Long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy

PURPOSE

The purpose of this study is to assess the long-term outcomes of modified transcanalicular diode laser dacryocystorhinostomy in a large cohort of patients affected by primary acquired nasolacrimal duct obstruction.

METHODS

This study, conducted from January 17 to June 2022, encompassed 141 patients (159 procedures) who underwent modified transcanalicular diode laser dacryocystorhinostomy (MT-DCR). The procedure employed an 810-nm diode laser. Patients were monitored for at least a year after the intervention. Anatomical success was determined by ostium patency upon irrigation, while functional success referred to epiphora resolution. Parameters studied included patient demographics, procedure duration, complications, and both anatomical and functional success. Statistical analysis was performed using the Statistical Package for the Social Sciences software, with results considered significant at a 95% confidence interval (p≤0.05).

RESULTS

A total of 159 lacrimal drainage systems (141 patients: 112 women and 29 men) were included in this study. Among them, 18 underwent bilateral procedures. The average patient age was 58 years (range: 34-91 years), and the average surgical duration was 24 minutes (range: 18-35 minutes). One year after the surgery, MT-DCR exhibited anatomical and functional success rates of 84.9% (135/159) and 83% (132/159), respectively.

CONCLUSION

MT-DCR achieved an anatomical success rate of 84.9%, reflecting an excellent outcome. However, further extensive studies with larger sample sizes and longer follow-up periods are necessary to substantiate these findings.

Three-Dimensional Analysis of Tear Trough Volume After Lower Blepharoplasty with Midface Lift

Background: This study aims to evaluate three-dimensional stereophotogrammetry measured volume changes in the tear trough area after lower blepharoplasty with midface lift with or without orbital fat manipulation. Objective: Among patients undergoing midface lift surgery, volume change by three-dimensional photography in the tear trough region was compared between those having no orbital fat manipulation, fat transposition, or fat resection. Methods: This is a prospective study of 260 eyelids of 130 patients who underwent cosmetic midface surgery. All patients had an external skin muscle flap midface lift. During the procedure, medial inferior orbital fat was resected, repositioned to a preperiosteal dissection pocket, or not manipulated. Forty-six patients (35.4%) had no fat manipulation, 42 patients (32.3%) had fat preservation with repositioning to the preperiosteal pockets on the medial inferior orbital rim, and 42 patients (32.3%) had fat resection without repositioning. Results: All patients had volume gain in tear trough volume. The amount was not statistically significantly different between fat treatment groups. Mean follow-up time was 12 months (range 6-20 months). Conclusions: Midface lifting improved tear trough volume irrespective of how fat was manipulated.

The effect of bevacizumab, 5-fluorouracil, and triamcinolone on the healing modulation of surgical wounds in rats

In this study, we aimed to analyze the effect of 5-fluorouracil, triamcinolone, and bevacizumab on scar modulation in an experimental rat model of surgical lesions. Rats (Rattus norvegicus albinus) were divided into four groups: bevacizumab, 5-fluorouracil + triamcinolone, bevacizumab + 5-fluorouracil + triamcinolone, and control (received no medication) groups. A linear, dorsal incision was created and sutured for the first intention wound healing, mimicking the surgical incision of upper blepharoplasty. Treatments were initiated on day 7, and the rats were euthanized on day 14. Only in the 5-fluorouracil + triamcinolone group was there a difference in the number of infiltrated monocytes. There was 56%, 86%, and 85% decrease in the number of neovessels in the bevacizumab, 5-fluorouracil + triamcinolone, and bevacizumab + 5-fluorouracil + triamcinolone groups, respectively, compared with the control. Picrosirius red staining showed higher collagen density and more organized collagen in the treatment groups than in the control group. Scar modulation was observed in all groups, but the 5-fluorouracil + triamcinolone group presented the best results. To our knowledge, this is the first study to evaluate the influence of three medications in combination on healing. When used together, these medications can prevent the development of unsightly scars, and are therefore promising alternatives to corticosteroids.

Lacrimal gland choristomas

The purpose of this article was to report a case of intraconal lacrimal gland tissue and to review the literature on lacrimal gland choristoma. The magnetic resonance imaging findings of a biopsy-proven orbital case are also presented. A PubMed database search was performed using the key terms heterotopic, ectopic, aberrant, choristoma, and lacrimal gland to identify all the previously documented studies on lacrimal gland choristoma, in English, Spanish, and French. We classified the lacrimal gland choristoma cases classified according to the location of the lesions, clinical appearance, management, and outcome. The search targeting the period between 1887 and 2019 returned 79 articles, which were reviewed. We found a total of 113 cases of choristomas with normal lacrimal gland tissue. Only two of them were not associated with the eye or its adnexa while the remaining 111 lesions were found either on the ocular surface (n=46) or in the orbit (n=34). Intraocular choristomas were found in 18 patients, and the rest of the lesions were noted either on the eyelids (n=10) or in the lacrimal drainage system (n=3). Orbital and intraocular choristomas are the most harmful lesions as orbital choristomas are frequently associated with permanent diplopia while intraocular lacrimal gland choristomas have a poor visual prognosis and are a common cause of enucleation of the eye. In one of the reported cases, a corneal lacrimal gland choristoma had been experimentally induced by activating the FGF10 signaling pathway. Lacrimal gland choristomas are not uncommon. This peculiar type of lesion has been experimentally induced and may appear in a variety of locations associated with the globe and its adnexa.

A Prospective Randomized Study of Lateral Brow-Eyelid Complex Volume after Internal Browpexy Using Three-Dimensional Stereophotogrammetry

Background: A full lateral brow-eyelid complex may help rejuvenate and feminize the face. Objectives: To compare periorbital volume change of patients as measured by three-dimensional (3D) stereophotogrammetry before and after blepharoplasty with or without internal browpexy sutures. Methods: This is a prospective randomized controlled study of 124 eyelids of 62 adult female patients who underwent cosmetic upper eyelid blepharoplasty by a single surgeon. Subjects were randomized to blepharoplasty alone (control) or blepharoplasty with an adjunctive "brassiere suture" internal browpexy (intervention). An observer masked to the intervention measured the brow-eyelid volume using standardized images obtained with a 3D camera, before and after surgery. The minimum follow-up was 6 months postoperatively. Results: Sixty eyelids (30 patients) were treated with upper blepharoplasty alone and 64 eyelids (32 patients) had blepharoplasty plus internal browpexy. The mean volume gain was 0.85 mL in the internal browpexy intervention group and 0.19 mL in the control group. The volume increased in all patients receiving browpexy and this change was greater than after blepharoplasty alone (p < 0.05). The mean follow-up time was 16.8 months (range 6-24 months). Conclusions: Adjunctive internal browpexy during blepharoplasty was associated with increased volume of the lateral brow-eyelid complex.

Solitary fibrous tumor of the lacrimal gland mimicking pleomorphic adenoma

Solitary fibrous tumor (SFT) is a rare mesenchymal spindle-cell neoplasm commonly found in the pleura; it is rare in the orbit and extremely rare in the lacrimal gland. We herein report a case of SFT of the lacrimal gland that mimicked a pleo morphic adenoma. We discuss the clinical, radiological, histopathological, and immunohistochemical findings that provided insight and rationale to accurately diagnose this case.

Extraconal cystic schwannoma mimicking an orbital dermoid cyst

To our knowledge, we report the first case of an extraconal orbital cystic schwannoma in Brazilian literature. The tumor grew slowly and progressively and was associated with minimal eccentric proptosis and diplopia. The radiologic study (orbital computed tomography) revealed a rounded, encapsulated, and extraconal cystic mass in the superior medial region of the right orbit in the supraorbital and supratrochlear nerve topography. An anterior orbitotomy with full excision of the tumor was performed, and the histopathology examination revealed that the tumor was a schwannoma. After the surgery, the patient experienced total remission of his symptoms.

Complications and Management of Polymethylmethacrylate (PMMA) Injections to the Midface

BACKGROUND

Polymethylmethacrylate (PMMA) has been used as an injectable filler to treat hollows and reduce rhytids. PMMA injections have been associated with several side effects, however, the literature is scarce on periorbital complications and their treatments.

OBJECTIVES

The purpose of this study is to report a series of complications after periorbital PMMA injections to the midface and to describe their management.

METHODS

Retrospective chart review, including photography and histopathology when available.

RESULTS

The authors identified 11 cases of complications of PMMA injections to the midface. Patient ages ranged from 36 to 62 years (mean, 47 years; median, 44 years). Two (18%) were males and 9 (82%) were females. Adverse effects began between 2 to 24 months after injection (mean, 7.2 months; median, 6 months). All patients had edema, erythema, and contour irregularity. Seven (64%) patients had nodules, 4 (36%) had yellow, xanthomatous skin changes, and 2 (18%) had eyelid malposition. Histopathology demonstrated a giant cell inflammation in 5 of 6 cases. Corticosteroid injection was tried in 6 cases but was associated with minimal clinical improvement. Surgical debulking of the implanted material was performed in 9 (82%) cases and was effective in improving edema, erythema, and nodularity.

CONCLUSIONS

PMMA injection to the midface may be associated with chronic inflammation, fibrotic nodules, yellowing of the skin, and eyelid malposition. Intralesional corticosteroid injections yielded minimal or no improvement; surgical debulking achieved favorable results. LEVEL OF EVIDENCE 4: Therapeutic.