Charles K. Beyer-Machule

Immunoglobulin Deposition in Localized Conjunctival Amyloidosis

Immunofluorescent studies were performed on tarsus and tarsal conjunctiva from a 30-year-old woman with blepharoptosis secondary to localized nonfamilial amyloidosis. Both kappa and lambda light chains were identified in abundance in the resected tissue. There was no evidence of any systemic disease or of amyloid deposition elsewhere. Six months after the patient underwent surgery, there was no sign of recurrence. The antigenic determinants of the amyloid suggested that the pathogenesis of localized nonfamilial ocular amyloidosis involves the accumulation of proteins similar to immunoglobulin.

Double composite lid reconstruction: a new method of upper and lower lid reconstruction.

The double composite grafting technique utilizes two composite lid grafts from an opposing upper and lower lid for reconstruction of extensive lid defects. These two composite grafts are covered by a rotational pedicle advancement skin flap. The skin defect created by such an advancement graft is covered by a free skin graft. The donor areas are closed directly by a layer-by-layer approximation. This new single-stage technique allows reconstruction of large lid defects without covering an affected eye for a prolonged period and without jeopardizing the irreplaceable entity of a “normal” lid margin.

Dermis Fat Graft in Eviscerated Sockets

Following evisceration, three patients who experienced extrusion of synthetic orbital implant underwent socket reconstruction using an autogenous dermis fat graft. An incision into the fundus of the existing sclera was necessary to provide for an adequate vascular bed for a composite fat graft, although the anterior ring of existing sclera with extraocular muscle attachments was not disturbed. Conjunctival reepithelialization of the dermal surface and enhancement of orbital volume occurred in each case. Furthermore, the autogenous fat graft retained the original excellent globe motility that was present before the socket reconstruction. After an average follow-up of 18 months, the volume restoration, integrity of conjunctival epithelium and fornices, and the graft viability have remained unchanged. As with alloplastic orbital implant extrusions in enucleated sockets, autogeneous dermis fat grafts can be useful in managing extrusions in previously eviscerated sockets.

Acquired ptosis associated with a conjunctival cyst

A 44-year-old woman with a history of previous ptosis surgery presented with a moderate ptosis of the left upper eyelid and a large cystic mass extending over the length of that lid. The mass was excised completely and histologically found to be a conjunctival ductal cyst. The levator aponeurosis was disrupted by the cyst and required reconstruction. This case demonstrates an acquired ptosis associated with a large conjunctival cyst as a late complication of ptosis surgery.

Fate of primary orbital dermis-fat grafts in guinea pigs.

A year-long study was undertaken to serially evaluate the tissue changes occuring in dermis-fat graft (DFG) after orbital implantation in nine guinea pigs. Methods used to evaluate the DFGs were histology, magnetic resonance imaging, mor-phometric analysis, and clinical observations. The histology of a 1-year-old failed human dermis-fat graft has been included for completeness. The study reveals that clinically successful DFGs have a fibrous capsule surrounding the DFG. Minimal revascularization was present. The grafts appear to undergo continual histological changes for ∼9 months before a steady-state condition ensues. Of interest are changes in the deep-orbital fat posterior to the DFG.

Eyelid Penetration of a Hard Contact Lens, Simulating a Neoplasm

A hard contact lens penetrated the right upper lid at the level of the aponeurosis of the levator palpebral superiors muscle. Later tumor-like symptoms developed of a hard movable mass with blepharoptosis.

Repair of the Lacerated Canaliculus Using a Modified Silver Wire Lacrimal Rod

Several techniques have been used to repair lacerated canaliculi with varying success in achieving functional results. In this communique, we describe a new procedure using a modified Johnson silver wire lacrimal rod.

An unusual case of adnexal infantile hemangioma

A four-year-old girl, a known case of infantile hemangioma of the left lower lid, presented, because of progressive rapid growth of the tumor, with episodes of spontaneous bleeding. Multiple local injections of a mixture of triamcinolone and betamethasone sodium phosphate were used with unsatisfactory results. Surgical excision of the lesion provided adequate cosmetic and physiologic control.

The modified Ambos lacrimal stent

The described silastic intubation method is workable and predictable and is an advisable therapeutic principle in congenital and acquired dacryostenoses. It represents a new method of introducing silastic tubing into the nasolacrimal excretory system.