Digital Evaluation of the Changes in Eyelid and Ocular Surface Measurements and the Correlation of These Parameters with Visual Field Parameters After Upper Eyelid Blepharoplasty.

Objectives: We aimed to evaluate the change in eyelid and ocular surface parameters that were measured using a digital measurement program, the change in the visual field (VF), and the correlation between ocular surface area (OSA) and VF parameters in patients who underwent upper eyelid blepharoplasty for involutional dermatochalasis. Methods: Patients who underwent upper eyelid blepharoplasty for involutional dermatochalasis between August 2015 and August 2019 were included in the study. The difference between preoperative and postoperative 3rd month values of manually measured margin reflex distance 1 (MRD1), digitally measured eyelid and ocular surface parameters (MRD1, MRD 2 [MRD2], upper eyelid crease height [ECH], pretarsal show height [PTH], eyebrow line-height [EBH] and OSA), and VF parameters were evaluated. The correlation between preoperative and postoperative values of manually and digitally measured MRD1 and also preoperative and postoperative values of OSA and VF parameters were analyzed. Results: Thirty-six eyes from 36 patients were included in this study and the mean age of patients was 57.93±7.64 years. There were statistically significant changes between preoperative and postoperative values in means of the manually measured MRD1 and the digitally measured MRD1, PTH, OSA, and ECH (p<0.001). However, the postoperative changes in the mean MRD2 and EBH were not statistically significant (p=0.664 and p=0.983). There were moderate positive correlations between pre- and post-operative OSA values and pre- and postoperative values of manual and digital MRD1. A statistically significant agreement was observed between the change in OSA and the change in all VF parameters (Bland-Altman analysis test). Conclusion: Digital measurements can be used to evaluate the changes in eyelid and ocular surface parameters in patients who underwent upper eyelid blepharoplasty surgery. OSA provides fast results in accordance with linear measurements and is compatible with the change in the VF.

Serum calcium, magnesium, phosphorus, and vitamin D in benign essential blepharospasm.

PURPOSE: This study aims to compare serum calcium, magnesium, phosphorus, and 25-hydroxy (OH)-vitamin D levels in patients with benign essential blepharospasm (BEB) and healthy subjects and to determine their association with disease severity and frequency. METHODS: This is a prospective study conducted in a tertiary care hospital. Fifty patients (female, 39; male, 11) with BEB and 22 healthy subjects (female, 15; male, 7) included in the study. Serum calcium, magnesium, phosphorus, and vitamin D levels of BEB and healthy groups were measured. Blepharospasm severity and frequency were assessed using scales ranging from 0 to 4 by following the Jankovic Rating Scale (JRS). RESULTS: Though there was no significant difference regarding magnesium, phosphorus, and 25(OH)-vitamin D levels between the two groups, serum calcium levels of the BEB group were significantly lower than the control group (9.5 ± 0.4 and 9.9 ± 0.4 mg/dl, respectively; P = 0.002), although in the normal range (9-10.5 mg/dl). In the BEB group, the mean Jankovic severity and frequency scores were 3.29 ± 0.54 and 3.59 ± 0.61, respectively. There was a moderate negative correlation between serum 25(OH)-vitamin D levels and Jankovic severity score (r = - 0.332; P = 0.022). CONCLUSION: Serum calcium levels of the BEB group were significantly lower than the healthy group. Serum vitamin D levels showed a moderate negative correlation with disease severity. The role of calcium and vitamin D in the evolution of the BEB need further investigation at the cellular and anatomical levels.

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.