Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,signif...Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,significant enophthalmos,or muscle entrapment.Surgical repair of these injuries may be challenging due to large fracture sizes or loss of bony supports.The transconjunctival and transcaruncular approaches have been popularized to reconstruct isolated floor and medial wall fractures,respectively.However,surgical approaches for fractures involving both these walls have not been well described in the literature.In this technical note,we detail a combined transcaruncular-transconjunctival approach that is safe,effective,and aesthetically sensitive.展开更多
Aim:Transconjunctival CO_(2)laser lower blepharoplasty is considered to be a safe and reliable approach.A retrospective review of transconjunctival approached CO_(2)laser lower blepharoplasty associated with fractiona...Aim:Transconjunctival CO_(2)laser lower blepharoplasty is considered to be a safe and reliable approach.A retrospective review of transconjunctival approached CO_(2)laser lower blepharoplasty associated with fractional CO_(2)laser ablation or fractioned non-ablative Fraxel laser resurfacing for lower eyelid rejuvenation is presented for comparison.Methods:From February 1996 to February 2016,250 patients underwent CO_(2)laser lower blepharoplasty with a male to female ratio of 1:7.5.The age ranged from 43 to 68 years(mean 52 years).A CO_(2)laser was applied to make a transconjunctival lower blepharoplasty.Immediately after CO_(2)laser lower blepharoplasty,40 patients received fractional CO_(2)laser and 40 patients took Fraxel laser for resurfacing.Results:Swelling occurred in all patients postoperatively.Complications related to transconjunctival CO_(2)laser lower blepharoplasty were 6(2.4%)patients with conjunctival chemosis,5(2.0%)with ecchymosis,and 3(1.2%)with granulomas.The early complications(≤1 month)related to fractional CO_(2)laser ablation were 40(100%)patients with mild erythema,40(100%)with mild edema,1(2.5%)with hyperpigmentation,1(2.5%)with infection,and 1(2.5%)with scarring.These problems resolved in all patients after 3 months.There was no complication after Fraxel laser right after lower blepharoplasty.The Fraxel group had short recovery time.However,there was no statistically significant difference between the two groups in final outcome(≥6 months).Conclusion:Transconjunctival CO_(2)laser lower blepharoplasty associated with fractional CO_(2)laser ablation or Fraxel laser resurfacing assisted the appearance around the periorbital regions.展开更多
AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients wh...AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.展开更多
Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags;in our practice this access has become the preferred technique...Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags;in our practice this access has become the preferred technique in most of our cases because it is simpler, faster, prevents bad scarring, produces less orbicularis muscle trauma, and decreases postoperative edema and possible retractions (ectropion) in patients with decreased lower palpebral tone. Objective: To identify important concepts when deciding this approach. Material and Methods: Retrospective review of 177 patients who underwent lower blepharoplasty by a single surgical group. Regarding techniques, the transconjunctival approach was selected in 42% of patients while the transcutaneous technique was preferred in 58%. Results: A lower rate of complications was observed by the transconjunctival approach, with greater patient satisfaction. Conclusions: In our experience, due to its simplicity and less traumatic effect on the patient, the transconjunctival approach is an ideal technique, except in cases where there is lower eyelid weakness and surgical resolution is needed.展开更多
The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose t...The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose the zygomatic arch and periorbital areas. The swinging eyelid procedure, therefore, enables appropriate reduction of zygomaticomalar fracture under direct visualization. We used this technique for a 27 years old man with a displaced zygomaticomalar fracture that pushed on the lateral rectus muscle. Good functional and cosmetic results were obtained postoperatively without ocular motility impairment.展开更多
Purpose:Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures.The aim of this study was to compare the findings of specific ophthalmologic assessment with...Purpose:Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures.The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction.Methods:A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil(ethisorb sheet or polydioxanone foil).A follow-up assessment including ophthalmological evaluation regarding visual acuity(eye chart projector),binocular visual field screening(Bagolini striated glasses test)and diplopia(cover test,Hess screen test)was conducted.Additionally,a questionnaire was performed to assess patients'satisfaction.Results:A total of 53 patients with a mean follow-up of 23 months(ranging from 11 to 72)after surgical therapy were included.Diplopia was present preoperatively in 23(43.4%)and reduced in follow-up examination(n=12,22.6%).Limitations in ocular motility reduced from 37.7%to 7.5%.The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters.Conclusion:Transconjunctival approach is a safe approach for orbital fracture therapy.Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.展开更多
文摘Double-walled orbital fractures involving the floor and medial wall are commonly encountered in instances of significant midface trauma.Operative intervention is indicated in the presence of persistent diplopia,significant enophthalmos,or muscle entrapment.Surgical repair of these injuries may be challenging due to large fracture sizes or loss of bony supports.The transconjunctival and transcaruncular approaches have been popularized to reconstruct isolated floor and medial wall fractures,respectively.However,surgical approaches for fractures involving both these walls have not been well described in the literature.In this technical note,we detail a combined transcaruncular-transconjunctival approach that is safe,effective,and aesthetically sensitive.
基金supported by research grants awarded of Chang Gung Memorial Hospital(CMRP 821,CMRPG3E0581)Additional institutional support was received from the National Science Council(NMRPG9002:NSC 89-2314-B-182A-150),Taiwan.
文摘Aim:Transconjunctival CO_(2)laser lower blepharoplasty is considered to be a safe and reliable approach.A retrospective review of transconjunctival approached CO_(2)laser lower blepharoplasty associated with fractional CO_(2)laser ablation or fractioned non-ablative Fraxel laser resurfacing for lower eyelid rejuvenation is presented for comparison.Methods:From February 1996 to February 2016,250 patients underwent CO_(2)laser lower blepharoplasty with a male to female ratio of 1:7.5.The age ranged from 43 to 68 years(mean 52 years).A CO_(2)laser was applied to make a transconjunctival lower blepharoplasty.Immediately after CO_(2)laser lower blepharoplasty,40 patients received fractional CO_(2)laser and 40 patients took Fraxel laser for resurfacing.Results:Swelling occurred in all patients postoperatively.Complications related to transconjunctival CO_(2)laser lower blepharoplasty were 6(2.4%)patients with conjunctival chemosis,5(2.0%)with ecchymosis,and 3(1.2%)with granulomas.The early complications(≤1 month)related to fractional CO_(2)laser ablation were 40(100%)patients with mild erythema,40(100%)with mild edema,1(2.5%)with hyperpigmentation,1(2.5%)with infection,and 1(2.5%)with scarring.These problems resolved in all patients after 3 months.There was no complication after Fraxel laser right after lower blepharoplasty.The Fraxel group had short recovery time.However,there was no statistically significant difference between the two groups in final outcome(≥6 months).Conclusion:Transconjunctival CO_(2)laser lower blepharoplasty associated with fractional CO_(2)laser ablation or Fraxel laser resurfacing assisted the appearance around the periorbital regions.
文摘AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.
文摘Currently in lower blepharoplasty, the transconjunctival approach indication has been limited to young patients without skin excess and prominence of bags;in our practice this access has become the preferred technique in most of our cases because it is simpler, faster, prevents bad scarring, produces less orbicularis muscle trauma, and decreases postoperative edema and possible retractions (ectropion) in patients with decreased lower palpebral tone. Objective: To identify important concepts when deciding this approach. Material and Methods: Retrospective review of 177 patients who underwent lower blepharoplasty by a single surgical group. Regarding techniques, the transconjunctival approach was selected in 42% of patients while the transcutaneous technique was preferred in 58%. Results: A lower rate of complications was observed by the transconjunctival approach, with greater patient satisfaction. Conclusions: In our experience, due to its simplicity and less traumatic effect on the patient, the transconjunctival approach is an ideal technique, except in cases where there is lower eyelid weakness and surgical resolution is needed.
文摘The swinging eyelid procedure is a versatile technique to approach orbital and periorbital surgical fields with less visible scar. Although mainly used in orbital surgeries, this procedure can also be used to expose the zygomatic arch and periorbital areas. The swinging eyelid procedure, therefore, enables appropriate reduction of zygomaticomalar fracture under direct visualization. We used this technique for a 27 years old man with a displaced zygomaticomalar fracture that pushed on the lateral rectus muscle. Good functional and cosmetic results were obtained postoperatively without ocular motility impairment.
文摘Purpose:Primary reconstruction via transconjunctival approach is a standardized treatment option for orbital floor fractures.The aim of this study was to compare the findings of specific ophthalmologic assessment with the patient's complaints after fracture reduction.Methods:A retrospective medical chart analysis was performed on patients who had undergone transconjunctival orbital floor fracture reduction for fracture therapy with resorbable foil(ethisorb sheet or polydioxanone foil).A follow-up assessment including ophthalmological evaluation regarding visual acuity(eye chart projector),binocular visual field screening(Bagolini striated glasses test)and diplopia(cover test,Hess screen test)was conducted.Additionally,a questionnaire was performed to assess patients'satisfaction.Results:A total of 53 patients with a mean follow-up of 23 months(ranging from 11 to 72)after surgical therapy were included.Diplopia was present preoperatively in 23(43.4%)and reduced in follow-up examination(n=12,22.6%).Limitations in ocular motility reduced from 37.7%to 7.5%.The questionnaire about the patient's satisfaction revealed excellent outcomes in relation to the functional and esthetical parameters.Conclusion:Transconjunctival approach is a safe approach for orbital fracture therapy.Postoperative diplopia is nearly never perceptible for the individual and differs to pathologic findings in the ophthalmic assessment.
