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At least 1,153 records · Page 64Linked to original sources
PubMed2001

Repair of orbital floor fractures with bioactive glass implants.

PURPOSE: The ideal management of orbital floor fractures has been highly controversial. Many implants, both autogenous and alloplastic, have been used to span the defects. This study evaluated the use of bioactive glass implants (BAG-implant, S53P4; Abmin Technologies Ltd, Turku, Finland) for the repair of orbital floor defects caused by blunt facial trauma. PATIENTS AND METHODS: This retrospective review of 36 patients was carried out from 1995 to 1999. All patients were diagnosed with an orbital floor fracture or a large orbital blowout fracture. The BAG-implant was placed over the defect, using a subciliary or transconjunctival approach. No screw fixation was used when the implant was the correct size. Follow-up examination was done at 1 and 3 months after surgery. Twenty-eight (82%) of the patients were also seen at one-year follow-up (21 men and 7 women). RESULTS: The implants did not cause a foreign body reaction in the bone or soft tissue. There was no sign of resorption or infection, nor postoperative extrusion, hemorrhage, or displacement of the implant. Diplopia was seen preoperatively in 17 cases (61%) and postoperatively in 5 cases (18%). In 1 patient, the implant was removed 3 months after operation because of diplopia. Infraorbital nerve paresthesia was seen preoperatively in 9 patients (32%) and postoperatively in 5 patients (18%). The functional and cosmetic results were good at the 1-year follow-up. CONCLUSION: The BAG-implant is a well-tolerated material in orbital floor reconstruction. It provides a favorable environment for an uncomplicated healing process because it is bioactive and biocompatible and because it causes new bone formation.

Adult↗
PubMed2002

Orbital floor reconstruction with an alloplastic resorbable polydioxanone sheet.

The orbital floor is frequently reconstructed after blow-out fractures or midface fractures to avoid a relapse of the repositioned orbital tissue and to prevent enophthalmos. A total of 31 patients underwent reconstruction of internal orbital wall fractures with a resorbable 0.25 mm or 0.5 mm-thick polydioxanone implant (PDS). Skeletal and functional outcome was evaluated retrospectively with regard to fracture size. Fracture size was graded as small, moderate or large by CT scans and operating records. Two of the 25 patients with small or moderate defects showed an enophthalmos of 2-3 mm. Five of the six patients with large defects or two orbital wall fractures had enophthalmos. The scar that formed after implant resorption was to weak to provide adequate support of the globe or to compensate the enlarged orbital volume. Endoscopic follow-up examination of 12 patients showed yielding of the scar in the orbital floor already in moderate defects. Eight patients had diplopia in extreme gaze and two had significant diplopia. Blow-out and midfacial fractures with small to moderate defects in the orbital floor (up to a size of 2.5 cm2) can be reconstructed by polydioxanone sheet to avoid enophthalmos. Polydioxanone implants should only be used in cases without massive orbital fat herniation. The scar formed after implant resorption may influence functional outcome.

Absorbable Implants↗
PubMed2000

Reconstruction of orbital floor fractures using bioactive glass.

INTRODUCTION: The management of orbital floor fractures continues to be debated. Bioactive glasses and glass-ceramics are in the new group of materials developed for the repair of bone defects which are beyond any innate healing capacity due to their size. OBJECTIVE: We compared the use of alloplastic implants (bioactive glass) with conventional autogenous grafts (cartilage--plus or minus Iyophilized dura) for the repair of orbital floor defects after trauma. MATERIAL AND METHODS: Twenty-eight patients having orbital floor fractures with persistent diplopia, enophthalmos, and/or infraorbital nerve paraesthesia were operated on from 1991 to 1995 at Turku University Central Hospital. Reconstruction was either with bioactive glass (S93P4) or autogenous cartilage implants. RESULTS: Postoperative tomograms in the 28 patients showed adequate maintenance of orbital and maxillary sinus volume without any evidence of resorption in either group. None of 14 patients in the study group had any evidence of dystopia or complications relating to implants follow-up. One had infraorbital nerve paraesthesia and another had entropion postoperatively. Among the 14 control subjects there were three cases of persistent diplopia, two of infraorbital nerve paraesthesia and one of enophthalmos. CONCLUSION: Bioactive glass implants are well-tolerated and seem to be a promising repair material for orbital floor fractures. Their use leads to less morbidity as no donor site operation is needed. Also it provides favourable healing as it is bioactive, biocompatible and causes new bone formation.

Adolescent↗
PubMed2006

[Acquired esotropia at advanced age].

BACKGROUND: Patients, most of whom are in their 8th decade of life, can suffer from a minimal acquired esotropia. They complain of blurred vision instead of diplopia due to their confusion. This is accompanied with the risk that the investigation covers only monocular disturbances. PATIENTS AND METHODS: Of 39 such patients, 22 underwent surgery while 10 were fitted with prisms. Another 3 recovered spontaneously and became, therefore, classified as VIth nerve palsies although no limitation of the abduction could be stated. Four patients refused any therapy, and 2 of them recovered in the course of many years. RESULTS: After 2 to 7 years, the individuals corrected with prisms were still compensated while within the operated cohort 3 had a recurrence after years. CONCLUSIONS: In almost all cases the prescription of separate glasses for distance with about 3 Delta base out on either side compensates the deviation for several years. In surgical units one finds a summation of chronically decompensated patients with obvious diplopia who need a bimedial recession. Lateral rectus resections are not appropriate as they lead to actual overabduction and final recurrence as well.

Age Factors↗
PubMed1994

[Post-traumatic anomalous innervation of the lateral rectus muscle by trigeminal fibers].

BACKGROUND: Congenital or acquired anomalous synkinetic movements are common in Neuro-Ophthalmology. Examples are the Stilling-Türk-Duane syndrome, the Marcus Gunn phenomenon or secondary oculomotor synkinesis in oculomotor nerve palsy. PATIENT AND METHOD: A 29-year-old woman with N.V-, N.VI-, N.VII- and N.VIII-lesion after blunt cranio-cerebral trauma developed a left sided trigemino-abducens synkinesis. The abduction of the left eye by gaze effort was limited to 30 degrees before the midline. With tight jaw closure the eye reached the midline. Eye muscle surgery was performed (recess-resect procedure) because of homonymous diplopia. This is the third published case of a posttraumatic trigemino-abducens synkinesis. RESULTS: Postoperatively the left globe was able to abduct 20 degrees over the midline using maximum coinnervation, with a left exotropia of 5 degrees. Without coinnervation, i.e., without jaw closure an residual esotropia of 26 degrees at distance and 14 degrees at near remained. The utilization of the synkinesis to compensate the esodeviation and to avoid diplopia was hardly possible even after a combined operation for esotropia. It is difficult to determine the amount and type of surgery since one has to take into account that the coinnervation produces an abduction of the eye depending on the intensity of jaw closure. DISCUSSION: The trigemino-abducens synkinesis may be explained by aberrant regeneration of the peripheral never at the temporal petrous bone. Here, aberrant regrowing fibres of the mandibular nerve destined for the masseter muscle may reach the lateral rectus muscle via adjacent distal sheaths of the degenerated proprioceptive fibres of the lateral rectus muscle. Other mechanisms (ephaptic transmission or central reorganisation between the N.V- and N.VI-nuclei in the brain stem) are very unlikely.

Abducens Nerve↗
PubMed2002

Long-term outcomes after surgical management of chronic sixth nerve palsy.

BACKGROUND: In a multicenter prospective data collection study of chronic sixth cranial nerve palsy, we previously reported that the initial successful outcome rate was 39% after a single surgical intervention and 25% after surgery combined with botulinum toxin (Botox), using strict success criteria. We now report the longer term outcome of these patients. METHODS: A previously described cohort of 31 patients in 18 centers who underwent strabismus surgery for a sixth nerve palsy of greater that 6 months duration was studied prospectively. Twenty-three had strabismus surgery alone and 8 surgery with Botox. Fourteen (45%) were complete palsies and 17 (55%) were incomplete. Seven (23%) were bilateral and 24 (77%) were unilateral. Outcome was classified at time of last follow-up, which was 5 weeks to 24 months postoperatively. Success was defined as no diplopia in primary position at distance fixation. Partial success was defined as no more than 10 PD esotropia despite diplopia. RESULTS: Overall, 16 (52%) of the patients were classified as successes, 7 (23%) as partial successes, and 8 (25%) as failures. Three (43%) of the partial successes were using prism. Eight (35%) of the patients classified as successes or partial successes required 2 surgical procedures. Of all patients (10, 32%) who had a second surgery, only 2 (20%) remained failures. CONCLUSIONS: Despite our reported poor initial surgical success rate in chronic sixth nerve palsy, additional strabismus surgery, longer follow-up, and the use of prism or face turn for small residual deviations yields an overall surgical success rate of 75%. More than 1 surgical procedure and prism are often necessary in the management of chronic sixth nerve palsy.

Abducens Nerve Diseases↗
PubMed1991

Reorganization of tactile perception following the simulated amputation of one finger.

The tactile counterpart of diplopia has recently been described: tactile diplopia or diplesthesia. The human fingers show a rather precise organization of the cutaneous areas eliciting diplesthesia. In particular, these areas are very extensive between nonadjacent fingers (second and fourth, second and fifth, and third and fifth), suggesting that the illusory doubling depends on the lack of reciprocal interaction between cutaneous zones during manipulation. In the present study, four subjects agreed to explore and manipulate objects only through nonadjacent fingers for a period of up to six months. The amputation of the third finger was simulated by excluding it from active exploration by means of a bandage. After six months, the diplesthetic areas of the nonadjacent fingers decreased in size or completely disappeared. It is suggested that this reorganization of tactile perception is due to the increase in temporal correlation of the sensory inputs between nonadjacent fingers.

Amputation, Surgical↗
PubMed2006

Perceiving surfaces in depth beyond the fusion limit of their elements.

An isolated dot appears double outside a small disparity range called Panum's fusional area. In random-dot stereograms (RDSs), however, this doubling, or diplopia of dot elements is not evident at any disparity. Nevertheless, depth is perceived up to disparities that greatly exceed Panum's fusional limit. Either one is unaware of dot diplopia at disparities exceeding Panum's fusional limit or the fusion limit is extended. To examine these possibilities, we developed a novel RDS in which dichoptically color-coded dots have a distinctive color when fused, and return to their intrinsic colors when diplopic. We measured the fusion limit of dots in this RDS, and compared it to the patent stereopsis limit of the perceived surface in similar RDSs. We found that the fusional area of dots in the RDS was comparable to Panum's fusional area. Furthermore, there was clear dissociation between the fusion limit and the patent stereopsis limit in the RDS. We conclude that the elements composing a surface are not necessarily fused when a large disparity surface is perceived in depth.

Depth Perception↗
PubMed2000

Balanced orbital decompression in Graves' orbitopathy: Upper eyelid crease incision for extended lateral wall decompression.

INTRODUCTION. This study reports on the results and complications detected in patients with Graves' orbitopathy who underwent balanced medial and lateral wall orbital decompression through concealed incisions. MATERIALS AND METHODS. The medial and lateral orbital walls of nine consecutive patients (14 eyes) were removed. A transnasal endoscopic spheno-ethmoidectomy was performed for the medial wall decompression. A lateral wall decompression was performed via an upper eyelid crease incision which was extended laterally in a relaxed skin tension line. The lateral aspect of the orbit was sculpted with a high-speed surgical drill from the inferior orbital fissure inferiorly and frontal bone of the lacrimal fossa superiorly to the orbital apex posteriorly, including the thick bone of the greater wing of the sphenoid. RESULTS. The decompression was performed for cosmetic purposes in seven patients (10 orbits) and for exposure keratopathy and restrictive myopathy in the remaining two patients (4 orbits). The average follow-up period was 13.6 months. The mean reduction of proptosis was 4.8 mm. The preoperative diplopia in two cases demonstrating restrictive myopathy worsened during the postoperative period. New onset diplopia was not detected in seven cases operated on for cosmetic purposes. All patients were satisfied with their eye status, visual rehabilitation and cosmetic appearance. CONCLUSIONS. The transnasal endoscopic approach for medial wall and extended lateral wall decompression with hidden eyelid crease incision provides a favorable cosmetic and physiologic outcome with proper retroplacement of the globe.

Journal Article↗
PubMed2002

Enophthalmos associated with primary breast carcinoma.

BACKGROUND AND OBJECTIVE: The most common source of metastases to the orbit is from breast carcinoma. The orbital presentation can be the presenting sign of the cancer. Proptosis or exophthalmos is the more usual way metastases present, associated with ocular motility problems or diplopia. We present a case of enophthalmos associated with breast carcinoma whereby there is as yet no radiological evidence of an actual orbital metastatic lesion. PATIENTS AND METHODS: A 51-year-old Caucasian woman with a known history of breast cancer presented with a 10-month history of vertical diplopia, particularly on upgaze. She noted that her left eye was becoming more "sunken" and examination confirmed an 8-mm enophthalmos on that side with restricted vertical eye movements and abduction. RESULTS: A provisional diagnosis of metastatic breast cancer was made. CT and MRI scans were performed. The main feature noted was that of orbital fat atrophy with no evidence of an orbital mass. She has been followed up for a period of 2(1/2) years with 6-monthly scans. There has been no progression of her clinical signs and no orbital lesion found so far. We are continuing to review her. CONCLUSION: Although no actual orbital mass has been found yet, we are treating her case as enophthalmos associated with scirrhosing breast carcinoma; she may, however, have spontaneous orbital fat atrophy, triggered by the cancer.

Breast Neoplasms↗
PubMedDate not supplied

Neuro-ophthalmologic complications of cataract surgery.

Neuro-ophthalmologic complications from cataract surgery are uncommon and include central nervous system toxicity, binocular diplopia, traumatic optic neuropathy and ischemic optic neuropathy. Retrobulbar blocks may be accidentally injected into the subarachnoid space with diffusion to the brainstem. This leads to cardiovascular, respiratory, and mental status compromise. Most patients have complete recovery with adequate support. Post-operative, binocular diplopia may occur secondary to anisometropia or previously unrecognized misalignment. Periocular injection may cause paresis or fibrosis of extraocular muscles. Anterior or posterior ischemic optic neuropathy can occur in the first 6 weeks after cataract surgery with or without periocular injection. The risk to the other eye is high with subsequent contralateral cataract extraction. Post-operative vision loss associated with direct traumatic needle injury is recognized immediately. Therefore, an orbital MRI may be warranted for a patient with an optic neuropathy in the first 24 hours after cataract surgery using periocular anesthesia. If evidence of needle injury is present on neuroimaging, a trial of steroids should be considered.

Aged↗
PubMed1998

Acquired central fusional disruption with spontaneous recovery.

Acquired loss of central fusion occurs most frequently after severe head trauma. It has also been described as a result of disruption of binocular function by unilateral deprivation from a cataract and following mid-brain injury due to vascular lesions, tumours or abscess. Symptoms include diplopia in all positions of gaze associated with a squint of variable size. Occasionally some patients experience a spontaneous, partial recovery of fusion, which may be manipulated with strabismus surgery to minimise diplopia. Recovery of fusion may take months or even a few years to occur. We present two cases of patients who lost fusion but later regained it spontaneously with a high degree of stereopsis. Neither patient required strabismus surgery. In the first case, fusion was lost following a severe head injury which resulted in unconsciousness and a unilateral vitreous haemorrhage. The second case followed the removal of a long-standing, unilateral cataract.

Journal Article↗
PubMed2000

Minimal invasive decompression of the orbit in Graves' orbitopathy.

BACKGROUND: Surgical decompresssion of the orbit may be considered as a suitable form of therapy if, as a result of the increased volume inside the orbit, there are motility disorders such as diplopia or a progressive decrease in visual acuity. In view of the fact that this operation will not cure the underlying disease, the treatment should be as mild as possible. METHODS: In five subjects with Graves' orbitopathy we managed to extend the volume of the intraconal orbit by microsurgical liposuction. We carried out a lateral canthotomy to approach the orbit behind the globe. After decompression of the soft tissue, the lateral palpebral ligaments were refixed. To assess the scale of the functional rehabilitation we compared preoperative parameters (visual acuity, Hertel's index, visual field, motility) with the postoperative results. RESULTS: In all cases we found a significant improvement of position and motility without signs of diplopia. There was a postoperative increase in the visual field and visual acuity was 0.4 and the protusion of the globe could be decreased by 3-6 mm (Hertel's index). Furthermore, the ocular hypertension we found preoperatively could no longer be detected after the operation. CONCLUSIONS: Microsurgical decompression of the soft tissue via an approach from behind the globe proved to be a very gentle alternative to conventional methods of orbital decompression because of the satisfying functional and esthetic rehabilitation in selected cases.

Adult↗
PubMed2006

Simultaneous endoscopic antrostomy and orbital reconstruction in silent sinus syndrome.

PURPOSE: To review the surgical outcome of five cases of silent sinus syndrome (SSS) who were treated with simultaneous endoscopic antrostomy and orbital implant placement. Patients with SSS often present with cosmetic change to their facial appearance (enophthalmos, hypoglobus, deep upper lid sulcus). DESIGN: Retrospective case series. METHODS: Chart review was performed for cases of SSS who were seen between 1995 and 2003 in two tertiary eye care centers. The age, affected side, presenting symptoms and duration, history of trauma, smoking, and chronic sinusitis, degree of enophthalmos and hypoglobus were recorded. RESULTS: All patients had a satisfactory post-operative result with correction of the enophthalmos, hypoglobus, and deep upper lid crease deformity. There were no untoward effects such orbital implant infection, diplopia, vision loss or hematoma. CONCLUSION: Simultaneous endoscopic antrostomy and orbital implant placement can achieve a satisfactory outcome in cases of SSS with significant enophthalmos and hypoglobus. Orbital implant placement carries minimal risks and should not be delayed only to potentially avoid infection, diplopia, or visual loss, as these events are unlikely.

Adult↗
PubMed1996

Severe acute metabolic acidosis and Wernicke's encephalopathy following chemotherapy with 5-fluorouracil and cisplatin: case report and review of the literature.

A 28-year-old woman with inoperable gastric carcinoma was given continuous infusion of 5-fluorouracil (5-FU) and low-dose cisplatin (CDDP) for 4 weeks while receiving intravenous hyperalimentation (IVH). Eleven days after her last treatment, she developed acute diplopia, deafness and gait ataxia, followed by severe confusion. She became markedly acidotic and hypotensive with a systolic blood pressure of 60 mmHg, necessitating intubation, dopamine treatment and hemodialysis for 7 h. She was also given thiamine. Thereafter, her blood pressure stabilized, the acidosis improved, and her deafness, diplopia, and confusion were resolved. This case suggests that FP (5-FU/CDDP) therapy toxicity, manifested as acute metabolic acidosis and Wernicke's encephalopathy, may be associated with IVH and thiamine deficiency.

Acidosis↗
PubMed1999

Surgical treatment for greater sphenoid wing fracture (orbital blow-in fracture).

The authors present 2 patients with greater sphenoid wing fractures that were treated surgically. This type of fracture is classified as a blow-in fracture of the lateral orbital wall. The first patient was a 16-year-old boy who was involved in a motor vehicle accident. Computed tomography (CT) disclosed a medial displacement of the inner wall of the greater sphenoid wing of the left orbit. He was unconscious for 3 days. After he recovered consciousness, he presented limited abduction of the left eye with diplopia in all gaze directions and mild left proptosis. Although these symptoms did not improve for 1 week, displaced bone fragments of the greater sphenoid wing were removed via the lateral orbital approach. The patient had a good postoperative course with progressive improvement in eye movement over the next several weeks. The second patient was a 22-year-old man whose face was hit in a fight. CT disclosed medial displacement of the inner wall of the greater sphenoid wing of the left orbit. Although the patient also presented limited abduction of the left eye on admission, this symptom improved gradually. However, diplopia in all gaze directions and mild left proptosis did not improve. Therefore, the displaced inner wall of the greater sphenoid wing was reduced via the lateral orbital approach. The patient showed a good postoperative course with progressive improvement over the next several weeks. This type of orbital fracture, which is classified as an orbital blow-in fracture, is relatively rare. This type of greater sphenoid wing fracture is caused by buckling of the orbital wall secondary to severe compression of the orbital rim. Surgical treatment using the lateral orbital approach through a hemicoronal skin incision afforded a wider operative field and better cosmetic result.

Adolescent↗
PubMed2001

Patterns of oculomotor nerve distribution to the levator palpebrae superioris muscle, and correlation to temporary ptosis after blepharoplasty.

Transient diplopia, blepharoptosis, or both conditions are rare postoperative complications of blepharoplasty performed with the patient under local anesthesia. It has been hypothesized that some cases of postoperative diplopia and blepharoptosis could be attributed to the myotoxic effects of local anesthetics to the extraocular muscles and the levator muscle or to the neurotoxic effects of lidocaine. In 30 cadavers, the superior division of the oculomotor nerve was severed en bloc 1.5 cm anterior to the annulus of Zinn with the levator palpebrae superioris (LPS) and the superior rectus muscles. These muscles were detached from their origins, and their attachments to the scleral and tarsal plates were divided respectively. The specimens were treated in guanidine-hydrochloride and Alizarin Red solution, and were dissected under an operating microscope. The nerve branches of the superior division of the oculomotor nerve innervated the proximal third (type I) in 2 of 30 LPS muscles (6.7%), in 8 of 30 muscles (26.7%) extended to the middle third (type II), and reached the distal third (type III) in 20 of 30 muscles (66.7%). The terminal branches ran through the medial third (type IIIa) in 6 of 20 type III LPS muscles (30%), the central third (type IIIb) in 8 muscles(40%), and the lateral third (type IIIc) in 6 muscles (30%). The oculomotor nerve ends that extend forward to the distal third of the LPS muscle (type III) are exposed and vulnerable to local anesthetics and may be numbed during blepharoplasty. If this is so, postoperative blepharoptosis may be caused by transient paralysis of the LPS muscle, and great care should be taken during the injection of local anesthetics near the LPS.

Anesthetics, Local↗
PubMed1993

Ocular motility disorders secondary to sinus surgery.

Sinus surgery has multiple potential ocular complications including visual loss, diplopia, infection, hemorrhage, and epiphora. We report six patients with ocular motility problems secondary to sinus surgery, review the literature on ocular motility disorders secondary to sinus surgery, and propose an approach for management of those ocular motility problems following sinus surgery. Intranasal sinus surgery was found to be the most common procedure resulting in injury to an extraocular muscle and the ethmoid sinus the most common structure being operated on when injury occurred. The medial rectus was the muscle most commonly injured and it had the poorest prognosis for recovery of functional vision free of diplopia. Optimal timing for repair depends on the structure injured, but early recognition and management appear to be a key to the best outcome for these injuries.

Adolescent↗