Single-Step Full-Face Surgical Treatment of the Facial Profile.

The present study was performed to describe how much affordable, feasible, and straightforward is the approach the authors called "single-stage full-face surgical profileplasty," tailored to greatly improve the surgery of the facial profiling setting and achieve complete profile correction at the same time. From January 2010 to May 2019, 113 patients (95 females and 18 males; aged 19 - 63 years) were surgically treated for full-face profile amelioration. Profile correction was performed by using a combination of five procedures out of other various previously experienced: forehead fat grafting, rhinoplasty, lip fat grafting, genioplasty, and submental liposuction. All patients were assessed at 1, 3, 6, and 12 months following surgery for assessing the surgical profile treatment (SPT) outcome and any possible side effects of the combined treatment. Facial profile stability at 1 year was taken as the completion point of this treatment. Arnett et al's "Soft Tissue Cephalometric Analysis" (1999) was used to clinically evaluate the soft tissues before and after the SPT. Patients' satisfaction was measured with the Client Satisfaction Questionnaire-8" at 3 and 12 months after surgery. Statistics were used for Arnett et al's evaluation. Almost all the values were consistent and reached the normal ranges indicated by Arnett et al (p < 0.001), confirming that the desired results of the surgical profileplasty have been achieved. Single-stage full-face surgical profile treatment helps in correcting faults of the global facial deformity, in every single treated area, providing an overall improvement in facial aesthetics and harmony. Obtaining the simultaneous correction in the whole face has also the advantage of avoiding multiple surgical procedures, reducing postoperative discomfort, and the overall risks for the patient due to multiple surgical and anesthetic procedures.

Reply to Mattei et al. Jacob Disease, Osteochondroma of the Coronoid Process, Coronoid Process Hyperplasia or Langenbeck Disease: The Big Jumble. Comment on "Raccampo et al. Jacob's Disease: Case Series, Extensive Literature Review and Classification Proposal. J. Clin. Med. 2023, 12, 938".

As authors of the text, we can only thank Mattei et al. [...].

Jacob's Disease: Case Series, Extensive Literature Review and Classification Proposal.

Jacob's disease is a rare entity consisting of the formation of a pseudojoint between an abnormal coronoid process of the mandible and the inner surface of the zygomatic bone. First described by Jacob in 1899, its diagnosis and definition have never been entirely univocal. In this paper, we present three emblematic cases and an extensive review of the literature on Jacob's disease. Given the variability observed in the presentation of the disease, we have developed a proposal for the classification, here reported.

Natural History of Treatment-Naïve Quiescent Choroidal Neovascularization in Age-Related Macular Degeneration Using OCT Angiography.

PURPOSE: To describe the evolution of treatment-naïve quiescent choroidal neovascularizations (CNVs) in age-related macular degeneration (AMD) by means of OCT angiography (OCTA). DESIGN: Prospective, observational, consecutive case series. PARTICIPANTS: Fifteen eyes (7 right eyes and 8 left eyes) of 14 patients (8 women and 6 men) fulfilled the criteria of quiescent CNV in AMD among an overall pool of 950 neovascular AMD patients. METHODS: Consecutive patients with treatment-naïve quiescent CNV seeking treatment at 2 tertiary referral centers were followed up longitudinally for 1 year after diagnosis. The study included 3 visits at different time points. Each visit included measurement of best-corrected visual acuity, dilated fundus biomicroscopy, structural OCT, and OCTA. At baseline, fluorescein angiography and indocyanine green angiography also were performed to confirm diagnosis. Qualitative and quantitative analysis were assessed during a 12-month follow-up period. MAIN OUTCOME MEASURES: Qualitative and quantitative assessment of OCTA images and evaluation of the rate of clinical activation. RESULTS: Fifteen eyes of 14 patients were included in the analysis. Fourteen of 15 CNVs remained quiescent, and the rate of clinical activation was 6.6%. Qualitative analysis disclosed that the CNV core was visible in 2 of 14 eyes at baseline and in 3 of 14 eyes at 6 and 12 months; the CNV margin was well defined in 10 of 14 eyes and the CNV location was foveal involving in 8 of 14 eyes at all time points; CNV growth was displayed in 3 of 14 eyes at 6 months and in 10 of 14 eyes at 12 months compared with baseline images. Quantitative analysis revealed that despite an increase in CNV area (P = 0.039), CNV vessel density did not change (P = 0.731) in quiescent CNVs during follow-up. CONCLUSIONS: We demonstrated biological activity of quiescent CNV by showing lesion growth over 12 months. Biological activity was not paralleled by clinical activity in most cases because of absence of exudation development over time, possibly because of unchanged CNV vessel density despite growth.

Dexamethasone intravitreal implant at the time of cataract surgery in eyes with diabetic macular edema.

PURPOSE: To determine the potential role of intraoperative dexamethasone intravitreal implant (DEX-I) in reducing diabetic macular edema (DME) worsening after phacoemulsification. METHODS: This was a prospective study on 19 eyes of 19 patients with type 2 diabetes mellitus with DME and cataract. Mean preoperative Early Treatment Diabetic Retinopathy Study visual acuity (VA) was 16.7 letters. Mean foveal thickness (FT) was 451 µm. The DME was naive in 11 eyes and refractory in 8 eyes. All eyes underwent a standard phacoemulsification and intraocular lens implantation; DEX-I was injected at the end of surgery. Follow-up was performed at 1 week and then monthly until DME recurrence (up to 8 months). RESULTS: At 1 week, mean VA improved by 15 letters (range 0-29 letters) and mean FT decreased by 147 µm (range 69-236 µm). Improvement consolidated at month 1, with a mean VA improvement of 18 letters (range 3-32 letters) and a mean improvement in FT of 193 µm (range 76-304 µm), remaining stable at month 2 after surgery in all eyes. The DME recurred in 1 eye at month 3, in 14 eyes (73.8%) between months 4 and 5, and after month 6 in 4 eyes (21%). Refractory DMEs demonstrated the same benefit but recurred earlier than naive ones (4 months versus 5.8 months, p<0.01). CONCLUSIONS: Intraoperative DEX-I prevents DME worsening after phacoemulsification. Its positive effects last for at least 3 months.

Dexamethasone intravitreal implant for diabetic macular edema: indications for a PRN regimen of treatment.

PURPOSE: To define the mean time of first recurrence of diabetic macular edema (DME) after a single injection of dexamethasone intravitreal implant (DEX-I), reducing the burden of monthly visits during a PRN regimen of treatment. METHODS: Twenty phakic eyes with DME (12 eyes naïve and 8 eyes with edema persistent after previous treatments) were followed monthly after DEX-I injection until evidence of first recurrence of edema, defined as a change in visual acuity (VA) ≥5 letters and/or in foveal thickness (FT) ≥50 µm. Reaching this point, the eyes were re-treated. Monitored parameters were changes in VA, FT, intraocular pressure (IOP), and lens opacity. RESULTS: Maximal efficacy was registered at month 1, when mean VA improved by 14 letters (19%), FT decreased by 325 µm (43.7%), and in 15 eyes (75%) edema was completely reabsorbed. The mean time of first recurrence was 5.1 months. No statistical difference was found between eyes with naïve or persistent DME. Five eyes needed topical medication for modest temporary IOP increase (21-24 mm Hg) between months 2 and 4. No increase in lens opacities was registered during follow-up. CONCLUSIONS: According to the results of this study, the first signs of DME recurrence after DEX-I injection appear at a mean time of 5 months, suggesting that an appropriate and prudent time schedule for a PRN regimen could be limited to monthly tonometry and a first complete examination not before 4 months.