Eye

SWorld 18-27 December 2012
http://www.sworld.com.ua/index.php/ru/conference/the-content-of-conferences/archives-of-individual-conferences/december-2012
MO DERN PROBLEMS AND W AYS O F THEIR SO LUTIO N IN SCIENCE, TRANSPORT, PRODUCTIO N AND EDUCATIO N 2012
Petrenko O.V., Rozumey N.M., Khibinova O.O.

EVALUATION OF RECONSTRUCTIVE INTERVENTION, PERFORMED
WITH AN INJURY OF AUXILIARY APPARATUS OF THE EYE.
Bogomolets National Medical University.
This paper introduces the developed evaluation methodology of reconstructive
procedures, performed with an eye injury, which considers restoration of form, function
and aesthetics of the auxiliary apparatus of the eye.
Keywords: eye injury, reconstructive intervention, ophthalmoplastics, auxiliary
apparatus of the eye, evaluation, quality analysis, anatomic and topographic features,
functional status, aesthetic condition.
Eye injuries, which constitutes 29.0% of common injuries, is a serious medical and
social problem all over the world. [4, 6]. Its particular relevance is that the damage to the
organ of vision is still a major cause of disability, which reached 30.1% of the working
population of Ukraine (Sergienko N.M., Rykov S.A., Kryzhanovskaya T.V., 2011).
According to many researchers, large fraction of modern eye damage injuries take
the auxiliary apparatus of the eye (AAE), namely 22,4% (Stepanov A.V., Kataev M.G.,
Kurbanov N.F., 2010). Modern damage of AAE characterized by extensive defects and
deformities, often lead to significant functional and aesthetic disturbances, and in many
cases - to disability. The most severe, mixed and combined injuries of AAE are common
among young patients of working age.
Quality and efficiency analysis of medical treatment for injuries of eye deserves
special attention, but the principles and methods of evaluation of anatomical, functional
and aesthetic effect after ophthalmic plastic surgery of AAE after its traumatic changes
are underrepresented in the literature, especially Ukrainian. The importance of this issue
is doubtless, because in our time there is dissatisfaction of patients and surgeons in result
after the operation.
Purpose - to develop an evaluation methodology to assess the results of
reconstructive operations performed with traumatic injuries of the auxiliary apparatus of
the eye.
Materials and methods the work was conducted in the period from 2007 to 2011
at the Department of Ophthalmology of the Bogomolets NMU at ophthalmology
department of center "Eye injury" of Alexander clinical hospital in Kiev (oft. Dep.
OCH). The research is based on the observation and treatment of 541 patients with
extensive post-traumatic defects, and 197 patients with strains of AAE. Evaluation of the
reconstructive procedures, performed with injuries of eye, was conducted with the
restoration of form, function and aesthetics of AAE operated patients.
Results
Analysis of anatomical and topographical features of the structure of AAE from the
standpoint of reconstructive ophthalmic plastic surgery, studies of its functional and
aesthetic conditions showed the need to assess the results of reconstructive operations on
the AAE, correlation between a group of indicators, which revealed the relationship
between quantitative and qualitative indicators using rankings technique. It dictated the
need to identify a universal set of criteria, which would be the key indicators for these
three components.
The correlation and regression analyses identified the need for the inclusion of
certain indicators in assessment methodology and demonstrated specific connections.
For the purpose of objective estimation of the results, considering individual
anatomical features of the structure of AAE, the basic parameters of anatomical,
functional and aesthetic state of AAE after reconstructive operations were converted to
point scale.
As the main criteria of restored function and aesthetics of damaged structures
considered reconstruction of the anatomical integrity of the original picture, the
anatomical parameters as assessment of the results of reconstructive operations on the

AAE, according to previous studies on microsurgical, functional and plastical anatomy,
used the position of the eyebrows, the area of damaged skin, tarsal plate, edge of the
eyelid, the measurement of the index symmetry of eyebrows, palpebral crease, orbit
palpebral fissure, the optic fissure, tear triangle (table 1).
Table 1
Anatomic evaluation of parameters of auxiliary apparatus of the eye
S/N
Title
Area of damage:
eyebrow
Lesion of eyelid edge
Skin
Symmetry index:
eyebrow
palpebral crease
orbitopalpebral fissure
lacrimal caruncle
Damage:
ligamentous apparatus
3.1
eyelids
3.2 tarsal plate
1
1.1
1.2
1.3
2
2.1
2.2
2.3
2.4
3
of
3.3 lacrimal caruncle

4
The difference of the optic

fissure
Score
(points)
Sign
best
worst
16
no
more then 4 mm2
19
no
more then 70%
14
symmetry
asymmetry more
then 3 mm
18
no
16
no
14
no
14
no
ruptures of all the

ligaments
more then 50%
rupture of both tear
ducts
more then 3 mm
Functional parameters of evaluation of ophthalmic plastic surgery of AAE after

traumatic injuries included an objective assessment of the motor, and lacrimal apparatus
before and after surgery with the assessment of the mobility of the upper eyelid, the
magnitude of ptosis, lagophthalmos, lagging index of lower lid, the functional state of
the circular eye muscles, eyelids position, assessment of lacrimal apparatus. (table 2).
For a comparative analysis of the aesthetic results of ophthalmic plastic surgery and
to objectively evaluate the results based on the individual characteristics of the structure
AAE the method of "computer cosmetic measure" was used as proposed by the Moscow
Research Institute of Eye Diseases of Helmholtz, SBD "Ufa Research Institute of Eye
Diseases, Academy of Sciences of Belarus" using software OphtoRule (Ukrainian
certificate number 2011615401).
Table 2
S/N
1
2
3
4
5
6
7
8
9
The parameters of the functional state of

auxiliary apparatus of the eye
Sign
Score
Title
(points)
best
worst
Mobility of the upper eyelid
16
15mm
2mm or less
The magnitude of ptosis
15
no
up to 5 mm or more
orbicular test
Functional state of the circular
orbicular test
1, 2
was
not
eye muscles
reduced
affected
Lagophthalmos
15
no
up to 5 mm or more
lag is more than 2
Lagging index of lower lid
14
no lag
mm
Eyelids position (inversion,
13
norm
strongly expressed
eversion)
Deformation
13
no
strongly expressed
Scar
13
no
affects the function
Patency assessment of tear
12
passable
not passable
ducts and nasal lacrimal
Comparative analysis was performed using overlay photos in a special computer

program, comparing a healthy eye with eye which had reconstructive surgery.
Difference of parameters of AAE position were taken as a base of comparison. Doctors
and the patients evaluation were considered (table 3).
Table 3
Evaluation of parameters of AAE aesthetic state
S/N
Title
1 Sndex of aesthetics
Score
Indicators
(points)
best
14
no deformation
worst
deformation
isstrongly
expressed
2 Doctors and the patients evaluation
15
fine
unsatisfacto
rily
Conclusion
Based on correlation and regression analysis, evaluation of reconstructive
procedures, performed with an eye injury, which considers individual anatomical
features in the structure of the auxiliary apparatus of the eye, the basic parameters of its
functional and aesthetic condition was shown in this study.
References:
1. Jayasundera T. Golf-related ocular injuries / T. Jayasundera, B. Vote, B.
Joondeph // Clin. Exp. Ophthalmol. Vol. 31. P. 110113.
2. Koo L. Gender differences in etiology and outcome of open globe injuries / L.
Koo, M. K. Kapadia, R. P. Singh [et al.] // J. Trauma. 2005. Vol. 59. P. 175178.
3. Kuhn F. A standardized classification of ocular trauma / F. Kuhn, R. Morris, C.
D. Witherspoon [et al.] // Ophthal. 1996. Vol. 103. P. 240243.
4. Pieramici D. J. A system for classifying mechanical injuries of the eye (globe).
The Ocular Trauma Classification Group / D. J. Pieramici, P. Jr. Sternberg, T. M.
Aaberg [et al.] // Am. J. Ophthal. 1997. Vol. 123. P. 820831.
5. Singh H. Visual Outcome after Fireworks Injuries / H. Singh, V. Deependra,
Sharma [et al.] // J. Trauma-Injury Infection&Critical Care. 2005. Vol. 59 (1). P.
109111.
6. Strategies for the Prevention of Blindness in National Programmes : Report of
the WHO / World Health Organization. [2nd ed.] Geneva : WHO, 1997. P. 63.
112 p.
7. Tyers A. G. Comparison of standard eyelid margin closure using silk with a
modified repair using 7/0 Vicryl and a buried knot / A. G. Tyers, B. Mokete, J. Self //
Orbit. 2005. Vol. 24. P. 103.

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SWorld 18-27 December 2012

Petrenko O.V., Rozumey N.M., Khibinova O.O.

anatomical parameters as assessment of the results of reconstructive operations on the

3.3 lacrimal caruncle

The difference of the optic

more then 4 mm2

more then 70%

ruptures of all the

Functional parameters of evaluation of ophthalmic plastic surgery of AAE after

The parameters of the functional state of

Comparative analysis was performed using overlay photos in a special computer

2 Doctors and the patients evaluation

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