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Background: In contrast to fetal scar tissue, adult scar tissue presents with visible scarring. Topical silicone creams have been shown to improve the appearance of scars. This case series compares the genetic expression of post-surgical scar tissues that received topical scar treatment with silicone cream, SKN2017B, or no treatment. SKN2017B is a recently formulated silicone-based scar cream that contains selective synthetic recombinant human growth factors, hyaluronic acid, and vitamin C. We hypothesise that scars treated with silicone-based scar creams have a more favourable genetic expression resembling a well-healing scar. Methods: Women who had undergone an abdominoplasty were included in this investigation and randomly assigned to treat part of the scar with topical silicone, another part with SKN2017B, and to leave a third part untreated. After four weeks, punch biopsies were taken and the RNA sequenced. Healthy abdominal skin was biopsied as baseline data. Genes of interest were identified and median values were calculated for the samples. Results: SKN2107B-treated scars demonstrated the lowest collagen type I to collagen type III ratio. Other key genes of interest in wound healing showed the lowest (favourable) expression of fibroblast activation protein alpha, lysyl oxidase and cartilage oligomeric matrix protein; the highest (favourable) expression of fibronectin type III domain containing 1 and matrix metallopeptidase 9 were found in scars treated with SKN2017B. Conclusion: The results of this small case series demonstrate a trend that those scars treated with topical silicone cream, notably SKN2017B, display the most favourable gene expression for wound healing., Lay Summary Silicone scar creams have been shown to improve the appearance of scars. In this case series, we evaluated the genetic expression of post surgical scars that were treated with SKN2017B (a silicone-based cream incorporating novel growth factors and ingredients), silicone scar cream or skin left untreated. We hypothesised that scars treated with a silicone-based scar cream would demonstrate a more favourable genetic expression trending toward the profile of a well-healing scar, as seen in fetal scar tissue, which undergoes scarless healing. For this case series, we included women who had undergone an abdominoplasty. They were instructed to treat part of the scar with silicone cream, another part with SKN2017B and to leave a third part untreated. After four weeks, punch biopsies were taken and the RNA sequenced. The genes of interest for the samples were identified due to their roles in wound healing based on peer-reviewed literature. The median expression levels of the genes of interest were calculated and compared between the 3 patients. The results of this case series demonstrate a trend that those scars treated with silicone cream, notably SKN2017B, display the most favourable gene expression for wound healing. Future studies should employ larger samples of scar tissues for gene expression analysis with longer followup period time.

Background Several growth factors and hyaluronic acid are implicated in fetal scarless healing. Whether these factors can be applied to an adult scar to improve scar characteristics is unknown. Objectives This study compared the efficacy and safety of SKN2017B, a proprietary topical cream consisting of selective synthetic recombinant human growth factors and hyaluronic acid in a silicone base containing a specifically formulated silicone cream for postsurgical scar treatment. Methods In this prospective, randomized, controlled, double-blinded study, unilateral or bilateral facial or truncal scars in adult surgical patients were randomly treated with SKN2017B or silicone cream. Study investigators, study patients, and 2 independent reviewers assessed improvement in scar characteristics after 4 and 12 weeks of treatment. Results Forty-nine bilateral and 12 unilateral scars in 45 patients were treated with SKN2017B or silicone. At 12 weeks, investigators rated 74% of scars treated with SKN2017B as showing overall improvement vs 54% of silicone-treated scars, a 73% relative improvement with SKN2017B (P < 0.0001). Patients rated a moderate-to-significant improvement in 85% of SKN2017B-treated scars vs 51% of silicone-treated scars, a 67% relative improvement with SKN2017B (P < 0.001). Independent reviewers rated 87% of scars treated with SKN2017B to be better overall vs 1% of scars treated with silicone (P < 0.0001). There were no tolerability issues or adverse reactions with either cream. Conclusions SKN2017B consists of highly selective growth factors within a silicone cream matrix and is well tolerated and effective for surgical scar management. Level of Evidence: 1

Thyroid Eye Disease (TED, Graves ophthalmopathy, thyroid ophthalmopathy) is the most common cause of orbital inflammation and proptosis in adults. There is no agreement on its management although corticosteroids and external beam orbital radiation (XRT) have traditionally been believed to provide benefit in active inflammation. Our review of the published literature in English disclosed an overall corticosteroid-mediated treatment response of 66.9% in a total of 834 treated patients who had moderate or severe TED. Intravenous corticosteroids used in repeated weekly pulses were more effective (overall favorable response = 74.6%, n = 177) and had fewer side effects than daily oral corticosteroids (overall favorable response = 55.5%, n = 265). A combination of corticosteroid and radiation therapy seemed to be more effective than corticosteroids alone. Our conclusions are tempered by a notable lack of standardization within and between study designs, treatment protocols, and outcome measures. Accordingly, the North American Neuro-Ophthalmology Society (NANOS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and the Orbital Society, in conjunction with Neuro-Ophthalmology Research and Development Consortium (NORDIC), will investigate the design and funding of a multi-center controlled trial.

Intraorbital foreign body (IoFB) presents an interesting therapeutic dilemma when located posterior in the orbit. Factors such as foreign body composition, inflammation, infection, functional deficit, and potential for iatrogenic damage are considered when choosing the appropriate treatment.

Objective To evaluate orbital pressure (OP), intraocular pressure (IOP), and the effectiveness of canthotomy, cantholysis, and septolysis using an experimental orbital hemorrhage model. Methods Expired whole blood was injected into the retrobulbar space of 10 human cadaver orbits. At 1-mL increments, OP, IOP, and globe position were documented. The mean (SD) time interval between the injections was 84 (36) seconds. Following injection of 22 mL, lateral canthotomy, cantholysis, and septolysis were performed. An additional 10 mL of blood was then injected. Results After injecting 22 mL of whole blood, mean (SD) OP and IOP were 68.4 (32.2) and 71.5 (19.1) mm Hg, respectively. The OP and IOP correlated closely throughout the experiment, with a mean (SD) difference of 11.4 (4.9) mm Hg (Pearson coefficient, 0.97). Following canthotomy, cantholysis, and septolysis, there was a mean (SD) decrease of 48.0 (27.2) mm Hg (70%) and 50.0 (18.1) mm Hg (59%) in OP and IOP, respectively. With additional injection of 10 mL of blood, OP and IOP increased rapidly. Conclusions The IOP and OP rose in direct proportion to the volume of whole blood injected; OP lagged behind IOP by 11 mm Hg, and surgical release of the orbit reduced OP by 70%. This effect was short-lived in the setting of continued simulated hemorrhage.

In their article “Anthropometry of the Eyelid and Palpebral Fissure in an Indian Population,” Dr. Patil et al establish normal periorbital anthropometric values for a population that has not been studied to a great degree in the oculoplastic surgery literature. Their study included 216 male and female patients, 16 to 60 years old. Digital image analysis was prospectively performed to measure the following parameters: In choosing these measurements, the authors investigated parameters consistent with ranges published in current ophthalmic plastic surgery literature.1-4 The authors found that the mean intercanthal distance increased with age in both males and females, along with an increase in the palpebral fissure width …

Periocular xanthogranuloma is a rare inflammatory condition characterised by histiocytes and Touton giant cells. It is encountered in several settings: juvenile xanthogranuloma, Erdheim–Chester disease (ECD) and necrobiotic xanthogranuloma. Recently, cases with an adult onset not associated with ECD have been described, with frequent involvement of the eyelids and orbit.1–3 In this report, we describe a unique case of adult-onset periocular xanthogranuloma precipitated by blepharoplasty. A 57-year-old woman was referred for persistent postoperative oedema/inflammation 18 months after bilateral upper and lower blepharoplasty. On the basis of a review of her medical record and a conversation with her cosmetic surgeon, there was no suggestion of disease before surgery: her periocular involutional changes were typical and no abnormalities were noted intraoperatively. Her …

Ethambutol (EMB) has been used as an antimycobacterial agent against tuberculosis since 1961, and its principal side effect is toxic optic neuropathy, which can be seen in up to 6% of patients.1,2 Through the use of optical coherence tomography (OCT), we can document evidence of reversible changes in nerve-fibre layer (NFL) secondary to EMB-induced optic neuropathy. A 70-year-old man weighing 70 kg, who was being treated for Mycobacterium avium intracellulare complex pneumonia, initially presented with a 3-month history of gradual, painless loss of vision in both eyes. He had received EMB treatment for 7 months at 2 g/day (29 mg/kg/day). His visual complaints began 7 months after initiation of EMB treatment, and continued to worsen up to his presentation to our clinic. Before EMB treatment, his best-corrected vision was 20/30 OU (with mild nuclear sclerotic cataracts), but with normal subjective colour and contrast sensitivity. Our patient underwent a full neuro-ophthalmological examination, which included an assessment of colour vision using the eight-plate Ishihara Color Vision Test, Humphrey Field Analyzer (HFA) 30-2 (SITA Fast test, Humphrey-Zeiss Medical Systems, …