Oculoplastics News

SALZBURG, Austria – A radical corneal prosthesis surgery can restore sight in patients blinded by severe corneal problems. The osteo-odonto-keratoprosthesis (OOKP), a precorneal fixed visual aid made from the patient’s own dental bone, can still be a viable option for selected patients, according to Günther Grabner, MD, of Salzburg Eye Clinic here.

The field of oculoplastic and orbital surgery has changed dramatically over the past 20 years. The American Society of Ophthalmic Plastic and Reconstructive Surgery has increased its numbers through fellowship programs that have grown from 1 year to 2 years long. Oculoplastic surgeons who have passed the rigorous oral and written exam and submitted a thesis for publication now number well over 300 physicians in the United States. The logical evolution of our expertise and skills has led us to become more involved in periorbital surgery such as endoscopic brow lifts, cheek lifts and many aspects of facial plastic surgery.

In today’s fast-paced society, sewing the upper and lower lids together for 4 to 6 weeks is considered more than a minor nuisance. In a one-eyed person, it is obviously a serious deterrent in their lives. It also can create difficulty for patients with ocular medications.

LAGUNA NIGUEL, Calif. — Blepharoplasty is one of the best enhancement procedures used in cosmetic surgery, but avoiding dry eye postoperatively is sometimes difficult, said Don O. Kikkawa, MD.

TAMPA, Fla. - The mini-Monoka (FCI Ophthalmics; Marshfield Hills, Mass.) is a silicone monocanalicular stent designed to repair canalicular lacerations. J. Justin Older, MD, an oculoplastic specialist here, instead uses the device to dilate the stenotic punctum and canaliculus.

Levator maldevelopment (dysmyogenic) ptosis is the most common type of ptosis seen in childhood and is caused by primary dystrophy of the levator muscle. Mueller's superior tarsal muscle is normal. Approximately 75% of congenital ptosis is unilateral. Congenital ptosis is usually a pure congenital ptosis. However, it may be associated with superior rectus weakness, Marcus-Gunn synkinetic jaw winking ptosis and blepharophimosis syndrome. Amblyopia is found in about 20% of patients, usually secondary to convergent strabismus, high astigmatism and anisometropia. Anderson and Baumgartner report rare instances of amblyopia due solely to the ptotic occlusion of the pupil.

The new European “collagens” are coming, and to borrow a phrase used by New York Sun Editor Francis Church on Sep. 21 in an editorial reply to reader Virginia O’Hanlon in 1897, “Yes Virginia, there is life for Healon after cataract surgery.” I have referred to this new material as European collagen, as most cosmetic patients are knowledgeable about collagen and can relate to the fact that a new type of filler agent is available in Europe.

In this report, Jerome R. Klein, MD, an oculoplastic surgeon who does much cosmetic surgery, describes the treatment of facial keloids using mitomycin. The article is well worth reading and keeping as a reference.

The most common complications of total transcutaneous lower eyelid blepharoplasty (skin-muscle flap with removal of bulging fat pockets) are ectropion and lid retraction. Preoperative horizontal lid laxity or excessive surgical shortening of the skin can result in postop ectropion. Horizontal lid laxity can be identified preop by evaluating the appositional tension and elasticity of the lid. A lid retraction test (STASIOR, snap) and slit lamp evaluation of the tear film distribution are essential. Horizontal lid laxity is an indication for combining lateral canthal suspension with transcutaneous lower eyelid blepharoplasty.

Upper eyelid retraction can be treated surgically by numerous techniques. The basic two approaches are through the conjunctiva or the skin. Various surgeons have developed different procedures within each of these two basic routes. One of the advantages of the transcutaneous approach is the ability to do a cosmetic blepharoplasty while correcting the eyelid retraction.