Clinical application of botulinum toxin type A in the treatment of thyroid-associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

Thyroid-associated ophthalmopathy(TAO)is an autoimmune inflammatory disease involving multiple orbital tissues with a variety of clinical manifestations, which has serious effects on the life quality of patients.Interventions of TAO mainly include medical treatment to stabilize thyroid function, reduce inflammation and regulate immune function, as well as surgical treatment to relieve ocular symptoms. Botulinum toxin type A can paralyze muscles by blocking nerve impulse conduction at the neuromuscular junction, which is of certain therapeutic value for restrictive strabismus due to extraocular muscle involvement and upper eyelid retraction due to involvements of levator palpebrae superioris and Müller's muscle in TAO patients, especially when they have surgical contraindications, lack surgical opportunity, or refuse surgery. This paper reviews the application of botulinum toxin type A in the treatment of TAO, focusing on its pharmacological mechanism, dosage, effectiveness, and possible complications when treating restrictive strabismus and upper eyelid retraction, and discussing potential therapeutic values of botulinum toxin type A for intraocular pressure elevation, glabellar frown lines and dry eye caused by extraocular muscle compression in TAO patients, in order to provide a reference for clinical intervention.

Clinical effect and prognosis of glucocorticoid combined with surgical method for TAO-related upper eyelid retraction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical efficacy and prognosis of glucocorticoid combined with surgical method for TAO-related upper eyelid retraction. <p>METHODS: A total of 96 patients(146 eyes)with upper eyelid retraction who were admitted to the plastic surgery clinic and ward of our hospital from February 2014 to July 2018 were selected. According to different treatment methods, the patients were divided into GI group: 72 patients with TAO-related upper eyelid retraction treated with glucocorticoids; 72 patients with GS group: 48 patients with TAO-related upper eyelid retraction treated with glucocorticoid combined with conjunctival approach. After treatment, the upper eyelid muscle strength, the treatment effect, the height of the eyelid fissure, and the actual double eyelid width were compared between the two groups of patients.<p>RESULTS: After treatment, the patients in GI group had significant treatment effects in 32 people and 47 eyes, and the patients in the GS group had significant treatment effects in 16 and 25 eyes. The patients in the GS group had significant treatment effects in 46 cases and 71 eyes, and there were no significant treatment effects in 2 people and 3 eyes. Compared with the GS group, the treatment effect of the GS group was significantly higher than that of the GI group(<i>P</i><0.05). There was no significant difference between GS group and GI group(<i>P</i>>0.05). According to the table, before treatment, the height of the eyelid fissures in the GI group and the GS group were 11.25±1.85 and 11.31±1.46mm, and the data in the two groups were similar(<i>P</i>>0.05). The height of the eyelid fissures was 10.14±1.23mm, 3mo after treatment was 8.52±1.01mm. Compared with the GI group, the recovery of blepharoplasty was better in the GS group than in the GI group(<i>P</i><0.05). According to the table, before treatment, the upper eyelid muscle strength of the patients in the GI group and the GS group were 15.34±2.13 and 15.26±1.78mm, the data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the upper eyelid muscle strength was 15.64±1.34, 14.36±1.56mm. There was no significant difference in upper eyelid muscle between the GI group and the GS group(<i>P</i>>0.05). The results showed that before treatment, the patients with GI group and GS group actually had a double eyelid width of 5.12±1.64 and 5.16±1.48mm. The data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the double eyelid was actually The widths were 7.67±2.95 and 8.49±2.39mm, respectively. Compared with the GI group, the GI group had a better change in the double eyelid width than the GI group(<i>P</i><0.05). <p>CONCLUSION: Glucocorticoid combined with conjunctival approach Müller myectomy is better for patients with upper eyelid retraction, which can significantly improve the height of the eyelid fissure and the width of the double eyelid.

A report of orbital metastasis from a urinary bladder adenocarcinoma

A 60-year-old man presented with sudden-onset proptosis of the left eye and intermittent diplopia of 2 months duration. Ophthalmic examination revealed bilateral eyelid retraction, left eye proptosis and a firm, non-tender mass (2 cm × 1.5 cm) in left supero-medial orbit with restricted extraocular movements. Contrast-enhanced computed tomography showed a well-defined, enhancing antero-medial orbital mass which was removed via anterior orbitotomy approach. The histopathology/immunohistochemistry showed adenocarcinoma; metastasis of urothelial origin. The oncology consultation and metastatic workup revealed a urinary bladder carcinoma with distant metastasis. Our patient expired within 6 months of diagnosis. The ophthalmic symptoms due to orbital metastasis may be the first presentation of some cancer patients.

Uso de la toxina botulínica en pacientes con alteraciones espásticas palpebrales / Use of botulinum toxin in patients with palpebral spastic alterations

Objetivo: evaluar los resultados terapéuticos de la aplicación de toxina botulínica A en pacientes con alteraciones espásticas palpebrales. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en 18 pacientes con estas afecciones, seleccionados en la consulta de Oculoplastia del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre enero y diciembre del año 2016. Se describió la muestra según la edad, el sexo, el color de la piel, los antecedentes patológicos personales, las afecciones palpebrales y las limitaciones en tareas de la vida diaria. Se evaluó en el posoperatorio el tiempo de desaparición de los síntomas, la duración del efecto de la inyección de toxina botulínica, las complicaciones inmediatas y las mediatas. Resultados: el 70,6 por ciento estuvo comprendido en el rango de edad mayor de 60 años, y el 52,9 por ciento fueron mujeres. La piel blanca constituyó el 58,8 por ciento de la muestra. La afección que se presentó con mayor frecuencia fue el blefaroespasmo (47,1 por ciento). Todos los pacientes presentaron limitaciones para realizar tareas de la vida diaria. El 100 por ciento presentó dolor en el sitio de la inyección. En el 94,1 por ciento de ellos hubo desaparición de los movimientos involuntarios entre el cuarto y el quinto día posterior a la aplicación de xeomeen y en el 88,2 por ciento demoró la reaparición de los síntomas entre cuatro y seis meses. Conclusiones: la toxina botulínica es efectiva en la corrección de las afecciones palpebrales espásticas con desaparición de los síntomas en un período de tiempo entre cuatro y cinco días, con una rápida incorporación del paciente a la vida laboral y social por cuatro a seis meses(AU)

Objective: to evaluate the therapeutic results of the application of toxin botulínica A in patients with palpebral spastic alterations. Methods: an observational, descriptive, longitudinal and prospective study was performed on 18 patients with these conditions, who were selected at the Oculoplasty Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period from January to December 2016. The analyzed variables were age, sex, race, personal pathological history, eyelid disorders and restricted daily life. In the postoperative period, length of time for symptom relief, duration of the effect of botulinum toxin injection, and immediate and mediate complications were assessed. Results: in the group, 70,6 percent were included in the over 60 y age group and 52,9 percent were women. Caucasians accounted for 58,8 percent of the sample. The most frequent condition was blepharospasm (47,1 percent). All patients had limitations to perform daily life tasks. In 94,1 percent of the patients, involuntary movements disappeared between the 4th and the 5th day after the administration of Xeomeen and in 88,2 percent, the symptoms delayed to appear again from 4 to 6 months. Conclusions: botulinum toxin A is an effective alternative to correct palpebral spastic conditions, with symptoms disappearing in four to five days, and quick reincorporation of the patient to working and social life for 4 to 6 months(AU)

Toxina botulínica A en el músculo recto superior para la corrección de la retracción palpebral / Botulinum toxin A in the upper rectus muscle for the correction of eyelid retraction

Objetivo: evaluar los resultados terapéuticos obtenidos con la inyección de toxina botulínica en el músculo recto superior en pacientes con retracción palpebral moderada y grave en el curso de la orbitopatía tiroidea; determinar la influencia de algunos factores relacionados con estos e identificar las complicaciones y las reacciones adversas asociadas a su uso terapéutico. Métodos: se realizó un estudio descriptivo prospectivo en el Servicio de Oftalmología del Hospital Hermanos Ameijeiras en una serie de 21 casos con retracción palpebral moderada y grave en el curso de la orbitopatía tiroidea. La inyección de toxina botulínica en el músculo recto superior para la corrección de la retracción de la orbitopatía tiroidea se realiza por primera vez en el país. Resultados: fueron satisfactorios en el 66,7 por ciento de los casos. La edad y la gravedad clínica de la retracción fueron los factores que influyeron sobre la respuesta terapéutica (p= 0,013 y p= 0,015 respectivamente). Conclusiones: la inyección de toxina botulínica en el músculo recto superior es efectiva en la mayoría de los casos tratados, sobre todo en adultos jóvenes y con menor gravedad clínica de la retracción. La hipercorrección es la complicación más temida de este procedimiento(AU)

Objective: to evaluate the therapeutic results of the botulinum toxin injection in the upper rectus muscle in patients with moderate and severe eyelid retraction in the course of thyroid orbitopathy, and to determine the influence of some factors related to these patients and to identify the complications and adverse reactions associated to its therapeutic use. Methods: prospective and descriptive study was carried out at the ophthalmological service of Hermanos Ameijeiras hospital in a 21 case series study with moderate and severe eyelid retraction in the course of thyroid orbitopathy. The injection of botulinum toxin into the upper rectus muscle for the correction of retraction in thyroid orbitopathy was performed for the first time in the country. Results: in this group, 66.7 percent of patients had satisfactory results. Age and clinical severity of retraction were the factors having influence on the therapeutic response (p= 0.013 and p= 0.015 respectively). Conclusions: the botulinum toxin injection into the upper rectus muscle is effective in most of treated cases, mainly in young adults with less clinical retraction severity. Hypercorrection is the most fearful complication in this procedure(AU)

Retracción palpebral en ojo contralateral: poscirugía de ptosis palpebral / Eyelid retraction in contralateral eye: eyelid ptosis postsurgery

Se presenta a una paciente con antecedentes de tratamiento quirúrgico hace dos años para la elevación del párpado superior por ptosis palpebral derecha, quien exhibía retracción palpebral izquierda, aparentemente secundaria a la cirugía de ptosis, que dejaba expuesta ampolla de filtración por trabeculectomía previa, la cual le causaba molestias permanentes y la limitaba a realizar sus actividades diarias, cuadro clínico que se constató a las 24 horas en el posoperatorio. Se remitió a nuestro Centro y se discutió en colectivo. Se decidió realizar nueva cirugía de la ptosis derecha y tarsorrafia izquierda, con lo que se logró corrección de la ptosis derecha y recubrimiento de la bula de filtración del ojo izquierdo. Se mantuvo asintomática hasta los 3 meses del posoperatorio en que apareció con retracción palpebral izquierda recurrente. Se evaluó nuevamente y se decidió, por la edad de la paciente y los antecedentes de reintervenciones en ambos ojos así como el riesgo de complicación de cirugía filtrante, aplicar toxina botulínica en el párpado superior, 3 cc equivalente a 7 U. Con la aplicación de la toxina botulínica se logró la caída del párpado superior izquierdo, lo que permitió cubrir la bula de filtración, y desapareció la sintomatología. La toxina botulínica, a pesar de tener un efecto transitorio, constituye una buena opción en los pacientes con retracción palpebral en quienes otros tratamientos no han sido satisfactorios(AU)

A female patient with a history of surgical treatment for eyelid ptosis is reported. Two years before, she was operated on for correction of upper eyelid due to right eyelid ptosis, but now she presented left eyelid retraction, apparently secondary to ptosis surgery, which exposed a filtering bleb caused by previous traveculectomy. This condition caused permanent disturbances and restricted her daily activities, a clinical picture that was confirmed 24 hours after the surgery. She was sent to our center and the case was collectively discussed. It was decided to perform a new surgery to correct right ptosis and left tarsoraphy. The result was correction of right ptosis and coating of the filtering bleb in the left eye. She remained asymptomatic for three months in the postoperative period, but recurrent left eyelid retraction occurred. She was re-evaluated and it was decided, due to the patient´s age and the history of resurgeries in both eyes in addition to the risk of filtering surgery complications, to apply botulinum toxin in the upper eyelid at a dose of 3cc equal to 7 U. The administration of botulinum toxin allows fall of the left upper eyelid and covering of the filtering bleb, thus symptoms disappeared. Despite its transient effect, botulinum toxic is a good option for patients with eyelid retraction who had not achieved satisfactory results with other types of treatment(AU)

A new technique of modified levator muscle prolongation treatment of iatrogenic upper eyelid retraction / 中华医学美学美容杂志

Objective To evaluate the effect of correcting upper eyelid retraction in patients with iatrogenic ophthalmopathy by a new technique of modified transsection and longitudinal suture levator muscle prolongation treatment.Methods The traditional levator muscle flap trapezoidal incision was changed into horizontal incision,According to the amount of upper eyelid retraction we designed a transverse incision with 1 ∶ 2 in the central part of levator aponeurosis.Along the line of incision was designed transverse incision of Mulller's muscle combined with levator aponeurosis complex was designed,with longitudinal suture of incision.Results Five patients (6 eyes) with iatrogenic upper eyelid retraction were treated by this method.The follow up was performed for 3 to 12 months.All were satisfied with good cosmetic results,the degree of bilateral corneal exposure was symmetrical,with no recurrence and complications,except for 1 cases of unilateral upper eyelid retraction width slightly asymmetry.Conclusions The application of modified levator muscle prolongation treatment is not only quite simple,easy to adjust in operation,but also with reliable effect and less complication.It is effective for iatrogenic upper eyelid retraction range from mild to moderate degrees of correction.

Modified levator lengthening for thyroid-associated ophthalmopathy related upper eyelid retraction / 上海交通大学学报（医学版）

Objective · To improve the surgical procedure of correcting upper eyelid retraction.Methods · Patients suffering upper eyelid retraction of 2-5 mm caused by thyroid-associated ophthalmopathy were treated with modified levator lengthening technique in Shanghai Ninth People's Hospital (Shanghai Jiao Tong University School of Medicine,China) from July 2013 to December 2014.Results· Of the 34 patients underwent the modified levator lengthening surgery for upper eyelid retraction correction,there were 7 males and 27 females.After 6 months,upper eyelid retraction got fully resolved in 25 cases and partly improved in 9 cases.The palpebral fissure height demonstrated an average decrease of 3.7 mm (P=0.000).Patient's ocular discomfort such as photophobia and tearing were either cured or improved.Conclusion · Modified levator lengthening surgery can effectively correct upper eyelid retraction,improve the patient's appearance and cure their ocular discomfort.

Diagnosis and treatment of upper eyelid retraction in thyroid-associated ophthalmopathy / 中华实验眼科杂志

Thyroid associated ophthalmopathy (TAO) is often shown as upper eyelid retraction,conjunctival hyperemia and edema,proptosis,diplopia,strabismus and decreased visual acuity.It is difficult to make a certain diagnosis in the early stage of TAO.Patients suffering from TAO often have upper eyelid retraction at the early stage of disease,which affects appearance and causes feelings of discomfort and decreased visual acuity.Learning more about upper eyelid retraction contributes to the early diagnosis and treatment of TAO.Although upper eyelid retraction with TAO has distinctive manifestations,it is easy to misdiagnose.The differential diagnosis includes congenital eyelid retraction,neurological disorders,high axial myopia,glaucoma filtering bleb,and so on.Family history,clinical manifestations and TAO related examinations should also be taken into consideration.Comprehensive treatments should be adopted.Glucocorticoids and eyelid retraction surgeries are current mainstay of treatment.There are controversies on the application of glucocorticoids about the specific dosage,while agreement achieved that the cumulative dose should not be more than 8 g in one stage in order to reduce the risk of liver failure and other adverse events.Different operation methods should be chosen according to the degrees of retraction and causes of disease for each type of patients.In addition,special attentions should be paid to the decrease of muscle strength in the temporal side.Individual analysis is needed in order to diagnose and treat upper eyelid retraction with TAO.Early diagnosis and intervention can improve the appearance,visual function and quality of life of the patients.

Causes and Surgical Outcomes of Lower Eyelid Retraction

PURPOSE: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. METHODS: We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. RESULTS: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. CONCLUSIONS: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required.

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy

PURPOSE: To evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO). METHODS: Twenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0). RESULTS: Forty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 +/- 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 +/- 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 +/- 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 +/- 0.8 to 3.8 +/- 0.5 mm postoperatively. CONCLUSIONS: The customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.

Effect of Mixed Injection of Botulinum Neurotoxin, Triamcinolone and 5-Fluorouracil in Graves' Upper Eyelid Retraction

PURPOSE: The aim of this study is to evaluate the effects and complications of mixed injections of botulinum neurotoxin A (BoNT-A), triamcinolone acetonide, 5-fluorouracil (5-FU) in patients with Graves upper eyelid retraction. METHODS: Twenty-four eyes of 17 patients with a mean age of 43.9 years showed symptoms of Grave's upper eyelid retraction (GUER). They received mixed injections of BoNT-A 4 IU/0.1 mL, triamcinolone acetonide 4 mg/0.1 mL and 5-FU 5 mg/0.1 mL via subconjunctival injection. The response to treatment and the presence of adverse effects were followed up for 9.0 ± 6.0 months and evaluated retrospectively. RESULTS: Margin reflex distance 1 decreased significantly from 5.6 ± 1.2 mm to 4.7 ± 1.1 mm at 1 month after injection. Tarsal platform show increased significantly from 1.4 ± 1.3 mm to 1.8 ± 1.3 mm, and tear break up time increased significantly from 5.2 ± 3.1 seconds to 10.3 ± 7.8 seconds. When success was defined as the correction amount of GUER being larger than 1 mm, the success rate was 66.7%. Kaplan-Meier survival analysis showed that GUER correction effects last longer in patients with a duration of disease longer than 6 months. There were no severe adverse effects such as diplopia, blepharoptosis and intraocular pressure elevation. CONCLUSIONS: Mixed injections of BoNT-A, triamcinolone acetonide and 5-FU, which compensate the side effects of solitary injection and enhances the anti-fibrotic effect, improves the eyelid position and tear film stability in the patients with GUER. It is an effective and safe method for treating GUER with long maintenance with less adverse effects.

Individualized surgical treatment of congenital entropion / 中华医学美学美容杂志

Objective To evaluate the clinical effect of the individualized treatment of congential entropion.Methods Totally 150 patients (285 eyes) with congenital entropion were analyzed,the individualized procedures were performed,including the simple incision and suture surgery for simple congenital entropion,removing the redundant skin of lower eyelid for congenital entropion with redundant skin of lower eyelid but without epicanthus,the correction of entropion combined withY-V epicanthoplasty for congenital entropion with epicanthus and the recession of lower eyelid retractor for congenital entropion with lower eyelid retraction.The clinical effect,the percentage of cure and the complication of these cases were evaluated.Results The excellent results were achieved and no relapse or complications occurred in all cases.The total cure rate was 98.6％ (281 of 285 eyes).The cure rate of simple congenital entropion was 92.0％ (23 of 25 eyes).The cure rate of congenital entropion with redundant skin of lower eyelid was 100％ (41 of 41 eyes).The cure rate of congenital halflength entropion accompanied by epicanthus was 99.4 ％ (179/180 eyes).The cure rate of congenital entropion associated with lower eyelid retraction was 97.4％ (38 of 39 eyes).Conclusions Individualized operations not only have well curative effect for various congenital entropions,but recurrence rate and complications have been reduced.

Neonatal orbital abscess.

Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28‑day‑old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.

Application of Lateral Tarsal Strip Procedure in Operation of Lower Eyelid Lesions / 昆明医科大学学报

Objective To evaluate the application of the lateral tarsal strip procedure for lower eyelid lesions. Methods We retrospectively analyzed 64 eyelids of 48 patients with lower eyelid laxity, ectropion, retraction, lagophthalmus and lateral canthus displacement from February 2010 to August 2013. All the patients were treated with the lateral tarsal strip procedure as the main surgical style, of which some combined with the surgery of lower-eyelid tarsal constrictor,some implanted with high porous polyethylene lower eyelid spacers (Medpor LES), and few cases of eyelid ectropion underwent transplantation or transposition of flap. The effect of relocation of lower eyelid and appearance improvement were evaluated after surgery. The degree of the low eyelid retraction, lagophthalmus and the lateral canthus displacement were examined quantitatively before and after operation, while the change of the low eyelid ectropion and laxity were done qualitatively. Results After two weeks of operation, eyelids of all the patients were relocated well except two cases of ectropion under mild correction. The quantitative evaluation showed there was significant difference between pre and post operation ( <0.001),while the qualitative effect of correction was satisfied after operation. Conclusion The lateral tarsal strip procedure had positive effects in the treatment of most sorts of lower eyelid diseases.

Three methods of surgical treatment for upper eyelid retraction / 局解手术学杂志

objective To explore a reasonable treatment for upper eyelid shrinking. Methods All 15 patients with upper eyelid retrac-tion were divided in group A,group B and group C. Group A with 9 eyes received botulinum toxin type A,group B with 10 eyes were corrected by central aponeurosis disinsertion,group C with 9 eyes upper eyelid were corrected by the lengthening of the levator muscle and Müller's muscle. And the data was summarized and analyzed. Results Five cases (9 eyes) with upper eyelid shrinking obviously were improved 72 h after injecting botulinum toxin type A,but the eyelids returned to previous states 4~6 months later. The shape of postoperative eyelid was good and the eyelids structure was natural in group B,recurrence was in 2 cases. Patients in group C had satisfactory results. And there was no recurrence and complications after 3~24 months of follow-up. Conclusion The three treatments have effect on upper eyelid shrinking at quiescence phase. The method of injecting botulinum toxin type A is simple,with reliable curative effect and short duration,while it was nee-ded repeated injections. The method of central aponeurosis disinsertion is simple but difficult to quantify properly. The lengthening of the leva-tor muscle is not only simple but also with reliable effect and less complications.

Outcomes of Various Surgical Procedures on Acquired Lower Eyelid Epiblepharon in Thyroid Associated Ophthalmopathy

PURPOSE: To report the outcomes of acquired lower eyelid epiblepharon after various surgeries in thyroid associated ophthalmopathy (TAO) patients. METHODS: A retrospective review of the medical records of 53 TAO patients with acquired lower eyelid epiblepharon between October 1999 and June 2011 was performed. Data were collected on demographics, type of lower eyelid epiblepharon, the detailed surgical history such as orbital decompression, retraction repair, or epiblepharon repair and surgical outcomes including follow-up period, recurrence of epiblepharon, and post-operative complications. RESULTS: Among the 53 TAO patients with acquired lower eyelid epiblepharon, 25 eyes of 17 patients underwent surgical management; 6 eyes of orbital decompression, 1 eye of orbital decompression followed by retraction repair, 2 eyes of orbital decompression followed by epiblepharon repair, 6 eyes of lower eyelid retraction repair, and 10 eyes of epiblepharon repair. Twenty two lower eyelid epiblepharons (88%) were resolved after final surgical treatment without complication during mean 16.2 months (SD, +/-29.9 months) of follow up period; three of 6 epiblepharons that remained after orbital decompression underwent subsequent surgical management of retraction repair or epiblepharon repair, and epiblepharons were well-corrected. Mean amount of lower eyelid retraction was decreased from 1.68 mm (SD, +/-1.17 mm) to 0.29 mm (SD, +/-0.44 mm) after surgery, regardless of the type of surgery (n = 25, p < 0.000, Wilcoxon signed rank test). CONCLUSIONS: Acquired lower eyelid epiblepharon of TAO should be managed sequentially according to the general serial order of surgical managements in TAO; orbital decompression, correction of lower eyelid retraction and epiblepharon repair. Acquired lower eyelid epiblepharon was well resolved after surgical management in consecutive order, especially after repair of the lower eyelid retraction with a graft, or lower eyelid epiblepharon repair. Decreased lower eyelid retraction with a resolution of epiblepharon after surgery implied that lower eyelid retraction was associated with lower eyelid epiblepharon.

Clinical Effect of a Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose During the Transconjunctival Approach for Orbital Wall Reconstruction / 전남의대학술지

This study aimed to evaluate the anti-adhesive effect of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) during the transconjunctival approach to orbital wall reconstruction. Eighty-seven patients who underwent orbital wall reconstruction by the transconjunctival approach were enrolled in this prospective study. We applied HACMC between the orbicularis oculi muscle and the orbital septum after surgery in 47 patients and did not use it in 40 patients. Lower lid retraction and marginal reflex distance 2 (MRD2) were measured to analyze the degree of postoperative adhesion at 1 week and 1, 3, and 6 months. The degree of MRD2 showed clinically significant differences at postoperative 1 week and 1 month between the HACMC and control groups (p<0.05). Lower lid ectropion developed in two patients (5.0%) in the control group but did not occur in the HACMC group. In orbital wall reconstruction by the transconjunctival approach, the HACMC mixture solution is effective for preventing adhesion and lower lid ectropion during the early postoperative period.

Clinical Effect of a Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose During the Transconjunctival Approach for Orbital Wall Reconstruction / 전남의대학술지

This study aimed to evaluate the anti-adhesive effect of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) during the transconjunctival approach to orbital wall reconstruction. Eighty-seven patients who underwent orbital wall reconstruction by the transconjunctival approach were enrolled in this prospective study. We applied HACMC between the orbicularis oculi muscle and the orbital septum after surgery in 47 patients and did not use it in 40 patients. Lower lid retraction and marginal reflex distance 2 (MRD2) were measured to analyze the degree of postoperative adhesion at 1 week and 1, 3, and 6 months. The degree of MRD2 showed clinically significant differences at postoperative 1 week and 1 month between the HACMC and control groups (p<0.05). Lower lid ectropion developed in two patients (5.0%) in the control group but did not occur in the HACMC group. In orbital wall reconstruction by the transconjunctival approach, the HACMC mixture solution is effective for preventing adhesion and lower lid ectropion during the early postoperative period.

Surgical Outcome of Levator Recession for Correction of Upper Eyelid Retraction

PURPOSE: To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction. METHODS: Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated. RESULTS: Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean +/- standard deviation of 27.7 +/- 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 +/- 1.3 mm from 6.3 +/- 1.5 mm preoperatively to 3.2 +/- 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession. CONCLUSIONS: Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.