The effect of thermo-mechanical device (Tixel) treatment on evaporative dry eye disease - A pilot prospective clinical trial.

PURPOSE: To examine the effects of treatment with a thermomechanical skin device to the eyelid area on the clinical signs and symptoms of patients who suffer from dry eye disease (DED) secondary to meibomian gland dysfunction (MGD). METHODS: Forty patients aged 45 years or older with DED due to MGD were recruited. Both eyes (n = 80) of each patient received three treatments with the Tixel device (Novoxel®, Israel), with each treatment separated by a 2-week period. Treatment was applied across the upper and lower eyelids, with the same intensity, tip protrusion distance, and contact duration. Two additional follow-up visits were performed at 2-week intervals after treatment cessation. DED status was evaluated during each visit via SPEED II questionnaire, tear break-up time (TBUT), corneal staining score (CSS), MGD score, and frequency of lubricant use. Visual acuity (VA) was recorded during first and last visits. RESULTS: Mean age was 64.3 ± 12.4 years and 72.5 % (n = 29) were female. 45 % (n = 18) had a history of blepharitis, 12.5 % (n = 5) had chalazia, and 17.5 % (n = 7) suffered from allergic conjunctivitis. Mean follow-up time was 2.1 ± 0.6 months. Comparing the first and last visits, all parameters showed significant improvement after Tixel treatment: mean SPEED II scores (16.5 ± 5.9 to 11.8 ± 6.7, p < 0.001), CSS (2.0 ± 1.3 to 0.5 ± 0.9, p < 0.001), TBUT (2.7 ± 0.8 s to 6.5 ± 2.2 s, p < 0.001), MGD score (2.7 ± 0.5 to 1.2 ± 0.4, p < 0.001), and rate of lubricant use (3.4 ± 2.4 per day to 1.9 ± 2.0, p < 0.001). VA also improved (0.10 ± 0.11 logMAR to 0.08 ± 0.10 logMAR, p < 0.05). No major side effects were observed. CONCLUSIONS: In this pilot study Tixel treatment induced significant improvement of signs and symptoms among patients with DED due to MGD. Benefits persisted for at least one month. Further randomized controlled double-blinded studies are needed.

The Sutureless Mullerectomy.

PURPOSE: Müller's muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller's muscle and conjunctiva, followed by suturing of the conjunctiva and Müller's muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures. METHODS: The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications. RESULTS: Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0-3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ test). One patient who underwent unilateral surgery demonstrated a Herring's response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively. CONCLUSIONS: The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.

Phi, Fat, and the Mathematics of a Beautiful Midface.

PURPOSE: The Golden ratio, or Phi, has been used to explain the substrates of two-dimensional beauty utilizing the faces of models. A "Phi point" has been identified at the apex of the cheek mound that can be targeted in filler injections. The authors report herein how they have applied this algorithm for surgical shaping of the "beautiful" cheek as a routine part of their lower blepharoplasty procedure. The authors present their technique and results with patients undergoing lower blepharoplasty along with the adjunct of liposculpture to areas of volume deficiency in the midface with a particular goal of enhancing the Phi point. METHODS: This study was retrospective, consecutive, nonrandomized, interventional case series. The authors reviewed the medical records of 113 consecutive patients who underwent lower blepharoplasty with autologous fat transfer to the Phi point. The aesthetic outcome, patient satisfaction, and complication/revisions were evaluated. RESULTS: One hundred two out of 113 patients achieved excellent lower lid position and cheek enhancement as assessed by both patient and surgeon. In these 102 patients, there was significant improvement in lower lid appearance, contour, transition to the cheek, and cheek projection as observed by the surgeon. Three patients required revision to achieve sufficient volume. Eight patients were satisfied with the outcome, nevertheless, requested additional filler injection to optimize. CONCLUSIONS: Lower blepharoplasty combined with autologous fat transfer to reshape the Phi point is a safe and reliable technique and another step further in our quest for recreating the beautiful face.

Assessment of surgical discharge summaries and evaluation of a new quality improvement model.

BACKGROUND: Discharge summaries after hospitalization provide the most reliable description and implications of the hospitalization. A concise discharge summary is crucial for maintaining continuity of care through the transition from inpatient to ambulatory care. Discharge summaries often lack information and are imprecise. Errors and insufficient recommendations regarding changes in the medical regimen may harm the patient's health and may result in readmission. OBJECTIVES: To evaluate a quality improvement model and training program for writing postoperative discharge summaries for three surgical procedures. METHODS: Medical records and surgical discharge summaries were reviewed and scored. Essential points for communication between surgeons and family physicians were included in automated forms. Staff was briefed twice regarding required summary contents with an interim evaluation. Changes in quality were evaluated. RESULTS: Summaries from 61 cholecystectomies, 42 hernioplasties and 45 colectomies were reviewed. The average quality score of all discharge summaries increased from 72.1 to 78.3 after the first intervention (P < 0.0005) to 81.0 following the second intervention. As the discharge summary's quality improved, its length decreased significantly. CONCLUSIONS: Discharge summaries lack important information and are too long. Developing a model for discharge summaries and instructing surgical staff regarding their contents resulted in measurable improvement. Frequent interventions and supervision are needed to maintain the quality of the surgical discharge summary.