PMC3350191_01
Preoperative view of Case  1.
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fig1
She presented with a sunken eye and ptotic upper eyelid (Figure 1).
Postoperative 5 days after aponeurotic surgery (Case  1).
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fig2
After the second surgery, the position of the corrected upper eyelid was balanced with the unaffected side, but appearance was unnatural (Figure 2).
Postoperative 6 months after aponeurotic surgery. Dehiscence of repaired aponeurosis developed (Case  1).
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fig3
However, during the first few months after aponeurotic surgery, upper eyelid ptosis recurred (Figure 3).
Preoperative (dagger) and final eye prosthesis (double dagger). Note thicker, malformed "sclera," and nonconcentric "cornea", preoperatively.
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fig4
Moreover, the recurrence of the upper eyelid ptosis may be associated with mechanical stress arising from insertion and removal of the prosthetic eye, which was heavier, thicker, and irregular (Figures 4(a) and 4(b)).
PMC3350191_02
Preoperative view of Case  2.
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fig5
She complained of a sunken eye and drooping of the affected upper eyelid (Figure 5).
Intraoperative views of the first surgery (Case  2). (a) Diced costal cartilage fragments wrapped with serratus fascia. (b) Prefabricated ball-shaped graft was placed into anophthalmic socket.
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fig6
Instead, we used an autologous ball-shaped graft composed of diced costal cartilage wrapped with the serratus fascia into the eye socket (Figures 6(a) and 6(b)).
Intraoperative view of the second surgery (Case  2). Lower eyelid support with an auricular cartilage, and frontalis sling for upper eyelid ptosis.
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fig7
We used an auricular cartilage graft for lower eyelid retraction, and a fascia lata graft for the frontalis sling to correct upper eyelid ptosis (Figure 7).
Postoperative view at 17-months followup (Case  2).
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fig8
During 17 months of followup, the patient has been satisfied with the aesthetic improvement of the affected eye, although her enophthalmos was partially corrected (Figure 8).