Analysis of Periorbital Soft Tissue in Thyroid Eye Disease.

PURPOSE: To investigate periorbital tissue enlargement in thyroid eye disease (TED) by 3-dimensional CT volumetric analysis. METHODS: Twenty-four adult subjects, 16 with TED and 8 controls, were studied. Three-dimensional volumetric calculations were performed on CT imaging of the orbit and face, focusing on the retroorbicularis oculi fat, suborbicularis oculi fat, facial muscles in periorbital region, orbital fat, extraocular muscles, and orbital volume. Analysis was performed using JMP version 12 software. Each measure was compared between the TED and control groups using Wilcoxon rank sum test. Correlations were investigated between periorbital and orbital tissue using the Spearman's correlation coefficient method. RESULTS: A statistically significant increase in volume was measured in TED patients in the superior and inferior periorbital fat tissue (p = 0.0044, p = 0.047), including the retroorbicularis oculi fat (p = 0.0011), suborbicularis oculi fat (p = 0.0093), and a decrease in facial muscle of superior periorbital region (p = 0.035). Strong positive correlation was noted between the muscles of superior and inferior periorbital region (rs = 0.65; p = 0.0006), and between the suborbicularis oculi fat and retroorbicularis oculi fat (rs = 0.50; p = 0.013). No correlation was observed between orbital and periorbital tissue, except between the orbital fat and the inferior periorbital fat tissue (p = 0.047). CONCLUSIONS: Facial fat in the periorbital region is enlarged in TED, with the superior component correlating with orbital fat tissue expansion. These findings may assist in the clinical evaluation and management of disfigurement in TED patients.Superior and inferior periorbital fat is enlarged in thyroid eye disease with the superior periorbital fat expansion correlating with orbital fat expansion.

Single Suture Müeller Muscle Conjunctival Resection (ssMMCR): A Modified Technique for Ptosis Repair.

PURPOSE: To evaluate the efficacy in degree of ptosis correction achieved by single suture Müeller muscle conjunctival resection (ssMMCR) when compared with that of traditional MMCR. METHODS: A retrospective chart analysis of patients who underwent either ssMMCR or traditional MMCR at 2 institutions. Single suture MMCR was performed after using a ptosis clamp to imbricate conjunctiva and Müeller muscle. Margin-to-reflex distance 1 was measured pre- and postoperatively, and the change in margin-to-reflex distance 1 was analyzed for both groups. Patients were monitored in follow up for postoperative complications including lagophthalmos, corneal abrasions, and change in visual acuity. Statistical analysis was performed using the Microsoft Excel and Stata software programs. RESULTS: Twenty-seven and 30 patients underwent single suture and traditional MMCR, respectively. The ssMMCR and MMCR groups were followed postoperatively for approximately 4.2 and 9.7 months, respectively and the average margin-to-reflex distance 1 increased by 2.93 mm and 2.81 mm, respectively. Notably, there was no statistically significant difference in the means identified by t test. Of the 94 eyelid surgeries evaluated, 1 ssMMCR and 3 MMCR eyelids required further surgical revision for persistent ptosis, and 1 ssMMCR developed a transient corneal epithelial abrasion. Surgical revisions were rare with both procedures, and patient satisfaction was high. CONCLUSIONS: Single suture MMCR is an efficient and effective method for ptosis repair. It results in comparable outcomes including elevation in margin-to-reflex distance 1, safety profile, and reoperation rates, when compared with traditional MMCR.

Prospective Comparative Analysis of 4 Different Intraocular Pressure Measurement Techniques and Their Effects on Pressure Readings.

PURPOSE: To compare intraocular pressure (IOP) measurement using the Goldmann applanation tonometry (GAT) without fluorescein, with fluorescein strips, with fluorescein droplets, and IOP measurement with Tono-Pen Avia (TPA). PATIENTS AND METHODS: This was a prospective comparative clinical analysis. It was performed in clinical practice. The study population consisted of 40 volunteer patients, 1 eye per patient. All patients who were 18 years and older having routine ophthalmological examination were eligible to participate. Active corneal abrasions and/or ulcers, previous glaucoma surgery, or prostheses interfering with GAT measurement were excluded. GAT IOP was measured first without fluorescein, then with fluorescein strip, then with fluorescein droplet, and finally with the TPA device. The main outcome measure was central corneal IOP. RESULTS: Mean±SD IOP measurements for GAT without fluorescein, with fluorescein strip, with fluorescein droplet, and for TPA groups were 12.65±3.01, 14.70±2.82, 15.78±2.64, and 16.33±3.08 mm Hg, respectively. Repeated-measures analysis of variance corrected with the Greenhouse-Geisser estimate ([Latin Small Letter Open E]=0.732) showed that measuring technique had a significant effect on IOP measurements (F2.20,85.59=34.66, P<0.001). The pairwise post hoc testing showed statistically significant mean differences (P≤0.001) between all techniques except when GAT with fluorescein droplet was compared with TPA (P=0.222). The Bland-Altman analyses showed 95% limits of agreement maximum potential discrepancies in measurement ranging from 5.89 mm Hg in the GAT with fluorescein strip versus droplet compared with 11.83 mm Hg in the GAT with fluorescein strip versus TPA comparison. CONCLUSIONS: IOP measurement technique significantly impacted the values obtained. The ophthalmologist should ensure consistent measurement technique to minimize variability when following patients.

Descemetorrhexis in endothelial keratoplasty to avoid peripheral bullous keratopathy.

Descemet-stripping automated endothelial keratoplasty has revolutionized the treatment of corneal endothelial disease. This procedure requires the removal of the Descemet membrane (DM) and the endothelium from the recipient cornea. We describe a simple technique to perform descemetorrhexis using an ophthalmic viscosurgical device to fill the anterior chamber and using capsulorrhexis forceps to create a controlled, continuous curvilinear DM tear in 19 cases. Avoidance of tearing the DM out to the periphery reduces endothelial cell loss, decreases migration of central endothelium to deficient areas, and minimizes the risk for chronic corneal edema and peripheral bullous keratopathy.

In utero gene delivery using chitosan-DNA nanoparticles in mice.

BACKGROUND: In utero gene transfer is a novel therapy for monogenic disorders diagnosed in the fetus. Enhanced biosafety alternatives to viral vectors include non-viral transfer agents such as chitosan. The purpose of this study was to evaluate in vitro and in utero gene transfer of reporter gene (GFP) using chitosan as a transfer vehicle. IN VITRO STUDIES: 1. Chitosan colloidal suspensions were prepared, and particle stability in murine amniotic fluid (AF) was determined. 2. Chitosan-reporter gene (EGFP) constructs were prepared and protection from endogenous digestion in AF was measured by gel electrophoresis. 3. Transfection efficiency (by chitosan-EGFP) of HEK293T cells was determined in varying proportions of medium and AF. In utero studies: Amniotic sacs of time-mated CD-1 mice were injected with chitosan-pEGFP (12.5 µg DNA) on G17. Pups and their dams were sacrificed and tissues were examined for transgene presence and expression. RESULTS: Chitosan formed stable aggregates in AF. Although AF decreased in vitro transfection efficiency, in vivo transfection by amniotic injection achieved short-term transgene expression in pup lung and intestine. CONCLUSIONS: In utero delivery of chitosan-EGFP results in postnatal gene expression, and shows promise for non-viral gene transfer in animal models of fetal gene therapy.