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PURPOSE: The lateral tarsal strip (LTS) procedure is commonly used to correct eyelid malposition. When performing LTS, some surgeons elect to remove conjunctiva from the tarsal strip, while others do not. It has been hypothesized that without conjunctival stripping, the buried conjunctival tissue can cause complications such as inclusion cysts and granulomas. However, there is limited data comparing LTS cases with and without conjunctiva removal. The authors sought to evaluate whether conjunctival stripping had any impact on complication rates with LTS. METHODS: LTS operations for ectropion correction were retrospectively reviewed and were separated into 2 cohorts, Con (conjunctiva not removed) or Coff (conjunctival removed). Charts were reviewed for outcomes and complications including inclusion cyst formation, granuloma formation, wound dehiscence, infection and focal rim tenderness. RESULTS: The complication rate was 10% vs 8% for Con vs Coff respectively (p=0.54). The common complications of LTS surgery were granuloma (4%), wound dehiscence (3%), focal rim tenderness (3%), and infection requiring antibiotics (

Ocular injuries occur frequently in sports, affecting the globe, surrounding soft tissues, and the orbital bony structure. This review provides the craniofacial surgeon a broad general overview of epidemiology, mechanism of disease, and prevention.

BACKGROUND Perceived pain during local anesthesia injections can be effected by the injection sequence. OBJECTIVE We sought to compare pain levels during local anesthesia injections during upper lid blepharoplasty (ULB) using 2 surgical sequences. MATERIALS AND METHODS We conducted a prospective, randomized clinical trial. Patients with ULB were randomized to either have local anesthesia injection followed by ULB in the right eyelid and then in the left (Group A) or to have local anesthesia injection to both eyelids followed by ULB on both eyelids (Group B). Pain was assessed using a visual analog scale (VAS) for pain score of 0 to 10. RESULTS Forty patients were included and randomized. The mean VAS score in Group A was 2.60 ± 1.84 and 3.30 ± 1.62 (right and left, respectively, p value = .035). The mean VAS score in Group B was 2.55 ± 1.63 and 2.80 ± 1.67 (right and left eyelids, respectively, p value = .258). No intergroup difference in pain was found. CONCLUSION Patients having sequential anesthesia during ULB perceived more pain on injection to the second eyelid, whereas patients having local anesthesia followed by ULB perceived the same amount of pain in both eyes. Pain levels in both groups were similar. Local anesthesia injections in both groups were well tolerated.

Reconstruction options after orbital exenteration can be challenging, time-consuming, and require intensive postoperative care. Engineered dermal acellular matrices offer a quick and easy option for wound healing that has proven to be successful in various settings. Specifically, the porcine urinary bladder matrix has demonstrated success in periocular and orbital wound healing. This report describes a pediatric patient who underwent repair with porcine urinary bladder matrix after orbital exenteration for recurrent alveolar rhabdomyosarcoma. The patient did not require any additional reconstructive procedures. To our knowledge, this is the youngest patient to receive a porcine urinary bladder matrix after exenteration.

Purpose To evaluate the rate of epiretinal membrane (ERM) recurrence in eyes that underwent ERM peeling surgery at least 5 years earlier. Methods Retrospective interventional case series study of 37 patients (15 women and 22 men; mean age, 70 ± 7.6 years) operated on for ERM removal with a follow-up of at least 5 years. The patients underwent testing for visual acuity, an ophthalmic examination, and optical coherence tomography imaging, all of which were assessed preoperatively, postoperatively, and at the 5-year follow-up. Results Visual acuity significantly improved at 1 year after peeling compared with baseline (P = 0.045), and the improved results were maintained at 5 years (P = 0.804) 0.766 logarithm of the minimum angle of resolution (Snellen 6/35). The central macular thickness decreased significantly at the 1-year follow-up compared with baseline and continued to decrease as measured at the 5-year follow-up (P = 0.04). At 5 years, the ERM recurrence rate reached 58% (28% extrafoveal). Photoreceptor atrophy and retinal pigment epithelium changes correlated with diabetes mellitus (P = 0.028). Conclusion The recurrence rate of ERM after peeling surgery was reported as being around 5% to 12%. It was 58% in the current study. Because the recurrent ERM is generally mild, visual acuity was unaffected.

Purpose: Post-Descemet stripping endothelial keratoplasty (DSEK) patients are prone for intraocular pressure (IOP) elevations and glaucoma. Corneal characteristics influence various IOP measuring devices in various ways. The aim of this study was to evaluate the agreement between four different IOP measuring devices: Goldmann applanation tonometer (GAT), I-care pro, Tonopen XL, and Schiotz tonometr in patients who underwent DSEK. Methods: This was a prospective comparative study using a convenience cohort of post-DSEK patients with compact grafts. Post-DSEK patients had IOP measured using GAT, I-care Pro, Tonopen XL, and Schiotz tonometer. Measurements were compared and agreement assessed. Wilcoxon signed-rank test was used for comparison of means as variables did not show a normal distribution. Bland–Altman plots were used for assessing agreement. Results: Thirty eyes of 24 patients were included in the study. Mean time from DSEK surgery was 25.31 ± 13.05 months. Mean IOP with GAT, I-care pro, Tonopen XL, and Schiotz tonometer was 13.99 ± 3.76, 13.92 ± 3.36, 13.31 ± 3.89, and 12.83 ± 4.07, respectively. GAT, I-care pro, and Tonopen XL had similar mean IOP measurements (P = 0.135 and P = 0.551, respectively), while Schiotz tonometry measurements were higher (P = 0.046). Bland–Altman plots show good agreement between GAT, Tonopen XL, and I-care pro. GAT and Schiotz tonometry show less agreement, with large variations in the differences of measured IOP. Conclusions: IOP measurements in post-DSEK patients showed good agreement between GAT and either Tonopen XL or I-care pro. Schiotz tonometer has large variations in this patient group. IOP measurements and IOP difference between devices were not dependent on central corneal thickness.

PURPOSE To report the outcomes of pars plana vitrectomy with internal aspiration under perfluorocarbon liquid for large macular holes (MH). METHODS Retrospective consecutive case series of patients with large (>400 µm) MH. All treated were with pars plana vitrectomy, internal limiting membrane peeling, internal fluid aspiration under perfluorocarbon liquid, and gas/oil tamponade. Outcomes included closure rate and visual acuity at 6 months. RESULTS Twenty eyes of 20 patients were included. Mean age of patients was 67.6 ± 7.3 years. Mean MH size was 609.4 ± 154.7 μm. Mean symptoms duration was 9.05 ± 7.3 months. Unfavorable prognostic factors included chronic MHs (≥4 months) in 15 eyes (75%), refractory MH in 6 eyes (30%), and poor initial visual acuity (≤20/200 logarithm of minimal angle of resolution) in 18 eyes (90%). Gas tamponade was used in 18 eyes (90%). Nineteen MHs (95%) had closed after a single operation. Two (10.5%) had Type-II closure. Mean visual acuity improved significantly from 20/330 to 20/140 Snellen acuity (1.22 ± 0.31-0.85 ± 0.35 logarithm of minimal angle of resolution; P < 0.001). Fifteen eyes (75%) had visual acuity improvement of more than 0.2 logarithm of minimal angle of resolution. Thirteen eyes (65%) achieved visual acuity better than 20/200. CONCLUSION Pars plana vitrectomy combined with internal fluid aspiration under perfluorocarbon liquid is an effective and safe surgical technique for the management of large MH. This innovative technique offers improved closure rates and visual acuity results.

To compare the standard Ishihara booklet with color-vision-testing smartphone applications.A prospective observational diagnostic study on 42 normal trichromats and 38 color-deficient subjects. Patients were presented with three color vision tests in random order: an Ishihara test booklet and two color-vision-testing smartphone applications: Eye2Phone and the Color Vision Test application (CVT app). Sensitivity and specificity of the electronic tests was compared with Ishihara results, and in each one of these applications every plate was individually analyzed for success/failure rate.Average age was 42.7 ± 12.9 years. There were 57 males (71.2%). Sensitivity and specificity of each test was 100% (38/38) and 95.2% (40/42) for the Eye2Phone, and 100% (38/38) and 54.8% (23/42) for the CVT app. There was no significant difference between the Ishihara booklet and the Eye2Phone (p = 0.500), with a high kappa measure of agreement (0.950, p0.001). The CVT app was significantly different than both other tests (p0.001) with a low kappa measure of agreement (0.535 with the Ishihara and 0.575 with the Eye2Phone). Of the 21 tested plates, color-deficient subjects failed 11.8 ± 3.1 plates in the Ishihara booklet and 14.1 ± 2.1 plates in the Eye2Phone (p0.001). Significant plate-specific differences for the color-deficient group were found in plate numbers 3, 6, 7, 8, 9, 15, and 16. Both tests were poorly able to give an indication of the specific dichromatism type. The Ishihara booklet was rated more comfortable and clearer than the Eye2Phone in color-deficient subjects. The CVT app was rated lowest for comfort and clarity in both groups.Smartphone applications testing for color vision deficiency are readily available; however, users of these apps should be aware that some may have different sensitivity for detection of color vision deficiency compared to Ishihara booklet, limiting their usefulness for clinical use. Therefore, further validation of these applications is required.

Purpose. To evaluate the visual prognosis and the occurrence of significant complications after silicone oil removal (SOR) in recent years and compare them to previously published data. Methods. A total of 89 eyes of 89 patients who underwent SOR and had at least 6 months of follow-up were included in this retrospective study. Recorded parameters included demographic information, previous ocular history, length of silicone oil retention in the eye, visual acuity (VA) and intraocular pressure (IOP) prior to the SOR procedure and throughout the follow-up period, and the occurrence of postoperative complications. Results. Indications for silicone oil injection included perforating trauma (9%), proliferative diabetic retinopathy (PDR) (6.7%), giant tear (7.8%), and rhegmatogenous retinal detachment (RRD) (76.5%). After SOR, RRD, keratopathy, persistent hypotony, and elevated IOP occurred at rates of 21.3%, 11.2%, 10.1%, and 9%, respectively. Eyes with preoperative hypotony were significantly more likely to have persistent hypotony and a poor visual prognosis. Discussion. Our results provide a thorough contemporary analysis of the visual prognosis and complication rates after SOR. Avoiding SOR with long-term silicone oil retention may be advisable in hypotonous eyes.

Purpose To study predictors and implications on outcome of premature silicone tube-loss, a post-operative complication of monocanalicular intubation (MCI) performed for treatment of congenital nasolacrimal duct obstruction (CNLDO). Methods We conducted a retrospective analysis of cases of post-operative loss of monocanalicular silicone tubes occurring at one medical center from January 2007 to December 2013. Results During the study period monocanclicular silicone tubes were lost in 24/54 eyes (44%) of 19/46 children. Multivariate regression analysis identified bilateral intubation as an important predictor of early tube-loss ( r = 0.54, P = 0.006). Seven of eight (88%) children who had both eyes intubated prematurely lost their tubes compared to 12/38 (32%) children who had unilateral intubation ( P = 0.005). Treatment success was lower in eyes with early tube-loss (17/24 eyes, 71%) compared to eyes with full tube retention (25/30 eyes, 83%), however this difference was not statistically significant ( P = 0.333). In our study, treatment outcome correlated with duration of intubation ( r = 0.51, P = 0.002). Surgical success was achieved in 33/39 eyes (85%) in which the tubes were retained at least 2 months compared to 7/15 eyes (47%) with shorter period of intubation ( P = 0.012). Conclusions Spontaneous tube-loss is a post-operative complication of monocanalicular silicone intubation that can occur more frequently than previously reported in certain populations. Tube-loss occurring soon after surgery is often associated with persistent symptoms and increased need of reoperation.

To determine risk factors for intrauterine fetal death (IUFD).A retrospective population-based study, of all singleton deliveries between the years 1988-2009 was conducted. Intrapartum deaths, postpartum death, and multiple gestations were excluded. A multiple logistic regression model was used to determine independent risk factors.During the study period, out of 228,239 singleton births, 1694 IUFD cases were recorded (7.4 per 1000 births). The following independent risk factors were identified in the logistic regression executed: Oligohydramnios (OR 2.6, 95% CI 2.1-3.2, p-value0.001), polyhydramnios (OR 1.8, 95% CI 1.4-2.2, p-value0.001), previous adverse perinatal outcome (OR 1.7, 95% CI 1.5-2.1, p-value0.001), congenital malformations (OR 2.0, 95% CI 1.8-2.3, p-value0.001), true knot of cord (OR 3.7, 95% CI 2.8-4.9, p-value0.001), meconium stained amniotic fluid (OR 2.7, 95% CI 2.3-3.0, p-value0.001), placental abruption (OR 2.9, 95% CI 2.4-3.5, p-value0.001), advanced maternal age (OR 1.03, 95% CI 1.02-1.04, p-value0.001), and hypertensive disorders (OR 1.24, 95% CI 1.0-1.4, p-value = 0.026). Jewish ethnicity (versus Bedouin - OR 0.64, 95% CI 0.57-0.72, p-value0.001), gestational diabetes (OR 0.7, 95% CI 0.5-0.8, p-value = 0.001), previous cesarean section (OR 0.8, 95% CI 0.7-0.97, p-value = 0.019), and recurrent abortions (OR 0.8, 95% CI 0.6-0.9, p-value = 0.011) were negatively associated with IUFD.Several independent risk factors were identified, suggesting a possible cause of death. Other pathologic conditions that facilitate tighter pregnancy surveillance and active management were found protective, pointing the benefit of such management approaches in high-risk pregnancies.