Aesthetic and Functional Outcomes of Upper Blepharoplasty Combined with Dacryoadenopexy in Lacrimal Gland Prolapse.

INTRODUCTION: Lacrimal gland prolapse (LGP) is a term used to describe a benign, anterior displacement of the lacrimal gland. If this condition is not properly addressed during upper blepharoplasty, the aesthetic and functional results are less than optimal. This study aimed to report the surgical outcomes of upper blepharoplasty combined with dacryoadenopexy in patients with LGP. METHODS: We reported an unusual case of severe LGP in a young patient. In addition, we performed a systematic review of the English literature on surgical cases of LGP published between 1973 and 2023. Eligible articles were analyzed for individual patient data (IPD) and aggregate patient data (APD). The primary predictor variable was the surgical technique used for lacrimal gland repositioning/suspension. The primary outcome variable was relapse rate. RESULTS: The bibliographic search retrieved 488 surgical cases of LGP: 12 in IPD, and 476 in APD datasets. The relapse rates in the IPD and APD cohorts were 8.3% (1/12) and 1.2% (6/476), respectively. Within the APD dataset, no significant difference in the relapse rates between dacryoadenopexy via suture suspension and Whitnall's ligament suspension (5/409 and 1/20, respectively; P > 0.05) was observed. Light cauterization of the lacrimal gland capsule and surrounding soft tissues was performed in mild LGP cases (< 4 mm prolapse), with a relapse rate of 0% (0/47). CONCLUSION: Upper blepharoplasty combined with dacryoadenopexy proved to be a safe surgical procedure with very satisfactory aesthetic outcome and minimal relapse rate. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pseudophakic Cystoid Macular Oedema (PCME) Prevention in Patients with Non-Proliferative Diabetic Retinopathy (NPDR)-Randomized Controlled Trial.

Background and Objectives: The purpose of this study was to compare the effect of topical bromfenac and dexamethasone on the intraocular concentration of interleukin 6 (IL-6) and incidence of pseudophakic cystoid macular oedema (PCME) after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Ninety eyes of patients with mild-to-moderate NPDR that underwent phacoemulsification cataract surgery were divided into three groups. A detailed description of the clinical study protocol is described later in paper. In short, Group 1 received topical bromfenac (0.9 mg/mL), Group 2 dexamethasone (1 mg/mL), and Group 3 placebo, both preoperatively and postoperatively. Additionally, all patients received combined topical steroid and antibiotic drops (dexamethasone, neomycin and polymyxin B) 3 weeks postoperatively. On the day of the surgery, aqueous humour samples (0.1-0.2 mL) were obtained and IL-6 concentrations were analysed. Central foveal subfield thickness (CFT) measured using spectral-domain optical coherence tomography (SD-OCT) was analysed preoperatively and postoperatively. Results: There was no significant difference in IL-6 concentrations between groups. Postoperative CFT was significantly lower in the dexamethasone group compared to the placebo group. In addition, the correlation between IL-6 and CFT was statistically significant in the dexamethasone group. No patient developed PCME in any of the three groups. No adverse events were reported during the study. Conclusion: Topical bromfenac and dexamethasone have no significant effect on intraocular IL-6 concentration in patients with NPDR. Topical bromfenac is not more effective than topical dexamethasone in reducing postoperative CFT in patients with NPDR.

Quantification of intraocular IFNgamma and IgG in cataract and diabetes.

The anterior eye chamber is called the immunologically privileged place. The inflammatory disturbances in the interior of the eye chamber are characterised primarly by the changes of the IFN-gamma, IgG and IL-4 concentration and appearance of the oligoclonal IgG. In type I diabetes, there are antibodies to the beta cells of the pancreas, IgG class (among others such as antiretinal antibodies) and they are also found in preretinal membranes of diabetics. In type II there are IgG antibodies to insulin receptors.

Skew Deviation: Case Report and Review of the Literature.

OBJECTIVE: To present a patient with a sudden onset ocular tilt reaction (OTR) and review recent knowledge and evolving insights of the underlying pathophysiological mechanisms of skew deviation and OTR. METHODS: A middle-aged hypertensive man who had previously suffered stroke with good recovery presented with sudden-onset double vision, slurred speech, ataxia, and a head tilt. Romberg test was positive. The patient denied having disturbances of visual acuity, eye pain, or recent trauma. The right eyeball was pushed upward. The patient complained of double vision in any gaze direction. Movements of the extraocular muscles (EOMs) in the horizontal plane were normal, whereas vertical version and convergence were not possible. We administered a Hess-Lancaster test, cover test, fundoscopic examination, Parks-Bielschowsky three-step test, upright-supine test, brain magnetic resonance imaging (MRI), transcranial doppler (TCD) ultrasonography, electrocardiogram (ECG), Holter monitor (24 h), and echocardiography. RESULTS: The Hess-Lancaster test showed superior rectus muscle and inferior obliquus muscle palsy to the left and rectus inferior muscle and superior obliquus muscle palsy to the right. The right eyeball fell behind when looking downward and the left eyeball when looking upward. Cover alternating test was positive from vertical, R/L. Examination of the ocular fundus showed incyclotorsion of elevated right eye and excyclotorsion of depressed eye. The Parks-Bielschowsky three-step test was negative. A brain MRI with gadolinium revealed a small zone of diffusion restriction in the medial portion of the right cerebral peduncle and right thalamus. There was a gradual improvement in the patient's neurological status following treatment. CONCLUSION: Skew deviation, a not uncommon clinical condition, should be promptly recognized when binocular vertical diplopia cannot be interpreted by trochlearis and oculomotor nerve lesion, myasthenia gravis, or orbital pathology. Maddox rod, cover test, Parks-Bielschowsky three-step, and other tests should help to establish the diagnosis. The prognosis depends on etiology, but it is commonly favorable; the majority of patients recover spontaneously after less than a year. More invasive management options should be discussed thereafter.