Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging

Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves’ ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2?weighted, fat?suppressed fast spin echo imaging (T2WI?fs) and T1?weighted, fat?suppressed, contrast?enhanced fast spin echo imaging (T1WI?fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non?effective group. Independent t?test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t?test was used to compare SIR and T of LPS muscle before and after treatment. Then cut?off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty?two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non?effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI?fs and T1WI?fs + C decreased after treatment in the effective group (PT2 < 0.001, PT1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non?effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non?effective treatment group on T1WI?fs + C (P < 0.001). SIR of LPS muscle on T1WI?fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy

Combination of conjoint fascia sheath suspension and levator palpebrae superioris shortening for treatment of congenital severe blepharoptosis / 中华医学美学美容杂志

Objective:To investigate the therapeutic effect of conjoint fascia sheath suspension and levator palpebrae muscle shortening on congenital severe blepharoptosis.Methods:From June 2014 to December 2018, 30 cases (40 eyes) of congenital severe ptosis were treated in Ningbo First Hospital and Shaoxing Women and Children＇s Hospital. All patients were corrected by conjoint fascia sheath suspension and levator palpebrae muscle shortening. Six months after operation, the distance between the middle point of upper eyelid margin and corneal reflex point was measured to evaluate the correction effect of blepharoptosis; the improvement of upper eyelid appearance was evaluated by 5-point Likert scale (LS), and the incidence of complications was counted.Results:Thirty patients (40 eyes) were followed up for 6-12 months. Correction effect showed that preoperative marginal reflex distance (MRD) was (0.10±0.05) and postoperative MRD was (3.80±0.55); the difference was statistically significant ( t=0.95, P<0.05); 38 eyes (95%) were corrected and 2 eyes (5%) were undercorrected; appearance of upper eyelid showed that preoperative LS was (0.50±0.05) and postoperative LS (3.80±0.55); the difference was statistically significant ( t=0.98, P<0.05). Only one case was complicated with keratitis caused by improper early nursing after incomplete closure exposure, and the patient was cured by sealing the eyes combined with drug conservative treatment. Conclusions:Combined conjoint fascial sheath suspension and levator palpebrae shortening in the treatment of severe blepharoptosis has significant effect, with the advantages of simple operation, small surgical trauma, low recurrence rate, low incidence of complications, high predictability of surgical results and high satisfactory rate of patients.

Treatment of recurrent severe blepharoptosis after frontal muscle flap suspension and levator palpebrae superioris shortening with conjoint fascia sheath suspension / 中华医学美学美容杂志

Objective@#To investigate the clinical effect of conjoint fascial sheath (CFS) suspension to correct the complications caused by the frontal muscle flap suspension and levator palpebrae superioris shortening in the treatment of severe blepharoptosis.@*Methods@#From February 2017 to April 2018, 19 severe blepharoptosis patients (21 eyelids) were operated before by the frontal muscle flap suspension and levator plapebrae superioris shortening, and repaired through the technology of CFS suspension.@*Results@#There were 19 cases, 17 cases operated by CFS suspension showed a good appearance and basically symmetrical of two eyes, and the other 2 cases obtained satisfactory results though reoperation. There were no complications of exposure keratitis, ectropion and infection occurred. Meantime the effect was satisfactory according to the follow-up ranging from 3 months to 12 months.@*Conclusions@#The application of conjoint fascial sheath (CFS) suspension shows a promising procedure in the treatment of severe blepharoptosis caused by the frontal muscle flap suspension and levator palpebrae superioris shortening.

Double-eyelid blepharoplasty by turning the orbital septum downward / 中华整形外科杂志

Objective@#To investigate a new approach for double-eyelid blepharoplasty.@*Methods@#Double-eyelid blepharoplasty was performed by turning the orbital septum downward and fixing it to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia, which is imitating physiological mechanical conduction. During double-eyelid blepharoplasty, the orbital septum was cut horizontally. Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the outcomes of this double-eyelid surgical procedure in patients undergoing the procedure from December 2015 to February 2018.@*Results@#622 eyes of 311 patients were included in the final analysis. Sutures were removed 7 days after surgery. All double-eyelid lines were well-formed, and the eyelids closed well. Three-to twelve-month follow-up results revealed that the double-eyelid shape was natural, no patients experienced upper eyelid retraction or incomplete eye closure. Notched scars did not occur, and patient satisfaction was achieved in all cases. 281 patients were fully satisfied with the surgical results and 30 were basically satisfied with the surgical results.@*Conclusions@#Turning the orbital septum downward is a good approach for double-eyelid blepharoplasty.

Double-eyelid blepharoplasty by turning the orbital septum downward / 中华整形外科杂志

Objective@#To investigate a new approach for double-eyelid blepharoplasty.@*Methods@#Double-eyelid blepharoplasty was performed by turning the orbital septum downward and fixing it to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia, which is imitating physiological mechanical conduction. During double-eyelid blepharoplasty, the orbital septum was cut horizontally. Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. We evaluated the outcomes of this double-eyelid surgical procedure in patients undergoing the procedure from December 2015 to February 2018.@*Results@#622 eyes of 311 patients were included in the final analysis. Sutures were removed 7 days after surgery. All double-eyelid lines were well-formed, and the eyelids closed well. Three-to twelve-month follow-up results revealed that the double-eyelid shape was natural, no patients experienced upper eyelid retraction or incomplete eye closure. Notched scars did not occur, and patient satisfaction was achieved in all cases. 281 patients were fully satisfied with the surgical results and 30 were basically satisfied with the surgical results.@*Conclusions@#Turning the orbital septum downward is a good approach for double-eyelid blepharoplasty.

Treatment strategy for severe lepharoptosis / 中华整形外科杂志

Objective@#To establish a treatment protocol for severe blepharoptosis. This protocol helps to achieve better accuracy and more stable result.@*Methods@#Evaluate levator muscle function pre-operatively. When levator function ≤ 1 mm, frontalis suspension technique was performed. When levator function more than 1 mm, technique of levator resection, combining excision of tarsus and levator, and tarsus-levator-CFS suspension was performed accordingly until it reaches adequate correction result during the surgery.@*Results@#A total of 275 severe ptosis patients was included from January 2015 to June 2016. 52 cases (388 eyes) received levator resection. 162 cases received combining excision of tarsus and levator. 24 cases received tarsus-levator- CFS suspension. 37 cases received frontalis suspension. 326 eyes achieved adequate correction results. 62 cases were still undercorrected. The asymmetry result showed that 76 cases presented good symmetry. 142 cases presented moderate asymmetry and 57 showed severe asymmetry.@*Conclusions@#The new treatment protocol shows a satisfactory result with better accuracy and more stable correction for severe ptosis correction.

The aesthetic analysis of midface ratio after folding aponeurosis of levator palpebrae superioris muscle in the ptosis correction / 实用医学杂志

Objective To measure the ratio of the length between upper edge of eyebrow and edge of lower eyelid(L1)/the length between edge of lower eyelid and nasal base(L2)in the fordless-eyelid and upper lid ptosis patients who received levator aponeurosis folding surgery. To analyze the change in the proportion of midfa-cial aesthetics. Methods From December 2015 to October 2016,a total of 21 patients were recruited as study group. Those patientswere diagnosed with foldless eyelid and upper lid ptosis. They received levator aponeurosis folding procedures were carried out in our departmentand the pre- and post-operative photographs were collected. Full-face pictures of 20 Chinese female movie stars were prepared as control group. The ratiosof L1/L2(J)were measured via Adobe Photoshop CS6. The statistical significance was analyzed and the change of midfacial propor-tion was evaluated. Results In study group,the mean value of pre- and post-operative L1/L2(J1)is 0.746 and (J2)0.657 postoperatively. In control group,the mean value of L1/L2(J3)is 0.667. Statistical differences showed between the pre- and post-operative samples and between pre-operative samples and control group. There was no statistical difference between post-operative and control group samples. The ratios between L1 and L2 in post-opera-tive samples are close to those in control group ,which are closer to the golden radio. Conclusions Levator aponeurosis folding can effectively lower eyebrow in patients with upper lid ptosis and shorten the length between eyebrow and lower eyelid. Therefore harvesting a more appropriate and harmonious ratio of L1/L2 according the golden section theory. The changes in the proportion of midfacial aesthetics after operation could be used as a key point in the pre-operative communication and post-operative effect evaluation ,besides the size of palpebral fissure and corneal exposure rate.

The aesthetic analysis of midface ratio after folding aponeurosis of levator palpebrae superioris muscle in the ptosis correction / 实用医学杂志

Objective To measure the ratio of the length between upper edge of eyebrow and edge of lower eyelid(L1)/the length between edge of lower eyelid and nasal base(L2)in the fordless-eyelid and upper lid ptosis patients who received levator aponeurosis folding surgery. To analyze the change in the proportion of midfa-cial aesthetics. Methods From December 2015 to October 2016,a total of 21 patients were recruited as study group. Those patientswere diagnosed with foldless eyelid and upper lid ptosis. They received levator aponeurosis folding procedures were carried out in our departmentand the pre- and post-operative photographs were collected. Full-face pictures of 20 Chinese female movie stars were prepared as control group. The ratiosof L1/L2(J)were measured via Adobe Photoshop CS6. The statistical significance was analyzed and the change of midfacial propor-tion was evaluated. Results In study group,the mean value of pre- and post-operative L1/L2(J1)is 0.746 and (J2)0.657 postoperatively. In control group,the mean value of L1/L2(J3)is 0.667. Statistical differences showed between the pre- and post-operative samples and between pre-operative samples and control group. There was no statistical difference between post-operative and control group samples. The ratios between L1 and L2 in post-opera-tive samples are close to those in control group ,which are closer to the golden radio. Conclusions Levator aponeurosis folding can effectively lower eyebrow in patients with upper lid ptosis and shorten the length between eyebrow and lower eyelid. Therefore harvesting a more appropriate and harmonious ratio of L1/L2 according the golden section theory. The changes in the proportion of midfacial aesthetics after operation could be used as a key point in the pre-operative communication and post-operative effect evaluation ,besides the size of palpebral fissure and corneal exposure rate.

Application of the Hering's law in corrective surgery for asymmetric bilateral ptosis / 中华医学美学美容杂志

Objective To evaluate the clinical result of Hering's law in the correction of asymmetric bilateral ptosis.Methods From January 2014 to July 2016,165 cases divided into 2 groups with asymmetric bilateral ptosis in mild and moderate ptosis were corrected with aponeurosis advancement type correction:A group of 15 cases,in which the surgery does not consider the influence of Hering's law,the first correction of mild side,and then corrected the heavier side;B group of 150 cases,in which the Hering's law was applied,the first correction of severe side so that the margin reached the edge of the cornea is tangent or low 0.5-1.0 mm,and then corrected mild side.That the difference of symmetry between the two sides of the palpebral fissure was less than 0.5 mm,and the follow-up was more than 3 months.The Pearson chi square test was used to compare the differences between the two groups.Results In this group,165 cases were followed up for 3-24 months,10 cases (66.67％) was satisfactory in group A (15 cases);145 cases (96.67％) was satisfactory in group B (150 cases);After 3 months,all the failure cases got satisfactory result by using the Hering's law in corrective surgery again.The P value of chi square test between groups was less than 0.05.Conclusions The application of Hering's law in the correction of asymmetry bilateral ptosis is more satisfactory.

A rare case of Enterococcus faecalis-induced orbital cellulitis and myositis.

Orbital cellulitis is an infection of soft tissue behind the orbital septum. Common pathogens isolated include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. It is a straightforward diagnosis and usually responds to empirical treatment without any sequela. We report a case of orbital cellulitis caused by Enterococcus faecalis, which was complicated by myositis of levator palpebrae superioris. To the best of our knowledge, only one case report exists dating way back to 1986.