The Harada-Ito procedure is an eye muscle surgery used to treat symptomatic excyclotorsion, commonly seen in cases of acquired cranial nerve 4 palsy. This condition can cause the eye to rotate outward, leading to torsional binocular diplopia. The procedure targets the anterior fibres of the superior oblique tendon, which are primarily responsible for the torsional function of the eye. By tightening or advancing these fibres toward the insertion of lateral rectus, the procedure increases incyclotorsion of the eye, helping to realign the visual axes and relieve diplopia. The Harada-Ito procedure is typically performed on patients who experience significant torsional symptoms but retain good vertical function of the superior oblique. Fell’s modification relates specifically to disinserting the isolated anterior tendon fibres and then reinserting them anteriorly and lateral to the insertion of the lateral rectus muscle. Postoperative results are generally favourable, with significant reduction of torsional diplopia.
Specialty: Ophthalmology
Surgical removal of giant cutaneous horn from a pyogenic granuloma
This video depicts the surgical excision of a pyogenic granuloma on the lower eyelid.
The patient was brought into the operating room and general anesthesia was induced,
the base of the lesion was injected with lidocaine and epinephrine. A warm compress
was applied to soften the crusted lesion. The crust was then gently elevated revealing
the giant pyogenic granuloma. A chalazion curette was used to completely remove the
lesion. A chalazion clamp was utilized to stabilize the lid and for hemostasis purposes.
External Dacryocystorhinostomy
This video demonstrates an external dacryocystorhinostomy surgery with insertion of a nasolacrimal duct stent in a patient with a history of dacryocystitis of rare fungal etiology.
Direct Brow Lift
The procedure in this video demonstrates a direct brow lift.
Bleb Needling in Trabeculectomy Revision
In this video, a patient presenting with an obstructed trabeculectomy bleb has a revision performed using an ab externo bleb needling approach. The procedure begins by inserting a corneal traction suture for improved access to the scarred bleb and is followed by the insertion of an infusion canula providing a continuous source of balanced salt solution. A bent 25- or 27-gauge needle is then used to carefully disrupt the scar tissue within the bleb. The procedure concludes with the injection of mitomycin-c, an anti-fibrotic agent that aims to promote the longevity of the cleared bleb.
Ab Externo Trabeculotomy Performed via Illuminated Microcatheter
In this video, a 7-month-old patient presenting with primary congenital glaucoma and corneal clouding has an ab externo trabeculotomy performed on her left eye. The procedure begins with subconjunctival dissection and formation of a temporal scleral flap to locate the back wall of Schlemm’s canal (SC). A 270-degree circumferential trabeculotomy is performed with an illuminated microcatheter. The microcatheter is blocked from completing a full 360 degree pass due to scarring from a previously failed superior trabeculectomy. A scleral cutdown is used to retrieve the microcatheter. Another 40 degrees of trabecular meshwork (TM) is incised in the opposite direction using a metal trabeculotome.
Evisceration
This video demonstrates an evisceration surgery with placement of a 16mm silicone implant in a patient with a blind, painful eye.
Punctal Dilation and Mini-Monoka Stent Insertion
This video demonstrates punctal dilation and insertion of a Mini-Monoka stent for treatment of epiphora due to punctal/canalicular stenosis.
Lacrimal Probing and Irrigation
This video demonstrates lacrimal probing and irrigation to investigate the anatomy, patency, and functional status of the lacrimal drainage system.
A Pediatric Case of Levator Palpebrae Resection
In this video, we present a case of levator palpebrae resection in an 8-year-old patient with right eye ptosis.
In the pre-op photo, significant ptosis of the right eye can be appreciated. An incision was planned along the lid crease. 0.1 ml of 1: 100,000 epinephrine was injected. An incision was made by electro-cautery along the lid through the skin and orbicularis. Westcott scissors were used to further dissect horizontally. The septum was identified and opened. The preaponeurotic fat was identified and lifted, and the levator aponeurosis was identified. The levator was then tagged with two 6.0 Vicryle sutures, and isolated from surrounding tissues. Next, three6-0 Mersilene sutures were run from the upper tarsus to the levator. They are tightened with releasable notes. The lid elevation and contour were evaluated and adjustments were made until contour and height were equal and appropriate. The temporary surgical knots were transitioned into permanent surgical knots. Approximately 14 mm of excess levator was then excised. Next, three lid crease formation sutures were placed using 6-0 Vicryl. These were attached to the subcu-skin and levator to recreate the upper eyelid crease. Skin closure was performed with 6-0 fast-absorbing gut sutures. In this one-week post-op photo, the ptosis of his right eye was improved.
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