Comparison of surgical techniques and results of upper blepharoplasty between Asian males and females.

The purpose of this study was to describe surgical techniques and results of upper blepharoplasty for dermatochalasis to optimize cosmetic outcome in males, compared with females. We conducted a retrospective, interventional study on 156 eyes (78 patients) that had been diagnosed with dermatochalasis and had undergone upper lid blepharoplasty at the Korea University Hospital between August 2008 and October 2008 by a single surgeon. Twenty-eight male patients and 50 female patients were enrolled. Patient age, sex, follow-up duration, complications, and treatment were analyzed. We evaluated intraoperative (1) lid crease height, (2) skin-muscle excision amount, and (3) whether or not fat was removed. In total, 78 patients (28 men and 50 women: 156 procedures) who underwent upper eyelid blepharoplasty for dermatochalasis were identified. The mean age was 59.6 years in male patients, and 62 years in female patients (P = 0.165). No significant difference was observed between mean lid crease height and the distance between eyebrow lower margin to lid crease in males and females. The amount of skin-muscle excision in the female group was significantly greater than that in males. The frequency of fat removal was significantly lower in males than in females. For a good cosmetic outcome, we recommend (1) lower lid crease, (2) less skin-muscle excision using a scalpel shape design, (3) lateral orbicularis oculi muscle preservation, and (4) minimizing fat removal to avoid feminization in older male upper blepharoplasty.

Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration.

BACKGROUNDS: Blow-out fracture and canalicular laceration can occur simultaneously as a result of the same trauma. Despite its importance, little research has been conducted to identify clinical characteristics or surgical techniques for repair of a blow-out fracture accompanied by canalicular laceration. The aim of this study was to evaluate the clinical characteristics, the surgical approach, and the outcomes. METHODS: Thirty-four eyes of 34 patients who underwent simultaneous repair of canalicular laceration using silicone tube intubation and reconstruction of blow-out fracture were included. Medical records were retrospectively reviewed for patient demographics, nature of injury, affected canaliculus, location, and severity of blow-out fracture, associated facial bone fracture, ophthalmic diagnosis, length of follow-up period, and surgical outcome. RESULTS: Mean patient age was 40.0 years (range, 17-71 y). The mean follow-up was 7.3 months. Fist to the orbital area (10 patients, 29.4%) was the most common cause. There were 24 lower canalicular lacerations (70.6%), 6 upper canalicular lacerations (17.6%), and 4 upper and lower canalicular lacerations (11.8%). Isolated medial wall fractures were most common (area A4: 20/34, 58.8%). Fractures involving both the floor and medial wall and maxillo-ethmoidal strut (areas A1, A2, A3, and A4) were the second most common (6/34, 17.6%), and floor and medial wall with intact strut (areas A1, A2, and A4) were injured in 6 patients (17.6%). Pure inferior wall fractures were least frequent (areas A1 and A2: 2/34, 5.9%). The severity of the fracture was severe in most patients except for 1 linear fracture with tissue entrapment and 1 moderate medial wall fracture (32/34, 94.1%). There was lid laceration in 20 patients (58.8%). Nasal bone fracture (5/34, 14.7%) was the most common facial bone fracture. Tubes were removed at a mean of 3.3 months (range, 3-4 mo). In total, 31 patients (91.2%) achieved complete success in canalicular laceration and blow-out fracture repair. No significant complications were encountered. CONCLUSION: Fractures involving the medial wall with a lower canalicular laceration were the most common among concomitant blow-out fractures and canalicular lacerations. The severity of the fracture was most often classified as severe. Computed tomographic scan of the orbit and facial bones for identification of any additional injuries such as orbital wall and facial bone fractures should be performed in patients with canalicular laceration. To avoid disruption of the medial canthal area, repair of the canalicular laceration with silicone tube intubation was performed before reconstruction of the blow-out fracture through transconjunctival and transcaruncular approaches. Finally, the tube was fixed after blow-out fracture surgery, and these surgical orders yielded good surgical outcomes without complications.

Correlation between ciliary sulcus diameter measured by 35 MHz ultrasound biomicroscopy and other ocular measurements.

PURPOSE: To measure horizontal ciliary sulcus diameters by 35 MHz ultrasound biomicroscopy (UBM) and evaluate correlations between these and other ocular measurements. SETTING: Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea. METHODS: A pilot group comprising 20 eyes of 10 patients was enrolled in a prospective trial. Horizontal sulcus diameter was measured using a 35 MHz UBM unit; other ocular measurements (eg, corneal curvature, refractive error, white-to-white [WTW] distance, anterior chamber depth [ACD]) were also taken in all patients. Linear regression analysis was used to evaluate the correlation between horizontal sulcus diameter and the other measurements. A regression equation was determined as a result of the analysis and applied to a second validation group (14 eyes). RESULTS: The mean horizontal diameter of the ciliary sulcus in the pilot group was 11.56 mm +/- 0.64 (SD). The mean corneal curvature was significantly and negatively correlated with the horizontal sulcus diameter (P<.001). Refractive error, ACD, and horizontal WTW diameter were not correlated with the horizontal sulcus diameter by multiple regression analysis. In the validation group, sulcus diameters estimated using the regression equation were significantly correlated with actual values, and these 2 sets of values were not statistically different. CONCLUSIONS: Mean corneal curvature was significantly and negatively correlated with horizontal sulcus diameter. The derived regression formula based on mean corneal curvature measurements may help predict sulcus diameters for proper sizing of posterior chamber phakic intraocular lenses.

Direct measurement of the ciliary sulcus diameter by 35-megahertz ultrasound biomicroscopy.

PURPOSE: To measure the ciliary sulcus diameters in 4 different axes and to determine the correlation with white-to-white distance. DESIGN: Cross-sectional observational study. PARTICIPANTS: Fourteen normal volunteers with no evidence of ocular disease. METHODS: Twenty-eight eyes were scanned using a 35-megahertz (MHz) ultrasound biomicroscopy (UBM) in sequential meridional scan planes at 45 degrees increments. Horizontal white-to-white distance was measured using Orbscan IIz (Bausch & Lomb-Orbtek, Inc., Salt Lake City, UT). MAIN OUTCOME MEASURES: Ciliary sulcus diameter, anterior chamber diameter, white-to-white distance, and coefficient of variation. RESULTS: The coefficient of variation for 35-MHz UBM was 0.90%. The mean diameters+/-standard deviations of ciliary sulci were 11.55+/-0.38 mm at 45 degrees, 11.99+/-0.36 mm at 90 degrees, 11.54+/-0.36 mm at 135 degrees, and 11.32+/-0.40 mm at 180 degrees. In all eyes, vertical diameters were greater than horizontal diameters. The mean difference between vertical and horizontal diameters was 0.67+/-0.26 mm (range, 0.36-1.13 mm), and this was statistically significant (P<0.001). Horizontal sulcus diameters and horizontal white-to-white distances were not correlated (r = 0.006; P = 0.976). CONCLUSIONS: The posterior chamber appears to have a vertically oval shape. The white-to-white technique is inaccurate at predicting the horizontal diameter of the ciliary sulcus. The 35-MHz UBM may provide a good means of measuring the ciliary sulcus diameter for the implantation of a posterior chamber phakic intraocular lens.

A case of intramuscular hemangioma presenting with large-angle hypertropia.

PURPOSE: To report the case of a patient with large-angle hypertropia of an intramuscular hemangioma of the right superior rectus muscle (SR). METHODS: A 63-year-old man with progressive vertical deviation of the right eye for the past 6 months visited our strabismus department; his condition was not painful. An examination indicated that he had 60PD of right hypertropia at distance and near in primary gaze. Additionally, a significant limitation of his downgaze was noted. The right eye appeared mildly proptotic, and the upper and lower eyelids were slightly edematous. Corrected vision was 20/20 in both eyes. RESULTS: Orbital magnetic resonance imaging (MRI) studies revealed fusiform enlargement of the right superior rectus muscle, with prominent but irregular enhancement following gadolinium administration. Incisional biopsy revealed an intramuscular hemangioma in the superior rectus muscle with cavernous-type vessels. CONCLUSIONS: This case demonstrates that intramuscular hemangioma should be considered in the differential diagnosis of isolated extraocular muscle enlargement and unusual strabismus.