STRABO care less traumatic strabismus surgery technique in the rehabilitation of patients with strabismus

Purpose. Comparative evaluation of patients' rehabilitation using less traumatic STRABO care technique and traditional methods of strabismus surgery. Material and methods. Sixty-two patients with esotropia were included in the study. All participants underwent medial rectus muscle recession and lateral rectus muscle plication. Patients were divided into two groups. In the main group (38 patients), the surgery was performed with less traumatic technique. Radio-wave knife was used for dissecting the connective tissues. Vicryl 7-0 was used as suture material. Traditional surgical technique was used in control group (24 patients). Scissors were used as a cutting tool and Vicryl 6-0 as a suture material. In the postoperative period conjunctival hyperemia, and width of the palpebral fissure were assessed after the surgery. Conjunctival flap edema (thickness) was measured one day after surgery by the anterior segment optical coherence tomography (AS-OCT). Results. The 1st day after surgery the median thickness of the conjunctival flap above the recession site according to AS-OCT was on average 1.5 times thinner in the main group than in the control group: 405 (351–555) µm vs. 618 (513–732) µm; p<0.001. During the entire observation period in the eyes operated with less traumatic technique, hyperemia was less expressed and palpebral fissure was wider as compared to the control group, where the standard surgical technique was used. Conclusion. Less traumatic STRABO care surgical technique allows to reduce the inflammatory response of tissues in response to surgical intervention and to facilitate the course of the early postoperative period. Key words: strabismus surgery, low-traumatic technique, radio-wave knife, oculomotor muscles, rehabilitation, STRABO care, anterior segment optical coherence tomography

COMPARISON OF EYELID ANGLE MEASURED USING MANUAL AND DIGITAL IMAGE ANALYSIS METHOD

Aim: To compare the eyelid angle measured by using a manual method (Using protractor) and digital image analysis method (Using ImageJ software) at different distances of eye gaze. Methodology: This prospective cross-sectional study was conducted in the preclinical lab at Manipal College of Health Professions. Subjects with no eyelid abnormalities were included in the study and they were asked to fixate at different distances a) at 3 metre (Distance gaze) b) at 70 cm (Intermediategaze) and c) at 40 cm(Near gaze). Using a protractor, the eyelid angle measurements were repeated at various distances which comprised the manual measurement. In the image analysis method, images were captured during distance, intermediate and near gaze using smartphone placed on theside of the face. These images were then analysed using ImageJ software for determining eyelid angle using image analysis method. Palpebral fissure height, Palpebral fissure width, Interpupillary distance, Intercanthal width, Binocular width, Height of open upper lid were some additional anthropometry measurements that were done using meter scale and PD ruler. Results: The mean age of the participants was 20±0.5 years. Anthropometry measurements of the eyelid and Palpebral fissure were done using meter scaleand PD ruler. The mean and standard deviation of the measured parametersare as follows Interpupillary distance: 60.95±2.37 mm, Endo Inter canthal distance: 32.20±2.39 mm, Exo Inter cantal distance: 95.50±3.80 mm, Palpebralfissure height_OD: 12.11±1.32 mm, Palpebral fissure height_OS:12.16±1.46mm, PFW_OD: 32.00±1.10 mm, PFW_OS: 32.11±1.24 mm, Height of upper eyelids_OD: 10.26±1.66 mm and Height of upper eyelids_OS:10.42±1.83 mm. In the right eye, there was no statistically significant difference (p&gt;0.05) between manual protractor method and digital image analysismethod at distance but there was a statistically significant difference (p&lt;0.05)between manual protractor method and digital image analysis method atIntermediate and near. In left eye, there was statistically significant difference(p&lt;0.05) between manual protractor method and digital image analysis method at all three distances. Conclusion: There is a significant difference in eyelid angle measured using manual protractor method and digital image analysis method. The measurement of eyelid angle serves as a critical reference point during cosmetic and reconstructive surgical interventions of the eyelid and accurate measurements are essential for preoperative assessment, surgical planning and postoperative evaluation. Hence more studies on the validation of the anthropometry measurements and eyelid angle using digital image analysis areessential to use digital image analysis in routine eye care practice.

The Design and Manufacture of Custom Ocular Prostheses (COPs) Based on Computer-Aided Semi-automation Workflow

Background: It is important to correct the ocular disfigurement by wearing prostheses as soon as possible after healing from the eye enucleation surgery. This study aimed to develop a new computer-aided approach to fabricate custom ocular prostheses (COPs) with higher accuracy and efficiency and to fit different anophthalmia sockets. Results: Five patients underwent enucleation surgery from November 2018 to October 2020 were enrolled in the study. The semi-automatic design and fabrication workflow of COPs was based on the conjunctival sac impression, combined with Computer-aided design/Computer-aided manufacture (CAD/CAM) workflow, which involves computer image analysis, reverse engineering (RE), and 3-dimensional (3D) printing technologies. The height of palpebral fissure in the artificial eye group was 0.8000 ± 0.09529, N=5.The height of palpebral fissure in the healthy eye group was 0.7660 ± 0.1147, N=5, and there was no statistical difference between the two groups (p>0.05). The artificial eye in the conjunctival sac had a good effect on the reconstruction of orbital fullness. Both of the vertical activity and horizontal activity of COPs is smaller than that of healthy eyes (p<0.05).Conclusions: COPs made by RE and 3D printing technologies can effectively make the COPs suitable for patients' conjunctival sac. This workflow improved the accuracy of the COPs, and also reduced patients’ waiting time, which is worthy to be popularized and applied.

Changes in eyelid position after glaucoma filtering surgery

Background While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes. Methods Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes. Results Of 100 eyes included 81 (81%) showed no change in eyelid height (−0.133 mm ± 0.496), 11 (11%) showed ptosis (−1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction. Conclusions Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction. The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.

Effect of Transcutaneous Upper Eyelid Blepharoplasty on Blink Parameters and Lipid Layer Thickness

Purpose: This study aimed to investigate the effect of transcutaneous upper eyelid blepharoplasty on lipid layer thickness (LLT) and blink parameters in young women during the early postoperative period.Methods: This prospective study included 110 eyes of 55 young female patients (age range, 19–31 years) who underwent transcutaneous upper eyelid blepharoplasty. The LLT and blink parameters measured using a LipiView interferometer were recorded before the surgery and 1 week and 1 month after the surgery. Ocular Surface Disease Index (OSDI) score, noninvasive tear film breakup time (NITBUT), and palpebral fissure height (PFH) measurements were also performed at each time point.Results: The number of blinks significantly decreased (P &lt; 0.001), and the number of partial blinks and partial blink rate (PBR) significantly increased 1 week after the surgery (P = 0.002 and P &lt; 0.001); they all returned to baseline in 1 month. The LLT and OSDI score increased significantly 1 week and 1 month after the surgery (P &lt; 0.001 and P &lt; 0.001). A significant increase in the NITBUT and a significant decrease in the PFH were observed 1 week after the surgery (P &lt; 0.001 and P &lt; 0.001), and the values returned to baseline 1 month after the surgery. No clinical correlation was found between blink parameters and ocular surface parameters.Conclusions: Transcutaneous upper eyelid blepharoplasty led to a change in blink parameters and ocular surface parameters during the early postoperative period. However, this influence was temporary, and the transitory change in blink parameters had no effects on the ocular surface environment.

Anthropometric Study of Facial Morphology in Northern Thai Population Aged 1 to 18 Years Old to Inform the Timing of Craniofacial Reconstruction

Objective: To determine normal range of craniofacial structures, compare between male and female and establish growth curves in subjects aged 4 to 18 years old. Moreover, to determine normal range of craniofacial structures in subpopulation aged 1 to 3 years old. Materials and Methods: The present study was a cross-sectional study including 388 healthy subjects consisted of 363 subjects aged 4 to 18 years old and 25 subjects aged 1 to 3 years old. Both groups were Northern Thai. All subjects were measured to record the craniofacial anthropometry and established the growth curves in 6 regions including head, face, orbit, nose, labio-oral and ears. Results: In the population aged 4 to 18 years old, upper vermillion height of males was 9.03±2.92 mm. while in females was 8.45±2.38 mm (p=0.039). Left auricular length of males was 57.22±5.33 mm, while in females was 55.89±4.59 mm (p=0.011). Right auricular length of males was 57.40±5.35 mm, while in females was 55.91±4.75 mm (p=0.006). In the population aged 1 to 3 years old, left palpebral fissure of male was 10.42±2.45 mm, while in females was 8.27±1.43 mm (p=0.041). The trend in morphological face height was stable after 13 years old. The trend in physiognomical face height, binocular width, mouth width, and auricular height was stable after 16 years old. The trend in forehead height, mandible width, and nasolabial angle was stable after 18 years old. Conclusion: Each of the parameters showed a tendency to be stable at a specific cut-off age. Therefore, craniofacial reconstruction should be carried out after the specific cut-off ages identified in the results. Keywords: Facial anthropometry; Anthropometrics; Craniofacial; Northern Thai

EFFICACY OF FRONTALIS MUSCLE FLAP SUSPENSION IN TREATING MODERATE TO SEVERE BLEPHAROPTOSIS

Purpose: This study aims to evaluate the efficacy of frontalis muscle flap suspension in treating moderate to severe blepharoptosis. Study subjects: 54 eyes of 47 moderate to severe blepharoptosis patients (aged 17.34 ± 9.17 years, 18 males, 29 females). Study design: Prospective uncontrolled clinical trial. Results: Following frontalis muscle flap suspension surgery, there was a statistically significant improvement (p<0.001) in margin reflex distance 1 (MRD1) and palpebral fissure height (PFH), from 0.009 ± 0.60 mm and 5.59 ± 0.68 mm (pre-operation) to 2.68 ± 1.10 mm and 8.26 ± 1.14 mm (1 week after operation), 3.63 ± 0.77 mm and 9.24 ± 0.85 mm (6 months after operation), 3.45 ± 0.80 mm and 9.02 ± 0.89 mm (12 months after operation). At the 12th month after operation, it was found that severe lagophthalmos, lid lag on down-gaze and forehead hypoesthesia were present in 7.4%, 9.3% and 14.0% of all treated eyes, respectively. Excellent functional results were determined in 66,0% of procedures postoperatively, with 31,9% and 2,1% rated as good and unsatisfactory. In terms of cosmetic results, 78,7%, 19,1% and 2,1% of cases were rated as excellent, good and unsatisfactory, respectively. Conclusion: Majority of case results were excellent (78,7%) and good (19,1%), unsatisfactory cases 2,1%.

Anatomy of eyelids muscles

Objective of the research was to study up-to-date literary data concerning anatomical peculiarities of palpebral muscles and their supporting and retaining apparatus. Eye diseases have become common nowadays. Very fast development of computer technology and deterioration of ecological conditions are one of the most important factors affecting visual organ impairment. Age physiological changes of the eye and adjacent tissues aggravate the quality of human life as well. Meanwhile, the majority of changes can be corrected. Modern ophthalmology possesses a plenty of surgical techniques, and development of skills in cosmetology and new pharmacological agents ensure a desirable delay of aging and deterioration of the visual organ functions. All the above factors are unlikely to become achievements in medicine without comprehensive awareness of the visual organ anatomy and its auxiliary apparatus. A lot of diseases are associated with eyelids, and ectropion and ptosis of the lower or upper eyelid are the commonest of them. Hypertrophy of the upper part of the orbicular muscle causes ectropion. It is a condition in which the upper eyelid is turned outwards. Isolation of the upper tarsal muscle from the tarsal plate leads to the development of aponeurotic ptosis. Strain of the lower retaining ligament, palpebral fissure septum and capsular-palpebral ligament result in ectropion of the lower eyelid. The presented literary review contains up-to-date information concerning the structure of the muscles of the eyelids and adjacent and auxiliary structures, their functions and possible functional disorders are described. Conclusions. Еhe review of scientific literature dealing with anatomical studies of palpebral muscles and their main adjacent structures is indicative of great interest of scientists in this issue. Though our study has found certain disembodied data and unsystematized fragments in the literature available. In our opinion, compiling an appropriate handbook dealing with the data base available concerning anatomy of the eyelids will considerably improve the quality of numerous surgical operations in cosmetology and ophthalmology.