Cosmetic and functional outcomes of frontalis suspension surgery using autologous fascia lata or silicone rods in pediatric congenital ptosis

Hsi-Wei Chung,1,2 Lay Leng Seah1,2,3 1Department of Ophthalmology, Singapore National Eye Centre, 2Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 3Department of Clinical Sciences, Duke-NUS Graduate Medical School, SingaporePurpose: Cosmetic and functional outcomes of frontalis suspension surgery using autologous fascia lata (FL) or silicone rods (SRs) in pediatric congenital ptosis.Design: Retrospective case series.Study subjects: Patients with congenital ptosis, aged 18 years or younger, during the period under study (2005–2011) at the Singapore National Eye Centre.Methods: Review of case records for functional and cosmetic outcome measures after frontalis suspension surgery using either SRs or autologous FL.Results: A total of 18 patients were studied (14 eyelids had FL, 16 eyelids had SRs) with mean ages of 7.1 (range 5–12) and 7.2 (range 4–18) years for the FL and SR groups, respectively. Mean follow-up period was 41.6 (range 11.2–77.9) and 48.6 (16.1–87.4) months, respectively. Patients in the FL group had better functional and cosmetic results compared to those in silicone group, with no recurrence of ptosis. More complications were experienced by patients in the SR group.Conclusion: Autologous FL for frontalis suspension remains an excellent choice for (and should be considered as useful surgical armamentarium for) repair of severe congenital ptosis.Keywords: fascia lata, silicone rod, congenital ptosis, frontalis suspensio

Periocular capillary hemangioma: management practices in recent years

Jo Anne Hernandez,1,3,4 Audrey Chia,2 Boon Long Quah,1,2 Lay Leng Seah1,2 1Department of Ophthalmology, Kandang Kerbau Women's and Children's Hospital, Singapore; 2Singapore National Eye Centre, Singapore; 3National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; 4Department of Ophthalmology, Cardinal Santos Medical Center, San Juan, Manila, Philippines Purpose: To present a case series on the management options for capillary hemangiomas involving the eyelid and orbit. Methods: This is a retrospective chart review of clinically diagnosed capillary hemangioma cases involving the periocular region treated at two local eye institutions. The patients' demographics and clinical presentation – including visual acuity, refractive error, periorbital and orbital examinations, and ultrasound and magnetic resonance imaging findings – were reviewed. The clinical progression, modalities of treatment, and treatment outcomes were studied. Results: Sixteen cases of capillary hemangiomas involving the eyelid and orbit were studied. The mean age at consultation was 9.6 months (range: 1 month–72 months). The majority were females (75%), with 50% presenting as upper-eyelid hemangiomas and the remaining as lower-eyelid (38%) and glabellar (12%) lesions. Combined superficial and deep involvement was common (64%). Cases whose lesions were located at the upper eyelid or superior orbit led to amblyopia (25%). Fifty-six percent of cases (9/16) were managed conservatively, and 44% (7/16) underwent treatment with either single-agent (n = 4) or combined treatments (n = 3). Conclusion: Close monitoring of visual development and prompt institution of amblyopia therapy for children with periocular capillary hemangiomas generally preserve vision. Extensive lesions that affect the visual axis require local and systemic treatments, alone or in combination, in order to reduce the size and impact of lesions on the eyeball, to reduce induced refractive error and visual occlusion, and to prevent the development of amblyopia, in order to achieve good visual outcomes. Keywords: vascular, vascular malformation, bleomycin, propranolol, prednisolone, amblyopi

Development and Validation of the Singapore Thyroid Eye Disease Quality of Life Questionnaire

Purpose: Current instruments to assess thyroid eye disease (TED) quality of life (QoL) were not developed using modern psychometric theory and may not be applicable to Asian populations. Therefore, we developed a psychometrically robust questionnaire, the Singapore Thyroid Eye Disease Quality of Life questionnaire (STED-QoL), for assessing QoL in Asian patients. Methods: This cross-sectional study was conducted at the Singapore National Eye Centre between 2012 and 2015. In Phase 1, content for the questionnaire was developed using qualitative methods. A total of 20 patients participated in three different focus groups. Thematic analysis was conducted to identify relevant themes from which 12 items, rated on a 5-point Likert-type scale, were generated. In Phase 2, the pilot instrument was administered to 59 TED patients and psychometric assessment of the STED-QoL was conducted using Rasch analysis. Results: After collapsing categories from five to four and deleting two misfitting items, we generated a 10-item STED-QoL befitting the Rasch model. The scale showed good criterion validity, with scores decreasing as severity of TED worsened: mild (1.78 logits), moderate (0.27 logits), and severe (0.92 logits). A 'Psychosocial' subscale also had adequate psychometric properties and psychosocial scores were significantly worse in those who underwent surgery for TED compared to those who had not (0.41 vs. 1.82 logits, P = 0.021). Conclusions: The STED-QoL is a robust 10-item questionnaire specifically developed to measure the impact of TED on QoL and psychosocial well-being in an Asian population. Translational Relevance: QoL assessment is important for holistic management of TED patients