ABSTRACT
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.
Subject(s)
Blepharoplasty/methods , Blepharoptosis/surgery , Eyelids/surgery , Oculomotor Muscles/surgery , Sutureless Surgical Procedures/methods , Follow-Up Studies , Humans , Retrospective StudiesABSTRACT
A 15-month-old boy with left congenital proptosis presented to the emergency department with melena. Upper GI endoscopy and magnetic resonance angiography revealed vascular lesions, consistent with gastrointestinal tract manifestations of blue rubber bleb nevus syndrome. MRI revealed vascular malformations in both orbits, with mass effect on the left side. The patient was started on a trial of the antiangiogenic agent sirolimus (also known as rapamycin), and after 6 months of treatment showed clinical improvement in proptosis supported by radiologic evidence of regression in the larger, left orbital mass, with stability of the smaller, right orbital mass. There are 11 published cases of orbital blue rubber bleb nevus syndrome in the English literature. To our knowledge, this is the first reported case of successful, long-term treatment with sirolimus causing a reduction in the size of an orbital vascular malformation.
Subject(s)
Exophthalmos/drug therapy , Gastrointestinal Neoplasms/complications , Nevus, Blue/complications , Orbit/blood supply , Orbital Diseases/complications , Sirolimus/therapeutic use , Skin Neoplasms/complications , Vascular Malformations/complications , Endoscopy, Gastrointestinal , Exophthalmos/diagnosis , Exophthalmos/etiology , Gastrointestinal Neoplasms/diagnosis , Humans , Immunosuppressive Agents/therapeutic use , Infant , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Nevus, Blue/diagnosis , Orbital Diseases/diagnosis , Skin Neoplasms/diagnosis , Tomography, X-Ray Computed , Vascular Malformations/diagnosisABSTRACT
BACKGROUND AND OBJECTIVE: To assess whether there is a correlation between anti-vascular endothelial growth factor (VEGF) therapy and the incidence of outer retinal tubulation (ORT) in patients with exudative age-related macular degeneration (AMD). PATIENTS AND METHODS: A retrospective review of all patients at the Cole Eye Institute who received anti-VEGF injections for exudative AMD and underwent optical coherence tomography (OCT) evaluation was performed. A total of 543 patients were identified and included in the study. The number of treatments and the change in Snellen visual acuity from the time of diagnosis until the development of ORT were tabulated. RESULTS: Seventy individuals with ORT were identified. The data analyzed showed a wide variation in the number of treatments until the development of ORT and did not show a significant correlation between ORT incidence and decreased visual acuity. CONCLUSION: Although a correlation was found between the increased incidence of ORT and length of anti-VEGF treatment, there was no evidence of decreased visual acuity, which suggests that the ORT might be benign.
