Abstract

Difference between examining eye and orbit is that you can’t see orbital content directly. If there is process in the orbit you need imaging equipment to visualize problem. Best solution in our opinion is multi slice CT scan. It shows bones, soft tissue changes and very good angiography. Also software enables you to make reconstructions, 3D reconstructions, all plains sections so that you can locate orbital disease and see its relations with surrounding tissues. Most important for planning orbital surgery is to define approach. If you select good approach surgery will be successful. Ultrasound can be used for fast evaluation and MRI is rare choice for pure defined soft tissue lesions.

Abstract

Abstract

Aim
To present the indications, intraoperative and postoperative complications and final outcome of three surgical procedures performed in a two-year period, by one surgeon, at a single institution.

Material and methods
In a two-year period (January 2010 – December 2011) at the Clinic of Eye Diseases Clinical Centre of Serbia, 172 consecutive surgical procedures (108 enucleations, 46 evisceration and 18 orbital exenterations) were done and, of these procedures, one surgeon (DMR) performed 118.

Results
Among those 118 (68,6%) procedures there were 72 enucleations with orbital PMMA implant accomplished by myoconjunctival technique, 32 eviscerations with scleral PMMA implant, and 14 eyelid-sparing orbital exenterations. Enucleations and orbital exenterations were done mostly in general anesthesia (two enucleations and one exenteration were done in local anesthesia), eviscerations were done in a vast majority of cases in local anesthesia (all except one, performed in general anesthesia in a young patient). The main indications were: for enucleations, uveal melanoma and a long-standing, severe, mostly painful eyeball atrophy/phthisis; for evisceration, perforating corneal ulcers in blind eyes, painful intractable glaucoma in blind eyes, severe panophthalmitis or endophthalmitis; for exenterations, orbital invasion by eyelid, conjunctival and uveal malignant neoplasm.
Conclusion
Procedures were done with minimal non-significant intraoperative complications (partial orbital hematoma in eight cases not compromising implantation and “loss” of one muscle suture in two cases of enucleations; evisceration and exenterations were done without intraoperative complications) and also with non-significant number of postoperative complications (partial migration of an orbital implant after enucleation in one case and extrusion of scleral implant after evisceration in two cases; exenterations were done without postoperative complications), and with a highly acceptable final cosmetic outcome.

Abstract

Aim
To present number and types of ocular adnexal surgery performed by two surgeons in a two-year period at a single institution.

Material and methods
From total number of 16564 consecutive surgical procedures perfomed in a two-year period (January 2010 – December 2011) at the Clinic of Eye Diseases Clinical Centre of Serbia, inpatient surgical procedures were done on 5782 consecutive patients and, of these procedures, 1382 were done on ocular adnexa, and two surgeons (DMR and MK) performed 741 of it. All outpatient ocular adnexal surgery were excluded from the study, although a substantial number of ophthalmic plastic surgery was done as outpatient surgery.

Results
Among 741 procedures there were 45 (6,07%) orbitotomies, 41 (5,53%) orbital decompressions for Graves orbitopathy, 17 (2,29%) orbital exenterations, 74 (9,99%) enucleations with orbital implant, 36 (4,86%) eviscerations with scleral implant, 189 (25,51%) dacryocystorhinostomies (125 external, 48 endoscopic endonasal, 12 trans-canalicular laser-assisted), 20 (2,70%) lacrimal canalicular reconstruction after injury, 18 (2,43%) lacrimal probing in general anesthesia, 137 (18,49%) various eyelid tumours excisions with reconstruction, 115 (15,52%) various lid procedures (blepharoptosis, entropium, ectropium, dermatochalasis) and 49 (6,61%) other adnexal procedures (such as eyelids trauma, incisional biopsies, etc).

Conclusion
Adnexal procedures present 23,90% of all inpatient surgical procedures performed at the Clinic in two years and two authors performed 53,62% of all inpatient adnexal procedures.

Abstract

Miroslav Knežević1,2 Gordana Vlajković1,2, Dejan M Rašić1,2
1 Faculty of Medicine, University of Belgrade, Serbia
2 Clinic of Eye Diseases Clinical Centre of Serbia

Aim
To present, compare and evaluate the outcomes and effectiveness of endoscopic endonasal instrumental dacryocystorhinostomy (EN-DCR), trans-canalicular laser-assisted dacryocystorhinostomy (TCL-DCR) and traditional external dacryocystorhinostomy (EX-DCR) in patients operated for primary lacrimonasal duct obstruction.
Material and methods
This is retrospective, nonrandomized, comparative interventional case series. A total of 189 consecutive patients with primary lacrimonasal duct obstruction, in a two-year period (2010-2011), at the Clinic of Eye Diseases Clinical Centre of Serbia, were managed by means of surgery – 48 by EN-DCR, 16 by TCL-DCR and 125 by EX-DCR. EN-DCR and TCL-DCR were done under general anesthesia, EX-DCR under local anesthesia. All procedures were performed by one surgeon (MK) and followed up to one year.
Results
Full success was achieved in 91.64% of EN-DCR patients [failure rate was 8.33% (4 out of 48 patients)], 87.5% of EN-DCR [failure rate was 12.5% (2 out of 16 patients), and 92% of EX-DCR [failure rate was 8% (10 out of 125 patients)]. There was no statistical significance between these outcomes.
Conclusion
Equivalent and high surgical success rate was achieved by EN-DCR and EX-DCR. Non-equivalent but not statisticaly significant lower success rate of TCL-DCR certainly is influenced by time/small-number-of-patients-operated related learning curve. The main advantages of EN-DCR and EN-DCR are better postoperative cosmetic appearance (there are no skin scars) but the main disadvantage is expensive equipment.