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Purpose: To describe the reconstruction of large upper eyelid defects with bilobed flap and tarsoconjunctival graft. Methods: The medical records of 5 patients who underwent upper eyelid tumor excision and eyelid reconstruction with a bilobed flap were reviewed. Various parameters, including demographic and clinical data, defect diameter, primary defect closure, complications, and follow-up time, were recorded. After tumor excision, the posterior lamella was reconstructed with an autologous tarsoconjunctival graft and anterior lamella with a superiorly based lateral bilobed flap. Results: All 5 patients (3 women, 2 men; age: 42–87 years) had malignant epidermal (n = 2) or adnexal (n = 3) tumors. Mean excisional defect diameter was between 18.5 and 25 mm. In all patients, the anterior lamellar defect was closed primarily with a bilobed flap. After surgery, a total of 4 complications occurred in 3 patients. One patient required orbital exenteration because of tumor recurrence. In the other patients, the functional and esthetic results were satisfactory. Follow-up time ranged from 4 to 102 months. Conclusion: Lateral periorbital bilobed flap can be a good alternative for the single-stage reconstruction of large upper eyelid defects.

Purpose: To review the outcomes of orbital exenteration defect reconstruction using cheek or combined cheek-forehead advancement flap. Methods: Charts of 14 patients who underwent reconstruction of the exenterated orbit with cheek advancement flap were reviewed. In surgery, a cheek flap elevated via a nasofacial sulcus incision, and preperiosteal dissection was advanced over the defect. The upper orbital defect, if necessary, was covered with a forehead flap, which was dissected through an incision in the midline or temporal forehead and advanced inferiorly. Results: In all patients (7 women, 7 men; mean age, 65 years), total (n = 7) or extended (n = 7) exenteration was performed for a malignant tumor. In 12 patients (86%), the defect was primarily closed with cheek flap alone (n = 6) or cheek plus forehead (n = 6) advancement flaps. Eight patients received radiotherapy before and after surgery. Four patients (29%) had a total of 6 postoperative complications (skin graft infection, orbital cavitary abscess, osteomyelitis, chronic skin ulcer, and 2 sino-orbital fistulae). The mean follow-up duration was 43 months (range, 11–79 months). Conclusions: Cheek advancement flap can be used alone or together with a forehead advancement flap to cover the orbital defects after total or extended exenteration. This repair may be resistant to radiotherapy-related complications in some cases.

Objectives: To define a haptic modification technique to increase the overall length of the intraocular lens (IOL) and evaluate the postoperative outcomes of patients in whom this technique was applied. Materials and Methods: The preoperative and postoperative characteristics of patients who underwent modified IOL implantation into the sulcus between May 2019 and December 2019 were evaluated. Modified Sensar AR40e lenses with hydrophobic acrylic optic and polymethylmethacrylate haptics were implanted to all eyes. Before implanting the IOL, the haptics were grasped with two toothless forceps and bent to elongate the total diameter of the IOL from 13.0 mm to 14.5 mm. Results: The study included 11 eyes of 11 patients who underwent modified three-piece IOL implantation into the sulcus due to insufficient capsular support. The mean age of the patients was 53.9±12.2 years. The mean axial length was 24.13±1.93 mm. Sulcus implantation was required due to aphakia in 9 eyes and IOL dislocation in 2 eyes. No haptic breakage occurred during the IOL modification technique or implantation. The mean preoperative best corrected visual acuity (BCVA) was 0.88±1.1 logMAR, while postoperative BCVA was 0.28±0.30 logMAR. No IOL dislocation or decentration was observed during 6-month postoperative follow-up. Conclusion: The larger diameter lenses obtained with this inexpensive and easily applicable technique may allow a more stable sulcus implantation in eyes with inadequate capsular support.

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