Evaluation of scleral incisions and their effects on corneal curvature in manual small-incision cataract surgery

Purpose: Incisions in cataract surgery can be modified in various ways in terms of size, shape, and axis to reduce or tailor astigmatism. This study was conducted to examine the effect of site (superior vs, temporal) and shape (frown vs. V?shaped, chevron) of scleral incisions for cataract surgery on corneal curvature. Methods: The prospective study was carried out on 200 consecutive patients with senile cataract and who were planned for surgery at a tertiary eye hospital in north India. The placement of the incision was decided by the steeper corneal meridian梬hether superior or temporal梐nd then patients of these two groups were randomized for frown and V?shaped incision; in this way, four groups of 50 patients each were formed. Follow?up was done on day 1, at 2 weeks, 4 weeks, 8 weeks, and 12 weeks. At each follow?up, post?operative keratometry with routine postoperative examination was done. The results were statistically analyzed by using student抯 t?test, Chi?squared test, and the Pearson correlation coefficient. Results: In all the four groups, the difference of preoperative astigmatism and surgically?induced astigmatism was statistically highly significant. The analysis of uncorrected visual acuity (UCVA) was statistically significant (P < 0.05) on postoperative day 1 and at 2, 4, and 12 postoperative weeks; it was statistically insignificant (P > 0.05) at postoperative week 8. Conclusion: Temporal incisions result in lesser postoperative surgically induced astigmatism (SIA) than superior incisions. Chevron incisions result in minimal change in corneal curvature. This effect can be utilized to tailor the postoperative astigmatism.

Comparison of surgically induced astigmatism in chevron, straight, and frown incisions in manual small-incision cataract surgery

Purpose: The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract surgery (MSICS). Methods: A prospective, hospital-based study was conducted on 90 patients aged 50 years and above with nuclear sclerosis of grade 4 or more. Each group had 30 patients, divided into Group V (chevron incision), Group S (straight incision), and Group F (frown incision). Patients who had with-the-rule (WTR) astigmatism were operated on through a chevron or straight incision superiorly, while patients who had against-the-rule (ATR) astigmatism underwent MSICS through a temporal frown incision. The patients were followed up post-operatively on days 1, 7, 6 weeks, and 12 weeks, and at each visit, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and SIA were calculated and compared. Results: The mean age of all the patients was 66.22 � 8.05 years. BCVA of at least 6/18 or better at 12 weeks post?operatively was achieved in 29 patients (97%) in Group V, 28 patients (93%) in Group F, and 29 patients (97%) in Group S. The mean SIA in Group V was 0.34D � 0.22D, in Group S was 0.97D � 0.29D, and in Group F was 0.575D � 0.25D. Conclusion: SIA by chevron incision is the least followed by the frown incision and straight incision. The superiorly placed chevron incision in WTR astigmatism provided optimal results for the best UCVA and minimal SIA. The temporal frown incision in ATR astigmatism also had good results.

Minimally Invasive Corrugator Resection and Backfill Using Self-made Modified Liposuction Needle in the Treatment of Moderate and Severe Glabellar Frown Lines / 中国医学科学院学报

To exploring a new minimally invasive method for the removal of moderate and severe glabellar frown lines. The corrugator supercilii muscles were subjected to blunt cutting and vacuum suction by using a self-made modified liposuction needle,and the obtained muscle particles were backfilled subcutaneously into the depression area between eyebrows to expand the wrinkles. Seventeen cases were followed up for six to twelve months after the operation.The glabellar wrinkles disappeared or became flatter in all patients. The minimally invasive corrugator resection and backfill by using self-made modified liposuction needle can effectively remove the glabellar frown lines without forming scar.

Safety, efficacy, and onset of a novel botulinum toxin type A (Nabota) for the treatment of glabellar frown lines: a single-arm, prospective, phase 4 clinical study

BACKGROUND: Safety, efficacy, and time to onset of effect of botulinum toxin type A is of importance to persons who seek improvement in glabellar frown lines, but this has not been well studied. The aim of this study was to determine the safety, efficacy, and onset of action of a newly developed botulinum toxin type A (Nabota) for the treatment of glabellar frown lines. METHODS: This was a single-arm, open-label, and phase 4 clinical study. Forty-two subjects with glabellar lines were treated with five times of intramuscular injection of 0.1 mL (4 U/0.1 mL) for a total of 20 U of Nabota. Efficacy and safety were assessed at 2, 3, 4, 5, and 14 days. Efficacy was assessed by the investigator and it was defined as a 1-point change on a 4-point scale. RESULTS: Improvement in glabellar frown lines at maximum frown was observed in 85.4% of subjects 2 days after administration. Improvement in glabellar lines at rest was observed in 51.2% of subjects 2 days after administration, and the proportion of subjects showing improvement increased with time. No severe adverse events were recorded. CONCLUSION: Onset of action was observed in the majority of subjects by 2 days after administration of Nabota. In addition, Nabota was found to be safe and effective for the treatment of glabellar frown lines.

Frown incision: A means to minimize astigmatism.

Introduction: Modern day cataract surgery is aimed at giving optimal catarefractive outcome . This study was inspired by a chance finding of high astigmatic reading on performing retinoscopy three weeks after surgery in a female who underwent manual small incision cataract surgery. Aim of study: To study effect of scleral tunnel incision at different locations on pre-existing astigmatism ,and to calculate surgically induced astigmatism there from . Design: The scleral tunnel incision is known to undergo changes upto six weeks after cataract surgery .If pre operative value and post operative values at the end of six weeks are known ,SIA can be calculated. All patients operated free of cost for cataract are implanted an all PMMA non foldable 6.0mm intraocular lens hence we chose a six mm frown incision. From our study we aim to give cut off values of native astigmatism to chose incision site in order to provide least residual astigmatism, since this group of patients being non affording cannot undergo any additional surgical procedure to get astigmatism corrected . The higher order post cataract surgery residual error degrades quality of image ,hence accentuation of native error by SICS is non justifiable . Rather,our aim should be to regress existing error by 50% -75%. Method: In 150 eyes undergoing cataract surgery in the department of Ophthalmology, Aurobindo Institute Of Medical Sciences under eye camp, the preoperative keratometric values in vertical and horizontal axis were noted .At the end of six weeks after cataract surgery performed by 6mm incision at superior, superotemporal and absolute temporal locations , keratometry readings were noted again along the principle meridia .SIA was calculated from these two readings. At the end of six weeks keratometry and retinoscopy weres done. Result: From the study it was concluded that location of incision in the eye has a bearing on existing astigmatic error . A regression (or accentuation) in the existing error is dependent on the incision site and the magnitude of pre-existant error. With superior and absolute temporal scleral tunnel incision , SIA average was 0.77 Dioptres while with BENT( between nine and twelve) clock hours it was lesser (0.68 Dioptres) Except in thirteen eyes who accepted cylindrical lens in oblique meridia, all others accepted glasses in primary meridia. Conclusion: For upto 1 D astigmatism, ATR or WTR, placement of incision on steeper axis should be the choice. For WTR, of any degree, a superior location should be the choice. For ATR amounting to 1.25D, a superotemporal incision offers best results. For higher ATR absolute temporal location should be the choice if regression in astigmatism is desired.

The Regional Anatomy of the Corrugator Supercilii Muscle and Facial Nerve

Glabellar frown lines develop as a result of contraction of the corrugator supercilii muscles. These lines make look angry or aging. The neurotomy of facial nerve supplying corrugator supercilii muscle will prevent complications of the surgical technique and the reversibility of the nonsurgical technique. The regional anatomy of corrugator supercilii muscle is necessary for developing new technique. However, there is little information regarding the motor innervation of this muscle. The purpose of this study is to identify the regional anatomy of corrugator supercilii muscle and facial nerve and help to develop new technique of the neurotomy. We have dissected 6 Korean adult cadavers(12 sides). The motor innervation of this muscle was the temporal branch of facial nerve. The entry point of facial nerve into this muscle was found to be the inferolateral part. It was directly beneath the hair of lateral side of mid one-third of the eyebrow. The average distance between median plane and the entry point was 35.8mm. The measurement was not significantly different between right and left side. This study will be helpful for developing new technique of the neurotomy of motor nerve that supplies to corrugator supercilii muscle.

Comparison of Surgically Induced Astigmatism between a No-Stitch Frown Incision and a No-Stitch Straight Incision

PURPOSE: This investigation was performed to evaluate the surgically induced astigmatism of no-stitch frown incision with 4.0 mm chord length, which was compared with no-stitch 3.2 mm straight incision. METHODS: Sixty eyes, which could be observed for 3 months, were divided into two groups. Both groups were composed of 30 eyes. Group 1 - a semicircular frown incision with 4.0 mm chord length was made 1 mm posterior and most convex to limbus. Group 2 - a 3.2 mm straight incision was made 2 mm posterior to limbus. No-stitch was done in both groups. The corneal astigmatism was evaluated at postoperative 1st day, 1st week, 2nd week, 1st month, 2nd month and 3rd month with Bausch & Lomb keratometry, calculated by values derived from Cravy's vector method and statistically analyzed by Student t-test. RESULTS: The change of surgically induced astigmatism in group 1 was 0.52 D, 0.45 D, 0.43 D, 0.38 D, 0.40 D, and 0.39 D at 1st day, 1st week, 2nd week, 1st month, 2nd month, and 3rd month, respectively. In group 2, it was 0.83 D, 0.72 D, 0.65 D, 0.52 D, 0.50 D, and 0.49 D at the same intervals. These differences of astigmatic change were not statistically significant(p>0.05). CONCLUSION: The astigmatic change in a no-stitch frown incision with 4.0 mm chord length was not enough to comparable with that of a no-stitch 3.2 mm straight incision. We could safely use PMMA intraocular lens by no-stitch frown incision. So, this method has some advantages over small incision with foldable intraocular lens.

Keratometric Cylinder Changes following Phacoemulsitication using Frown Incision and Linear Scleral Tunnel Incision with 10-0 nylon Interrupted Sutures

To evaluate surgically induced astigmatism in cataract surgery, we studied retrospectively a series of 30 eyes with 6.5mm sutureless frown incision(Group 1) and 30 eyes with linear scleral tunnel incision and 3 interrupt sutures using 100 nylon(Group 2). In all cases phacoemulsifications were performed and posterior chamber lenses were implanted. Group 1 showed the against-the-rule astigmatism at postoperative 2 week, and then the change of the astigmatism was minimal and still against-the-rule by postoperative 6 week and 3 month. In contrast, Group 2 showed with-therule astigmatism at postoperative 2 week and then showed the against-the-rule by postoperative 6 week and 3 month. There was no significant difference in the proportion of corrected visual acuity of 0.5 or better between two groups at postoperative 3 month, while uncorrected visual acuity of 0.5 or better was 93.3% in group 2, and 30.0% in group 1 at postoperative 3 month. In this study, it was found that the pattern of surgically induced astigmatism and uncorrected visual outcome in cataract surgery were different according to incision and suture techniques.