Strategies of upper blepharoplasty in aging patients with involutional ptosis

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.

Bio-Sulfur Pre-Treatment Suppresses Anthracnose on Cucumber Leaves Inoculated with Colletotrichum orbiculare

Bio-sulfur can be produced in the process of desulfurization from a landfill and collected by some microorganism such as Thiobacillus sp. as a sulfur element. In order to investigate practical use of bio-sulfur as an agent for controlling plant disease, in vitro antifungal activity of bio-sulfur was tested against Colletotrichum orbiculare known to cause cucumber anthracnose. Efficacy of bio-sulfur for suppressing anthracnose disease was also evaluated in vivo using cucumber leaves. Mycelial growth of C. orbiculare on medium containing bio-sulfur was inhibited. Disease severity of cucumber leaves pre-treated with bio-sulfur was significantly decreased compared to that of untreated ones. To illustrate how bio-sulfur could suppress anthracnose disease, structures of cucumber leaves infected with C. orbiculare were observed under a fluorescent microscope and a scanning electron microscope (SEM). Cucumber leaves pre-treated with bio-sulfur showed a low rate of appressorium formation whereas untreated ones showed abundant appressoria. Shrunk fungal hyphae were mostly observed on bio-sulfur-pretreated leaves by SEM. Similar results were observed on leaves pre-treated with a commercial fungicide Benomyl®. These results suggest that inhibition of appressorium formation of C. orbiculare by bio-sulfur may contribute to its suppression of cucumber anthracnose.

Choroidal Metastasis from Prostate Cancer

Metastasis of choroid from prostate cancer is not common and has not been reported before in Korea. We report a case of decreased vision in a patient with prostate cancer. After external beam radiotherapy, patient had complete response in the choroidal metastasis. Metastasis of choroid secondary to prostate is not common. There have been only 8 cases reported. In this case, we demonstrated that external beam radiotherapy showed a therapeutic effect.

Transconjunctival Lower Eyelid Widening using Tucking Method between Lower Eyelid Retractor and Lower Tarsal Plate

Double eyelidplasty, ptosis correction with epicanthoplasty are widely-performed surgeries in Asians. However, patients with a narrow palpebral fissure or an up-slanting appearance tend to have a slightly disappointing surgical outcome. In those patients, cosmetic lateral canthoplasty may be an effective adjunctive procedure for lengthening the palpebral fissure in selected patient, but may have limiting results on patients with a short palpebral fissure or severe up-slanting appearance. Lower eyelid descent was previously recognized as a symptom of aging process or a complication of lower blepharoplasty. In the present, many Korean women want large, round, and oval-shaped eyes. The authors have introduced a lowering the lower eyelid via a transconjunctival approach to enlarge the palpebral fissure in selected patients. A total of 441 Korean patients underwent lowering of the lower eyelid via a tranconjunctival approach with or without lateral canthoplasty from 2005 to 2011. There were 12 males and 429 female with age ranging from 19 to 44 years old. The procedure was composed of transconjunctival incison and tucking procedure between lower eyelid retractor and lower tarsal plate. The up-slanting lower eyelid shape was easily modified by the procedure in all cases. Most patients were satisfied with the results. Mean follow-up period from 2 weeks to 4 years. Postoperative conjunctival swelling and chemosis were spontaneously resolved within 2 or 3 weeks. The lowering of the lower eyelid is a simple, effective and reliable method for selective patients.

Blepharoptosis Correction with Muller Tuck Method

There are several methods for blepharoptosis correction. Many complication of blepharoptosis induced by operation. Lid lag and lagophthalmos is especially, a difficult problem to resolve. So, many plastic surgeons make an effort to prevent lid lag or lagophthalmos. One of blepharotposis correction methods, we have used Muller's muscle tucking method since 2004. The author's method is Muller's muscle tuck with fixation to the tarsal plate and pretarsal fascia with nylon #6-0 and aponeurosis sutured with pretarsal orbicularis muscle or pretarsal area dermis. We have found this method to show good results, with resulting no or only mild lagophthalmos than previous ptosis corrective methods. This method yield results with more post-operative predictability than aponeurosis surgery due to preservation of the aponeurosis gliding plane. If this method is applied to mild and moderate ptosis, it is one of good method of ptosis correction.