Müller Muscle Conjunctiva Resection for Revision of Residual Ptosis After External Levator Advancement Surgery.

PURPOSE: To evaluate surgical outcomes of Müller muscle conjunctival resection surgery for reoperation of residual ptosis after external levator advancement in patients with aponeurotic ptosis. METHODS: A total of 23 eyes of 23 patients who had undergone Müller muscle conjunctival resection for residual ptosis between January 2016 and July 2018 were reviewed retrospectively. Margin reflex distance (MRD), interlid crease, and show distance measurements were performed with a ruler in millimeters during the office examination, and the photographs of patients were taken before the procedure and on the 10th day, at the first, third, and sixth months after the procedure. The successful outcome was described as MRD1 between 3 and 5 mm, interlid MRD1 difference ≤1 mm, interlid crease difference ≤2 mm, interlid show difference ≤2 mm, and the presence of symmetrical lid contour. RESULTS: The mean increases in MRD1 were statistically significant at the first, third, and sixth months postoperatively when compared with preoperative values both before external levator advancement and before Müller muscle conjunctival resection (p = 0.000). There was statistically significant decrease in interlid MRD1 difference, interlid crease difference, and interlid show difference relative to preoperative values. Interlid crease and show difference within the range of successful outcome criteria were achieved in all patients. However, interlid MRD1 difference exceeded 1 mm in only 1 patient who had overcorrection. CONCLUSIONS: In patients who have residual ptosis without contour abnormality following external levator advancement, and positive response to phenylephrine testing, Müller muscle conjunctival resection is an effective approach.

Risk factors for treatment failure and recurrence of anisometropic amblyopia.

PURPOSE: The aim of this study was to identify factors associated with failed vision improvement and recurrence following occlusion therapy for anisometropic amblyopia in children aged 7-9 years. METHODS: We retrospectively reviewed the medical records of 64 children aged 7-9 years who had been diagnosed as having anisometropic amblyopia and were treated with patching. Functional treatment failure was defined as final visual acuity in the amblyopic eye of worse than 20/32. Improvement of fewer than two logMAR lines was considered relative treatment failure. Recurrence was defined as the reduction of at least two logMAR levels of visual acuity after decreased or discontinued patching. RESULTS: Functional and relative success rates were 51.6 and 62.5 %, respectively. The most important factor for functional treatment failure [adjusted odds ratio (OR) (95 % confidence interval, CI) 11.57 (1.4-95.74)] and the only risk factor for recurrence [adjusted OR (95 % CI) 3.04 (1.13-8.12)] were the same: high spherical equivalent (SE) of the amblyopic eye. A large interocular difference in the best-corrected visual acuity was found to be a risk factor for both functional and relative failure. CONCLUSION: High SE of the amblyopic eye was the most influential risk factor for treatment failure and recurrence in compliant children aged 7-9 years.

Bilateral Choroidal Metastases from Lung Adenocarcinoma: A Case Report.

The most common malignancy of the eye is metastatic tumors, with choroidal metastases being the majority of them. In women, breast cancer is the most common cause of orbital metastases, and in men, it is lung cancer. Despite the fact that there are efficient treatment options for orbital metastases, the benefit of procedures to detect choroidal metastases is debatable due to the quick progression and poor prognosis of lung cancer. In choroidal metastases resulting from lung cancer, patients are usually presented with decreased sight. Defects in the field of vision, flashes of light and floating bodies generally follow. Treatment options of choroidal metastases include many methods including laser photocoagulation, cryotherapy, chemotherapy, radiotherapy, surgical resection, enucleation and photodynamic therapy. There are reports emphasizing radiotherapy as the most efficient treatment option. In this case report, we sum up the case of a male patient presenting with blurry vision in both eyes, who was subsequently detected to have bilateral choroidal metastatic tumor and was diagnosed with primary lung adenocarcinoma.