Comparison of Stab Incision and Eyelid Crease Incision Techniques in Children with Revision Frontalis Sling Surgeries Using Silicone Rods.

PURPOSE: To compare stab and eyelid crease incision techniques in revision frontalis sling surgeries using silicone rods. METHODS: This retrospective study involved 52 eyes in 48 consecutive pediatric patients who underwent revision frontalis sling surgery between 2008 and 2019. All primary surgeries were performed by making eyelid crease incisions and suturing of silicone rods onto the tarsal plates. The revision surgeries were performed by either making stab incisions over the eyelid through which to pass the silicone rods (group A), or by refixing the same or a new silicone rod to the tarsal plate (group B). The surgical results were compared. RESULTS: The mean follow-up period was 22.4 months (range, 6-62 months) and the mean age of the patients was 6.1 years (range, 1-16 years). There were 28 female and 20 male patients. Surgical success was achieved in 23 of 28 patients (82.1%) in group A, and 12 of 24 patients (50.0%) in group B. The difference between the groups was statistically significant (p = 0.012). Superficial punctate epithelial defects were detected in six group A patients (21.4%) and seven group B patients (29.1%). In group B, lid hematoma occurred in three patients (12.5%) and entropion occurred in three patients (12.5%). The silicone rods were removed from two eyes, and entropion spontaneously resolved in one eye with close follow-up. CONCLUSIONS: Using the stab incision technique increases revision frontalis sling surgery success rates when primary surgeries are performed using eyelid crease incisions and suturing silicone rods to the tarsal plates in children.

Evaluation of Demographic Features of Eyelid Lesions.

OBJECTIVES: This study was an evaluation of demographic and histopathologic features of eyelid lesions. METHODS: The medical records of 261 patients (296 eyelid lesions) who attended a single clinic between 1997 and 2011 were examined retrospectively. The incidence of benign and malignant lesions, the pathological classification, and age and sex data were investigated. RESULTS: A total of 204 benign lesions (68.9%) and 92 malignant neoplasms (31.1%) were found. Among these, the most frequently seen types of benign neoplasms were xanthelasma (28.4%), papilloma (14.7%), chalazion (8.8%), nevus (6.4%), moll cyst (5.9%), and capillary hemangioma (4.9%). The most frequently seen malignant neoplasms were basal cell carcinoma (72.8%), squamous cell carcinoma (13%), and sebaceous gland carcinoma (5.4%). The study group was made up of 149 (57%) female patients and 112 (43%) male patients. The majority of benign lesions were seen in women, whereas malignant neoplasms were observed more often in male patients. The mean age of patients with benign lesions and malignant neoplasms was 38.1±21.7 and 62.7±15.3 years, respectively. Benign lesions involved the upper eyelid more frequently than the lower, while malignant lesions were seen more frequently in the lower eyelid, with the exception of sebaceous gland carcinoma. CONCLUSION: The majority of eyelid lesions were benign and malignant neoplasms were seen more frequently in the older population. Basal cell carcinoma was the most common malignant eyelid tumor. The most common site of malignant tumor origin was the lower eyelid, with the exception of sebaceous gland carcinoma.

Outcome of External Dacryocystorhinostomy and Monocanalicular Intubation in Patients with Total Obstruction of One Canalicus.

PURPOSE: We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus. METHODS: Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively. RESULTS: Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606). CONCLUSIONS: In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.

Lagophthalmos and frozen globe as the initial presentation of invasive breast carcinoma.

A 75-year-old woman presented with six months history of progressing lagophthalmos and immobility of the left eye. Magnetic resonance imaging (MRI) of the orbit demonstrated infiltration of orbital fat and the extra-ocular muscles. We performed transverse blepharotomy of the left eyelid to correct lagophthalmos; and during surgery, we took a biopsy sample from levator muscle and orbital fat. After the operation, the patient was able to close her eyelids, and epithelial problems were resolved. Biopsy revealed fibro-vascular, muscle and fat tissue infiltrated with minimally differentiated carcinoma cells. Breast examination revealed a nodule in the left breast. Biopsy of the mass confirmed the diagnosis of invasive breast carcinoma. Orbital manifestation of metastases, such as diplopia, lagophthalmos or pain may reduce life quality of the patients and must be evaluated on a multidisciplinary basis.

Levator resection in the management of myopathic ptosis.

PURPOSE: To evaluate the results of levator resection in patients with myopathic ptosis. METHODS: The medical records of consecutive patients who underwent levator resection surgery performed for myopathic ptosis between October 2009 and March 2013 were reviewed. Indications for surgery were ptosis obscuring the visual axis and margin-reflex distance ≤ 2 mm. Surgical success was defined as clear pupillary axis when the patient voluntarily opened his eye and margin-reflex distance ≥ 3 mm. We analyzed the effect of levator function and Bell's phenomenon on the rates of success and corneal complication. RESULTS: This series included six male and six female patients. Levator function was between 4 and 12 mm. We performed bilateral levator resection surgery in all patients. The mean follow-up time was 14.8 months (range, 6 to 36 months). No patient was overcorrected. Adequate lid elevation was achieved after the operation in 20 eyes. Ptosis recurred in three out of 20 eyes after adequate lid elevation was achieved. Our overall success rate was 70.8%. In three eyes with poor Bell's phenomenon, corneal irritation and punctate epitheliopathy that required artificial eye drops and ointments developed in the early postoperative period, although symptoms resolved completely within 2 months of the resection surgery. No patients required levator recession or any other revision surgery for lagophthalmos or corneal exposure after levator resection. CONCLUSIONS: Levator resection seems to be a safe and effective procedure in myopathic patients with moderate or good Bell's phenomenon and levator function greater than 5 mm.

Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy.

Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in patients with acquired nasolacrimal duct obstruction (NLDO). Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20-30 years), 56% in Group 2 (31-40 years), 64% in Group 3 (41-50 years), 76% in Group 4 (51-60 years), and 88% in Group 5 (over 60 years). The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P = 0.009). Additionally, the 20-30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P = 0.009; 95% CI, 1.605-28.542). Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.

Incision-sparing management of canaliculitis.

PURPOSE: To report our results of canaliculitis treatment with our incision-sparing technique which includes dilation of the punctum and compression of the canaliculus to express the sulphur granules, curettage and irrigation of the canaliculus with antibiotic solutions, and topical antibiotic use. METHODS: The medical records of all patients treated for canaliculitis between October 2009 and March 2013 were rewiewed. The punctum of affected canaliculus was dilated under local anesthesia. Then, starting just distal to common canaliculus, the horizontal canaliculus was compressed along its entire length using either a forceps or a cotton tip applicator on the conjunctival surface and a curette on the skin. Compression was repeated until no more sulphur granules appeared and the swelling of the canaliculus disappeared. A chalazion curette was inserted into canaliculus to evacuate any residual concretions. The canaliculus were irrigated with antibiotic solutions and the patients were prescribed topical antibiotic solutions for one month Patients with follow-up less than 3 months after the intervention were excluded from the study. RESULTS: Nine patients met criteria for canaliculitis. There were 1 male and 8 female patients. Median age of the patients was 53 years (range 36-72 years). All patients had unilateral lower canaliculitis. Mean duration of the symptoms was 13.4 months (range 4-36 months). We followed up all patients for at least 3 months after the intervention. The signs and symptoms resolved completely in all patients within 1 month and recurrence was not observed in any patient. No patients reported epiphora after the procedure. CONCLUSION: Our incision-sparing technique is effective in the treatment of canaliculitis. We suggest that minimally invasive or incision-sparing techniques be attempted before canaliculotomy to decrease postoperative complications rates.

Comparison of revision surgeries with transcanalicular diode laser and external approaches in cases with failed transcanalicular diode laser dacryocystorhinostomy.

PURPOSE: To compare the success rates of revision surgeries with transcanalicular diode laser (TCDL) and external approaches in cases with failed TCDL dacryocystorhinostomy (DCR). METHODS: The medical records of the consecutive TCDL DCR surgeries performed for nasolacrimal duct obstruction between October 2009 and March 2013 were reviewed. Cases with the presence of canalicular stenosis, bone deformities, lacrimal sac neoplasms, additional intranasal deformities, dacryolithiasis, history of previous nasolacrimal surgery, and follow up less than 3 months were excluded from the study. Patency to irrigation was obtained in all patients during surgery. Patients with surgical failure during the follow-up period underwent external DCR or TCDL DCR for revision. Data regarding surgical outcomes after primary surgeries and revision surgeries were analyzed. RESULTS: One hundred seventy-six primary TCDL DCR surgeries were performed on 162 patients. Forty-four (25.0%) surgeries considered failure during follow up. Four patients had canalicular obstruction and were excluded from study. Six patients declined a second intervention. Eighteen patients underwent external DCR and 16 patients underwent repeated TCDL DCR for revision. Success rates of revision surgeries were 94.4% (17/18) with external DCR and 43.8% (7/16) with TCDL DCR. The difference was statistically significant (p = 0.002). CONCLUSIONS: Revisions with external DCR are recommended for failed TCDL DCR. Revision TCDL DCR should be performed only in patients avoiding facial incision and preferring incision-sparing surgical techniques for revision.

The efficacy of the combined procedure in involutional entropion surgery: a comparative study.

PURPOSE: To evaluate the efficacy of the combined procedure in the management of involutional entropion. METHODS: In this study, we reviewed 45 eyes of 36 patients who underwent the combined procedure (lateral tarsal strip, retractor tightening, and everting sutures) for the management of involutional lower eyelid entropion and compared the results with 31 eyes of 25 patients who underwent the Wies procedure. Exclusion criteria included previous lower eyelid surgery and follow-up of less than 6 months. RESULTS: No patients demonstrated entropion on the first postoperative day. The mean follow-up period was 18.4 months (6 to 52 months) in the Wies group and 22.6 months (6 to 59 months) in the combined procedure group. During the follow-up period, 9 of 31 eyes in the Wies group presented with recurrence and only 1 of 45 eyes in the combined procedure group presented with recurrence (p = 0.001). The average time of recurrence was 4.8 months in the Wies group. Recurrence occurred at 2 months postoperatively in the patient in the combined procedure group. Six of the 9 recurrences in the Wies group were managed by the combined procedure. None of these patients had further recurrence after correction. Three patients complained about a visible incision line after the Wies procedure. CONCLUSIONS: The combined procedure seems to be more effective than the Wies procedure in the management of involutional entropion. The combined procedure addresses the three major causative factors in involutional entropion and makes it possible to perform the surgery using a small incision.

Effect of intravitreal bevacizumab injection before Ahmed glaucoma valve implantation in neovascular glaucoma.

PURPOSE: To assess the efficacy of preoperative intravitreal bevacizumab injection (IVB) before Ahmed glaucoma valve (AGV) implantation in the treatment of neovascular glaucoma (NVG). METHODS: This retrospective, comparative and consecutive case series study included 41 eyes from 41 patients who underwent AGV implantation for treatment of NVG. The study group was composed of 19 patients (19 eyes) to whom IVB was administered before surgery, while the control group was composed of 22 patients (22 eyes) to whom IVB was not administered before AGV implantation. Findings such as intraocular pressures measured before and after surgery, surgical success rates, and postoperative complications were compared between the groups. RESULTS: There were no significant differences in preoperative data between groups. The surgical success rate in the study group (79%) was better than in the control group (64%), but this difference was not statistically significant (p = 0.28). Early postoperative complications such as fibrinous reaction in the anterior chamber as well as hyphema were less frequently observed in the study group. CONCLUSIONS: Intravitreal bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in eyes with severe NVG and intractable intraocular pressure.

Primary probing for congenital nasolacrimal duct obstruction with manually curved Bowman probes.

PURPOSE: To evaluate the effect of the shape of Bowman probes on the success of primary probing for congenital nasolacrimal duct obstruction. MATERIALS AND METHODS: Records of 42 nasolacrimal duct obstructions in 37 children who underwent probing with straight Bowman probes (group A) and 128 nasolacrimal duct obstructions in 110 children who underwent probing with Bowman probes manually bent to mimic the natural curve of the bony nasolacrimal pathway (group B) were evaluated and compared. All children were under 2 years of age. The main outcome was successful probing. Successful probing was defined as a complete resolution of signs and symptoms. RESULTS: The mean age of the patients was 16.4 ± 4.1 months (range 8-24 months) in group A and 16.8 ± 4.2 months (range 7-24 months) in group B. No canalicular or nasolacrimal sac pathologies were diagnosed during probing. The success rate was 76.2% (32/42) in group A and 91.4% (117/128) in group B. The difference was statistically significant (P < 0.01). CONCLUSION: Manually curved probes can be used efficiently during probing and increase the success rates.

Effect of suturing the silicone rod to the tarsal plate and the suture material used on success of frontalis suspension surgery.

PURPOSE: To evaluate the effect of suturing the silicone rod to the tarsal plate and the suture material used in suturing on surgical success of frontalis suspension for congenital ptosis. METHODS: Eighty eyes of 56 consecutive patients who underwent frontalis suspension surgery using silicone rods for congenital ptosis between 2005 and 2011 were included in this retrospective study. The surgical results of eyes were compared, in which silicone had not been sutured to the tarsal plate (group 1), with those sutured with monofilament polypropylene suture (group 2), and those sutured with polybutylate-coated braided polyester suture (group 3). Surgical success indicated that the postoperative eyelid position was maintained within 1 mm of the normal eyelid position, that is, 1 mm below the superior limbus in bilateral cases and the same level with the other eyelid in unilateral cases, in the primary position of gaze. Postoperative eyelid level beyond these limits was defined as surgical failure. RESULTS: The mean follow up was 16.3 months (6-38 months) and the mean age was 5.48 years (1-24 years). Thirty were male and 26 were female patients. Surgical failure occurred in 9 of 18 (50%) cases in group 1, in 5 of 24 (20.8%) cases in group 2, and in 5 of 38 (13%) cases in group 3 during the follow-up period after adequate eyelid elevation had been achieved just after the operation. The difference between surgical success rates in group 1 and group 2 (p = 0.047) and group 1 and group 3 (p = 0.003) was statistically significant. However, the difference between group 2 and group 3 did not reach statistical significance. CONCLUSIONS: Suturing the silicone rod to the tarsal plate increases the surgical success rates of frontalis suspension surgery for congenital ptosis. Suturing with polybutylate-coated braided polyester, even though statistically insignificant, seems to be more effective than suturing with monofilament polypropylene.

Long-term outcomes of pegged and unpegged bioceramic orbital implants.

PURPOSE: To evaluate the long-term outcomes of pegged and unpegged bioceramic orbital implants. METHODS: A retrospective analysis of 101 cases of evisceration, enucleation, or secondary implant surgery with placement of a bioceramic porous implant was conducted. Type of surgery, existence of a peg, peg system used, time of pegging, problems encountered before and after pegging, treatment methods, and final status were recorded. RESULTS: Evisceration was performed on 74, enucleation on 16, and secondary implant surgery on 11 patients. The patients were observed for a mean of 68.4 months (3 months-12 years). Fifty-three of the 101 patients were pegged. Patients were pegged at a mean of 9.3 months (6-23 months). Hydroxyapatite-coated, titanium-sleeved, titanium pegs were used in 43 patients, and titanium peg and sleeve system was used in 10 patients. Major complications were exposure and infection. Three patients presented with early exposure and late exposure developed in 14 of pegged and 4 of unpegged patients. The difference in late-exposure rates between pegged and unpegged group was statistically significant (p < 0.05). Implant infection developed in 9 of the pegged and in 1 of the unpegged patients. Implant exposure was noted in 6 of these 10 patients with infection. The difference in infection rates between the pegged and unpegged patients was statistically significant (p < 0.05). In 2 of the pegged patients, removal of bioceramic implant was required and after resolution of infection, another type of porous implant was implanted and repegged. The peg system was removed in 6 patients for the management of either exposure, infection, extrusion, hypermobility of sleeve, or peg falling out. Four patients were repegged. The time period between peg insertion and development of complications ranged from 15 days to 10 years. 86.8% of pegged patients were free of major complications and satisfied with the result at the last follow-up visit. CONCLUSION: Despite potential complications that can occur as late as 10 years, bioceramic porous implants yield satisfactory long-term results. Existence of a peg system appears to play a role in the increased rate of late-onset complications. Further investigations on new and safer pegging systems should be conducted.

Corneal biomechanical properties in patients with recurrent anterior uveitis.

PURPOSE: This study aimed to investigate the biomechanical changes in cornea in patients with recurrent anterior uveitis in comparison to healthy controls. METHODS: Eighty-five eyes in 51 patients with inactive recurrent anterior uveitis (25 male, 26 female) and 34 eyes of 34 age-matched control subjects (16 male, 18 female) were included. The following measurements were done and compared between patients and controls: corneal hysteresis, corneal response factor, intraocular pressure, and central corneal thickness. RESULTS: Patients had significantly lower mean corneal hysteresis (8.57 ± 1.60 versus 10.91 ± 1.41, p = .001) and corneal resistance factor (9.24 ± 1.68 versus 11.56 ± 1.46, p = .001) when compared to controls. Among patients, corneal hysteresis and corneal resistance factor did not correlate with duration of the disease or number of attacks per year. CONCLUSIONS: Anterior uveitis seems to be associated with impaired biomechanical strength of the cornea, although no correlations with the duration of illness or attack frequency could be determined.

Modified capsular tension ring implantation in eyes with traumatic cataract and loss of zonular support.

PURPOSE: To evaluate the outcomes of implantation of a Cionni modified capsular tension ring (CTR) and a posterior chamber intraocular lens (PC IOL) in patients with traumatic cataract and loss of zonular support. SETTING: Eye Clinic II, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. DESIGN: Case series. METHODS: Eyes with traumatic cataract and loss of zonular support had phacoemulsification with implantation of a foldable IOL and a 1- or 2-eyelet modified CTR. Preoperative features, preoperative and postoperative corrected distance visual acuity (CDVA), intraoperative performance, IOL position, and complications were evaluated. RESULTS: The study enrolled 16 eyes (16 patients). The mean CDVA was 0.89 logMAR ± 0.41 (SD) preoperatively and 0.33 ± 0.43 logMAR at the last postoperative examination (P=.001). Postoperatively, the mean spherical equivalent was -0.23 diopter (D) (range -1.50 to +1.00 D) and the mean postoperative astigmatism, 1.59 D (range 0.50 to 4.00 D). Eight eyes (50.0%) had phacodonesis preoperatively; no eye had pseudophacodonesis postoperatively. Preoperatively, 10 eyes (62.5%) had symptomatic decentration. Two eyes (12.5%) had asymptomatic nonprogressive decentration in the early postoperative period; no eye had symptomatic decentration throughout the follow-up. Three eyes (18.8%) preoperatively and 1 eye (6.2%) postoperatively had vitreous in the anterior chamber. Four eyes (25.0%) required anterior vitrectomy. Other complications were symptomatic posterior capsule opacification in 8 eyes (50.0%) and transient increased intraocular pressure in 2 eyes (12.5%). CONCLUSION: The use of a modified CTR preserved the capsular bag and resulted in good PC IOL centration with few significant complications in patients with traumatic cataract and loss of zonular support. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Impression cytology of the ocular surface and tear function in patients with periocular vitiligo.

PURPOSE: We evaluated the ocular surface and tear function in patients with periocular vitiligo in this prospective, case-control study. METHODS: Sixty eyes of 30 vitiligo patients with periocular involvement and 100 eyes of 50 control subjects were included in the study. Patients and control subjects were compared for Schirmer test and tear film break-up time (BUT) results and impression cytology findings graded according to Nelson's classification. RESULTS: The mean BUT value was 9.5 ± 4.1 seconds in patients with periocular vitiligo and 13.1 ± 4.2 seconds in the control group. The difference was statistically significant (p=0.005). Thirty-seven eyes (61.7%) in the vitiligo group and 28 eyes (28.0%) in the control group had BUT values less than 10 seconds (p<0.001). The mean Schirmer test value was 14.6 ± 4.3 mm in patients with periocular vitiligo and 15.1 ± 4.4 mm in the control group (p>0.05). Nineteen eyes (31.7%) in patients with periocular vitiligo and 8 eyes (8.0%) in the control group had grade 2-3 changes according to Nelson's classification (p<0.001). Three eyes (5.0%) in the periocular vitiligo group and none of the eyes in the control group had inflammation signs in the impression cytology analysis. CONCLUSIONS: In patients with periocular vitiligo, ocular surface and tear function alterations may occur. Further studies on ocular surface involvement in periocular vitiligo patients may help to increase understanding of the pathophysiology of vitiligo.

Corneal endothelial cell loss in post-penetrating keratoplasty patients after cataract surgery: phacoemulsification versus planned extracapsular cataract extraction.

PURPOSE: To compare the changes in endothelial cell density (ECD) in post-penetrating keratoplasty (PKP) patients after cataract extraction with phacoemulsification or planned extracapsular cataract extraction (ECCE). SETTING: Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. DESIGN: Clinical trial. METHODS: Eyes with hard nuclear cataract that had previous PKP were randomly assigned to have phacoemulsification or ECCE. Noncontact specular microscopy was performed preoperatively and 1, 3, and 6 months postoperatively. RESULTS: Twenty-six eyes of 26 patients were enrolled (14 phacoemulsification; 12 ECCE). Six months postoperatively, the mean corneal ECD was statistically significantly lower in the phacoemulsification group (1869.50 cells/mm(2) ± 158.05 [SD]) than in the ECCE group (1996.00 ± 127.96 cells/mm(2)) (P=.024). The mean percentage of endothelial cell loss at 6 months was 20.3% and 12.7%, respectively (P<.05). In both groups, there was no significant difference in the percentage hexagonality between preoperatively and postoperatively (P>.05). CONCLUSION: Extracapsular cataract extraction seemed to cause less endothelial cell damage than phacoemulsification in post-PKP patients with hard nuclear cataract.