Eyelid reconstruction using a monopedicle flap and buccal mucosa: report of 15 cases.

A method is described for eyelid reconstruction to close a large defect involving the lid margin using a myocutaneous flap over a free buccal mucosal graft. The procedure was performed on 15 patients over a three-year period. Thirteen patients had loss of lower lid tissue alone. One included the lateral canthus and one over 50% of both upper and lower lids. Results were good in all patients except the one with extensive reconstruction of both lids. Advantages over other techniques of lid reconstruction include ease of surgery, adaptability of the technique to any eyelid site, good tissue match and the need for only a one-stage procedure.

Congenital ptosis: results of surgical management.

PURPOSE: To determine the visual and cosmetic outcome following the surgical correction of isolated congenital ptosis. METHODS: A retrospective review of the outcome of isolated congenital ptosis corrected under the supervision of one surgeon at The Children's Hospital, Camperdown, between January 1983 and January 1993 was examined. Some 65 patients with 80 involved eyes were identified; 30 eyes underwent a levator resection procedure, 40 eyes underwent a brow suspension using donor stored fascia lata, and in 10 eyes a brow suspension was performed using mersilene mesh. RESULTS: In 78 eyes of 63 patients, a good cosmetic result was achieved. In two patients (two eyes) a poor cosmetic result was achieved. These two patients refused further surgery following an undercorrection of their initial ptosis. The recurrence rates for the primary procedures were 16.7% for levator resection procedures, 35% for brow suspension procedures using donor fascia lata, and 30% for brow suspension surgery using mersilene mesh. Some 35.3% of eyes following mersilene slings required further surgery for granulomas and exposed mersilene mesh compared with 6% having similar complications with stored fascia lata. Nine patients (11.25%) had reduced visual acuity (one line or more on the Snellen chart or its equivalent with the other tests used) on the operated side. Only one patient was found to have significant astigmatism. CONCLUSIONS: An acceptable cosmetic result was achieved with one operation in 75.3% of cases. In 20.8% of cases a second operation was required and in 3.9% of cases three or more operations were required. This series supports the view that where possible, levator resection is the preferred form of surgery to correct congenital ptosis. When the levator function is inadequate, brow suspension is performed. The use of donor fascia lata resulted in a good cosmetic appearance with a low occurrence of surgical side effects. Amblyopia, when strictly defined, occurred in 11.25% of eyes despite early surgery for severe cases and intensive amblyopia therapy. Management requires repeated follow up for early detection and introduction of occlusion therapy or surgical ptosis correction.

Expulsive choroidal haemorrhage--a clinical and pathological review.

This paper describes two cases of expulsive choroidal haemorrhage (ECH) where the final corrected visual acuity was 6/5. The management of one case consisted simply of vitrectomy; and the other of suprachoroidal drainage of blood followed by vitrectomy. The pathological findings in a series of eyes enucleated following ECH are also described. The literature is reviewed with regard to the aetiology, pathology and management of ECH.