Eyelash Ptosis in Unilateral Myogenic and Aponeurotic Blepharoptosis: A Prospective, Controlled, Before- and After-Study.

PURPOSES: The purposes of this study were to compare lash ptosis (LP) with contralateral eyelid in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis before and after the ptosis repair and to assess the correlation between postoperative eyelid height and LP symmetry. METHODS: Patients older than 5 years were included from June 2015 to April 2017. Eyelid examination, LP grading (0-3), and photography were performed before and at least 6 months after ptosis repair. Success of ptosis repair (levator resection) was defined as margin reflex distance 1 within 0.5 mm of the contralateral eyelid; LP improvement, as at least 1 grade improvement at the last follow-up; and LP symmetry, as 2 eyelids being within 1 grade. RESULTS: There were 58 patients with MP and 20 with AP, with mean age of 19.2 and 49.5 years and median follow-up of 10 months. Lash ptosis was observed in 89.5% of ptotic and 33.3% of control eyelids. Mean LP grade was significantly higher in the MP (1.5) than in the AP (1.1), which significantly improved to 0.6 and 0.4, respectively. However, it persisted in 50.9% of MP and 31.2% of AP postoperatively. Lash ptosis symmetry was observed in 97.4% of patients, which was not correlated with margin reflex distance 1 symmetry. Lower levator function was the only significant factor correlated with LP. CONCLUSION: Lash ptosis was significantly worse in MP than in AP. Lower LF was correlated with more severe LP. Ptosis repair resulted in significant improvement of LP and its symmetry with the contralateral eyelid. Lash ptosis symmetry did not correlate with eyelid height symmetry postoperatively.

Acute primary angle closure after periorbital facial procedures report of four cases and literature review.

AIMS: To report four cases of acute primary angle closure (PAC) after blepharoplasty and forehead lifting procedures and review the previous reported cases in the literature. METHODS: Four female subjects with age range of 50-67 years developed PAC 2-5 days after blepharoplasty and endoscopic forehead lifting procedures. All presented with pain, nausea, blurred vision, red eye, and eyelid swelling. Diagnosis was delayed in the first subject because of considering the signs and symptoms as usual postoperative ones. Presumed risk factors for the PAC were female gender (all), advanced age (all), pupillary dilation (all), and hyperopia (case 2). RESULTS: Medical treatment controlled the pressure which was followed by bilateral YAG Laser iridotomy. They fully recovered with no optic neuropathy in their last follow-up examination 10 months to 10 years after the procedures. CONCLUSION: Risk of PAC should be investigated preoperatively and its presentation should be considered in the postoperative follow-up of subjects with periorbital facial procedures.

Inadvertent inferior oblique extirpation during orbital decompression.

PURPOSE: To report a case of inadvertent inferior oblique extirpation during orbital decompression, its management, and postoperative result. METHODS: A 38-year-old female with thyroid eye disease underwent cosmetic right orbital decompression during whichinferior oblique extirpation was noticed. RESULT: The muscle was repaired on the same session (illustrated in the article) with no postoperative diplopia at 3-month follow-up. CONCLUSION: Inferior oblique injury should be considered among the uncommon yet important complications of orbital decompression. It can be easily found and repaired in the same session as demonstrated in this case report.

Corrigendum to "Periorbital facial rejuvenation; applied anatomy and pre-operative assessment" [J. Curr. Ophthalmol. 29 (3), (September 2017) 154-168].

[This corrects the article DOI: 10.1016/j.joco.2017.04.001.].

Periorbital facial rejuvenation; applied anatomy and pre-operative assessment.

PURPOSE: Since different subspecialties are currently performing a variety of upper facial rejuvenation procedures, and the level of knowledge on the ocular and periocular anatomy and physiology is different, this review aims to highlight the most important preoperative examinations and tests with special attention to the eye and periocular adnexal structures for general ophthalmologist and specialties other than oculo-facial surgeons in order to inform them about the fine and important points that should be considered before surgery to have both cosmetic and functional improvement. METHODS: English literature review was performed using PubMed with the different keywords of "periorbital rejuvenation", "blepharoptosis", "eyebrow ptosis", "blepharoplasty", "eyelid examination", "facial assessment", and "lifting". Initial screening was performed by the senior author to include the most pertinent articles. The full text of the selected articles was reviewed, and some articles were added based upon the references of the initial articles. Included articles were then reviewed with special attention to the preoperative assessment of the periorbital facial rejuvenation procedures. RESULTS: There were 254 articles in the initial screening from which 84 articles were found to be mostly related to the topic of this review. The number finally increased to 112 articles after adding the pertinent references of the initial articles. CONCLUSION: Static and dynamic aging changes of the periorbital area should be assessed as an eyelid-eyebrow unit paying more attention to the anthropometric landmarks. Assessing the facial asymmetry, performing comprehensive and detailed ocular examination, and asking about patients' expectation are three key elements in this regard. Furthermore, taking standard facial pictures, obtaining special consent form, and finally getting feedback are also indispensable tools toward a better outcome.

Correlation between Corneal Endothelial Cell Loss and Location of Phacoemulsification Incision.

PURPOSE: To assess the relationship between corneal endothelial cell loss after phacoemulsification and the location of the clear corneal incision. METHODS: A total of 92 patients (92 eyes) with senile cataracts who met the study criteria were included in this cross sectional study and underwent phacoemulsification. The incision site was determined based on the steep corneal meridian according to preoperative keratometry. Endothelial cell density was measured using specular microscopy in the center and 3 mm from the center of the cornea in the meridian of the incisions (temporal, superior, and superotemporal). Phacoemulsification was performed by a single surgeon using the phaco chop technique through a 3.2 mm clear cornea incision. Endothelial cell loss (ECL) was evaluated 1 week, and 1 and 3 months postoperatively. RESULTS: At all time points during follow-up, ECL was comparable among the 3 incision sites, both in the central cornea and in the meridian of the incision (P > 0.05 for all comparisons). However, 3 months postoperatively, mean central ECL with superior incisions and mean sectoral ECL with temporal incisions were slightly higher. Superotemporal incisions entailed slightly less ECL than the other 2 groups. Overall, one month after surgery, mean central ECL was 10.8% and mean ECL in the sector of the incisions was 14.0%. Axial length and effective phaco time (EFT) were independent predictors of postoperative central ECL (P values 0.005 and < 0.0001, respectively). CONCLUSION: A superotemporal phacoemulsification incision may entail less ECL as compared to other incisions (although not significantly different). The amount of central ECL may be less marked in patients with longer axial lengths and with procedures utilizing less EFT.