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Rail-roading technique using 18 gauge intravenous catheter and silicon rod for frontalis suspension in blepharophimosis syndrome.

Goel R, A G A, Jain S, K P S M, Nagpal S, Kishore D - Open Ophthalmol J (2015)

Bottom Line: However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle.To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod -needle assembly.The technique is easily reproducible, safe and can be used in all silicon rod suspensions.

View Article: PubMed Central - PubMed

Affiliation: Gurunanak Eye center, Maulana Azad Medical College, New Delhi, India.

ABSTRACT
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod -needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.

No MeSH data available.


Related in: MedlinePlus

The stainless steel needle attached to the silicon rod is docked into the lumen of the catheter after withdrawing the stillete.
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Figure 2: The stainless steel needle attached to the silicon rod is docked into the lumen of the catheter after withdrawing the stillete.

Mentions: Under local anesthesia, the lid sutures were passed in the upper lid. The lid plate was placed to protect the globe and standard incision sites of the Fox’s method were marked on the lid and forehead. The lid marks were made 3 mm above the lid margin. The brow incision sites were marked on the brow slightly medial and lateral to the medial & lateral lid incision sites respectively. The superior brow incision site, 1 cm superior and central to both the brow incisions, was deepened with tenotomy scissors to bury the silicon rod ends. In the left eye silicon sling was passed starting from superior brow incision medially in an anti-clockwise direction. At the time of passing the sling from the lateral- most lid incision up wards towards the lateral brow incision, a lot of resistance was encountered, possibly due to the thin tarsus and the deficient orbital rim. As the sling was not passing through, despite, repeated attempts, to prevent further damage to soft tissues, an 18 gauge intravenous catheter (internal diameter 1.03 mm, outer diameter 1.2 mm, 30 mm in length) was passed along with the stilette in place through the lateral brow incision downwards towards the lateral lid marking to make a tract, the stilette was then withdrawn and the sling attached to its steel needle (0.9 mm outer diameter) was engaged in the flexible catheter tubing (Fig. 1). The catheter was then withdrawn along with the silicon sling easily through the lateral brow incision (Fig. 2). The same procedure was carried out for bringing out the sling through the superior brow incision (Fig. 3, 4). The sling was then passed through the sleeve and tightened at the forehead to lift the lids to achieve the desired lid height and contour. The ends of the sling were trimmed. The sleeve was then buried in the superior forehead incision to prevent extrusion. The superior incision was then sutured in 2 layers using 5-0 vicryl and 6-0 silk. The other incisions were left to heal as such. Similar procedure was repeated on the other eye. Frost sutures were applied.


Rail-roading technique using 18 gauge intravenous catheter and silicon rod for frontalis suspension in blepharophimosis syndrome.

Goel R, A G A, Jain S, K P S M, Nagpal S, Kishore D - Open Ophthalmol J (2015)

The stainless steel needle attached to the silicon rod is docked into the lumen of the catheter after withdrawing the stillete.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321230&req=5

Figure 2: The stainless steel needle attached to the silicon rod is docked into the lumen of the catheter after withdrawing the stillete.
Mentions: Under local anesthesia, the lid sutures were passed in the upper lid. The lid plate was placed to protect the globe and standard incision sites of the Fox’s method were marked on the lid and forehead. The lid marks were made 3 mm above the lid margin. The brow incision sites were marked on the brow slightly medial and lateral to the medial & lateral lid incision sites respectively. The superior brow incision site, 1 cm superior and central to both the brow incisions, was deepened with tenotomy scissors to bury the silicon rod ends. In the left eye silicon sling was passed starting from superior brow incision medially in an anti-clockwise direction. At the time of passing the sling from the lateral- most lid incision up wards towards the lateral brow incision, a lot of resistance was encountered, possibly due to the thin tarsus and the deficient orbital rim. As the sling was not passing through, despite, repeated attempts, to prevent further damage to soft tissues, an 18 gauge intravenous catheter (internal diameter 1.03 mm, outer diameter 1.2 mm, 30 mm in length) was passed along with the stilette in place through the lateral brow incision downwards towards the lateral lid marking to make a tract, the stilette was then withdrawn and the sling attached to its steel needle (0.9 mm outer diameter) was engaged in the flexible catheter tubing (Fig. 1). The catheter was then withdrawn along with the silicon sling easily through the lateral brow incision (Fig. 2). The same procedure was carried out for bringing out the sling through the superior brow incision (Fig. 3, 4). The sling was then passed through the sleeve and tightened at the forehead to lift the lids to achieve the desired lid height and contour. The ends of the sling were trimmed. The sleeve was then buried in the superior forehead incision to prevent extrusion. The superior incision was then sutured in 2 layers using 5-0 vicryl and 6-0 silk. The other incisions were left to heal as such. Similar procedure was repeated on the other eye. Frost sutures were applied.

Bottom Line: However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle.To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod -needle assembly.The technique is easily reproducible, safe and can be used in all silicon rod suspensions.

View Article: PubMed Central - PubMed

Affiliation: Gurunanak Eye center, Maulana Azad Medical College, New Delhi, India.

ABSTRACT
Silicon rods are widely employed for frontalis sling suspension. However, on passing through the tissues, at times, the silicon rod gets detached from the stainless steel needle. This occurs more commonly in patients of blepharophimosis syndrome, in which hypoplasia of superior orbital rim with deficiency of skin between lid and brow, causes difficulty in passage of the needle when it is manipulated upwards from lid towards the brow. To overcome these problems we describe the use of an 18 G intravenous catheter to railroad the needle with the silicon rod, obviating the blind upward maneuvers with the needle and protecting against the damage to the silicon rod -needle assembly. The technique is easily reproducible, safe and can be used in all silicon rod suspensions.

No MeSH data available.


Related in: MedlinePlus