Correction of Tear Trough Deformity with Minced Orbital Fat Grafts During Transconjunctival Lower Blepharoplasty.

BACKGROUND: The correction of tear trough deformity poses a significant challenge in the context of facial rejuvenation. Our aim was to introduce a technique that corrects tear trough deformity during transconjunctival lower blepharoplasty using minced orbital fat grafts. METHODS: The medical records of patients who underwent lower blepharoplasty from January 2019 to December 2021 were reviewed. The study included patients with various grades of tear trough deformity, who underwent lower blepharoplasty using minced orbital fat grafts and followed up for at least 6 months. Modified Barton's grading for tear trough depression, patient satisfaction, and postoperative complications were evaluated. RESULTS: A total of ninety-eight patients, with a mean age of 48.07 ± 9.72 years, consisting of 93 (94.9%) females were included in the study. The average duration of follow-up was 7.2 months, ranging from 6 to 13 months. Tear trough depression significantly improved after the operation (preoperative tear trough depression grade mean (SD): 3.11 (0.60); postoperative tear trough depression grade mean (SD): 0.87 (0.66); P < 0.001). 78.5% of the participants reported their outcome as excellent or good, 20.4% reported as fair, and 1.0% (only one patient) reported as no improvement. None of the participants rated their outcome as worsening. No major complication was observed during the follow-up period. CONCLUSION: Minced orbital fat grafting during transconjunctival lower eyelid blepharoplasty has good effectiveness for correcting tear trough deformity without the risk of major complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Transconjunctival lower blepharoplasty: a 2-sided assessment of results and subjects' satisfaction.

PURPOSE: To assess the results and satisfaction after transconjunctival lower blepharoplasty, evaluate the effect of associated aesthetic procedures on the satisfaction, and compare surgeon versus subjects' perspective on the results. METHODS: In a retrospective cross-sectional study, a chart review was performed on transconjunctival lower blepharoplasty procedures performed by 1 eye plastic surgeon from April 2003 to April 2009. Subjects with less than 6 months follow-up time or reoperation were excluded. Demographic data, associated surgical procedures, intra and postoperative complications, subjects and surgeon's perspectives on postoperative results, photographs (before and after the operation), and satisfaction score (Visual analogue scale score) at last follow-up time were recorded. RESULTS: There were 164 subjects (133 women, 81.1%) with mean age of 50.7 years (standard deviation=11.6, range: 23-80). Mean follow-up time was 22.8 months (standard deviation=11.5, range=6-60 months). Complications, observed by the surgeon and subjects, were undercorrected fat excision (4.9% vs. 3.7%), eyelid retraction (1.2% vs. 1.2%), and tear trough deformity (9.7% vs. 0.6%). Subjects reported less complication rate (5.4%) than surgeon (15.8%). Mean visual analogue scale score was 92.8 (standard deviation=0.36), which was significantly higher in subjects who had simultaneous upper blepharoplasty and lower in subjects with postoperative eyelid retraction. CONCLUSIONS: Transconjunctival lower blepharoplasty is associated with a high satisfaction. Subjects reported less complication rate than surgeon especially for tear trough deformity. Postoperative eyelid retraction significantly decreased and simultaneous upper blepharoplasty procedure significantly increased the satisfaction.

Long-term follow-up of invasive ocular surface squamous cell carcinoma treated with excision, cryotherapy, and topical mitomycin C.

BACKGROUND: To evaluate the efficacy of surgical excision, cryotherapy and topical Mitomycin C (MMC) for ocular surface squamous cell carcinoma (SCC) with at least 24 months follow-up. METHODS: Seventeen patients with primary and recurrent invasive SCC of ocular surface underwent surgical excision and map biopsy of the margins, and double freeze-thaw cryotherapy of the bed and margins. Topical MMC (0.04%, 4 times daily) was commenced 7-10 days after operation. It was delivered in cycles that consisted of medication 4 times daily for 7 consecutive days followed by 7 consecutive days of no medication. Patients with primary SCC received two cycles (protocol 1) and those with recurrent SCC received three cycles (protocol 2). Patients with intra-ocular and or orbital extension or those with less than 24 months of follow-up were excluded. The frequency of tumor recurrence and complications associated with treatment were measured. RESULTS: Mean age was 70.7 years (SD = 10, range: 48-80). Mean follow-up time was 48 months (SD = 21, range: 24-89). There were 12 patients with primary SCC and five with recurrent SCC. Mean largest diameter was 9.7 mm (3-20). Surgical margins were free in 12 cases. One patient with recurrent SCC who received protocol 2 treatment developed recurrence 9 months after excision, and remained free of recurrence 24 months after second treatment. Complications comprised transient mild punctate corneal epithelial erosion (eight), irritation and conjunctival hyperemia (11), corneal scar (six), and scleral thinning (three). All except one responded well to conservative management. One scleral thinning required scleral patch graft 1 year after treatment. CONCLUSION: The combination of surgical excision, cryotherapy, and post-operative topical mitomycin-C was effective treatment for ocular surface invasive SCC in long-term follow-up.

Diplopia after hyaluronic acid gel injection for correction of facial tear trough deformity.

A 38 Year-old-female presented with diplopia and bilateral lower eyelid swelling 1.5 months after hyaluronic acid filler injection of tear trough deformity. Comprehensive eye examination showed an inferior oblique muscle restriction on the right eye. Diplopia and bilateral lower eyelid puffiness were treated by injection of hyaluronidase which resulted in disappearance of both diplopia and bilateral lower eyelid puffiness.

Erythropoietin: a novel treatment for traumatic optic neuropathy-a pilot study.

BACKGROUND: To determine the visual outcome and safety of intravenous erythropoietin in patients with indirect traumatic optic neuropathy (TON). METHODS: In a university-based hospital, from December 2008 to March 2010, seven cases with indirect TON (EPO group) received three intravenous (IV) injections of 10,000 IU of recombinant human erythropoietin in three successive days. They were compared to eight patients with indirect TON who had received no specific treatment from December 2006 to November 2008 (observation group). The primary end point was best-corrected visual acuity (BCVA) in both groups at last follow-up and secondary measure was systemic adverse effects of medication in the EPO group. RESULTS: Mean ages of patients in the observation and EPO groups were 23.3 (SD = 10.8) and 19.7 (SD = 12.1) years, respectively. Mean follow-up in the observation and EPO groups were 5.8 (SD = 3.8) and 7.0 (SD = 5.8) months, respectively. Mean best-corrected visual acuity (BCVA) significantly (p = 0.028) improved from 1.82 logMAR (SD = 1.27) at initial visit to 0.94 logMAR (SD = 0.82) at last follow-up in the EPO group, whereas the observation group showed an insignificant (p = 0.285) improvement from 2.55 log MAR (SD = 0.62) to 2.32 logMAR (SD = 0.83). Mean final BCVA was significantly higher in the EPO group than in the observation group (p = 0.012). Two cases developed mild transient systemic hypotension during EPO injection. CONCLUSIONS: Intravenous erythropoietin may be a new effective and safe treatment for patients with indirect TON.

High-density porous polyethylene wedge implant in correction of enophthalmos and hypoglobus in seeing eyes.

INTRODUCTION: To report the results of post-traumatic enophthalmos/hypophthalmos correction with high-density porous polyethylene wedge implants in seeing eyes. METHODS: This is an interventional case series of 25 patients (25 eyes) with post-traumatic enophthalmos and hypophthalmos, who underwent orbital reconstruction to correct the enophthalmos and hypophthalmos using Medpor® wedge implant. The aim was an overcorrection of 1 mm in comparison to the other eye, intra-operatively. If needed, trimming of the wedge implant or adding Medpor® sheets were used to achieve the goal. Success was defined as achieving the globe position within 1 mm of the other eye in the last follow-up. Improvement and failure were considered as correction outside the success range of 1 mm and no change in the amount of enophthalmos/hypophthalmos, respectively. RESULTS: Patients were followed for at least 6 months (mean= 12.66, SD= 12.32). Success, improvement and failure of enophthalmos correction were: 58.3% (14/24), 37.5% (9/24) and 1 (1/24, 4.1%), respectively. Success, improvement and failure of hypophthalmos correction were 73.68% (14/19), 15.78% (3/19) and 5.26% (1/19), respectively. There was no significant difference between the success rate of enophthalmos versus hypophthalmos correction (P= 0.8). Results of 1-month follow up change in enophthalmos and hypophthalmos significantly correlated (r= 0.92, P= 0.000) with the change recorded at last follow up. CONCLUSIONS: Porous polyethylene wedge implants are useful and safe in correction of enophthalmos and hypoglobus in seeing eyes. Appropriately positioned implant yields no significant difference in correction of enophthalmos versus hypophthalmos.

Lacrimal gland fistula after upper eyelid blepharoplasty.

To report the first case of lacrimal gland fistula after upper eyelid blepharoplasty for blepharochalasis. Standard upper blepharoplasty and the hooding excision were performed in a female with blepharochalasis. The patient developed a fistulous tract with tearing from the incision few days after hooding excision. Fistula excision and lacrimal gland repositioning were performed. There were no complications after the repositioning procedure (6 months follow up). Prolapsed lacrimal gland and fistula formation can occur after upper blepharoplasty hooding excision.

Silicone intubation with intraoperative mitomycin C for nasolacrimal duct obstruction in adults: a prospective, randomized, double-masked study.

PURPOSE: To assess the efficacy of intraoperative mitomycin C (MMC) during silicone intubation (SI) as a substitute for dacryocystorhinostomy (DCR) in nasolacrimal duct obstruction (NLDO). METHODS: In this prospective, double-masked study, 88 patients with complete NLD obstruction who were candidates for DCR were randomized in 2 groups. All study patients underwent SI with application of MMC or placebo in a randomized, double-masked fashion, with the former receiving 0.2 mg/mL for 2 minutes before SI. RESULTS: After a mean follow-up interval of 8 months, 25 of the 43 eyes in the MMC group and 21 of the 44 eyes in the placebo group had a successful outcome and were free of tearing and discharge. No significant difference was noted between the 2 groups (p = 0.331). In patients with simple epiphora and less than 6 months of duration, SI alone was effective in 83% of patients; however, in the same group, MMC application during SI did not show beneficial effect over SI alone. But in patients with simple epiphora of 6-months duration or longer, the application of MMC during SI resulted in better efficacy compared with SI alone. The success rates in the patients that had chronic dacryocystitis was lower (23%) compared with patients that had only epiphora (63.7%). CONCLUSIONS: SI alone could effectively substitute for a more extensive procedure such as DCR in patients with simple epiphora, particularly those with newly developed symptoms. In cases with longer duration of symptoms of epiphora, application of MMC would increase the success rate significantly.