Evaluation of surgical outcomes for ptosis surgery by face recognition software.

PURPOSE: This study was aimed to use the age estimation segment of face recognition software to determine whether patients appeared younger after surgery for aponeurotic ptosis and dermatochalasis. DESIGN: This is a prospective interventional case series. METHODS: Face recognition software was used to estimate the age of 12 Japanese patients who had surgery to repair aponeurotic ptosis or dermatochalasis. Photographs of the faces before and 1 month after the surgery were taken and uploaded to the face recognition software to estimate the age of the subjects. RESULTS: The preoperative estimated age significantly correlated with the actual age (r = 0.647, P = 0.023), and the postoperative estimated age also significantly correlated with the actual age (r = 0.727, P = 0.007). The scores of the palpebral fissure width of the right eyes (P = 0.003) and left eyes (P = 0.002) significantly improved postoperatively. However, the postoperative estimated age was not significantly younger than the preoperative estimated age (P = 0.173). CONCLUSIONS: The face recognition software may not be influenced by the lid plastic surgery. Many factors other than the width of the palpebral fissure influence the estimation of age by the face recognition software.

Repair of blowout orbital floor fracture by periosteal suturing.

The study objective was to evaluate the outcome of a periosteal suturing technique in eyes with orbital blowout fractures. Fifteen orbital floor fractures were classified into: type 1, linear fracture; type 2, middle fracture; and type 3, posterior fracture extending two-thirds into the orbit. The feasibility of periosteal suturing without silicone plates or one of minimal size was determined. The improvement of ocular movements and surgical complications were evaluated. A complete suture of the torn periosteum without implanting a silicone plate was achieved in 2/2 (100%) type 1 cases, 5/7 (71%) type 2 cases and 0/6 (0%) type 3 cases. A partial fixation was achieved in 3/6 (50%) type 3 cases with an implantation of a silicone plate of approximate one-third of the usual size in one case. Conventional surgery with silicone plates after failed periosteal suture was required in 2/7 (29%) type 2 cases and 3/6 (50%) type 3 cases. Eye movements were improved postoperatively in all eyes, and a complete range of eye movements was achieved in 6/7 (86%) cases with complete periosteal closure, 1/3 (33%) of cases with partial closure and 2/5 (40%) cases without closure. In conclusion, periosteal suturing can minimize the need for silicone plates especially for anterior or middle orbital floor factures.

Dehiscence of levator aponeurosis in ptosis after sub-Tenon injection of triamcinolone acetonide.

OBJECTIVE: To report the incidence, intraoperative findings, and surgical outcome of secondary ptosis that developed after a sub-Tenon injection of triamcinolone acetonide (TA). STUDY DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: One hundred forty-seven cases with a total of 286 sub-Tenon TA injections. METHODS: The medical records of 163 eyes of 147 cases treated with a sub-Tenon injection of 10 mg or 20 mg TA were reviewed. The incidence of secondary ptosis (palpebral fissure >2 mm narrower than that of the fellow eye) after a sub-Tenon TA injection was determined. The preoperative levator function and margin reflex distance (MRD) of the affected eyes, and the intraoperative findings in eyes that underwent reconstructive surgery, were evaluated. RESULTS: Eight eyes (5%) developed secondary ptosis after the injection and 6 eyes were treated by reconstructive surgery. The preoperative levator function of the affected eyes did not differ from that of the fellow eyes. Intraoperatively, no septal disruption or fat herniation was noted, but an aponeurotic disinsertion was identified and repaired with an advancement of the leading edge to the anterior tarsal plate. The surgery led to satisfactory results, with improvement of the MRD from -1.3 (SD 1.5) mm preoperatively to 2.3 (SD 0.5) mm postoperatively (p = 0.027). Additional sub-Tenon TA injections were required in 2 eyes after eyelid surgery but the ptosis did not worsen. CONCLUSIONS: A sub-Tenon TA injection can occasionally cause ptosis by inducing a disinsertion of the levator aponeurosis. However, surgical reconstruction can lead to successful resolution of the ptosis.

Oriental oculopalpebral dimensions: Quantitative comparison between Orientals from Japan and Brazil.

OBJECTIVES: Quantitative evaluation of palpebral dimensions of Japanese residents in Japan and Japanese descendant (Nikkeis) who live in Brazil, in order to define if environmental factors may influence these parameters. METHODS: A prospective study evaluating 107 Nikkeis from Brazil and 114 Japanese residents in Japan, aged 20 years or older. Exclusion criteria were those with palpebral position alterations, prior palpebral surgery, and crossbreeding. Images were obtained with a digital camera, 30 cm from the frontal plane at pupil height, with the individual in a primary position and the eye trained on the camera lens. Images were transferred to computer and processed by the Scion Image program. Measurements were made of distance between medial canthi, distance between pupils (IPD), superior eyelid crease position, distance between the superior lid margin and corneal reflexes (MRD), horizontal width, height, area, and obliquity of the palpebral fissure. Data were analyzed using analysis of variance for a three factor model and respective multiple comparison tests. RESULTS: Japanese residents and Nikkeis living in Brazil have similar measurements. Statistical differences were found for some age groups concerning distance between pupils, horizontal, and vertical fissures, palpebral fissure area, and obliquity with native Japanese presenting discretely higher measurements than Nikkeis. CONCLUSION: Environmental factors do not affect palpebral dimensions of Nikkeis living in Brazil.