Analysis of surgical outcome after upper eyelid surgery by computer vision algorithm using face and facial landmark detection.

PURPOSE: To evaluate the postoperative changes with a computer vision algorithm for anterior full-face photographs of patients who have undergone upper eyelid blepharoplasty surgery with, or without, a Müller's muscle-conjunctival resection (MMCR). METHODS: All patients who underwent upper eyelid blepharoplasty surgery (Group I), or upper eyelid blepharoplasty with MMCR (Group II) were included. Both preoperative and 6-month postoperative anterior full-face photographs of 55 patients were analyzed. Computer vision and image processing technologies were used to measure the palpebral distance (PD), eye-opening area (EA), and average eyebrow height (AEBH) for both eyes. Preoperative and postoperative measurements were calculated and compared between the two groups. RESULTS: In Group II, change in postoperative Right PD, Left PD, Right EA, Left EA was significantly higher than in Group I (p = 0.004 for REPD; p = 0.001 for LEPD; p = 0.004 for REA; p = 0.002 for LEA, p < 0.05). In Group II, the postoperative change in Right AEBH, Left AEBH was significantly higher than in Group I (p = 0.001 for RABH and LABH, p < 0.05). CONCLUSION: Eyelid surgery for esthetic purposes requires artistic judgment and objective evaluation. Because of the slight differences in photograph sizes and dynamic factors of the face due to head movements and facial expressions, it is hard to compare and make a truly objective evaluation of the eyelid operations. With a computer vision algorithm, using the face and facial landmark detection system, the photographs are normalized and calibrated. This system offers a simple, standardized, objective, and repeatable method of patient assessment. This can be the first step of Artificial Intelligence algorithm to evaluate the patients who had undergone eyelid operations.

Long term motor and sensory outcome after surgery for infantile esotropia and risk factors for residual and consecutive deviations.

Purpose: To present long-term motor and sensory outcomes after surgery for infantile esotropia and assess risk factors for residual and consecutive deviations.Methods: Data of infantile esotropia patients operated between 2002 and 2016 with minimum follow-up of 2 years were retrospectively reviewed.Results: Among a total of 62 patients, 35 had a successful motor outcome (alignment within 10 PD from orthotropia) after one surgery (Group A), while 27 required horizontal reoperation (Group B). Patients with residual esotropia had larger preoperative angle of deviation (P = .005) and younger age at first surgery (P = .01), while consecutive exotropia was associated with longer follow-up (P = .03) and higher rate of DVD (P = .003) compared to patients in Group A. Stereopsis was present in 30.3% of patients in Group A and associated with younger age at first surgery (P = .03).Conclusions: Successful motor alignment may be obtained with single surgery in infantile esotropia; however, reoperations are common. Younger age at first surgery may be associated with both higher rate of stereopsis and risk of reoperation. Careful preoperative assessment and surgical timing, with long-term postoperative follow-up is required to achieve satisfactory outcome.

BILATERAL SEROUS MACULAR DETACHMENT IN A PATIENT WITH NEPHROTIC SYNDROME.

PURPOSE: The purpose of this study was to report a case of a woman with nephrotic syndrome who presented with blurred vision because of bilateral serous macular detachment. METHODS: Case report and literature review. RESULTS: A 55-year-old woman with a history of essential hypertension, diabetes, and nephrotic syndrome was presented with blurred vision in both eyes. Her fluorescein angiography revealed dye leakage in the early and subretinal pooling in the late phases, and optical coherence tomography scans confirmed the presence of subretinal fluid in the subfovel area. CONCLUSION: In nephrotic syndrome cases especially with accompaniment of high blood pressure, fluid accumulation in the retina layer may occur. Serous macular detachment must be kept in mind when treating these patients.

Association of Upper Eyelid Ptosis Repair and Blepharoplasty With Headache-Related Quality of Life.

IMPORTANCE: Headache can be a functional indication for ptosis repair and blepharoplasty. OBJECTIVE: To evaluate the changes in headache-related quality of life in patients who underwent upper eyelid ptosis repair or blepharoplasty. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted among 108 patients who underwent standard upper eyelid blepharoplasty and 44 patients who underwent ptosis repair (levator resection, Müller muscle resection, or frontalis suspension) for obscuration of the superior visual field at an ophthalmology clinic's oculoplastic department from September 1, 2014, to September 1, 2015. A validated headache-related quality-of-life survey, the Headache Impact Test-6 (HIT), was administered preoperatively and postoperatively to patients who had tension-type headache. The minimum time interval after the operation was 3 months (mean, 13.5 weeks; range, 12-17 weeks). MAIN OUTCOMES AND MEASURES: Postoperative HIT scores, decline in HIT scores, and marginal reflex distance test 1 scores. RESULTS: Of the 108 patients (66 women and 42 men; mean [SD] age, 49.8 [10.7] years) who underwent blepharoplasty and the 44 patients (26 women and 18 men; mean [SD] age, 45.6 [17.8] years) who underwent ptosis repair, 38 (35.2%) and 28 (63.6%), respectively, had symptoms of tension-type headaches. In both groups, the mean (SD) postoperative HIT scores were statistically significantly better than the preoperative HIT scores (blepharoplasty group: preoperative score, 55.9 [6.6] vs postoperative score, 46.4 [9.0]; ptosis repair group: preoperative score, 60.0 [7.2] vs postoperative score, 42.3 [9.3]; P = .001). In the patients who underwent ptosis repair, the mean (SD) preoperative HIT score was significantly higher than in those who underwent blepharoplasty (60.0 [7.2] vs 55.9 [6.6]; P = .007) and the postoperative HIT score was significantly lower than those who underwent blepharoplasty (42.3 [9.3] vs 46.4 [9.0]; P = .03). The mean (SD) decline in the HIT score was significantly higher in patients who underwent ptosis repair than in those who underwent blepharoplasty (17.8 [9.9] vs 9.5 [8.6]; P = .002). For patients who underwent ptosis repair, there was a statistically significant negative correlation between the results on the marginal reflex distance test 1 (median, 1.82; minimum, 1.0; maximum, 3.5) and change in the HIT score (median, 18; minimum, 0; maximum, 30) (P = .005; r = -0.645). In patients who underwent ptosis repair, the mean (SD) difference between the preoperative and postoperative HIT scores was significantly higher for the patients who underwent levator resection (3.1 [0.3]) than for those who underwent Müller muscle resection (1.5 [0.7]) and frontalis suspension procedures (1.9 [0.7]) (P = .001). CONCLUSIONS AND RELEVANCE: The operations for ptosis and blepharoptosis provide significant relief for tension-type headache and result in improved headache-related quality of life. As a result, tension-type headache can be a functional indication for upper eyelid blepharoplasty and ptosis repair, especially for patients with lower results on the marginal reflex distance test 1. LEVEL OF EVIDENCE: 3.

Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions.

The aim of this study was to determine whether retinal nerve fibre layer (RNFL) thickness is correlated with cerebral white matter lesions (WML) in migraine patients. Forty migraine and 40 healthy subjects were included in this study. The difference in RNFL thickness between the control and a migraine group with WML and a migraine group without WML were investigated using analysis of variance (ANOVA). A Tukey post hoc test was conducted to determine from which group the difference originated. Lower RNFL thicknesses were observed in the migraine patient group where WML was detected using magnetic resonance imaging (MRI), compared with the control group and with the migraine group with no WML. Statistically significant difference was found between the three groups in terms of RNFL thickness. Although there was a statistically significant difference between the control and the migraine group with WML detected with MRI, no statistically significant difference was found in terms of RNFL thickness between the control and the migraine group with no WML related to Tukey post hoc test. Moreover, there was a statistically significant difference between migraine patients with WML and patients without WML in terms of retinal nerve fibre layer thickness. The results indicate that reduction in RNFL detected via optical coherence tomography may be related to cerebral WML in migraine patients. Further studies by neurologists and ophthalmologists are necessary to determine the clinical relevance of the relation between RNFL and cerebral WML.

Evaluation of Biochemical Composition of Vitreous of Eyes of Diabetic Patients Using Proton Magnetic Resonance Spectroscopy.

PURPOSE: To investigate possible metabolic changes in vitreous of patients with diabetes mellitus with or without diabetic retinopathy using proton magnetic resonance spectroscopy. MATERIAL AND METHODS: Twenty-eight healthy control subjects (group 1), 18 patients with diabetes mellitus without diabetic retinopathy (group 2) and 18 patients with diabetic retinopathy (group 3) were included. Proton magnetic resonance spectroscopy was performed in left vitreous of all subjects; amounts of Glutamate, Choline, Lactate and Creatine values were measured. Choline/Creatine, Glutamate/Creatine and Lactate/Creatine ratios were calculated. RESULTS: Glutamate/Creatine and Lactate/Creatine ratios were significantly higher in group 2 and 3 when compared to group 1. Both Glutamate/Creatine and Lactate/Creatine ratios did not show any difference in group 2 when compared to group 3. CONCLUSIONS: Our results suggest that when compared to healthy subjects, Glutamate and Lactate are the main metabolites of vitreous in diabetes mellitus patients. This may help us to better understand the metabolic factors in pathogenesis of diabetic retinopathy.

Retinal Precapillary Arteriolar Occlusion after Coronary Artery Bypass Grafting Surgery.

BACKGROUND: The aim of this study is to evaluate the microembolic changes related to occlusions of precapillary arterioles in the retina during coronary artery bypass grafting (CABG) surgery using fundus photography, and to examine systemic and operational factors related to occurrent lesions. METHODS: Retinal microvascular damage was assessed by color fundus photography one day before CABG surgery, on postoperative day five, and again three months after surgery. In addition to patients' demographics, diabetes mellitus, hypertension, chronic renal failure, and hypercholesterolemia (LDL level) were examined. Smoking history was recorded. Additionally, each patient's carotid Doppler results were ranked by four degrees. Data related to the surgery were recorded. RESULTS: No retinal emboli were seen in any patient before surgery. In fundus photographs taken on the fifth day after surgery, retinal precapillary arteriolar occlusions were seen in 20 (28.57%) of the patients. Lesions were observed to have disappeared in the third month after surgery. There was no significant (P > .05) difference in age, sex, diabetes mellitus, HT ratio, tobacco consumption percentage, LDL values, and Doppler USG distribution between the two groups of patients with and without lesions. However, CABG surgery and cross-clamp removal time measured significantly (P < .05) longer in the group with lesions than in the group without lesions. CONCLUSION: Our results show that retinal microembolism can occur after CABG surgery in association with surgery time and cross-clamp time; however, this does not cause any clinical outcome.

Effect of Upper Eyelid Blepharoplasty on Vision and Corneal Tomographic Changes Measured By Pentacam.

PURPOSE: The aim of this study is to determine whether any change occurs in corneal astigmatic values measured by a pentacam and any subjective visual acuity changes occurs following the upper eyelid blepharoplasty. METHODS: This is a prospective study; 43 eyes of 23 patients with dermatochalasis underwent pentacam and surveyed for blurred vision before, 1 and 3 months after blepharoplasty surgery. In the course of those 3 measurements, both refractive and keratometric data were recorded and analyzed. The changes in refractive sphere, cylinder and cylindrical axis from both preoperative and postoperative readings were compared statistically. RESULTS: Compared to preoperative measurements, 26 eyes (60%) had a measurable increase in corneal astigmatism after the surgery. Increased astigmatism observed by pentacam in the first and the third month after surgery, showed statistically significant results according to Wilcoxon test with (p = 0.028 < 0.05) and (p = 0.048 < 0.05) values, respectively. The mean change in astigmatism was reported as 0.15D. Regarding the astigmatism axis, no significant change was detected; in the 1 month (p = 0.435 > 0.05) and 3 months (p = 0.560 > 0.05) postoperative measurements compared to preoperative values. Two patients (4.34%) reported visual acuity change 3 months after the surgery. CONCLUSION: We discovered statistically significant astigmatic changes; however, these were clinically insignificant visual acuity changes in compatibility with prior studies. Patients undergoing blepharoplasty surgery should be advised that this procedure may potentially alter vision. It is also very important to advise the patients to undergo cataract and/or refractive surgery after having upper eyelid surgery that this procedure may induce vision changes.

External Dacryocystorhinostomy for the Treatment of Functional Nasolacrimal Drainage Obstruction.

OBJECTIVES: To determine the outcome and long-term efficacy of external dacryocystorhinostomy (ext-DCR) with or without bicanalicular silicon intubation in patients with functional nasolacrimal drainage obstruction (FNLDO). MATERIALS AND METHODS: Patients with epiphora and patent lacrimal systems on nasolacrimal irrigation were prospectively enrolled in the study. Each patient was assessed with lacrimal scintigraphy to differentiate drainage abnormalities as presac (proximal) or postsac (distal) delays. All patients underwent ext-DCR; bicanalicular silicone intubation was performed only in presac delay cases. On follow-up examinations patients were asked to report their symptoms as none, mild, moderate or unchanged. Success was defined as lacrimal patency to irrigation and no or mild epiphora at the end of the follow-up period. RESULTS: Twenty-six lacrimal systems of 23 patients were eligible for inclusion. There were 9 presac delay and 17 postsac delay cases. Average follow-up time was 72.85 weeks (47-88 weeks). A successful outcome was achieved in 76.9% of the operated lacrimal systems. Success rate was 55.5% among presac obstructions and 88.2% among postsac obstructions. CONCLUSION: The long-term efficacy of ext-DCR in FNLDO patients is confirmed with our overall successful outcome of 76.9%. In preoperative assessment, lacrimal scintigraphy is helpful to determine the surgical approach and to predict the surgical outcome.

Retinal Nerve Fibre Layer Thickness in Migraine Patients with or without Aura.

The objective of this study was to evaluate the retinal nerve fibre layer (RNFL) thickness using spectral-domain optical coherence tomography (Optos SD-OCT, UK) in migraine patients with or without aura and to search for possible structural effects of migraine on the retina. Eighty eyes of 40 migraine patients and 80 eyes of 40 healthy subjects were included in this study. All four quadrants (temporal, superior, nasal, and inferior) and average peripapillary RNFL measurements were taken with SD-OCT in both groups. The average age of the patients and the control group were 35.7 ± 9.5 and 40.9 ± 12.7 years, respectively. In the migraine group, 45% of patients were with aura, and 55% were without aura. The average frequency of attacks per month and the migraine diagnosis time was 4.6 ± 4.4 and 6.2 ± 5.6, respectively. Parameters related to RNFL thickness of right and left eyes' average, superior, inferior, nasal, and temporal quadrant values were found to be similar in migraine and control subjects (p > 0.05). Focusing on the RNFL thickness of right and left eyes and the migraine parameters, there were no statistically significant differences between migraineurs with aura and without aura (p > 0.05). The correlations between the RNFL thickness parameters and the migraine patient's MIDAS (Migraine Disability Assessment Score) score, frequency of attacks, and diagnosis time of migraine were studied and no correlation was noted (p > 0.05). These findings demonstrated that migraine disease with or without aura does not have any effect on the thickness of the RNFL.

Painful Ophthalmoplegia Following Dental Procedure.

This case report is about a 26-year-old patient complaining of painful diplopia shortly after a dental procedure. Magnetic resonance imaging demonstrated a mass lesion in the cavernous sinus that responded well to oral corticosteroids. The possible side effect of the intraoral local anaesthetic injection used during the dental procedure was questioned.

A case of recurrent bloody tears.

Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an erythema multiforme-like drug eruption. He experienced chronic conjunctivitis which resulted in a few minor symblephara. One year later, the patient developed attacks of bloody tearing. All clinical, radiologic, and laboratory investigations related to bloody epiphora were within normal limits except for a mild, nonspecific chronic inflammatory reaction in the perivascular tissues of the lacrimal gland and orbital soft tissues. Also, an increase in vascular permeability and contrast extravasation on carotid angiography was detected. High-dose vitamin C was administered. The patient continued to have unilateral bloody tears intermittently for two years, but the episodes became much less frequent and had resolved by three years. It is conceivable that increased vascular permeability following the systemic inflammatory process could have played a role in the etiology of recurrent bloody tears in this atypical patient.

Benzaldehyde lyase catalyzed enantioselective self and cross condensation reactions of acetaldehyde derivatives.

Flexible protected 1,3,4-trihydroxy-2-butanone is synthesized in high enantiomeric excesses by using asymmetric homo- and cross- acyloin coupling of aliphatic aldehydes catalyzed by benzaldehyde lyase.

Carboligation reactions with benzaldehyde lyase immobilized on superparamagnetic solid support.

Histidine-tagged recombinant benzaldehyde lyase (BAL, EC 4.1.2.38) was efficiently immobilized to surface-modified magnetic particles with affinity ligand binding. In addition to conventional benzoin condensation reactions, two important representative BAL-catalyzed carboligation reactions, were also performed with this magnetically responsive biocatalyst. The results obtained from the carboligation reactions that were performed with this simple and convenient heterogenous biocatalyst were comparable to that of free-enzyme-catalyzed reactions.

Anterior limbal approach in the treatment of a late and extensive post-traumatic retrobulbar abscess.

The authors report a case of acute development of an extensive retrobulbar abscess 3 weeks after an orbital floor fracture. Urgent drainage of the abscess was performed by an anterior transconjunctival approach. A dramatic recovery was observed a few days following the operation. The visual acuity increased from hand motions to 0.7 to 0.8 in the early postoperative period and to 1.0 shortly thereafter. The severity of infection, the importance of antibiotic prophylaxis for blowout fractures, and the efficacy of the transconjunctival approach on the final visual and functional outcome are described.

Implant infection in porous orbital implants.

PURPOSE: To analyze implant infection in patients with porous orbital implants. METHODS: A retrospective analysis of 212 patients with one of five types of porous orbital implants (bone-derived hydroxyapatite [HA], coralline HA, synthetic HA, porous polyethylene, and aluminium oxide) was conducted. Reasons for surgery, type of surgery, type of implant, peg system used, time of pegging, problems before and after pegging, treatment, and follow-up duration were recorded for all patients, along with additional data including time of onset of infection, microorganism cultured, antibiotics used, patient response to antibiotic therapy, additional interventions, and final status for patients with infection. RESULTS: Of the 212 patients with porous orbital implants, 116 (54.72%) were pegged. Implant infection was observed in 11 of 116 patients (9.48%) with pegs, whereas 0% of unpegged implants was infected (p = 0.001). The interval between pegging and the onset of infection was 3 to 83 months (average, 36.27 +/- 29.12 months). Implant exposure was noted in 5 of the 11 patients with infection. Symptoms resolved completely with antibiotic treatment in 7 patients. One patient required implant removal as the result of frequent exacerbations. The remaining 3 patients presented with hemorrhagic, purulent discharge and/or pyogenic granuloma on their last visits after being free of symptoms for 5 to 6 months. CONCLUSIONS: Implant infection is a serious problem that requires additional patient visits, intensive antibiotic therapy, surgery, or some combination of these. Existence of a peg system appears to play a role in implant infection. Infection may develop as late as 6 to 7 years after pegging, and the patient should be cautioned about potential late-onset problems. It is possible to control the infection with appropriate antibiotic therapy; removal should be reserved for refractory cases.