elastography in primary open-angle glaucoma

Objective: The aim of this study was to compare sonoelastographic findings in the retina-choroid-sclera (RCS) complex and vitreous in glaucomatous and healthy eyes.Methods: For this cross-sectional comparative study, 20 patients with primary open-angle glaucoma and 20 healthy volunteers were recruited. Ultrasound elastography measurements were taken with a sonographic scanner of the RCS complex, anterior vitreous (AV), posterior vitreous (PV), retrobulbar fat tissue (RFT), optic disc (OD) and optic nerve (ON) in each eye.Results: The elasticity index of the RCS complex, RFT, OD, ON, AV and PV was similar in both groups (p > 0.05), although the AV/PV strain ratio in the group of patients with glaucoma was significantly higher (p = 0.04).Conclusion: Glaucoma increases the AV/PV strain ratio. In providing reproducible and consistent values, the real-time elastography (RTE) technique may be helpful in elucidating the mechanisms of glaucoma in some aspects.Advances in knowledge: This study can help to evaluate the elasticity of the RCS complex and vitreous in glaucomatous eyes with RTE

“Suspension of the eyelid to the check ligament of the superior fornix in congenital blepharoptosis”

A new surgical procedure for the treatment of all types of congenital blepharoptosis is described: suspension of the eyelid to the check ligament of the superior fornix. This is a dynamic suspension technique by which the check ligament, which is an extension of Tenon's capsule and normally inserts into the superior conjunctival fornix, is brought forward and sutured to the tarsus, which raises the eyelid. This technique does not sacrifice or add any tissue and is simple to repeat if necessary. Sixty-two patients were operated on using the technique and followed up for a mean of 23 months (range 3 months to 9.6 years). In a group of patients not operated on before for ptosis, 50 eyelids were raised with 74% normalisation, 22% improvement, and one eyelid each that showed only slight change or overcorrection. In a group of patients with 27 eyelids operated on before using other techniques, 67% of the eyelids were normalised, 30% were improved, and only one eyelid showed no change. In conclusion, this new technique has proved to be quite successful in raising the level of the upper eyelid in congenital blepharoptosis, with results at least comparable to those of most other techniques. The advantages with the check ligament over other techniques are the minimal trauma of the surgery, its simplicity, and its repeatability

The evaluation of fibrin tissue adhesive for skin closure following eyelid surgery

The use of fibrin tissue adhesives in clinical practice has grown over the past 10 years, and there has been increased use of adhesives in different surgical subspecialties. Conventional suture closure of periorbital tissues is effective however may result in complications, which has led to the search for other techniques and innovations. Although tissue adhesives have been used in clinical practice there is a paucity of randomized controlled studies that have evaluated their advantages and disadvantage in surgical practice. The goals of eyelid surgery include the restoration of tissue structure and function while causing minimal morbidity. The use of a medical product that induces physiological clotting and fibrin formation is appealing in both theory and clinical practice. However fibrin tissue adhesives present disadvantages and complications of their own. This thesis set out to evaluate the use of fibrin tissue adhesives in eyelid surgery and includes a 5-year randomized control study comparing fibrin tissue adhesives to suture closure of skin. A challenge in the evaluation of eyelid surgery is the definition of a successful outcome. Surgical outcomes have traditionally been measured by surgical complications and the need for further redo surgery. Other relevant aspects of surgical outcome that have rarely been evaluated include surgical healing and scar formation, asymmetry that is present however not requiring further surgery, patient experience and satisfaction. This research set out to further define outcomes for eyelid surgery to enable a more comprehensive and objective evaluation of surgical outcome

How to avoid from an ectropion complication by using motor innervation prevention at lower eyelid blepharoplasty surgery

The subciliary incision is the most commonly used approach for lower eyelid blepharoplasty because of the advantages like ease of combining with other periocular and midface rejuvenation techniques. However, the most common reported major complication is lower lid malposition. In this article we described our subciliary dissection technique to protect the motor branches of tarsal orbicularis oculi to avoid from ectropion

Complications of Blepharoplasty: Prevention and Management

Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. The surgery involves removing redundant skin, fat, and muscle. In addition, supporting structures such as canthal tendons are tightened. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. Due to the complexity and intricate nature of eyelid anatomy, complications do exist. In addition to a thorough pre operative assessment and meticulous surgical planning, understanding the etiology of complications is key to prevention. Finally, management of complications is just as important as surgical technique

An effective option for the repair of facial defects V-Y advancement flaps and modifications

Objective: V-Y advancement flaps are pliable local flaps that can be used in nearly every part of the body with relatively minimal technical difficulty. These flaps provide the best color and quality match, especially in the facial region. With effective planning, donor site morbidity can be acceptable, even on the face. Methods: The results of 38 patients who underwent 53 V-Y advancement flap facial reconstructions were analyzed retrospectively. The defects were evaluated according to their anatomical region, etiology, postoperative complications, and final aesthetic results. Results: V-Y advancement flaps were used for defects that were either not amenable to primary repair or had a high risk of cosmetic distortion. The defects were located in the cheek (9 patients), nasolabial fold (7 patients), nose (6 patients), forehead (5 patients), preauricular area (3 patients), infraorbital region (3 patients), lower lip (1 patients), gingivobuccal sulcus (2 patients), and medial canthal region (2 patients). In 32 patients, the primary pathology was malignant tumor (22 basal cell carcinomas, 9 epidermoid carcinomas, 1 malignant eccrine poroma). Etiologies of the other patients' defects were benign tumors (n=2), traumatic wounds (n=2), and contractures (n=2). Conclusions: Despite the widespread use of V-Y flaps in surgical practice, the technique continues to demonstrate additional advantages, particularly in facial reconstruction. They are not only applicable for medium and small defects, but can be used for all defects with sufficient surrounding tissue. They enable various modifications and the elevation of multiple flaps

Strabismus surgery complications: prevention and management

Journal ArticleStrabismus surgery is increasingly becoming a subspecialty domain, especially with cyclovertical muscles, restricted muscles, or reoperations. While is impossible to completely eliminate complications from strabimus surgery, it is possible to minimize their occurrence and significance by proper prevention and management. In general, the best policy for avoiding poor outcomes from complicated surgery is to perform procedures only for which one has been fully trained and has the necessary experience. This update will describe intraoperative and postoperative complications of strabismus surgery, emphasizing their prevention and management