Eyelid reconstruction in ophthalmic surgical practice

Introduction: Eyelid reconstruction is not implemented very often in ophthalmic surgical practice.  Numerous surgical procedures exist, and the surgeon’s experience is one of the leading factors for the choice of a technique.Aim: The aim of this article is to study the causes and frequency of eyelid surgeries at the Specialized Eye Hospital for а five-year period and to evaluate the chosen surgical approach in relation to patients’ disease.Materials and Methods: A retrospective study was conducted on all patients who underwent eyelid surgery in the hospital for the study period (2011-2015). Detailed information was collected on demographic data, clinical details for the diagnosis, histological results, and type of surgery.Results: A total of 692 reconstructive eyelid surgeries were performed, which represents 5.63% of all surgeries in the hospital for the study period. The most common cause of planed eyelid surgery was tumor excision (50.8%) and the used reconstructive procedures were: direct closure in 78.3% of cases, skin flap transposition – 15.5%, Hughes procedure – 3.1%, full-thickness skin graft – 2.7%, and Cutler-Beard procedure – 0.4%. Entropion was diagnosed in 18.5%, ectropion – 13.0%, dermatochalasis – 9.1%, and ptosis – 8.5% of the planned surgeries. The most frequently used technique for entropion repair was the Quickert procedure – 44.7% and for ectropion repair this was the Bick procedure – 59.1%. Ptosis was acquired in 62.8% of cases, and the most frequently used technique was aponeurosis surgery – 57.2%.Conclusion: Eyelid reconstruction is an important branch of oculoplastic surgery. We found that tumor excision was the most common reason for planned eyelid surgeries.  In recent years, the number of blepharoplasties has increased markedly

Trends in registered blindness in eastern Bulgaria

Purpose: The purpose of the study was to evaluate the incidence and causes of registered blindness and low vision in Eastern Bulgaria.Methods: Documentation per each included patient based on archives of the Expert Disability committee was evaluated and divided in two intervals. The cumulative incidence per 100 000 was calculated in 3 severity groups for bilateral and monocular blindness and by residence.Results: The incidence of binocular blindness decreased from 63.79 to 41.61 for males and from 64.21 to 41.14 for females during the second period. Meanwhile, monocular blindness increased from 41.14 to 65.14 for males and from 33.01 to 48.83 for females. It rapidly increases after 60 years of age and is the highest for those over 80. Patients with visual acuity (VA) below 0.05 comprise 40-35%, between 0.06 and 0.1 - 22- 35%, and 0.15 to 0.3 - 38-34%. The proportion and incidence of patients with VA below 0.05 have decreased two times during the second period among residents of cities and remained high - 42-48% in the rural population. Severe monocular blindness was significantly higher among males across the whole population. In the age group below 19 years, the leading causes of binocular blindness were retinopathy of prematurity (ROP), congenital glaucoma, microphthalmos and congenital cataract and for monocular impairment - trauma and amblyopia. For those above 20, the main causes were glaucoma, end-stage diabetic retinopathy, cataract - both with significant reduction in the incidence, AMD and trauma.Conclusions: Systematic evaluation of the deteriorated quality of life and estimation of the cost of vision loss and eye diseases to individuals and their families as well as extended family caregivers and thirdparty payers, the health care system and Bulgarian society is essential in the development of evidence-based interventions that translate research into enhanced clinical and community practice and prevention of unnecessary visual impairment

Surgical treatment of periocular basal cell carcinomas - 15 years of experience

PURPOSE: To analyze the outcome of periocular basal cell carcinoma (BCC) treated by surgical excision and evaluated using formalin fixed, paraffin-embedded sections.METHODS: One hundred-ninety-three patients with periocular BCC, were operated in Department of ophthalmology and Specialized Eye Hospital, Varna, Bulgaria since 1999 to 2013. Data were analyzed considering demographics, tumor localization, histological results, type of eyelid reconstruction, recurrence rate and aesthetic outcome.RESULTS: Of the total 193 patients with BCC, 136 (70.5%) had lower eyelid involvement. The most common histologic subtype was solid 126 (65.3%). One hundred seventy-six patients (91.2%) were with primary and 17 (8.8%) with recurrent tumors. Fifty-nine percent of lid defects were treated by direct closure. The mean follow-up period was 50 months. There were 15 (7.8%) recurrences. Excellent aesthetic outcome was achieved in 45%.CONCLUSIONS: Basal cell carcinoma is the most common malignant tumor of the eyelid engaging mainly the lower eyelid. Surgical excision with paraffin sections is a viable technique for managing periocular BCCs. Delayed repair is advisable in cases of poorly demarcated tumors. Significantly higher risk of recurrence exists in a more aggressive form of BCC. Using different techniques of reconstruction provides very good functional and aesthetic results

Eyelid Reconstruction with Full Thickness Skin Grafts After Carcinoma Excision

Background: Various techniques have been proposed for reconstruction of the eyelid anterior lamella after carcinoma excision: among these are the transposition of skin flaps, and full-thickness skin grafts or combination of these two

50 години Катедра „Социална медицина и организация на здравеопазването`

22 Май 201