Ophthalmic Plastic and Reconstructive Surgery, 2016
To compare the functional outcome of the polypropylene trapezoid frontalis suspension with the po... more To compare the functional outcome of the polypropylene trapezoid frontalis suspension with the polypropylene modified Crawford frontalis suspension in a large cohort of patients with oculopharyngeal muscular dystrophy. Retrospective, nonrandomized comparative case series. Patients with oculopharyngeal muscular dystrophy who underwent bilateral polypropylene frontalis suspension were selected for chart review. Main outcome measures were margin reflex distance, duration of surgery, and ptosis recurrence. Ninety-two patients qualified for chart review; 39 patients underwent the trapezoid sling and 53 patients the modified Crawford sling. There was no difference in preoperative margin reflex distance or levator function between the 2 surgical groups. Postoperative improvement in margin reflex distance was 2.95 ± 1.56 mm in the trapezoid group compared with 2.85 ± 1.65 mm in the modified Crawford group (p = 0.67). Duration of surgery was 40.49 ± 13.33 minutes in the trapezoid group compared with 53.77 ± 16.04 minutes in the modified Crawford group (p < 0.001). Five percent of eyes in the trapezoid group had ptosis recurrence compared with 13% of eyes in the modified Crawford group (p = 0.07). Both polypropylene frontalis suspension techniques generated an equivalent increase in margin reflex distance. However, the trapezoid frontalis suspension required less operative time and trended toward a lower rate of ptosis recurrence.
To compare axial length (AL) measurements obtained with ultrasound (US) and IOLMaster (software v... more To compare axial length (AL) measurements obtained with ultrasound (US) and IOLMaster (software version 3.01.0294; Carl Zeiss Meditec, Jena, Germany) in eyes with diabetic clinically significant macular edema (CSME) and to examine the correlation between measurement difference and foveal thickness. Prospective nonrandomized clinical study. Twenty-three healthy eyes of 23 participants and 21 eyes with CSME of 21 diabetic outpatients. The authors prospectively measured AL using US and IOLMaster in eyes of both groups. Foveal thickness was measured with optical coherence tomography. The difference between both methods was assessed using the t test, and its correlation to foveal thickness was evaluated by Pearson coefficient. Difference in AL measurements between IOLMaster and US. Mean+/-standard deviation foveal thickness in healthy and CSME eyes was 201+/-26 microm (range, 156-240) and 475+/-106 microm (range, 331-758), respectively. Mean AL by US and IOLMaster in healthy eyes was 23.17+/-1.07 mm (range, 21.17-25.18) and 23.25+/-1.10 mm (range, 21.17-25.26), respectively (P = 0.51); in CSME eyes, it was 23.02+/-0.97 mm (range, 21.53-24.81) and 23.27+/-0.924 mm (range, 21.9-25.13), respectively (P<0.001). Correlation between AL difference and foveal thickness was poor in both healthy (r = 0.18, P = 0.40) and CSME (r = 0.02, P = 0.93) eyes. Axial length measurements using applanation A-scan US and IOLMaster in eyes with CSME differ statistically and clinically significantly. This is likely a result of the fundamentally different methodology of the 2 methods in measuring eyes with a pathologically thickened retina. A conversion formula based on foveal thickness can not be provided at present.
To evaluate the feasibility of tacrolimus 0.03% dermatological ointment (Protopic) in the treatme... more To evaluate the feasibility of tacrolimus 0.03% dermatological ointment (Protopic) in the treatment of intractable allergic conjunctivitis. Twenty patients (mean age 10.8 years, range 6-26) with intractable allergic conjunctivitis were enrolled in an open-label study. Tacrolimus 0.03% ointment was applied into the conjunctival sac of both eyes twice daily for 8 weeks, followed by a 2-week washout period. Other ocular medications were discontinued. Conjunctivitis severity was recorded with a composite subjective/objective score (chemosis, tarsal papillary size, corneal staining, tearing, itching, and photophobia) at baseline, week 8, and after washout. Tacrolimus blood levels were measured at 2 weeks. Statistically significant improvement in all categories of the conjunctivitis score was observed between baseline and the week 8 examination (p < 0.001). Adverse events were limited to local burning in one patient who discontinued treatment. Blood tacrolimus levels were mostly undetectable. Application of tacrolimus 0.03% dermatological ointment into the conjunctival sac appears to be effective, well tolerated, and safe in the treatment of allergic conjunctivitis refractory to traditional treatment.
To compare 2 surgical approaches to conjunctival flap placement during pterygium surgery using a ... more To compare 2 surgical approaches to conjunctival flap placement during pterygium surgery using a biologic adhesive: single rotational flap and double sliding flaps. Thirty-three consecutive patients (34 eyes) with primary pterygium were assigned prospectively and randomly to receive pterygium surgery with either 1 rotational flap (group A, 19 eyes) or double sliding flaps (group B, 15 eyes) by using a biologic adhesive to secure the flaps. The patients were followed for 24 weeks. In group A, 1 (5.3%) flap was lost because of ischemia, whereas all the others remained in position and became fully integrated. In group B, 4 (26%) flaps did not retain their primary position. In 2 (13%) eyes, the superior and inferior flaps partially dehisced, resulting in a 2- to 3-mm gap; in 1 (6.5%) eye, the inferior flap dehisced completely and retracted to the lower fornix; and in 1 (6.5%) eye, both flaps completely dehisced and retracted, leaving an area of bare sclera. The use of tissue adhesive is a promising technique in pterygium surgery. In this study, gluing 1 rotational flap resulted in excellent postoperative results, but it seemed less suitable for use with double sliding flaps.
Ophthalmic Plastic and Reconstructive Surgery, 2016
To compare the functional outcome of the polypropylene trapezoid frontalis suspension with the po... more To compare the functional outcome of the polypropylene trapezoid frontalis suspension with the polypropylene modified Crawford frontalis suspension in a large cohort of patients with oculopharyngeal muscular dystrophy. Retrospective, nonrandomized comparative case series. Patients with oculopharyngeal muscular dystrophy who underwent bilateral polypropylene frontalis suspension were selected for chart review. Main outcome measures were margin reflex distance, duration of surgery, and ptosis recurrence. Ninety-two patients qualified for chart review; 39 patients underwent the trapezoid sling and 53 patients the modified Crawford sling. There was no difference in preoperative margin reflex distance or levator function between the 2 surgical groups. Postoperative improvement in margin reflex distance was 2.95 ± 1.56 mm in the trapezoid group compared with 2.85 ± 1.65 mm in the modified Crawford group (p = 0.67). Duration of surgery was 40.49 ± 13.33 minutes in the trapezoid group compared with 53.77 ± 16.04 minutes in the modified Crawford group (p < 0.001). Five percent of eyes in the trapezoid group had ptosis recurrence compared with 13% of eyes in the modified Crawford group (p = 0.07). Both polypropylene frontalis suspension techniques generated an equivalent increase in margin reflex distance. However, the trapezoid frontalis suspension required less operative time and trended toward a lower rate of ptosis recurrence.
To compare axial length (AL) measurements obtained with ultrasound (US) and IOLMaster (software v... more To compare axial length (AL) measurements obtained with ultrasound (US) and IOLMaster (software version 3.01.0294; Carl Zeiss Meditec, Jena, Germany) in eyes with diabetic clinically significant macular edema (CSME) and to examine the correlation between measurement difference and foveal thickness. Prospective nonrandomized clinical study. Twenty-three healthy eyes of 23 participants and 21 eyes with CSME of 21 diabetic outpatients. The authors prospectively measured AL using US and IOLMaster in eyes of both groups. Foveal thickness was measured with optical coherence tomography. The difference between both methods was assessed using the t test, and its correlation to foveal thickness was evaluated by Pearson coefficient. Difference in AL measurements between IOLMaster and US. Mean+/-standard deviation foveal thickness in healthy and CSME eyes was 201+/-26 microm (range, 156-240) and 475+/-106 microm (range, 331-758), respectively. Mean AL by US and IOLMaster in healthy eyes was 23.17+/-1.07 mm (range, 21.17-25.18) and 23.25+/-1.10 mm (range, 21.17-25.26), respectively (P = 0.51); in CSME eyes, it was 23.02+/-0.97 mm (range, 21.53-24.81) and 23.27+/-0.924 mm (range, 21.9-25.13), respectively (P<0.001). Correlation between AL difference and foveal thickness was poor in both healthy (r = 0.18, P = 0.40) and CSME (r = 0.02, P = 0.93) eyes. Axial length measurements using applanation A-scan US and IOLMaster in eyes with CSME differ statistically and clinically significantly. This is likely a result of the fundamentally different methodology of the 2 methods in measuring eyes with a pathologically thickened retina. A conversion formula based on foveal thickness can not be provided at present.
To evaluate the feasibility of tacrolimus 0.03% dermatological ointment (Protopic) in the treatme... more To evaluate the feasibility of tacrolimus 0.03% dermatological ointment (Protopic) in the treatment of intractable allergic conjunctivitis. Twenty patients (mean age 10.8 years, range 6-26) with intractable allergic conjunctivitis were enrolled in an open-label study. Tacrolimus 0.03% ointment was applied into the conjunctival sac of both eyes twice daily for 8 weeks, followed by a 2-week washout period. Other ocular medications were discontinued. Conjunctivitis severity was recorded with a composite subjective/objective score (chemosis, tarsal papillary size, corneal staining, tearing, itching, and photophobia) at baseline, week 8, and after washout. Tacrolimus blood levels were measured at 2 weeks. Statistically significant improvement in all categories of the conjunctivitis score was observed between baseline and the week 8 examination (p < 0.001). Adverse events were limited to local burning in one patient who discontinued treatment. Blood tacrolimus levels were mostly undetectable. Application of tacrolimus 0.03% dermatological ointment into the conjunctival sac appears to be effective, well tolerated, and safe in the treatment of allergic conjunctivitis refractory to traditional treatment.
To compare 2 surgical approaches to conjunctival flap placement during pterygium surgery using a ... more To compare 2 surgical approaches to conjunctival flap placement during pterygium surgery using a biologic adhesive: single rotational flap and double sliding flaps. Thirty-three consecutive patients (34 eyes) with primary pterygium were assigned prospectively and randomly to receive pterygium surgery with either 1 rotational flap (group A, 19 eyes) or double sliding flaps (group B, 15 eyes) by using a biologic adhesive to secure the flaps. The patients were followed for 24 weeks. In group A, 1 (5.3%) flap was lost because of ischemia, whereas all the others remained in position and became fully integrated. In group B, 4 (26%) flaps did not retain their primary position. In 2 (13%) eyes, the superior and inferior flaps partially dehisced, resulting in a 2- to 3-mm gap; in 1 (6.5%) eye, the inferior flap dehisced completely and retracted to the lower fornix; and in 1 (6.5%) eye, both flaps completely dehisced and retracted, leaving an area of bare sclera. The use of tissue adhesive is a promising technique in pterygium surgery. In this study, gluing 1 rotational flap resulted in excellent postoperative results, but it seemed less suitable for use with double sliding flaps.
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