Changes in Direction of Eyelashes After Epiblepharon Surgery Using the Hotz Procedure.

PURPOSE: To analyze the change of direction of eyelashes after epiblepharon surgery using the Hotz procedure and to propose the appropriate correction amount to reduce the risk of undercorrection or overcorrection. METHODS: Surgical correction using the Hotz procedure was performed in 60 patients who then were followed for 3 months in Korea University Anam Hospital. Clinical photographs were collected before and after the correction to measure the angle of the lower eyelashes. RESULT: The average angle before and after correction was 38.5° and -24.1°, respectively. The lower eyelashes gradually became introverted, and the amount of angle change was 9.3° at postoperative 1 month ( P < 0.001). These lashes become slightly extroverted to -15.0° at 3 months after the correction. CONCLUSIONS: Lower eyelashes become introverted to about 9 degrees after surgical correction. They become more introverted after operation when the epiblepharon is more severe and when they are more reconditioned to extroversion immediately after the operation.

Ptosis With Aberrant Facial Nerve Regeneration Following Bell Palsy.

ABSTRACT: Bell palsy is the most common lesion affecting the facial nerve. Aberrant facial nerve regeneration following facial nerve palsy may cause facial nerve synkinesis and ptosis. The authors present a 65-year-old male who suffered from left peripheral facial nerve palsy in 2017. During the recovery period, he had moderate ptosis in primary gaze, and he also noted left upper eyelid closure when he tried to blow something or puff his cheeks. Neurologic examination was normal except for the synkinetic movements as described above. Surgery was planned with an attempt to resect a part of the orbicularis oculi muscle (OOM) to decrease the synkinetic eyelid closure. In addition, the levator muscle was advanced for treatment of the ptosis. Before surgery, an electromyography study by a neurologist showed normal activity of the OOM but failed to demonstrate the relationship between this muscle and other muscles due to technique failure. However, after surgery electromyography studies of the facial and orbicularis oris muscle suggested that cheek puffing produced contraction in the OOM. During follow-up time, the patient was satisfied with the surgical results. To the best of our knowledge, this is the first report to describe ptosis with aberrant facial synkinesis during cheek puffing was treated with surgery.

Traumatic Globe Subluxation Accompanied by Traumatic Optic Neuropathy.

A 52-year-old, alcohol-intoxicated woman suffered periorbital trauma to the left eye and presented to the emergency department with proptosis and complaints of decreased vision in the left eye. Physical examination revealed loss of light perception (LP), relative afferent pupillary defect (RAPD), pupil dilatation, and corneal epithelial defect of the left eye. In addition, the fundus of the left eye was not easily visible due to severe corneal abrasion and edema, but there was no retinal detachment or vitreous hemorrhage on B-scan ultrasonography. Hertel exophthalmometric values differed by 7 mm between the eyes and measured 13 mm in the right eye and 20 mm in the left eye. In addition, she had severely limited left eye movement in all directions. Computerized tomography (CT) imaging of the orbit showed that the left optic nerve extended 15 mm further than the optic nerve of the right eye and retrobulbar hemorrhage of the left eye. The patient underwent emergency lateral canthotomy, cantholysis, and conjunctival incision to release the optic nerve extension and reduce the eyeball subluxation of the left eye. An intraoperative examination demonstrated that all extraocular muscles of the left eye were intact. The left eyeball returned to its normal position after surgery. Two days after surgery, proptosis of the left eye improved significantly, and there was no difference in Hertel exophthalmometric values between the eyes, both eyes measured 13 mm. However, the patient continued to suffer LP, RAPD, and pupil dilatation of the left eye.

Surgical Outcomes of Endoscopic Conjunctivodacryocystorhinostomy Using a Castroviejo Double-Ended Lacrimal Dilator.

PURPOSE: The aim of this study was to describe the surgical method of endoscopic conjunctivodacryocystorhinostomy with Jones tube insertion using a Castroviejo double-ended lacrimal dilator and to elucidate the surgical outcomes. METHODS: Under general anesthesia and preoperative epinephrine soaking, a monopolar needle cautery instrument was used to remove the nasal mucosa over the lacrimal and maxillary bone junction. After the lacrimal and maxillary bone junction was exposed, an oval osteotomy was formed. A Castroviejo double-ended lacrimal dilator was then inserted to create a direct fistula from the conjunctiva to the nasal cavity through the bony ostium. The dilator was grasped and withdrawn using smooth forceps to determine the tube length. The selected tube was then inserted into the fistula with a guide probe. Following removal of the probe, the inserted tube was fixed with 7-0 Ethilon suturing. RESULTS: Among 39 patients, a total of 49 cases were examined. The success rate was 73.4% (36/49 eyes). The average surgical time was 29.1 minutes for single-eye operations and 47.3 minutes for double-eye operations. Lateral migration (6/13; 46.2%), medial migration (3/13; 23.1%), granulation tissue obstruction (2/13; 15.4%), inflammation (1/13; 7.7%), and malpositioning (1/13; 7.7%) were the noted complications that led to reoperation. CONCLUSIONS: In conclusion, surgical management of endoscopic conjunctivodacryocystorhinostomy using a Castroviejo double-ended lacrimal dilator has several advantages. Using this device, easier surgical procedure, shorter surgical time, and more favorable success rate can be achieved without serious complications.

Correlation Between Lacrimal Syringing Test and Dacryoscintigraphy in Patients With Epiphora.

The purpose of this study was to evaluate the correlation between the lacrimal syringing test (LST) and dacryoscintigraphy (DSG) in patients with epiphora. The authors retrospectively reviewed the clinical records of patients who underwent both LST and DSG from March 2016 to February 2018. From this, 636 eyes of 336 patients with a mean age of 61.20 ±â€Š11.93 years (range, 22-86 years) were included. The concordance rate between LST and DSG was 43.7% (278 eyes). The sensitivity of DSG was 68.78%, and specificity was 30.99%. Factors of age and sex were analyzed in terms of concordance. The authors categorized age into 2 groups of younger and older than 65 years. Only sex was found to affect the results, with a much higher concordance rate in the female group than the male group. The lack of correlation between the tests indicates that the LST and DSG methods are complementary to each other. There is no single reliable method for testing patency of the lacrimal drainage system. Therefore, physicians should refer to these tests as complementary in a clinic setting.

Small-Incision Sutureless Surgical Technique for Subconjunctival Orbital Fat Prolapse.

Surgical outcomes of 20 patients treated by one surgeon between March 2014 and August 2019 were reviewed retrospectively. The authors included 20 patients with subconjunctival orbital fat prolapse (SOFP) treated by a small-incision, sutureless surgical technique using local anesthesia. All patients were followed for at least 3 months postoperatively. Medical information such as patient's age, number of eyes involved, location of fat, surgical time and whether or not the prolapse recurred was reviewed. Twenty patients (16 men and 4 women) were included and had a mean age of 67.1 years. There were 7 bilateral and 13 unilateral SOFP cases. There were no intra-operative or postoperative complications and no cases of recurrence within a mean follow-up of 3 months. All surgeries were successful from both cosmetic and symptomatic perspectives. Our small-incision, sutureless surgical technique is an effective method to manage SOFP. This technique, performed with local anesthesia, is both cost- and time-effective.

Idiopathic Orbital Inflammation With Superior Rectus and Levator Complex may be Misdiagnosed as Involutional Ptosis.

Idiopathic orbital inflammation (IOI) is a benign inflammatory disease usually confined to the orbit. Two middle-aged patients with IOI have been reported who could have been misdiagnosed as involutional ptosis. Two patients presented to the clinic with eyelid ptosis. One patient's erythrocyte sedimentation rate was slightly increased; the other patient's immunoglobulin G4 (IgG4), IgG, and thyroid-stimulating hormone results were higher than the upper limits of normal. The computed tomographic images and orbit magnetic resonance imaging tests showed an inflammatory condition around the droopy eyelids. They were both admitted to the hospital with diagnosis of IOI, and intravenous antibiotic and steroid treatment were administered, which improved their symptoms.

Effectiveness and Satisfaction Degree of Transconjunctival-Approach Lower Blepharoplasty Combined With Pinch Skin Excision Technique.

The purpose of this study was to evaluate and compare the effectiveness and satisfaction of transconjunctival-approach lower blepharoplasty combined with a pinch skin excision technique between young patients (younger than 60 years of age) and elderly patients (older than 60 years of age) in Korea. The medical records of 69 patients who underwent transconjunctival-approach lower blepharoplasty combined with a pinch skin excision technique from January 2003 to February 2018 were reviewed. Success rate postoperative complications, and degree of satisfaction with the surgical technique were evaluated and statistically compared between the 2 different age groups. All 69 patients were satisfied with the final result. The average success rate of surgery was 96.7% in the young patients (group A) and 97.4% in the elderly patients (group B) during the mean follow-up period of 6 months. There were 3 cases reported as having persistent complications (2 cases in group A and 1 patient in group B). The satisfaction rating between groups A and B showed no statistically significant difference (P = 0.430). We confirmed lower-eyelid fat prolapse and dermatochalasis can be effectively corrected using transconjunctival lower blepharoplasty with a pinch skin excision technique in patients regardless of age.

Immuno-stimulatory effects of sulfated polysaccharides isolated from Codium fragile in olive flounder, Paralichthys olivaceus.

Sulfated polysaccharides isolated from Codium fragile have been previously demonstrated to possess immune-stimulating effects on murine cell lines and the fraction F2 (F2) isolated by ion exchange chromatography was the most effective. In this study, the effects of the fraction F2 were evaluated on the expressions of immune genes including IL-1ß, TNF-α, IL-8, IFN-γ and lysozyme in vitro and in vivo as well as lysozyme and complement activities in serum of olive flounder, Paralichthys olivaceus. In vitro, these gene expressions were up-regulated by F2 in head kidney cells. In vivo, IL-1ß and IL-8 gene expressions were up-regulated in peritoneal cells, head kidney, liver, gill and spleen, while TNF-α, IFN-γ and lysozyme gene expressions were mostly up-regulated but varied depending on tissue types or time points. Indeed, lysozyme and complement activities in serum were increased. Overall, these results indicate that the sulfated polysaccharides from C. fragile have immuno-stimulatory effects on olive flounder and may be used to enhance immunity during aquaculture.

Cloning and expressional analysis of secretory and membrane-bound IgM in rock bream (Oplegnathus fasciatus) under megalocytivirus infection and vaccination.

In this study, for better understanding the humoral immunity of rock bream (Oplegnathus fasciatus), 2 transcripts of immunoglobulin M (IgM) heavy chain gene including membrane bound (m-IgM) and secretory (s-IgM) forms were sequenced and analyzed their tissue distribution and differential expression in rock bream under rock bream iridovirus (RBIV) infection and vaccination since RBIV has caused mass mortality in rock bream aquaculture in Korea. Consequently, s-IgM cDNA was 1902 bp in length encoding a leader region, a variable region, four constant regions (CH1, CH2, CH3, CH4) and a C-terminal region while m-IgM cDNA was 1689 bp in length encoding shorter three constant regions (CH1, CH2, CH3) and two transmembrane regions. The predicted s-IgM and m-IgM represent a high structural similarity to other species including human. In tissue distribution analysis in healthy fish, the highest expression of s-IgM was observed in head kidney followed by body kidney, spleen, and mid gut whereas m-IgM expression was the highest in blood followed by head kidney and spleen. In vitro, s-IgM expression was up-regulated by LPS in head kidney and spleen cells at 24 h with no change of m-IgM expression. In vivo upon vaccination, s-IgM expression was up-regulated in liver and blood but not in head kidney while m-IgM expression was only up-regulated in head kidney. After challenge with RBIV, s-IgM expression level was higher in vaccinated fish than in unvaccinated fish and m-IgM expression was up-regulated in head kidney of vaccinated group. In conclusion, differential expression of m-IgM and s-IgM may indicate their differential functions to produce the most effective IgM during adaptive immune response. Although it is not able to assess specific IgM at protein level due to a lack of antibody against rock bream IgM, the present study on s-IgM and m-IgM gene expressions upon infection and vaccination will be useful in developing efficient vaccines in the future.

The Characteristics of Lower Eyelid Reverse Ptosis After Reconstruction of Orbital Floor Wall Fracture Using Transconjunctival Approach.

The purpose of this study was to evaluate the changes of lower eyelid position and the incidence of reverse ptosis after reconstruction of orbital floor fracture. The authors retrospectively reviewed the clinical records of patients who received reconstruction of orbital floor wall fractures between 2014 and 2017. Digital photographs were taken preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Main measurements were marginal reflex distance 2 (MRD 2), which was measured by analyzing the digital photographs using ImageJ software. Among 264 patients with orbital wall fracture, The authors enrolled 32 eyes (18 right eyes and 14 left eyes) of 32 patients (21 males and 11 females) with a mean age of 32.1 years (range, 16-57 years). 7 (21.9%) of 32 patients had reverse ptosis at postoperative 3 months. When MRD2 of affected eye was compared based on the fellow eye, 7 patients with reversed ptosis showed a definite MRD 2 decrease (>1 mm) of affected eye from postoperative 1 month. Age showed a significant negative correlation with the difference of MRD2 between affected and fellow eye at postoperative 1 and 3 months (r = -0.378, P = 0.033 and r = -0.372, P = 0.036, respectively). Postoperative complications were not observed in all patients. The transconjunctival access in orbital floor wall surgery is a safe and useful surgical approach. However, some may have a reverse ptosis postoperatively, especially older patients. Reverse ptosis is a major clinical finding that should not be overlooked in post-operative follow-up.

A Patient With Periorbital Necrotizing Fasciitis by Klebsiella pneumoniae.

Periorbital necrotizing fasciitis (NF) is a very rare disease with a mortality rate of 10% to 20%, requiring rapid diagnosis and active treatment. The most common causative organism is Group A ß-hemolytic Streptococcus, and trauma, operative incisions, pre-existing ulcers, or injection sites may be predisposing factors for periorbital NF. In this study, the subject, who had a medical history of diabetes mellitus and chronic liver disease, developed periorbital NF suddenly and without any specific triggering factors, and Klebsiella pneumoniae was identified in a necrotic tissue biopsy. Klebsiella pneumoniae has not been reported as a causative organism of periorbital NF. It is believed that latent infection with K pneumoniae, which caused a brain abscess in the patient 2 years prior, caused inflammation around the periorbit by hematogenous spread. The authors were able to manage the patient successfully by performing total exenteration and reconstructing the affected site using a transverse rectus abdominis myocutaneous flap procedure.

Granulomatous Inflammation of the Upper Eyelid After Autologous Fat Injection.

A 45-year-old female came to the clinic complaining of periorbital swelling and ptosis on the left upper eyelid that had started 6 months previously. She had received an autologous fat injection in the forehead 6 months prior, and there was no other ophthalmologic history. There were no abnormal findings, including pupil, extraocular movement, or fundus examination. There was eyebrow elevation of the left upper eyelid, and the marginal reflex distance 1 was 1 mm on the left eye compared to 4 mm on the right eye. There were a 2-cm-sized round and firm mass on the left upper eyelid that was not accompanied by tenderness. Orbital computed tomography showed heterogeneous infiltration with an ill-defined margin. Excisional biopsy and levator advancement were performed on the left upper eyelid, and histological findings showed chronic granulomatous inflammation with foreign body reaction and fat necrosis.A complete history for patient presentation with autologous fat injection is important when a periorbital mass is encountered clinically because granulomatous inflammation of the eyelid may occur after autologous fat injection in the forehead and can be related to migration of the injected fat.

The Effect of Upper Aging Blepharoplasty on Upper and Lower Eyelid Position.

PURPOSE: Change in eyelid position after upper blepharoplasty is an important factor that can affect postoperative patient satisfaction. However, no one has investigated eyelid changes during follow-up for upper eyelid surgery. Thus, the purpose of this study was to investigate position changes in the upper and lower eyelids during the follow-up period after upper blepharoplasty in Korean. METHODS: The authors retrospectively reviewed the clinical records of patients who underwent upper blepharoplasty for uncomplicated upper eyelid dermatochalasis. Digital photographs were taken preoperatively, immediately after surgery, and at 1 week postoperative, 1 month postoperative, and 3 months postoperative. Our main-effect variables were marginal reflex distance (MRD) 1 and 2 and palpebral fissure height (PFH), which were measured from digital photographs using ImageJ software. RESULTS: We enrolled 180 eyes from 90 patients (M: 35 and F: 55) with a mean age of 63.8 ± 10.3 years. The eyelid measurements (MRD1, MRD2, PFH) taken preoperatively, immediately after surgery, and 1 week, 1 month, and 3 months postoperative were, respectively: MRD1 (mm): 2.56 ± 1.08, 1.91 ± 0.86, 2.21 ± 1.02, 2.66 ± 1.01, 2.75 ± 0.99; MRD2 (mm): 4.91 ± 0.93, 4.62 ± 0.87, 4.68 ± 0.90, 4.87 ± 0.86, 4.91 ± 0.83; and PFH (mm): 7.48 ± 1.64, 6.53 ± 1.46, 6.89 ± 1.53, 7.52 ± 1.51, 7.65 ± 1.49. All postoperative measurements for MRD1 and PFH were significantly different from the preoperative measurement, except for measurements taken 1 month postoperative. MRD2 measurements differed significantly from the preoperative measurements immediately after surgery and 1 week postoperative. Among age, preoperative PFH, and amount of skin-muscle resection, only preoperative PFH significantly affected PFH changes immediately after surgery and at 3 months postoperative (OR 0.636, 95% CI 0.478-0.847, OR 0.506, 95% CI 0.386-0.663). CONCLUSION: All eyelid measurements (MRD1, MRD2, and PFH) decreased 1 week postoperatively from values immediately after surgery, but MRD1 and PFH increased slightly 3 months postoperative. We note that postoperative changes in PFH may be large in patients with large PFH before blepharoplasty. It should also be noted that reverse ptosis of the lower eyelid occurs immediately after upper eyelid surgery.

Surgical Outcomes of Endonasal Conjunctivodacryocystorhinostomy According to Jones Tube Location.

PURPOSE: The aim of this study was to compare surgical outcomes and complications of endonasal conjunctivodacryocystorhinostomy (CDCR) according to Jones tube location. METHODS: Patients who underwent endonasal CDCR owing to proximal obstruction of the lacrimal drainage system between 2009 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the location of the proximal end of the Jones tube. The canthal-based group included patients in which the proximal end of the Jones tube was located in the medial canthal angle, and the fornix-based group included patients in which the proximal end of the Jones tube was located in the inferomedial conjunctival fornix. Success rates were evaluated at 3 months and 6 months after surgery. Causes of failure, incidence of tube migration, and incidence of canthal deformity were also evaluated. RESULTS: The success rate at 3 months postoperative was 95% in the canthal-based group and 78.6% in the fornix-based group (P = 0.283). Success rates at 6 months postoperative were 85% in the canthal-based group and 71.4% in the fornix-based group, respectively (P = 0.410). The main cause of failure was granuloma in the canthal-based group (2/20) and medial migration in the fornix-based group (3/14). Medial canthal deformity occurred in 12 of 20 cases in the canthal-based group, but none occurred in the fornix-based group. CONCLUSION: The canthal-based group had a lower migration rate and slightly better surgical success rate than the fornix based group, but canthal deformity was more prevalent.

Measurement of Lacrimal Sac Fossa Using Orbital Computed Tomography.

PURPOSE: To evaluate the clinical usefulness of measuring the lacrimal sac fossa length using orbital computed tomography in normal Koreans. METHODS: The authors retrospectively evaluated 140 patients (70 males and 70 females) who underwent orbital computed tomography at Guro Hospital and who had no history of orbital disease or orbital trauma. Computed tomography scans of the right orbit, including the proportion of the lacrimal bone and maxillary bone that comprise the lacrimal sac fossa, were evaluated at 3 different axial planes (lower, middle, and upper levels). Additionally, the mid-point thickness and maximum thickness of the maxillary bone were measured. Finally, the authors also evaluated the relationship between nasal bone height and maxillary bone thickness in the lacrimal sac fossa. RESULTS: Maxillary bone thickness in the lacrimal sac fossa was thicker in males than in females at mid-point thickness and maximum thickness (P < 0.05). However, there was no significant difference in the size of the lacrimal sac fossa and the proportion of the maxillary bone between males and females.In comparisons between maxillary cross-sections, bone thickness was greater toward the upper level of the lacrimal sac fossa (P = 0.008), and the proportion of the maxillary bone was also greater (P = 0.006).Aging had a significant positive correlation with maxillary bone thickness at all 3 axial planes (P < 0.05), but there was no relationship between age and maxillary bone proportion. Nasal bone height and maxillary bone thickness were also not significantly related. CONCLUSION: In comprising the lacrimal sac fossa, the maxillary bone accounted for a bigger proportion than the lacrimal bone. Male maxillary bone thickness was greater than female thickness. The authors also observed that maxillary bone thickness increased toward the upper areas of the lacrimal sac fossa and with increasing subject age. Understanding the form and variation of a normal lacrimal sac fossa is helpful for preparing for a successful osteotomy with endoscopic dacryocystorhinostomy.

Reconstruction of Large Orbital Posterior Floor Wall Fracture Considering Orbital Floor Slope Using Endoscope.

PURPOSE: Reconstruction of a large orbital fracture extending to the posterior wall of the maxillary sinus is difficult and challenging. In this study, the authors present transconjunctival or transcaruncular approach using endoscopy and layered porous polyethylene barrier sheets to manage large orbital floor wall fracture. METHODS: A retrospective review of all patients who underwent reconstruction of large orbital floor wall fractures between June 2009 and July 2015 was conducted. Patient demographics, degree of enophthalmos, ocular motility and diplopia test results, and surgical complications were reviewed. RESULTS: This study included 53 eyes of 53 patients. The mean time from trauma to surgery was 34.1 days (range, 1-360 days). The average postoperative follow-up period was 6.1 months (range, 3-14 months). The degrees of enophthalmos preoperatively, and 1 week, 1 month, and 3 months postoperatively were -1.98 mm (range, -1.5 to -3 mm), 0.13 mm (range, -1.0 to +1.5 mm), -0.09 mm (range, -2.0 to +1.5 mm), and -0.43 mm (range, -2.0 to +1.0 mm), respectively. The mean improvement in enophthalmos at 3 months postoperation was 1.55 mm (P < 0.001). There was only 1 patient with residual 2 mm enophthalmos at 3 months postoperation. There were no definite surgical complications in any patient. CONCLUSION: Sufficient dissection to the posterior extent of the fracture and reconstruction of the orbital floor slope are the most important surgical factors to prevent residual enophthalmos. The authors believe using an endoscope and layered porous polyethylene are effective techniques in challenging patients with large orbital wall fracture.

Using the Endoscopic Transconjunctival and Transcaruncular Approach to Repair Combined Orbital Floor and Medial Wall Blowout Fractures.

PURPOSE: To demonstrate the effectiveness of the endoscopic transcaruncular and transconjunctival approach in the repair of combined medial and inferior orbital wall fractures. METHODS: A retrospective chart review was conducted on 160 patients with combined medial and inferior orbital wall fractures. All patients underwent surgery via an endoscopic transcaruncular and transconjunctival approach without lateral canthotomy, performed by a single surgeon. Porous polyethylene sheets (1.0 mm in thickness) were implanted to cover the orbital defects. The minimal postoperative follow-up period was 6 months. The authors evaluated enophthalmos, diplopia, and ocular motility pre and postoperatively and report surgical complications. RESULTS: A total of 160 patients were included, comprising 121 men and 39 women. The mean patient age was 33.9 ±â€Š14.1 years, and the mean postoperative follow-up period was 12 months. The average enophthalmos was 3.20 mm preoperatively, and the mean improvement at 6 months after surgery was 2.82 mm. One patient suffered a canalicular laceration after surgery, and another retrobulbar hemorrhage; however, both of these complications resolved with appropriate management. Otherwise, there were no significant surgical complications including newly developed diplopia, decreased visual acuity, or cerebrospinal fluid leakage. CONCLUSIONS: The endoscopic transcaruncular and transconjunctival approach is a useful and promising technique to repair combined medial and inferior orbital wall fractures.

Enhancement in the electrochemical performance of zirconium/phosphate bi-functional coatings on LiNi0.8Co0.15Mn0.05O2 by the removal of Li residuals.

The effect of bi-functional coatings consisting of Zr and phosphate (P) on the electrochemical performance of Li1.0Ni0.8Co0.15Mn0.05O2 (NCM) has been investigated. The presence of various types of Zr and P compounds such as oxides (ZrO2 and Li2ZrO3) and phosphates (Zr2P2O9, ZrP2O7 and LiZr2(PO4)3) in the coating was confirmed by experiments as well as density functional theory (DFT) calculations. When the NCM samples were coated with the Zr/P hybrid material, the cycle retention and the amount of removed Li residuals (LiOH, Li2CO3) were enhanced by the synergistic effect from Zr and P. The NCM sample coated with a Zr/P layer with a Zr/P ratio of 1 : 1 exhibited an increase in the initial capacity (209.3 mA h g-1) compared to the pristine sample (207.4 mA h g-1) at 0.1C, owing to the formation of the coating layer. The capacity retention of the Zr/P coated sample (92.4% at the 50th cycle) was also improved compared to that of the pristine NCM sample (90.6% at the 50th cycle). Moreover, the amount of Li residuals in the Zr/P coated NCM sample was greatly reduced from 3693 ppm (pristine NCM) to 2525 ppm (Zr/P = 5 : 5).

Analysis of Lid Contour in Thyroid Eye Disease With Upper and Lower Eyelid Retraction Using Multiple Radial Midpupil Lid Distances.

PURPOSE: The aim of this study was to analyze upper and lower eyelid contours in adult patients with thyroid eye disease (TED) and normal adults using a software program that measures multiple radial midpupil lid distance (MPLD). METHODS: Analysis targeted 61 eyes from 61 normal adults who had never undergone eyelid surgery or ophthalmic surgery and 63 eyes from 63 patients with TED. Digital pictures of primary gaze were analyzed using custom software. Conventional MPLD (90°, 270°) and 12 oblique MPLDs were collected every 15° across the temporal (105°, 120°, 135°, 150°, 165°, 180°) and nasal (75°, 60°, 45°, 30°, 15°, 0°) sectors of the upper eyelid. For lower eyelid contours, 9 oblique MLPDs in the temporal sector (255°, 240°, 225°, 210°, 195°) and nasal sector (285°, 300°, 315°, 330°) of the lower eyelid were analyzed. RESULTS: From all angles, the MPLD of patients with TED was larger than that of the control group. The mean difference between the 2 groups was larger for the upper eyelid (0° ∼ 180°) than the lower eyelid (195° ∼ 330°). When comparing symmetry by dividing into each angle, the ratio of 90°/270° (MRD1/MRD2) demonstrated greater in patients with TED (P = 0.000). Temporal/nasal eyelid contour symmetry in the upper eyelid, investigated using the distance ratio of the nasal sector/temporal sector (15°/165°, 30°/150°, 45°/135°, 60°/120°, 75°/105°), was significantly smaller in patients with TED (P < 0.05). However, there was no significant difference between the 2 groups regarding temporal/nasal eyelid contour symmetry of the lower eyelid (330°/210°, 315°/225°, 300°/240°, 285°/255°). CONCLUSIONS: Radial MPLD is effective for analyzing eyelid contour. In our study, lateral flare of upper lid retraction and flat appearance of lower lid retraction were distinct characteristics in patients with TED. Consideration of eyelid contour in patients with TED may improve corrective surgery for eyelid retraction.