Debunking the Puzzle of Eyelid Apraxia: The Muscle of Riolan Hypothesis

Chat GPT vs an experienced ophthalmologist: evaluating chatbot writing performance in ophthalmology

PURPOSE

To examine the abilities of ChatGPT in writing scientific ophthalmology introductions and to compare those abilities to experienced ophthalmologists.

METHODS

OpenAI web interface was utilized to interact with and prompt ChatGPT 4 for generating the introductions for the selected papers. Consequently, each paper had two introductions-one drafted by ChatGPT and the other by the original author. Ten ophthalmology specialists with a minimal experience of more than 15 years, each representing distinct subspecialties-retina, neuro-ophthalmology, oculoplastic, glaucoma, and ocular oncology were provided with the two sets of introductions without revealing the origin (ChatGPT or human author) and were tasked to evaluate the introductions.

RESULTS

For each type of introduction, out of 45 instances, specialists correctly identified the source 26 times (57.7%) and erred 19 times (42.2%). The misclassification rates for introductions were 25% for experts evaluating introductions from their own subspecialty while to 44.4% for experts assessed introductions outside their subspecialty domain. In the comparative evaluation of introductions written by ChatGPT and human authors, no significant difference was identified across the assessed metrics (language, data arrangement, factual accuracy, originality, data Currency). The misclassification rate (the frequency at which reviewers incorrectly identified the authorship) was highest in Oculoplastic (66.7%) and lowest in Retina (11.1%).

CONCLUSIONS

ChatGPT represents a significant advancement in facilitating the creation of original scientific papers in ophthalmology. The introductions generated by ChatGPT showed no statistically significant difference compared to those written by experts in terms of language, data organization, factual accuracy, originality, and the currency of information. In addition, nearly half of them being indistinguishable from the originals. Future research endeavours should explore ChatGPT-4's utility in composing other sections of research papers and delve into the associated ethical considerations.

Frontalis muscle flap eyelid reanimation technique in adults with severe ptosis or apraxia of eyelid opening

PURPOSE

Assessment of the frontalis muscle flap eyelid reanimation surgical technique for adults with severe ptosis and apraxia of eyelid opening.

METHODS

A retrospective case series of 30 eyes with severe ptosis or apraxia of eyelid opening. Outcomes were assessed for margin to reflex distance 1 (MRD1), lagophthalmos, complications, and need for subsequent surgical intervention. A paired t-test was used to compare preoperative and postoperative scores of a quality-of-life questionnaire.

RESULTS

Thirty eyes of 19 patients underwent surgery, 16 (53%) with combined frontalis + levator-Muller muscle flap and 14 (46%) with frontalis muscle flap alone. There were 14 female and 5 male patients, with an average age of 55 years (range, 18-76). Mean preoperative MRD1 was -0.6 mm (range, -5 to 2) with mean levator excursion of 7.1 mm. Seventeen eyes had a myogenic etiology, five had a paralytic etiology, six had blepharospasm with apraxia of lid opening, and two had a neurodegenerative etiology. Nineteen eyes (63%) had previously undergone ptosis repair. Mean postoperative MRD1 was 2.5 mm (range, 0.5 to 5) at mean follow-up of 63.3 days. There were no serious surgical complications; minor complications included ocular surface keratopathy and one patient who required surgical revision. Results of the QOL questionnaire indicated significant improvement in vision-related symptoms postoperatively (p = 0.02).

CONCLUSIONS

Use of the frontalis muscle flap eyelid reanimation technique, with or without a levator-Muller retractor muscle flap, was very effective in this case series and provided good upper eyelid position with acceptable corneal protection and high patient satisfaction.

A major review of punctal stenosis: Updated anatomy, epidemiology, etiology, and clinical presentation

We aim to provide a detailed and updated literature review on the epidemiology, etiology, clinical presentations, histopathology, and ultrastructural features of punctal stenosis. There are inconsistencies in the definition and staging of punctal stenosis. While advanced optical coherence tomography imaging techniques have revolutionized the way the punctum and vertical canaliculi are assessed or monitored following treatment, the planes of measurement to characterize punctum anatomy need to evolve further. The current criteria for diagnosing and grading punctal stenosis are inadequate and based on empirical clinical findings. There is increasing evidence of the role of lymphocytes and myofibroblasts in the pathogenesis of punctal stenosis. There is a need for a uniform assessment of punctal stenosis and a uniform reporting of severity that would help standardize the several management options available in the lacrimal armamentarium.

Extended frontalis orbicularis oculi muscle flap shortening for treating refractory apraxia of eyelid opening associated with blepharospasm

BACKGROUND

Refractory apraxia of eyelid opening (AEO) is mostly unresponsive to botulinum toxin (BTx) and inevitably leads to functional blindness. To treat this challenging condition, an innovative surgical technique was proposed.

METHODS

The extended frontalis orbicularis oculi muscle (FOOM) flap shortening consisting of frontalis suspension, partial myectomy, and myotomy in situ of eyelid protractors was applied to treat refractory AEO associated with blepharospasm. The postoperative outcomes and patient satisfaction were evaluated.

RESULTS

Seven patients (mean ages 64.1 ± 3.9 years) of 14 eyelids in total had an average flap shortening distance of 24.4 ± 1.3 mm. During a mean follow-up of 31.6 ± 11.4 months, the average BTx dosage reduced from 58.6 ± 12. 1 units to 30.0 ± 8.2 units, with a mean injection interval decreasing from 2.3 ± 0.5 months to 4.1 ± 0.9 months (p < 0.05). Palpebral fissure height increased from 1.4 ± 0.5 mm to 7.9 ± 0.7 mm, and the disability scale decreased from 78.8% ± 7.2% to 12.6% ± 7.0% (p < 0.05). The postoperative BTx dosage and frequency were significantly reduced. All patients restored voluntary eyelid opening and reported high postoperative satisfaction (average Likert scale 4.6 ± 0.5).

CONCLUSION

Extended FOOM flap shortening is an effective treatment to solve refractory AEO associated with blepharospasm.