The "bespoke" upper eyelid blepharoplasty and brow rejuvenation.

Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. In this article, we describe our approach to the patient with aging of the periorbita. At all times, the approach is tailored to the individual's needs, trying to achieve a natural result that will not in any way affect the function of the eyelid. Our current approach and techniques for upper eyelid blepharoplasty and brow lifting are described.

Laser-assisted subepithelial keratectomy retreatment after laser in situ keratomileusis.

PURPOSE: To evaluate the efficacy and safety of laser-assisted subepithelial keratectomy (LASEK) retreatment after laser in situ keratomileusis (LASIK). SETTING: Mater Private Hospital, Dublin, Ireland. METHODS: In this retrospective study, 22 eyes of 20 patients had LASEK retreatment for residual refractive errors after LASIK. All patients who had the procedure between January 2004 and May 2007 were included in the study. The main outcome measures at the final follow-up visit were efficacy, predictability, safety, and stability. RESULTS: The mean spherical equivalent (SE) was -4.50 diopters (D)+/-2.88 (SD) (range -10.00 to +3.87 D) before LASIK and -1.23+/-0.95 D (range -2.50 to +2.00 D) after LASIK. The mean time between the initial LASIK procedure and LASEK enhancement was 56.2+/-24.3 months (range 6 to 84 months). The mean follow-up after retreatment was 6.68+/-6.47 months (range 3 to 24 months). At the final follow-up visit, 19 eyes (86.4%) had an uncorrected visual acuity of 20/30 or better and 17 eyes (77.3%) were within +/-1.00 D of the target refraction. No patient lost more than 1 line of best corrected visual acuity or developed corneal haze greater than grade 1. CONCLUSION: Results indicate that LASEK retreatment after LASIK is a safe and effective alternative when LASIK retreatment is deemed unsafe because there is not sufficient residual corneal stromal bed or when retreatment is required many years after LASIK and relifting the original flap is expected to be problematic.

The prognostic influence of chronicity of rhegmatogenous retinal detachment on anatomic success after reattachment surgery.

PURPOSE: To investigate anatomic success after surgery for chronic retinal detachment. DESIGN: Retrospective, case series review. METHODS: The surgical outcomes of reattachment surgery for 36 eyes of 35 patients with chronic retinal detachments are reported and are compared with the outcomes for 129 fresh retinal detachments. RESULTS: After exclusion of retinal detachments secondary to retinal dialysis and of cases with proliferative vitreoretinopathy (PVR), success after a single procedure was seen in eight of 14 (57.1%) chronic retinal detachments, and this compares with 92 of 107 (86.0%) fresh retinal detachments (P = .0161). CONCLUSIONS: Chronicity of retinal detachment at presentation is an important and poor prognostic indicator for reattachment surgery.

Postoperative pain following epi-LASIK, LASEK, and PRK for myopia.

PURPOSE: To compare mechanical epithelial separation using the epi-LASIK technique with alcohol assisted separation (LASEK). METHODS: Patients deemed suitable for surface ablation were randomized to receive epi-LASIK in one eye and LASEK in the other eye. If epi-LASIK failed, the procedure was converted to photorefractive keratectomy (PRK), forming the third comparison group. The outcome measures were postoperative pain, vision, refraction, and haze. Patients were followed for 3 months. RESULTS: Fifty-seven patients (95 eyes) were included in this study (38 epi-LASIK, 19 PRK, and 38 LASEK eyes). There was a 33% rate of conversion from intended epi-LASIK to PRK. Epi-LASIK patients were found to have significantly less pain in the first few hours after surgery but at 4 hours all patients had the same levels of pain, which improved to minimal or no pain at 24 hours. No significant difference was noted among groups for vision, refractive error, and haze; however, epi-LASIK patients had the best day 1 visual acuity. CONCLUSIONS: Epi-LASIK offers comparable visual and refractive results to other surface ablation techniques with lower levels of postoperative pain only for the first 2 hours. However, there was a high rate of flap failure and conversion to PRK.

Analysis of the visual and refractive outcome following laser in situ keratomileusis (LASIK) retreatment over a four-year follow-up period.

PURPOSE: To evaluate the safety and refractive stability following LASIK retreatment over a four-year follow-up period. METHODS: In this retrospective study, 60 eyes of 52 patients underwent LASIK retreatment for residual refractive errors after LASIK. Retreatment was performed by lifting the original flap followed by laser ablation of the stromal bed. The main outcome measures at the latest follow-up visit were efficacy, predictability, safety and stability. The mean follow-up time after retreatment was 22.3 +/- 10.5 (range 12-48 months). RESULTS: The baseline mean spherical equivalent (SE) was -4.85 +/- 2.57 dioptres (D) (range +2.25 to -11.75 D). At the latest follow-up visit, the uncorrected visual acuity (UCVA) was 6/9 or better in 88% of the eyes, the mean SE was -0.33 +/- 0.8 D (-2.50 to +2.25 D), and 77% of the eyes were within +/-0.50 D of target refraction. None of the patients lost lines of best corrected visual acuity (BCVA) and 25 eyes (41%) gained one or more lines. Three eyes (5%) developed peripheral epithelial in-growth and none of the patients had corneal ectasias or retinal complications. CONCLUSION: LASIK retreatment is a safe and effective procedure for correcting residual refractive errors after LASIK. After retreatment, the visual and refractive outcome remained stable during the four-year follow-up period of the study.

Outcome of LASIK for myopia in women on hormone replacement therapy.

PURPOSE: To investigate the effect of hormone treatment on refractive and visual outcome after LASIK in women. METHODS: A retrospective review of the hospital notes of all women on hormone replacement therapy (HRT) and oral contraceptives at the time of LASIK was performed. Their refractive and visual outcomes were compared with those of women not on hormone treatment. RESULTS: At 6 months after LASIK, 20 (45%) HRT eyes and 61 (75%) control eyes had a visual acuity of > or = 20/20. Thirty-six (82%) eyes from the HRT group and 74 (91%) eyes from the control group could see > or = 20/40. A statistically significant difference was noted in both refractive and visual outcome in women taking HRT at the time of surgery in comparison to controls. Women on the oral contraceptive pill did not differ in outcome from controls. CONCLUSIONS: Women on HRT are at an increased risk of refractive regression after LASIK.