Orbital Fat Research Articles

Cicatricial Ectropion Treated by Orbital Septum Fat Combined with Retro-Orbicularis Oculi fat

Cicatricial Ectropion Treated by Orbital Septum Fat Combined with Retro-Orbicularis Oculi fat

Nasal and temporal intraconal orbital fat densities differ on computerized tomographic scans of normal orbits

AbstractBackground and AimThe anatomy and function of different areas within the intraconal fat remain poorly understood. A potential difference between nasal and temporal orbital fat densities in normal eyes may assist clinicians and radiologists in more accurately interpreting computerized tomographic (CT) scans and making more informed diagnostic and therapeutic decisions for patients with orbital pathologies.Patients and MethodsData from randomly selected patients who underwent orbital CT scans at Sheba Medical Center in 2022 were analyzed. Patients with abnormal imaging findings in either orbit were excluded. Intraconal orbital fat density was measured in six nasal and temporal sites by means of Hounsfield units (HU).ResultsThe study included 54 patients (mean age 45.3 ± 25.5 years, 29 [54%] females) who were scanned for ophthalmologic etiologies unrelated to the orbit. Non-contrast-enhanced (NCE)-CT scans were available for 36 patients (67%), CE-CT scans for 31 patients (57%), and both CE and NCE scans for 13 patients. HU values were significantly higher in the nasal orbit compared to the temporal orbit on both NCE-CT (−75.8 ± 7.5 nasal vs. −78.1 ± 8.4 temporal, P < 0.001) and CE-CT (−72.7 ± 6.7 nasal vs. −74.6 ± 8.6 temporal, P = 0.02). Age, sex, and laterality had no effect on the HU values.ConclusionsThe density of nasal intraconal fat is higher compared to temporal intraconal fat, as observed on both CE and NCE-CT scans of normal eyes.These results suggest the presence of anatomical differences between these compartments and could have significant clinical implications in the diagnosis of various orbital pathologies.

A New Method of Orbital Septal Fat Flap in Transconjunctival Approach.

Orbital fat release is critical in blepharoplasty for correcting tear trough deformities, but traditional transconjunctival approaches often face limitations due to restricted fat volume and pedicle length. This study introduces an innovative technique by reconstructing the orbital fat flap, aiming to improve tear trough coverage and optimize Aesthet outcomes. The technique is achieved by reconstructing the orbital fat flap. To enhance fat survival, meticulous preservation of the pedicle's vascular supply was ensured during surgery. Microsurgical techniques were employed to precisely dissect and position the fat flap, ensuring full coverage of the tear trough area while maintaining facial symmetry. Postoperative follow-up was conducted to evaluate functional and Aesthet outcomes. The modified technique resulted in complete tear trough coverage and significant reduction in postoperative retraction. Patients reported improved Aesthet outcomes, with natural restoration of the lower eyelid contour and preservation of the culturally significant "Lower-lid Pretarsal Roll" appearance. No major complications such as fat atrophy or eyelid retraction were observed. This new technique for extending the orbital fat flap in blepharoplasty offers better coverage of tear trough deformities, reduces the risk of postoperative complications, and improves patient satisfaction, making it an important advancement in eye contour surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Percutaneous External Fixation of Redistributed Orbital Fat in Transcutaneous Lower Eyelid Blepharoplasty.

While percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty. This study aims to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty. From May 2022 to December 2023, a consecutive cohort of 97 patients underwent this surgical technique. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes. Following a mean follow-up of 7.2 months (ranging from 6 to 17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < 0.05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients' social confidence (P < 0.05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0±19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision. External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, presenting a viable alternative to conventional fixation techniques.

TRATAMENTO DE GORDURA INFRAORBITAL COM ULTRASSOM MICROFOCADO

Aging is a physiological process determined by various intrinsic and extrinsic factors, being a normal and inevitable process. The periorbital region is one of the first to show signs. This aging in the periorbital region is manifested by several anatomical changes that result in dark circles, wrinkles and sagging skin. These changes are influenced by factors such as the loss of adipose tissue volume and reduced collagen production, in addition to the projection of orbital fat and reduced skin elasticity. Given the significant aesthetic impact of these changes, effective treatment of dark circles has become a priority in aesthetic procedures. This study aimed to present and describe a treatment technique and its results in infraorbital pockets, using the non-invasive method of microfocused ultrasound. Through a case report involving a 50-year-old male patient with complaints of persistent dark circles, a treatment protocol was carried out with microfocused ultrasound using 60 shots per infraorbital region in two sessions, with an interval of 3 months. The evaluation of the results included photographic documentation and facial scanning, which showed a significant improvement in skin firmness and a reduction in infraorbital bags. The work concludes that microfocused ultrasound proved to be effective in treating localized fat and repositioning tissues in the dark circles region, promoting facial rejuvenation and representing a less invasive alternative to blepharoplasty. Results may vary depending on age, skin condition and technique used, in which case additional sessions may be necessary.

Eye-Opening Effect Achieved by Modified Transconjunctival Lower Blepharoplasty.

Enophthalmia (abnormally sunken eyeball in the socket) and ptotic upper lid as well as with lower lid symptoms are commonly observed in patients seeking periorbital rejuvenation. It is not only functionally disruptive, causing restricted eye opening, but also aesthetically displeasing, thus creating a demand for more sophisticated solutions. Conventional transconjunctival lower blepharoplasty (TCLB) has been performed mainly for lower lid symptoms with the removal and transposition of excess lower orbital fat compartment (LOFC). In this study, TCLB is modified by adding de-flaming and decompression maneuvers to the LOFC and its support structures to obtain better results in both the lower and upper lids. The results after the modified TCLB clearly demonstrate increased eye-opening ability and marked resolution of observable symptoms. The anatomical dynamics of the orbit involved in this procedure are detailed through scientific data. Modified TCLB was performed in patients with lower eyelid symptoms. Palpebral fissure height (PFH) (the distance between the upper and lower eyelids in vertical alignment with the center of the pupil) was measured before surgery and 12 months postoperatively using 3 dimensional photographs. This data was compared to validate the postoperative eye-opening effect. The weight of the excised fat from each LOFC was also measured and compared. Forty patients (36 females and 4 males) who underwent modified TCLB in 2022 were followed up 12 months postoperatively. Preoperative PFHs were 8.41±1.15 (6.1-10.7) mm for the right and 8.41±1.12 (5.5-10.4) mm for the left. Postoperative PFHs were 9.26±0.95 (6.4-11.1) mm for the right eyelid and 9.21±0.94 (6.2-11.1) mm for the left eyelid. The improvement in postoperative eye opening was statistically significant. The total excised LOFC was 0.43±0.24 (01.2) g for the right and 0.42±0.25 (0-1.5) g for the left. The largest amount of fat was excised bilaterally from the lateral LOFC, and the difference was statistically significant. The modified TCLB with de-framing and decompression of the LOFC was not only effective in improving symptoms present in the lower lid but also increased the eye-opening ability with marked aesthetic improvements in most patients.

Proteome Expression Signatures: Differences between Orbital and Subcutaneous Abdominal Adipose Tissues.

Differences between orbital and subcutaneous abdominal fat in the same patient have been noted but not formally investigated, previously. The objective of this research was to compare the differential expression of protein profiles in subcutaneous abdominal and orbital adipose tissues. In this cross-sectional, observational study, orbital fat tissue was sampled from 10 patients who underwent blepharoplasty and agreed to provide a small sample of subcutaneous abdominal fat. Shotgun mass spectrometry was performed on the extracted proteome. Data were analyzed using protein appearance patterns, differential expression and statistical enrichment. Protein analysis revealed significant differences in proteomics and differential expression between the orbital and subcutaneous abdominal adipose tissues, which presented five proteins that were uniquely expressed in the orbital fat and 18 in the subcutaneous abdominal fat. Gene Ontology analysis identified significantly different cellular processes and components related to the extracellular matrix or basement membrane components. This analysis shows the differences between orbital and subcutaneous abdominal fat found in proteomics differential expression, uniquely expressed proteins, and cellular processes. Further research is needed to correlate specific proteins and cellular processes to the mechanism of fat accumulation and obesity.

Sublimbal orbital fat transposition in neurotrophic keratopathy: a case series

Neurotrophic keratopathy is a progressive condition resulting from corneal denervation, leading to the development and persistence of corneal ulcers. Among the pathogenetic treatment methods there are corneal neurotization, a technically challenging approach associated with a prolonged rehabilitation period, and the usage of recombinant human nerve growth factor (cenegermin), which is practically inaccessible due to its high cost and lack of registration in Russian Federation. We propose a technique of orbital fat transposition to the sclerocorneal pocket for the treatment of persistent ulcers associated with neurotrophic keratopathy. This method is based on neuronal embryology of orbital adipose tissue, as well as the abundance of neurotrophic factors and stem cells. This method was applied to three patients with different etiologies of neurotrophic keratopathy, reaching the observation endpoint in two months after the operation. Visual acuity was ranging from 0.005 to 0.01. All patients received standard therapy for 1–2 months without significant improvement. Surgery was then performed using the proposed technique, which involves repositioning the medial and central orbital fat pads into the sclerocorneal pocket. In the postoperative period, partial epithelialization was observed in all patients during the first week, followed by complete healing and scar formation. The maximum visual acuity in 2 months ranged from 0.06 to 0.3.

Spectrum of orbital fat necrosis in rhino-orbital-cerebral mucormycosis in post-COVID-19 patients.

Rhino-orbital-cerebral mucormycosis (ROCM) is the most common presentation of mucormycosis. Sinonasal-orbital debridement with exenteration is a life-saving procedure in ROCM patients in view of severe involvement of sinuses and the eyeball. Following the second wave of coronavirus disease 2019 (COVID-19), there was a massive surge in mucormycosis cases in India in post-COVID-19 patients. Of over 300 cases of mucormycosis admitted in our hospital, many underwent exenteration and these specimens were evaluated histopathologically, where fat necrosis was found to be a prominent finding. The spectrum of fat necrosis in ROCM in orbital fat has not been described in literature. Hence, we sought to evaluate the significance and spectrum of orbital fat necrosis in ROCM. This 3-month retrospective study included 15 cases of ROCM which underwent exenteration. Clinical data, radiologic details, and histopathologic findings were tabulated. Sections were also subjected to Periodic acid Schiff (PAS) and Gomori's methenamine silver (GMS) stains for confirming the fungus. All 15 cases showed fat stranding on computed tomography (CT) scan. On histopathologic examination, various tissue reaction patterns observed included acute/chronic inflammatory infiltrate, suppurative granulomas with giant cells, coagulative and fat necrosis, broad aseptate fungal hyphae with or without angioinvasion, and neural invasion. Fungal hyphae were confirmed with PAS and GMS stains. The spectrum of fat necrosis observed in all the cases included 1) acute necrotizing fat necrosis, 2) ghost adipocytes with or without saponification, and 3) crystalline/gouty fat necrosis. Fat necrosis is a significant finding in ROCM, both on CT scan and histopathology. All three patterns of fat necrosis may be observed simultaneously in a case of ROCM.

Evaluation of the Effect of Topical Prostaglandin Analog Treatment on Orbital Structures in Open-Angle Glaucoma with Computed Tomography

Background/Objectives: This study aims to evaluate the computed tomography (CT) scans of glaucoma patients using prostaglandin analogs (PGA) in one eye, investigate findings associated with prostaglandin-associated periorbitopathy (PAP), and compare these findings with those of the contralateral eyes. Methods: Patients with open-angle glaucoma who had CT images of the orbital region taken for another reason at least one month after starting PGA treatment in one eye were included in the study. Enophthalmos measurements from thin-slice CT images, along with 3D volume measurements of orbital fat tissue, periorbital muscles, and the optic nerve, were performed. Ophthalmological examination findings and treatment information were collected. The values were compared with those of the contralateral eyes of the same patients not using PGA. Intraclass correlation coefficients (ICCs) were computed to evaluate measurement repeatability. Results: Forty patients were included in the study. Among them, 29 (72.5%) used latanoprost, 9 (22.5%) used bimatoprost, and 2 (5%) used travoprost. The mean enophthalmos values on the treated side (15.5 ± 2.0 mm) were lower than on the untreated side (16.1 ± 1.4 mm), but this difference was not statistically significant (p = 0.07). In 29 patients (72.5%), enophthalmos measurements were smaller on the treated side, with 7 patients (17.5%) showing a difference of 2 mm or more. No significant correlation was found between the duration of PGA use and enophthalmos measurements (p = 0.768 r = −0.048). Additionally, no significant differences were found in orbital fat volume, total extraocular muscle volume, and optic nerve volume (p &gt; 0.05). ICC values demonstrated excellent reliability (ICC &gt; 0.75) for all measurements. Conclusions: We did not find significant differences in enophthalmos measurements, orbital fat volume, total muscle volume, and optic nerve volume between the PGA-treated and untreated eyes.

Enhanced Transconjunctival Lower Blepharoplasty: A Novel Method for Intraorbital Fat Transposition and Stabilization.

The evolution of lower blepharoplasty has shifted from simply removing of orbital septum fat to smoothing of the lid-cheek junction through fat repositioning. This paper adopts a novel technique to transpose and stabilize intraorbital fat during transconjunctival lower blepharoplasty. The tear trough and nasal alar base were filled to correct the pouch while ensuring the blood supply of the fat flap. Between September 2019 and June 2022, 104 patients aged between 22 and 49 who underwent bilateral fat flap transposition-nasal alar base filling lower blepharoplasty were selected. The surgical results were assessed by non-operative plastic surgeons according to the Hirmand grading system. Moreover, a self-satisfaction survey was conducted and patients were followed up for at least 6months to evaluate any complications and surgical outcomes. A high-frequency ultrasound imaging system was used to assess the degree of filling of the tear trough and nasal alar base. All 104 patients were followed up for at least 6months. The postoperative Hirmand grade was 0 for 96 out of 104 (92.3%) patients. In terms of self-satisfaction assessment, there were 92 out of 104 (88.5%) patients reported satisfaction. Dermatologic ultrasound showed no obvious gaps 6months after surgery. Transconjunctival fat flap transposition combined with nasal alar base filling during lower blepharoplasty has been shown to have a positive postoperative effect and high patient satisfaction. This procedure can preserve the blood supply of the fat flap, reduce the rates of fat absorption and denaturation, and improve facial contour, resulting in a satisfactory repairing effect. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Characteristics and Underlying Pathophysiology in 4 Subtypes of Dysthyroid Optic Neuropathy Patients

Objective: To analyze different subtypes, clinical characteristics, and pathophysiologies of dysthyroid optic neuropathy (DON) based on orbital fat and extraocular muscle (EOM) volume increases on orbital CT images. Methods: The author retrospectively reviewed the medical records of 80 patients (152 eyes) who were diagnosed with DON and treated at Anam, Guro, or Ansan hospitals of the Korea University College of Medicine from February 2006 to December 2023. Clinical features, ophthalmic examination, demographic characteristics, thyroid status, and radiographic findings from computed tomography scans (prevalence of fat or muscle volume increases) were analyzed. Results: Four groups were designated based on EOM volume (MV) and orbital fat volume (FV). Group 1 had no increase in MV or FV (5.3%, 8 eyes), group 2 had increased FV only (8.66%, 13 eyes), group 3 had an increase in MV only (52.6%, 80 eyes), while group 4 had both MV and FV increase (33.6%, 51 eyes). Patients in group 1 were younger and had low diplopia scores than patients in the other groups. Decreases in visual acuity, color vision abnormalities, diplopia score, and apical crowding were less frequent in groups 1 and 2 than groups 3 and 4 (P=0.000). Patients in groups 3 and 4 had significantly more apical crowding and higher diplopia scores and CAS scores than patients in groups 1 and 2 (P=0.000 and 0.013, respectively). The number of patients who underwent decompression surgery was significantly higher in groups 3 and 4 than groups 1 and 2 (P=0.000). Conclusion: Extraocular muscle enlargement occurred in 86% of DON patients and compression of the optic nerve due to enlargement of EOMs at the orbital apex is the main cause of DON. Optic nerve stretch and vascular insufficiency due to increased orbital pressure are other potential mechanisms underlying DON in groups without an increase in FV or MV. Although decreased visual acuity, color vision abnormalities, and diplopia were less frequent in these groups, greater attention should be paid to the timely diagnosis of DON.

Differentiation of bacterial orbital cellulitis and diffuse non-specific orbital inflammation on magnetic resonance imaging.

To examine the radiological differences between bacterial orbital cellulitis (OC) and diffuse non-specific orbital inflammation (DNSOI) on magnetic resonance imaging (MRI). Retrospective study of patients with OC and DNSOI with an MRI orbital scan. Localised orbital inflammation (e.g., idiopathic dacryoadenitis and myositis), quiescent orbital inflammation and pre-septal cellulitis were excluded. Thirty-two patients presenting between 2008 and 2023, including twenty-one OC patients (mean age: 42.5 ± 24.9 years old, male: 6), and eleven DNSOI patients (mean age: 52.3 ± 17.8 years old, male: 16). Both OC and DNSOI demonstrate orbital fat contrast-enhancement. However, whilst OC demonstrated a hyperintense T2 signal (P < 0.001), variable signal was observed in DNSOI, with a hypointense T2 signal more suggestive of DNSOI (P = 0.012). When the lacrimal glands were involved, indistinct margins were more likely in OC (P < 0.001), whilst gross enlargement and contrast-enhancement was observed in DNSOI (P = 0.032 and 0.017, respectively). Peripheral contrast-enhancement of the extraocular muscle (EOM) (P = 0.002) was more common in OC, whilst DNSOI demonstrated variable contrast-enhancement throughout the affected EOM (P < 0.001). The presence of contralateral abnormalities, such as lacrimal gland enlargement and EOM involvement, are more suggestive of DNSOI. Several MRI features, beyond overt sinogenic disease, may help to differentiate OC from DNSOI, including the orbital fat signal intensity, EOM and/or lacrimal gland involvement, and contralateral orbital abnormalities. However, these features may not be specific, and thus highlights the ongoing radiological dilemma clinicians are faced when tasked with differentiating between infectious and non-infectious orbital inflammatory disease.

Cellular pattern and orbital fat involvement are possible risk factors for the failure of corticosteroids in patients with pure idiopathic orbital inflammation syndrome: lessons from the French prospective SIOI cohort study (part II)

PurposeTo better characterise the effects of corticosteroids on the course of pure idiopathic orbital inflammation syndrome (pIOIS).MethodsThis was a national, multicentre, prospective, non-interventional cohort study (SIOI). Among the 35 patients...

Role of diffusion tensor imaging of extra ocular muscles and orbital fat in Graves’s ophthalmopathy and relation to disease activity

BackgroundGraves’ ophthalmopathy (GO) is one of the most common autoimmune inflammatory disorders affecting the orbit that characterized by swelling of extra ocular muscles (EOMs) and expansion of the orbital fat. Diffusion tensor imaging (DTI) could assess the microstructural integrity of tissue. We aimed at this study to assess the role of DTI in the evaluation of EOMs and orbital fat in GO and identify the relationship with disease activity.ResultsCase–control study included 40 patients diagnosed as Graves’ disease (20 active and 20 inactive) and 10 health control subjects underwent DTI. Low fraction anisotropy (FA) and high mean diffusivity (MD) of inferior rectus (IR), medial rectus (MR) and orbital fat in GO versus healthy control (HC), while high FA and high MD in active group versus inactive group. In order to differentiate between GO and HC; FA cutoff point of IR, MR& orbital fat were 0.46, 0.45 and 0.26 with sensitivity 98.8%,98.8% and 93.8% and specificity 95.0%, 95.0% and 85%, respectively. MD cutoff point for IR, MR and orbital fat 1.24, 1.27 and 1.275 with sensitivity 97.5%, 98.8% and 98.8% and specificity 95.0%, 95% and 95%, respectively. To differentiate between active and inactive GO; FA cutoff point of IR, MR and orbital fat were 0.35, 0.36 and 0.22 respectively with sensitivity 80.0%, 82.5% and 72.5% and specificity 95.0%, 85.0% and 65.0%, respectively. MD cutoff point for IR, MR and orbital fat were 1.58, 1.63 and 1.54 respectively with sensitivity 90.0%, 97.5% and 85.0%, and specificity 90.0%, 80.0% and 62.5%, respectively.ConclusionsDTI parameters (FA and MD) of EOMs and orbital fat are considered as crucial radiological biomarkers for diagnosis of GO and could quantitatively differentiate active form inactive disease.

Fat-suppression T2 relaxation time and water fraction predict response to intravenous glucocorticoid therapy for thyroid-associated ophthalmopathy.

To investigate the value of fat-suppression (FS) T2 relaxation time (T2RT) derived from FS T2 mapping and water fraction (WF) derived from T2 IDEAL to predict the treatment response to intravenous glucocorticoids (IVGC) in patients with thyroid-associated ophthalmopathy (TAO) based on texture analysis. In this study, 89 patients clinically diagnosed with active and moderate-to-severe TAO were enroled (responsive group, 48 patients; unresponsive group, 41 patients). The baseline clinical characteristics and texture features were compared between the two groups. Multivariate analysis was performed to identify the independent predictors of treatment response to IVGC. ROC analysis and the DeLong test were used to assess and compare the predictive performance of different models. The responsive group exhibited significantly shorter disease duration and higher 90th percentile of FS T2RT and kurtosis of WF in the extraocular muscle (EOM) and 95th percentile of WF in the orbital fat (OF) than the unresponsive group. Model 2 (disease duration + WF; AUC, 0.816) and model 3 (disease duration + FS T2RT + WF; AUC, 0.823) demonstrated superior predictive efficacy compared to model 1 (disease duration + FS T2RT; AUC, 0.756), while there was no significant difference between models 2 and 3. The orbital tissues of responders exhibited more oedema and heterogeneity. Furthermore, OF is as valuable as EOM for assessing the therapeutic efficacy of IVGC. Finally, WF derived from T2 IDEAL processed by texture analysis can provide valuable information for predicting the treatment response to IVGC in patients with active and moderate-to-severe TAO. The texture features of FS T2RT and WF are different between responders and non-responders, which can be the predictive tool for treatment response to IVGC. Texture analysis can be used for predicting response to IVGC in TAO patients. TAO patients responsive to IVGC show more oedema and heterogeneity in the orbital tissues. WF from T2 IDEAL is a tool to predict the therapeutic response of TAO.

Shear-wave elastographic imaging in choroidal melanomas: clinical and hemodynamic correlations.

This study evaluated the role of shear wave elastography imaging (SWEΙ) in uveal melanomas and the associations between SWEI and clinical and hemodynamic findings. Prospective, clinical study METHODS: Twelve patients with uveal melanomas, scheduled to undergo Ru-106 brachytherapy, were prospectively recruited from the Department of Ophthalmology of the University Hospital of Heraklion (September-December 2022). B-mode, hemodynamic and SWEI ultrasonography examinations were performed with the HiScan (OPTIKON 2000) and the LOGIQ E9 (GE Healthcare) sonographic systems, respectively. Differences in SWEI scores (kPa) between tumor (TS) and adjacent non-affected choroid (CS), as well as between TS and orbital fat (FS) were examined. Correlations between SWEI and intra-tumoral hemodynamic parameters, including peak systolic and end diastolic velocities and resistivity index (RI) were also examined. TS was significantly correlated with intra-tumoral RI (Pearson's bivariate correlation coefficient 0.681, p=0.015) and with maximal tumor height (Pearson's bivariate correlation coefficient 0.620, p=0.031). TS was significantly higher than both FS and CS scores (paired-samples t-test, p=0.003 and p=0.006, respectively). SWEI score is applicable as a quantitative biomechanical marker in the assessment of choroidal melanoma. Choroidal melanomas are stiffer than both adjacent choroid and orbital fat. Moreover, choroidal melanomas with higher RI as well as those with higher apical elevations display higher SWEI scores.

Sublabial transmaxillary approach to the inferior aspect of the orbit.

The objective was to demonstrate the surgical steps and outcomes of the sublabial transmaxillary microsurgical approach with endoscopic assistance to treat lesions in the inferior aspect of the orbit, as well as to describe the use of patient-specific 3D models to facilitate surgical preparation and improve experience with the technique. The authors' study evaluated data from patients who underwent an endoscope-assisted sublabial transmaxillary approach for inferior orbital lesions. For 2 patients, 3D models were created for preoperative planning and assessment of the approach. Surgical steps comprised osteotomy to access the maxillary sinus, bony resection of the orbital floor, opening of the periorbital fascia, and dissecting and removing the lesion, followed by closure. The neuroendoscope was used to inspect the surgical cavity between each step. The study included 5 patients with varying visual field defects and proptosis who underwent the sublabial transmaxillary microsurgical approach with endoscopic assistance. Complete resection was achieved in all, and all patients reported improvement in visual field defects and proptosis after the procedure. No complications were observed except for transient unilateral maxillary edema noted around the incision site in 3 patients during the early postoperative period, which resolved within a few days. Histopathological examination confirmed the diagnosis of cavernous malformation in all patients. The sublabial transmaxillary approach is a direct and safe method to resect cavernous malformations at the inferior aspect of the orbit. It reduces the risk of complications associated with lateral, transcranial, and transnasal approaches that may cross critical structures. The microsurgical approach provides the benefit of two-handed dissection for lesions embedded in orbital fat, which can be challenging because of adhesions to surrounding tissues. The use of 3D models can facilitate surgical planning and enhance familiarity with the approach.

The Experience in Lower Eyelid Blepharoplasty: Improvement of Surgical Procedures Based on Anatomical Basis.

This study characterizes the appearance changes associated with aging of the human lower eyelid, grounded in its anatomical basis. Tailored approaches to lower eyelid bag are performed by these anatomical manifestations. From January 2017 to January 2023, lower eyelid blepharoplasty was performed on 137 patients, aged 20 to 60 years. These patients were divided into 3 groups according to the periorbital aging appearance, primarily characterized by the presence and location of the "bag" bulge of the lower eyelid. We analyzed the corresponding changes in anatomical structures for each type, which included a weakened fibrous orbital support system, reduced muscle tone, and increased orbital fat. Patients were treated with tailored blepharoplasty techniques according to their classification. All patients in this study ranged in follow-up from 1 to 12 months. With patients' permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome. Our study identified 3 morphologies of the lower eyelid. Type 1 presents a "bubble bag" in the medial and inferior aspect of the lower eyelid. Type 2 features a double convexity contour, with separate fat pad herniations demarcated by fibrous connective tissue. Type 3 exhibits a single convexity with a uniform herniation of fat pads across the entire lower eyelid. We have delineated the anatomical changes associated with each morphology type. With an approach grounded in "remodeling" and "recovery," the surgical treatment targets the fibrous support tissue to improve the outcomes of lower eyelid rejuvenation. No complications occurred. All postoperative results reached both surgeon's and patient's expectations. Surgeons must recognize the pivotal role of fibrous connective tissues-including the arcuate expansion, fascia of the inferior oblique muscle, and the orbicularis retaining ligament-and endeavor to preserve or reinforce these structures during surgical procedures. An anatomically based surgical approach would more effectively and safely to resist the facial aging process.

A Rare Case of Subconjunctival Nerve Sheath Myxoma Presenting as Orbital Fat Prolapse.

Nerve sheath myxomas are extremely rare myxoid peripheral nerve sheath tumors with a predilection for the distal extremities, particularly common in the fingers and knees. Here, we report a 60-year-old male patient with a subconjunctival epibulbar nerve sheath myxoma, which was clinically diagnosed as an orbital fat prolapse. The lesion was successfully debulked without clinical recurrence over more than 3 years. To our knowledge, this is the first case with subconjunctival presentation and fourth orbital reported case.