Improved Eyelid Muscle Tension Balance With Refined Frontalis Muscle Flap Suspension in the Treatment of Severe Ptosis.

BACKGROUND: The tension balance of the upper eyelid following ptosis repair is crucial to a successful postoperative outcome. To improve on existing surgical techniques, the authors developed a new refined frontalis muscle flap suspension (FMFS) for severe ptosis repair and explored the balancing effect between the orbicularis muscle and frontalis muscle following surgery. METHODS: Forty-three patients (47 eyes) with a mean age of 6.07 ± 2.55 years old were diagnosed with severe congenital ptosis and underwent refined FMFS with complete orbicularis preservation between January 1, 2010 and December 31, 2017 in the Wenzhou Eye Hospital, Wenzhou, China. The outcomes measured include upper eyelid margin reflex distance (MRD1), degree of lagophthalmos, and cosmetic outcome (lash angle, eyelid contour, and crease). Surgical complications were also recorded. RESULTS: The preoperative mean MRD1 was -1.29 ± 0.88 mm and preoperative levator function was 1.87 ± 0.82 mm (ranged from 0 to 3.0 mm). Following surgery, lagophthalmos was observed in all cases in the first week with a mean palpebral fissure height of 1.68 ± 0.40 mm and diminished over 3 months. The MRD1 improved to +3.04 ± 0.68 mm at 6 months following surgery. All cases showed excellent cosmetic outcomes. There were no significant complications. CONCLUSION: The refined FMFS is a safe and reliable surgery in treating severe ptosis. The eye-closing power of the intact orbicularis muscle is sufficient at countering the lifting power of the frontalis muscle suspension, achieving a balanced blink mechanism and eyelid closure.

Tumescent Liposuction Combined with Power-Assisted Dermal Curettage Through Small Incisions for Axillary Osmidrosis.

BACKGROUND: Osmidrosis is a troublesome disease characterized by excessive bodily malodor. Invasive surgical treatments have proven effective and permanent in treating this disease. This study sets out to evaluate the effect of tumescent liposuction with power-assisted dermal curettage for the treatment of axillary osmidrosis. METHODS: Twenty-eight patients with axillary osmidrosis (56 axillae) were treated with tumescent liposuction and power-assisted dermal curettage between January 2016 and May 2019. Patients were followed up and evaluated using survey questionnaire at least 3 months after the procedure. RESULTS: Twenty-four (85.7%) patients responded excellent for malodor elimination, 4 (14.3%) patients evaluated it as good and no patients evaluated it as fair or poor. One patient reported mild pigmentation in the axilla after the procedure. No recurrence and no serious side effects were reported. CONCLUSION: Tumescent liposuction with power-assisted dermal curettage is a safe and effective surgical treatment of axillary osmidrosis with high patient satisfaction, rapid recovery time and minimal complications or recurrences. 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.

Integrated and Stepwise Epicanthoplasty Combined with Blepharoplasty (ISEB) in an Ethnic Chinese Population.

PURPOSE: To evaluate the efficacy of the integrated and stepwise epicanthoplasty combined with blepharoplasty (ISEB) technique in an ethnic Asian population. METHOD: The medical records of patients who underwent ISEB at the Eye Hospital of Wenzhou Medical University over a period of 36 months were retrospectively reviewed. RESULTS: A total of 104 patients (208 eyelids) were included in this study with ages ranging from 16 to 36 years old (mean 21.2 ± 2.8 years) and follow-up duration ranging from 6 months to 26 months (mean 9.7 ± 4.1 months). All patients achieved cosmetically desirable and natural appearances with adequate lacrimal caruncle exposure and horizontal lengthening of palpebral fissure. At the 6-month follow-up, there was no or minimal visible scarring in the medial canthal region. Postoperative evaluation at least 6 months following surgery showed that 98.1% (102/104) of patients felt that their surgical results were good or excellent. No recurrences of the epicanthal fold or disturbances of lacrimal function occurred throughout the follow-up period. CONCLUSION: The ISEB is a novel surgical technique that is effective in dealing with vector forces during epicanthoplasty in combination with blepharoplasty and has been shown to be a practical and reliable method with good aesthetic outcomes. LEVEL OF EVIDENCE V: 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 .

Intraocular pressure-lowering medications and long-term outcomes of selective laser trabeculoplasty.

BACKGROUND: To investigate the effects of current intraocular pressure-lowering medications on the efficacy of selective laser trabeculoplasty. DESIGN: Retrospective chart review of records from an urban glaucoma clinic in Sydney, Australia. PARTICIPANTS: Patients who received their first selective laser trabeculoplasty between 2002 and 2005 were studied (grouped from 0 to 3 according to the number of pre-selective laser trabeculoplasty medications, and followed for 5 years). Those with previous argon laser therapy, trabeculectomy or angle-closure were excluded. METHODS: Selective laser trabeculoplasty (Ellex) used to deliver 180 or 360 degree of treatment, under the same protocol. MAIN OUTCOME MEASURES: Responders were defined by ≥20% reduction from baseline intraocular pressure. Data were censored when pressure-lowering intervention was required. The mean intraocular pressure, survivor, response rate, number and type of medications were compared. RESULTS: There were 206 patients with ocular hypertension, primary, pseudo-exfoliation, or pigmentary glaucoma who used none (n = 20), one (n = 33), two (n = 61) or three or more (n = 92) pre-selective laser trabeculoplasty topical anti-glaucoma medications. The mean baseline intraocular pressures for each group was 23.7, 22.2, 20.7 and 20.4 mmHg, respectively (P = 0.061). Post-treatment mean intraocular pressure was 17.9, 17.7, 15.5, and 15.7 mmHg; percentage reduction was similar between groups (23.6-25.6%, P = 0.20). Kaplan-Meier survival analysis showed comparable survival rates across groups (P = 0.445). At 60 months, 11.1, 17.1, 30.5 and 11.5% of responders remained in each group. Higher proportions of patients in groups 2 and 3 required further laser or surgery. CONCLUSION: The number of pre-selective laser trabeculoplasty medications did not affect the intraocular pressure-lowering effectiveness of selective laser trabeculoplasty; however, groups on more medications required more pressure-lowering interventions.

Utilisation of a Novel Test to Measure Severity and Treatment Efficacy of Posterior Blepharitis.

Background. This study evaluated the effectiveness of managing posterior blepharitis (PB) using a novel Posterior Blepharitis Management Protocol (PBMP). Design. Prospective, consecutive case series with 100% followup to one month. Participants. 27 patients (54 eyes) with PB from an Ophthalmology practice in Sydney, Australia. Methods. Each patient's PB was assessed by grading the nature and expressibility of the central lower lid tarsal gland secretions on Compression Of The Eyelid (COTE). Patients were then instructed in detail to undertake daily PB management sessions at home using our modified PBMP. Main Outcome Measures. On a subjective scale, patients compared their symptoms at one month with baseline. COTE scores were reevaluated to assess the objective effectiveness of each individual's PBMP. COTE scoring was described as grades 1 (clear oil), 2 (pus, liquid), 3 (toothpaste-like secretions), and 4 (complete tarsal gland obstruction). Results. Patients reported a mean 77.8% ± 13.5% subjective improvement in symptoms. There was a trend towards improvement in COTE grading at one month compared with baseline: grades 1 (0 to 7.4%), 2a (22.2 to 16.6%), 2b (7.4 to 3.7%), 3 (18.5 to 27.7%), and 4 (51.8 to 44%). Conclusions. PBMP provided a rapid, inexpensive, simple, effective, and safe method of treating PB.