The Sutureless Mullerectomy.

PURPOSE: Müller's muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller's muscle and conjunctiva, followed by suturing of the conjunctiva and Müller's muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures. METHODS: The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications. RESULTS: Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0-3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ test). One patient who underwent unilateral surgery demonstrated a Herring's response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively. CONCLUSIONS: The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.

Biological glue in pterygium surgery with a rotational flap or sliding flaps.

PURPOSE: To compare 2 surgical approaches to conjunctival flap placement during pterygium surgery using a biologic adhesive: single rotational flap and double sliding flaps. METHODS: Thirty-three consecutive patients (34 eyes) with primary pterygium were assigned prospectively and randomly to receive pterygium surgery with either 1 rotational flap (group A, 19 eyes) or double sliding flaps (group B, 15 eyes) by using a biologic adhesive to secure the flaps. The patients were followed for 24 weeks. RESULTS: In group A, 1 (5.3%) flap was lost because of ischemia, whereas all the others remained in position and became fully integrated. In group B, 4 (26%) flaps did not retain their primary position. In 2 (13%) eyes, the superior and inferior flaps partially dehisced, resulting in a 2- to 3-mm gap; in 1 (6.5%) eye, the inferior flap dehisced completely and retracted to the lower fornix; and in 1 (6.5%) eye, both flaps completely dehisced and retracted, leaving an area of bare sclera. CONCLUSIONS: The use of tissue adhesive is a promising technique in pterygium surgery. In this study, gluing 1 rotational flap resulted in excellent postoperative results, but it seemed less suitable for use with double sliding flaps.

Israel: a comparison of army personnel satisfaction rates in different primary healthcare settings.

The Israeli medical corps has recently been examining different primary healthcare settings for home-front career army personnel. This study compares the satisfaction rates of this unique population in different primary healthcare settings. Previously validated patient-satisfaction surveys were conducted 4 months apart in 10 large primary care clinics that treat home-front army career personneL. Satisfaction was highest in a civilian hospital-based primary care clinic. The specialized military career personnel clinics produced less satisfaction than the hospital setting, according to the survey; however, the differences were not statistically significant. Patient satisfaction was significantly lower in the classic military-based general practices. The hospital setting of civilian primary care created higher satisfaction in aspects of accessibility, availability, and interpersonal relationships. However, the patients' perception of quality of care was lower than in the other settings.

The changing prevalence of myopia in young adults: a 13-year series of population-based prevalence surveys.

PURPOSE: To determine the changing prevalence of myopia during the years 1990 through 2002 among the 16- to 22-year age group and identify possible risk factors. METHODS: A retrospective study, based on 13 repeated prevalence surveys conducted over a 13-year period. The study subjects were all Israeli nationals belonging to the 16- to 22-year age group from the years 1990 to 2002. Refraction was determined by using subjective visual acuity followed by noncycloplegic autorefraction and subjective validation based on the autorefraction RESULTS: Mild myopia was defined as a refractive error of -0.50 to -3.00 D in at least one eye, moderate myopia as -3.25 to -6.00 D, and high myopia as more than -6.00 D. results. There were 919,929 subjects (382,139 [42%] females and 537,790 [58%] males) included in the study. The overall prevalence of myopia increased from 20.3% in 1990 to 28.3% in 2002. The prevalence of high, moderate, and mild myopia significantly increased in males from 1.7%, 5.7%, and 11.6% in 1990 to 2.05%, 7.2%, and 16.3% in 2002, respectively (P < 0.001). In females, the prevalence of myopia increased from 1.9%, 6.6%, and 13.5% in 1990 to 2.4%, 9.2%, and 20.7% in 2002, respectively (P < 0.001). A correlation between myopia and the number of years of education was observed. Non-Israeli origin was found to be a significant risk factor for myopia. CONCLUSIONS: During the 13 years from 1990 to 2002, the prevalence of myopia significantly increased among the Israeli population. Although there was an association with the level of education, gender, ethnicity, and origin, the prevalence of myopia increased on an annual basis, independent of these factors.

Benign opsoclonus in preterm infants.

Opsoclonus is a rare childhood ocular motility disorder characterized by irregular, chaotic, involuntary bursts of high amplitude, back-and-forth oscillations of the eyes,without pause intervals. Although this disorder is associated with neuroblastoma and other neural crest tumors, as well as with other neurologic abnormalities, it was also reported in healthy infants. The purpose of this study was to prospectively investigate the prevalence of opsoclonus in preterm infants, and to find any conditions associated with this disorder. Between August 2000 and April 2003, 528 consecutive preterm infants with gestation of less than 33 weeks or birth weight of less than 1500 gm were examined in accordance with our medical centers' retinopathy of prematurity screening policy. Opsoclonus was identified in three patients (0.6%), who were all otherwise physically and neurologically intact. One patient developed threshold retinopathy of prematurity that resolved after laser treatment. On follow-up examinations, the opsoclonus gradually disappeared by the age of 6 months in all infants,with no other complications. This study suggests that opsoclonus can be a benign, self-limiting phenomenon in preterm infants as was previously reported in term infants. However, because of the risk of severe associated illnesses, it is prudent to perform several diagnostic procedures and to continue careful follow-up until this phenomenon spontaneously resolves.