Dry eye in the upper blepharoplasty patient: a study comparing orbicularis-sparing versus orbicularis-excising techniques.

PURPOSE: To compare subjective and objective dry eye syndrome (DES) metrics preoperatively and postoperatively in patients undergoing bilateral upper eyelid blepharoplasty (ULB) using orbicularis-sparing versus orbicularis-excising techniques. METHODS: A double-blind, randomized clinical trial was conducted on patients without prior DES or other severe conditions who presented to our institution between 2017 and 2019 for routine functional ULB. Patients were randomized into two treatment arms: bilateral ULB using the orbicularis-sparing technique or bilateral ULB using the orbicularis-excising technique. One subjective and seven objective DES assessments were performed on all patients preoperatively and 1 month and 1 year after surgery. RESULTS: A total of 63 patients were recruited for the study. Standard Patient Evaluation of Eye Dryness (SPEED) scores decreased in both treatment groups at 1 month and 1 year postoperatively. This change did not significantly vary based on surgical technique. Objective DES assessments were not significantly changed at both postoperative time points for either group. There was a correlation between the severity of preoperative DES symptoms and the subjective improvement of DES symptoms postoperatively in both groups. CONCLUSIONS: ULB with an orbicularis-sparing or orbicularis-excising technique does not worsen subjective or objective DES metrics and so, surgeons may confidently use either surgical technique. These findings may impact postoperative expectations for surgeons and patients alike.

Warfarin: Impact on hemostasis after radial catheterization.

OBJECTIVES: This study explores bleeding risk of warfarin patients undergoing radial catheterization. BACKGROUND: Traditionally warfarin has been held prior to catheterization due to bleeding risk; however, this practice is being reconsidered with radial access. This study examined if radial patients receiving warfarin have similar hemostasis times to those not taking warfarin. METHODS: A convenience sample of patients undergoing radial catheterization was analyzed. Demographics, procedure characteristics, and pharmacologic therapies were reviewed. Hemostasis times, defined as compression band times, were compared. To exclude confounding effects of aspirin and clopidogrel, a separate analysis of band times for each medication was performed. Specifically, analysis of variance models and exact logistic regression models were used to assess means between usage or nonusage of medications (warfarin, aspirin, clopidogrel) while adjusting for other medications. RESULTS: Of 208 patients, 60 (29%) were taking warfarin. The breakdown of warfarin, aspirin, and clopidogrel use was as follows: 6 (3%) not taking medications; 14 (7%) warfarin alone; 88 (42%) aspirin alone; 2 (1%) clopidogrel alone; 39 (19%) both warfarin and aspirin; 52 (25%) clopidogrel and aspirin; and 7 (3%) warfarin, aspirin, and clopidogrel. No major complications occurred. Mean hemostasis times for warfarin and nonwarfarin patients were not different (118 vs. 116 min; P = 0.25). Likewise, there was no difference for aspirin (117 vs. 114 min; P = 0.70). There was a nonsignificant trend toward clopidogrel prolonging hemostasis (123 vs. 114 min; P = 0.09). CONCLUSION: There were no apparent differences in adequacy of hemostasis or duration of compression time between patients taking warfarin or not taking warfarin after controlling for antiplatelet therapy. © 2014 Wiley Periodicals, Inc.