Biomedical subjects
Publications and source records attributed to V A Przybyla.
Two patients with postoperative cicatricial lower lid ectropion were managed by having the patient massage the lower lid in an upward direction over a methyl-methacrylate scleral ring. The ectropion was corrected. Such nonsurgical management may be attempted as an alternate initial therapy for the patient who refuses or should not immediately undergo additional surgery.
Intraoperative visual-evoked potential recording has been a potentially useful procedure for monitoring the functional status of the visual pathways during certain neurosurgical procedures. Technical problems have limited its adoption. We report a light-emitting diode array globe protector photostimulator which enhances the stimulation component of the visual-evoked potential recording technique.
In 1948, ophthalmologists started implanting plastic spheres partially covered with tantalum mesh (eg, the Valley Forge Implant) in anophthalmic sockets. Numerous patients have developed complications ten to 15 years after surgery: pain ("pinching" or "deep"), headache, heavy mucopurulent discharge and diffuse conjunctival inflammation, migration of the implant, thinning or erosion of tissues covering the implant (extrusion), and inability to wear an artificial eye. Management includes refabrication of the artificial eye and replacement of the implant with a dermis-fat graft or a silicone ball plus scleral graft. Tantalum-mesh--covered orbital implants should probably not be used.
Anophthalmic orbits that reject conventional implants may accept the dermis-fat graft. The subsequent fitting of such a socket differs in many important ways from the fitting of sockets containing conventional implants. Before surgery, the ocularist should construct a custom-made scleral ring to be inserted after the operation. This replaces the standard conformer that can erode the underlying dermis. The socket must be observed carefully for any evidence of damage to the conjunctiva-dermis suture line by the ring, and the latter modified or replaced as necessary. Granulation tissue forming around the sutures uniting conjunctiva and dermis may have to be resected and cauterized. Impression molding of an artificial eye is performed five weeks after surgery. The artificial eye always requires modifications over the first six months as the graft recedes due to partial atrophy of the fat of the graft, thus deepening the socket.
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