The current alternative for ocular surface and anophthalmic socket reconstruction, cryopreserved umbilical amniotic membrane (cUAM).

PURPOSE: This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. METHODS: The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. RESULTS: cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. CONCLUSIONS: cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

Chasing the objective upper eyelid symmetry formula; R2, RMSE, POC, MAE, and MSE.

PURPOSE: Investigate the most appropriate mathematical formula to objectively express upper eyelid contour symmetry. METHODS: 62 eyes of 31 patients were included in the study. The upper eyelid contour symmetry of the patients was classified subjectively (independent of MRD1) as poor, acceptable, and good by three oculoplastic specialists (senior, expert, and junior surgeon). Bézier curves of the upper lid contour were drawn with ImageJ software (NIH, Bethesda, MA, USA). Using the algorithms created by Author SKC in Spyder (Python 3.7.9.), the symmetry of the Bézier curves of the left eyelids were obtained according to the y-axis, and the mid-pupils of both eyes were superimposed. The lower curve moved vertically to the equal height of the other curve to equalize MRD1's. R2 (Coefficient of determination), RMSE (Root-mean-square error), MSE (Mean squared error), POC (Percentage of co-efficiency), and MAE (Mean absolute error) were calculated. We evaluated the correlation between these objective formulas and the subjective grading of three surgeons using Spearman's rho (ρ). RESULTS: The correlation coefficient of RMSE and MSE were the same for all surgeons grading. There was a strong correlation between the senior surgeon's subjective scoring (N; poor = 8, acceptable = 16, good = 8) and R2, RMSE, POC, MAE (ρ = 0.643, p < 0.001, ρ = -0.607, p < 0.001, ρ = 0.562, p < 0.001, ρ = -0.517, p < 0.001, respectively). We found a strong relationship between the expert surgeon's subjective scoring (N; poor = 9, acceptable = 13, good:10) and R2 (ρ = 0.611, p < 0.001), RMSE (ρ = -0.549, p < 0.001), POC (ρ = 0.511, p < 0.001), and MAE (ρ = -0.450, p < 0.05). We found a strong correlation between junior surgeon's subjective scoring (N; poor = 6, acceptable = 18, good = 8) and R2, RMSE, and POC (ρ: -0.517, p < 0.001; ρ: -0.470, p < 0.001; ρ: 0.521, p < 0.001; respectively) and moderate correlation between MAE (ρ:-0.394, p < 0.05). The highest correlation is observed with R2. CONCLUSIONS: RMSE, MSE, POC, MAE, and especially R2, may quantitatively express upper eyelid contour symmetry, comparable with the oculoplastic surgeon. The highest correlation was observed between the senior surgeon and R2, and decreases with the experience of the surgeon.

Reconstruction of Large Upper Eyelid Defects With Bilobed Flap and Tarsoconjunctival Graft.

PURPOSE: To describe the reconstruction of large upper eyelid defects with bilobed flap and tarsoconjunctival graft. METHODS: The medical records of 5 patients who underwent upper eyelid tumor excision and eyelid reconstruction with a bilobed flap were reviewed. Various parameters, including demographic and clinical data, defect diameter, primary defect closure, complications, and follow-up time, were recorded. After tumor excision, the posterior lamella was reconstructed with an autologous tarsoconjunctival graft and anterior lamella with a superiorly based lateral bilobed flap. RESULTS: All 5 patients (3 women, 2 men; age: 42-87 years) had malignant epidermal (n = 2) or adnexal (n = 3) tumors. Mean excisional defect diameter was between 18.5 and 25 mm. In all patients, the anterior lamellar defect was closed primarily with a bilobed flap. After surgery, a total of 4 complications occurred in 3 patients. One patient required orbital exenteration because of tumor recurrence. In the other patients, the functional and esthetic results were satisfactory. Follow-up time ranged from 4 to 102 months. CONCLUSION: Lateral periorbital bilobed flap can be a good alternative for the single-stage reconstruction of large upper eyelid defects.

Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers.

CLINICAL RELEVANCE: The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. BACKGROUND: Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. METHODS: This study included 134 patients who underwent surgery for eyelid lesions between 2021-2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. RESULTS: Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. CONCLUSION: High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.

Intraocular Lens Elongation Technique with Haptic Modification for Sulcus Implantation.

Objectives: To define a haptic modification technique to increase the overall length of the intraocular lens (IOL) and evaluate the postoperative outcomes of patients in whom this technique was applied. Materials and Methods: The preoperative and postoperative characteristics of patients who underwent modified IOL implantation into the sulcus between May 2019 and December 2019 were evaluated. Modified Sensar AR40e lenses with hydrophobic acrylic optic and polymethylmethacrylate haptics were implanted to all eyes. Before implanting the IOL, the haptics were grasped with two toothless forceps and bent to elongate the total diameter of the IOL from 13.0 mm to 14.5 mm. Results: The study included 11 eyes of 11 patients who underwent modified three-piece IOL implantation into the sulcus due to insufficient capsular support. The mean age of the patients was 53.9±12.2 years. The mean axial length was 24.13±1.93 mm. Sulcus implantation was required due to aphakia in 9 eyes and IOL dislocation in 2 eyes. No haptic breakage occurred during the IOL modification technique or implantation. The mean preoperative best corrected visual acuity (BCVA) was 0.88±1.1 logMAR, while postoperative BCVA was 0.28±0.30 logMAR. No IOL dislocation or decentration was observed during 6-month postoperative follow-up. Conclusion: The larger diameter lenses obtained with this inexpensive and easily applicable technique may allow a more stable sulcus implantation in eyes with inadequate capsular support.