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Stallard S Eye Surgery Ebook 11


This technique is not feasible in patients who underwent lateral wall decompression surgery. A novel method uses the posterior clinoid (PC) process as a landmark and measures the distance between the PC and the anterior corneal surface[44]




Stallard S Eye Surgery Ebook 11



Elective surgical options are reserved for inactive thyroid eye disease cases not responding to conservative or maximal medical management. During cosmetic rehabilitation, orbital decompression surgery is the primary procedure to correct proptosis. After six months, strabismus surgery achieves adequate ocular alignment. After an additional six months, a definitive lid retraction surgery helps restore the cosmetic and functional status.


The surgical plan is customized depending on the amount of proptosis correction, the pattern of strabismus, and the orbital anatomy. The restricted EOM is recessed to achieve orthophoria in the primary gaze. The final correction for the lid retraction is planned at least six months after the strabismus surgery. Blepharotomy, blepahromyotomy, levator recession, and spacer grafts are the common strategies for lid retraction correction.[75]


The patient was operated under local retro bulbar anaesthesia, the surgery was started by synechiolysis, and iris dilators were put in place revealing the abscess which was a homogeneous opacity, dense, yellowish white, well demarcated from the rest of the lens, with vascularization from the adhesion of the adjacent iris (Figure 2). This collection was punctuated and its purulent content was emptied into the anterior chamber (Figure 3); the pus has been removed and drained; and the remaining fibrous shell was detached from the iris and removed with forceps (Figure 4), phacoemulsification continued without incident and we ended with the placement of a lens implant in the capsular bag (Figure 5).The sequellar corneal opacity which presents the point of penetration of the thorn was better visualized after the dilation of the iris (Figure 6) Microbiological examination of pus, aqueous humor,and aspirated cortical material found Staphylococcus epidermidiswhich was sensitive to methicillin, so a topical and general antibiotictreatment was continued for 10 days, with clinical improvementand final visual acuity at 8/10.


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