AIM: To report the long-term outcomes of a large cohort of upper lid retraction patients treated with subconjunctival triamcinolone acetonide injections.METHODS: This retrospective clinical study was conducted from ...AIM: To report the long-term outcomes of a large cohort of upper lid retraction patients treated with subconjunctival triamcinolone acetonide injections.METHODS: This retrospective clinical study was conducted from 2009 to 2016. The documents of 97 patients(126 eyes) were reviewed. The patients were treated with subconjunctival triamcinolone acetonide injections monthly and evaluated pre-and post-treatment by taking measurements of the upper margin reflex distance(MRD1, the distance between the upper-lid margin and the pupil center), lid aperture, lagophthalmos and proptosis. The patients were divided into the cured group, the improved group and the ineffective group based on the final treatment effectiveness. The improved group and the ineffective group were combined into non-cured group.RESULTS: The follow-up time was 23.45±14.86 mo. Of the patients, 63(64.9%) were assigned to the cured group, 22(22.7%) in the improved group, 12(12.4%) in the ineffective group. Injection times for cured group was 4.66±1.74, and for non-cured group was 5.17±2.08(P≤0.05). The MRD1 was significantly reduced between baseline and 1 mo after the initiation of treatment in the cured and improved groups(P〈0.001). The values did not change significantly after 4 mo for the improved group, while they continued to decrease in the cured group. In the ineffective group, the MRD1 did not significantly change after treatment. A statistically significant difference was observed between the baseline and post-treatment values of the mean muscle thickness(2.95±0.99 mm vs 2.04±0.63 mm, P〈0.05) and surface area(27.27±10.5 mm2 vs 18.3±7.04 mm2,P〈0.05) of the levator superioris with magnetic resonance imaging examination. Twelve patients(12.4%) relapsed after treatment and required additional subconjunctival injections. The main side effects included menstrual cycle disturbances(32%) and elevations of intra-ocular pressure(18.6%). CONCLUSION: A repeated subconjunctival injection of triamcinolone is an effective and relatively safe treatment for upper lid retraction due to thyroid-associated ophthalmopathy. This is related to the anti-inflammation effect of the medicine and the levator thickness can become thinner. Patients must be monitored regularly for recurrences and side effects.展开更多
Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion.Based on the causes of lower eyelid retraction,we divided the forming factors of lower eyelid retr...Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion.Based on the causes of lower eyelid retraction,we divided the forming factors of lower eyelid retraction into three categories:(1)change in the balance of forces associated with the lower eyelid margin;(2)excessive loss of lower eyelid volume;(3)changes in the relative position of the eyeball and lower lid margin.In this review,the corresponding treatment methods are elaborated on individually for the above three forming factors.We also reported,for the first time,a new treatment for lower eyelid retraction.We created a dermal-orbicularis oculi suspension flap on the lateral side of the canthus and suspended it upward and inward on the dense connective tissue over the lateral bony surface of the orbital rim.The longest follow-up time was one year,and the results were satisfactory.展开更多
AIM:To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion(UCE) correction using anterior lamellar recession(ALR) with addressing the associated conditions including dermatochalas...AIM:To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion(UCE) correction using anterior lamellar recession(ALR) with addressing the associated conditions including dermatochalasis,brow ptosis,blepharoptosis,and lid retraction.METHODS:Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed.Success was defi ned as the lack of any lash in contact with the globe,no need for a second procedure,and acceptable cosmesis at the fi nal follow up.RESULTS:Sixty eight patients(97 eyelids) were operated by ALR with simultaneous correction of associated lid problems in each case when necessary.The mean followup time was 17.8 mo(range,6.0-24.0 mo).Concomitantly,levator tucking was performed in 19 eyelids(19.6%),upper lid retractor recession in 18 eyelids(18.6%),and internal browpexy in 31 eyelids(32.0%).In 95.8% of patients(95%CI:0.85-0.96),satisfactory functional and cosmetic outcome was achieved with a single surgical procedure.CONCLUSION:Based on the principles of lamellar recession and concurrently addressing the associated lid problems,this approach is an effective and safe treatment of UCE.展开更多
Upper eyelid blepharoplasty is one of the most frequently performed surgeries by plastic surgeons worldwide. A prospective observational study was conducted to describe the anthropometric measurements of the upper eye...Upper eyelid blepharoplasty is one of the most frequently performed surgeries by plastic surgeons worldwide. A prospective observational study was conducted to describe the anthropometric measurements of the upper eyelid and eyebrow in a Mexican population. The researcher measured the anthropometry of the eyelids and eyebrows to establish the diagnosis and surgical plan according to the checklist created and applied by the plastic and reconstructive surgery service. In anatomical position with a caliper instrument, the marginal reflex distance (MRD1), the tarsal thickness, the length of the vertical and horizontal slit, and finally the distance at which the external canthus is located with respect to the internal canthus were measured in millimeters. For the anthropometry of the eyebrows, the distance from the eyebrows to the hairline, the position in millimeters of the orbital rim with respect to the eyebrow, and the angle of its apex were measured. A sample of 210 patients was obtained, of which 65 were male and 145 females, divided by age groups. It was observed that in the three age groups, females presented a vertical palpebral fissure with a higher mean than males. Similar is the case of tarsal thickness, in which the difference was significantly greater in the female of the three age groups. On the other hand, it was observed that the horizontal slit in males was higher than that of females, while the MDR1 was similar in both sexes. Finally, it was identified that in the group of 41 to 50 years old significant decreases are observed both in the vertical cleft, tarsal thickness and the position of the external canthus compared to the group of 20 to 30 years old, this is due to the aging process. When evaluating the anthropometrics of the eyebrows, a greater distance from the trichion to the eyebrow was observed in males than in females, in contrast to the position of the eyebrow with respect to the supraorbital rim and its apex, in which it was shown that in females there is a greater distance. In the other groups, the trends were maintained;however, a decrease was observed in the angle of the apex of the eyebrow and the RSO-eyebrow distance in males and females with advancing age, being more important in the group of 41 to 50 years. Systematized palpebral and periorbital anthropometric analysis is fundamental in the evaluation consultation. It allows us to make a precise diagnosis of the functional and aesthetic alterations that must be corrected during a surgical procedure, according to the concept of beauty of each culture or ethnicity.展开更多
A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplas...A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.展开更多
Aim:We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid.Methods:From November 2020 to October 2021,89 cases of correction with autologous chyle fat to sunken upper...Aim:We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid.Methods:From November 2020 to October 2021,89 cases of correction with autologous chyle fat to sunken upper eyelid were performed(with or without other cosmetic procedures related to the eyes).An appropriate amount of fat was extracted from the superficial layer of the patient’s thigh and processed to chyle fat.About 0.5-2.8 mL of fat was injected under the orbicularis oculi muscle(roof-retro orbicularis oculi fat)or in the area where the orbital septal fat exists from the outer orbital margin of the upper eyelid.Results:In total,59 patients were followed up for 1-11 months after surgery.No infection,necrosis,vascular embolism,upper eyelid lumpiness,fat calcification,or liquefaction occurred in all patients,while seven cases showed inadequate correction.The depression basically disappeared,the shape was relatively full,the youthfulness was greatly improved,and the satisfaction of patients was high during the follow-up period.Conclusion:The correction with autologous chyle fat to sunken upper eyelid showed little trauma,short recovery periods,and satisfactory results,and it is worthy of being popularized and applied more widely.展开更多
目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗...目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗组行眉下缘切口提升术联合重睑术,眉下切口组行眉下缘切口提升术,术后对患者进行随访,比较两组术后矫治效果,上睑缘至眉距离(The distance between the upper eyelid margin and the eyebrow,DEE)、睑裂宽度(The height of the palpebral fissure,HPF)、瞳孔中点睑缘与重睑距离(Middle pupil margin-fold distance,MPMFD)、角膜内侧睑缘与重睑距离(Medial corneal margin-fold distance,MCMFD)以及外眦处睑缘与重睑距离(Lateral canthus margin-fold distance,LCMFD)、上睑皱纹改善效果(Lemperle评分)、术后外观满意度、术后并发症发生率。结果:治疗后,联合治疗组DEE、HPF、MPMFD、MCMFD、LCMFD均高于对照组(P<0.05);治疗后,两组患者Lemperle评分均有所降低,但联合治疗组低于眉下切口组(P<0.05);治疗后,联合治疗组术后外观满意度96.88%高于眉下切口组76.67%(P<0.05);治疗后,联合治疗组与眉下切口组并发症发生率比较,差异无统计学意义(P>0.05)。结论:眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛,能够有效改善上睑松弛情况,减少上睑皱纹,且患者外观满意度较高。展开更多
A 67-year-old male had suffered from eye movement disturbance from Graves’ orbitopathy. His right eye was fixed in an esotropic position. Examination by synoptophore showed that his right eye deviation was 22 degrees...A 67-year-old male had suffered from eye movement disturbance from Graves’ orbitopathy. His right eye was fixed in an esotropic position. Examination by synoptophore showed that his right eye deviation was 22 degrees medially. The upper eyelid margin reflex distance (MRD) was 3.5 mm OD and 5.6 mm OS, and the lower eyelid MRD was 5.1 mm OU. Six mm medial rectus muscle recession with tenotomy was performed in the patient. The next day after the surgery, his eye position did not change and the right eyelid fissure demonstrated narrowing with upper eyelid lowering and lower eyelid elevation. The right upper eyelid MRD was decreased to 1.9 mm and the right lower eyelid MRD was similarly decreased to 4.3 mm. On the same day, 4 mm resection of the ipsilateral lateral rectus muscle was performed, but the same MRDs were ob-served postoperatively. Patients undergoing medial rectus muscle recession in Graves’ orbitopathy need to be informed of this potential complication.展开更多
基金Supported by the National Natural Science Foundation of China (No.81271043)
文摘AIM: To report the long-term outcomes of a large cohort of upper lid retraction patients treated with subconjunctival triamcinolone acetonide injections.METHODS: This retrospective clinical study was conducted from 2009 to 2016. The documents of 97 patients(126 eyes) were reviewed. The patients were treated with subconjunctival triamcinolone acetonide injections monthly and evaluated pre-and post-treatment by taking measurements of the upper margin reflex distance(MRD1, the distance between the upper-lid margin and the pupil center), lid aperture, lagophthalmos and proptosis. The patients were divided into the cured group, the improved group and the ineffective group based on the final treatment effectiveness. The improved group and the ineffective group were combined into non-cured group.RESULTS: The follow-up time was 23.45±14.86 mo. Of the patients, 63(64.9%) were assigned to the cured group, 22(22.7%) in the improved group, 12(12.4%) in the ineffective group. Injection times for cured group was 4.66±1.74, and for non-cured group was 5.17±2.08(P≤0.05). The MRD1 was significantly reduced between baseline and 1 mo after the initiation of treatment in the cured and improved groups(P〈0.001). The values did not change significantly after 4 mo for the improved group, while they continued to decrease in the cured group. In the ineffective group, the MRD1 did not significantly change after treatment. A statistically significant difference was observed between the baseline and post-treatment values of the mean muscle thickness(2.95±0.99 mm vs 2.04±0.63 mm, P〈0.05) and surface area(27.27±10.5 mm2 vs 18.3±7.04 mm2,P〈0.05) of the levator superioris with magnetic resonance imaging examination. Twelve patients(12.4%) relapsed after treatment and required additional subconjunctival injections. The main side effects included menstrual cycle disturbances(32%) and elevations of intra-ocular pressure(18.6%). CONCLUSION: A repeated subconjunctival injection of triamcinolone is an effective and relatively safe treatment for upper lid retraction due to thyroid-associated ophthalmopathy. This is related to the anti-inflammation effect of the medicine and the levator thickness can become thinner. Patients must be monitored regularly for recurrences and side effects.
基金The study was sponsored by the Natural Science Foundation of Shanghai(grant no.19ZR1430100)the National Natural Science Foundation of China(grant no.81871576).
文摘Lower eyelid retraction describes the inferior displacement of the lower eyelid with or without inversion or ectropion.Based on the causes of lower eyelid retraction,we divided the forming factors of lower eyelid retraction into three categories:(1)change in the balance of forces associated with the lower eyelid margin;(2)excessive loss of lower eyelid volume;(3)changes in the relative position of the eyeball and lower lid margin.In this review,the corresponding treatment methods are elaborated on individually for the above three forming factors.We also reported,for the first time,a new treatment for lower eyelid retraction.We created a dermal-orbicularis oculi suspension flap on the lateral side of the canthus and suspended it upward and inward on the dense connective tissue over the lateral bony surface of the orbital rim.The longest follow-up time was one year,and the results were satisfactory.
文摘AIM:To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion(UCE) correction using anterior lamellar recession(ALR) with addressing the associated conditions including dermatochalasis,brow ptosis,blepharoptosis,and lid retraction.METHODS:Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed.Success was defi ned as the lack of any lash in contact with the globe,no need for a second procedure,and acceptable cosmesis at the fi nal follow up.RESULTS:Sixty eight patients(97 eyelids) were operated by ALR with simultaneous correction of associated lid problems in each case when necessary.The mean followup time was 17.8 mo(range,6.0-24.0 mo).Concomitantly,levator tucking was performed in 19 eyelids(19.6%),upper lid retractor recession in 18 eyelids(18.6%),and internal browpexy in 31 eyelids(32.0%).In 95.8% of patients(95%CI:0.85-0.96),satisfactory functional and cosmetic outcome was achieved with a single surgical procedure.CONCLUSION:Based on the principles of lamellar recession and concurrently addressing the associated lid problems,this approach is an effective and safe treatment of UCE.
文摘Upper eyelid blepharoplasty is one of the most frequently performed surgeries by plastic surgeons worldwide. A prospective observational study was conducted to describe the anthropometric measurements of the upper eyelid and eyebrow in a Mexican population. The researcher measured the anthropometry of the eyelids and eyebrows to establish the diagnosis and surgical plan according to the checklist created and applied by the plastic and reconstructive surgery service. In anatomical position with a caliper instrument, the marginal reflex distance (MRD1), the tarsal thickness, the length of the vertical and horizontal slit, and finally the distance at which the external canthus is located with respect to the internal canthus were measured in millimeters. For the anthropometry of the eyebrows, the distance from the eyebrows to the hairline, the position in millimeters of the orbital rim with respect to the eyebrow, and the angle of its apex were measured. A sample of 210 patients was obtained, of which 65 were male and 145 females, divided by age groups. It was observed that in the three age groups, females presented a vertical palpebral fissure with a higher mean than males. Similar is the case of tarsal thickness, in which the difference was significantly greater in the female of the three age groups. On the other hand, it was observed that the horizontal slit in males was higher than that of females, while the MDR1 was similar in both sexes. Finally, it was identified that in the group of 41 to 50 years old significant decreases are observed both in the vertical cleft, tarsal thickness and the position of the external canthus compared to the group of 20 to 30 years old, this is due to the aging process. When evaluating the anthropometrics of the eyebrows, a greater distance from the trichion to the eyebrow was observed in males than in females, in contrast to the position of the eyebrow with respect to the supraorbital rim and its apex, in which it was shown that in females there is a greater distance. In the other groups, the trends were maintained;however, a decrease was observed in the angle of the apex of the eyebrow and the RSO-eyebrow distance in males and females with advancing age, being more important in the group of 41 to 50 years. Systematized palpebral and periorbital anthropometric analysis is fundamental in the evaluation consultation. It allows us to make a precise diagnosis of the functional and aesthetic alterations that must be corrected during a surgical procedure, according to the concept of beauty of each culture or ethnicity.
文摘A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.
文摘Aim:We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid.Methods:From November 2020 to October 2021,89 cases of correction with autologous chyle fat to sunken upper eyelid were performed(with or without other cosmetic procedures related to the eyes).An appropriate amount of fat was extracted from the superficial layer of the patient’s thigh and processed to chyle fat.About 0.5-2.8 mL of fat was injected under the orbicularis oculi muscle(roof-retro orbicularis oculi fat)or in the area where the orbital septal fat exists from the outer orbital margin of the upper eyelid.Results:In total,59 patients were followed up for 1-11 months after surgery.No infection,necrosis,vascular embolism,upper eyelid lumpiness,fat calcification,or liquefaction occurred in all patients,while seven cases showed inadequate correction.The depression basically disappeared,the shape was relatively full,the youthfulness was greatly improved,and the satisfaction of patients was high during the follow-up period.Conclusion:The correction with autologous chyle fat to sunken upper eyelid showed little trauma,short recovery periods,and satisfactory results,and it is worthy of being popularized and applied more widely.
文摘目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗组行眉下缘切口提升术联合重睑术,眉下切口组行眉下缘切口提升术,术后对患者进行随访,比较两组术后矫治效果,上睑缘至眉距离(The distance between the upper eyelid margin and the eyebrow,DEE)、睑裂宽度(The height of the palpebral fissure,HPF)、瞳孔中点睑缘与重睑距离(Middle pupil margin-fold distance,MPMFD)、角膜内侧睑缘与重睑距离(Medial corneal margin-fold distance,MCMFD)以及外眦处睑缘与重睑距离(Lateral canthus margin-fold distance,LCMFD)、上睑皱纹改善效果(Lemperle评分)、术后外观满意度、术后并发症发生率。结果:治疗后,联合治疗组DEE、HPF、MPMFD、MCMFD、LCMFD均高于对照组(P<0.05);治疗后,两组患者Lemperle评分均有所降低,但联合治疗组低于眉下切口组(P<0.05);治疗后,联合治疗组术后外观满意度96.88%高于眉下切口组76.67%(P<0.05);治疗后,联合治疗组与眉下切口组并发症发生率比较,差异无统计学意义(P>0.05)。结论:眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛,能够有效改善上睑松弛情况,减少上睑皱纹,且患者外观满意度较高。
文摘A 67-year-old male had suffered from eye movement disturbance from Graves’ orbitopathy. His right eye was fixed in an esotropic position. Examination by synoptophore showed that his right eye deviation was 22 degrees medially. The upper eyelid margin reflex distance (MRD) was 3.5 mm OD and 5.6 mm OS, and the lower eyelid MRD was 5.1 mm OU. Six mm medial rectus muscle recession with tenotomy was performed in the patient. The next day after the surgery, his eye position did not change and the right eyelid fissure demonstrated narrowing with upper eyelid lowering and lower eyelid elevation. The right upper eyelid MRD was decreased to 1.9 mm and the right lower eyelid MRD was similarly decreased to 4.3 mm. On the same day, 4 mm resection of the ipsilateral lateral rectus muscle was performed, but the same MRDs were ob-served postoperatively. Patients undergoing medial rectus muscle recession in Graves’ orbitopathy need to be informed of this potential complication.