Conjunctival changes following Muller's muscle conjunctival resection.

PURPOSE: To analyze the conjunctival changes, especially goblet cell populations, following Muller's muscle conjunctival resection (MMCR) by histologically evaluating pre and post-MMCR specimens. METHODS: This is a retrospective analysis of conjunctival samples sent for histologic evaluation from two patient populations: those who had previously undergone a MMCR and required repeat surgery and controls who underwent a MMCR surgery in a previously unoperated eyelid. Specimens underwent hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining to accentuate goblet cell identification and were evaluated by two ocular pathologists to quantify goblet cell populations and note other anatomical changes. Statistical analysis of goblet cell populations was then performed. RESULTS: Four samples were identified for each group: (1) post-MMCR and (2) control. The mean age was 67 years in the post-MMCR group and 66 years in the control group. The mean goblet cell population was 7 ± 5 cells/mm in the post-MMCR conjunctiva and was 39 ± 16 cells/mm in the control group, which was statistically significant (p = 0.01). Samples from both groups demonstrated scarring and inflammatory cell infiltrate. CONCLUSIONS: While there was a relative loss of goblet cell populations in the conjunctiva overlying the region of surgery following MMCR, the lack of dry eye symptoms or changes in tear production reported in prior studies suggests that there may be enough goblet cell population reserve in the remaining accessory lacrimal glands and in the unaltered conjunctiva to provide sufficient lubrication and ocular protection.

Tarsal Epithelial Cysts: Prevalence, Case Series, and Synthesis of Existing Literature.

PURPOSE: Tarsal epithelial cysts (TECs) are squamous epithelial-lined lesions of the eyelid that are often mistaken for chalazia or epidermal inclusion cysts. They remain poorly described in the literature. This study is designed to characterize the prevalence and clinical features of TEC. METHODS: We conducted a single-center retrospective review of adult patients with a diagnosis of eyelid neoplasm, eyelid cyst, hordeolum, stye, or chalazion between January 1, 2011 and July 1, 2017. Among this cohort, we identified patients with a histopathologic diagnosis of TEC. We also conducted a PubMed literature review and synthesis of existing clinical data of patients reported to have TEC, noting common clinical and histopathological features. RESULTS: Of 7,516 patients, we identified 6 patients with a histopathological diagnosis of TEC, amounting to a prevalence of 0.08% amongst patients with eyelid lesions. Average age was 49.7 years (range 18-76 years), with a 1:1 male to female ratio. The most common presenting symptom was a painless eyelid mass, and the majority (66.6%) had a preoperative diagnosis of chalazion. All but 1 patient had surgical excision from the posterior approach and there was 1 recurrence in the follow-up period. On review of the literature, we identified 68 prior cases of TEC from 18 clinical studies, with clinical features mirroring our case series. CONCLUSIONS: TEC has stereotypical clinical and histologic features that distinguish it from other tarsal lesions. Our review identified TEC as a relatively rare cause of eyelid lesions.

The Mathematical Analysis of the Aesthetically Pleasing Eyelid.

PURPOSE: To analyze and quantify the characteristics and parameters of the eyelid and adnexa of males and females and correlate these findings to an aesthetically pleasing score. METHODS: This is an Institutional Review Board approved study involving healthy male and female volunteers. The margin-to-reflex distance, palpebral fissure, inferior scleral show, tarsal platform show, and brow fat span were measured using Image J digital photographic analysis and the images were scored by 110 non-ophthalmologists. The eyelid parameters were compared between the groups with Student t tests and the total aesthetic score was correlated to the measured parameters with Pearson's correlation coefficients (r). This study was HIPAA-compliant with protection of individually identifiable information. RESULTS: Twenty male and 22 female participants were included and divided into 2 groups based on the aesthetic score. The average aesthetic score was 3.06 for males and 3.36 for females. None of the eyelid parameters were found to be significantly significant between the 2 male groups. In females, both inferior scleral show and tarsal platform show were significantly lower in the more aesthetic group. A greater margin-to-reflex distance correlated with increased aesthetic appeal. The ratio of brow fat span/tarsal platform show was not significantly different between the 2 female groups. CONCLUSIONS: Quantifying goals are important for the surgical and nonsurgical management of the eyelid and periorbita. Beauty is considered to be subjective and is comprised of various criteria. However, this study reveals that the female sex may have certain quantifiable goals for eyelid parameters that are considered more aesthetically pleasing.

Predictive Value of Preoperative Periocular Skin Cancer Measurements for Final Mohs Defect Size.

PURPOSE: To evaluate the relationship between pre-Mohs skin cancer lesion measurements with the post-Mohs defect size in order to most accurately estimate post-Mohs defect size. METHODS: This is a retrospective analysis of patients who underwent Mohs excision by one of 3 Mohs surgeons followed by reconstruction for basal cell carcinoma or squamous cell carcinoma of the eyelid. The study included all patients from January 2011 to May 2018 operated on by a single oculoplastic surgeon (R.M.) at the University of Texas Southwestern Medical Center. Maximum horizontal and vertical (H/V) dimensions were determined clinically by Mohs surgeons at the time of excision and photographs of the lesion and defect size were analyzed in order to determine the total area of the lesion preoperatively and the defect postoperatively with Image J using H/V dimensions and the area tracing function. RESULTS: Forty-two patients with periocular skin cancers underwent Mohs resection followed by reconstruction. The Mohs defect was overall 4.88 times the size of the preoperative skin cancer measurement using maximum H/V dimensions by Mohs surgeons (p < 0.0001). When using Image J, the area of the Mohs defect was 6.5 times the size of the preoperative lesion (p < 0.0001) using both the maximum H/V dimensions and the area tracing function. There was a statistically significant difference between the Image J area tracing and area determined with H/V dimensions by both the Mohs surgeon and Image J. CONCLUSIONS: Postoperative Mohs defect size can be estimated based on maximum H/V dimensions clinically or with Image J technology. Image J digital photograph analysis using the area tracing function more accurately determines the pre-Mohs lesion size and the post-Mohs defect area when compared with standard maximum H/V measurements and digital photographic analysis of maximum H/V measurements with Image J.The preoperative periocular skin cancer measurements can assist in determining the post-Mohs defect size.

7-Hexagon Multifocal Electroretinography for an Objective Functional Assessment of the Macula in 14 Seconds.

PURPOSE: We present the multifocal electroretinogram (mfERG) with a 7-hexagon array as an objective test of macular function that can be recorded in 14 s. We provide normal values and investigate its reproducibility and validity. METHODS: Healthy participants underwent mfERG testing according to International Society for Clinical Electrophysiology of Vision (ISCEV) standards using the Espion Profile/D310 multifocal ERG system (Diagnosys, LLC, Lowell, MA, USA). One standard recording of a 61-hexagon array and 2 repeated recordings of a custom 7-hexagon array were obtained. RESULTS: A total of 13 subjects (mean age 46.9 years) were included. The median response densities were 12.5 nV/deg2 in the center and 5.2 nV/deg2 in the periphery. Intereye correlations were strong in both the center (ρCenter = 0.821; p < 0.0001) and the periphery (ρPeriphery = 0.862; p < 0.0001). Intraeye correlations were even stronger: ρCenter = 0.904 with p < 0.0001 and ρPeriphery = 0.955 with p < 0.0001. Bland-Altman plots demonstrated an acceptable retest mean difference in both the center and periphery, and narrow limits of agreement. We found strong correlations of the center (ρCenter = 0.826; p < 0.0001) and periphery (ρPeriphery = 0.848; p < 0.0001), with recordings obtained by the 61-hexagon method. CONCLUSIONS: The 7-hexagon mfERG provides reproducible results in agreement with results obtained according to the ISCEV standard.

Effect of anti-VEGF treatment on choroidal thickness over time in patients with neovascular age-related macular degeneration.

PURPOSE: To evaluate change in subfoveal choroidal thickness (SCT) as measured by spectral-domain optical coherence tomography (SD-OCT) in patients with neovascular age-related macular degeneration (NVAMD) undergoing anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Patients with a diagnosis of NVAMD were retrospectively reviewed to identify those who had at least 12 months of follow-up. The SCT was manually measured from Bruch membrane to the choroid-sclera junction at baseline and last follow-up. Only cases in which the choroid was fully visible were included in quantitative analyses. The SCT measurements were correlated with other characteristics including number and duration of treatments. RESULTS: Sixty eyes of 47 patients with a follow-up of 23.8 months (SD 7.3) met study inclusion criteria, and 49 eyes of 40 patients received anti-VEGF treatment. Mean age was 83.7 years, and 52% were female. Treated eyes received a mean of 7.8 (SD 7.3) intravitreal anti-VEGF injections. The SCT at baseline was 126.7 µm (SD 50.6) for untreated and 136.2 µm (SD 57.6) for treated eyes. The SCT showed a decrease over time in both groups, with a mean rate of reduction of 6.0 µm (p<0.0002) in treated eyes and 3.6 µm (p = 0.3741) in untreated eyes. However, the change in SCT did not differ between the groups (p = 0.5113), and did not correlate with the number of re-treatments (p = 0.552), visual acuity at baseline (p = 0.618), or change in visual acuity over time (p = 0.429). CONCLUSIONS: Although choroidal thickness decreased over time in eyes with NVAMD, anti-VEGF therapy did not appear to accelerate or otherwise alter this decline.

Comparison of manually corrected retinal thickness measurements from multiple spectral-domain optical coherence tomography instruments.

BACKGROUND/AIMS: To compare retinal thickness measurements from three different spectral domain optical coherence instruments when manual segmentation is employed to standardise retinal boundary locations. METHODS: 40 eyes of 21 healthy subjects were scanned on the Cirrus HD-OCT, Topcon 3D-OCT-2000 and Heidelberg Spectralis-OCT. Raw data were imported into custom grading software (3D-OCTOR). Manual segmentation was performed on every data set, and retinal thickness values in the foveal central subfield were computed. RESULTS: 37 eyes of 20 subjects were gradable on every machine. The average retinal thicknesses for these eyes were 236.7 µm (SD 20.1), 235.7 µm (SD 20.4) and 236.5 µm (SD 18.0) for the Cirrus, 3D-OCT-2000 and Spectralis, respectively. Comparing manual retinal thickness measurements between any two machines, the maximum difference was 18.2 µm. The mean absolute differences per eye between two machines were: 4.9 µm for Cirrus versus 3D-OCT-2000, 3.7 µm for Cirrus versus Spectralis and 4.4 µm for 3D-OCT-2000 versus Spectralis. CONCLUSIONS: When a uniform position is used to locate the outer retinal boundary, the retinal thickness measurements derived from three different spectral domain optical coherence instruments devices are virtually identical. Manual correction may allow OCT-derived thickness measurements to be compared between devices in clinical trials and clinical research.