The Efficacy of Orbital Septal Flap in the Treatment of Moderate and Severe Upper Eyelid Retraction.

PURPOSE: To assess the long-term effectiveness of the orbital septal flap to lengthen the levator muscle in management of moderate and severe upper eyelid retraction. METHODS: This study reports 46 eyes of 43 consecutive patients with moderate or severe upper eyelid retraction who were recommended for surgery. The period of the study was between October 2016 and October 2019. All cases were evaluated for eyelid position before and at 3, 6, and 12 months after the operation. Successful outcome was defined as "perfect," "acceptable," and "failure". RESULTS: The average age was 33.3 years (range, 16-59 years). The average orbital septal flap height was 5.28 ± 0.77 mm. Before surgery, 78.3% had 1 of 3 central upper eyelid retraction (group 1), and 21.7% had 1 of 3 lateral upper eyelid retraction (group 2). During follow-up postoperatively, all eyelid parameters of upper marginal reflex distance, upper scleral show, and palpebral fissure height significantly decreased compared with preoperative values in both groups. The result was considered "perfect" or "acceptable" in 42 eyes (91.3%). However, at 12 months after surgery, of the 36 middle eyelid retraction cases (group 1), 35 (97.2%) showed a successful outcome (perfect or acceptable results), while the success rate in group 2 was 70% (7 of 10 cases), a significant difference (p = 0.008). No severe complications were seen during follow up. CONCLUSIONS: Orbital septal flap is a safe and reliable procedure for management of upper eyelid retraction of moderate and severe degree.

Evaluation of Anterior Chamber Depth and Anterior Chamber Angle Changing After Phacoemulsification in the Primary Angle Close Suspect Eyes.

BACKGROUND: Phacoemulsification surgery has the ability to deeply alter the segment anterior morphology, especially in eye with shallow anterior chamber (AC), narrow anterior chamber angle (ACA). However, the changes of anterior chamber depth (ACD) and ACA on the close angle suspect eyes after phacoemulsification have not been mentioned in many studies. So, we conduct this research. AIM: To evaluate the alteration in the ACA and ACD after phacoemulsification in the close angle suspect eyes. METHODS: Interventional study with no control group. Subjects were the primary angle closure suspect (PACS) eyes, that were operated by phacoemulsification with intraocular lens (IOL) at Glaucoma Department of VNIO from December 2017 to October 2018. RESULTS: 29 PACS eyes with cataract were operated by phacoemulsification with intraocular lens. After 3 months of monitoring, the average ACD augmented from 2.082 ± 0.244 to 3.673 ± 0.222 mm. AOD500 increase from 0.183 ± 0.088 to 0.388 ± 0.132 µm, AOD750 increased from 0.278 ± 0.105 to 0.576 ± 0.149 µm. The TISA500 enlarged from 0.068 ± 0.033 to 0.140 ± 0.052 mm2, TISA750 enlarged from 0.125 ± 0.052 to 0.256 ± 0.089 mm2 at the third month (p < 0.01). CONCLUSION: Phacoemulsification surgery increases the ACD and enlarged the angle in the PACS eyes.