Analysis of surgical outcome after upper eyelid surgery by computer vision algorithm using face and facial landmark detection.

PURPOSE: To evaluate the postoperative changes with a computer vision algorithm for anterior full-face photographs of patients who have undergone upper eyelid blepharoplasty surgery with, or without, a Müller's muscle-conjunctival resection (MMCR). METHODS: All patients who underwent upper eyelid blepharoplasty surgery (Group I), or upper eyelid blepharoplasty with MMCR (Group II) were included. Both preoperative and 6-month postoperative anterior full-face photographs of 55 patients were analyzed. Computer vision and image processing technologies were used to measure the palpebral distance (PD), eye-opening area (EA), and average eyebrow height (AEBH) for both eyes. Preoperative and postoperative measurements were calculated and compared between the two groups. RESULTS: In Group II, change in postoperative Right PD, Left PD, Right EA, Left EA was significantly higher than in Group I (p = 0.004 for REPD; p = 0.001 for LEPD; p = 0.004 for REA; p = 0.002 for LEA, p < 0.05). In Group II, the postoperative change in Right AEBH, Left AEBH was significantly higher than in Group I (p = 0.001 for RABH and LABH, p < 0.05). CONCLUSION: Eyelid surgery for esthetic purposes requires artistic judgment and objective evaluation. Because of the slight differences in photograph sizes and dynamic factors of the face due to head movements and facial expressions, it is hard to compare and make a truly objective evaluation of the eyelid operations. With a computer vision algorithm, using the face and facial landmark detection system, the photographs are normalized and calibrated. This system offers a simple, standardized, objective, and repeatable method of patient assessment. This can be the first step of Artificial Intelligence algorithm to evaluate the patients who had undergone eyelid operations.

Association of Upper Eyelid Ptosis Repair and Blepharoplasty With Headache-Related Quality of Life.

IMPORTANCE: Headache can be a functional indication for ptosis repair and blepharoplasty. OBJECTIVE: To evaluate the changes in headache-related quality of life in patients who underwent upper eyelid ptosis repair or blepharoplasty. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted among 108 patients who underwent standard upper eyelid blepharoplasty and 44 patients who underwent ptosis repair (levator resection, Müller muscle resection, or frontalis suspension) for obscuration of the superior visual field at an ophthalmology clinic's oculoplastic department from September 1, 2014, to September 1, 2015. A validated headache-related quality-of-life survey, the Headache Impact Test-6 (HIT), was administered preoperatively and postoperatively to patients who had tension-type headache. The minimum time interval after the operation was 3 months (mean, 13.5 weeks; range, 12-17 weeks). MAIN OUTCOMES AND MEASURES: Postoperative HIT scores, decline in HIT scores, and marginal reflex distance test 1 scores. RESULTS: Of the 108 patients (66 women and 42 men; mean [SD] age, 49.8 [10.7] years) who underwent blepharoplasty and the 44 patients (26 women and 18 men; mean [SD] age, 45.6 [17.8] years) who underwent ptosis repair, 38 (35.2%) and 28 (63.6%), respectively, had symptoms of tension-type headaches. In both groups, the mean (SD) postoperative HIT scores were statistically significantly better than the preoperative HIT scores (blepharoplasty group: preoperative score, 55.9 [6.6] vs postoperative score, 46.4 [9.0]; ptosis repair group: preoperative score, 60.0 [7.2] vs postoperative score, 42.3 [9.3]; P = .001). In the patients who underwent ptosis repair, the mean (SD) preoperative HIT score was significantly higher than in those who underwent blepharoplasty (60.0 [7.2] vs 55.9 [6.6]; P = .007) and the postoperative HIT score was significantly lower than those who underwent blepharoplasty (42.3 [9.3] vs 46.4 [9.0]; P = .03). The mean (SD) decline in the HIT score was significantly higher in patients who underwent ptosis repair than in those who underwent blepharoplasty (17.8 [9.9] vs 9.5 [8.6]; P = .002). For patients who underwent ptosis repair, there was a statistically significant negative correlation between the results on the marginal reflex distance test 1 (median, 1.82; minimum, 1.0; maximum, 3.5) and change in the HIT score (median, 18; minimum, 0; maximum, 30) (P = .005; r = -0.645). In patients who underwent ptosis repair, the mean (SD) difference between the preoperative and postoperative HIT scores was significantly higher for the patients who underwent levator resection (3.1 [0.3]) than for those who underwent Müller muscle resection (1.5 [0.7]) and frontalis suspension procedures (1.9 [0.7]) (P = .001). CONCLUSIONS AND RELEVANCE: The operations for ptosis and blepharoptosis provide significant relief for tension-type headache and result in improved headache-related quality of life. As a result, tension-type headache can be a functional indication for upper eyelid blepharoplasty and ptosis repair, especially for patients with lower results on the marginal reflex distance test 1. LEVEL OF EVIDENCE: 3.

Retinal Precapillary Arteriolar Occlusion after Coronary Artery Bypass Grafting Surgery.

BACKGROUND: The aim of this study is to evaluate the microembolic changes related to occlusions of precapillary arterioles in the retina during coronary artery bypass grafting (CABG) surgery using fundus photography, and to examine systemic and operational factors related to occurrent lesions. METHODS: Retinal microvascular damage was assessed by color fundus photography one day before CABG surgery, on postoperative day five, and again three months after surgery. In addition to patients' demographics, diabetes mellitus, hypertension, chronic renal failure, and hypercholesterolemia (LDL level) were examined. Smoking history was recorded. Additionally, each patient's carotid Doppler results were ranked by four degrees. Data related to the surgery were recorded. RESULTS: No retinal emboli were seen in any patient before surgery. In fundus photographs taken on the fifth day after surgery, retinal precapillary arteriolar occlusions were seen in 20 (28.57%) of the patients. Lesions were observed to have disappeared in the third month after surgery. There was no significant (P > .05) difference in age, sex, diabetes mellitus, HT ratio, tobacco consumption percentage, LDL values, and Doppler USG distribution between the two groups of patients with and without lesions. However, CABG surgery and cross-clamp removal time measured significantly (P < .05) longer in the group with lesions than in the group without lesions. CONCLUSION: Our results show that retinal microembolism can occur after CABG surgery in association with surgery time and cross-clamp time; however, this does not cause any clinical outcome.