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Excision of upper and lower xanthelasma
 
02:36
Although the books always say that lipids and cholesterol should be checked in patients with xanthelasmas, I think that I have yet to detect anyone who has markedly abnormal levels. Incorporating the upper lid excision into a blepharoplasty gives a nice result. There are some xanthogranulomatous diseases (e.g. Erdheim-Chester) that are associated with xanthelasmas, and I always keep that in mind in any patient with a xanthelasma. Usually the lesions associated with xanthogranulomatous disease look a little different than the typical xanthelasma. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/excision-upper-and-lower-xanthelasma.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 12807 Oculoplastic Surgery Videos
Repair of canalicular laceration with a pigtail probe HD
 
03:29
A pigtail probe can be used to repair a canalicular laceration. The advantage of the pigtail probe is that you do not need to retrieve the stents from the nose, and the procedure can be done more easily under local anesthesia. However, sometimes it can be difficult to pass the pigtail probe in the area of the common canaliculus, which can result in canalicular damage. I personally prefer Crawford stents (bicanalicular with retrieval from the nose) for repair of canalicular lacerations, but I think it is important to feel comfortable using the pigtail probe, because it may be necessary in some scenarios. Monocanalicular stents can be used as well in some situations. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/6/9-pigtail-probe.htm
Просмотров: 3867 Oculoplastic Surgery Videos
Epiblepharon repair
 
02:36
Many of you have much more experience than I in the treatment of epiblepharon. Often I find it does not need to be surgically treated if the patient is asymptomatic and/or there is no corneal staining. Lubrication and time may take care of the problem. I had a pediatric ophthalmologist once tell me that he only operates if the child avoids light. My approach in surgical treatment of these patients is to excise a small amount of skin, debulk pretarsal orbicularis, and incorporate the lower lid retractors into the skin closure to prevent override of the anterior lamella. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/5/2-epiblepharon-repair.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 2694 Oculoplastic Surgery Videos
BPES blepharophimosis epicanthus inversus syndrome repair
 
03:37
Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) is autosomal dominant and caused by mutations in the FOXL2 gene. There are always questions regarding when to address the ptosis and when to address the medial canthus. I believe that if there is amblyopia, address the ptosis and worry about the medial canthus later. If there is no amblyopia, potentially you could do both surgeries at the same time. Whether to do a levator resection or a frontalis sling depends on the amount of ptosis and strength of the levator muscle. For the medial canthoplasty, I like the Y to V and double Z-plasty technique. Interestingly, females with BPES may have premature ovarian failure, and the potential for this should be discussed with the parents.
Просмотров: 4218 Oculoplastic Surgery Videos
Muller muscle-conjunctival resection in a pediatric patient
 
02:44
I rarely will do a Muller muscle-conjunctival resection (MMCR) for congenital ptosis. My belief is that an MMCR is really just an internal levator advancement, and if you can get a maximal resection of 10 mm for an MMCR, that is usually not enough of a levator advancment for most congenital ptosis. However, you will have those congenital ptosis patients that have 1-2 mm of ptosis with a good response to phenylephrine. In those cases I will consider an MMCR, but always remind myself that the procedure is very weak. For a written transcript of this video, see below: This is Richard Allen at the University of Iowa. This video demonstrates a Muller muscle conjunctival resection in a pediatric patient. In general, I do not do MMCRs in pediatric patients unless they have an excellent levator function, less than 2 millimeters of ptosis, and an excellent response to phenylephrine. A 4-0 silk suture is placed through the upper eyelid at the level of the tarsus. The eyelid is then everted over a Desmarres retractor. The needle tip cautery is then used to make 2 markings at the superior border of the tarsus corresponding to the central third of the eyelid. I think that for pediatric patients, at least a 9 millimeter resection should be performed. This is measured with calipers at 4.5 mm. The Putterman clamp is then placed so that it engages the conjunctiva at the level of the superior border of the tarsus. A portion of the conjunctiva is excised so that the suture knot can be buried. The suture then enters the excised portion of the conjunctiva and is then run in a horizontal mattress fashion just below the edge of the Putterman clamp. This is performed along the length of the eyelid. The suture used here is a 6–0 plain gut suture. The suture is then turned around to complete the passage. It then exits out adjacent to where the entrance was. A 15 blade is then used to make metal-on-metal contact along the Putterman clamp so as not to cut the suture. The suture can then be tied so that the knot recesses into the area where the conjunctiva was excised. The area is inspected. The 4-0 silk sutures are cut. Antibiotic ointment is then placed into the eye. In this case I will patch the patient overnight. Antibiotic ointment is use three times per day and the patient returns in approximately 1-2 weeks. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1726 Oculoplastic Surgery Videos
Repair of a large cheek Mohs defect with a rotational flap
 
04:31
Part of the fun (and fear) of Mohs defects is being surprised by what the Mohs surgeon delivers to us. I think it is important for us to challenge ourselves -- that is what makes us better surgeons. Although I would have asked for help from one of my ENT colleagues with this defect early in my career, as I got older, I felt comfortable doing this on my own. Staying true to basic principles of reconstruction enables us to take care of larger and larger defects. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/9/repair-lrg-cheek-defect-rotational-flap.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1330 Oculoplastic Surgery Videos
Lacrimal system examination
 
01:30
Evaluation of the lacrimal outflow system consist of three parts: examination of the position and the caliber of the punctum, examination of the patency of the canaliculi, and examination of the patency of the nasolacrimal duct. This can all be performed fairly easily in the clinic, but can be difficult (if not impossible) in children and some adults. Equipment needed includes a punctal dilator (I like these to have a fine point), a Bowman probe (I prefer a 0 Bowman probe), and a cannula on a 3 mL syringe (I prefer a 3 mL syringe because I get better "feel" with this size). For a written transcript of this video, please see below: Evaluation of the lacrimal drainage system involves dilating the puncta first. The lower puncta is dilated with the punctal dilator. The dilator is placed vertical followed by horizontal. The same is done for the upper punctum, again passing the dilator vertical followed by horizontal. The patency of the canaliculus is evaluated using a Bowman probe. Usually I will use a 0 Bowman probe. The probe is placed vertical followed by horizontal. The probe is placed along the length of the canaliculus to palpate for any evidence of obstruction or a soft stop. The same is done for the upper canaliculus. A lacrimal cannula on a 3 cc syringe filled with saline is then used to evaluate the patency of the nasolacrimal duct. The lacrimal cannula is introduced into the canaliculus followed by irrigation with the saline. The patient should be able to taste the saline in the back of their throat if the nasolacrimal duct is not obstructed. The same can be done on the upper eyelid. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1881 Oculoplastic Surgery Videos
Repair of full thickness lower eyelid laceration
 
01:58
Repair of a full-thickness lid laceration follows the basic principles of repairing the anterior and posterior lamella separately, paying special attention to the eyelid margin. I prefer two 7-0 Vicryl sutures placed in a vertical mattress fashion for the eyelid margin, one at the level of the Meibomian gland orifices and one at the level of the lash follicles. Remember to keep your tarsal sutures partial thickness, especially on the upper eyelid. A written transcript of this video is below: This is Richard Allen at the University of Iowa. This video demonstrates repair of a full-thickness lower lid laceration. A 5-0 Vicryl suture is placed partial thickness through the anterior surface of the tarsus. This suture is then placed on the other side of the laceration in the exact same position and depth. A second suture is placed in a similar fashion inferiorly. The first suture is left untied for ease of placement of the second suture. The inferior suture is then tied to reappose the tarsus. The superior suture is also tied which results in reapproximation of the lid margin in the correct anatomical position. A 7-0 Vicryl suture is then placed in a vertical mattress fashion at the meibomian gland orifices. This is placed far – far, then near – near; tying the suture results in eversion of the lid margin. A second 7-0 Vicryl suture is placed in a similar fashion at the level of the lash follicles. This provides additional eversion of the lid margin. The skin can then be closed with interrupted 7-0 vicryl sutures placed in a simple or vertical mattress fashion. At the conclusion of the case, the lashes are removed from under any sutures. Antibiotic ointment is placed over the repair and the patient returns in approximately one week for reevaluation. Over 300 oculoplastic videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 728 Oculoplastic Surgery Videos
Repair of large orbital floor and medial wall fractures with a combined trans conjunctival and trans
 
07:02
I believe that some of the most difficult orbital fractures to repair are those that involve both the medial wall and orbital floor. These large fractures often require a large implant to bridge the fracture, which can be difficult to approach through a single inferior or medial incision. My preference in these fractures is to release the inferior oblique and connect a transconjunctival incision and transcaruncular incision. This gives me an 180 degree view of the orbit with easy insertion of a large implant. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/10/74-transconj-transcaruncular-insicion.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1808 Oculoplastic Surgery Videos
Lateral orbitotomy
 
02:52
The approach for a lateral orbitotomy can be performed through a number of incisions including a superior lid crease, extended superior lid crease (Kronlein), coronal/hemi-coronal, sub-brow (Stallard-Wright) and lateral canthal. I prefer the lateral canthal incision with an inferior and superior cantholysis. I believe it gives me good access to the entire lateral orbit, the closure is simple, and the cosmetic result is great. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Lateral-orbitotomy-3.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 987 Oculoplastic Surgery Videos
Left Lateral Orbital Decompression
 
04:36
I spend a lot of time on the lateral wall when I do an orbital decompression. I believe that a maximal lateral wall decompression can provide significant proptosis reduction. I always get a preoperative CT scan to look closely at the anatomy of the lateral orbital wall. If the greater wing of the sphenoid bone and zygoma are thick, that tells me that a lot of bone will be able to be removed, which will provide an excellent decompression. Also, it allows access for an orbital fat decompression. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/left-lateral-orbit-decompress.htm
Просмотров: 1726 Oculoplastic Surgery Videos
Treatment of Canaliculitis
 
01:32
Treatment of canaliculitis requires a canaliculotomy; however, this can be punctal involving or punctal sparing. Some surgeons have advocated a punctal sparing approach, and this video demonstrates this. I do not place a stent or close the canaliculotmy with sutures, but I think you could consider this if you want. I do not place the patients on antibiotics post-operatively (other than antibiotic ointment for a week). I don't think that antibiotics are necessary as long as all of the stone/foreign body is removed. For a written transcript of this video, please see https://vimeo.com/132969591 Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1731 Oculoplastic Surgery Videos
Levator advancement in a patient with a deep superior sulcus
 
03:41
Performing ptosis surgery in patients with a deep superior sulcus can be quite challenging. The patient in this video failed a previous posterior approach ptosis repair, therefore an external levator advancement will be performed. It is important to recognize that the preaponeurotic fat pad (the landmark of external ptosis surgery) will be difficult to find. This video demonstrates how I like to identify the anatomy in these patients. For a written transcript of this video, please visit http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/9/levator-advancement-deep-superior-sulcus.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1080 Oculoplastic Surgery Videos
Tenzel flap
 
03:36
If a full-thickness defect of the lower lid is less than 50%, primary closure is attempted first. If there is too much tension, then a Tenzel flap is often performed. In this procedure, a lateral canthotomy and inferior cantholysis are performed, followed by an incision that is directed superior-temporal from the canthotomy incision. Transposing the tissue then allows closure of the defect. There is always discussion with regards to how to address the lateral canthus. Some surgeons will address the lateral canthus with complex maneuvers; I usually try not to do too much and just re-associate the new anterior and posterior lamella. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/5/4-tenzel-flap.htm
Просмотров: 5209 Oculoplastic Surgery Videos
Repair of full thickness upper eyelid laceration
 
02:59
I believe that full-thickness lid lacerations should only be repaired by ophthalmologists and oculoplastic surgeons. Repairing the anterior and posterior lamella separately is mandatory, as is precisely repairing the eyelid margin. Traditionally, permanent sutures are used at the eyelid margin, however I have used 7-0 Vicryl suture now for the last 2 decades with rarely any problems. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/repair-full-thickness-UpperLid-laceration.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1967 Oculoplastic Surgery Videos
Repair of a lateral canthal defect with an O to Z flap
 
01:50
Some lateral canthal defects seem to be custom made for an O to Z flap. Others options include a skin graft or lateral cheek lift. I almost always perform a lateral tarsal strip with the repair to add additional stabilization to the canthus. Transcript of the video: This is Richard Allen at the University of Iowa. This video demonstrates repair of a lateral canthal defect with an O to Z flap. A number of flaps could be fashioned in order to repair this defect. In this case, a subciliary incision is made extending from the medial portion of the defect medially. Wide undermining is then performed between the orbicularis muscle and the orbital septum. An incision is then made to complete the Z extending from the lateral portion of the defect superiorly. Dissection is then carried out in the subcutaneous fat plane. Transposition of the flap shows good coverage of the defect. For these cases, I prefer to tighten the lower eyelid. This could be performed with a lateral canthopexy. In this case, a lateral tarsal strip is performed. A lateral canthotomy and inferior cantholysis are performed followed by fashioning of the lateral tarsal strip. The strip will then be sutured to the lateral orbital rim at the level of Whitnall's tubercle with a 4-0 Mersilene suture. The flaps are then placed into position. A deep 4–0 Vicryl suture is placed through the inferior flap which then engages the periosteum of the lateral orbital rim. This results in elevation of the cheek and will take tension off of the lower eyelid. Additional deep sutures are placed with 5–0 Vicryl sutures followed by superficial 5-0 fast-absorbing sutures to complete the repair. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1219 Oculoplastic Surgery Videos
Repair of 40% full thickness defect of the lower eyelid
 
02:35
My approach to repair of most eyelid defects is to separate the anterior and posterior lamella, then repair the posterior lamella followed by the anterior lamella. In this video, the defect could be repaired primarily (similar to a pentagonal wedge), but that would give a vertical scar. By separating the anterior and posterior lamella, the posterior lamella can be repaired similar to what you would do with a wedge, but the anterior lamella can be redistributed across the lid and a subciliary incision can be used, which I think will give a better cosmetic result. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/5/1-posterior-wedge.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1356 Oculoplastic Surgery Videos
Transconjunctival lower lid blepharoplasty with fat resection
 
03:09
A number of factors need to be addressed when considering a lower lid blepharoplasty: fat, anterior lamella, and lid laxity. Fat can be resected or repositioned. Skin can be excised in varying amounts, depending on what is needed. And the lower lid can be stabilized through tightening with either a lateral canthopexy or stronger procedure such as a lateral tarsal strip. In this video, the lower lid fat is resected through a tranconjunctival incision without any skin resection or lower lid tightening. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/transconj-LL-bleph-w-fat-resection.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 665 Oculoplastic Surgery Videos
Harvesting of Mucous Membrane Graft
 
02:19
Knowing how to harvest a mucous membrane graft is useful for repair of severe cicatricial entropion and in some cases of ocular surface reconstruction. I use mucous membrane most often for reformation of the lower fornix in anophthalmic patients. You can take the mucous membrane either from the buccal space or labial space. I use the buccal mucosa more (I think it is less bothersome to the patient), but I have a lot of colleagues that use the labial mucousa from the lower lip. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/2/Mucous-membrane-harvest.htm 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1241 Oculoplastic Surgery Videos
Full thickness blepharotomy with debulking of medial and brow fat pads
 
05:02
I believe that upper eyelid retraction is best treated with a full-thickness blepharotomy. It is important to leave the septum intact in order to prevent elevation of the eyelid crease post-operatively. Many patients will also have prominent medial fat as well as brow fat pads. I believe these fat pads can be safely debulked at the time of the eyelid recession. However, I do believe that the preaponeurotic fat should be left intact. I previously have tried to resect some of the preaponeurotic fat at the time of eyelid recession, and this has given me unsatisfactory results. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/5/7-levator-recession-with-debulking.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 1910 Oculoplastic Surgery Videos
Repair of lower lid retraction with a hard palate graft and medial tarsorrhaphy
 
02:45
There are certain cases of lower lid retraction that fail multiple attempts at repair. In those situations, I believe that a hard palate graft is the best spacer to use. I also like the eyelid to heal "on stretch", which is usually done with a Frost suture for one week post-operatively. Sometimes I will want the eyelid on stretch for longer than a week, however it is difficult to do that with Frost sutures. A pillar tarsorrhahy can act as a long term Frost suture. They can be easily released any time after surgery. In some situations I will leave the pillar tarsorrhaphy in permanently, and it is surprisingly well tolerated. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/hard-palate-graft-w-pillar.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 624 Oculoplastic Surgery Videos
Excision of high superior lateral dermoid cyst
 
01:37
Even though this dermoid cyst is above the brow, I will still try to reach it through a lid crease incision. I believe that almost any periocular dermoid can be reached this way. I prefer a lid crease incision because I think it will give the best post-operative scar. A written transcript of this video is as follows: This video demonstrates excision of a relatively high superior lateral dermoid cyst. I believe that almost every dermoid can be reached from a lid crease incision. The lid crease is marked, and the 15 blade is used to make an incision through the skin and orbicularis muscle. Dissection is then carried out along the surface of the orbital septum to the superior orbital rim. The dermoid should usually lay in the plane of the periosteum and orbital septum. Once the dermoid is identified superiorly, careful dissection is carried out along the surface of the dermoid cyst. This can be performed with Westcott scissors. In this case, tissue has been left on the surface of the dermoid so that I can fixate it with toothed forceps. If there is some difficulty in doing this, a cryoprobe could be utilized. Usually I will dissect around the dermoid until I find it difficult, then I will move to another spot. The dermoid is excised completely. The goal in the surgery is to excise the dermoid without it rupturing. The lid crease incision can then be closed with simple interrupted 5-0 fast-absorbing sutures. 275 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 668 Oculoplastic Surgery Videos
Lateral Tarsal Strip
 
02:24
I think that the lateral tarsal strip is still the workhorse for functional lower eyelid malposition. I prefer the double-armed 4-0 Mersilene suture on an S-2 needle. I am doing fewer of these in patients undergoing cosmetic lower lid blepharoplasty. But, if you really need to tighten/stabilize a lower lid, this is the best procedure in my opinion. For a written transcript of this video, see below: This is Richard Allen at the University of Iowa. This video demonstrates the lateral tarsal strip procedure. A lateral canthotomy is performed with either the needle tip cautery or a 15 blade. An inferior cantholysis is then performed with either the needle tip cautery or scissors. Dissection is then carried out between the anterior and posterior lamella for approximately 5 to 10 mm, depending on the laxity of the eyelid. The mucocutaneous junction is then excised along the length of the strip with Westcott scissors. The posterior surface of the strip is then scraped with a 15 blade to denude the area of any epithelium. The strip is then grasped and placed into position along the lateral orbital rim to determine the appropriate amount to shorten it, which is performed with Westcott scissors. This is usually somewhere around 3-5 mm, depending on the laxity of the lid. A double arm 4-0 Mersilene suture on an S-2 needle is then placed so that each arm exits the anterior surface of the strip. The needle then engages the lateral orbital rim at the level of Whitnall's tubercle which is at least 2 mm superior to the medial canthus. This is placed in the periosteum posterior to the lateral orbital rim. The periosteal bite is confirmed by pulling on the sutures. The second needle is placed in the same manner. Again, the needle used here is a half circle needle which works well in small spaces. The sutures are then tied. The canthus is then reformed be excising the lash follicles corresponding to the anterior lamella of the strip. The anterior lamella is sutured to the strip medial to the lateral orbital rim with a single 5-0 fast-absorbing sutures. The remaining sutures are placed lateral to the lateral orbital rim to repair the canthotomy. This patient also had a medial spindle performed. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 337 Oculoplastic Surgery Videos
Crawford stent rescue
 
02:41
Placing a bicanalicular Crawford stent can sometimes run into difficulty. In this video, the upper canaliculus likely has a false passage and cannot be intubated from the punctum. You could cut down over the canaliculus to find the native canaliculus, or you can attempt the procedure described in this video. This has saved me quite a few times! For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/crawford-stent-rescue.htm Over 300 oculoplastic surgery videos are available, free of charge and without registration, at http://www.oculosurg.com
Просмотров: 4001 Oculoplastic Surgery Videos
Skin only upper blepharoplasty
 
03:33
There is a lot of discussion as to whether to excise or retain orbicularis muscle in patients undergoing an upper blepharoplasty. The advantage of retaining the orbicularis is that it retains some fullness to the upper eyelid, which currently is preferred over a hollow or skeletonized appearance. Also, it is useful to retain orbicularis in patients with orbicularis weakness, incomplete eyelid closure, or dry eye. A disadvantage is that the orbicularis is a brow depressor, and you may exacerbate brow ptosis after the procedure. Also, some patients may not prefer the fullness to the upper lid after the procedure. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/skin-only-upper-blepharoplasty.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 405 Oculoplastic Surgery Videos
Temporal artery biopsy
 
03:15
A temporal artery biopsy can be challenging at times. However, by understanding the anatomy of the temporal region, the artery can usually be identified. I prefer to palpate the artery prior to the surgery with my finger, rather than depend on a doppler, which I think can sometimes be too sensitive. I then make an incision through the skin with a 15 blade, followed by blunt dissection with a cotton-tipped applicator through the subcutaneous fat. The artery can then be identified within the superficial temporalis fascia. If I see deep temporalis fascia, then I know that I have gone too far. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/5/14-termoral-artery-biopsy.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 679 Oculoplastic Surgery Videos
Incision & Drainage of Lower Lid Chalazion
 
01:45
This may be one of the simplest procedures, but it is also one of the most satisfying. This video is of a pediatric patient, and that is why there is so much preparation and draping. I think adult patients can have the procedure performed "in the chair." Of course, if there is a recurrence in an older patient, then tissue should be sent to pathology. For a written transcript of this video, please see below: This is Richard Allen at the University of Iowa. This video demonstrates incision and drainage of a right lower lid chalazion. The chalazion is palpated and is noted to be internal. The area is then marked. The area is marked because subsequent infiltration with local anesthetic can sometimes make the chalazion difficult to palpate. The area is infiltrated with local anesthetic. The area is then prepped with betadine. A chalazion clamp is placed over the area. This will be drained from the inside of the eyelid. The eyelid is everted and an 11 blade is used to make a vertical incision through the conjunctiva parallel to the orientation of the meibomian glands. The chalazion curette is used to gently scrape the inside of the chalazion. Some of this material could be sent to the pathologist if there were a question regarding the diagnosis. If this were a recurrence, Westcott scissors could be used to excise some of the capsule and send it to the pathologist. I am usually pretty vigorous with regards to scraping the inside of the lesion. The clamp is then removed. The area is inspected and antibiotic ointment is placed into the eye. The patient follows up as needed. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 334 Oculoplastic Surgery Videos
Repair of full-thickness, medial, lower eyelid defect
 
02:56
I like this video because it demonstrates some basic principles of eyelid reconstruction: first, address the lacrimal drainage system; second, separate the anterior and posterior lamella; third, reconstruct the posterior lamella; and lastly, reconstruct the anterior lamella. I follow this sequence in almost all of my eyelid reconstructions. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/medial-lower-lid-defect.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 742 Oculoplastic Surgery Videos
Lid Margin Biopsy
 
01:14
This video demonstrates a biopsy of an eyelid margin lesion.
Просмотров: 2219 Oculoplastic Surgery Videos
Bilateral upper eyelid blepharoplasty
 
03:27
This video is of a bilateral upper eyelid blepharoplasty. For such a basic procedure, I think there are still a lot of questions: What cutting instrument do you prefer? Do you resect the orbicularis muscle? Do you resect medial and/or preaponeurotic fat? And, what is your choice for suturing? I interchangeably use the Colorado needle and the 15 blade. I usually resect orbicularis muscle. I hardly ever take preaponeurotic fat, but I almost always take the medial fat pad. And, I prefer a 6-0 Prolene suture in a running fashion for closure. For a written transcript of this video, please see below: This is Richard Allen at the University of Iowa. This video demonstrates an upper eyelid blepharoplasty with medial fat pad excision. The area has been anesthetized with lidocaine with epinephrine. An incision is then made along the markings with a 15 blade. I usually attempt to make two continues cuts without raising the blade. One can excise skin only or skin and underlying orbicularis muscle. I this case, I am excising both skin and orbicularis muscle with the monopolar cautery. This could also be performed with scissors. Hemostasis is attained with bipolar or monopolar cautery with minimal cautery at the skin edges. Attention is then directed medially where the orbital septum is opened and the medial fat pad is exposed. Sometimes this can be difficult to find. In this case, the fat is exposed relatively easily. The fat is carefully teased forward to prevent deep hemorrhage. This can sometimes be uncomfortable for the patient. After the fat is exposed, it is anesthetized with lidocaine with epinephrine. The same procedure is performed on the other side. The fat is then excised carefully with the monopolar cautery. Some surgeons will clamp the fat at this point. I have found over the years that this has a tendency to place more traction on the fat and potentially cause a deep hemorrhage. After hemostasis is assured, the incision is closed with 6-0 prolene suture. I will usually start centrally and move laterally with a running suture. Then a small burrows triangle is excise medially. This is performed with a Westcott scissors. A single 6-0 prolene closes the triangle. The remainder of the incision is closed with a running 6-0 prolene suture. Other options for closure include interrupted sutures, a subcuticular suture, as well as the use of other suture materials such as nylon and in some cases fast absorbing suture. At the conclusion of the case, antibiotic ointment is placed over the incision. The patient returns in approximately one week for suture removal. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 266 Oculoplastic Surgery Videos
Repair of 100% lower eyelid defect
 
07:41
Although some Mohs defects can be alarming when first encountered, a protocol of reconstruction addressing the lacrimal system first, followed by the posterior lamella, then the anterior lamella is useful. In this case, the defect involves the entire lower lid, but the patient has adequate anterior lamellar redundancy to avoid a skin graft. Therefore, the most difficult part of this case is reconstruction of the posterior lamella, thus a combination of a Hughes flap, periosteal strip, and free tarsal graft is used. For a written translation of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/8/7-Hughes-flap-w-free-tarsal-graft.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 589 Oculoplastic Surgery Videos
Transblepharoplasty Canthopexy
 
01:51
The transblepharoplasty canthopexy is my preferred procedure in patients who need some stabilization to their lower eyelid, but not so much that they need a lateral tarsal strip. I think it is a great procedure in conjunction with a lower lid blepharoplasty. Adapting this procedure has led to my doing many fewer lateral tarsal strip procedures. I wouldn't use it in cases of frank entropion or ectropion. For a written transcript of this video, please see below: This is Richard Allen at the University of Iowa. This video demonstrates a transblepharoplasty canthopexy. The patient has had a previous excision of skin and orbicularis muscle for the blepharoplasty. Dissection is carried out between the orbicularis muscle and the orbital septum to expose the superior lateral portion of the orbital rim. A 4-0 prolene suture is then used. The larger needle of the suture is introduced through the incision and exits at the level of the meibomian gland orifices of the lateral lower lid. The needle is then placed adjacent to the exit wound and directed posteriorly to engage the periosteum of the superior lateral orbital rim. The needle can often be visualized through the blepharoplasty incision and then backed up to feel the orbital rim. The needle is then advanced to engage the periosteum. The needle is then grasped, and the tightening effect of the canthopexy is demonstrated by pulling on the suture. The suture is then tied. The blepharoplasty incision can then be closed. I think that this procedure is particularly useful in those patients undergoing upper lid surgery who would benefit from lower lid tightening but do not need as extensive of a surgery as a lateral tarsal strip. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 173 Oculoplastic Surgery Videos
Transcaruncular access to the medial orbital wall
 
01:26
Access through a transcaruncular incision to the medial orbit has several advantages over a transcutaneous or "Lynch" incision: there is no risk of cutaneous scar and there is little risk to the lacrimal system. This access if very useful for medial orbital wall decompressions and also drainage of medial subperiosteal abscesses. A minimal closure is performed with 3 interrupted sutures -- some colleagues do not even close it. Below is a written transcript for this video: This is Richard Allen at University of Iowa. This video demonstrates transcaruncular access to the medial orbital wall. In this case, traction sutures are placed through the medial portion of the upper and lower lid at the level of the tarsus. The caruncle is then fixated with toothed forceps. An additional forceps grasps the plica. A retrocaruncular incision is then made with Wescott scissors. This incision is made through the conjunctiva and underlying Tenons. The incision is made in the direction of the posterior lacrimal crest. Stevens scissors are then used to bluntly dissect to the medial orbital wall just posterior to the posterior lacrimal crest. A small malleable is then used to expose the periosteum of the medial orbital wall. A small Desmarres retractor is placed to hold the caruncle. A Freer periosteal elevator is then used to make an incision through the periosteum of the medial orbital wall. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 777 Oculoplastic Surgery Videos
External levator advancement
 
04:13
My mainstay for ptosis repair is a levator advancement, although I have been doing more and more MMCRs (Muller muscle – conjunctival resection) with time. I think it is key to identify the preaponeurotic fat. I absolutely love using a high temperature cautery for the dissection of the levator aponeurosis from the underlying Muller muscle. Usually I can get the contour right with a single pass of the double-armed 5-0 Nylon suture. Sometimes (especially in children) I need to place a temporal suture. For a written transcript of this video, please see below: This is Richard Allen at the University of Iowa. This video demonstrates an external levator advancement. This is an adult patient. A 15 blade is used to make an incision through the skin and orbicularis muscle along the eyelid crease. In this case, a small blepharoplasty is also performed. Westcott scissors are then used to excise the skin and orbicularis muscle. The monopolar cautery is then used to dissect through the orbital septum. The goal of this dissection is to identify the preaponeurotic fat which is posterior to the orbital septum. The thermal cautery is used to perform additional dissection until the preaponeurotic fat is identified. The preaponeurotic fat is then dissected from the underlying levator aponeurosis. As you can see in this case, there is a fair amount of fat in the levator muscle. A thermal cautery is then used to disinsert the levator aponeurosis from the anterior surface of the tarsus. Dissection is then carried out between the levator aponeurosis and the underlying mullers muscle with the thermal cautery. This can at times be uncomfortable for the patient and topical tetracaine can be used to relieve any discomfort. The assistant then holds mullers muscle which can also be somewhat uncomfortable for the patient. As you can see in this case, the patient also has fat in the mullers muscle. Dissection is carried out until the end of the aponeurosis and can be carried out further in more severe cases of ptosis. A double armed 5-0 nylon suture on a spatula needle is then placed partial thickness through the anterior surface of the tarsus, 2 mm inferior to the superior boarder of the tarsus. This is placed at the area where the peak of the eyelid should be. Each of the needles is then placed through the levator aponeurosis. In this case the sutures are placed right at the junction of the aponeurosis and the muscular portion of the levator, which I think is a good place to start. A temporary tie is then placed. The patient then opens his or her eyes. In almost all of my adult patients, I place the patient in a sitting position at this point in the surgery to inspect the height and contour. In this case, it was determined that the height was a bit too high, therefore the sutures are positioned more inferior on the aponeurosis and a temporary tie is again placed. The height and contour are reinspected and found to be acceptable. The temporary tie is now converted to a permanent tie. A portion of the redundant levator aponeurosis is excised and the skin is closed by placing approximately three lid crease formation sutures. This suture incorporates the cut end of the levator aponeurosis into the skin closure. This is performed with a 6-0 prolene suture. Additonal interrupted sutures are placed. Antibiotic ointment is placed over the incision and the patient will return in one week for suture removal. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 474 Oculoplastic Surgery Videos
Muller muscle conjunctival resection
 
01:59
I did exactly zero Müller muscle conjunctival resections during my fellowship. Now, I probably do them on almost 50% of my ptosis patients. It is a great surgery, but only for the right indications: 2.5 mm or less of ptosis, excellent levator function, and I like to see a response to phenylephrine. There are a lot of variations to this procedure with regards to what suture to use, whether to externalize the knot, etc. For a written transcript of this video, please see below: This video demonstrates a Müller muscle conjunctival resection or MMCR. 4-0 silk traction sutures are place at the eyelid margin and the eyelid is everted over a desmarres retractor The monopolar cautery is then used to make two marks at the superior boarder of the tarsus corresponding to the central third of the eyelid. A mark is then made from the previous marks corresponding to half of the total desired resection. In this case it is 4 mm to make a total resection of 8mm. Toothed forceps are then used to grasp each of the superior marks. The Putterman clamp is then placed flush with the superior tarsal border. A 6-0 chromic suture is then placed in a running mattrees fashion below the Putterman clamp. There is significant debate regarding the preferred suture and method of suture placement. The suture is placed across the eyelid and then turned around. Some surgeons will use a Prolene suture and some will place the suture from the cutaneous side of the eyelid to externalize the eventual knot. The 15 blade makes metal on metal contact with the Putterman clamp to cut across the conjunctiva and presumably the muller muscle. The chromic suture is then tied and cut. Since the knot will be internal on the conjunctival side, a contact lens is placed at the end of the case to prevent ocular irritation. The patient will use antibiotic drops three times per day for one week and return at one week for follow up and contact lens removal. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 197 Oculoplastic Surgery Videos
Temporal scalp incision browplasty
 
05:56
I really like this procedure for temporal brow elevation, and I think it is underutilized. It is ideal for women with moderate temporal brow ptosis who do not need an endoscopic brow lift, but have too much brow ptosis for a browpexy. The most difficult part of the procedure is getting comfortable with the temporal dissection, and one should be careful so that the facial nerve is not damaged. Once you are comfortable with this dissection, the procedure with a blepharoplasty can be performed in under an hour. It can easily be done under monitored anesthesia care. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/6/11-small-temporal-scalp-incision-browplasty.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 490 Oculoplastic Surgery Videos
Upper Canalicular Laceration Repair
 
03:18
This video demonstrates the repair of an upper canalicular laceration. I believe that all canalicular lacerations should be repaired in order to prevent chronic tearing. I prefer bicanalicular intubation to make sure I have a patent system from the puncta to the nose. A written transcript of this video is as follows: This is Richard Allen at the University of Iowa. This video demonstrates repair of a right upper lid canalicular laceration. I like to inspect the area first with a cotton tip applicator to see if the cut ends of the canaliculus can be identified. Some people like to use fluorescein, some like to use viscoelastic, but I think that careful inspection will reveal the cut ends of the canaliculus, as demonstrated here, we can see the proximal end of the canaliculus. The upper punctum is dilated and the lower punctum is dilated. I personally like to perform bicanalicular intubation in these patients so that I have a patent system from the puncta to the nose. A Crawford stent is then placed through the upper punctum and retrieved, followed by placing the stent through the cut end of the canaliculus, where a hard stop is appreciated, followed by advancement of the stent down the nasolacrimal duct. The stent is retrieved from the nose. The same is done to the uninvolved lower lid where the stent is retrieved again from the nose. The intubation is inspected and the stent appears to be in good position. The cut ends of the canaliculus are then sutured together over the stent. This is performed with 7-0 vicryl sutures. This is essentially an anastomosis of the canaliculus over the Crawford stent. Pericanalicular bites are taken. Usually 2-4 sutures are placed. It can be difficult at times to place more than two sutures, and in this situation we are using two sutures to reappose the canaliculus. The first suture is left untied so that the second suture can be placed. The sutures are then tied one at time. After the canaliculus has been repaired, the remainder of the laceration is repaired. Usually this can be performed with the same 7-0 vicryl suture. Permanent sutures in this area can be uncomfortable for the patient. At the conclusion of the case, the stent appears to be at appropriate tension and the laceration is well apposed. Antibiotic ointment is placed over the repair for a week and the stent is removed approximately 4 months later. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 152 Oculoplastic Surgery Videos
Medial lid split anterior orbitotomy
 
02:00
I do not use this approach as much as I used to, but it is a great approach if you need wide exposure to the superior medial intraconal or extraconal space. I probably use a medial lid crease approach more often lately, as shown in the optic nerve sheath fenestration videos. The full-thickness lid incision heals very well. For a written transcript of this video, please see below: This is Richard Allen at the University of Iowa. This video demonstrates the use of an upper eyelid split incision to access the superior medial intraconal space. This approach can be used or an upper lid crease incision, as demonstrated in the optic nerve sheath fenestration video, can be used. A 15 blade is used to make a full thickness incision along the junction of the medial one-third and lateral two thirds of the eyelid. 4-0 silk sutures are placed at the edges of the incision in order to provide retraction during the case. Dissection is then carried out within the Tenon's layer. This can be performed bluntly with malleable retractors until the orbital fat is exposed. This approach can very useful those larger intraconal lesion that are located in the superior medial space. Additional 4-0 silk sutures can be placed through the edges of the incision in order to provide additional traction. This allows direct exposure to the superior medial intraconal space. It is useful to employ an operating microscope once the area of the lesion is encountered. Closure of the incision can be performed similar to repair of wedge resection or full thickness lid margin incision. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 421 Oculoplastic Surgery Videos
Basic eyelid biopsy
 
00:47
This video demonstrates a simple biopsy of an anterior lamellar lesion.
Просмотров: 4720 Oculoplastic Surgery Videos
Enduragen graft to lower eyelid
 
04:17
Lower lid malposition secondary to a facial nerve palsy traditionally has been called an ectropion, treated with a lateral canthoplasty (e.g. lateral tarsal strip). In my opinion, this will not adequately treat the malposition. I believe that there is also a component of retraction and that the retractors should be recessed. My "go-to" procedure for the lower lid in a patient with a facial nerve palsy is a lateral tarsal strip, medial tarsorrhaphy (Lee procedure), retractor recession with placement of a spacer, and then placement of the eyelid on upward traction for a week with a Frost suture. In the video shown here, the patient will also have a small mid-face lift, which is sometimes necessary in those patients with a heavy cheek. I use Enduragen (acellular dermal matrix) as the spacer (I have no financial interest in this product), but many different spacers could be used including a thin dermis fat graft or ear cartilage.
Просмотров: 548 Oculoplastic Surgery Videos
Demonstration of the orbital septum in a pediatric patient
 
01:36
One of the most striking difference between the upper eyelids of adults and children is the thickness of the orbital septum. It can be difficult, at times, to find the main landmark of the eyelid (the preaponeurotic fat) because of the thick orbital septum. My preference is to expose a large are of the orbital septum and slowly dissect through it until the preaponeurotic fat is detected. Pressure on the globe allows prolapse of the fat so that the septum can be opened in the correct area. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/pediatric-orbital-septum.htm 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 822 Oculoplastic Surgery Videos
Combination Mustarde and glabellar flap
 
03:47
Repair of a medial canthal defect depends on its position and depth. For a deeper defect, a flap is preferable over a skin graft in order to prevent a mismatch in thickness. Also, one must always evaluate the lacrimal system and repair it if it is involved. If the defect is superior to the medial canthal tendon, a glabellar flap is a reasonable choice; if the defect is inferior to the medial canthal tendon, then a rotational flap will give a good result. When the defect involves an area both superior and inferior to the medial canthal tendon, I prefer a combination glabellar and rotational flap, as illustrated in this video. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/4/14-mustarde-glabellar.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 708 Oculoplastic Surgery Videos
Exenteration in patient with large adenoid cystic carcinoma
 
05:00
Sometimes, tumors (and patients) are neglected. I initially saw this patient at the age of 99 with a smaller tumor and told her I thought this was going to cause a problem for her. She basically told me that she wanted to make it to 100, and I wasn't going to operate on her. She returned at the age of 101 and said no one would eat dinner with her anymore. She lived another 2 years after the surgery to an age of 103, and was welcomed back to the dining room. She is the oldest patient I have ever operated on. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/9/exenteration-lrg-adenoid-ca.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 442 Oculoplastic Surgery Videos
Double stent intubation for canalicular obstruction
 
04:21
Repair of a canalicular obstruction usually involves a cut-down over the area of the obstruction with excision of the obstruction, followed by intubation of the lacrimal system with Crawford stents. I have found that placement of two stents seems to improve my surgical success. Patients usually tolerate the two stents well. I will remove one of the stents at 4 months, then remove the other 4 months after that (8 months post-op). Sometimes, I will leave one stent in long-term if they are doing well, or have failed a previous attempt at repair. For a written transcript of this video, please visit http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/6/2-double-stent.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 673 Oculoplastic Surgery Videos
Modified full thickness blepharotomy
 
02:21
I think that the full-thickness blepharotomy is the current preferred method to surgically treat upper eyelid retraction secondary to thyroid eye disease. Demonstration of each of the layers is a good way to start adapting the procedure. I also really like a high temperature thermal cautery to do some of the dissection. It always amazes me that a small bridge of conjunctiva can still lift the lid significantly. For a written transcript of this video, please see below: This is Richard Allen at the University of Iowa. This video demonstrates a modified full-thickness blepharotomy for treatment of upper lid retraction secondary to thyroid eye disease. The eyelid creases are marked with a marking pen with a small blepharoplasty. The area is then infiltrated with lidocaine with epinephrine. The marks are then incised with the cutting tool of the surgeon's choice. A flap of skin and orbicularis muscle is then removed. Using a high-temperature thermal cautery, the confluence of the levator aponeurosis and orbital septum is dissected from the anterior surface of the tarsus. Dissection then continues superiorly between the levator aponeurosis and the underlying Muller's muscle. The goal here is to not expose and preaponeurotic fat. Westcott scissors could be used, but I think the thermal cautery is ideal for this dissection. The lateral horn of the levator is then lysed with the thermal cautery followed by Westcott scissors. This is important to do to relieve any temporal flare. The thermal cautery is then used to make an incision superior to the superior border of the tarsus through the Mullers muscle and underlying conjunctiva. This will expose the underlying globe. This then proceeds medially to the central portion of the eyelid. The patient is sat up and the position of the lid is inspected. It appears too high. Addition dissection is then performed medially to excise the Mullers muscle from the underlying conjunctiva. In addition, an incision is made through the conjunctival medially to leave just a small bridge of conjunctiva attached to the tarsus, usually at the level of the peak of the pupil. The height of the eyelid appears appropriate. The same procedure is performed on the other side. The full-thickness nature of the procedure is demonstrated. The eyelid incisions are then closed with a single layer of 6-0 prolene suture through the skin edges in an interrupted and running fashion. Antibiotic ointment is used three times a day over the incisions and in the eye. The patient returns in one week for suture removal. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 126 Oculoplastic Surgery Videos
Enucleation with placement of implant
 
04:27
Although enucleations are usually performed under general anesthesia, you would be surprised how well patients tolerate the surgery with a good retrobulbar block. I don't think any implant has been proven to be superior at this point. I like a porous implant, and will usually choose the one that is least expensive. For a written transcript of this video, please see below: This is RIchard Allen at the University of Iowa. This video demonstrates an enucleation with placement of a porous polyethylene implant. The patient in this video had a choroidal melanoma. A 360 degree conjunctival peritemy is performed with Westcott scissors. Dissection is then performed in each of the quadrants between the rectus muscles with Stevens scissors. A Von Graefe muscle hook is used to hook the medial rectus muscle. This is often then transferred to a Green hook. The rectus muscle is then tagged with a 5-0 Vicryl suture on a spatula needle placed in a locking fashion. The muscle is then disinserted from the globe with Westcott scissors. A portion of the muscle insertion is left remaining for the medial and lateral rectus muscle for future traction suture placement while the inferior and superior rectus muscles are disinserted flush with the globe. The inferior rectus muscle is the tagged and disinserted, as is the lateral rectus and superior rectus. A 4-0 silk suture is then placed through the stumps of the medial and lateral rectus muscles for traction. The superior oblique tendon is then hooked and transected with Westcott scissors. The inferior oblique muscle is then hooked and transected with cautery. Enucleation scissors are then used to identify the optic nerve from the lateral approach. With the scissors closed, the optic nerve is felt both from above and below, then the blades of the scissors are opened and the nerve is transected. The posterior tenons is removed from the globe and pressure with a 4 by 4 guaze is placed for approximately 5 minutes to insure hemostasis. Any remaining bleeders are identified and cauterized. The orbital implant is then placed. This is a 20 mm porous polyethylene implant with predrilled holes. The rectus muscles are then attached to the implant using the predrilled holes. This is performed with each of the four rectus muscles insuring that none of the conjunctiva is advanced with the rectus muscles. The conjunctiva and tenons are inspected and then the Tenons is then closed with interrupted 5-0 Vicryl suture placed in a buried fashion with the knot deep. The Tenons is closed to insure adequate apposition and also to insure that none of the conjunctiva is buried in the closure. The conjunctiva is then closed with a running 7-0 vicryl suture. A conformer is placed and then the eye is patched for at least 3 days. Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 227 Oculoplastic Surgery Videos
Maximal eyelid surgeries with a single external blepharoplasty incision
 
06:36
The challenge: how many surgeries can be done with as few external incisions as possible? In this video, an upper blepharoplasty, MMCR, browpexy, and canthoplasty are performed. I am doing more and more browpexies and canthoplasties through the blepharoplasty incision to stabilize both the brow and lower lid. Other procedures also to consider through the blepharoplasty incision would be transection of the corrugators and mid-face elevation. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/10/72-Max-lid-surg-single-incis.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 511 Oculoplastic Surgery Videos
Upper eyelid blepharoplasty with cautery
 
03:23
I would be interested to know what surgeons like to use for upper lid blepharoplasty incision. Traditionally, people have said that a blade is the gold standard. However, we recently published a paper examining the results between patients who underwent blepharoplasty using a blade on one side and monopolar cautery on the otherside (https://insights.ovid.com/crossref?an=00002341-201711000-00006). We showed that there was no difference in scar outcome. This video demonstrates the use of a monopolar cautery in a patent undergoing an upper lid blepharoplasty. The monopolar is nice, because you have very little bleeding. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/1/Upper-lid-bleph-w-monopolar-cautery.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 272 Oculoplastic Surgery Videos
Retractor recession with medial and lateral tarsorrhaphy
 
03:44
Exposure keratopathy can be treated with many different methods. Of course, maximizing medical treatment should be performed prior to any surgical interventions. Surgical options include tarsorrhaphies and optimizing lid position. Tarsorrhaphies an be cosmetically objectionable to patients, especially large lateral tarsorrhaphies. In this case, we do a combination of surgical interventions, including a medial tarsorrhaphy, small lateral tarsorrhaphy, and retractor disinsertion to give the best coverage of the cornea and not be too cosmetically objectionable to the patient. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/retractor-recession-w-tarsorrhaphies.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 179 Oculoplastic Surgery Videos
Hughes flap with skin graft
 
04:18
I think it would be difficult to do anything but a Hughes flap for the defect in this video. I would be interested to know if anybody would try something different. For lateral defects, I like to have good fixation laterally with a periosteal strip. The anterior lamella in this patient is also quite short, so a skin graft is placed. The other option would be to transpose a flap from the upper lid (Tripier flap) to reconstruct the anterior lamella. For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/8/10-Hughes-flap-w-skin-graft.htm Over 300 oculoplastic surgery videos are available, free of charge, at http://www.oculosurg.com
Просмотров: 230 Oculoplastic Surgery Videos