The Role of Tissue Resection Length in the Determination of Post-Operative Eyelid Position for Muller’s Muscle-Conjunctival Resection Surgery

Purpose: To investigate the relationships between pre-operative marginal reflex distance (MRD), tissue resection length, phenylephrine response, and change in MRD with surgery for a cohort of individuals undergoing Muller’s muscle conjunctival resection (MMCR) surgery.

Methods: All cases of MMCR surgery performed over a 13-year period at a single institution were screened for entry. Individuals with adequate photographic documentation and follow up were included. Patients with previous or concurrent upper eyelid, orbital or eyebrow disease of surgery were excluded. Marginal reflex distance (MRD) was calculated based on photographs utilizing public domain software. Data was plotted for inspection and appropriate statistical tests were performed.

Results: During the study period 198 eyes fit criteria for analysis. A loose association between tissue resection length and change in MRD with surgery was found (r?=?0.176, p?p?=?0.367). There was a strong association between MRD change with surgery and pre-operative MRD (r?=?0.498, p?r?=??0.441, p?2?mm and pre-operative MRD as variables revealed a model with pre-operative MRD as the only significant predictor (p?Conclusion: Tissue resection length and phenylephrine response play small roles relative to pre-operative MRD in the determination of change in MRD with MMCR surgery.     

Sub-brow lift combined with orbicularis oculi folding for periorbital rejuvenation

The study aimed to evaluate a new method of periorbital rejuvenation in which periorbital muscle manipulation is utilised. Patients (n = 82) who underwent eyebrow lifting surgery in Yichang Central People's Hospital were retrospectively included. All the patients had drooping eyebrows and lateral hooding of the upper eyelids combined with a flat or depressed outer-upper side of the eyebrow arch. Data were collected on the position of the eyebrow relative to the eye before and after surgery and the postoperative satisfaction of patients. The study included 43 patients in the traditional group and 39 patients in the combined group. The postoperative results showed that the combined approach group had more aesthetically pleasing mean (SD) ratio of the position of eyebrows relative to eyes (1.6 ± 0.2 vs 1.7 ± 0.2, p = 0.021). Furthermore, the satisfaction of the patients in the combined group was significantly higher than that of the traditional group (37/39 vs 34/43, p = 0.036). The periorbital rejuvenation through the sub-brow incision, combined with supraorbital orbicularis muscle folding had more aesthetically pleasing ratio of the position of eyebrows relative to eyes and the satisfaction of the patients in the combined group was significantly higher.     

Association between cannabis and the eyelids: A comprehensive review

Cannabis is the most consumed illicit drug worldwide. As more countries consider bills that would legalize adult use of cannabis, health care providers, including eye care professionals (ophthalmologists, optometrists), will need to recognize ocular effects of cannabis consumption in patients. There are only 20 studies on the eyelid effects of cannabis usage as a medical treatment or a recreational drug. These include ptosis induction, an “eyelid tremor” appearance and blepharospasm attenuation. Six articles describe how adequately dosed cannabis regimens could be promising medical treatments for blepharospasm induced by psychogenic factors. Fourteen articles report eyelid tremors in intoxicated drivers and ptosis as a secondary effect in cannabinoid animal experimental models. The exact mechanism of cannabinoids connecting cannabis to the eyelids is unclear. Further studies should be conducted to better understand the cannabinoid system in relation to the eyelid and eventually develop new, effective and safe therapeutic targets derived from cannabis.     

上睑下垂矫正术后并发角膜炎的原因分析和护理对策

目的探究上睑下垂矫正术后并发角膜炎的原因,并提出相应的护理对策。方法对384例接受上睑下垂矫正术的患者术后角膜炎发生率和原因进行回顾性分析,针对引起患者角膜炎的不同原因采取相应的护理措施,对护理前后患者角膜炎症状和体征的严重程度进行统计比较。结果上睑下垂矫正术后并发角膜炎的原因包括术后角膜暴露、角膜损伤、个人卫生和生活方式、环境因素等;不同矫正术引起术后角膜炎的发生率不同;积极有效的护理措施可以降低严重性角膜炎比例(P<0.01)。结论有效的护理干预措施能减轻上睑下垂矫正术后角膜炎并发症的严重程度,从而提高手术疗效。     

Mastopexy for breast ptosis: Utility outcomes of population preferences

BACKGROUND:

Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states.

OBJECTIVE:

To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics.

METHODS:

Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student’s t test were used for statistical analysis; P<0.05 was considered to be statistically significant.

RESULTS:

Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance.

DISCUSSION:

For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to ‘perfect health’ than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema.

CONCLUSIONS:

Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.     

Comparison of incidence of ptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification

Objective:To compare the incidence of upper eyelid blepharoptosis after combined phacotrabeculectomy with mitomycin C and phacoemulsification surgeries and the relationship of bleb morphology to the incidence of ptosis.Design:Retrospective observation study.Participants:We included 46 patients after combined phacotrabeculectomy and 44 patients with phacoemulsification in the former group, and all eyes underwent a standardized two-site surgery with intra-operative mitomycin C.Results:There were 8 eyes (17.4%) and 5 eyes (11.4%) with postoperative ptosis in the phacotrabeculectomy and phacoemulsification groups, respectively (P = 0.342). In multivariate regression analysis, reduced total bleb area was significantly associated with upper eyelid ptosis after adjusting for age, gender, and type of anesthesia. The trend seemed to show that increased bleb height was also associated with ptosis, but this did not reach statistical significance.Conclusions:Incidence of persistent ptosis after phacoemulsification combined with trabeculectomy and mitomycin C is similar compared to stand alone phacoemulsification surgery in a multiethnic Asian population. Bleb morphology may play an important role in postoperative ptosis development and should be considered in the evaluation of upper eyelid blepharoptosis.     

Quantitative efficacy of external and internal browpexy performed in conjunction with blepharoplasty

Browpexy surgery is a minimally invasive surgical adjunct to upper blepharoplasty. The traditional internal (IB) approach is well documented, while the newer external (EB) variant has only recently been described. To date, there is little quantitative data to evaluate the efficacy of either procedure, and no data to compare results between the two. We determine the efficacy of, and compare surgical results between, internal and external browpexy surgery in lifting the central and lateral brow. A 3.5-year retrospective review of patients undergoing internal and external browpexy surgery to assess the amount of central and lateral lift to the brow was performed. Patients undergoing blepharoplasty without brow lift were used as a control group. The Massachusetts Eye and Ear Infirmary FACE-gram program was used to quantify surgical outcome. Ninety-eight patients are included for review, with an average follow-up of 4–5 months. The average elevation in lateral/central brow position was 2.29 mm and 1.47 mm in the IB group, and 2.97 mm and 1.90 mm in the EB group. These were not statistically significant (p = 0.164, and p = 0.507, respectively). There was a statistically significant elevation in central and lateral brow height for both browpexy techniques and the control group (p < 0.001). External and internal browpexy surgery afford a similar, and non-statistically different, elevation of the central and lateral brow at 4–5 months. When compared to standalone blepharoplasty (control) the amount of lift for both procedures is statistically significant.     

How Much Drool Is Too Much?

A 3-year-old boy presented to the emergency department with a chief complaint of “lethargy” and was found to have ptosis with eventual respiratory failure and need for emergent intubation. There is a broad differential for a patient with respiratory failure, and careful physical examination and history are imperative to reduce morbidity and prevent mortality. After further evaluation and workup, the diagnosis is ultimately revealed.