Septum-sparing minimally invasive technique for levator advancement surgery in aponeurotic ptosis.

PURPOSE: To evaluate the outcome of small incision levator advancement with septum-sparing technique and compare it with standard levator advancement. METHODS: The surgical findings and clinical data of patients with aponeurotic ptosis who underwent small incision or standard levator advancement surgery in our clinic between 2018 and 2020 were analyzed retrospectively. For both groups; age, gender, systemic and ophthalmic comorbidities, levator function, preoperative and postoperative margin-reflex distance, change in margin-reflex distance after surgery, symmetry between the eyes, follow-up time, perioperative and postoperative complications (under/overcorrection, contour irregularity, lagophthalmos) were all evaluated and recorded. RESULTS: The study included 82 eyes, 46 from 31 patients in Group I who had small incision surgery, and 36 from 26 patients in Group II who had standard levator surgery. There was no statistically significant difference in surgical success between the two groups (80% and 81% respectively, p = 0.692). The levator function and preoperative margin-reflex distance correlated positively with surgical success. CONCLUSION: Small incision levator advancement is a less invasive procedure than standard levator advancement because of the smaller skin incision and preservation of orbital septum integrity, but it requires good knowledge of eyelid anatomy and experience in eyelid surgery. In patients with aponeurotic ptosis, this surgery can be performed as a safe and effective surgical technique with a similar success rate as standard levator advancement.

Bruch's membrane opening-minimum rim width: An alternative OCT biomarker study for multiple sclerosis.

PURPOSE: Bruch's membrane opening-minimum rim width (BMO-MRW) and RNFL measured using anatomic positioning system (APS-RNFL) are novel OCT methods and remained unexplored in MS patients.To investigate the novel parameters of spectral-domain OCT as an alternative biomarker in patients with multiple sclerosis (MS). METHODS: Retrospective cohort study; participants consisted of relapsing-remitting MS (RRMS) patients and healthy controls (HC). Eyes were classified according to the presence of MS and previous optic neuritis (ON). Measurements of standard peripapillary RNFL (S-RNFL), BMO-MRW, and APS-RNFL were performed. RESULT: A total of 244 eyes of 122 participants (MS-patients: 63, HC: 59) were included in the study. Fifty-one eyes had a history of previous ON. In almost all measured parameters, neuroretinal rim thicknesses were observed the thinnest in eyes with ON history between all subgroups. S-RNFL and APS-RNFL techniques showed the difference in neuroretinal rim thickness in all three subjects (ON+, ON-, and HC). However, BMO-MRW, on the other hand, could not distinguish between ON(-) patients and HC. The relationship between OCT parameters and EDSS were observed only in eyes with an ON history in all three techniques. A meaningful model with 78% accuracy was obtained by using only the OCT parameters as risk factors. In the ROC analysis, no parameters were found to have acceptable high sensitivity and specificity. BMO-MRW was statistically weaker in every aspect than other RNFL techniques. CONCLUSION: The novel APS-RNFL technique appears to be a bit more reliable alternative to S-RNFL technique to support therapeutic decision-making in MS. BMO-MRW has not been found as a successful alternative to S-RNFL.