Application of artificial intelligence in ophthalmic plastic surgery / 国际眼科杂志(Guoji Yanke Zazhi)

The advancement of computers and data explosion have ushered in the third wave of artificial intelligence(AI). AI is an interdisciplinary field that encompasses new ideas, new theories, and new technologies, etc. AI has brought convenience to ophthalmology application and promoted its intelligent, precise, and minimally invasive development. At present, AI has been widely applied in various fields of ophthalmology, especially in oculoplastic surgery. AI has made rapid progress in image detection, facial recognition, etc., and its performance and accuracy have even surpassed humans in some aspects. This article reviews the relevant research and applications of AI in oculoplastic surgery, including ptosis, single eyelid, pouch, eyelid mass, and exophthalmos, and discusses the challenges and opportunities faced by AI in oculoplastic surgery, and provides prospects for its future development, aiming to provide new ideas for the development of AI in oculoplastic surgery.

Glabellar flap technique in oculoplastic surgery

Facial skin defect reconstruction in medial?canthal area of the lids can be a challenge even when performed by a skilled surgeon. The excision of large tumors in this area leads to significant surgical defects that cannot be repaired by merely closing the wound. The glabellar area provides a source of redundant skin with similar characteristics to that of the medial?canthal lid area. The purpose show the possibility of the glabellar flap technique surgery in patients after tumor excision in the medial canthal area with the formation of a large surgical defect and especially those with defect under the medial canthal tendon. We selected 15 well?documented retrospective cases of patients operated over 2 years and followed up for a minimum of 36 months, who underwent surgery with a glabellar flap technique. Patients were operated with V?Y glabellar rotation, advancement, or combined transposition flap techniques. According to the defect’s location, we divided the patients into three groups: upper, medial, and lower surgical defects. A satisfactory functional result was obtained in all the patients. In most of them, the cosmetic results were also good. No additional surgical procedures were required in any of the patients. Our experience showed excellent results with the glabellar flap technique in all three types of lesions in the medial canthal zone— upper, medial, and especially lower which until recently was thought to be inappropriate

A “flexible tripod” mounted video camera: An economical and effective method to record oculoplastic surgeries

Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.

Patología oculoplástica: experiencia de 7 años en Hospital del Sistema de Salud Público de Chile / Oculoplastic Pathology: experience of 7 years in Hospital of the Public Health System of Chile

INTRODUCCIÓN: La cirugía oculoplástica estudia y trata los trastornos de párpados, órbita y vías lagrimales. Entre las patologías más importantes por frecuencia e impacto tenemos: ptosis palpebral, blefarochalasis, ectropión y entropión. OBJETIVO: Analizar la experiencia del Hospital El Pino en cuanto al manejo de patología oculoplástica en manos de un cirujano plástico. MATERIALES Y MÉTODO: Estudio descriptivo y retrospectivo. Se revisaron fichas de pacientes operados con diagnóstico de blefarochalasis, ptosis palpebral, ectropión y entropión entre los años 2010 y 2017. Se analizaron datos como edad, sexo, comorbilidades, causa del defecto, cirugía oculoplástica, tipo de anestesia, complicación posoperatoria, tiempo de seguimiento y resultados. RESULTADOS: Entre los años 2010 y 2017 se operaron 79 pacientes con patología oculoplástica, 17 por ptosis palpebral, 42 por blefarochalasis, 14 por ectropión y 6 por entropión, siendo la principal causa senil (93,7%). Las cirugías realizadas fueron: pexia del elevador para Ptosis palpebral, blefaroplastía para blefarochalasis y para ectropión-entropión tarsal strip. La principal técnica anestésica utilizada fue anestesia local + sedación (54,4%). Entre el total de complicaciones posoperatorias tenemos: lagoftalmo (2 casos), ectropión residual (3 casos), conjuntivitis (3 casos), dehiscencia de herida (2 casos) y hematoma palpebral (1 caso). Se reintervinieron 6 pacientes por complicaciones. Los resultados obtenidos según la evaluación subjetiva del cirujano plástico y pacientes fueron regular (5 casos), bueno (20 casos) y muy bueno (54 casos). CONCLUSIÓN: El manejo de la patología oculoplástica requiere en su mayoría de cirugías ambulatorias con buenos resultados y poca morbilidad, lo cual es factible de realizar en un hospital público. Creemos necesario el uso de algún instrumento objetivo para evaluar de mejor manera los defectos palpebrales y su corrección.

INTRODUCTION: The oculoplastic surgery studies and treats disorders of the eyelids, orbit and lacrimal ways. Among the most important pathologies by frequency and impact are: palpebral ptosis, blepharochalasis, ectropion and entropion. AIM: Analyze the experience of El Pino Hospital regarding the management of oculoplastic pathology in the hands of a plastic surgeon. MATERIALS AND METHOD: Descriptive and retrospective study. We reviewed files of patients operated with diagnosis of blepharochalasis, palpebral ptosis, ectropion and entropion between the years 2010 and 2017. Data were analyzed as age, sex, comorbidities, cause of the defect, oculoplastic surgery, type of anesthesia, postoperative complication, follow-up time and results. RESULTS: Between the years 2010 and 2017, 79 patients with oculoplastic pathology operated, 17 for palpebral ptosis, 42 for blefarochalasis, 14 for ectropion and 6 for entropion, being the main senile cause (93,7%). The surgeries performed were: elevator pexis for palpebral ptosis, blepharoplasty for blefarochalasis and for ectropion-entropion tarsal strip. The main anesthetic technique used was local anesthesia + sedation (54,4%). Among the total postoperative complications, we have: lagophthalmos (2 cases), residual ectropion (3 cases), conjunctivitis (3 cases), wound dehiscence (2 cases) and palpebral hematoma (1 case). Six patients were reoperated due to complications. The results obtained according to the subjective evaluation of the plastic surgeon were regular (5 cases), good (20 cases) and very good (54 cases). CONCLUSION: Management of oculoplastic pathology requires mostly ambulatory surgeries with good results and low morbidity, which is feasible to perform in a public hospital. We believe it is necessary to use some objective instrument to better evaluate the palpebral defects and their correction.

Knowledge, Attitude and Practice of Eyelid Surgeries among Surgeons in Nigeria

Aim:To determine the level of knowledge, attitude and practice of eyelid surgeries among surgeons in Nigeria.Methods:A self-administered questionnaires about their knowledge, attitude and practice of eyelid surgeries were given to 135 medical practitioners attending the 49th Annual General Meeting and Scientific Conference of the International College of Surgeons (Nigeria National Section) held in Port Harcourt from 16th to 20th June 2015. Questions asked tested the Knowledge, Attitude and Practice of the medical practitioners on matters related to eyelid surgeries. Study participants’ knowledge, attitude and practice were graded as Good for scores of 75% and above, Fair for 50-74% score and Poor for scores less than 50%. Respondents’ demographic data, responses and corresponding scores were entered into computer software-Scientific Package for Social Sciences (SPSS) version 20 and analysed.Results: There were 135 responders, out of which 121 (89.62%) were male while 14 (10.38%) were females. They were aged between 21-70 years with a mean value of 51.6 +/-8.6 years, range = 40 years and mean = 50 years. Specialist surgeons with collegefellowship accounted for 84.4% ReviewArticle while specialist surgeons in training (college membership) accounted for 15.6%. Most of the responders (73.3%) were in public servicewhile 9% were in the private service and 17.7% were in both public and private service. Sixty seven per cent of responders had good knowledge of eyelid surgeries, 22.2% had fair knowledge while 11.1% had poor knowledge. Majority (73.3%) had poor attitude while only 26.7% had good attitude to eyelid surgeries. Responders with poor practice of lid surgeries accounted for 77.8%, fair practice were 13.4% while only 8.8% had good eyelid surgery practice.Conclusion:Most of our responders were experienced surgeons as shown by their ages, educational and professional status. Though majority of them had good knowledge of eyelid surgeries their attitude and practice of it were poor in spite of their experience in the field of surgery. This could be due to the paucity of oculoplastic surgeons in Nigeria. Measures should therefore be taking to improve on subspecialty training especially in oculoplastic surgery and collaborations should be encouraged amongst surgeons involved in facial surgeries.

Comprehensive Review of Asian Cosmetic Upper Eyelid Oculoplastic Surgery: Asian Blepharoplasty and the Like

BACKGROUND: Asian Aesthetic Oculoplastic Surgery is a fast-growing field, both within the United States and abroad. With growing interest, there have also been multiple terminologies used for the same concepts. This has created redundant and confusing language - prone to errors in patient-physician communication. In addition, there has been an upsurge of various techniques or variations to existing techniques that has created unnecessary confusion among plastic surgeons. The objective of this article is to provide organization and simplification to the terminology and to the techniques used in what some broadly refer to as "Asian Blepharoplasty" or perhaps more correctly termed Asian Aesthetic Oculoplastic Surgery. METHODS: Unified terminology, aesthetic goal and detailed operative technique of commonly conducted Asian blepharoplasty were suggested by experienced oculoplastic surgeons. RESULTS: The main procedures of Asian Aesthetic Oculoplastic Surgery including supratarsal crease surgery and medial epicanthoplasty were presented with figure and video in this paper. We also have provided author's preferred selection of the major techniques with evaluation of its advantages and disadvantages. CONCLUSIONS: The most important element in patient satisfaction is clear communication of surgical expectations. Then, proper selection of the most suitable pre-operative design, type of surgery performed, and specific crease configuration based on the individual's anatomic and physiological characteristics can be achieved.

A Survey on the Perceptions of Guardians of Pediatric Oculoplastic Patients

PURPOSE: This survey was performed to gather information about the guardians of pediatric oculoplastic patients undergoing certain medical care services in order to recommend improvements in these services. METHODS: Questionnaires were distributed to guardians of pediatric oculoplastic patients who were admitted for operations to correct epiblepharon and ptosis. Completed questionnaires, which numberd 100, were then analyzed. RESULTS: The results of this survey show that most guardians were the parents of the patient; most had a level of education higher than or equal to junior college graduation; and most were middle-class. The parents themselves had discovered their children's disease and had a great influence on the decision to operate. Most parents took an optimistic view of the results of the operation. The higher the guardians' economic status, the more likely he or she believed that both an ophthalmic and a plastic surgeon could perform oculoplastic operations. Many guardians chose an ophthalmic clinic over a plastic surgery clinic because the likelihood of a satisfactory result is higher and because these diseases are related to visual acuity. Half of the guardians knew that there is an oculoplastic clinic at the department of ophthalmology, and many of them gathered information about oculoplastic surgery from the internet. CONCLUSIONS: Better explanations about oculoplastic diseases and more education about these diseases should be available to the guardians of patients with these diseases. Systematic publicity for the field of oculoplastic surgery is needed urgently, and the availability of accurate information and specialized medical counseling about these diseases on the internet should be increased.

The important role of evaluating the circumstance of ptosis before the corrective operation / 眼科

Ptosis is one of the most common diseases in oculoplastics. Surgical treatment is the only way to correcting ptosis. Most of doctors paid special attention to surgical technique, rather than to some related issues of operation. Timing is crucial for ptosis surgery. Both cosmetic and function need to be considered for a success surgery, the evaluation of extraocular muscle disorder is impor- tant for surgical result and postoperative complications.

Surgical treatment of patients with blepharochalasis and its associated abnormalities / 眼科

Objective To assess the effects of surgical treatment for patients with blepharochalasis and its associated abnormali- ties. Design Retrospective case series, Participants 35 cases (52 eyes) with blepharochalasis in stable phase. Methods The correction of the abnormalities in upper eyelids: after designing the lid crease incision, the redundant eyelid skin and prolapsed fat were excised, and prolapsed lacrimal glands were sutured back into position in 18 cases (36 eyes) and ptosis was treated in 10 cases (16 eyes). The correction of abnormalities in lower eyelids: lower eyelid retraction was corrected in 4 cases (6 eyes). The correction of lateral canthus malformation: lateral canthus rounding was treated in 7 cases (14 eyes), accompanied with or followed by correction of baggy eyelid or ptosis. Main Outcome Measures The shape, location and movement of bilateral eyelids, the location of lacrimal glands and the cir- cumstance of tear secretion. Results During the follow-up of 6～60 months, the appearance and location of bilateral eyelids and can- thuses were satisfying, the function of eyelids were normal, and no dry eye symptoms were found. Two cases (3 eyes) appeared recurrent lacrimal gland prolapse 29 and 36 months postoperation and received surgeries for correction again. There was no recurrence after the second prolapse correction surgery in the follow-up of 18 and 24 months respectively. Conclusions Surgical treatment for patients with blepharochalasis and its associated abnormalities is safe and effective. Its recurrence rate is low.