Lower eyelid position before and after blepharoptosis repair.

PURPOSE: This study aimed to examine the changes in lower eyelid position after blepharoptosis surgery and the factors that influence the outcome. METHODS: We conducted a retrospective study of 155 eyes of 89 patients who underwent blepharoptosis surgery between June 2019 and October 2022. The margin reflex distance (MRD)-1 and MRD-2 were examined preoperatively and 3 months postoperatively in two groups: one with lower scleral show (LSS) (n = 37) and one without LSS (n = 118). The clinical characteristics of the two groups were compared. RESULTS: Both the LSS and non-LSS groups showed significant postoperative improvement in MRD-1 scores (p < .01, p < .01, respectively). MRD-2 was significantly reduced in the LSS group, while it remained unchanged in the non-LSS group (p < .01, p = .27, respectively). There were no significant differences between the two groups in age, sex, history of hard contact lens use, preoperative levator function, use of topical steroids, history of endophthalmic surgery, or history of filtration surgery; however, the LSS group significantly used prostaglandin analogs (PGAs) (p = .03). Postoperatively, MRD-2 decreased in 13 eyes (35.1%) and was maintained in 24 eyes (64.9%) in the LSS group and was maintained in all eyes in the non-LSS group. In the LSS group, we also examined the association between postoperative MRD-2 reduction and the use of PGAs and found that more patients with MRD-2 reduction used PGAs (p = .02). CONCLUSION: Lower scleral show in PGAs-associated blepharoptosis is expected to improve after blepharoptosis surgery.

Incidence of Blepharoptosis After Pars Plana Baerveldt 350 Glaucoma Implant Surgery by a Single Surgeon.

PURPOSE: To investigate the incidence of postoperative blepharoptosis and clinical risk factors for blepharoptosis after pars plana Baerveldt 350 glaucoma implantation (BGI) by a single surgeon for refractory glaucoma. METHODS: Twenty-four patients (30 eyes) who underwent pars plana BGI for refractory glaucoma at Toyama University Hospital between November 2019 and February 2021 were included. Patients with a preoperative margin reflex distance-1 (MRD-1) of ≥2 mm were included in the study, and a decrease in MRD-1 of ≥2 mm at 6 months postoperatively was defined as blepharoptosis. RESULTS: The mean MRD-1 decreased significantly from 3.2 ± 0.6 mm preoperatively to 2.4 ± 1.1 postoperatively ( p < 0.01). Postoperative ptosis developed in 8 eyes (26.7%). A comparison of the ptosis (n = 8) and nonptosis (n = 22) groups showed a significant difference in the history and number of previous filtration surgeries ( p = 0.02 and p = 0.03, respectively). Those with previous filtration surgery had a higher risk of blepharoptosis after pars plana BGI compared with those without previous filtration surgery (OR: 6.43; 95% confidence interval: 1.03-40.26; p = 0.04). CONCLUSION: Pars plana BGI is a risk factor for postoperative blepharoptosis. Particular attention should be paid to eyes that have undergone previous filtration surgery.

Saccade Analysis in Patients With Orbital-Wall Fractures Without Diplopia.

PURPOSE: This study aimed to analyze saccades in patients with orbital-wall fractures with little or no ocular motor impairment. METHODS: We included 7 eyes of 7 patients with unoperated orbital-wall fractures (3 cases of orbital-floor fractures and 4 cases of medial orbital-wall fractures) with mild or no diplopia who presented to our hospital between August 2019 and March 2021. Eye movements were assessed at the first visit and after 1 month using the Hess area ratio according to the Hess screen test, binocular single vision (BSV) scores (total 59 points) obtained using Goldman perimetry, and maximum velocity and amplitude of saccades within 15 degrees obtained using an eye tracker system. RESULTS: Hess area ratio and BSV scores at the first visit and after 1 month were 88.6±8.2% and 97.4±3.6% and 49.6±8.5 points and 53.5±6.6 points, respectively, with no significant change (Hess area ratio, P =0.06; BSV, P =0.44). Next, the authors compared the velocity and amplitude of the saccades between the first visit and 1 month later and found no significant changes in any of the 4 directions (adduction, abduction, upgaze, and downgaze). Similarly, no significant differences were observed between the velocity and amplitude of the saccades between the injured and noninjured eyes, both at the first visit and after 1 month. CONCLUSIONS: In patients with orbital-wall fractures with little or no eye movement impairment, eye tracker-based saccade analysis showed that the saccade velocity and amplitude did not change during the natural course of healing of the fracture.

Association between tear meniscus dimensions and higher-order aberrations in patients with surgically treated lacrimal passage obstruction.

PURPOSE: To analyze the relationship between tear meniscus dimensions and higher-order aberrations (HOAs) in patients with lacrimal passage obstruction using anterior segment optical coherence tomography (AS-OCT). METHODS: This study was a retrospective observational study of 71 eyes of 49 patients with lacrimal passage obstruction. These patients received sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) at Toyama University Hospital between August 2020 and October 2021. Using AS-OCT, tear meniscus height (TMH), tear meniscus area (TMA), and total corneal HOAs values were measured before and after surgery. RESULTS: Surgical success was achieved in 69 eyes (97.1%). At the final observation, 62 eyes showed lacrimal patency (89.8%). The preoperative TMH, TMA, and HOAs values were 1.55 ± 0.96 mm, 0.11 ± 0.14 mm2, and 0.37 ± 0.27 µm, respectively, and the final postoperative TMH, TMA, and HOAs values were 0.97 ± 0.74 mm (p < 0.0001), 0.06 ± 0.11 mm2 (p = 0.02), and 0.29 ± 0.16 µm (p = 0.001), respectively. The results showed a significant improvement. The changes in HOAs before and after surgery were positively correlated with the changes in TMH (r = 0.3476, p = 0.0241) and TMA (r = 0.3653, p = 0.0174). CONCLUSION: SG-BCI for lacrimal passage obstruction resulted in a significant decrease in measured HOAs. The decrease in HOAs was correlated with decreases in tear meniscus dimensions.

Efficacy and Safety of Cryotherapy for Residual Tarsus and Free Tarsal Graft Implantation After Excision of Malignant Eyelid Tumor.

PURPOSE: To examine the usefulness and safety of cryotherapy for residual tarsus and free tarsal graft implantation for eyelid reconstruction after excision of malignant eyelid tumor. METHODS: Fifteen patients with 17 eyelid malignancies (10 sebaceous gland carcinomas and 7 basal cell carcinomas) who underwent eyelid reconstruction between June 2017 and February 2021 were included in the study. In these patients, the tumors were resected in the entire eyelid layer including the safety margin. Only sebaceous gland carcinomas patients underwent cryotherapy at the residual tarsus margin. Then, a free tarsal graft taken from the ipsilateral or contralateral upper eyelid was transplanted into the eyelid plate defect, and anterior lamella reconstruction was performed with an orbicularis oculi myocutaneous advance flap. RESULTS: In both the non-cryotherapy and cryotherapy groups, there were no serious complications such as dropout or necrosis of the free tarsal graft. There were no differences in the occurrence of complications such as eyelid retraction or trichiasis between the 2 groups, but 1 patient who underwent cryotherapy required revision surgery to correct eyelid retraction. In addition, there were no complications on the donor side associated with free tarsal graft collection. CONCLUSIONS: The use of a free tarsal graft in the reconstruction of eyelid malignancies is relatively effective and safe, and if vascular support of the anterior lamella is obtained, cryotherapy is less likely to affect the viability of the free tarsal graft and may contribute to a decrease in local recurrence.

Glaucoma Filtering Bleb Analysis Before and After Aponeurotic Blepharoptosis Surgery.

PURPOSE: To evaluate the effectiveness and safety of aponeurotic blepharoptosis surgery and the morphology of filtering bleb in patients with filtrating bleb. METHODS: This retrospective case series included 7 consecutive patients (9 eyes) with filtering bleb after trabeculectomy. They underwent transcutaneous levator aponeurotic advancement from May 2018 to April 2019. The authors evaluated margin reflex distance-1 and intraocular pressure and analyzed filtering bleb morphology, such as filtering bleb volume, filtering bleb height, and filtering bleb wall thickness, using anterior segment optical coherence tomography before and after aponeurotic advancement. The authors also evaluated intra and postoperative complications. RESULTS: The mean age was 75.6 ± 7.8 years; the mean duration from glaucoma surgery to blepharoptosis surgery was 36.9 ± 26.8 months; the mean follow-up after blepharoptosis surgery was 6.1 ± 2.9 months. The mean margin reflex distance-1 value changed significantly from 0.7 ± 0.8 mm before surgery to 3.3 ± 0.4 mm after surgery (p < 0.0001). The mean intraocular pressure showed no significant change from 12.9 ± 2.6 mm Hg before surgery to 12.7 ± 3.3 after surgery. In the filtering bleb analysis using anterior segment optical coherence tomography no significant differences were found, such as in bleb volume, height and wall thickness, before and after blepharoptosis surgery. There were no intraoperative complications in any of the cases. A postoperative corneal disorder was seen in 1 eye, but there was no infection of or damage to filtering bleb in any of the cases during the postoperative follow-up period. CONCLUSIONS: In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be highly safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.

Effectiveness of Blepharoptosis Surgery in Patients With Deepening of the Upper Eyelid Sulcus.

The purpose of this retrospective study was to evaluate the effectiveness of blepharoptosis surgery in patients with deepening of the upper eyelid sulcus (DUES). This case series included 10 consecutive patients (19 eyes) with DUES associated with use of a prostaglandin analog for glaucoma. Patients who had used bimatoprost and developed DUES were changed to an alternative prostaglandin analog and observed for ≥3 months. If there was no improvement, they underwent levator resection for blepharoptosis and were followed up for ≥6 months postoperatively. Improvement in margin reflex distance-1 and surgical complications was evaluated. After discontinuation of bimatoprost in 3 cases (6 eyes), mild subjective and objective improvement in DUES was seen in 2 cases (4 eyes) but without improvement in blepharoptosis. The prostaglandin analog used before surgery was travoprost in 4 eyes (21.0%), tafluprost in 7 eyes (36.9%; including 4 eyes switched from bimatoprost), and latanoprost in 8 eyes (42.1%; including 2 eyes switched from bimatoprost). The mean margin reflex distance-1 value was 1.11 ±â€Š0.96 mm before surgery and 3.72 ±â€Š0.81 mm at the final postoperative follow-up; the difference was significant (P = 3.32 × -10). There were no intraoperative or postoperative complications. Levator resection is a useful and safe procedure for blepharoptosis with DUES.

CDKN2A, CDK1, and CCNE1 overexpression in sebaceous gland carcinoma of eyelid.

PURPOSE: To investigate the overexpression of genes in sebaceous gland carcinoma (SGC) of the eyelid compared to sebaceous adenoma of the eyelid in order to elucidate the molecular mechanism underlying pathogenesis. METHODS: We performed histopathological examination of eyelid tissues surgically removed from four patients diagnosed with SGC (cases 1-3) and sebaceous adenoma (case 4) of the eyelid. Next, we performed global gene expression analysis of surgical tissue samples using a GeneChip® system and the Ingenuity Pathways Knowledge Base. The results of the GeneChip® analysis were explored with quantitative real-time polymerase chain reaction (qRT-PCR) analysis. RESULTS: In the SGC samples, we found that 211, 199, and 199 genes, respectively, showed ≥ 2.0-fold higher expression than those in the sebaceous adenoma sample (case 4); 194 genes were common to all three SGC samples. For the 194 genes with upregulated expression, functional category analysis showed that SGC of the eyelid employed a unique gene network, including cyclin-dependent kinase inhibitor 2A (CDKN2A), cyclin-dependent kinase 1 (CDK1), and cyclin E1 (CCNE1), which are related to cell cycle progression, incidence of tumor, and cell viability. Furthermore, qRT-PCR analysis showed that the expression levels of CDKN2A, CDK1, and CCNE1 were significantly upregulated in all SGC cases compared to those in the sebaceous adenoma case. These data were similar to the results of microarray analysis. CONCLUSION: Overexpression of cell cycle-related genes CDKN2A, CDK1, CCNE1, and their gene network may help elucidate the pathogenic pathway of SGC of the eyelid at the molecular level.

Growth and neurite stimulating effects of the neonicotinoid pesticide clothianidin on human neuroblastoma SH-SY5Y cells.

Neonicotinoids are one of most widely used pesticides targeting nicotinic acetylcholine receptors (nAChRs) of insects. Recent epidemiological evidence revealed increasing amounts of neonicotinoids detected in human samples, raising the critical question of whether neonicotinoids affect human health. We investigated the effects of a neonicotinoid pesticide clothianidin (CTD) on human neuroblastoma SH-SY5Y cells as in vitro models of human neuronal cells. Cellular and functional effects of micromolar doses of CTD were evaluated by changes in cell growth, intracellular signaling activities and gene expression profiles. We examined further the effects of CTD on neuronal differentiation by measuring neurite outgrowth. Exposure to CTD (1-100 µM) significantly increased the number of cells within 24 h of culture. The nAChRs antagonists, mecamylamine and SR16584, inhibited this effect, suggesting human α3ß4 nAChRs could be targets of neonicotinoids. We observed a transient intracellular calcium influx and increased phosphorylation of extracellular signal-regulated kinase 1/2 shortly after exposure to CTD. Transcriptome analysis revealed that CTD down-regulated genes involved in neuronal function (e.g., formation of filopodia and calcium ion influx) and morphology (e.g., axon guidance signaling and cytoskeleton signaling); these changes were reflected by a finding of increased neurite length during neuronal differentiation. These findings provide novel insight into the potential risks of neonicotinoids to the human nervous system.

Clinicopathological features of considerable reduction in androgen receptor expression in sebaceous gland carcinoma of the eyelid.

PURPOSE: This study aimed to evaluate the relationships between androgen receptor (AR) expression and clinicopathologic features of sebaceous gland carcinoma (SGC) of the eyelid. METHODS: AR expression was evaluated via immunohistochemistry analysis of surgically derived samples from 11 patients with SGC of the eyelid. RESULTS: The expression of AR was evident in 9 of 11 patients (82%). We divided patients into high AR (7 patients) and low AR (4 patients: 2 patients with low expression and 2 patients with no expression) groups. The low AR group showed significantly greater progression than the high AR group with regard to T category and exhibited a lower grade of differentiation. CONCLUSION: In patients with SGC of the eyelid, a marked decrease in AR expression may be associated with a poor prognosis. AR may be a prognostic factor and a potential therapeutic target in cases of SGC of the eyelid.

BAG3 protects against hyperthermic stress by modulating NF-κB and ERK activities in human retinoblastoma cells.

PURPOSE: BCL2-associated athanogene 3 (BAG3), a co-chaperone of HSP70, is a cytoprotective and anti-apoptotic protein that acts against various stresses, including heat stress. Here, we examined the effect of BAG3 on the sensitivity of human retinoblastoma cells to hyperthermia (HT). METHODS: We examined the effects of BAG3 knockdown on the sensitivity of Y79 and WERI-Rb-1cells to HT (44 °C, 1 h) by evaluating apoptosis and cell proliferation using western blotting, real-time quantitative PCR (qPCR), flow cytometry, and a WST-8 assay kit. Furthermore, we examined the effects of activating nuclear factor-kappa B (NF-κB) and extracellular signal-regulated kinase (ERK) using western blotting and real time qPCR. RESULTS: HT induced considerable apoptosis along with the activation of caspase-3 and chromatin condensation. The sensitivity of Y79 and WERI-Rb-1 cells to HT was significantly enhanced by BAG3 knockdown. Compared to HT alone, the combination of BAG3 knockdown and HT reduced phosphorylation of the inhibitors of kappa B α (IκBα) and p65, a subunit of NF-κB, and degraded IκB kinase γ (IKKγ) during the recovery period after HT. Furthermore, BAG3 knockdown increased the HT-induced phosphorylation of ERK after HT treatment, and the ERK inhibitor U0126 significantly improved the viability of the cells treated with a combination of BAG3 knockdown and HT. CONCLUSIONS: The silencing of BAG3 seems to enhance the effects of HT, at least in part, by maintaining HT-induced inactivity of NF-κB and the phosphorylation of ERK. These findings indicate that BAG3 may be a potential molecular target for modifying the outcomes of HT in retinoblastoma.

Genes and gene networks involved in sodium fluoride-elicited cell death accompanying endoplasmic reticulum stress in oral epithelial cells.

Here, to understand the molecular mechanisms underlying cell death induced by sodium fluoride (NaF), we analyzed gene expression patterns in rat oral epithelial ROE2 cells exposed to NaF using global-scale microarrays and bioinformatics tools. A relatively high concentration of NaF (2 mM) induced cell death concomitant with decreases in mitochondrial membrane potential, chromatin condensation and caspase-3 activation. Using 980 probe sets, we identified 432 up-regulated and 548 down-regulated genes, that were differentially expressed by >2.5-fold in the cells treated with 2 mM of NaF and categorized them into 4 groups by K-means clustering. Ingenuity® pathway analysis revealed several gene networks from gene clusters. The gene networks Up-I and Up-II included many up-regulated genes that were mainly associated with the biological function of induction or prevention of cell death, respectively, such as Atf3, Ddit3 and Fos (for Up-I) and Atf4 and Hspa5 (for Up-II). Interestingly, knockdown of Ddit3 and Hspa5 significantly increased and decreased the number of viable cells, respectively. Moreover, several endoplasmic reticulum (ER) stress-related genes including, Ddit3, Atf4 and Hapa5, were observed in these gene networks. These findings will provide further insight into the molecular mechanisms of NaF-induced cell death accompanying ER stress in oral epithelial cells.

Comparative study of surgical outcomes regarding tear meniscus area and high-order aberrations between two different interventional methods for primary acquired nasolacrimal duct obstruction.

PURPOSE: To compare endonasal dacryocystorhinostomy (EN-DCR) with sheath-guided dacryoendoscopic probing and bicanalicular intubation (SG-BCI) by evaluating tear meniscus area (TMA) and total high-order aberrations (HOAs) for primary acquired nasolacrimal duct obstruction (PANDO). METHOD: We retrospectively reviewed 56 eyes of 42 patients (7 men, 35 women; age, 72.7±13.1 years) who underwent EN-DCR or SG-BCI for PANDO in Toyama University Hospital from February 2020 to June 2022. In the EN-DCR and SG-BCI groups, we measured the patency of the lacrimal passage, preoperative and postoperative TMA, and HOAs of the central 4 mm of the cornea using optical coherence tomography (AS-OCT), six months postoperatively. RESULTS: There was a positive correlation between preoperative TMA and preoperative HOAs in all cases. Postoperative patency of lacrimal passage was 100% in the EN-DCR and 80.8% in the SG-BCI group. There was a significant difference in the number of passages between the two groups (p = 0.01). Preoperative TMA and HOAs showed a significant postoperative decrease in both groups (EN-DCR group: p<0.01, p<0.01, SG-BCI group: p<0.01, p=0.03, respectively). We then calculated the rate of change of preoperative and postoperative TMA and HOAs and compared them between the two groups. The rate of change was significantly higher in the EN-DCR group than that in the SG-BCI group (TMA, p=0.03; HOAs, p=0.02). CONCLUSION: Although both EN-DCR and SG-BCI are effective for PANDO, our results suggest that EN-DCR is more effective in improving TMA and HOAs.

Clinical Characteristics of Idiopathic Orbital Inflammation Syndrome in Relation to Intraocular Pressure.

Purpose: To investigate the clinical characteristics of idiopathic orbital inflammation and changes in intraocular pressure (IOP) before and after its treatment. Patients and Methods: We retrospectively studied 20 eyes from the medical records of 19 patients who were diagnosed with idiopathic orbital inflammation between April 1, 2004, and April 30, 2019, at Toyama University Hospital. The inflammation site (type of disease), treatment provided, IOP before and after treatment, and the symptoms (proptosis, decreased ocular movements or diplopia, periorbital edema, and ocular pain) were analyzed. Results: The types of idiopathic orbital inflammation were dacryoadenitis in 14, myositis in 7, diffuse-type in 3, and posterior periscleritis in 1 case. The mean IOP after treatment was 15.4±3.9 mm Hg, which was significantly lower than the mean pretreatment IOP of 19.0±5.3 mm Hg (p = 0.009). Before treatment, all cases with the diffuse-type had high IOPs of 21 mm Hg or more. Ocular pain and eye movement disorders were present in 86% and 100% of subjects in the group with an IOP of 21 mm Hg or higher, but 38% and 31% in the group with an IOP of 20 mm Hg or lower, respectively. Conclusion: Diffuse-type of idiopathic orbital inflammation is prone to develop high IOP. Patients with idiopathic orbital inflammation and high IOP exhibit many symptoms such as decreased ocular movements, diplopia, and ocular pain.

Visual field changes in glaucoma patients after blepharoptosis surgery.

PURPOSE: To examine changes in parameters of the visual field test before and after blepharoptosis surgery in patients with glaucoma. METHODS: Twenty-three eyes of 14 glaucoma patients who underwent blepharoptosis surgery at Toyama University Hospital between July 2015 and September 2020 were included in this study. Pre- and post-operative values for the mean deviation (MD), pattern standard deviation (PSD) and total deviation (TD) of the upper or lower hemi-visual field in the Humphrey visual field test, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and margin reflex distance (MRD)-1 were compared. RESULTS: MRD-1 showed a significant improvement after blepharoptosis surgery (preoperative MRD-1: 1.0 ± 0.82 mm, postoperative MRD-1: 3.26 ± 0.66 mm, p < 0.001). There were no significant differences in BCVA, IOP, MD and PSD values before and after surgery. On the other hand, there was a significant improvement in the superior TD (preoperative: -11.29 ± 6.57 dB, postoperative: -9.88 ± 7.31 dB, p = 0.044) although no significant difference was detected in the inferior TD postoperatively. The preoperative parameters of 2 groups (improvement and non-improvement groups of postoperative superior TD) were compared. Preoperative MD and superior TD were significantly lower in the improvement group (p = 0.03, p = 0.004, respectively), although there was no significant difference in preoperative PSD and inferior TD between the two groups. CONCLUSION: In glaucoma patients, blepharoptosis may interfere with accurate visual field assessment, especially of superior TD.

Orbital myositis as an initial manifestation of Behcet's disease.

Purpose: We report the case of a 32-year-old woman with orbital myositis prior to onset of Behcet's disease (BD). Observations: A 32-year-old woman was referred to our hospital for a complaint of right eyelid swelling, eye pain, and diplopia. Her best-corrected visual acuity was 20/32 on the right, and 20/16 on the left. She was diagnosed as idiopathic orbital inflammation, and received two pulses of intravenous administration of methylprednisolone, followed by oral prednisolone. Three months later, she developed bilateral orbital myositis, and received one more pulse therapy, followed by oral prednisolone and cyclosporin. About one year after the first visit, oral aphthae, genital ulcers, and folliculitis-like skin rash appeared, and the physician diagnosed incomplete type BD. The patient had no uveitis during the disease course. Orbital inflammation and systemic manifestations of BD were ultimately well controlled with small doses of prednisolone. Conclusion and importance: BD may develop during the course of orbital inflammation.

Evaluation of saccadic velocity in patients with orbital floor fracture before and after surgery.

Saccadic eye movement plays an important role in the rapid movement of the eyes to visual targets; however, it has not been fully investigated in patients with an orbital floor fracture. Thus, this study investigated saccadic eye movement before and after surgery in patients with an orbital floor fracture. The saccadic peak velocity (PV) was recorded using an eye-tracking device before and after surgery in nine eyes of nine patients with an orbital floor fracture. The type of fracture was a depressed fragment fracture in all cases, and there was no trap-door fracture. Ocular motility and diplopia were evaluated by the Hess area ratio (HAR%) and the scoring of binocular single vision (BSV). The preoperative HAR% and those at 1 month post-surgery and the final post-surgery observation were 62 ± 6%, 83 ± 11%, and 91 ± 8%, respectively. The preoperative, 1 month post-surgery, and final observation post-surgery BSV scores were 34 ± 18, 46 ± 8, and 50 ± 8 points, respectively. The postoperative HAR% and BSV were significantly improved at the final post-surgery observation (p < .05 each). The saccadic PVs of adduction, abduction, and downgaze before and after surgery were not significantly different in both the non-injured eyes and the injured eyes. However, the upgaze saccadic PVs at 1 month and the final post-surgery observation in the injured eyes were significantly increased (p < .05 each). The saccadic PV may be useful to evaluate detailed and precise extraocular muscle function before and after surgery for orbital floor fractures.

Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator.

BACKGROUND: In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). OBJECTIVES: The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. MATERIALS AND METHODS: One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. RESULTS: Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. CONCLUSIONS AND SIGNIFICANCE: The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

Corneal topographic changes after blepharoptosis surgery in patients with deepening of the upper eyelid sulcus.

PURPOSE: We analyzed the corneal topography before and after blepharoptosis surgery and examined whether there was a difference in the corneal topographic changes with and without deepening of the upper eyelid sulcus (DUES). STUDY DESIGN: Retrospective study. METHODS: A total of 23 eyes of 23 patients (6 men and 17 women) were enrolled in this study. The patients were divided into two groups according to the presence or absence of DUES, and their clinical characteristics were compared. RESULTS: There were no significant differences between the DUES (n = 9) and non-DUES (n = 14) groups in any of the parameters examined before blepharoptosis surgery, including age, best-corrected visual acuity (BCVA), margin reflex distance-1 (MRD-1), spherical equivalent, average keratometry (AveK), cylindrical power (CYL), corneal higher order aberrations (HOAs) and central corneal thickness (CCT). In the non-DUES group, BCVA, spherical equivalent, AveK, CYL, and CCT were not significantly different between before and after surgery. On the other hand, in the DUES group, BCVA, spherical equivalent, and CCT were not significantly different before or after surgery, however, AveK, CYL and HOAs showed significant decreases after surgery. In addition, related to the post-surgical changes in CYL, the DUES group had a higher rate of reduced CYL. CONCLUSION: It is expected that in eyes with DUES blepharoptosis surgery can reduce AveK, CYL and HOAs in association with postoperative corneal flattening, and that will contribute to improvements in visual function.

Corneal Topographic Analysis in Patients with Involutional Lower Eyelid Entropion.

Purpose: To analyze the corneal morphology before and after surgery by the advancement of posterior lower eyelid retractors (LERs) alone or in combination with a lateral tarsal strip (LTS) for lower eyelid involutional entropion.Methods: We retrospectively analyzed the cases of 24 consecutive elderly patients (24 eyelids) who underwent posterior layer advancement of LERs alone or in combination with an LTS for involutional entropion. All patients underwent general ophthalmological examinations including best-corrected visual acuity (BCVA), fundus examination, and slit lamp microscopy. The degree of corneal damage was evaluated using the area (A) and density (D) classification of corneal fluorescein staining. Corneal topography was measured using anterior segment optical coherence tomography (AS-OCT). The parameters were steep keratometry (Ks), flat keratometry (Kf), average keratometry (AveK), cylindrical power (CYL), central corneal thickness (CCT), and total higher-order aberrations (HOAs) within a 4-mm diameter.Results: There was no significant difference in the Ks, Kf, AveK, CYL or CCT values between before and after surgery. The HOAs were significantly decreased after surgery. In the AD classification, both the A and D values were significantly decreased after surgery. Significant correlations were observed between preoperative mean HOAs and the mean of A classification, and between preoperative mean HOAs and the mean of D classification.Conclusion: Involutional entropion does not appear to significantly affect corneal morphology before or after posterior LER advancement alone or in combination with an LTS. However, this surgery is thought to result in an improvement of corneal disorders and consequent improvement of HOAs.