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Mian OT, Lippe CM, Khan A, Bugg VA, Bryant JC, Riaz KM, Dvorak JD, Ding K, Moreau A. Dry eye in the upper blepharoplasty patient: a study comparing orbicularis-sparing versus orbicularis-excising techniques. Graefes Arch Clin Exp Ophthalmol 2023; 261:3625-3634. [PMID: 37354267 DOI: 10.1007/s00417-023-06131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/04/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To compare subjective and objective dry eye syndrome (DES) metrics preoperatively and postoperatively in patients undergoing bilateral upper eyelid blepharoplasty (ULB) using orbicularis-sparing versus orbicularis-excising techniques. METHODS A double-blind, randomized clinical trial was conducted on patients without prior DES or other severe conditions who presented to our institution between 2017 and 2019 for routine functional ULB. Patients were randomized into two treatment arms: bilateral ULB using the orbicularis-sparing technique or bilateral ULB using the orbicularis-excising technique. One subjective and seven objective DES assessments were performed on all patients preoperatively and 1 month and 1 year after surgery. RESULTS A total of 63 patients were recruited for the study. Standard Patient Evaluation of Eye Dryness (SPEED) scores decreased in both treatment groups at 1 month and 1 year postoperatively. This change did not significantly vary based on surgical technique. Objective DES assessments were not significantly changed at both postoperative time points for either group. There was a correlation between the severity of preoperative DES symptoms and the subjective improvement of DES symptoms postoperatively in both groups. CONCLUSIONS ULB with an orbicularis-sparing or orbicularis-excising technique does not worsen subjective or objective DES metrics and so, surgeons may confidently use either surgical technique. These findings may impact postoperative expectations for surgeons and patients alike.
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Affiliation(s)
- Osamah T Mian
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- College of Medicine, University of Oklahoma, Norman, OK, USA
| | - Christina M Lippe
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- Eye Consultants of Pennsylvania, Wyomissing, PA, USA
- Department of Ophthalmology, Drexel University, Philadelphia, PA, USA
| | - Asher Khan
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- College of Medicine, University of Oklahoma, Norman, OK, USA
| | - Victoria A Bugg
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA.
| | - Juliana C Bryant
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
| | - Justin D Dvorak
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kai Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Annie Moreau
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, Oklahoma City, OK, 73104, USA
- College of Medicine, University of Oklahoma, Norman, OK, USA
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Shirakawa Y, Uemura K, Kumegawa S, Ueno K, Iwanishi H, Saika S, Asamura S. Safety and Pitfalls of Blepharoptosis Surgery in Elderly People. Arch Plast Surg 2023; 50:446-451. [PMID: 37808334 PMCID: PMC10556323 DOI: 10.1055/s-0043-1770082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 10/10/2023] Open
Abstract
Background Elderly patients often have complications of blepharoptosis surgery that can result in the appearance or exacerbation of superficial punctate keratopathy (SPK). However, postoperative changes to SPK status have not been previously reported. We used subjective assessment of symptoms and measurement of SPK scale classification to investigate the safety and efficacy of blepharoptosis surgery in elderly patients. Methods Included in this prospective study were 22 patients (44 eyes) with bilateral blepharoptosis that underwent surgery. Patients comprised 8 males and 14 females with a mean (±standard deviation) age of 75.7 ± 8.2 years (range: 61-89). Blepharoptosis surgery consisted of transcutaneous levator advancement and blepharoplasty including resection of soft tissue (skin, subcutaneous tissue, and the orbicularis oculi muscle). Margin reflex distance-1 (MRD-1) measurement, a questionnaire survey of symptoms and SPK scale classification, was administered preoperatively and 3 months postoperatively for evaluation. Results The median MRD-1 was 1 mm preoperatively and 2.5 mm postoperatively, representing a significant postoperative improvement. SPK area and density scores were found to increase when the MRD-1 increase was more than 2.5 mm with surgery. All 10 items on the questionnaire tended have increased scores after surgery, and significant differences were observed in 7 items (poor visibility, ocular fatigue, heavy eyelid, foreign body sensation, difficulty in focusing, headaches, and stiff shoulders). Conclusion Blepharoptosis surgery was found to be a safe and effective way to maintain the increase in MRD-1 within 2.0 mm. Despite the benefits, surgeons must nonetheless be aware that blepharoptosis surgery is a delicate procedure in elderly people.
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Affiliation(s)
- Yuji Shirakawa
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Kazuhisa Uemura
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shinji Kumegawa
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Kazuki Ueno
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroki Iwanishi
- Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shinichi Asamura
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline: Eyelid Surgery for Upper Visual Field Improvement. Plast Reconstr Surg 2022; 150:419e-434e. [PMID: 35895522 DOI: 10.1097/prs.0000000000009329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A group of experts from different disciplines was convened to develop guidelines for the management of upper visual field impairments related to eyelid ptosis and dermatochalasis. The goal was to provide evidence-based recommendations to improve patient care. METHODS A multidisciplinary group of experts representing their specialty organizations was selected. A systematic literature review was performed including topics regarding documentation of the underlying cause for visual field impairment, selection of an appropriate surgical repair, assessment of the type of anesthesia, the use of adjunctive brow procedures, and follow-up assessments. The Grading of Recommendations, Assessment, Development, and Evaluation methodology process was used to evaluate the relevant studies. Clinical practice recommendations were developed using BRIDGE-Wiz (Building Recommendations In a Developers' Guideline Editor) software. RESULTS Each topic area was assessed. A clinical recommendation was made, and the relevant literature was discussed. CONCLUSIONS The review of the literature revealed varied complication rates and diverse treatment modalities for the correction of upper visual field deficit. Strong recommendations could not be made in most topic areas because of a paucity of methodologically sound studies in the literature. More rigorously designed studies are needed to measure outcomes of interest, with fewer sources of potential error or bias. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Asamura S, Wada Y, Tanaka S, Saika S. Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters. Arch Plast Surg 2022; 49:473-478. [PMID: 35919549 PMCID: PMC9340170 DOI: 10.1055/s-0042-1751101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background
We investigate the effect of involutional blepharoptosis (IB) surgery based on dry eye symptoms by analysis using objective and subjective measures.
Methods
We recorded various parameters from patients that underwent levator advancement surgery for IB, totaling 125 eyes (total 65 patients, 5 unilateral, 60 bilateral). Subjective assessment comprised a questionnaire on dry eye-related quality of life score (DEQS), a summary score calculated from DEQS, and six-grade evaluation, the patient's own measure of eye comfort. Objective assessment comprised marginal-reflex distance-1 (MRD-1), measurement of tear film breakup time, and superficial keratopathy (SPK) existence by slit lamp microscope.
Results
Subjective assessments showed that IB patients had improvement of dry eye symptoms and eye comfort when surgery increased MRD-1. On the other hand, objective assessments showed that the presence of SPK is suspected when the postoperative MRD-1 level is 3 mm or higher.
Conclusion
IB surgery must not only increase MRD-1 value, but also to perform maintenance of the appropriate ocular surface condition. From our parameters, we suggest postoperative MRD-1 value should be maintained at < 3 mm to safe and effective of IB surgery.
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Affiliation(s)
- Shinichi Asamura
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yoshitaka Wada
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Saiichi Tanaka
- Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
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Sato Y, Mimura M, Fujita Y, Oku H, Ikeda T. Chronologic Analysis of Tear Dynamics on Blinking Using Quantitative Manometry in Healthy Humans. Ophthalmic Plast Reconstr Surg 2022; 38:22-28. [PMID: 33710038 DOI: 10.1097/iop.0000000000001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the tear dynamics during blinking by measuring the inner pressure of the upper lacrimal drainage system. METHODS This observational study involved 11 healthy bi- or tricenarian volunteers. Direct manometry was performed using a fiber optic pressure sensor inserted into the conjunctival sac, upper/lower canaliculus (5 mm from punctum), and inferior lacrimal sac (15 mm from punctum) during both involuntary and intentional tight blinking. Pressure was measured 200 times/second during 3 separate blinks and then chronologically analyzed. RESULTS In all subjects of all locations during both types of blinking, the inner pressures during the stationary eyelid closing/opening were positive/approximately zero, while a positive/negative pressure spike was observed during the eyelid closing/opening movement. The averages of the maximum pressure in the spike during the intentional tight blinking (tPmax: mm Hg) in the conjunctival sac, upper/lower canaliculus, and lacrimal sac were 8.00, 12.39/12.93, and 10.59, respectively, while for the minimum (tPmin: mm Hg), the pressures were -3.18, -3.91/-3.43, and -3.31, respectively. The tPmax and tPmin in the lacrimal duct were positively correlated with that of the conjunctival sac, which suggested synchronism of the drainage system. However, the tPmax in the canaliculus was significantly higher than that of the conjunctival sac, which suggested that tears do not flow from the conjunctival sac into the lacrimal duct during eyelid closure. CONCLUSIONS The upper lacrimal drainage system functions as one united lumen in the lacrimal pump. The positive /negative pressure spike is essential for the lacrimal pump to efficiently eject/aspirate the tear from the lacrimal/conjunctival sac.
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Affiliation(s)
- Yohei Sato
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
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Zhao S, Song N, Gong L. Changes of Dry Eye Related Markers and Tear Inflammatory Cytokines After Upper Blepharoplasty. Front Med (Lausanne) 2021; 8:763611. [PMID: 34957146 PMCID: PMC8695769 DOI: 10.3389/fmed.2021.763611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the changes of dry eye-related clinical manifestations, ocular surface parameters, and tear inflammatory cytokines after upper blepharoplasty. Methods: Forty eyes of 20 who underwent upper blepharoplasty were divided into either the group with or the group without preexisting dry eye before upper blepharoplasty. Ocular Surface Disease Index (OSDI), Schirmer I test, tear meniscus height, lipid layer thickness, non-invasive tear break-up time (NIKBUT), fluorescein tear film break-up time (FBUT), corneal fluorescein staining, meibum expression, lid margin changes, and tear inflammatory cytokines were assessed preoperatively and at 1, 3, and 6 months postoperatively. Correlations between inflammatory cytokines and dry eye-related parameters were determined. Results: The OSDI scores increased significantly at 1 month (p = 0.040) and subsequently decreased to the preoperative levels at 6 months postoperatively in subjects with dry eye. First (f)-NIKBUT and FBUT were significantly shortened at 1, 3, and 6 months postoperatively in subjects with dry eye (f-NIKBUT: p <0.001, p = 0.010, p = 0.042; FBUT: p = 0.002, p = 0.005, p = 0.037, respectively), but were only shortened at 1 month (p = 0.028, p = 0.005) and returned to baseline levels at 6 months postoperatively in subjects without preexisting dry eye. A significant increasing trend of interleukin (IL)-6 was found in both dry eye and subjects without preexisting dry eye (p = 0.016, p = 0.008), while IL-8 and tumor necrosis factor alpha (TNF-α) were only found to be increased in subjects with dry eye postoperatively (p = 0.031, p = 0.031). The levels of IL-8 and TNF-α were positively correlated with OSDI scores (p = 0.046, p = 0.043, respectively) and negatively correlated with f-NIKBUT and FBUT (p = 0.026, p = 0.006, respectively). Conclusions: Upper blepharoplasty might increase the release of tear inflammatory cytokines and tear film instability that contribute to the development of postoperative dry eye in the early postoperative period and the changes most relieved in 6 months. Preexisting dry eye is a higher risk factor for worse and persistent ocular surface damage after upper blepharoplasty.
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Affiliation(s)
- Songjiao Zhao
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Nan Song
- Department of Facial Plastic and Reconstructive Surgery, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Lan Gong
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China.,Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
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Song HM, Tran KN. Incisional Blepharoplasty for the Asian Eye. Facial Plast Surg Clin North Am 2021; 29:511-522. [PMID: 34579834 DOI: 10.1016/j.fsc.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The goal of Asian blepharoplasty is to create a lid crease configuration that resembles the natural-appearing crease found in other Asians. Because the Asian upper eyelid contains more prominent preseptal fat resulting in greater lid fullness, soft tissue work in blepharoplasty of the Asian eye is even more diverse and essential than that of whites in order for there to be the sustainability of the eyelid crease. Hence, Asian blepharoplasty should be performed specifically following the orbital anatomy of Asians. This article details the incisional method of blepharoplasty to create natural-appearing creases for Asians with single eyelids.
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Affiliation(s)
- Hyung Min Song
- Drsong4u Aesthetic Plastic Surgery Clinic, 2-3 Floors, Dosandaero 37gil 6, Gangnam-gu, Seoul 06026, Korea.
| | - Khanh Ngoc Tran
- Drsong4u Aesthetic Plastic Surgery Clinic, 2-3 Floors, Dosandaero 37gil 6, Gangnam-gu, Seoul 06026, Korea
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Gurnani B, Kaur K. Current approach in surgical management of dry eyes – Dry eye review II. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Yan Y, Zhou Y, Zhang S, Cui C, Song X, Zhu X, Fu Y. Impact of Full-Incision Double-Eyelid Blepharoplasty on Tear Film Dynamics and Dry Eye Symptoms in Young Asian Females. Aesthetic Plast Surg 2020; 44:2109-2116. [PMID: 32696159 DOI: 10.1007/s00266-020-01874-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dry eye symptoms as a complication of double-eyelid blepharoplasty are controversial. This article evaluates tear film dynamics and changes in dry eye symptoms after cosmetic double-eyelid blepharoplasty in young Asian female. METHODS One hundred and twenty patients underwent full-incisional double-eyelid blepharoplasty. Subjective and objective parameters were documented before surgery, at 1 week, 1 month and 3 months post-surgery, which included Ocular Surface Disease Index questionnaire (OSDI), tear meniscus height (TMH), noninvasive breakup time (NIBUT), Schirmer I test, corneal and conjunctival fluorescein staining scores, and palpebral fissure height. Dry eyes were defined based on the DEWS II criteria: OSDI ≥ 13 points and NIBUT < 10 s. Patients were divided into two groups, group A included patients with redundant skin, while group B included patients with absence of redundant skin. RESULTS The incident rate of dry eyes preoperatively, and at 1 week, 1 month and 3 months were 12.5%, 12.5%, 32.5%, and 16.67%. OSDI scores were significantly increased at 1 week (9.71 ± 10.07, P < 0.001) and 1 month (11.35 ± 12.28, P < 0.001) postoperatively. A significant increase in TMH, NIBUT and Schirmer's test I values were observed at 1 week post-surgery (P < 0.001). Patients in group A showed higher OSDI scores compared to group B at 1 week and 1 month (P = 0.051) post-surgery, and the other variables showed no difference between the groups. CONCLUSIONS Cosmetic double-eyelid blepharoplasty may temporarily affect tear film dynamics and aggravate dry eye symptoms in young females. However, these changes generally recover 3 months postoperatively. LEVEL OF EVIDENCE IV 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 .
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10
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Zhang SY, Yan Y, Fu Y. Cosmetic blepharoplasty and dry eye disease: a review of the incidence, clinical manifestations, mechanisms and prevention. Int J Ophthalmol 2020; 13:488-492. [PMID: 32309188 DOI: 10.18240/ijo.2020.03.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/07/2019] [Indexed: 02/02/2023] Open
Abstract
Dry eye disease is a multifactorial disease of the ocular surface and can be caused by a variety of iatrogenic interventions, especially ophthalmic surgical procedures. This article reviews the incidence, clinical manifestations, mechanisms and prevention of dry eye disease caused or worsened by cosmetic blepharoplasty, and focus on how to reduce and prevent the occurrence of postoperative dry eye disease and provide the basis for the selection of operation methods and the rational drug during the perioperative period.
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Affiliation(s)
- Si-Yi Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Yan Yan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Yao Fu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Ka SI, Kim SE, Park DH. Analysis of long-term outcomes after surgery in patients with severe blepharoptosis. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2019. [DOI: 10.14730/aaps.2019.25.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Li K, Zhang XC, Cai XX, Quan YD, Lu R. The inflammation influence on corneal surface after frontalis suspension surgery. Int J Ophthalmol 2018; 11:1489-1495. [PMID: 30225223 DOI: 10.18240/ijo.2018.09.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines. METHODS A prospective, observational case series. Thirty-one eyes of 25 patients with severe congenital blepharoptosis who underwent frontalis muscle flap suspension surgery with at least 6mo of follow-up were included in the study. The main outcome measures were margin reflex distance 1 (MRD1), degree of lagophthalmos, ocular surface disease index (OSDI), fluorescein staining (Fl), tear break-up time (BUT), Schirmer I test, and inflammatory cytokine assay. RESULTS The degrees of lagophthalmos significantly increased after surgery. The OSDI scores significantly increased 1wk postoperatively and then decreased 4wk after operation. The Fl scores reflected corneal epithelial defects in sixteen patients at early stage postoperatively. The BUT and Schirmer I test values remained stable and did not show change compared to those before surgery. The inflammatory cytokines in conjunctival epithelial cells (including IL-1β, IL-6, IL-8, TNF-α, and IL-17A) significantly increased 1wk after the surgery (P<0.001), then returned to the normal level at 24wk postoperatively. The levels of inflammatory cytokine IL-1β, IL-6, IL-8, TNF-α, and IL-17A elevated significantly and were positively correlated with OSDI and Fl scores. CONCLUSION Frontalis muscle flap suspension surgery results in lagophthalmos in early period of post-operation and relieved after months. The elevation of inflammatory cytokines level may participate in the occurrence of corneal epithelial defects at the early postoperative stage.
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Affiliation(s)
- Kang Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xin-Chun Zhang
- Department of Prosthodontics, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xian-Xian Cai
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ya-Dan Quan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Rong Lu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Chen C, Dong ZQ, Shen JH, Chen HW, Zhu YH, Zhu ZG. 2D Photonic Crystal Hydrogel Sensor for Tear Glucose Monitoring. ACS OMEGA 2018; 3:3211-3217. [PMID: 31458578 PMCID: PMC6641290 DOI: 10.1021/acsomega.7b02046] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/06/2018] [Indexed: 05/27/2023]
Abstract
Photonic crystal (PC) materials have huge potentials as sensors for noninvasive and real-time monitoring glucose in tears. We developed a glucose-sensitive PC material based on monolayered colloidal crystals (MCCs). Polystyrene nanoparticles were first self-assembled into a highly ordered MCC, and this two-dimensional (2D) template was then coated by a 4-boronobenzaldehyde-functionalized poly(vinyl alcohol) hydrogel. Such a sensor efficiently diffracts visible light, whose structural color could change from red through yellow to green, as the glucose concentration altered from 0 to 20 mM, covering both tears' and bloods' physiological ranges. The sensor also represents a rapid response within 180 s at each titration of glucose, combining the characteristics of high accuracy and sensitivity in detecting the glucose concentration in tears, and this intelligent sensing material presents certain possibility for the frontier point-of-care glucose monitoring.
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Affiliation(s)
- Cheng Chen
- School
of Environmental and Materials Engineering, College of Engineering, Shanghai Polytechnic University, 2360 Jinhai Road, Shanghai 201209, China
- Shanghai
Innovation Institute for Materials, Shanghai 200444, China
| | - Zhi-Qiang Dong
- School
of Environmental and Materials Engineering, College of Engineering, Shanghai Polytechnic University, 2360 Jinhai Road, Shanghai 201209, China
| | - Jian-Hua Shen
- Key
Laboratory for Ultrafine Materials of Ministry of Education, School
of Materials Science and Engineering, East
China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China
| | - Hao-Wen Chen
- School
of Environmental and Materials Engineering, College of Engineering, Shanghai Polytechnic University, 2360 Jinhai Road, Shanghai 201209, China
| | - Yi-Hua Zhu
- Key
Laboratory for Ultrafine Materials of Ministry of Education, School
of Materials Science and Engineering, East
China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China
| | - Zhi-Gang Zhu
- School
of Environmental and Materials Engineering, College of Engineering, Shanghai Polytechnic University, 2360 Jinhai Road, Shanghai 201209, China
- Shanghai
Innovation Institute for Materials, Shanghai 200444, China
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 247] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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15
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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16
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Abstract
The aim of this study was to predict the improvement of the marginal reflex distance (MRD1) in each blepharoptosis surgery.In PubMed and Scopus, the search terms 1. (blepharoptosis) AND 2. (surgery) AND 3. (levator OR outcome OR MRD OR function OR ptosis amount) were used and 1268 titles were found. Among them 28 papers were analyzed: Aponeurotic surgery (A-group, 8), Muller muscle resection (M-group, 10), Levator resection (L-group, 4), and Frontalis suspension (F-group, 6).The preop-MRD1 was greatest in L-group (1.7 ± 1.0 mm) followed by the A-group (1.3 ± 0.5 mm) and the M-group (1.3 ± 0.5 mm). The F-group had the lowest (-0.4 ± 0.7 mm). Age was oldest in the M-group (58.6 ± 11.9 years) followed by the A-group (42.4 ± 18.9 years) and the F-group (27.2 ± 17.9 years). The L-group was the youngest (18.9 ± 11.5 years). The mean improved amount of MRD1 (ΔL) was 2.15 ± 0.90 mm. The ΔL was different among the four operative methods. The F-group was greatest (2.4 ± 1.5 mm) followed by the A-group (2.3 ± 0.5 mm) and the M-group (2.0 ± 0.6 mm). The L-group had the least improved amount of MRD1 (1.8 ± 0.8 mm). There were significant differences between the groups (P < 0.05), except between the F-group and the A-group (P = 0.284). The mean follow-up period was 8.1 ± 7.0 months. In the 3 groups except A-group, the ΔL decreased in follow-up periods, with different degree of decrement. Only in A-group, ΔL increased slightly in follow-up periods. We think this is due to relatively well preserved levator function and short follow-up period (5.4 ± 3.3 months) of A-group patients.The results of this review can be used in choosing blepharoptosis correction methods.
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