Ophthalmic Plastics and Reconstructive Surgery

The authors evaluated Histoacryl (butyl 2-cyanoacrylate) for closure of blepharoplasty incisions. The study was conducted on seven pigs with evaluations at 1,2,4 and 9 weeks post operatively.

Wound tensile strength was measured using the standard Instron machine. Each end of a 4x20 mm section of tissue with the incision located centrally is "stretched" under controlled environmental variables. Only at the nine week point was any difference noted - the glued incisions had greater tensile strength than the nylon incisions.

Hisopathologic studies showed no deleterious effect compared to nylon sutures at any stage in the healing process. There were areas of focal necrosis and a few giant cells noted in the glued samples however. In the final analysis, at 9 weeks/two months, the scars were minimally wider in the sutured wounds and suture granulomas were present. The glued wounds had no inflammation and no residual glue could be seen with oil red O staining.

From this study, Histacryl appears to be an ideal substance for closing blepharoplasty incisions. What the study does not address is the legality of using Histacryl on patients in the U.S., it availablity and restrictions on importation into the U.S. Histacryl is made by Trihawk International in Montreal, Canada.

Raymond Magauran, M.D.
West Bloomfield, MI

Ophthalmic Plastics and Reconstructive Surgery

The goal of this article is to establish the incidence and scope of adverse reactions to bone wax in a large orbital surgical series. We report two patients with bone wax granulomas of the orbit as a remote surgical complication. These are the first reported cases of adverse reactions to bone wax in the ophthalmic literature. A chart review was conducted on all patients from the University of British Columbia Orbit Clinic that had surgery with temporary or permanent removal of orbital bone. Two patients with bone wax granulomas were identified, In one case, intraoperative cultures grew Staphylococcus aureus, confirming that the wax may indeed act as a nidus for infection. No cases of pseudoarthrosis have occurred. This syndrome of chronic granulomatous giant cell foreign body inflammation has characteristic clinical, radiologic, and histopathologic features. The literature regarding adverse reactions to bone wax is reviewed, and specific implications for orbital surgery are discussed.

Authors' abstract, OPRS
Vancouver, Canada

Ophthalmic Plastics and Reconstructive Surgery

We prospectively studied 10 patients who were status postenucleation and primary placement of the hydroxyapatite orbital implant. Both the technetium-99m bone scan and gadolinium-enhanced magnetic resonance images (MRI) were obtained on the same day at variable time points in the postoperative period in order to assess the degree of vascularization. Up to 78% of the bone scans were interpreted as being completely vascularized, while only 10% of the corresponding MRI scans were consistent with complete vascularization. Cost analysis showed that MRI was a cost-effective imaging modality. We conclude that contrast-enhanced MRI provides a more accurate assessment of vascularization of the hydroxyapatite orbital implant when compared to bone scan. [References: 7]

Author's abstract, OPRS
Colorado

Ophthalmic Plastics and Reconstructive Surgery

We performed a prospective study using the palmaris longus tendon as the sling material to correct 8 consecutive ptotic eyelids in 7 adults, All operations were done with the patient under local anaesthesia by a single surgeon (D.S.C.L.). With a mean follow-up period of 14 months (range 2-20 months), all the ptotic eyelids were well corrected with no recurrence, intraoperative or post-operative complications, Use of the palmaris longus tendon as an alternative to fascia lata for sling surgery in adults is recommended. [References: 12]

Author's Abstract, EYE
Hong Kong

Ophthalmic Plastics and Reconstructive Surgery

A retrospective study looks a the records of 54 consecutive patients with orbital fractures. 19 of these patients were women. 17 of these were adults. 6 (35.3%) of these adult females suffered the fracture secondary to sexual or domestic violence. 31.5% of all fractures resulted from motor vehicle accidents (MVA). 12/19 females suffered fractures as a result of a MVA or sexual/domestic violence. No men in the study suffered trauma from sexual/domestic violence. This patient population hailed from Penn State.

This study served to increase our awareness of domestic.sexual violence in our communities. As the authors eloquently pointed out in the July Ophthalmology issue's Letters to the Editor, this study will hopefully lead to a protocol to better identify and treat these victims. Without awareness, the problem too often is unrecognized. An AMA study showed women who suffer from domestic violence have an 86% willingness to discuss this problem with their doctor. How often do we ask our patients if they are affected by domestic violence? This study seems to say not often enough...

Raymond G. Magauran, M.D.
Kresge Eye Institute
Detroit, MI