The study determined to compare the clinical outcomes of traditional gold weight implantation for the correction of paralytic lagophthalmos with those of a newly designed model.
In this ...retrospective cohort study, we enrolled 30 patients (76% females; average age 60.8 ± 12 years) with facial palsy who underwent implantation of either the traditional pretarsal gold weight (PT group;
= 15) or a new supratarsal model (ST group;
= 15) from May 2014 to April 2019. The main outcome measures were the 12-month postoperative weight prominence, weight migration, improvement of lagophthalmos, upper eyelid contour, and upper eyelid ptosis. The secondary outcome was long-term (24 months) reoperative rate.
The new model group had significantly better eyelid contour (risk ratio RR 3.16, 95% confidence interval CI 1.62-6.15,
= 0.001), less weight prominence (RR 1.74, 95% CI 1.13-2.70,
= 0.013), less weight migration (RR 1.31, 95% CI 1.12-1.54,
= 0.001), and less eyelid ptosis (RR 2.36, 95% CI 1.21-4.59,
= 0.011) than the traditional model group. Improvement of lagophthalmos was not statistically significant between the two groups (RR 1.44, 95% CI 0.72-2.91,
= 0.303). The 24-month reoperative rate was 53.3% in the PT group versus 13.3% in the ST group (RR 2.00, 95% CI 1.15-3.49,
= 0.015).
The newly designed supratarsal gold weight showed superior postoperative outcomes than the standard traditional model.
Graves' ophthalmopathy (GO) is an extra-thyroidal complication of Graves' disease which can lead to vision loss in severe cases. Currently, treatments of GO are not sufficiently effective, so novel ...therapeutic strategies are needed. As platelet-derived growth factor (PDGF)-BB induces several effector mechanisms in GO orbital fibroblasts including cytokine production and myofibroblast activation, this study aims to investigate the roles of histone lysine methyltransferases (HKMTs) in PDGF-BB-activated GO orbital fibroblasts by screening with HKMTs inhibitors library. From the total of twelve selective HKMT inhibitors in the library, EZH2, G9a and DOT1L inhibitors, DZNeP, BIX01294 and Pinometostat, respectively, prevented PDGF-BB-induced proliferation and hyaluronan production by GO orbital fibroblasts. However, only EZH2 inhibitor, DZNeP, significantly blocked pro-inflammatory cytokine production. For the HKMTs expression in GO orbital fibroblasts, PDGF-BB significantly and time-dependently induced EZH2, G9a and DOT1L mRNA expression. To confirm the role of EZH2 in PDGF-BB-induced orbital fibroblast activation, EZH2 silencing experiments revealed suppression of PDGF-BB-induced collagen type I and α-SMA expression along with decreasing histone H3 lysine 27 trimethylation (H3K27me3) level. In a more clinically relevant model than orbital fibroblast culture experiments, DZNeP treated GO orbital tissues significantly reduced pro-inflammatory cytokine production while slightly reduced ACTA2 mRNA expression. Our data is the first to demonstrate that among all HKMTs EZH2 dominantly involved in the expression of myofibroblast markers in PDGF-BB-activated orbital fibroblast from GO presumably via H3K27me3. Thus, EZH2 may represent a novel therapeutics target for GO.
PURPOSE OF REVIEWAsians make up the worldʼs largest ethnic group, and the eyelid is one of the most prominent features of the face, regardless of race. Recent advances in Asian eyelid research have ...improved the understanding of its unique anatomy and, more importantly, highlighted differences surgeons should be aware of when performing Asian eyelid surgery.
RECENT FINDINGSThe most obvious characteristic of the Asian eyelid is the absent or very low lid crease and fuller upper eyelid. Caucasian eyelids typically have a double eyelid, but Asian eyelids can be categorized into three typessingle eyelid, low eyelid crease, and double eyelid. Morphological variations in each layer from the different skin complexities to a taller, more circular-shaped orbital bone create a different eyelid appearance. Some components such as a submuscularis fibroadipose tissue layer and a lower-positioned transverse ligament were recently identified and found exclusively in the Asian eye. Many eyelid crease formation theories have been postulated, but none is scientifically proven because multiple factors are possibly involved.
SUMMARYThorough understanding of Asian eyelid anatomy is imperative. The eyelid is the key distinctive feature of the Asian eye. Improving patient appearance while maintaining ethnic characteristics is the goal of Asian eyelid surgery.
PURPOSE OF REVIEWPurpose of review is to emphasize the clinical significance of the epicanthal fold when evaluating Asian eyelids. Advances in Asian eyelid research have improved the understanding of ...the epicanthal fold and highlighted key steps to performing successful epicanthoplasty. Up-to-date epicanthoplasty surgical techniques are also discussed.
RECENT FINDINGSThe epicanthal fold is common in the Asian population. It is composed of the preseptal part of the orbicularis oculi muscle. Various epicanthoplasty techniques have been described and can be broadly categorized into two types based on the type of skin flap createdthe advancement flap and the transposition flap. The skin flap can be created in several ways depending on surgeon preference and the severity of the epicanthal fold but is not the key step in epicanthoplasty. Releasing all vertical tension by subcutaneous tissue dissection and orbicularis oculi myectomy are the main surgical steps to successful correction. Earlier described epicanthoplasty methods created obvious scarring, under correction, and recurrent deformity. Newer techniques offer improvements with a shorter skin incision, smaller flap creation, and minimal or no medial canthal ligament plication to lessen wound tension.
SUMMARYFor optimal surgical results in Asian upper eyelid surgery, presence of the epicanthal fold and surgical correction options should be discussed primarily.
Background : : Aging in the lower eyelids creates bags under the eyes from the protruding orbital fat, and periorbital wrinkles. Therefore, lower blepharoplasty should be combined with a skin ...tightening procedure to enhance the results.Objective: To compare the effects between lower blepharoplasty combined with an insulated microneedle radiofrequency (RF) device and lower blepharoplasty alone.Methods : : Twelve Asian (24 eyes) patients with baggy eyelids were included. One eye per patient was randomized for lower blepharoplasty combined with insulated microneedle RF devices (RF group), and the other eye for lower blepharoplasty alone (LB group). All patients underwent transconjunctival lower blepharoplasty with fat transposition and orbicularis oculi suspension. The primary outcome was the difference between both groups on the five-point Wrinkle Assessment Scale (WAS), assessed at baseline and at 2 months post-surgery. The secondary outcome was patient satisfaction using the Global Aesthetic Improvement Scale (GAIS).Results : : The WAS improvements were 75.0% (9/12 eyes) and 58.3% (7/12 eyes) in the RF and LB groups, respectively. The GAIS showed high patient satisfaction in both groups, with an average of 4.12 (3-5) in the RF group and 4.0 (2-5) in the LB group (p=0.157). There was no difference in the postoperative inflammation between both eyes at 1 week; and no decrease in the WAS score at 2 months or any adverse effects at 6 months were observed.Conclusion : : Wrinkle improvement was observed post-lower blepharoplasty with or without microneedle RF treatment. The insulated microneedle RF device proved safe when performed concurrently with lower blepharoplasty.
BACKGROUND:The purpose of this study was to compare the efficacy of external levator advancement and Müller muscle–conjunctival resection in aponeurotic blepharoptosis repair.
METHODS:Mild to ...moderate blepharoptosis patients with good levator function and a positive phenylephrine test were randomized to upper blepharoplasty with either external levator advancement or Müller muscle–conjunctival resection. The primary outcome was marginal reflex distance 1 at 1 month after surgery. Secondary outcomes were cosmetic outcome, complications, and operating room time.
RESULTS:Forty patients were enrolled, six men and 34 women, with an average age of 62.4 years. The mean preoperative marginal reflex distance 1 in the levator group (39 eyes/20 subjects) and the Müller group (38 eyes/20 subjects) was 1.2 ± 0.8 mm and 1.5 ± 0.7 mm, respectively. The mean postoperative marginal reflex distance 1 in the levator and Müller groups was 3.0 ± 1.0 mm and 3.2 ± 1.0 mm, respectively. The difference in the mean change was 0.008, and was not statistically different (95 percent CI, −0.59 to 0.61; p = 0.978). The mean cosmetic outcome was 2.69 ± 0.81 for the levator group and 3.07 ± 0.68 for the Müller group, with a mean difference of 0.373 (95 percent CI, 0.06 to 0.69; p = 0.020). The average operating room time was 75 ± 19.2 minutes for the levator group and 71 ± 23.6 minutes for the Müller group (p = 0.439). There were four eyes that underwent reoperation, three in the levator group (7.7 percent) and one in the Müller group (2.6 percent).
CONCLUSIONS:External elevator advancement and Müller muscle–conjunctival resection are both effective in correction of mild to moderate blepharoptosis. However, Müller muscle–conjunctival resection yields a statistically significant better cosmetic outcome and causes less eyelid asymmetry.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, II.
Complex orbital fractures, including orbital rims and walls, require precise reconstruction. A titanium-based patient-specific implant (PSI) benefits over other implants when challenged with narrow ...surgical space and designable implant fixation point.
This is a prospective noncomparative case series to evaluate the effect of complex orbital reconstruction using the newly designed lateral fixation patient-specific implant. The PSI was individually fabricated by 3D reconstruction using the mirrored nonaffected orbit as a template. The fixation point was at maxillary or zygomatic bone, depending on the bony remnant. Outcomes were obtained from computed tomography scan to compare orbital tissue volume and exophthalmometry value by posterior clinoid method before and after the surgery and also between both orbits in each patient.
Sixteen patients with complex orbital fracture with inferior orbital rim defect were enrolled. Seven were previously repaired with other implants. Compared with the preoperative measurement, the postoperative mean difference of orbital volume and exophthalmometry value between both eyes was significantly decreased (reduction of the mean difference of 2904.40 mm
;
< 0.001 and 2.89 mm;
< 0.001, respectively). The mean orbital volume and exophthalmometry value between affected and unaffected eyes were not different after surgical correction (
= 0.57 and
= 0.28, respectively). There was one infected wound from retained foreign body and one unresolved vertical diplopia after the reconstruction.
Reconstruction of complex orbital fractures using the novel designed-PSI had excellent outcomes. Appropriate implant design with caution of orbital anatomy and placement techniques are keys for successful results.
The study on the magnification of the clear acrylic resin in prosthetic dentistry is important but lacking. Hence, this research aimed to investigate the magnification of the iris in the ocular ...prosthesis with various thicknesses of clear heat cure acrylic resin. A total of 60 ocular prostheses were divided into six groups with various thicknesses of clear heat cure acrylic resin over the iris; T0 (control): no acrylic resin, T1: 2, T2: 4, T3: 6, T4: 8, and T5: 10 mm of clear acrylic resin over the iris. Each ocular prosthesis was manufactured from white acrylic, with a 10.250 mm iris. Then, the clear heat cure resin was placed over the iris, cured, then polished. The final diameter of the iris was measured with a vernier caliper. The sizes of the iris were compared among various groups using one-way ANOVA, and a significant level was chosen at p value = 0.01. The mean sizes of iris were T0 = 10.25, T1 = 10.92, T2 = 11.26, T3 = 11.91, T4 = 12.75, and T5 = 13.43 mm. The size of the iris was significantly different among the group (p < 0.0001). The magnification of the iris for different groups was 1.06 for T1, 1.10 for T2, 1.16 for T3, 1.24 for T4, and 1.31 for T5. The magnification of the iris increased as the thickness of clear heat cure acrylic resin over the iris is increased on the ocular prosthesis.
The aim of this study was to describe the manifestations of post-blepharoplasty high eyelid crease patients and to propose steps of clinical evaluation and corrective operations. High eyelid crease ...patients were categorized into 3 groups, including pre-existing ptosis (PP), surgical induced levator compromised (SI), and high eyelid crease alone (HC), based on their MRD1 and signs of compromised levator muscle. The primary outcomes were the type and success rate of the operative techniques. The secondary outcomes were the complications. A total of 131 patients were enrolled, 7 males and 124 females, with an average age of 39.7 years. The mean scar height in the HC, SI, and PP groups were 10.4 ± 2.2, 12.8 ± 2.6, and 9.0 ± 2.0 mm, respectively. The scar height in the SI group was statistically differently higher than the other groups (mean: 1.7 mm, 95% CI: 0.91, 2.43; P < 0.001). In total, 117 eyes of 67 patients underwent corrective operations with significant lower eyelid fold height and an 83.6% success rate. There were 6 re-operation eyes, 5 in the SI group and 1 in the PP group. High blepharoplasty incision scar can lead to surgical induced levator compromise and ptosis. Systematical evaluation and optimal corrective operations are needed to achieve targeted outcome.
Purpose
To develop and assess the psychometric properties of the Thai version of the Graves’ Ophthalmopathy Quality of Life (GO-QOL) questionnaire.
Background
Graves’ ophthalmopathy (GO) is a chronic ...condition that causes negative self-image and impaired visual function. These conditions impact quality of life (QOL) but are rarely documented. Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL) has good validity, reliability and responsiveness. In this study we developed a Thai GO-QOL questionnaire by translating the questionnaire from English to the Thai language and evaluated its reliability and validity.
Patients and methods
Forward and backward translations were performed independently by four translators with extensive experience in both English and Thai. Seventy patients at the thyroid clinic responded to the Thai translated version upon their first visit and again 2–3 weeks afterwards. Validity was assessed by the content validity index (CVI) and correlation with relevant clinical parameters. Reliability was evaluated by Cronbach’s alpha, the intraclass correlation coefficient, and the Bland-Altman plot.
Results
The Thai GO-QOL version showed high CVI (0.97) and a moderate negative correlation of the functional QOL score with disease severity (r = − 0.49), the clinical activity score (r = − 0.31), and exposure parameter (r = − 0.32). It showed good reliability with a high intraclass correlation coefficient (0.92) and high Cronbach’ s coefficient (0.86).
Conclusion
The Thai GO-QOL has good validity and reliability. It can be used to evaluate the quality of life of Graves’ ophthalmopathy patients as a consequence of their disease in thyroid treatment programs.
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