Subkonjontival Orbital Yağ Fıtıklaşması: Bir Olguda Yeni Bir Teknikle Onarım

1. 1Torbali State Hospital, Department Of Ophthalmology, Izmir, Turkey
2. 2Ulucanlar Eye Education And Research Hospital, Ankara, Turkey
3. 3S.B. Ankara Ulucanlar Göz Egitim Ve Arastirma Hastanesi, Ankara

Sorumlu Yazar: Subconjunctival HOF is an uncommon clinical condition, in contrast to the extraconal fat, which is a frequent finding such as herniated fat pads of the lower eyelids in patients over 60 years of age.3 It usually occurs in elderly (average onset of 65 years) obese men, unilaterally or bilaterally in the superotemporal quadrant of the eye.3 Clinically, (an elevated, soft, yellowish mass with superficial blood vessels and a convex well demarcated anterior border), distinction from other ocular pathologies including dermoid cysts, dermolipoma, lacrimal gland abnormalities, and subconjunctival lipomas is usually possible.1 In this case report, the patient was male but not obese, and was diagnosed clinically by its typical local findings. Also, orbital imaging was helpful for the diagnosis. Sires et al6 demonstrated that superotemporal fat was not usually included in extraconal space. Furthermore, Koornneef reported that the thinnest intermuscular septum was in the superotemporal region.7 In the light of this knowledge, because of slimming of the superotemporal intermuscular septum with ageing, the intraconal fat may come forward without trauma, and the HOF may be surrounded by stretched intermuscular septum. The approach to treatment of HOF has frequently been to excise the “herniated fat”1,2,4,5, but excision of the orbital fat may be difficult, and postoperative bleeding from the pedicle of the removed fat is a potential risk for a retrobulbar hematoma.1 Otaka and Kyu exhibited their surgical procedure lacking a conjunctival opening: The HOF was pushed back, and the conjunctiva was fixed to the sclera with several stitches.8 However, in this technique, serious complications such as choroidal hemorrhage or rhegmatogenous retinal detachment by an accidental scleral perforation or restriction of eye movements by deeper (more posterior) sutures may occur. In our technique, conjunctiva was opened and the intermuscular septum was fixed to the Tenon’s capsule with several shallow stitches to preclude damage to the globe. This fixation limits additional fat herniation with minimal trauma to the intermuscular septum. We preferred this modification in the fat conserving technique to avoid serious complications and recurrence. Although further studies with many cases and long-term follow-up are needed to ascertain the safety and efficacy of this technique; relocating rather than removing of HOF seems to be more favorable in selected cases. In view of the fact that we observed a lasting excellent result, we recommend the procedure in similar patients. Address for Correspondence/Yazisma Adresi: Melike Balikoglu-Yilmaz MD, Torbali State Hospital, Department of Ophthalmology, Izmir, Turkey Phone: +90 232 856 62 70 E-mail: drmelkebalkoglu@yahoo.com Received/Gelis Tarihi: 09.06.2012 Accepted/Kabul Tarihi: 18.09.2012