Exorbital Lacrimal Gland Ablation and Regrafting Induce Inflammation but Not Regeneration or Dry Eye.

The study evaluated the regenerative responses of the lacrimal functional unit (LFU) after lacrimal gland (LG) ablation. The LG of Wistar rats was submitted to G1) partial LG ablation, G2) partial ablation and transplantation of an allogeneic LG, or G3) total LG ablation, (n = 7-10/group). The eye wipe test, slit lamp image, tear flow, and histology were evaluated. RT-PCR analyzed inflammatory and proliferation mediators. The findings were compared to naïve controls after 1 and 2 months (M1 and M2). G3 presented increased corneal sensitivity, and the 3 groups showed corneal neovascularization. Histology revealed changes in the LG and corneal inflammation. In the LG, there was an increase in MMP-9 mRNA of G1 and G2 at M1 and M2, in RUNX-1 at M1 and M2 in G1, in RUNX-3 mRNA at M1 in G1, and at M2 in G2. TNF-α mRNA rose in the corneas of G1 and G2 at M2. There was an increase in the IL-1ß mRNA in the trigeminal ganglion of G1 at M1. Without changes in tear flow or evidence of LG regeneration, LG ablation and grafting are unreliable models for dry eye or LG repair in rats. The surgical manipulation extended inflammation to the LFU.

The Relation of the Anterior Ethmoidal Foramen to the Cranial Base.

PURPOSE: To perform a radiological analysis of the relation of the anterior ethmoidal foramen (AEF) to the cranial base and olfactory fossa (OF). METHODS: Retrospective analysis of computed tomography coronal scans of 35 orbits of 35 patients with Graves orbitopathy. Following a standard multiplanar reconstruction of the orbit, the authors measured the vertical and the horizontal distances of the AEF to the cranial base and to the lateral border of the OF, respectively. The height of the OF was measured at the level of the AEF and at the position of Keros classification. The presence of supraorbital ethmoid cells (SOEC) was also recorded. RESULTS: The vertical distance of the AEF to the cranial base ranged from 0.1 to 7.3 mm with a mean = 2.5 mm (SD = 2.17). In 47.5% of the orbits the foramen was adjacent (<1 mm) to the cranial base. The horizontal distance of the AEF to the lateral border of the OF ranged from 2.3 to 9.5 mm (mean = 5.4 mm, SD = 1.98). The presence of an SOEC (n = 12) increased significantly both the distance from the AEF to the cranial base and to the lateral border of the OF. The height of the OF at the level of AEF is not correlated with the depth of the OF at the level of Keros classification. CONCLUSIONS: In the absence of supraorbital pneumatization, the AEF location is a dangerous landmark for the upper limit of the transconjunctival medial wall decompression.

Distinct Inflammatory and Oxidative Effects of Diabetes Mellitus and Hypothyroidism in the Lacrimal Functional Unit.

Diabetes mellitus (DM) and hypothyroidism (HT) are prevalent diseases associated with dry eye (DE). Their impact on the lacrimal functional unit (LFU) is poorly known. This work evaluates the changes in the LFU in DM and HT. Adult male Wistar rats had the disease induced as follows: (a) DM: streptozotocin and (b) HT: methimazole. The tear film (TF) and blood osmolarity were measured. Cytokine mRNA was compared in the lacrimal gland (LG), trigeminal ganglion (TG), and cornea (CO). Oxidative enzymes were evaluated in the LG. The DM group showed lower tear secretion (p = 0.02) and higher blood osmolarity (p < 0.001). The DM group presented lower mRNA expression of TRPV1 in the cornea (p = 0.03), higher Il1b mRNA expression (p = 0.03), and higher catalase activity in the LG (p < 0.001). The DM group presented higher Il6 mRNA expression in the TG (p = 0.02). The HT group showed higher TF osmolarity (p < 0.001), lower expression of Mmp9 mRNA in the CO (p < 0.001), higher catalase activity in the LG (p = 0.002), and higher expression of Il1b mRNA in the TG (p = 0.004). The findings revealed that DM and HT induce distinct compromises to the LG and the entire LFU.

Impact of counterclockwise rotation of the occlusal plane on the mandibular advancement, pharynx morphology, and polysomnography results in maxillomandibular advancement surgery for the treatment of obstructive sleep apnea patients.

PURPOSE: Evaluate the impact of counterclockwise rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients. METHODS: Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP. RESULTS: The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively. CONCLUSION: Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.

Vocal resistance among choir singers.

PURPOSE: The purpose of the present study was to compare the voice of choir singers before and after 60 min of singing and after an absolute rest. METHODS: Twenty-one female choir singers aged on average 26.59 years, with experience in choir singing of at least one year were instructed to emit the vowel /a/ before and after singing and after a vocal rest of 30 min for an analysis of acoustic measures, and for the evaluation of their tactile-kinesthetic self-perception. Vocal warm-up was performed for 10 min. The participants were instructed to sing the "Ave Verum" music continuously for 60 min. RESULTS: f0 (p = 0.0001) and Flo (p = 0.0002) increased after the singing test and were reduced after the vocal rest, in contrast to Fhi (p = 0.001), which continued to be increased compared to the pre-test measure even after the vocal rest. The vAm parameter (p = 0.05) was reduced after continuous singing and rest. All self-evaluation symptoms increased after the continuous singing task and were reduced after the 30 min rest, except for complaints of low voice, pain when swallowing and cough/throat clearing. CONCLUSION: 60 min of continuous use of the singing voice induced signs of vocal fatigue with an increase in f0, with improvement of symptoms and a reduction of f0 occurring after 30 min of vocal rest.

Swallowing changes related to chronic temporomandibular disorders.

OBJECTIVES: To investigate whether chronic temporomandibular disorder (TMD) patients showed any changes in swallowing compared to a control group. Moreover, it was examined whether swallowing variables and a valid clinic measure of orofacial myofunctional status were associated. MATERIAL AND METHODS: Twenty-three patients with chronic TMD, diagnosed with disc displacement with reduction (DDR) and pain, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and 27 healthy volunteers (control group) were compared. Surface electromyography (EMG) of the temporalis, masseter, sternocleidomastoid, and suprahyoid muscles was performed during swallowing tasks of thin liquid (10 and 15 mL) and spontaneous saliva. Data were normalized. RESULTS: Compared to the control group, TMD patients showed a prolonged duration of swallowing for liquid and saliva and required a longer time to reach the activity peak and half the integral. While the overall mean value of the relative peaks was similar for the groups, the suprahyoid peak was significantly lower in the TMD group during swallowing of liquid. Moreover, TMD patients recruited the jaw elevator muscles proportionally more than controls. The orofacial myofunctional status was moderately correlated with EMG parameters. CONCLUSION: Patients with chronic TMD showed temporal prolongation and changes in the relative activity of the muscles during the swallowing tasks. CLINICAL RELEVANCE: The present results contribute additional evidence regarding the reorganization of muscle activity in patients with chronic TMD.

Dynamic comparison of pharyngeal stability during sleep in patients with obstructive sleep apnea syndrome treated with maxillomandibular advancement.

PURPOSE: To compare the dynamic differences occurring in the pharynx during sleep after maxillomandibular advancement (MMA) surgery for the treatment of patients with obstructive sleep apnea syndrome. METHODS: This was a prospective, cross-sectional study conducted on 20 patients (15 men and 5 women) with a polysomnography diagnosis of obstructive sleep apnea (OSA) submitted to surgical treatment with MMA. All patients were submitted to magnetic resonance (MR) during propofol-induced sleep before and 6 months after surgery. Thirty linear measurements (30 sections) were obtained over time in the retrolingual (RL) region to compare their variability before and after MMA. RESULTS: The mean linear anteroposterior increase of the pharynx during induced sleep after MMA was 66 % in the RL region (P < 0.01). The coefficient of variation of the linear measurements was 117.5 % before surgery, being reduced to 51 % after surgery. CONCLUSIONS: MMA promoted an important increase of the pharynx during induced sleep and a more significant change in the variability of its lumen. With a lower variation in the diameter of the organ during the respiratory movements, there is greater airway stability and a consequent maintenance of the pharyngeal lumen that reduces or even prevents pharyngeal collapse.

Globe Protrusion and Interorbital Divergence in Syndromic Faciocraniosynostoses.

PURPOSE: The aim of this study was to quantify the relationship between globe protrusion (GP), length of medial and lateral walls, interzygomatic distance, and interorbital angle in syndromic faciocraniosynostoses. METHODS: The axial slices of computed tomography of the orbits of 43 patients with faciocraniosynostosis (31 with Crouzon syndrome and 12 with Apert syndrome) and 23 control subjects were measured with the Image J software. The following 5 variables were quantified: the degree of GP, the length of the medial and lateral walls, the interzygomatic distance, and the interorbital angle. RESULTS: Independent t-tests revealed significant differences between the patients and the controls regarding the mean values of all variables measured. The degree of GP was better correlated with the interorbital angle (r = 0.81) than with the medial wall length (r = 0.73). No correlation was found between GP and lateral orbital wall length. CONCLUSIONS: In syndromic faciocraniosynostoses, GP is highly correlated with the interorbital angle. The increment in the interorbital angle is a natural geometric consequence of the fact that a decrease in the orbital depth is not adequately compensated by an increase in the distance between the lateral orbit rims.

Relationship between bite force, occlusal contact area, and three-dimensional facial soft tissue in dentofacial deformities.

PURPOSE: This study aimed to investigate three-dimensional facial soft tissue dimensions, maximum bite force (MBF), and occlusal contact area in patients with DFD. In addition, we analyzed the relationship between MBF and the three-dimensional facial measurements. METHODS: Thirty-two patients with skeletal Class III DFD and 20 patients with Class II DFD underwent a soft tissue evaluation using surface laser scanning, as well as MBF and occlusal contact area assessments. The DFD groups were compared with each other and with 25 healthy subjects. RESULTS: Significant morphological differences were found in the transversal, vertical, and anteroposterior dimensions between Class II DFD and Class III DFD. Both DFD groups presented an increased linear distance of chin height, which was strongly related with decreased MBF magnitude. The DFD groups exhibited lower MBF and occlusal contact area, with no significant differences between Class II and Class III DFD. CONCLUSION: The presence of DFD affected 3D measurements of facial soft tissue, causing variations beyond normal limits, lower MBF, and occlusal contact area in both Class II and Class III DFD patients. The vertical dimension might have influenced the lower MBF magnitude in the studied skeletal deformities.

Lateral and medial upper eyelid contour abnormalities in graves orbitopathy: the influence of the degree of retraction.

PURPOSE: To determine the location of contour abnormalities in Graves upper eyelid retraction. METHODS: Multiple midpupil angular eyelid distances of 75 upper eyelids of 55 patients (mean age = 41.7 ± 13.3 SD years) in the inactive phase of Graves orbitopathy were measured with a recently developed custom-made software. Sixty eyelids of 60 normal subjects were also measured as a control group. A contour peak was defined by the highest midpupil angular eyelid distance normalized (divided) by the superior limit of normality (mean + 2SD). RESULTS: In 45 eyelids (60%), the peaks were lateral between 120° and 150°. For high levels of retraction, the peaks tended to be centrally located with a substantial number of medial deformities (30 eyelids). Although the lateral and medial peaks were not affected by exophthalmometry, there was a statistically significant increase of medial peaks when midpupil eyelid distance was greater than 6.75 mm (χ = 5.20, p = 0.02). CONCLUSIONS: Lateral contour abnormalities are more frequent than medial deformities. With minor degrees of retraction, there is a predominance of lateral peaks. With higher degrees of retraction, the number of medial abnormalities is similar to the lateral ones.

Tissue ingrowth into perforated polymethylmethacrylate orbital implants: an experimental study.

PURPOSE: To evaluate the clinical response and fibrovascular ingrowth into perforated acrylic orbital implants in a rabbit model. METHODS: Perforated implants were manufactured by drilling channels interconnected at the center in conventional 12- to 13-mm acrylic spheres. The implants were placed in 16 eviscerated eyes with posterior sclerotomy of 16 New Zealand white rabbits. Clinical evaluation was performed daily for the first 14 days after surgery and at 7-day intervals until the end of the study (180 days). Histopathologic analysis was performed at 14, 45, 90, and 180 days after implantation. Hematoxylin-eosin and picrosirius red staining was used to assess the inflammatory reaction and collagen formation. RESULTS: There were no signs of infection, implant exposure, or extrusion in any animal during the study. Tissue ingrowth in the implant center was already detected by 14 days. At the end of the study, there was a dense collagen ingrowth with just a few inflammatory cells inside the implant. No multinucleated giant cells were found in any implant. CONCLUSIONS: Similar to porous implants, perforated acrylic implants permit fibrovascular ingrowth from surrounding orbital tissues.

Clinical and laboratory evaluation of sicca complaints: distinctive aspects of primary, secondary and non-Sjogren syndrome.

BACKGROUND: Sjögren Syndrome (SS) is a systemic autoimmune disease with a wide spectrum of manifestations that can lead to misdiagnosis. This study describes and compares demographic, clinical, serological, and histopathological data from subjects with SS and non-Sjögren Syndrome (NSS). It also details specific features within the primary SS (pSS) and secondary SS (sSS) groups identifying sub-groups. METHODS: The sample included individuals referred to an academic medical center in Brazil for investigation of SS from 2012 to 2020. Patients were retrospectively classified as primary SS (pSS), secondary SS (sSS), or NSS, based on the American-European Consensus Group criteria (AECG-2002), after multi-professional clinical and laboratory evaluation. RESULTS: A total of 676 individuals were screened and 510 (75.4%) completed the assessments; 198 patients were classified as pSS, 149 as sSS, and 163 as NSS. Symptoms and glandular dysfunction tests were similar in the groups. Concerning pSS, extraglandular manifestations were present in 59% of patients; the elderly had more dry symptoms and peripheral neurological disorders; and 2.5% developed non-Hodgkin lymphoma. In sSS, each overlap promoted distinct clinical and laboratory variants. Several alternative diagnoses were identified as a cause of sicca complex in NSS group. CONCLUSIONS: The diagnosis of SS remains a challenge behind dryness. Up to 31% of the suspected cases had other conditions associated to the symptoms. Histopathological analysis of LSG and SSa determined the diagnostic. Aging in pSS and overlap disease in sSS were responsible for distinct phenotypes and characteristic sub-groups in SS.

Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese.

INTRODUCTION: Obstructive sleep apnea is a frequent entity in childhood that can lead to important consequences for the health and children's quality of live. Polysomnography is the gold-standard exam to diagnose obstructive sleep apnea, but it is expensive, complex, and poorly affordable in Brazil. The pediatric sleep questionnaire has shown to be a valuable screening test for obstructive sleep apnea. It is a simple questionnaire with good sensitivity and specificity compared to polysomnography in the countries where it has been validated. OBJECTIVE: Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ), into Brazilian Portuguese. METHODS: The translation of the PSQ into Brazilian Portuguese was carried out in accordance with good practices. The validated and adapted questionnaire was applied to parents/caregivers of 60 children (40 of them with obstructive sleep apnea and 20 controls) aged 2-18 years. Retest was applied to 30 children with obstructive sleep apnea. The following tests were performed: internal consistency, test-retest, validation of questionnaire (the latter by ROC curve). RESULTS: Brazilian PSQ has shown high internal consistency by Cronbach's alpha (0.86 for the total test, 0.83 for subscale "snoring", 0.64 for "sleepiness" and 0.65 for "behavior"). Test-retest presented a correlation of 0.89 for subscale "snoring", 0.93 for "sleepiness" and 0.86 for "behavior". Accuracy by ROC curve was 0.99. Nine was considered the optimal value to discriminate patients with obstructive sleep apnea from controls, with a sensitivity of 0.92 and specificity of 1.0. CONCLUSION: The translation and cross-cultural adaptation of the PSQ into Brazilian Portuguese proved to be successful. In places with difficult access to polysomnography, PSQ can be a useful tool in screening and follow-up of children with obstructive sleep apnea.

Changes in jaw and neck muscle coactivation and coordination in patients with chronic painful TMD disk displacement with reduction during chewing.

The treatment of a complex temporomandibular disorder (TMD), such as disk displacement with reduction (DDR) associated with arthralgia and myalgia, may depends on understanding the impairments in muscle function. The aim of this study was to investigate the behavior of the anterior temporalis, masseter and sternocleidomastoid muscles in the time and frequency domains during chewing in patients with chronic painful TMD-DDR using electromyographic (EMG) analysis. Thirty-three patients who met the diagnostic criteria for TMD and 32 volunteers without TMD (control group) underwent clinical examination, chewing pattern classification and EMG analysis. For the EMG analyses, the side of habitual unilateral chewing, as determined by the chewing pattern classification, was selected for recording; in cases of bilateral chewing, the recording side was randomly selected. The EMG-EMG coherence function and EMG-EMG transfer function (gain and phase) values were obtained at the first chewing frequency peak, and the working-side masseter signal was used as a reference in the analyses of the other muscles. Compared to the control group, the TMD group showed a longer chewing stroke duration (P = 0.01) as well as changes in the coactivation and coordination strategies of the jaw muscles, evidenced by greater relative energy expenditure (P< 0.01) and impaired differential recruitment (P< 0.05) and coherence (P< 0.01). Delays in peak and temporal asynchrony occurred in the jaw and neck muscles (P< 0.05). Patients with chronic painful TMD-DDR during chewing presented changes in the jaw and neck muscles, with more compromised function of the former, which are specific to chewing.

Microperimetry differences in macular sensitivity threshold between first and second tested eyes.

PURPOSE: To comparatively assess the macular sensitivity threshold of microperimetry and the fixation stability between the first (right) and second (left) tested eye of normal participants. METHODS: Thirty healthy patients were randomly assigned to two groups. The participants underwent microperimetry in the fast mode and expert mode in groups I and II, respectively. Each participant underwent a single test and the right eye was tested first. RESULTS: The mean macular sensitivity threshold (± standard deviation [SD]) was 24.5 ± 2.3 dB and 25.7 ± 1.1 dB in the first (right) and second (left) eyes of group I, respectively (p=0.0415) and 26.7 ± 4.5 dB and 27.3 ± 4.0 dB in the first (right) and second (left) eyes of group II, respectively (p=0.58). There was no statistically significant difference between eyes in either group (p=0.1512). Regarding fixation stability (evaluated in the microperimetry expert mode group), the mean ± SD percentage of fixation points within the 1-degree central macula (P1) was 87.9 ± 11.5% in the right eye and 93.8 ± 6.6% in the left eye. The paired t-test did not show a statistically significant difference between eyes (p=0.140). Mean ± SD P2 value was 95.5 ± 4.9% in the right eye and 98.5 ± 2.1% in the left eye. The analysis demonstrated an increase in the percentage of fixation points in the second tested eye compared with the first one (paired t-test= 2.364; p=0.034). There was a negative correlation between the macular sensitivity threshold of the right eye and the duration of the examination for both groups (microperimetry expert mode: r=-0.717; p=0.0026; microperimetry in the fast mode: r=-0.843; p<0.0001). CONCLUSION: Mean macular sensitivity threshold was higher in the second tested eye in the microperimetry in the fast mode group and was similar in both eyes in the expert mode. Our data suggest that comprehension of the examination by the individual may impact the results of the microperimetry test.

Limitations and advances in new treatments and future perspectives of corneal blindness.

This review is intended to describe the therapeutic approaches for corneal blindness, detailing the steps and elements involved in corneal wound healing. It also presents the limitations of the actual surgical and pharmacological strategies used to restore and maintain corneal transparency in terms of long-term survival and geographic coverage. In addition, we critically review the perspectives of anabolic agents, including vitamin A, hormones, growth factors, and novel promitotic and anti-inflammatory modulators, to assist corneal wound healing. We discuss the studies involving nanotechnology, gene therapy, and tissue reengineering as potential future strategies to work solely or in combination with corneal surgery to prevent or revert corneal blindness.

Orofacial Motor Functions and Temporomandibular Disorders in Patients With Sjögren's Syndrome.

OBJECTIVE: Sjögren's syndrome (SS) induces difficulty in chewing and swallowing due to low salivary flow. However, these symptoms may be associated with other factors, such as orofacial myofunctional disorders and temporomandibular disorder (TMD), which have not been comprehensively assessed in this population. The aims of this study were to investigate orofacial muscles and functions as well as the presence of TMD in patients with SS compared with a group without SS and to analyze whether the patients' experience of limitations in orofacial functioning is associated with the orofacial functional status and muscle pain related to TMD. METHODS: Women with SS based on the 2002 American-European Consensus Group criteria and volunteers paired by age and sex were compared. The examinations included the orofacial myofunctional evaluation with scores (OMES) protocol, tongue and lip strength measures, and electromyography of the masticatory muscles. TMD investigations included clinical examination, self-report of symptoms, and assessment according to the Jaw Functional Limitation Scale. RESULTS: Patients with SS present with impaired muscle and orofacial functions based on lower scores of all categories of OMES (P < 0.0001), tongue strength (P = 0.0003-0.0004), and masticatory muscle activity (P = 0.0002-0.007), as well as worse TMD signs and symptoms (P < 0.05) and jaw functional limitation (P < 0.0001-0.0003). CONCLUSION: Patients' experiences with limitation in mastication and swallowing were associated with orofacial myofunctional status and muscle pain related to TMD. Those disorders should be monitored along with disease control and must be addressed in the clinical evaluation to prevent nutritional and metabolic comorbidities in patients with SS.

ETDRS panretinal photocoagulation combined with intravitreal ranibizumab versus PASCAL panretinal photocoagulation with intravitreal ranibizumab versus intravitreal ranibizumab alone for the treatment of proliferative diabetic retinopathy.

PURPOSE: To compare visual acuity, macular thickness, and the area of active neovascularization based on fluorescein angiography outcomes associated with standard single-spot panretinal photocoagulation in the Early Treatment Diabetic Retinopathy Study (ETDRS) pattern combined with intravitreal ranibizumab injection versus multiple-spot full scatter (PASCAL) panretinal photocoagulation combined with intravitreal ranibizumab injection versus intravitreal injection alone in patients with proliferative diabetic retinopathy. METHODS: Patients with proliferative diabetic retinopathy and no prior laser treatment were randomly assigned to receive three different types of treatment. Panretinal photocoagulation in the ETDRS group was administered in two sessions (weeks 0 and 2), and panretinal photocoagulation in the PASCAL group was administered in one session (week 0). Intravitreal injection of ranibizumab was administered at the end of the first laser session in both the ETDRS and PASCAL groups and at week 0 in the intravitreal injection group. Comprehensive ophthalmic evaluations were performed at baseline and every 4 weeks through week 48. RESULTS: Thirty patients (n=40 eyes) completed the 48-week study period. After treatment, best-corrected visual acuity was significantly (p<0.05) improved at all follow-up visits in the group receiving intravitreal injection alone, at all but week 4 in the ETDRS group, and at all but weeks 4 and 8 for the PASCAL group. A significant decrease in central subfield macular thickness was observed in the PASCAL group at weeks 4, 8, and 48; only at week 48 in the intravitreal injection group; and never in the ETDRS group. There was no significant difference among the three treatment groups with respect to change from baseline to week 48 in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization. CONCLUSIONS: Intravitreal injection alone or combined with single- or multiple-spot panretinal photocoagulation yielded similar outcomes with respect to mean change in best-corrected visual acuity, central subfield macular thickness, and fluorescein leakage from active neovascularization at up to one-year of follow-up. All subjects provided written informed consent to participate (NCT02005432 in clinicaltrials.gov).

Upper eyelid contour symmetry measurement with Bézier curves.

PURPOSE: The purpose of the present work is to measure the interocular upper lid contour symmetry using a new method of lid contour quantification. METHODS: The Bézier curve tool of the Image J software was used to extract the right and left upper eyelid contours of 75 normal subjects. Inter-observer variability of 29 right lid contours obtained by two independent observers was estimated using the coefficient of overlap of two curves and an analysis of the differences of the contour peak location. A two-way analysis of variance was used to test the mean value of the coefficient of overlap of the right and left contours in males and females and lid segments. The same analysis was performed to compare the location of the contour peak of the right and left contours. RESULTS: The coefficient of contour overlap obtained by independent observers ranged from 93.5% to 98.8%, with a mean of 96.1% ± 1.6 SD. There was a mean difference of 0.02 mm in the location of the contour peak. Right and left contour symmetry did not differ between females and males and was within the range of the method variability for contour overlap and location of the contour peak. CONCLUSIONS: The upper eyelid contour is highly symmetrical. Bézier lines allow a quick and fast quantification of the lid contour, with a mean inter-observer variability of 3.9%.

Lower Eyelid Contour in Graves Orbitopathy.

Purpose: The aim of the present study was to analyze quantitively the lower lid contour of patients with Graves orbitopathy.Methods: Bézier curves were manually adjusted to the ciliated and nasal (or lacrimal) portions of the lower lid contour of 41 patients with Graves orbitopathy and 43 normal subjects using National Institute of Health (NIH) ImageJ software. Considering the main coordinates of the Bézier functions, the Matlab software was employed to express the lid contours with 1000 points. The first order numerical derivative of the curves was calculated in order to compare the curvature of the whole lid contour of patients and controls. The same comparison was made for the temporal and nasal contour segments. Other parameters measured included the location of the lowest point on the contours (contour peak); the position of the lateral and medial canthi, as well as the angle formed by the lower lacrimal punctum and the vertex of the inner canthus.Results: The curvature of the temporal portion of the lid contours of patients and controls correlated with both the height of the lateral canthus and the magnitude of the MRD2. Graves retraction affects the medial and lateral portion of the lid. Both segments were more curved in patients than in controls. The lower punctum was significantly lowered, increasing the angle between the lower punctum and the medial canthus.Conclusions: The increased lateral curvature of the lower lid seen in patients with Graves disease is a natural geometric effect of the increment of MRD2. The nasal portion of the lid is also significantly lowered by retraction.