Eyelid Position Research Articles

Association of blepharoptosis with refractive error in the Korean general population.

We investigated the effect of blepharoptosis on refractive errors across different age groups in Korean population. This cross-sectional study was performed with data obtained in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2012. A total of 33,103 participants were enroled in our study. Blepharoptosis was defined as a marginal reflex distance 1 (MRD1) less than 2 mm, and was diagnosed in 3,305 (9.98%) participants. Ophthalmic examinations were performed, including measurements of MRD1, spherical equivalent, and degree of astigmatism. The age range was divided into three groups: less than 20 years old; more than 20 years and less than 60 years old; and more than 60 years old. The mean spherical equivalent were -0.28 ± 2.23 D in the ptotic eyelids and -1.13 ± 2.30 D in the non-ptotic eyelids (p < 0.001, 95% CI: -0.93, -0.77). The mean cylinder dioptre were -1.03 ± 0.87 D and -0.80 ± 0.77 D respectively (p < 0.001, 95% CI: 0.20, 0.26). The association with the eyelid position and refractive error significantly differed according to the age group and body mass index. Increased positive spherical change and increased astigmatism were prominent among ptotic participants aged less than 60 years. A decrease in MRD1 was associated with a hyperopic shift and higher astigmatism. Mechanical compression of the ptotic eyelid may affect ocular biometry, with the effect being particularly prominent in younger participants who had greater eyelid tension.

Upper eyelid weighting for lagophthalmos results in contralateral upper eyelid elevation

ABSTRACT Introduction Upper eyelid weighting decreases lagophthalmos by improving blink dynamics. The effect of weighting on static eyelid position is less well understood. This study describes the effect of upper eyelid weighting on ipsilateral and contralateral upper eyelid position. Methods Patients with unilateral lagophthalmos who underwent upper eyelid weight implantation were included. Primary outcome measures were ipsilateral and contralateral margin to reflex distance 1 (MRD1), preoperatively and postoperatively. MRD1 symmetry was assessed as a secondary outcome measure. Weight mass was examined as a covariate of MRD1 change. Results 23 patients (16 female, 7 male) met inclusion criteria. After weighting, contralateral MRD1 increased from mean [SD] 2.91 [1.41] mm to 3.77 [1.75] mm (p < .05). Ipsilateral (weighted) MRD1 did not significantly change (2.64 [1.41] mm to 2.40 [1.18] mm, p = .11). Preoperatively, paretic and normal side MRD1 were not different (p = .52). Postoperatively, weighted and unweighted MRD1 were significantly different (p < .05). Weight mass was not a covariate of MRD1 change, neither ipsilateral nor contralateral (p = .76, p = .71, respectively). The proportion of patients with MRD1 asymmetry ≥ 1 mm preoperatively (12/23, 52.2%) did not change following surgery (17/23, 73.9%, p = .12). Conclusion Weight insertion led to contralateral eyelid elevation, a manifestation of Hering’s law. Weight mass did not impact the magnitude of MRD1 change, and the proportion of patients with MRD1 asymmetry ≥ 1 mm did not change following surgery. These findings may guide surgeons in their preoperative planning and in counseling of patients.

Research on Vision Perception Technology of Auto Fueling Robot on opencv-based gas tank cap recognition

Designing a suitable algorithm to recognize the fuel tank cap and perform automatic refueling by manipulating a robotic arm. In exploring a new recognition algorithm for automatic vehicle refueling technology, for motor vehicle fuel tank lid, through the difference of images taken by binocular camera, combined with the basic calculation principles such as the imaging principle of binocular camera and the conversion relationship between coordinate systems, the recognition of ROI area is carried out automatically, then a closed-loop system is formed for real-time tracking, and finally the accurate positioning of fuel tank lid position is completed. The matching recognition and tracking technology of the target combines the comprehensive discipline research of mathematical analysis, image processing, object kinematics, artificial intelligence, automation control and other related fields, and has a very important status and research value in military aerospace, industrial production, intelligent medical care, security monitoring, intelligent driving, human-computer interaction and other fields.

Contralateral eyelid elevation following unilateral upper eyelid retraction repair

ABSTRACT Purpose To report the influence of unilateral upper eyelid retraction repair on the upper eyelid position of the contralateral, non-operative side. Methods An IRB-approved retrospective chart review was performed to identify patients who underwent unilateral upper eyelid retraction repair. Patient demographics, etiology of upper eyelid retraction, previous surgeries, and periocular measurements from pre-operative and follow-up visits were reviewed. Results Thirteen patients who underwent unilateral upper eyelid retraction repair due to thyroid eye disease or iatrogenic retraction secondary to ptosis repair demonstrated an elevation in contralateral eyelid height post-operatively. The mean pre-operative MRD-1 was 6.6 mm in the operative eye and 2.6 mm in the contralateral eye. All patients demonstrated a decreased MRD-1 in the operative eye (mean change: −2.6 mm [−38.4%]; standard deviation [SD]: 1.2 mm) and an increased MRD-1 in the contralateral eye (mean change: +1.3 mm [+62.4%]; SD: 0.6 mm) following unilateral upper eyelid retraction repair. The mean post-operative MRD-1 measurements were 4.0 mm ± 0.5 mm and 3.9 mm ± 0.6 mm in the operative and contralateral eyes, respectively. Conclusions Unilateral upper eyelid retraction repair may induce an elevation of the contralateral upper eyelid position in some patients. The findings in this report may support unilateral intervention in patients with upper lid retraction, especially in the setting of contralateral blepharoptosis.

"Complications in Blepharoplasty and How to Resolve Them"

Any type of eyelid correction or postoperative blepharoplasty complication should be well managed and studied before attempting its correction, as it could lead to a worsening of the original alteration. Although postoperative scars in a blepharoplasty are relatively rare, they can generally be improved by massage and late with the application of topical corticosteroids, with the understanding that their best use is during the first twelve months. An early intervention should be avoided as this can worsen the result and rarely improve the final result, when there is a healing problem, remembering that stress is a determining factor in the final result. The laxity of the canthus tendons should always be evaluated either by directly pulling the eyelid down, with an eyelid glide test, the impingement test, and a poor eyelid position prior to surgery should always be documented. In these cases, the surgeon who operates blepharoplasty must have a perfect knowledge of the management of the canthal tendons and have within his surgical resources the realization of the canthal application or the repositioning of the palpebral canthal tendon.

Lateral Tarsal Strip Technique in Correction of Eyelid Ectropion and Entropion

Ectropion and entropion are eyelid malpositions associated with a number of unpleasant symptoms. One of several surgical methods that can correct these problems is referred to as the lateral tarsal strip technique. In this paper, we evaluate the postoperative results and quality of this technique. We also examine the complications associated with this surgical method. The study took place from April 2018 to April 2020 at the Military University Hospital in Prague. The operation was performed by two surgeons. The study included 43 eyes of 33 patients (17 women and 16 men), average age was 79 years. Before the operation, 23 eyes were affected by ectropion and 20 eyes affected by entropion, 35 of the 43 were cases of involutional origin. The study does not include patients who underwent other surgical techniques. There were no perioperative or postoperative complications in the entropion surgery group. Successful correction was achieved, and adverse symptoms disappeared in 91.3% of cases. Correct position of the eyelid was not achieved in two cases. For patients with ectropion, surgical correction was successful in 95% of cases. Ectropion persisted after surgery only in one patient. The lateral tarsal strip technique is a safe, reliable and highly effective surgical technique. Correction of eyelid malposition was achieved in more than 90% of cases. The vast majority of patients were satisfied and reported relief from preoperative symptoms.

ИСПОЛЬЗОВАНИЕ АЛЛОТРАНСПЛАНТАТА ИЗ ПОДКОЖНО-ЖИРОВОЙ КЛЕТЧАТКИ С АПОНЕВРОЗОМ ПОДОШВЫ ДЛЯ ФОРМИРОВАНИЯ ОПОРНО-ДВИГАТЕЛЬНОЙ КУЛЬТИ ПРИ ЭНУКЛЕАЦИИ

Objective. To develop a method for the formation of a musculoskeletal stump for an ocular prosthesis during enucleation using an allograft from subcutaneous fat with a plantar aponeurosis was developed Methods. The study included patients with the diagnosed choroid melanoma (n=15), and retinoblastoma (n=2). The orbital cavity was replenished with the section of subcutaneous adipose tissue with the sole aponeurosis, preserved by cryopreservation. The orbital cavity was filled with a section of subcutaneous adipose tissue with plantar aponeurosis, preserved by cryopreservation. The immediate effect was assessed 3 and 6 months after the treatment according to the following criteria: the presence of the orbital tissues edema, the mobility of the supporting stump with the prosthesis, the position of the stump with the prosthesis in the orbit, and the position of the upper eyelid. Results. In all cases, a positive result was obtained: after 3 months, the orbital tissue edema was absent in 7 patients, in 7 - it was mild, in 3 - it was moderately pronounced. After 6 months, the orbital tissue edema was absent in all patients. After 3 months the mobility of the supporting stump was moderately marked in 10 patients, and in 7 - it was feeble marked. After 6 months, the mobility of the stump was marked moderately in all patients. After 3 months in 7 patients, the position of the stump with the prosthesis had a symmetrical position; there was hypereffect in 10 patients. By 6 months, all patients had a symmetrical arrangement of the healthy eye and prosthesis. Conclusion. The designed method for the formation of the functional stump for an ocular prosthesis during enucleation using the allograft from subcutaneous fat with the plantar aponeurosis makes it possible to obtain good anatomical, cosmetic and functional results of the operation due to the achievement of a sufficient rangeofprosthetic movement of the ocular prosthesis. The introduction of the designed method of the functional stump formation into clinical practice increases the medical, social, economic efficiency of the rehabilitation of patients with malignant neoplasms of the eyeball membranes. What this paper adds For the first time, a method for the formation of a musculoskeletal stump for an ocular prosthesis during enucleation using an allograft from subcutaneous fat with a plantar aponeurosis was developed. It is shown that the allograft application makes it possible to obtain a good anatomical, cosmetic and functional result by achieving a sufficient rangeofprosthetic movement of the eye prosthesis.

Ocular Lesions and Neurologic Findings in Traumatic Birds: A Retrospective Evalution of 114 Cases

This study was conducted to identify the occurrence and types of trauma-related ocular disorders in 114 birds belonging to 39 species. For this purpose, both detailed neurological examination and ophthalmologic examina-tion results of the birds admitted to our clinics with a trauma history or trauma findings are presented. Thirty cases were evaluated to suffer from trauma-related eye injuries. Uvea lesions (n=12) were the most frequent disorder of traumatic eye injury. On cranial nerve assessment, anisocoria, pupillary light reflex, menace response, globe and third eyelid position, palpebral reflex, and nystagmus were evaluated. The most frequent neurologic finding of traumatic eye injury was anisocoria (n=9). Ophthalmologic examination accompanying neurological examination is the most important fac-tor in the early management of traumatic birds.

Multidisciplinary approach to orbital decompression. A review.

SUMMARYEndoscopic orbital surgery has become a highly evolving multidisciplinary surgical field thanks to development in technical skills of ophthalmologists and otolaryngologists. These advances expanded the clinical application of orbital decompression, with a growing body of literature describing the multidisciplinary management of thyroid eye disease and compressive optic neuropathy, since 1990. Although techniques have improved considerably, only few Randomized Control Trials (RCT) provide evidence to support recommendations in clinical practice. This review provides an overview of the current knowledge of orbital decompression to clarify which is the most standardized therapeutic strategy. In the literature, we observed several approaches with contradicting results and the comparison of different surgical techniques was biased by inclusion of patients at different stage of disease (active or inactive), different surgical indications (dysthyroid neuropathy or disfiguring proptosis) and measures of outcomes (such as different system for ocular motility evaluation). The timing of surgical decompression is one of the debated issues. One RCT focusing on Graves’ orbitopathy showed how intravenous corticosteroids achieve better visual recovery than surgical orbital decompression; but in case of absent or poor response to medical therapy the patient should undergo surgery within two weeks. There is slight evidence that the removal of the medial and lateral wall (so-called balanced decompression) with or without fat removal could be the most effective surgical technique, with low complication rate, but an increasing number of authors are promoting, for selected cases, a pure endoscopic surgical approach (with removal of medial and infero-medial orbital wall), less invasive than the balanced one; the latter indicated to more severe proptosis or diplopia after endoscopic procedure. Three-wall decompression is chosen for high degrees of proptosis, but complications are more frequent. Timing of surgical orbital decompression, in particular when a concomitant optic neuropathy is present, is still to be determined. Additional ophthalmological procedures are needed to restore normal eye function and cosmesis. Strabismus surgery to address diplopia and lowering the position of the upper eyelid represent some of the additional steps for the final rehabilitation of Graves’ orbitopathy. The main clinical outcomes including visual acuity, proptosis, and new-onset diplopia are changing. Recent studies focused on the development of imaging measurements in order to objectively evaluate the surgical results and QOL questionnaires are gaining increasing importance.

The Effect of Upper Eyelid Muller Muscle Conjunctival Resection Surgery on Lower Eyelid Position

ABSTRACT Purpose: To examine whether Müller’s-muscle-conjunctival-resection (MMCR) changes the position of the lower eyelid. Methods: Retrospective controlled-cohort study. All patients who underwent MMCR (study group) or blepharoplasty (control group) between January 2016 and September 2018 were recruited. The data retrieved from the patients’ medical records included demographics, visual-acuity, eyelid parameters and dry-eye parameters before and 3 months after surgery. Frontal photographs of the patient’s eyes in primary position were taken preoperatively and at 3 months postoperatively. The margin-reflex-distance 1 (MRD1) and MRD2 were evaluated. The preoperative and 3 months postoperative MRD1, MRD2,and dry-eye signs and symptoms were compared. Results: Sixty-nine patients underwent MMCR and 54 patients underwent blepharoplasty during the study period. There were significant changes in MRD2 after MMCR surgery compared to preoperative values (P < .01, paired t-test), but no significant changes in MRD2 after blepharoplasty surgery (P = .091, paired t-test). The mean changes in MRD2 (delta MRD2) were 0.51 in the MMCR group versus (−0.10) in the blepharoplasty group (P = .04, t-test). Conclusions: The position of the lower eyelid was altered significantly in patients that underwent MMCR surgery. This sequela should be discussed with the patients before surgery and should be considered by physicians when planning ptosis surgery.

Early Experience With the Clinical Use of Teprotumumab in a Heterogenous Thyroid Eye Disease Population.

To describe the clinical course in a heterogeneous series of subjects with thyroid eye disease (TED) treated with teprotumumab. Cross-sectional cohort study including patients with clinical diagnosis of TED who was treated with teprotumumab. The entire cohort was analyzed together and subsequently in clinical subgroups based on stage and grade of disease. Primary outcome measure was change in proptosis ≥2 mm. Secondary outcome measures included change in clinical activity score (CAS), ductions, strabismic deviation, MRD1, and MRD2. Bivariate and multivariate statistics were performed. The study included 21 patients. Mean ± SD age was 61.5 ± 12.6 years and 71.4% were female. Reduction in proptosis ≥2 mm was achieved in 71.4% of the sample. Stage and grade were not significant predictors of outcome. Treatment with teprotumumab resulted in a 2.5 ± 1.8 mm reduction of proptosis (P < 0.001), 2.2 ± 1.4 reduction in CAS (P < 0.001), and 16.9 ± 19.3 degree improvement in extraocular motility (P < 0.001). There were no significant differences for change in CAS, proptosis, ductions, or MRD2 between different grades and stages of disease. Total strabismus and MRD1 improvement were greater in the active stage of disease (P < 0.05). Three cases of dysthyroid optic neuropathy, refractory to methylprednisolone therapy improved after initiation of teprotumumab. Treatment of TED with teprotumumab in a heterogeneous patient population is associated with improvement in proptosis, extraocular motility, and CAS. Patients beyond those defined in the clinical trials, including those affected by stable stage, milder grade, and vision-threatening TED may benefit from this therapy. There are, however, limits on the overall efficacy of this medication in the management of certain physical characteristics in TED including eyelid position and strabismus.

Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts.

Purpose:Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated.Methods:Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns (n = 3), fireworks (n = 3), trauma (n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma (n = 1) with three average previous socket surgeries (range 2–6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries.Results:Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two.Conclusions:Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.

The Effect of Zero Gravity on Eyelid and Brow Position.

To describe the effect of spaceflight on upper eyelid and brow position. Images of astronauts on earth and in space were collected from a National Aeronautics and Space Administration image library. For each astronaut, front facing portraits captured within a 5-year period were obtained. At least 6 photos were collected per astronaut, 3 taken on earth, and 3 in zero gravity. Measurements from the center of the pupil to the upper eyelid margin (MRD1) and center of the pupil to the inferior eyebrow margin [pupil-to-brow (PTB)] were performed digitally for each image and averaged for each condition and each individual. Differences in mean MRD1 and PTB were assessed to illustrate the effects of zero gravity on eyelid and eyebrow position respectively. Linear-mixed effects modeling, analysis of variance and post hoc power analysis were performed. One hundred and twelve photographs (55 earth, 57 space) from 18 astronauts (4 women, 14 men; mean age 45.9 years) were retrieved. Zero gravity resulted in a mean PTB increase of 3.7 mm (p < 0.01) but did not result in significant change in MRD1 (p = 0.21). Post hoc power analysis of the measured MRD1 difference was performed by simulation. At an MRD1 difference of 0.5 mm, the probability of a type II error is 2.6%, equivalent to a beta power of 97.4%. Thus, we can be 97.4% confident that a difference in MRD of 0.5 mm or greater would be detected. While spaceflight led to significant elevation of PTB, it did not consistently alter MRD1. As such, the brow and eyelid appear to be independently regulated with respect to gravitational changes.

English

A 3-year-old intact female Old English Bulldog and 5-month-old spayed female Chow Chow were diagnosed with entropion. Instead of surgery, hyaluronic acid (HA) filler injections were performed to correct the entropion and relieve the associated symptoms. We used the layered feathering technique, which was effective for the administration of the HA into the tissues for the correction of canine entropion. The eyelid positions were maintained for 6-8 months after the procedures. These cases demonstrate that HA filler injections relieve clinical signs quickly and effectively, though temporarily, in patients with entropion

Ocular Surface Characteristics and Colonization in a Burn Center: A Prospective Cohort Study.

We aimed to evaluate the characteristics and colonization by pathogenic microorganisms of the ocular surface in patients in a burn center and to determine their association with sedation, mechanical ventilation, and periocular burn. We prospectively evaluated 40 patients during an 8-mo period. Five evaluations where performed, at baseline and weekly on four more occasions or until hospital discharge or death. On each visit, we assessed periocular burn, lid position, Bell's phenomenon, Schirmer's test, presence of chemosis, conjunctival hyperemia, and exposure keratopathy; conjunctival fornix swabs were taken for microbiology culture. Also, we documented the level of sedation, mechanical ventilation status, and systemic and ocular treatment. Absent Bell's phenomenon and chemosis were significantly different at baseline in patients under mechanical ventilation, sedation, and in those with a periocular burn. The cumulative incidence of exposure keratopathy was 22.5% and the cumulative incidence of ocular surface colonization by pathogenic microorganisms was 32.5%. Both outcomes were associated with mechanical ventilation and periocular burn. The most frequent pathogenic microorganisms on the ocular surface were Candida parapsilosis, Acinetobacter baumanii, and Pseudomonas aeuroginosa. We did not observe any case of a persistent epithelial defect, infectious keratitis, corneal perforation or corneal opacity in this cohort. Results from our study may benefit future patients by allowing better risk stratification and treatment strategies for the ocular surface care in burn units.

Beyond shared signals: The role of downward gaze in the stereotypical representation of sad facial expressions.

According to the influential shared signal hypothesis, perceived gaze direction influences the recognition of emotion from the face, for example, gaze averted sideways facilitates the recognition of sad expressions because both gaze and expression signal avoidance. Importantly, this approach assumes that gaze direction is an independent cue that influences emotion recognition. But could gaze direction also impact emotion recognition because it is part of the stereotypical representation of the expression itself? In Experiment 1, we measured gaze aversion in participants engaged in a facial expression posing task. In Experiment 2, we examined the use of gaze aversion when constructing facial expressions on a computerized avatar. Results from both experiments demonstrated that downward gaze plays a central role in the representation of sad expressions. In Experiment 3, we manipulated gaze direction in perceived facial expressions and found that sadness was the only expression yielding a recognition advantage for downward, but not sideways gaze. Finally, in Experiment 4 we independently manipulated gaze aversion and eyelid closure, thereby demonstrating that downward gaze enhances sadness recognition irrespective of eyelid position. Together, these findings indicate that (1) gaze and expression are not independent cues and (2) the specific type of averted gaze is critical. In consequence, several premises of the shared signal hypothesis may need revision. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficacy and predictability of Muller\u2019s muscle-conjunctival resection with different tarsectomy lengths for unilateral blepharoptosis treatment

BackgroundTo investigate the efficacy and predictability of Muller’s muscle-conjunctival resection (MMCR) with different lengths of tarsectomy for the treatment of unilateral mild-to-moderate blepharoptosis.MethodsA retrospective study of patients who underwent MMCR with tarsectomy for unilateral mild-to-moderate blepharoptosis between January 2016 and December 2019 was performed. Individuals with adequate photographic documentation and good levator function were included. Data on age, gender, surgical designs, pre-operative and post-operative marginal reflex distance 1 (MRD1) and tarsal platform show (TPS), and complications were retrieved.ResultsSixty patients underwent 8-mm MMCR with 1- or 2-mm tarsectomy; 53 patients (88.3%) showed postoperative symmetry of MRD1 within 1 mm. The average postoperative improvement in MRD1 was 2.15 ± 0.8 mm. Thirty-two patients received 8-mm MMCR with 1-mm tarsectomy (group 1), and 28 patients underwent 8-mm MMCR with 2-mm tarsectomy (group 2). In group 1, postoperative symmetry rate was 90.6%, and the mean elevation of MRD1 was 1.66 ± 0.6 mm. In group 2, postoperative symmetry rate was 85.7%, and the mean elevation of MRD1 was 2.72 ± 0.6 mm. Both groups showed postoperative symmetry of TPS and significant improvement in eyelid position (p < 0.0001). No postoperative complication was noted, and no secondary surgery was needed.ConclusionsMMCR with tarsectomy was proven to be a safe, rapid, and effective method for patients with mild-to-moderate ptosis. Predictability and symmetry of the outcome were statistically confirmed. We further suggest a 2.1-mm expected MRD1 elevation as a cut point for choosing between 1- or 2-mm tarsectomy.

Müller Muscle-conjunctival Resection with or without Tarsectomy and Combined with Bandage Contact Lens Use in Ptosis Patients with Corneal Graft.

PurposeTo examine the efficacy of ptosis correction with a Müller muscle-conjunctival resection with or without tarsectomy (MMCR±T), combined with bandage contact lens (BCL) use, in corneal graft patients.MethodsSeven patients with corneal grafts who underwent MMCR±T for treatment of ptosis were evaluated retrospectively. A BCL was applied to the grafts at the end of the surgery. The collected data included preoperative and postoperative visual acuity, marginal reflex distance 1 (MRD-1), presence of Hering’s dependency by the phenylephrine test, symmetry outcomes, and complications after MMCR±T.ResultsThe average duration between the penetrating keratoplasty and MMCR±T was 14 months, with a follow-up time of 10.4 months after MMCR±T. Hering’s dependency was observed in four (57.2%) patients before MMCR±T, and MRD-1 was increased in all patients based on preoperative phenylephrine tests. The mean preoperative MRD-1 was −0.14 ± 0.55 mm, and the mean postoperative MRD-1 was 2.35 ± 0.89 mm (p < 0.0001). Symmetry outcomes of perfect (<0.5 mm), good (0.5–1 mm), and fair (≥1 mm) were noted after MMCR±T in three, three, and one patients, respectively. During the follow-up, no obvious corneal epitheliopathy, keratitis, or corneal graft rejection/failure were noted in any cases. BCL use was well tolerated by all patients.ConclusionsMost patients achieved good surgical outcomes with the application of the BCL to protect the graft and with the use of the phenylephrine test and Hering’s dependency to predict the final eyelid position and symmetry. MMCR±T combined with BCL may therefore represent an alternative approach for correction of ptosis in patients with corneal graft.

Long-term surgical outcomes of levator resection in patients with Marcus-Gunn jaw-winking ptosis

ABSTRACT Purpose To report long-term surgical outcomes of a series of MGJWS patients with moderate ptosis who underwent levator resection. Materials and Methods A retrospective review of medical records of 10 MGJWS patients with moderate ptosis who underwent levator resection was performed in two major eye centers in Riyadh, Saudi Arabia from January 1987 to December 2019. Clinical features, pre-operative and post-operative data of the 10 patients were recorded. Outcome Measures Long-term upper eyelid position. Results The mean patient age at presentation was 5.4 years. Seven patients were female and three were male. All patients had moderate ptosis with marginal reflex distance ranged from 1 to 2 mm. The mean age at surgery was 9.5 years. After initial good ptosis correction for all patients, seven of them had a recurrence of ptosis several months after levator resection. Conclusions Levator resection in MGJWS patients with moderate ptosis and good levator function is associated with a high rate of ptosis recurrence and less predictable surgical results.

Efficacy of 0.05% cyclosporine A on the lipid layer and meibomian glands after cataract surgery: A randomized, double-masked study.

PurposeTo quantitatively evaluate the effects of 0.05% cyclosporine A (CsA) on lipid layer thickness (LLT) and meibomian glands after cataract surgery using the LipiView® ocular surface interferometer.MethodsThis study was a prospective randomized double-masked clinical trial conducted by Pusan National University Yangsan Hospital between April 04, 2019, and November 31, 2019. Sixty-two participants were recruited, and 12 of them were not enrolled because they had undergone previous treatments for ocular surface diseases. The participants were adult patients with cataract, exhibiting normal lid position; they did not present any other ocular disease and did not meet the exclusion criteria of the clinical trial. Fifty subjects were enrolled in the study. The randomized subjects received treatment with 0.05% CsA (group A) or 0.5% carboxymethyl cellulose (CMC) (group B) over the 3 months following the cataract surgery. Subjective and objective assessments were performed at preoperative and postoperative visits. Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), and Schirmer’s I test were performed by the same surgeon, and LLT and meiboscore were determined using the LipiView® interferometer.ResultsFifty subjects subjects enrolled consisted of men (50%) and women (50%), with a mean (SD) age of 65.94 (10.35) years. Four subjects in group A and five in group B were excluded from the analysis as they were lost to follow-up within 1 month after cataract surgery. Thus, the study comprised 41 eyes of 41 subjects; 21 subjects were treated with CsA and 20 subjects with CMC. Comparing the clinical measurements between groups A and B taken at the last visit, while controlling the effects of the preoperative values, TBUT and LLT showed significant differences (p = 0.035 and p = 0.047, respectively, by ANCOVA). The TBUT between the subjects using CsA and those using CMC after cataract surgery showed a significant difference during follow up (p = 0.003 by repeated measures ANOVA). In the multivariate analysis, preoperative LLT and the use of CsA were found to be independent parameters for postoperative LLT (R2 = 0.303; p = 0.008 and p = 0.045, respectively), whereas the follow-up duration exhibited a positive correlation with the difference between the preoperative and postoperative values of LLT in the group treated with CsA (R2 = 0.738 and p < 0.001).ConclusionTreatment with 0.05% CsA following cataract surgery is effective in improving TBUT and LLT in comparison with 0.5% CMC. A higher preoperative value of LLT and the postoperative use of CsA could be significant determinants of a higher postoperative LLT value.Trial registrationISRCTN registry with ISRCTN 10173448.