Post-oncological full-thickness eyelid defect reconstruction: An aesthetical overview.

Purpose of the current study was to introduce a new detailed aesthetical subunit (ASU) involvement chart to localize the defect configuration on the eyelids, and, to evaluate the aesthetical and functional outcomes of the post-oncological full-thickness eyelid defect reconstruction surgery by using a modified aesthetical rating guideline. Medical records of subjects who were diagnosed with a primary malignant full thickness eyelid tumor involving the eyelid margin and underwent full-thickness eyelid defect reconstruction surgery between April 2016 and May 2022 were retrospectively reviewed. Age, sex, pathological diagnosis, follow-up time, the ASU of the eyelid involvement, and surgical methods used to reconstruct the anterior and posterior lamella were examined from medical records. The reconstructed eyelid photos were scored according to the modified aesthetical rating guideline to analyze the aesthetical and functional outcomes of the surgeries. A total of 31 subjects were included to the study, and the overall mean aesthetical score was 3.5. Seventeen subjects with aesthetical scores greater than 3.5 were included in the more aesthetically pleasing (AP) group, and 14 subjects with aesthetical score less than 3.5 were included in less AP group. Anterior lamella repair was mainly performed using myo-cutaneous flaps in the more AP group and multiple flap combinations in the less AP group (P: 0.13). Posterior lamella reconstruction was performed using tarso-conjunctival tissue in both groups. In more AP group, tissue scarring, lash line disruption, eyelid thickness, and retraction or ectropion scores were significantly higher when compared with less AP group (P:0.03, P:0.03, P:0.02, and P:0.01, respectively). Subjects with fair eyelash color were significantly more common in more AP group (P: 0.009). The ASU involvement chart and outcomes of the current study may aid novice surgeons to determine which method will provide the best result for an individual patient for full-thickness eyelid defect repair and may offer some insight into the different surgical techniques used for repairing similar wounds.

Evaluation of angle kappa using the autorefractometer front monitor image.

Purpose The aim of this study was to present a novel angle kappa (k) measurement method and grading scale using the autorefractometer front monitor image. Methods Two hundred sixty eyes of 130 subjects were included in the study. All eyes were evaluated using the front monitor image from an autorefractometer (ARFMI) (Canon, RK-F1, Japan). The distance from the center of the pupil to the visual axis on the ARFMI was measured using Image J software (http://rsbweb.nih.gov/ij). Sixty eyes of 30 subjects were evaluated using the Lens Star 900 (Haag-Streit AG, Koeniz, Switzerland), and Lens Star 900 angle-k values were compared with autorefractometer measurements to analyze the reliability of the method. Factors that may influence angle-k value were analyzed, and an ARFMI angle-k grading scale was developed and presented in the study. Results The mean ARFMI angle-k was 0.41 ± 0.22 mm, and the Lens Star 900 angle-k was 0.38 ± 0.24 mm. The Pearson correlation test was used to evaluate the reliability of the method, and there was a statistically significant positive correlation between the two methods (r: 0.628, p < 0.001). The mean ARFMI angle-k was higher in old and adult subjects when compared with young subjects, and the difference was statistically significant (p: 0.02 and p: 0.04, respectively). According to the ARFMI analysis, old subjects had narrow and nasally decentralized pupils when compared with young subjects, and the difference was statistically significant (p < 0.00 and p < 0.03, respectively). According to the ARFMI angle-k grading scale, 36.1% of subjects were grade 1, 38.3% were grade 2 on the x axis, and 58.5% were grade 1 on the y axis. Conclusions A novel angle-k measurement method and grading scale is presented in this study. In addition, the factors influencing the ARFMI angle-k and pupillary properties obtained from the ARFMI are evaluated. According to the results, angle-k and pupil properties may be evaluated using an easily evaluable, cost-effective device, which is present in every ophthalmic clinic.

Histologic and Immunohistochemical Evaluation of Radiosurgery in Strabismus Surgery in a Rabbit Model.

PURPOSE: The aim of this study was to evaluate the use of monopolar radiosurgery (MRS) assisted strabismus surgery and to compare its histologic and immunohistochemical wound healing outcomes with conventional surgery. METHODS: Superior rectus muscle resection was performed on 30 white rabbits with three different surgical muscle cutting techniques: monopolar radiosurgery (MRS group), conventional scissors preceded by bipolar electrocautery (BEC group), and conventional scissors with no cauterization (control group). Degree of tissue injury, bleeding, inflammation, and fibrosis, as well as wound healing rate (CD68+ cell number), were evaluated. RESULTS: In CS group, hemorrhage scores were significantly higher than those in the other groups (MRS group: Z = 5.182; p < 0.001 and BEC group: Z = 4.463; p < 0.001) and MRS group had lower scores than BEC group; however, the difference was not significant (Z = 1.423; p = 0.211). The tissue injury score in BEC group was higher when compared with MRS, and the difference was statistically significant (p = 0.028). Median inflammation scores at days 1 and 21 were lowest in MRS group, but the difference was not statistically significant among groups (day 1; p = 0.115, day 21; p = 0.095). The median fibrosis score was higher in the control group, when compared with MRS, and the difference was statistically significant (muscle-sclera; p = 0.011 and muscle-conjunctiva: p = 0.003). The macrophage score (number of CD68+ cells) was lowest in CS group; however, the difference was not significant (p = 0.657). CONCLUSIONS: Monopolar radiosurgery is a novel method for strabismus surgery and provides equivalent hemostasis effects and wound healing properties, compared with conventional methods, and enhances surgeon comfort, as muscle incisions are made in one step with clean surgical area.

A novel method to measure margin reflex distance using the autorefractometer.

PURPOSE: To determine the margin reflex distance (MRD) in healthy subjects using autorefractometer front monitor images (ARFMI) and validate the accuracy of this method by comparing it with conventional methods. METHODS: One hundred eyes of 50 healthy subjects aged 20-59 years were included in the study. Autorefractometer front monitor images were video-recorded using a smartphone camera, and screenshots were taken to analyze the MRD. The results were compared with those from conventional methods to determine the reliability of the method. To evaluate the repeatability and reproducibility of all measurement methods, we performed two different visits by two observers. RESULTS: The mean MRD-1 of the autorefractometer image measurement was 4.29 ± 0.90 mm, mean MRD-1 of the of the digital photography image measurement was 3.78 ± 1.03 mm, and mean MRD-1 of the manual measurement was 4.02 ± 1.09 mm. The mean difference (MD) of MRD-1 was analyzed and it was found that MD of the autorefractometer image was significantly higher than the MD of other groups (p < 0.001). The best repeatability was found in the autorefractometer image measurement [intraclass correlation coefficients (ICC): 0.960], and substantial to excellent repeatability was found in the manual (ICC: 0.903) and digital photography image measurements (ICC: 0.843). The mean inter-eye difference of MRD-1 measured by the three methods was analyzed, and there was a statistically significant difference in the autorefractometer and digital image groups (p: 0.001, p: 0.002, respectively). CONCLUSION: Margin reflex distance measurement using ARFMI analysis is a novel, simple, accurate, reliable, and objective method. The autorefractometer device is readily available and can be found in any ophthalmic clinic. Therefore, ophthalmologists can easily measure and record MRD values and use the accurate and reliable results for follow-up and medicolegal issues.

Tear Opiorphin Levels in Ocular Pain Caused by Corneal Foreign Body.

PURPOSE: Opiorphin is an endogenous inhibitor of enkephalin-degrading enzymes. It has a strong analgesic effect in chemical and mechanical pain models. We aimed to evaluate the tear opiorphin levels in ocular pain caused by corneal foreign bodies and demonstrate whether there is any correlation with pain levels obtained from the Visual Analog Scale (VAS) score and tear opiorphin level. METHODS: Thirty-two healthy individuals and 34 individuals diagnosed with corneal foreign bodies were included in this study. Tear opiorphin levels were measured by the ELISA method using a commercially available kit. The difference in tear opiorphin levels between the patient and control groups were evaluated using the Mann-Whitney U test. The correlation between VAS scores and tear opiorphin levels was evaluated using the Spearman rank correlation coefficient. RESULTS: The median values of tear opiorphin levels of the patient and control groups were 134 pg/mL (86.86-296.25) and 109.80 pg/mL (66.15-191.49), respectively. The Mann-Whitney U test showed a statistically significant difference in tear opiorphin levels between patient and control groups (P < 0.05). No ocular pain was reported in the control group. The median VAS score of the patient group was 6 points (1-9). No correlation was found between VAS scores and tear opiorphin levels in the patient group. CONCLUSIONS: The cornea is the most densely innervated tissue, and the highest opiorphin concentrations have been observed in tear. It is, therefore, expected that the stimulation or damage to the nerve endings in cornea would cause an increase in opiorphin secretion as a pain relief mechanism.