients with orbital blowout fracture is rarely studied. So, the authors investigate the value of visual electrophysiology and vision field examination in the diagnosis of ocular contusion. METHODS: The position and range of fracture of 81 patients were determined by computed tomography (CT) scanning. Visual evoked potential (VEP), electroretinogram (ERG), and mfERG were vision field examination detected in 81 patients and the results were compared with those of contralateral healthy eyes. In addition, visual electrophysiology and vision field examination in diagnosis of eye contusion was analyzed and the correlation of the VEP, ERG, mfERG injury duration, and visual acuity was further analyzed. RESULTS: The visual acuity of orbital fractures was significantly decreased compared with that in the uninjured eyes (t = 2.181, P = 0.032). Compared injured eyes and normal eyes in 54 patients, b wave of Max-ERG and Cone-ERG implied value extension (t = -2.426, P = 0.025; t = -2.942, P = 0.014), P-VEP P100 Peak duration and amplitude significantly extended (t = 3.162, P = 0.007; t = 9.314, P = 0.000), and F-VEP P1 amplitude decreased significantly (t = 3.362, P = 0.004). mfERG showed that the injured eye central reaction was significantly decreased (t = 8.727, P = 0.000). There was a significant correlation between P-VEP P100 amplitude and visual acuity (r = 0.067, P = 0.000). But there was no significant correlation between the P100 peak value, amplitude of P-VEP, mfERG central reaction, and injured days, respectively. There was significant difference between 2 groups with average visual acuity and mean defect value (t = 3.253, 3.461, P = 0.006, 0.003). There was statistical means the difference in P-VEP abnormal group, visual field abnormal group, and combined detection abnormal groups, the abnormal rate increased significantly (χ = 3.931, P < 0.01). CONCLUSION: Orbital floor fracture can lead to optic nerve damage and also may be associated with decreased macular function. The combination analysis of visual electrophysiology and vision field examination is beneficial to early diagnosis of ocular trauma and can improve the positive rate in clinic practice.

Postoperative Improvement of Diplopia and Extraocular Muscle Movement in Patients With Reconstructive Surgeries for Orbital Floor Fractures.

OBJECTIVE: With orbital floor fracture incidence rates increasing year by year, many patients require surgical treatment to improve diplopia, limitation of extraocular muscle movement (EOM), enophthalmos, and midface appearance. With the use of high-density polyethylene, titanium screws, titanium plate, and titanium mesh to repair an orbital floor fracture, enophthalmos and midfacial deformity correction procedures have made great progress. However, attenuating diplopia and the limitation of EOM are still difficult problems to prevent. METHODS: The clinical data of 92 patients with reconstructive surgeries after orbital floor fracture were prospectively studied. The position, range of fracture, and incarceration of extraocular muscles were determined by computed tomography scanning. A Hess screen and a synoptophore examination were used to determine the EOM and diplopia. The Hess area ratio (HAR%) and the grade of diplopia were measured before and 1, 3, and 6 months after surgery. Diplopia was evaluated, and the severity was recorded accordingly. RESULTS: Diplopia rates in patients with simple orbital floor fracture showed a significant difference preoperatively and postoperatively at 1 and 3 months (P < 0.05) compared with diplopia rates at 6 months and 12 months after operation, which had no significant difference (P > 0.05). There was a statistically significant difference (P < 0. 05) among patients with an orbital floor fracture who had an operation within 3 weeks or more than 3 months after injury. Compared with preoperative and postoperative findings at 1 and 3 months, the limitation of EOM in patients with orbital floor fractures had a significant difference (P < 0.05); however, compared with 3 and 6 months after operation, there was no significant difference (P > 0.05). There was a statistically significant difference (P < 0.05) in patients with orbital floor fractures having had an operation within 3 weeks and more than 3 months after injury. The difference of improvement for diplopia after operation among HAR% < 65%, 65% ≤ HAR% ≤ 85%, and HAR% >85% groups were statistically significant (P <0.05). Postsurgically, the HAR% of the patients was improved, and the difference of HAR% between patients before and after the operation was statistically significant (P < 0.05). CONCLUSION: Surgical management can effectively improve diplopia and EOM disorder of patients with orbital floor fractures. Improvement statistics were calculated by a Hess screen and a synoptophore. Hess area ratio is a useful method to convert the Hess screen into a numerical value and can therefore be used to compare patients in clinical treatment of orbital wall fracture.

[SOX2 defect and anophthalmia and microphthalmia].

As a severe congenital developmental disorder, anophthalmia and microphthalmia are usually accompanied with vision impairment and hypoevolutism of the orbit in the affected side. Many genes are involved in anophthalmia and microphthalmia, in which, SOX2 is an important one. The defect of SOX2 causes multiple system disorders, including anophthalmia and microphthalmia. We describe the relationship between the SOX2 defect and anophthalmia/microphthalmia, in order to offer some proposals for the differential diagnosis, treatment and research of anophthalmia and microphthalmia.

[Continuous funding of National Natural Science Foundation of China has boosted the development of the discipline of ophthalmology over the past 25 years].

OBJECTIVE: To analyze the role of National Natural Science Foundation of China (NSFC) on the development of the discipline of Ophthalmology from 1986 to 2010. METHODS: Data on the total number of projects and funding of NSFC allocated to Ophthalmology, as well as papers published, awards, personnel training, subject construction were collected, and the role of NSFC on other sources of funding was evaluated. RESULTS: From 1986 to 2010, NSFC supported a total of 593 scientific research projects of Ophthalmology, funding a total amount of 152.44 million Yuan, among which were 371 free application projects, 156 Young Scientist Funds, 9 Key Programs, 5 National Science Fund for Distinguished Young Scholars, 3 Major international (regional) joint research programs, 1 Science Fund for Creative Research Group and 48 other projects. Over the past 25 years, the number of NSFC projects received by Ophthalmology has been an overall upward trend in the share in the Department of Life (Health) Sciences. Take the projects (186 of 292, 63.7%) as examples completed between 2002 and 2010, a total 262 papers were published in Science Citation Index (SCI) included journals and 442 papers were published in Chinese journals. Meanwhile, 8 Second prizes of National Science and Technology Progress Award and 1 State Technological Invention Award were received. As of 2010, the training of a total of more than 40 postdoctoral, more than 400 doctoral students and more than 600 graduate students have been completed. 5 national key disciplines and 1 national key laboratory have been built. Moreover, 2 "973" programs from Ministry of Science and Technology and 1 project of special fund in the public interest from Ministry of Public Health were obtained. 2 scholars were among the list of Yangtze Fund Scholars granted by Ministry of Education. CONCLUSIONS: Over the past 25 years, a full range of continuous funding from NSFC has led to fruitful results and a strong impetus to the progress of discipline of Ophthalmology.

Doxycycline vs Placebo at 12 Weeks in Patients With Mild Thyroid-Associated Ophthalmopathy: A Randomized Clinical Trial.

Importance: Mild thyroid-associated ophthalmopathy (TAO) negatively impacts quality of life, yet no clinical guidelines for its treatment are available. Existing evidence supports the use of doxycycline in treating mild TAO. Objective: To evaluate the short-term (12 weeks) efficacy of doxycycline in treating mild TAO. Design, Setting, and Participants: In this placebo-controlled multicenter randomized double-masked trial, 148 patients were assessed for eligibility. After exclusions (patients who were pregnant or lactating, had an allergy to tetracyclines, or had uncontrolled systematic diseases), 100 patients with mild TAO (orbital soft tissue affected mildly) at 5 centers in China were enrolled from July 2013 to December 2019 and monitored for 12 weeks. Interventions: Participants were randomly assigned 1:1 to receive doxycycline (50 mg) or placebo once daily for 12 weeks. Main Outcomes and Measures: The primary outcome was the rate of improvement at 12 weeks compared with baseline assessed by a composite indicator of eyelid aperture (reduction ≥2 mm), proptosis (reduction ≥2 mm), ocular motility (increase ≥8°), and Graves ophthalmopathy-specific quality-of-life (GO-QOL) scale score (increase ≥6 points). Adverse events were recorded. Results: A total of 50 participants were assigned to doxycycline and 50 to placebo. The mean (SD) age was 36.7 (9.1) years; 75 participants (75.0%) were female and 100 (100.0%) were Asian. Medication compliance was checked during participant interviews and by counting excess tablets. At week 12, the improvement rate was 38.0% (19 of 50) in the doxycycline group and 16.0% (8 of 50) in the placebo group (difference, 22.0%; 95% CI, 5.0-39.0; P = .01) in the intention-to-treat population. The per-protocol sensitivity analysis showed similar results (39.6% [19 of 48] vs 16.0% [8 of 50]; difference, 23.6%; 95% CI, 6.4-40.8; P = .009). No adverse events other than 1 case of mild gastric acid regurgitation was recorded in either group. Conclusions and Relevance: The results of this study indicate that oral doxycycline, 50 mg daily, resulted in greater improvement of TAO-related symptoms at 12 weeks compared with placebo in patients with mild TAO. These findings support the consideration of doxycycline for mild TAO but should be tempered by recognizing the relatively short follow-up and the size of the cohort. Trial Registration: ClinicalTrials.gov Identifier: NCT02203682.

Functional study on a novel missense mutation of the transcription factor FOXL2 causes blepharophimosis-ptosis-epicanthus inversus syndrome (BPES).

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare autosomal dominant disease caused by FOXL2 gene mutations. However, only one missense mutation has been found in family with BPES type I. Here, we report a novel missense mutation in the forkhead domain of the FOXL2 gene (c.340A > G, NM_023067) resulted in the replacement of lysine by glutamic acid at amino acid position 114 of the FOXL2 protein (p.K114E, NP_075555) that was identified in a Chinese family with BPES type I, members of which displayed clinical symptoms such as shortened palpebral fissures, drooping eyelids, a vertical skin fold arising from the lower eyelid, and premature ovarian failure (POF) in affected females. Based on the patients' clinical features and computational analysis of this missense mutation in a three-dimensional structural model, we hypothesised that the mutation might disturb the intermolecular contacts between FOXL2 and the StAR gene. The disturbance of this interaction might contribute to the POF observed in BPES type I patients. We performed subcellular localisation and functional studies and as expected, observed significant nuclear aggregation and cytoplasmic mislocalization of the mutant type protein and loss-of-function was confirmed by electrophoretic mobility shift assays, transcriptional activity assays and quantitative real-time polymerase chain reaction. This functional study on a novel missense mutation has important implications for the molecular analysis of this gene.

[Pay attention to development of ophthalmic plastics and orbital diseases in China].

Ophthalmic plastics and orbital diseases have developed rapidly as a young branch of ophthalmology in recent years. The current situation and development of ophthalmic aesthetics, plastics and orbital surgery are discussed in this paper. The functional reconstruction and appearance rehabilitation are both important to the ophthalmic plastic surgery. Although the ophthalmic plastics and orbital surgery started late in China, it developmented rapidly. The development of this branch is based on innovative research, active interdisciplinary, medical-engineering cooperation and academic exchange. However, there are still some problems about ophthalmic plastics and orbital surgery in China. To promote the development of ophthalmic plastic and orbital surgery, we should regulate the training of ophthalmic plastic surgeons, and pay attention to the clinical translational research.

[Application of computer-aided surgical navigation system in orbital surgery].

Computer-aided surgical navigation system, which is a combination of computer technology and medical imaging, is one of the most popular and developing fields in recent years. The navigation system is aimed to improve the accuracy and security of the surgery by pre-operative planning, intra-operative navigation and post-operative evaluation. This paper introduces the essential elements, fundamental principles, and implementation steps of the navigation system; further reviews its usefulness and progress in orbital fractures reduction, orbital tumor surgery and orbital decompression.

[Three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction].

OBJECTIVE: To evaluate the outcomes of the clinical application of three-dimensionally preformed titanium mesh plates for posttraumatic complex orbital bone fracture reconstruction. METHODS: Thirteen patients (13 eyes) manifested with complex orbital fractures (including orbital-zygomatic-maxillary bone fracture in 6 patients, nasal-orbital-ethmoid bone fracture in 5 patients and complex multiple periorbital bone fracture in other 2 patients) underwent the reconstructive surgery by using three-dimensionally preformed titanium mesh plates. Eight cases underwent high density porous polyethylene implantation simultaneously. Evaluation of enophthalmos, eyeball movement, and orbit CT scan were taken pre- and post-operatively. RESULTS: The average enophthalmos was (3.9 ± 1.7) mm and the position of the affected eyeball was (3.1 ± 2.6) mm bellow the contralateral side preoperatively. Twelve patients suffered from eyeball movement restriction, including grade I in 4 cases, grade II in 7 cases and grade III in 2 cases. During the 3 to 6 months post operative follow-up, enophthalmos was completely corrected in 10 patients while the other 3 patients had residual 1.0 mm enophthalmos. The affected eyeballs were repositioned in 8 cases and 3 cases had residual 1 mm lower position and 2 cases with a 1 mm higher positioned eyeball. Eye movement was not restricted in 8 patients, whereas 3 patients had grade I movement restriction and 2 patients had grade II movement restriction. There were no rejection, infection and other complications during follow-up. CONCLUSIONS: Three-dimensionally preformed titanium mesh plates can be used to reconstruct posttraumatic complex orbital bone fractures in order to improve the orbital volume and to correct enophthalmos effectively.

[Clinical features and treatment of lateral orbital wall blow-in fracture].

OBJECTIVE: To analyze the clinical features of lateral orbital wall blow-in fracture and summarize the points of treatment. METHODS: A retrospective analysis of 12 patients with lateral orbital wall blow-in fracture treated in the Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from January 2007 to January 2010 was investigated. Clinical records and results of follow-up were analyzed. RESULTS: Twelve cases of the lateral orbital wall blow-in fracture with the frontal process of the zygoma impacted into the orbit were confirmed. Globe rupture occurred in 1 case, 4 cases had traumatic optic neuropathy. 1 case suffered exophthalmos, 8 cases had enophthalmos. Diplopia was found in 5 cases and eyeball movement disturbance in 5 cases.3 cases had upper eyelid deformity, 1 case had ptosis, 3 cases had telecanthus accompanied with lacrimal ducts obstruction. 11 cases suffered orbital floor fracture, 9 cases had zygomatic arc fracture, 6 cases had orbital medial wall fracture, and 3 cases had naso-orbito-ethmoid fracture. Surgical treatment was performed by different combination of approaches according to the extents of injury; Osteotomy was performed in patients whose blow-in fracture was malformation. Orbital reconstructive surgery was performed in 11 patients and fractures were completely restored. CONCLUSIONS: The lateral orbital wall blow-in fracture could cause serious impairment to the ocular components, better outcomes could be achieved by timely and proper treatment with improving recognition of this type of fracture.

Ocular surface changes in Graves' ophthalmopathy.

Many patients with Graves' ophthalmopathy (GO) suffer from dry eye syndrome (DES), and this is one of the most common reasons of eye discomfort in patients with GO. The prevalence of DES in patients with GO is significantly higher than normal subjects. The ocular surface changes involving changes in tears, cornea, conjunctiva and glands occur in GO patients. However, the mechanism of how DES occurs in GO still remains unclear. In this review, the ocular surface changes were illustrated and analyzed the reasons for high prevalence of DES in GO patients.

Comparison of choroidal thickness in high myopic eyes after FS-LASIK versus implantable collamer lens implantation with swept-source optical coherence tomography.

AIM: To investigate the changes in choroidal thickness (CT) in high myopic eyes after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery or central hole implantable collamer lens (ICL V4c) implantation using swept-source optical coherence tomography (SS-OCT). METHODS: We examined the right eyes of 116 patients with high myopia who were candidates for FS-LASIK surgery and ICL implantation. Sixty eyes underwent ICL V4c implantation and 56 eyes were subjected to FS-LASIK surgery. The CT was measured with SS-OCT. All data were recorded preoperatively and 2h, 1wk, 1 and 3mo postoperatively. Other demographic information was collected, including age, sex, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP) and axial length (AL). RESULTS: The UCVA improved in both groups and showed no significant differences between groups. There also were no significant differences between the two groups in postoperative BCVA and SE (P=0.581 and 0.203, respectively). The foveal CTs, inner nasal and outer nasal CTs were significantly thicker at 2h postoperatively in both groups (P<0.05) but returned to baseline levels in 1wk; after 1mo, no significant differences were found relative to the preoperative values. At 3mo in each group, nine regions showed variations in the CT as compared with preoperative thickening, but only the foveal and nasal area CTs preoperative differences were statistically significant (P<0.05). In addition, there was no significant difference in 9 regions of CT between the two groups at all follow-up times (P>0.05). CONCLUSION: The CTs after ICL implantation and FS-LASIK surgery are significantly thicker than those before operation, especially in the foveal and nasal areas, but there is no significant difference between the two methods.

[Emphasis on pathology and hemodynamics based classification of orbital vascular lesions].

Orbital vascular lesions, mainly including hemangioma and vascular malformation, are the most common disorders among orbital diseases. Vascular lesions of the orbit have clinically complicated presentations and are very hard to deal with. Selection of therapeutic modality on orbital vascular lesions requires an appropriate classification of them. An improved classification of these lesions has been proposed by the Orbital Society based on the pathological types and hemodynamic features and has been extensively used in developed countries. However, orbital vascular lesions are still being classified based on morphology in China. This classification system does not represent the pathological difference between hemangioma and vascular malformation of the orbit, nor the hemodynamic characteristics among different vascular malformations of the orbit. Morphology based classification has hampered scientific dialogue and confused clinicians, with occasionally serious consequences for patients. Thus, the use of a pathology and hemodynamics based classification of orbital vascular lesions should be highly advocated. We can expect that the use of appropriate classification can improve the management of these lesions in our country.

[Pharmacologic vitreolysis in diabetic rats].

OBJECTIVE: To evaluate the efficacy and safety of plasmin or hyaluronidase in the inducing of posterior vitreous detachment in diabetic rats. METHODS: Forty SD rats were induced diabetes by Streptozotocin (STZ). Four weeks later, these rats were randomized into 4 groups: rats in group A received 5 U hyaluronidase intravitreal injection in right eyes; rats in group B received 0.5 U plasmin intravitreal injection in right eyes; rats in group C received 0.5 U plasmin +5 U hyaluronidase intravitreal injection in right eyes; rats in group D received BSS (balance salt solution) 2 microl intravitreal injection in right eyes. Clinical examination were performed at 1, 3, 7 days after injection. After 1 week, scanning electron microscope (SEM) was performed to judge whether the PVD was induced. ERG and histology were examined to evaluate the toxicity after the intravitreal injection of these two drugs. RESULTS: No PVD was found in SEM disclosed group A and group D. Forty percent eyes were induced complete PVD in groups B, and one hundred percent eyes were induced complete PVD in group C. ERG and histology showed no toxicity changes in any group. CONCLUSION: Intravitreal injection of 0.5 U plasmin + 5 U hyaluronidase can induce complete PVD without obvious toxicity in diabetic rats. Solo usage of plasmin or hyaluronidase can not induce complete PVD.

[Small interference RNA targeting vascular endothelial growth factor inhibits rat corneal neovascularization].

OBJECTIVE: To test the effects of VEGF-siRNA-transfected corneal epithelium on corneal neovascularization (CNV). METHODS: It was an experimental study. Cultured rat corneal epithelial cells and keratocytes were transfected with synthesize VEGF siRNA by lipofectamine 2000. The level of VEGF mRNA was analyzed by real time PCR, and the protein levels were determined by enzyme-linked immunosorbent assay (ELISA). CNV was induced by cauterization with 1 mol/L sodium hydroxide in rat corneas. The VEGF-siRNA-transfected-corneal epithelium cells were transplanted to the CNV lesions. Immediately after transplantation, the VEGF-siRNA combined with lipofectamine 2000 were directly transfected rat cornea through injecting into the anterior chamber. After surgery, the surface areas occupied by new vessels were measured, and VEGF protein was localized by immunohistochemistry. RESULTS: The levels of VEGF expression at both mRNA and protein in the VEGF-siRNA transfected corneal epithelial cells and keratocytes were significantly lower than those of control cells. VEGF siRNA could inhibit the expression of VEGF mRNA in corneal epithelial cells and keratocytes to 57% - 85% and 59% - 78%, respectively. The VEGF-siRNA-transfected-corneal epithelium transplantation significantly decreased the surface areas occupied by new vessels. VEGF expression level in interference groups was lower than that in the control group. CONCLUSIONS: The development of CNV is markedly suppressed by VEGF-siRNA transfection in vivo.

[Repairing rabbit orbital defects with human BMP-2 gene modified bone marrow stromal cells and coral].

OBJECTIVE: To investigate the efficacy of tissue-engineered bone (human BMP-2 genetic modified BMSC combined with coral) in healing the segmental orbital defect in rabbits. METHODS: Rabbit BMSC were isolated and cultured in vitro, and cells of passage 2 were infected with adenovirus-mediated transfection of human BMP-2 gene (150 pfu/cell). After infection, the expression of BMP-2 was determined by RT-PCR and Western blot analysis, and cell proliferation and osteogenic differentiation were observed by flow cytometry, ALP and Alizarin red staining. A 12 mm bone defect in the infraorbital rim was induced by surgery in both orbits of 24 New Zealand white rabbits. The defects were repaired with modified tissue-engineered bone constructed with coral plus BMP-2 transfected BMSC (Group A, n = 12), constructed by coral plus non-transfected BMSC (Group B, n = 12) and grafts of coral alone (Group C, n = 12), with untreated group (Group D, n = 12) served as control. The osteogenesis of bone defect was monitored by gross observation, micro-CT measurement, histological and histomorphologic analysis at 4, 8, and 16 weeks after the implantation. RESULTS: After transfection, the BMP-2 expression was confirmed by RT-PCR and western blot, and the osteogenesis activity of BMSC could be obviously enhanced. The 12 mm segmental defect of rabbit orbit couldn't heal alone. Gross observation and micro-CT demonstrated well the bony-union in experimental group, with higher bone mineral density and more bone volume than other control groups (F = ll.46, F = 7180.97; P < 0.05). CONCLUSION: This study demonstrated that the rabbit orbital defect could be successfully repaired by tissue-engineered bone constructed with human BMP-2 gene modified BMSC and coral.

[Comparison of contrast sensitivity and wavefront analysis after implantation of AcrySof IQ aspherical intraocular lens].

OBJECTIVE: To determine vision quality when testing two acrylic intraocular lenses, AcrySof IQ and AcrySof Natural, after routine cataract extraction and IOL implantation. METHOD: Prospective, randomized, double-masked study that 260 eyes of patients who underwent cataract extraction and IOL implantation was performed. Patients were randomly divided into 2 groups: AcrySof IQ or AcrySof Natural. One week, one and three month postoperative evaluations included contrast sensitivity and wavefront analysis. The independent-samples T test was used. P < 0.05 was considered statistically significant. RESULT: The AcrySof IQ group has significantly higher and middle spatial frequency of contrast sensitivity. The difference in low spatial frequency was getting significant along with time. Patients with AcrySof IQ had a reduction in total high-order aberrations and spherical aberration. There were no difference in coma between two groups. CONCLUSION: The use of aspheric acrylic AcrySof IQ IOL may improve the quality of vision as a result of the reduction of contrast sensitivity and spherical aberration.

[Treatment of orbital venous malformation using surgical procedure combined with Nd:YAG laser].

OBJECTIVE: To evaluate the security and efficacy of surgical procedure combined with Nd:YAG laser in the management of orbital venous malformation. METHODS: A total of 17 successive patients with orbital venous malformation were treated with surgical excision in conjunction with Nd:YAG laser from July 2003 to June 2005. General anesthesia was performed in all patients. Appropriate approach was used according to the location and size of the lesion as well as its relation with adjacent tissues. Surgical procedure and laser coagulation were performed alternatively. Intermittent or continuous photocoagulation aimed at minor and deep lesions or large and superficial lesions was administrated, respectively, when indicated. Laser power of these two procedures was set at 60 to 90 J/cm2 or less than 100 J/cm2, respectively. Cold saline solution was used to cool the targeted region immediately after photocoagulation in case of damage to surrounding normal tissues. RESULTS: Seventeen patients were followed-up for 12 to 26 months. Notable lesion regression was found in 15 cases and fair reduction of the lesion in 2 cases. Vision acuity decrease did not occur and vision acuity increase was found in 2 patients. Exophthalmos was completely corrected, enophthalmos was found in 4 patients, the movement of the eyeballs was markedly improved. Complications consisted of superior oblique muscle paralysis (1 case) and ptosis (1 case). Relapse or aggravation of residual lesion was not found during the whole follow-up period. CONCLUSIONS: Surgical procedure combined with Nd:YAG laser is a safe and effective procedure in managing patients with orbital venous malformation. Laser treatment can decrease the hemorrhage during operation, make the surgical procedure easier, reduce the risk of operation and improve the results of surgical treatment.

[Removal and plastic reconstructive surgery of orbital neurofibroma].

OBJECTIVE: To investigate the safety and efficacy of surgical management of orbital neurofibroma (NF). METHODS: Twenty-six patients with orbitotemporal NF underwent tumor resection. And then 12 of the 26 patients that were of Jackson group I, underwent blepharoplasty surgery, including lid plastic and reconstructive surgery, lateral canthal reattachment and ptosis surgery. Ten patients of group II underwent blepharoplasty combined with orbital reconstruction. And 4 patients of group III underwent blepharoplasty surgery, orbital reconstruction, and hydroxyapatite orbital implanting. The functionally useless eyes of 2 patients were retained for cosmetic appearance. RESULTS: There was no recrudescence after neurofibroma resection. 10 patients had their vision acuity improved. All patients obtained satisfying results after eyelid and orbital plastic surgery. 2 patients relapsed into ptosis that was cured with further frontalis suspension procedure with autogenous fascia lata. CONCLUSION: Neurofibroma removal surgery is a safe and effective treatment method for NF patients. The periorbital appearance and visual acuity of patients with orbitotemporal NF can be significantly improved through oculoplastic surgery.

[Problems and countermeasures in orbital plastic and reconstructive surgery].

The great progress in orbital plastic and reconstructive surgery (OPRS) in China has been reached since the 21st century. However, obvious disparities exist between China and the developed countries in terms of the insufficiency of quality and quantity of surgeons of OPRS, lack of standardized and systematic training in China. It is necessary to pay attention to the diagnosis, prevention and treatment of orbital deformities, master surgical techniques and selection of the right moment of OPRS, study on orbital repairing materials and tissue engineering bone. Other important measures to improve the level of OPRS in China would include considering the characteristic of OPRS, establishing standardized and systematic professional trainings for orbital plastic surgeon, and strengthening basic and clinical research in OPRS.