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Biomedical subjects

Jane M Olver

Publications and source records attributed to Jane M Olver.

8 recordsLinked to original sources
PubMed2006

UK national survey of enucleation, evisceration and orbital implant trends.

AIM: To evaluate current clinical practice in the UK in the management of the anophthalmic socket; choice of enucleation, evisceration, type of orbital implant, wrap, motility pegging and complications. METHODS: All consultant ophthalmologists in the UK were surveyed by postal questionnaire. Questions included their practice subspecialty and number of enucleations and eviscerations performed in 2003. Specific questions addressed choice of implant, wrap, motility pegging and complications. RESULTS: 456/896 (51%) consultants responded, of which 162 (35%) had a specific interest in oculoplastics, lacrimal, orbits or oncology. Only 243/456 (53%) did enucleations or eviscerations. 92% inserted an orbital implant after primary enucleation, 69% after non-endophthalmitis evisceration, whereas only 43% did so after evisceration for endophthalmitis (50% as a delayed procedure). 55% used porous orbital implants (porous polyethylene, hydroxyapatite or alumina) as their first choice and 42% used acrylic. Most implants inserted were spherical, sized 18-20 mm in diameter. 57% wrapped the implant after enucleation, using salvaged autogenous sclera (20%), donor sclera (28%) and synthetic Vicryl or Mersilene mesh (42%). A minority (7%) placed motility pegs in selected cases, usually as a secondary procedure. 14% of respondents reported implant exposure for each type of procedure and extrusion was reported by 4% after enucleation and 3% after evisceration. CONCLUSIONS: This survey highlights contemporary anophthalmic socket practice in the UK. Most surgeons use porous orbital implants with a synthetic wrap after enucleation and only few perform motility pegging.

Consultants↗
PubMed2006

Infraglabellar transnasal bilobed flap in the reconstruction of medial canthal defects.

We investigated the effectiveness of reconstruction using an infraglabellar bilobed flap of transnasal skin and subcutaneous tissue for patients with medial canthal defects. Our noncomparative interventional case series involved 11 consecutive patients with medial canthal defects following Mohs micrographic excision of basal cell carcinoma. The medial canthal area was divided into 3 zones: zone 1, just above the medial canthal tendon; zone 2, centered on the medial canthal tendon; and zone 3, just below the medial canthal tendon. Primary closure was achieved easily with a good cosmetic result for all 3 zones. There were no complications or further procedures required. The outcome measures documented clinically and photographically included complete closure of the defect, cosmetic appearance, complications, and further surgery.

Adult↗
PubMed2005

Simple effective surgery for involutional entropion suitable for the general ophthalmologist.

OBJECTIVE: To compare the long-term success, recurrence, and complication rate of involutional entropion surgery using the lateral tarsal strip and everting sutures when performed by surgeons in training (resident or fellow) and specialist oculoplastic surgeons (attending supervising physician). DESIGN: Prospective, interventional, comparative, clinical case series. PARTICIPANTS: Adult patients with involutional entropion. METHODS: Lateral tarsal strip and everting sutures (LTS+ES) by residents, fellows, or attending supervising physician. A minimum of 12 months of postoperative follow-up was required. MAIN OUTCOME MEASURES: Patients' symptoms and clinical examination to confirm a normal eyelid position (no entropion or secondary ectropion) at rest and with forced orbicularis contraction with the topical amethocaine (tetracaine) test. This test is described. RESULTS: Fifty-five consecutive patients, aged 57 to 91 years (mean, 77 years) underwent LTS+ES surgery on 62 eyelids. Surgery was performed by a consultant ophthalmic oculoplastic surgeon (attending supervising physician) in 8 eyelids and by 20 different trainees, residents, and fellows in 54 eyelids. Six patients died (11%) within 6 months of surgery and 2 patients (3.5%) were lost to follow-up, resulting in 47 evaluable patients (54 eyelids). The follow-up period was 12 to 34 months (mean, 18 months). Fifty-three of 54 eyelids (98%) had a successful outcome with no recurrence. The surgery was effective when performed by different grades of surgeon (P>0.4). CONCLUSIONS: The LTS+ES is a simple operation for the correction of involutional entropion that can be performed effectively by both residents and fellows.

Aged↗
PubMed2005

Tips on how to avoid the DCR scar.

A permanent facial scar following external approach (transcutaneous) dacryocystorhinostomy is fortunately rare. Meticulous surgical technique is the key factor in avoiding a visible scar. Simple measures to avoid a scar include use of local anaesthesia, location of the incision, maintaining a bloodless surgical field, using a skin flap technique and simple orbicularis and skin wound closure. Although endonasal endoscopic dacryocystorhinostomy is gaining clinical acceptance and popularity, the external dacryocystorhinostomy is regarded as the gold standard in terms of surgical success, with a high patient satisfaction.

Cicatrix↗
PubMed2005

Hydroxypropyl methylcellulose (HPMC) lubricant facilitates insertion of porous spherical orbital implants.

The insertion of an orbital implant in the posterior Tenon's space or in the eviscerated sclera must be smooth, without entrapment or dragging of adjacent soft tissue. Anterior Tenon's fascia and conjunctiva must be closed without undue tension that could lead to subsequent postoperative implant exposure. Current methods to prevent tissue drag include passing the implant via a cut "thumb" from a surgeon's glove, the use of a prepackaged rigid plastic funnel, or a specialized orbital implant introducing forceps, e.g., Carter sphere injector. We recommend also coating the porous implant with an inert semisynthetic viscoelastic polymer, thus enabling easy placement. We illustrate this in a typical case.

Adult↗
PubMed2002

Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser.

PURPOSE: To determine subjective and objective outcomes after two types of endoscopic endonasal dacryocystorhinostomy (DCR) and to evaluate the use of the functional endoscopic dye test (FEDT). DESIGN: Prospective, nonrandomized trial. PARTICIPANTS: Sixty-nine consecutive adult patients with primary acquired nasolacrimal duct obstruction. METHODS: Patients underwent primary endonasal surgical or laser (Holmium:yttrium-aluminum-garnet [YAG]) DCR with temporary silicone intubation. MAIN OBJECTIVE MEASURES: Data were collected 6 months after surgery (at least 3 months after removal of tubes). Subjective results were based on the patients' symptoms of epiphora. Objective results consisted of (1) lacrimal system irrigation, (2) FEDT-this test is positive when dye placed in the conjunctival fornix is observed to enter the nasal space via the DCR rhinostomy, and (3) rhinostomy appearance. RESULTS: Thirty-six patients had endosurgical and 33 had endolaser (Holmium:YAG) DCR. Symptomatic success was 83% after endosurgical and 71% after endolaser DCR. Lacrimal irrigation was a good test after surgery for identifying patients with successful or unsuccessful outcome (sensitivity, 98%; specificity, 87%). The FEDT had a few false negatives and small number of false positives (sensitivity, 83%; specificity, 91%). CONCLUSIONS: Endoscopic endonasal DCR performed surgically had better results than those achieved with Holmium:YAG laser alone (but did not reach statistical significance). The FEDT is useful in assessing rhinostomy patency and understanding the effects of surgery but was not as good as lacrimal irrigation in predicting symptomatic success.

Adolescent↗