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Bartley R Frueh - One of the best experts on this subject based on the ideXlab platform.
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palpebral spring in the management of lagophthalmos and Exposure Keratopathy secondary to facial nerve palsy
Ophthalmic Plastic and Reconstructive Surgery, 2009Co-Authors: Hakan Demirci, Bartley R FruehAbstract:PURPOSE To evaluate the use of a palpebral spring, a dynamic facial reanimation technique, in the management of lagophthalmos and Exposure Keratopathy secondary to facial nerve palsy. METHODS A palpebral spring was placed in 29 eyelids of 28 patients with symptomatic facial nerve palsy. Preoperative and postoperative symptoms, upper eyelid margin to midpupil distance, lagophthalmos, and Exposure Keratopathy were evaluated. RESULTS At an average of 83 months follow-up, preoperative symptoms improved or resolved in 26 (90%) eyes. The upper eyelid margin to midpupil distance decreased and lagophthalmos and Exposure Keratopathy significantly improved after palpebral spring placement (p < 0.001). After modification of the technique by suturing the spring to the anterior tarsal surface, rather than encasing the tip in a silicone tube and letting it ride freely, tension of the spring required adjustment in 4 eyes (27%). Dislocation of the spring from the tarsus without Exposure through the skin was observed in 1 eyelid (7%). The spring was replaced because of loss of function secondary to metal fatigue in 5 eyelids (33%) after an average of 43 months. Exposure of the spring through the skin was observed in 2 eyelids (14%) and required spring removal from 1 eyelid and replacement of the spring in the other. CONCLUSION A palpebral spring is an effective treatment for lagophthalmos and Exposure Keratopathy in patients with facial nerve palsy who do not receive adequate relief from the static procedures of lower eyelid tightening and upper eyelid lowering. This technique significantly improved symptoms and signs in these patients while allowing some of the blink reflex.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper eyelid retraction that results in Exposure Keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction. METHODS: Fifty eyelids of 32 patients with Graves eye disease-associated upper eyelid retraction, causing symptomatic ocular Exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular Exposure symptoms, upper eyelid position, lagophthalmos, and Keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P<.001), lagophthalmos (P<.001), and Keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid retraction that results in Exposure Keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid retraction. METHODS: Fifty eyelids of 32 patients with GED-associated upper lid retraction causing symptomatic ocular Exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular Exposure symptoms, upper lid position, lagophthalmos, and Keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P < .00001), lagophthalmos (P < .0001), and Keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.
Victor M Elner - One of the best experts on this subject based on the ideXlab platform.
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severe pediatric thyroid eye disease surgical case series
Ophthalmic Plastic and Reconstructive Surgery, 2017Co-Authors: Victor M Elner, Alon KahanaAbstract:Thyroid eye disease (TED) usually has mild manifestations in pediatric patients, and orbital decompression is rarely necessarily. The authors present the clinical course of 3 pediatric patients age 16 or younger at the time of decompression surgery with severe orbitopathy. Case 1 is a 9-year-old prepubertal Asian-American female with Graves' disease and TED who underwent balanced decompression for compressive optic neuropathy. Case 2 is a 14-year-old white female with Graves' disease and TED who underwent balanced decompression for compressive optic neuropathy, stretch optic neuropathy, and globe subluxation. Case 3 is a 14-year-old African-American male with unilateral euthyroid TED who underwent staged right-sided lateral, medial, and floor decompressions for asymmetric proptosis. All cases also had disfiguring proptosis and Exposure Keratopathy, and in all cases, surgery successfully ameliorated the indications. Children, both pre- and post-pubertal, can rarely manifest visually threatening severe orbitopathy due to TED. This represents the first reports of thyroid-related optic neuropathy and globe subluxation in pediatric patients. Further studies examining the mechanism responsible for the disparities in pediatric and adult TED are warranted.
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ultrasonic bone removal versus high speed burring for lateral orbital decompression comparison of surgical outcomes for the treatment of thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2010Co-Authors: Raymond I Cho, Christina H Choe, Victor M ElnerAbstract:Purpose: To evaluate the efficacy of ultrasonic bone removal during lateral orbital decompression for thyroid eye disease. Methods: Retrospective, comparative, interventional case series of lateral orbital decompressions performed by the senior author for thyroid eye disease between July 2005 and July 2008. Patients were excluded if they had other coexisting orbital conditions or concurrent decompression of other orbital walls. Primary outcome measures included visual acuity, proptosis, lagophthalmos, eyelid retraction, and Exposure Keratopathy. Results: Thirty-six consecutive lateral orbital decompressions performed by the senior author were reviewed. The Sonopet Omni ultrasonic surgical aspirator was used to remove the lateral wall in 18 cases, and a high-speed drill with a cutting burr was used in the other 18 cases. There was no significant difference between the groups in postoperative visual acuity, proptosis reduction, lagophthalmos, eyelid retraction, Exposure Keratopathy, or surgical complications. The average reduction in proptosis was 3.9 mm (range, 1–6.5 mm) in the Sonopet group and 4.0 mm (range, 1–6 mm) in the drill group (p = 0.86). In our series, the average surgical case time was slightly shorter in the Sonopet group than in the drill group (104 vs. 118 minutes, p = 0.032). Conclusions: Ultrasonic bone removal is a safe and effective alternative to high-speed burring during lateral orbital decompression for thyroid eye disease.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper eyelid retraction that results in Exposure Keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction. METHODS: Fifty eyelids of 32 patients with Graves eye disease-associated upper eyelid retraction, causing symptomatic ocular Exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular Exposure symptoms, upper eyelid position, lagophthalmos, and Keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P<.001), lagophthalmos (P<.001), and Keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid retraction that results in Exposure Keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid retraction. METHODS: Fifty eyelids of 32 patients with GED-associated upper lid retraction causing symptomatic ocular Exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular Exposure symptoms, upper lid position, lagophthalmos, and Keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P < .00001), lagophthalmos (P < .0001), and Keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.
David J Schanzlin - One of the best experts on this subject based on the ideXlab platform.
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COSMETIC Blepharoplasty in the Post–Laser In Situ Keratomileusis Patient: Preoperative Considerations to Avoid Dry Eye Syndrome
2015Co-Authors: Bobby S Korn, Don O Kikkawa, David J Schanzlin, Ph. D, La Jolla CalifAbstract:Background: The authors used a retrospective case series to describe the in-creased frequency of dry eye syndrome in patients who have undergone both laser in situ keratomileusis and blepharoplasty. Methods: The authors reviewed records from six patients who required surgical correction for Exposure Keratopathy previously treated by both laser in situ keratomileusis and blepharoplasty. Results: All six patients developed significant Exposure Keratopathy postoper-atively requiring surgical intervention. Four patients had blepharoplasty fol-lowed by laser in situ keratomileusis, and two patients had laser in situ kerato-mileusis followed by blepharoplasty. Symptomatic dry eye symptoms followed the second procedure 1 week to 4 months later. Surgical correction of eyelid malposition and lagophthalmos markedly improved symptoms. Conclusions: Patients with a history of laser in situ keratomileusis contemplat-ing blepharoplasty are at higher risk of developing postoperative dry eye syn-drome. Surgeons performing these procedures should perform thoroug
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blepharoplasty in the post laser in situ keratomileusis patient preoperative considerations to avoid dry eye syndrome
Plastic and Reconstructive Surgery, 2007Co-Authors: Bobby S Korn, Don O Kikkawa, David J SchanzlinAbstract:Background: The authors used a retrospective case series to describe the increased frequency of dry eye syndrome in patients who have undergone both laser in situ keratomileusis and blepharoplasty. Methods: The authors reviewed records from six patients who required surgical correction for Exposure Keratopathy previously treated by both laser in situ keratomileusis and blepharoplasty. Results: All six patients developed significant Exposure Keratopathy postoperatively requiring surgical intervention. Four patients had blepharoplasty followed by laser in situ keratomileusis, and two patients had laser in situ keratomileusis followed by blepharoplasty. Symptomatic dry eye symptoms followed the second procedure 1 week to 4 months later. Surgical correction of eyelid malposition and lagophthalmos markedly improved symptoms. Conclusions: Patients with a history of laser in situ keratomileusis contemplating blepharoplasty are at higher risk of developing postoperative dry eye syndrome. Surgeons performing these procedures should perform thorough preoperative evaluation and surgical planning to minimize this potential complication.
Bobby S Korn - One of the best experts on this subject based on the ideXlab platform.
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COSMETIC Blepharoplasty in the Post–Laser In Situ Keratomileusis Patient: Preoperative Considerations to Avoid Dry Eye Syndrome
2015Co-Authors: Bobby S Korn, Don O Kikkawa, David J Schanzlin, Ph. D, La Jolla CalifAbstract:Background: The authors used a retrospective case series to describe the in-creased frequency of dry eye syndrome in patients who have undergone both laser in situ keratomileusis and blepharoplasty. Methods: The authors reviewed records from six patients who required surgical correction for Exposure Keratopathy previously treated by both laser in situ keratomileusis and blepharoplasty. Results: All six patients developed significant Exposure Keratopathy postoper-atively requiring surgical intervention. Four patients had blepharoplasty fol-lowed by laser in situ keratomileusis, and two patients had laser in situ kerato-mileusis followed by blepharoplasty. Symptomatic dry eye symptoms followed the second procedure 1 week to 4 months later. Surgical correction of eyelid malposition and lagophthalmos markedly improved symptoms. Conclusions: Patients with a history of laser in situ keratomileusis contemplat-ing blepharoplasty are at higher risk of developing postoperative dry eye syn-drome. Surgeons performing these procedures should perform thoroug
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blepharoplasty in the post laser in situ keratomileusis patient preoperative considerations to avoid dry eye syndrome
Plastic and Reconstructive Surgery, 2007Co-Authors: Bobby S Korn, Don O Kikkawa, David J SchanzlinAbstract:Background: The authors used a retrospective case series to describe the increased frequency of dry eye syndrome in patients who have undergone both laser in situ keratomileusis and blepharoplasty. Methods: The authors reviewed records from six patients who required surgical correction for Exposure Keratopathy previously treated by both laser in situ keratomileusis and blepharoplasty. Results: All six patients developed significant Exposure Keratopathy postoperatively requiring surgical intervention. Four patients had blepharoplasty followed by laser in situ keratomileusis, and two patients had laser in situ keratomileusis followed by blepharoplasty. Symptomatic dry eye symptoms followed the second procedure 1 week to 4 months later. Surgical correction of eyelid malposition and lagophthalmos markedly improved symptoms. Conclusions: Patients with a history of laser in situ keratomileusis contemplating blepharoplasty are at higher risk of developing postoperative dry eye syndrome. Surgeons performing these procedures should perform thorough preoperative evaluation and surgical planning to minimize this potential complication.
Daniel G Ezra - One of the best experts on this subject based on the ideXlab platform.
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randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of Exposure Keratopathy in the critically ill
Intensive Care Medicine, 2009Co-Authors: Daniel G Ezra, Michelle P Y Chan, Lola Solebo, Aeesha N J Malik, Elizabeth Crane, Andrew Coombes, Marie HealyAbstract:Purpose To compare the cost and effectiveness of the two most popular forms of eye care in intensive care, ocular lubricant (Lacrilube) and polyacrylamide hydrogel dressings (Geliperm); for the prevention of Exposure Keratopathy in the critically ill.
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preventing Exposure Keratopathy in the critically ill a prospective study comparing eye care regimes
British Journal of Ophthalmology, 2005Co-Authors: Daniel G Ezra, G Lewis, M Healy, A CoombesAbstract:Microbial keratitis has been reported among critically ill patients and the need for effective eye care in the intensive care unit (ICU) has been recognised for some time.1 However, different eye care regimes are not always evidence based2 and there is no clear consensus defining the best form of eye care. A recent survey in the United Kingdom found that 75% of ICUs used Geliperm routinely as eye care, with 25% using ocular lubricants3 Although Geliperm was originally designed as a wound dressing and there is no evidence to support its use in eye protection. Lacrilube, however, has been shown to be effective in reducing Exposure Keratopathy in sedated and paralysed patients.4 This prospective comparative study aims to assess the prevalence of corneal surface disease in ICU and the effectiveness of two different eye care regimes at preventing corneal surface disease. Three main types of eye care are …
