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Victor M Elner - One of the best experts on this subject based on the ideXlab platform.
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ultrasonic bone removal versus high speed burring for lateral orbital decompression comparison of surgical outcomes for the treatment of thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2010Co-Authors: Raymond I Cho, Christina H Choe, Victor M ElnerAbstract:Purpose: To evaluate the efficacy of ultrasonic bone removal during lateral orbital decompression for thyroid eye disease. Methods: Retrospective, comparative, interventional case series of lateral orbital decompressions performed by the senior author for thyroid eye disease between July 2005 and July 2008. Patients were excluded if they had other coexisting orbital conditions or concurrent decompression of other orbital walls. Primary outcome measures included visual acuity, proptosis, Lagophthalmos, eyelid retraction, and exposure keratopathy. Results: Thirty-six consecutive lateral orbital decompressions performed by the senior author were reviewed. The Sonopet Omni ultrasonic surgical aspirator was used to remove the lateral wall in 18 cases, and a high-speed drill with a cutting burr was used in the other 18 cases. There was no significant difference between the groups in postoperative visual acuity, proptosis reduction, Lagophthalmos, eyelid retraction, exposure keratopathy, or surgical complications. The average reduction in proptosis was 3.9 mm (range, 1–6.5 mm) in the Sonopet group and 4.0 mm (range, 1–6 mm) in the drill group (p = 0.86). In our series, the average surgical case time was slightly shorter in the Sonopet group than in the drill group (104 vs. 118 minutes, p = 0.032). Conclusions: Ultrasonic bone removal is a safe and effective alternative to high-speed burring during lateral orbital decompression for thyroid eye disease.
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graded full thickness anterior blepharotomy for correction of upper eyelid retraction not associated with thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Hakan Demirci, Bartley R Frueh, Adam S Hassan, Stephen D Reck, Victor M ElnerAbstract:PURPOSE To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper eyelid retraction of various causes not associated with Graves eye disease. METHODS Twenty-one eyelids of 18 patients with upper eyelid retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper eyelid distance, Lagophthalmos, and superficial punctuate keratopathy were evaluated. RESULTS Upper eyelid retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper eyelid distance, Lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred. CONCLUSIONS Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper eyelid retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper eyelid height symmetry and contour.
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mullerectomy for upper eyelid retraction and Lagophthalmos due to facial nerve palsy
Archives of Ophthalmology, 2005Co-Authors: Adam S Hassan, Bartley R Frueh, Victor M ElnerAbstract:Background Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to Lagophthalmos. Objective To evaluate the role of mullerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Methods Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Muller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, Lagophthalmos, and keratopathy were compared. Results Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm ( P P = .002) and corneal exposure ( P Conclusion Mullerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper eyelid retraction that results in exposure keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction. METHODS: Fifty eyelids of 32 patients with Graves eye disease-associated upper eyelid retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, Lagophthalmos, and keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P<.001), Lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid retraction. METHODS: Fifty eyelids of 32 patients with GED-associated upper lid retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, Lagophthalmos, and keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P < .00001), Lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.
Bartley R Frueh - One of the best experts on this subject based on the ideXlab platform.
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palpebral spring in the management of Lagophthalmos and exposure keratopathy secondary to facial nerve palsy
Ophthalmic Plastic and Reconstructive Surgery, 2009Co-Authors: Hakan Demirci, Bartley R FruehAbstract:PURPOSE To evaluate the use of a palpebral spring, a dynamic facial reanimation technique, in the management of Lagophthalmos and exposure keratopathy secondary to facial nerve palsy. METHODS A palpebral spring was placed in 29 eyelids of 28 patients with symptomatic facial nerve palsy. Preoperative and postoperative symptoms, upper eyelid margin to midpupil distance, Lagophthalmos, and exposure keratopathy were evaluated. RESULTS At an average of 83 months follow-up, preoperative symptoms improved or resolved in 26 (90%) eyes. The upper eyelid margin to midpupil distance decreased and Lagophthalmos and exposure keratopathy significantly improved after palpebral spring placement (p < 0.001). After modification of the technique by suturing the spring to the anterior tarsal surface, rather than encasing the tip in a silicone tube and letting it ride freely, tension of the spring required adjustment in 4 eyes (27%). Dislocation of the spring from the tarsus without exposure through the skin was observed in 1 eyelid (7%). The spring was replaced because of loss of function secondary to metal fatigue in 5 eyelids (33%) after an average of 43 months. Exposure of the spring through the skin was observed in 2 eyelids (14%) and required spring removal from 1 eyelid and replacement of the spring in the other. CONCLUSION A palpebral spring is an effective treatment for Lagophthalmos and exposure keratopathy in patients with facial nerve palsy who do not receive adequate relief from the static procedures of lower eyelid tightening and upper eyelid lowering. This technique significantly improved symptoms and signs in these patients while allowing some of the blink reflex.
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graded full thickness anterior blepharotomy for correction of upper eyelid retraction not associated with thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Hakan Demirci, Bartley R Frueh, Adam S Hassan, Stephen D Reck, Victor M ElnerAbstract:PURPOSE To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper eyelid retraction of various causes not associated with Graves eye disease. METHODS Twenty-one eyelids of 18 patients with upper eyelid retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper eyelid distance, Lagophthalmos, and superficial punctuate keratopathy were evaluated. RESULTS Upper eyelid retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper eyelid distance, Lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred. CONCLUSIONS Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper eyelid retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper eyelid height symmetry and contour.
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mullerectomy for upper eyelid retraction and Lagophthalmos due to facial nerve palsy
Archives of Ophthalmology, 2005Co-Authors: Adam S Hassan, Bartley R Frueh, Victor M ElnerAbstract:Background Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to Lagophthalmos. Objective To evaluate the role of mullerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Methods Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Muller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, Lagophthalmos, and keratopathy were compared. Results Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm ( P P = .002) and corneal exposure ( P Conclusion Mullerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper eyelid retraction that results in exposure keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction. METHODS: Fifty eyelids of 32 patients with Graves eye disease-associated upper eyelid retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, Lagophthalmos, and keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P<.001), Lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid retraction. METHODS: Fifty eyelids of 32 patients with GED-associated upper lid retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, Lagophthalmos, and keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P < .00001), Lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.
Adam S Hassan - One of the best experts on this subject based on the ideXlab platform.
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graded full thickness anterior blepharotomy for correction of upper eyelid retraction not associated with thyroid eye disease
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Hakan Demirci, Bartley R Frueh, Adam S Hassan, Stephen D Reck, Victor M ElnerAbstract:PURPOSE To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper eyelid retraction of various causes not associated with Graves eye disease. METHODS Twenty-one eyelids of 18 patients with upper eyelid retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper eyelid distance, Lagophthalmos, and superficial punctuate keratopathy were evaluated. RESULTS Upper eyelid retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper eyelid distance, Lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred. CONCLUSIONS Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper eyelid retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper eyelid height symmetry and contour.
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mullerectomy for upper eyelid retraction and Lagophthalmos due to facial nerve palsy
Archives of Ophthalmology, 2005Co-Authors: Adam S Hassan, Bartley R Frueh, Victor M ElnerAbstract:Background Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to Lagophthalmos. Objective To evaluate the role of mullerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. Methods Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Muller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, Lagophthalmos, and keratopathy were compared. Results Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm ( P P = .002) and corneal exposure ( P Conclusion Mullerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Archives of Ophthalmology, 2004Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:BACKGROUND: A chief morbidity of Graves eye disease is upper eyelid retraction that results in exposure keratopathy and cosmetic deformity. OBJECTIVE: To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction. METHODS: Fifty eyelids of 32 patients with Graves eye disease-associated upper eyelid retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, Lagophthalmos, and keratopathy were compared. RESULTS: At a mean +/- SD of 8.5 +/- 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P<.001), Lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all wound dehiscence, and a full-thickness hole each occurred once. The mean +/- SD time taken to perform the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.
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graded full thickness anterior blepharotomy for upper eyelid retraction
Transactions of the American Ophthalmological Society, 2003Co-Authors: Victor M Elner, Adam S Hassan, Bartley R FruehAbstract:PURPOSE: A chief morbidity of Graves' eye disease (GED) is upper lid retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid retraction. METHODS: Fifty eyelids of 32 patients with GED-associated upper lid retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, Lagophthalmos, and keratopathy were compared. RESULTS: At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P < .00001), Lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per eyelid. CONCLUSIONS: Graded anterior blepharotomy for upper lid retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.
Mohsen Bahmani Kashkouli - One of the best experts on this subject based on the ideXlab platform.
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tear film lacrimal drainage system and eyelid findings in subjects with anophthalmic socket discharge
American Journal of Ophthalmology, 2016Co-Authors: Mohsen Bahmani Kashkouli, Roya Zolfaghari, Acieh Eshaghi, Anahita Amirsardari, Mohammad Bagher Abtahi, Nasser Karimi, Amirpooya Alemzadeh, Mohamadreza AghamirsalimAbstract:Purpose To compare the results of tear film and lacrimal drainage system tests between anophthalmic socket and normal eye and assess discharge characteristics and frequency of prosthesis removal (questionnaire), eyelid function, and meibomian glad dysfunction (MGD). Design Prospective masked case control. Methods Subjects (≥6 years and ≥6 months of wearing prosthesis) with unilateral acquired anophthalmic socket discharge were included. Excluded was ocular adnexal abnormality of any reason and incomplete tests. The subjective questionnaire was completed. Blinking rate, Lagophthalmos, eyelid laxity, MGD, Schirmer test, tear meniscus height, and dye disappearance test were assessed by a masked examiner. Another masked examiner performed an irrigation test 1 week later and interpreted the scintigraphy images at the end of the study. Results Included were 50 subjects (mean age: 31.3 years, mean prosthesis wear: 96.1 months). Discharge was frequent or very frequent in 85%, mucoid or mucopurulent in 90%, and moderate to severe in 86% of the subjects. MGD in 58%, Lagophthalmos in 80%, and eyelid laxity in 46% were observed. Anophthalmic socket sides showed a significantly lower tear production and higher tear drainage obstruction. Subjects with frequent prosthesis removal had a significantly ( P = .02) greater Lagophthalmos and blinking rate ( P = .04). The blinking rate was also significantly greater in subjects with higher frequency of discharge ( P = .04). Conclusion Tear film impairment (aqueous and lipid) and lacrimal drainage obstruction should be considered in subjects with anophthalmic socket discharge. A significantly higher blinking rate and Lagophthalmos were found in subjects with higher frequency of prosthesis removal.
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anterior lamellar recession blepharoplasty and supratarsal fixation for cicatricial upper eyelid entropion without Lagophthalmos
Eye, 2016Co-Authors: Gholamhoseyn Aghai, A Gordiz, Khalil Ghasemi Falavarjani, Mohsen Bahmani KashkouliAbstract:To assess the results of anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure in patients with upper eyelid cicatricial entropion without Lagophthalmos. In a prospective interventional case series, 52 eyelids (32 patients) were included (April 2009–December 2010). Excluded were patients with previous eyelid surgeries, Lagophthalmos, and <12 months of follow-up. Using a microscope, after recessing anterior lamella 3–4 mm above the eyelid margin, it was fixed with 4–5 interrupted 6-0 vicryl sutures. Excess anterior lamella was then excised (blepharoplasty), supratarsal fixation sutures (6-0 vicryl) were put and the skin was closed with 6-0 nylon sutures. Success and failure defined based upon eyelash-globe touch on the last follow-up visit (at least 12 months), respectively. There were 21 females (65.6%) and 11 males (34.4%) with a mean age of 69.7 years (SD=6.9) and mean follow-up of 21.06 months (SD=8.26). Success was observed in 39 (75%) and failure in 13 (25%). Mean time of failure was 4.5 months (SD=3). Although re-treatment with radio-frequency electrolysis (eight eyelids) and re-anterior lamellar recession (two eyelids) resulted in success in 12 eyelids with failure, two patients (three eyelids) declined further procedure. Except for thickened eyelid margin, no complications were observed. Anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure is an effective and safe technique for the treatment of the upper eyelid cicatricial entropion without Lagophthalmos.
Robert A. Goldberg - One of the best experts on this subject based on the ideXlab platform.
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nonsurgical management of congenital eyelid malpositions using hyaluronic acid gel
Ophthalmic Plastic and Reconstructive Surgery, 2009Co-Authors: Mehryar Taban, Raymond S Douglas, Angelo Tsirbas, Ronald Mancini, Tanuj Nakra, Federico G Velez, Noa Eladalman, Robert A. GoldbergAbstract:Purpose: To report our preliminary experience using hyaluronic acid gel fillers as a nonsurgical alternative in the management of congenital eyelid malpositions. Methods: In this retrospective interventional case series, 5 patients (10 eyes) with congenital eyelid malpositions, including eyelid retraction, ectropion, euryblepharon, epiblepharon, and abnormalities associated with a shallow orbit, with resultant Lagophthalmos and/or keratopathy and tearing were evaluated before and after injection with hyaluronic acid gel (Restylane) in the pretarsal and/or septal regions of the affected eyelid(s). Pretreatment, posttreatment, and follow-up photographs were analyzed for eyelid position and degree of eyelid closure and Lagophthalmos, and slit-lamp evaluation of the degree of keratopathy. Results: All 5 patients demonstrated significant improvement of eyelid position and degree of keratopathy. The mean improvement in Lagophthalmos was 4.5 mm (range, 2‐7 mm). The average volume of hyaluronic acid gel used was 0.5 ml per eyelid. Complications were minor, including transient edema and ecchymosis at the sites of injection. Of the 10 eyelids injected, only one had increased astigmatism after injection. Conclusions: Hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of certain eyelid malpositions, disorders traditionally requiring surgical intervention if aggressive ocular lubrication fails. This treatment is particularly useful in such patients who are commonly premature with poor general health and serves as a temporizing measure by allowing the much needed tissue expansion to take effect over time.
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use of hyaluronic acid gel in the management of paralytic Lagophthalmos the hyaluronic acid gel gold weight
Ophthalmic Plastic and Reconstructive Surgery, 2009Co-Authors: Ronald Mancini, Raymond S Douglas, Angelo Tsirbas, Mehryar Taban, Alan Lowinger, Tanuj Nakra, Norman Shorr, Robert A. GoldbergAbstract:Purpose: To evaluate the safety and efficacy of injecting hyaluronic acid gel in the upper eyelid as a nonsurgical alternative in the treatment of paralytic Lagophthalmos. Methods: This is a retrospective study of 9 patients (10 eyelids) with paralytic Lagophthalmos treated with hyaluronic acid gel in the prelevator aponeurosis region and/or pretarsal region of the paralytic upper eyelid. Pretreatment, posttreatment, and follow-up photographs were digitized, and overall outcomes assessed. Measurements of Lagophthalmos were standardized and compared. Slit-lamp examination was used to evaluate the degree of exposure keratopathy. ImageJ was used for photographic analysis. Results: Ten eyelids (9 patients, 7 men; mean age 69.2 years; range, 31‐90 years) with paralytic Lagophthalmos were treated with hyaluronic acid gel. The average amount of injected hyaluronic acid gel was 0.9 ml (range, 0.2‐1.2 ml). All patients demonstrated significant improvement in Lagophthalmos and exposure keratopathy. The mean improvement in Lagophthalmos was 4.8 mm (range, 0.9‐11.9 mm; p 0.001). Of the 5 patients with follow-up, the mean follow-up period was 3.6 months (range, 2‐5 months). Of these, 2 had no change in Lagophthalmos (both maintained 0 mm at 5 months), one had a slight decrease in Lagophthalmos (4.8‐4.6 mm at 2 months), one had a slight increase in Lagophthalmos (0.3‐0.5 mm at 2 months), and one had a more significant increase in Lagophthalmos (1.9‐4.3 mm at 4 months). The latter patient underwent a second treatment with further reduction of Lagophthalmos to 0.4 mm. Overall, there was a decrease in margin reflex distance from the upper eyelid margin to the corneal light reflex (MRD1) but it was not statistically significant. Complications were minor and included transient ecchymosis, edema, and tenderness at the injection sites. Conclusions: On the basis of these preliminary results, hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of paralytic Lagophthalmos. This treatment may be particularly useful in patients who are poor surgical candidates and/or as a temporizing measure in patients in whom return of facial nerve function is anticipated, given the hyaluronic acid gel’s properties of slow resorption and reversibility with hyaluronidase.
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transconjunctival muller muscle recession with levator disinsertion for correction of eyelid retraction associated with thyroid related orbitopathy
American Journal of Ophthalmology, 2005Co-Authors: Guy Ben J Simon, Ahmad M Mansury, Robert M Schwarcz, John D Mccann, Sara P Modjtahedi, Robert A. GoldbergAbstract:● PURPOSE: To evaluate the efficacy of transconjunctival Muller muscle recession and graded levator disinsertion for eyelid retraction in patients with thyroid-related orbitopathy (TRO). ● DESIGN: Retrospective consecutive case series. ● METHODS: Medical record review of 78 TRO patients (107 eyelids) who underwent surgery for upper eyelid retraction in a 5-year period was performed. Main outcome measures were anatomic and functional success, minimal reflex distance (MRD), Lagophthalmos, eyelid asymmetry, and patient discomfort. ● RESULTS: One hundred seven eyelid retraction surgeries were performed on 78 TRO patients (63 women, mean age 49 years); mean follow-up time was 16.7 months. Upper eyelid position, Lagophthalmos, exposure keratopathy, and patients’ discomfort markedly improved after surgery (P < .001). Marginal reflex distance (MRD1) decreased an average of 2.6 mm from 6 mm pre-operatively to 3.4 mm post-operatively (P < .001); Lagophthalmos decreased an average of 0.6 mm from 1.3 mm pre-operatively to 0.4 mm post-operatively (P .006) Failure rate was 8.4%, most improved with a second surgery. Overcorrection was noticed in three cases (2.8%). Eyelid asymmetry improved from a mean of 1.0 mm pre-operatively to 0.4 mm post-operatively (P .001); more than 80% of patients showed eyelid asymmetry of 1 mm or less. ● CONCLUSION: Transconjunctival Muller muscle and
