Histological and ultrasonographic alterations in skin and soft tissue in upper eyelid excised blepharoplasty due to ipsilateral eyebrow tattooing: (preliminary findings).

BACKGROUND: Eyebrow tattooing (ET) is a relatively common cosmetic procedure for middle-aged women which can hide age-related ptosis. AIMS: We aimed to evaluate the periocular soft tissue changes following ET and its effects on upper eyelid blepharoplasty (UEBL). PATIENTS/METHODS: In this non-randomized prospective case-controlled study, 28 subjects recruited, 14 with ET for at least 5 years and 14 without ET. Eyebrows ultrasonography was performed to measure the periocular soft tissue thickness including skin and subcutaneous tissue on the medial and lateral side of the eyebrow. Then, UEBL was performed with extended eyelid skin incisions. So, the excised tissues being evaluated histopathologically. RESULTS: The mean age of patients was 50.6 ± 0.6 and 51.2 ± 5.59 years in non-eyebrow tattooing (NET) and ET groups, respectively (P = .78). In the ET group, soft tissue thickness was, respectively, equal to 5.90 ± 1.10 and 6.3 ± 0.95 mm on the lateral and medial side of the eyebrow, which were significantly thicker compared to the NET group (4.68 ± 0.69 and 4.78 ± 0.56 mm, respectively)(P = .001). Histopathological findings were ranging from edema-congestion to chronic inflammation and dermal fibrosis which were more frequently seen in ET group. However, this difference was statistically significant only for dermal fibrosis (P = .02). Surgical wound complications were observed in 3 patients who were in the ET group (P = .22). CONCLUSION: Subjects with eyebrow tattooing, as compared to a control group, showed a thicker eyebrow skin on ultrasonography and higher upper eyelid dermal fibrosis on histopathological examination.

Optic canal size in idiopathic intracranial hypertension and asymmetric papilledema.

OBJECTIVE: Asymmetric papilledema (AP) is a rare condition in idiopathic intracranial hypertension (IIH). As the pathophysiology of papilledema developement in IIH remains unclear, the study of AP could clarify some etiologic aspects. We aimed to evaluate bony optic canal size in IIH patients with AP. PATIENTS AND METHODS: All IIH patients based on modified Dandy criteria in our referral tertiary eye hospital underwent neuro-opthalmologic exams and grading of papilledema according to modified Frisén scale. Very asymmetric papilledema (VAP) defined as a ≥2 grade difference between the two eyes. Clinical features, cerebrospinal fluid opening pressure (CSF OP), best corrected visual acuity, Humphery visual field, and brain magnetic resonance imaging (MRI) and MR venography was performed for all patients. Spiral orbital computed tomography (CT) scan which is the choice method for details of bony structures with axial, coronal and sagittal planes was done in patients with VAP. RESULT: 59 patients with IIH were diagnosed that 18.6% of them (n = 11) had VAP. There was no IIH patient with strictly unilateral Papilledema. Presenting symptoms and CSF OP was not significantly different between patients with symmetric and asymmetric papilledema. In patients with VAP, bony optic canal size was not statistically significant different in axial, coronal and sagittal plane when comparing the eye with higher grade edema to the fellow eye. CONCLUSION: Our study showed that bony optic canal size evaluated by orbital CT scan was not different in VAP in IIH patients. Finding the exact pathophysiology of AP need further studies.

Clinical and Ultrasonographic Evaluation of Infantile Periocular Hemangioma Treated With Oral Propranolol.

PURPOSE: To evaluate the clinical and ultrasonographic response of periocular infantile capillary hemangioma during treatment with oral propranolol. METHODS: Patients with infantile periocular hemangioma and visual or cosmetic concerns were enrolled in this prospective interventional case series. Propranolol was given at a dose of 2 mg/kg per day for at least 6 months. Evaluation of treatment response was performed at month 3 (time point 1) and month 6 (time point 2). Gray scale ultrasonography and color Doppler imaging were performed at baseline and month 3. RESULTS: Thirty-one patients with mean age of 4.1 ± 2.3 months were eligible for analysis. Complete or near complete clinical resolution was observed in 4 patients (12.9%) at time point 1 and 21 patients (67.7%) at time point 2. Longitudinal diameter, transverse diameter, thickness, arterial peak systolic velocity, and end diastolic velocity reduced significantly from baseline to 3-month follow up. Complete clinical response at time point 2 was significantly higher in patients with peak systolic velocity reduction >50% from baseline to month 3 than patients with peak systolic velocity reduction of 10% to 50% and <10%. CONCLUSIONS: Propranolol is safe and effective for infantile periocular hemangioma. Ultrasonography and color Doppler imaging are useful modalities to monitor and predict the treatment response.

Color Doppler imaging in thyroid eye disease and its correlation to disease activity.

Purpose: To evaluate alterations in orbital color Doppler imaging (CDI) parameters and their correlation to disease activity and severity in patients with thyroid eye disease (TED). Methods: Seventy-six orbits of 45 TED patients and 40 orbits of 40 normal controls were enrolled in this cross-sectional study. According to clinical activity score (CAS), patients were categorized to active (CAS ≥ 3) or inactive disease (CAS < 3). Patients were also classified as having mild, moderate or severe disease. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) in ophthalmic artery and central retinal artery, and maximum and minimum velocity in superior ophthalmic vein and central retinal vein were determined in all subjects. Results: There was a significant difference in maximum velocity of superior ophthalmic vein and EDV and RI of ophthalmic artery between patients with TED and normal subjects. Superior ophthalmic vein maximum and minimum velocity and ophthalmic artery RI were significantly higher in patients with active disease than inactive cases. Disease severity did not affect the blood flow parameters independently. A cutoff point of 3.99 cm/s in superior ophthalmic vein maximum velocity yielded a sensitivity of 91.2% and specificity of 81.2% in detecting active disease. Conclusion: Retrobulbar blood flow is altered in TED and is related to disease activity. Superior ophthalmic vein maximum velocity could be helpful in differentiation of active and inactive cases.

Color Doppler imaging of orbital vasculature before and after orbital decompression in thyroid eye disease.

Purpose: To measure alterations in orbital blood flow parameters using color Doppler imaging (CDI) before and after orbital decompression in patients with moderate to severe thyroid eye disease (TED). Methods: Resistance index (RI) and maximum and minimum velocity of ophthalmic artery (OA), superior ophthalmic vein (SOV), and central retinal artery (CRA) of 24 eyes (14 patients) with TED were measured before and at least 3 months after cosmetic orbital decompression procedure (single or double walls) using CDI. Complete eye examination was performed to define the severity (EUGOGO classification) and activity (clinical activity score) of TED. Results: Median OA (p = 0.003) and CRA (p = 0.001) resistance indices were significantly reduced postoperatively. Significant differences were found in maximum (p = 0.001) and minimum (p = 0.014) velocity of SOV before and after surgery. While a significant decrease in exophthalmometry was observed after the orbital decompression (p = 0.031), intraocular pressure changes were not significant (p = 0.182). Conclusion: Orbital decompression procedure led to a significant reduction of RI in both CRA and OA in patients with TED.

A mathematical model for estimating the axial stress of the common carotid artery wall from ultrasound images.

Clarifying the complex interaction between mechanical and biological processes in healthy and diseased conditions requires constitutive models for arterial walls. In this study, a mathematical model for the displacement of the carotid artery wall in the longitudinal direction is defined providing a satisfactory representation of the axial stress applied to the arterial wall. The proposed model was applied to the carotid artery wall motion estimated from ultrasound image sequences of 10 healthy adults, and the axial stress waveform exerted on the artery wall was extracted. Consecutive ultrasonic images (30 frames per second) of the common carotid artery of 10 healthy subjects (age 44 ± 4 year) were recorded and transferred to a personal computer. Longitudinal displacement and acceleration were extracted from ultrasonic image processing using a block-matching algorithm. Furthermore, images were examined using a maximum gradient algorithm and time rate changes of the internal diameter and intima-media thickness were extracted. Finally, axial stress was estimated using an appropriate constitutive equation for thin-walled tubes. Performance of the proposed model was evaluated using goodness of fit between approximated and measured longitudinal displacement statistics. Values of goodness-of-fit statistics indicated high quality of fit for all investigated subjects with the mean adjusted R-square (0.86 ± 0.08) and root mean squared error (0.08 ± 0.04 mm). According to the results of the present study, maximum and minimum axial stresses exerted on the arterial wall are 1.7 ± 0.6 and -1.5 ± 0.5 kPa, respectively. These results reveal the potential of this technique to provide a new method to assess arterial stress from ultrasound images, overcoming the limitations of the finite element and other simulation techniques.