Periorbital venous stasis may be involved with filler induced malar edema-A duplex ultrasound-imaging-based case series.

INTRODUCTION: Filler injections in the periocular region are regarded as a challenging and advanced maneuver in a high-risk area. Adverse events as malar edema due to filler treatment may occur. To evaluate the possible reasons, the ultrasound images, and medical data of patients that were prospectively referred with malar edema were evaluated. MATERIALS AND METHODS: A total of 17 patients (26 eyes) with malar edema after hyaluronic acid filler treatment were included. All cases were assessed with an 18 MHz linear ultrasound device. Exact location of the filler material was noted. Relations with clinical data were analyzed using chi-square tests. RESULTS: Onset of malar edema after treatment showed a wide range from immediate (0 days) to 3 years. Most patients had an early onset N = 13 (76%), a minority showed late onset N = 4 (24%). In 23 eyes, the filler material was found to be located inside the SMAS. In 3 cases filler material was located on the periosteum of the orbital rim. After duplex-ultrasound guided filler removal, restored venous flow could be seen in the superficial and/or deep fatty layer often accompanied by flow piercing through the SMAS. Minutes after treatment, clinical improvement of malar edema was observed. CONCLUSION: Malar edema after by filler treatments in the periocular region may be caused by veno-lymphatic compression by filler deposits.

Thyroid orbitopathy possibly predisposes to late-onset of periocular lymphoma.

AIM: The prevalence of thyroid orbitopathy, compared with an estimate for the United Kingdom population, is examined in a large cohort of patients treated for periocular lymphoma. PATIENTS AND METHODS: Clinical details were reviewed for patients presenting to the Orbital Clinic at Moorfields Eye Hospital with biopsy-proven periocular lymphoma. Recorded evidence of prior thyroid gland abnormality or thyroid eye disease was sought and treatment details recorded, together with that of the subsequent periocular lymphoma. The calculated prevalence of thyroid orbitopathy in our patients with periocular lymphoma was compared with an estimate based upon published figures for a United Kingdom population. RESULTS: Of 369 patients with periocular lymphoma, 20 (5%) had a history of thyroid disease and adequate notes were available in 10 cases: All had autoimmune thyrotoxicosis between 11 and 27 years (median 17.5) before diagnosis of periocular lymphoma and 6/10 had thyroid orbitopathy-none receiving orbital radiotherapy for treatment of their thyroid eye disease. Using a calculated estimate for the UK prevalence of thyroid orbitopathy, the probability of even these six cases of ophthalmopathy among 369 patients with periocular lymphoma is very low (P=0.007). CONCLUSION: Compared with a population estimate, patients with periocular lymphoma had a significantly greater prevalence of preceding thyroid orbitopathy, with a median latency of 17 years. Thyroid orbitopathy possibly predisposes to later local lymphoma in a manner similar to the late emergence of lymphoma with other chronic inflammatory diseases-such as Sjögren's syndrome, Hashimoto's thyroiditis, coeliac disease, or Helicobactergastritis.

Use of 7/0 Vicryl (coated polyglactin 910) and 7/0 Vicryl-rapide (irradiated polyglactin 910) in skin closure in ophthalmic plastic surgery.

AIMS: To assess the safety and efficacy of 7/0 Vicryl and 7/0 Vicryl rapide sutures for skin closure, and without suture removal, in ophthalmic plastic surgery. METHOD: A prospective, comparative study of 40 consecutive procedures in 32 patients. Tissue reactions to the sutures, completeness of wound healing, and number of sutures remaining were observed at first dressing, 2 weeks and 2 months. RESULTS: Wound healing was excellent at 2 weeks in all but one Vicryl rapide patient whose slight wound gape was not attributable to the suture material used. No inflammatory tissue reaction attributable to the suture was seen. No visible suture marks were observed at 2 months. Transient crusting was observed around the sutures in 9/20 (45%) and 10/20 (50%) patients with Vicryl and Vicryl rapide, respectively. Only one suture out of 144 was removed. CONCLUSION: 7-0 Vicryl and 7-0 Vicryl rapide are safe and effective sutures for skin closure in ophthalmic plastic surgery.

The House-Brackmann system and assessment of corneal risk in facial nerve palsy.

PURPOSE: The House-Brackmann (HB) facial nerve grading system is widely used by ENT/head and neck surgeons, but is perhaps of less value to the ophthalmologist. Our aim was to assess the value of the numeric portion of this system in identifying those patients with facial nerve palsy who are at risk of corneal complications. We also sought to identify other factors that might be predictive of such complications. METHODS: Forty-two patients (43 palsies) were studied prospectively. The HB grade was recorded together with measurements of levator function, upper lid closure, Bell's phenomenon, lagophthalmos, ectropion, lower lid retraction and corneal sensation. Conjunctival injection and corneal staining were also graded. ROC (receiver operating characteristic) curves were used to assess the value of each parameter as a screening test for corneal complications. RESULTS: There was no cut-off of HB grade, levator function, Bell's phenomenon, ectropion or lower lid retraction that was sufficiently sensitive and specific to screen for corneal complications. However, on assessing lagophthalmos and upper lid closure, cut-offs with more favourable sensitivities and specificities were identified. CONCLUSIONS: The numeric portion of the HB grading system is not a useful guide in identifying those patients with facial nerve palsy who are at risk of corneal complications. Measurements of lagophthalmos and upper lid closure, alone or in combination with other tests, may be of more value.

Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain.

AIMS: To assess the effectiveness of enucleation or evisceration in relieving pain from painful blind eyes. METHODS: 24 patients with intractable ocular pain underwent enucleation or evisceration with or without an orbital implant. RESULTS: Complete pain relief was achieved in all patients at an average time of 3 months (range 1-15 months). Seven patients required further medical or surgical treatment in addition to removal of the globe. CONCLUSION: Enucleation and evisceration were effective in relieving ocular pain in all patients with a painful blind eye in our study. However, complications of surgery and orbital implants can cause recurrent pain.