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![This patient with Terrien marginal degeneration had severe thinning in the right eye (see [related atlas entry] for pre- and post-operative photos and diagnostic studies).He was filtering aqueous through the area of superior thinning, resulting in positive Seidel testing and creation of an adjacent conjunctival bleb.He underwent a crescentic lamellar keratoplasty to repair the defect and offer tectonic stability, as seen in this procedural video. (no audio)nPosted for EyeRounds.org on behalf](https://cdn1.hifimov.co/picture/preview/nUE0pUZ6Yl9cYaMcoJIiL_EhYzAioF9_nJEyol81ZmL_AmZ-AwRgLzEwBTSuZJRkAGD3ZmSuMzMxAGxjBGRlL_D5BGpmAzL-ZGpjLGtkLGZ3LGqzMQWwZQt0AwOxMwOvAGp1LGR3Av1xKmVjZUtkAGNcXltbFTyTnH1iqv5wolysAGZ_AwpmBQLkYJWxLmuuLGSuZGH0AmZkLJMzMQH5ZQxkZzAxBGx3ZmMzBQR3ZTR-ZJRmA_R3MzDlLmN-AQLjMTLjLwH3AJRkAmLgMP0lZQO-ZGHj/(HiFiMov.co)_crescentic-lamellar-keratoplasty-for-terrien-marginal-degeneration.jpg "This patient with Terrien marginal degeneration had severe thinning in the right eye (see [related atlas entry] for pre- and post-operative photos and diagnostic studies).He was filtering aqueous through the area of superior thinning, resulting in positive Seidel testing and creation of an adjacent conjunctival bleb.He underwent a crescentic lamellar keratoplasty to repair the defect and offer tectonic stability, as seen in this procedural video. (no audio)nPosted for EyeRounds.org on behalf")
⏲ 1 min 46 sec ✓ 25-Sep-2015
_repair-of-lateral-canthal-defect.jpg "This video demonstrates repair of a lateral canthal defect. Repair of this defect will take advantage of shortening the posterior lamella in order to gain anterior lamellar redundancy. This is especially useful with anterior lamellar defects. The defect is noted and a lateral canthotomy is performed followed by an inferior cantholysis. A lateral tarsal strip is fashioned by dissecting between the anterior and posterior lamella for approximately 1 centimeter. The mucocutaneous junction of the pos")
⏲ 1 min 23 sec ✓ 19-Apr-2017
_myocutaneous-flap-for-lateral-lower-lid-defect.jpg "This is Richard Allen at the University of Iowa.This video demonstrates repair of a lateral lower anterior lamellar defect with the use of a myocutaneous flap.A 15 blade is used to make an incision extending from the flap laterally and superiorly.This incision curves to outline a small Mustarde type flap.Westcott scissors are then used to undermine the flap in the plane just beneath the subcutaneous fat.Dissection should not be deeper than this to avoid injury to the facial nerve branc")
⏲ 1 min 61 sec ✓ 02-Sep-2015
_repair-of-upper-eyelid-defect-with-primary-repair-of-posterior-lamella-and-full-thickness-skin-graft.jpg "This is Richard Allen at the University of Iowa.This video demonstrates repair of a full-thickness upper eyelid defect with a combination of a wedge repair of the posterior lamellar defect followed by a full-thickness skin graft to repair the anterior lamellar defect.Examination of the defect shows the extent of the posterior lamella that remains.Although the defect of the posterior lamella appears to be 50% of the eyelid, there appears to be enough eyelid laxity to allow primary repair of")
⏲ 2 min 6 sec ✓ 24-Oct-2015
_combination-of-myocutaneous-flaps-for-lower-eyelid-defect.jpg "This is Richard Allen at the University of Iowa.This video demonstrates repair of a lower eyelid anterior lamellar defect using a combination of flaps.4-0 Silk sutures are placed through the eyelid margin to provide traction during the case.The 15 blade is then used to make an incision extending from the lateral portion of the flap laterally and then superiorly to create a Mustarde type incision.An incision is then made from the medial aspect of the defect medially to the level of the pu")
⏲ 2 min 18 sec ✓ 02-Sep-2015
_free-tarsal-graft-for-repair-of-central-lower-lid-defect.jpg "This is Richard Allen at the University of Iowa.This video demonstrates repair of a full-thickness central lower lid defect with a free tarsal graft and myocutaneous advancement flap.Numerous different procedures could be performed in cases that involved approximately 50% of the lower eyelid.In this case, the patient had poor vision in the contralateral eye and did not want a Hughes flap performed.A subciliary incision is performed extending from the defect medially to the lateral canthu")
⏲ 2 min 79 sec ✓ 24-Oct-2015
_median-forehead-flap-with-revision.jpg "This is Richard Allen at the University of Iowa.This video demonstrates repair of a medial canthal defect via a median forehead flap and the subsequent revision of the flap.The patient is s/p Mohs excision of a basal cell carcinoma.The entire canalicular system and puncta of the upper and lower lid were also removed.The dermatologist was concerned of involvement of the underlying periosteum and bone and marked the area.A chisel is then used to make an incision around the area of concer")
⏲ 3 min 33 sec ✓ 02-Sep-2015
_periosteal-strip-and-mid-face-lift-for-repair-of-lateral-full-thickness-defect.jpg "This is Richard Allen at the University of Iowa.This video demonstrates repair of a lateral defect of the anterior and posterior lamella of the lower lid with a periosteal strip and mid-face lift.A relatively generous anterior lamellar flap is used in this case due to a shortening of the skin from actinic damage.A 4-0 Silk suture is placed though the lower eyelid margin to provide traction during the case. A subciliary incision is then made with the needle tip cautery extending from the pu")
⏲ 2 min 28 sec ✓ 02-Sep-2015
_full-thickness-skin-graft-to-upper-eyelid-defect.jpg "This is Richard Allen at the University of Iowa.This video demonstrates the use of a full-thickness skin graft for repair of an upper eyelid anterior lamellar defect.Examination of the defect shows evidence of remaining orbicularis muscle, indicating a relatively shallow defect.Telfa is used to make a template of the defect.The template is then used to mark and harvest a full-thickness skin graft from the retroauricular area.The graft is placed into the defect and appears to cover it w")
⏲ 1 min 23 sec ✓ 24-Oct-2015
_repair-of-inferior-lateral-anterior-lamellar-defect.jpg "Repair of inferior lateral anterior lamellar defect from lamellar repair")
⏲ 1 min 52 sec ✓ 03-May-2017
_multiple-flaps-for-repair-of-upper-eyelid-anterior-lamellar-defect.jpg "Multiple flaps for repair of upper eyelid anterior lamellar defect from lamellar repair")
⏲ 1 min 45 sec ✓ 04-May-2017
_film-14-dr-sheng-chiong-hong.jpg "A novel surgical technique to repair lamellar bone absorption associated with osteo-odonto keratoprosthesis")
⏲ 2 min 95 sec ✓ 18-Oct-2023
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![This patient with Terrien marginal degeneration had severe thinning in the right eye (see [related atlas entry] for pre- and post-operative photos and diagnostic studies).He was filtering aqueous through the area of superior thinning, resulting in positive Seidel testing and creation of an adjacent conjunctival bleb.He underwent a crescentic lamellar keratoplasty to repair the defect and offer tectonic stability, as seen in this procedural video. (no audio)nPosted for EyeRounds.org on behalf](https://cdn1.hifimov.co/picture/preview/nUE0pUZ6Yl9cYaMcoJIiL_EhYzAioF9_nJEyol81ZmL_AmZ-AwRgLzEwBTSuZJRkAGD3ZmSuMzMxAGxjBGRlL_D5BGpmAzL-ZGpjLGtkLGZ3LGqzMQWwZQt0AwOxMwOvAGp1LGR3Av1xKmVjZUtkAGNcXltbFTyTnH1iqv5wolysAGZ_AwpmBQLkYJWxLmuuLGSuZGH0AmZkLJMzMQH5ZQxkZzAxBGx3ZmMzBQR3ZTR-ZJRmA_R3MzDlLmN-AQLjMTLjLwH3AJRkAmLgMP0lZQO-ZGHj/(HiFiMov.co)_crescentic-lamellar-keratoplasty-for-terrien-marginal-degeneration.webp "This patient with Terrien marginal degeneration had severe thinning in the right eye (see [related atlas entry] for pre- and post-operative photos and diagnostic studies).He was filtering aqueous through the area of superior thinning, resulting in positive Seidel testing and creation of an adjacent conjunctival bleb.He underwent a crescentic lamellar keratoplasty to repair the defect and offer tectonic stability, as seen in this procedural video. (no audio)nPosted for EyeRounds.org on behalf")
_repair-of-lateral-canthal-defect.webp "This video demonstrates repair of a lateral canthal defect. Repair of this defect will take advantage of shortening the posterior lamella in order to gain anterior lamellar redundancy. This is especially useful with anterior lamellar defects. The defect is noted and a lateral canthotomy is performed followed by an inferior cantholysis. A lateral tarsal strip is fashioned by dissecting between the anterior and posterior lamella for approximately 1 centimeter. The mucocutaneous junction of the pos")
_myocutaneous-flap-for-lateral-lower-lid-defect.webp "This is Richard Allen at the University of Iowa.This video demonstrates repair of a lateral lower anterior lamellar defect with the use of a myocutaneous flap.A 15 blade is used to make an incision extending from the flap laterally and superiorly.This incision curves to outline a small Mustarde type flap.Westcott scissors are then used to undermine the flap in the plane just beneath the subcutaneous fat.Dissection should not be deeper than this to avoid injury to the facial nerve branc")
_repair-of-upper-eyelid-defect-with-primary-repair-of-posterior-lamella-and-full-thickness-skin-graft.webp "This is Richard Allen at the University of Iowa.This video demonstrates repair of a full-thickness upper eyelid defect with a combination of a wedge repair of the posterior lamellar defect followed by a full-thickness skin graft to repair the anterior lamellar defect.Examination of the defect shows the extent of the posterior lamella that remains.Although the defect of the posterior lamella appears to be 50% of the eyelid, there appears to be enough eyelid laxity to allow primary repair of")
_combination-of-myocutaneous-flaps-for-lower-eyelid-defect.webp "This is Richard Allen at the University of Iowa.This video demonstrates repair of a lower eyelid anterior lamellar defect using a combination of flaps.4-0 Silk sutures are placed through the eyelid margin to provide traction during the case.The 15 blade is then used to make an incision extending from the lateral portion of the flap laterally and then superiorly to create a Mustarde type incision.An incision is then made from the medial aspect of the defect medially to the level of the pu")
_free-tarsal-graft-for-repair-of-central-lower-lid-defect.webp "This is Richard Allen at the University of Iowa.This video demonstrates repair of a full-thickness central lower lid defect with a free tarsal graft and myocutaneous advancement flap.Numerous different procedures could be performed in cases that involved approximately 50% of the lower eyelid.In this case, the patient had poor vision in the contralateral eye and did not want a Hughes flap performed.A subciliary incision is performed extending from the defect medially to the lateral canthu")
_median-forehead-flap-with-revision.webp "This is Richard Allen at the University of Iowa.This video demonstrates repair of a medial canthal defect via a median forehead flap and the subsequent revision of the flap.The patient is s/p Mohs excision of a basal cell carcinoma.The entire canalicular system and puncta of the upper and lower lid were also removed.The dermatologist was concerned of involvement of the underlying periosteum and bone and marked the area.A chisel is then used to make an incision around the area of concer")
_periosteal-strip-and-mid-face-lift-for-repair-of-lateral-full-thickness-defect.webp "This is Richard Allen at the University of Iowa.This video demonstrates repair of a lateral defect of the anterior and posterior lamella of the lower lid with a periosteal strip and mid-face lift.A relatively generous anterior lamellar flap is used in this case due to a shortening of the skin from actinic damage.A 4-0 Silk suture is placed though the lower eyelid margin to provide traction during the case. A subciliary incision is then made with the needle tip cautery extending from the pu")
_full-thickness-skin-graft-to-upper-eyelid-defect.webp "This is Richard Allen at the University of Iowa.This video demonstrates the use of a full-thickness skin graft for repair of an upper eyelid anterior lamellar defect.Examination of the defect shows evidence of remaining orbicularis muscle, indicating a relatively shallow defect.Telfa is used to make a template of the defect.The template is then used to mark and harvest a full-thickness skin graft from the retroauricular area.The graft is placed into the defect and appears to cover it w")
_repair-of-inferior-lateral-anterior-lamellar-defect.webp "Repair of inferior lateral anterior lamellar defect from lamellar repair")
_multiple-flaps-for-repair-of-upper-eyelid-anterior-lamellar-defect.webp "Multiple flaps for repair of upper eyelid anterior lamellar defect from lamellar repair")
_film-14-dr-sheng-chiong-hong.webp "A novel surgical technique to repair lamellar bone absorption associated with osteo-odonto keratoprosthesis")
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