Luz María Vásquez

Permanent Blindness after Endoscopic Sinus Surgery

Few cases of ophthalmic complications have been reported following sinus endoscopic surgery with current techniques. Irreversible damage to orbital structures was found in a 21-year-old patient referred to our department for evaluation after sinus endoscopic surgery and ipsilateral amaurosis.

Hyaluronic Acid Treatment for Upper Eyelid Retraction After Glaucoma Filtering Surgery

A 51-year old female presented with upper lid retraction after glaucoma filtering surgery. After two surgical procedures to correct the retraction with only transient effect, she was finally treated with hyaluronic acid gel filling achieving good aesthetic and functional result.

Direct Frontalis Flap with and without Levator Pulley for Correction of Severe Ptosis with Poor Levator Function in the Same Patient

Purpose: To compare two techniques of frontalis muscle flap suspension in different eyelids of the same patient for correction of severe ptosis with minimal levator function. Material and methods: A prospective study of four patients with severe bilateral ptosis and poor levator function, who underwent direct frontalis muscle flap on the right eyelid and frontalis muscle flap with levator pulley on the left eyelid was conducted. Eyelid studies measurements were taken at baseline, 2 months, one year and 5 years after surgery. The presence of complications, flap function and palpebral contour were evaluated. Results: Despite the surgical technique performed, good results in terms of functionality, contour and aesthetics were observed. In the eyes that underwent frontalis muscle flap (FMF)-direct, there were 2 cases with moderate anteriorization of eyelid margin in extreme upgaze and all patients showed eyelash ptosis that persisted one year after surgery, but improved after 5 years. In the eyes that underwent FMF-pulley, no upgaze anteriorization of eyelid margin was observed and three patients had eyelash ptosis of lesser extent than the fellow eye, improving after 1 year follow-up. FMF-pulley showed more long-term stability in eyelid height, compared with FMF-direct. Conclusions: Frontalis muscle flap with a pulley in the levator aponeurosis prevents some complications caused by the excessive vertical component of the direct frontalis muscle flap, especially in deep-set eye patients, with better stability of the eyelid height and contour over time.

Lagophthalmos after facial palsy: current therapeutic options.

As the facial nerve carries sensory, motor and parasympathetic fibres involved in facial muscle innervation, facial palsy results in functional and cosmetic impairment. It can result from a wide variety of causes like infectious processes, trauma, neoplasms, autoimmune diseases, and most commonly Bells palsy, but it can also be of iatrogenic origin. The main ophthalmic sequel is lagophthalmos. The increased surface exposure increases the risk of keratitis, corneal ulceration, and potentially loss of vision. Treatment options are wide; some are temporary, some permanent. In addition to gold standard and traditional therapies and procedures, new options are being proposed aiming to improve not only lagophthalmos but also the quality of life of these patients.

Transcaruncular rectus tendon fixation to the orbit and frontalis flap for complete third nerve palsy

ABSTRACT Purpose: To describe our experience and outcomes managing complete third cranial nerve palsy. Methods: This was a retrospective analysis of the clinical records of 7 consecutive patients treated at our centre for unilateral third nerve palsy over the period 2010–2016. We describe our surgical approach using a frontalis muscle flap to correct the eyelid ptosis associated with medial fixation of the rectus muscle tendon to the orbit to correct the horizontal deviation. Results: The seven patients, four women and three men, were of mean age of 44 ± 19 years [18–75 years]. Follow up was 29 ± 31 months [5–82 months]. In the preoperative exam, exotropia in prism diopters (PD) was −70 ± −28 PD [−30 to −90 PD]. At the end of follow up, this was reduced to −11 ± −14 PD [0 to −30 PD]. Preoperative marginal reflex distance 1 (MRD1) was −4 ± 1 mm [−3 to −5 mm] and palpebral fissure height (PFH) was 0.5 ± 1 mm [0–2 mm]. Surgical undercorrection was the target in all patients due to the absent or poor Bell’s phenomenon. At the end of follow up, MRD1 was 2.5 ± 0.5 mm [2–3 mm] and PFH was 7 ± 1 mm [6–8 mm]. Cosmetic and functional results were good in all patients. Conclusions: Medial fixation of the rectus muscle tendon to the orbit associated with a frontalis muscle flap is a valid option for the treatment of exotropia and ptosis in patients with third cranial nerve palsy.

Orbital and peri-orbital amyloidosis: a report of four cases

ABSTRACT Our objective was to describe our experience with orbital amyloidosis, and illustrate the different forms of presentation. This was a retrospective case series of four patients with biopsy-proven orbital amyloi- dosis, over the period from 2014 to 2016. We describe its diagnostic and clinical characteristics, management and systemic study. The series comprised three women and one man of mean age 52 ± 9.4 years. Affected sites were the lacrimal gland, tarsal conjunctiva, lacrimal sac and orbit. In three of the four patients, calcifications were observed. Three patients had associated ptosis. The patient with orbital involvement suffered an unusual vascular complication during surgery and systemic disease was detected. Management included debulking and complete resection of the lesion. In conclusion, orbital amyloidosis presents as a wide variety of forms. Its diagnosis is biopsy-based. Calcifications in biopsy specimens or images should raise suspicion of amyloidosis. It is important to always check for systemic amyloidosis.

Inferior tarsal muscle-conjunctivectomy for reverse ptosis repair: A novel technique

ABSTRACT We describe a new technique for treatment of reverse ptosis in a patient with Horner Syndrome by means of excision of conjunctiva and inferior tarsal muscle. Surgery with eversion of inferior ptotic eyelid, placement of the Putterman ptosis clamp on the conjunctiva under inferior tarsus, suturing under incarcerated tissue and resection of 6mm of conjunctiva and inferior tarsal muscle was done under local anaesthesia in a short operating time with good cosmetic results without eyelid malposition or skin scar.

Contents Vol. 52, 2014

175 SIRCOVA-OFTARED-RIG Joined Congress Abstracts Valencia (Spain), November 7–8, 2014 (online only) 239 Acknowledgement to Referees