Copenhagen 2016 Registration Programme Exhibitor Information Virtual Exhibition Satellite Meetings Glaucoma Day 2016 Hotel Star Alliance
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10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits

 

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Steri-strip temporary browplasty: a helpful technique during cataract surgery in the patient with brow ptosis or dermatochalasis

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Session Details

Session Title: Presented Poster Session: Combined Cataract Surgery

Session Date/Time: Saturday 10/09/2016 | 15:00-16:30

Paper Time: 16:00

Venue: Poster Village: Pod 1

First Author: : J.Spaulding USA

Co Author(s): :    A. Fantin              

Abstract Details

Purpose:

Small excision phacoemulsification with intraocular lens placement is an extremely refined surgical procedure, but like all surgical procedures, exposure plays a large role in the case. In our general population undergoing cataract surgery, a significant proportion of the patients have significant dermatochalasis and brow ptosis. This redundant tissue frequently crowds the surgical field and can be further complicated in patients with a prominent brow or deep sulcus. We are presenting a temporary browplasty. This is a simple procedure to help with the limited exposure in these patients without inducing increased mechanical trauma on the lids.

Setting:

77-year-old male with complaints of glare, halos, and decreased vision OD. On exam, he had dermatochalasis and brow ptosis, a nuclear sclerotic 20/40 cataract, and brightness acuity testing of 20/400 in both eyes. He was scheduled for cataract extraction with phacoemulsification and a SN60WF 19.5D lens was selected.

Methods:

To improve exposure on the day of surgery a temporary browplasty and lid lift was placed. This was accomplished cutting a tegaderm transparent film dressing (2-¾” x 3-¼”) in half, creating 2 equal halves (2-¾” x 1-⅝”). These halves were used to hold the eye lashes away from the surgical field. Steri strips (3” x ¼”) were then applied creating a vertical vector force, pulling the redundant lid skin and ptotic brow out of the surgical field. A speculum was inserted and the case proceeded without complication. Postoperative pictures were taken to note the lack of post surgical ptosis.

Results:

Blepharoptosis post anterior segment surgery has been described throughout the literature. Although the etiology and pathophysiology is poorly understood at this time. There are two main explanations, the superior rectus bridle suture theory and the speculum theory. Both of these theories are based on the idea that the bridle suture or speculum results in trauma, dehiscence, or excessive stretch of the levator aponeurosis/superior rectus (SR) muscle complex.

Conclusions:

Our proposed temporary browplasty is a simple technique that can help with surgical exposure in a nontraumatic fashion. The goal of such is to try to decrease surgical time and stretch induced by the speculum. Although there is not a united consensus on the pathophysiology of speculum induced postoperative ptosis, it is clear that whatever the mechanism limited exposure to the speculum may help decrease horizontal stretch or damage to the levator.

Financial Disclosure:

NONE

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