Upper blepharoplasty and lateral wound dehiscence

Purpose: To report the frequency of lateral wound dehiscence (LWD) after upper blepharoplasty (UB), a technique and its outcome to prevent LWD. Materials and Methods:A retrospective review was performed for cases of LWD after UB presenting between 2003 and 2009, and then a prospective comparative study was performed between February 2009 and March 2013. For the comparison, subjects were divided into two groups based on intraoperative assessment of lateral wound tension (same technique and surgeon). Group 1 received 1-3 orbicularis/subcutaneous buried sutures (6-0 polyglactin) before interrupted 6-0 nylon skin closure. Group 2 underwent skin closure only. Subjects, who had re-operation, skin healing disorders, and incomplete follow-up (<6 months), were excluded. P < 0.05 was considered as statistically significant. Results: There were 14 (14/678, 2) cases with LWD with a mean age of 36.2 years in the audit (2003-2009). The prospective study included 68 subjects (68/293, 23.2) in Group 1 and 225 in Group 2. Gender and simultaneous forehead and eyebrow procedures were similar between groups (P = 0.3 and P = 0.4 respectively). Group 1 was statistically significantly younger at mean age of 41.4 years, compared to Group 2 at 56.1 years (P = 0.000). The frequency of LWD significantly (P = 0.04) decreased to 0.3 (1/293). Conclusion: In the presence of wound tension on skin closure (intraoperative assessment), tension relieving buried orbicularis/subcutaneous 6-0 polyglactin suturing of the lateral UB incision could prevent LWD. © 2015 Middle East African Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

Perfluorocarbon liquid migration into the subarachnoid space in a patient with morning glory syndrome

Purpose: To report a case of perfluorocarbon liquid (PFCL) migration into the subarachnoid space at the time of vitreoretinal surgery in a patient with morning glory syndrome associated retinal detachment. Case report: A 9-year-old girl underwent pars plana vitrectomy and silicone oil injection for retinal detachment associated with morning glory syndrome. PFCL was used for retinal stabilization before endolaser photocoagulation. The retina detached, and repeated vitrectomy and silicone oil injection was performed. Postoperative magnetic resonance imaging revealed PFCL in the subarachnoid space. Conclusion: The migration of perfluorocarbon into the subarachnoid space is a rare complication of vitrectomy in patients with morning glory syndrome. © 2015 Iranian Society of Ophthalmology

Vitrectomy and Release of Presumed Epipapillary Vitreous Traction for Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy Associated with Partial Posterior Vitreous Detachment

Objective: To study the results of vitrectomy and release of epipapillary vitreous adhesions for the treatment of nonarteritic anterior ischemic optic neuropathy (NAION) associated with partial posterior vitreous detachment (PVD). Design: Prospective noncomparative interventional case series. Participants: A series of 16 patients with clinical picture of NAION and small discs associated with partial PVD, diagnosed clinically and confirmed by optical coherence tomography and B-scan ultrasonography. Intervention: All patients underwent standard pars plana vitrectomy with meticulous removal of epipapillary vitreous adhesions within 1 month from the onset of visual symptoms. Main Outcome Measures: Best-corrected visual acuity (BCVA), mean deviation of visual fields, and color vision testing. Results: In 15 patients BCVA improved (93.7), mean preoperative BCVA was 6/38 (0.82±0.53 logarithm of the minimum angle of resolution logMAR), which improved to 6/18 (0.49±0.37 logMAR) postoperatively at 3 months. Nine eyes (56%) had �3 lines of visual improvement. Visual fields improved in 4 patients and color vision improved in 1 patient. Conclusion: Vitreous traction from partial PVD may have a causative role in some cases of NAION associated with small discs. In these cases, vitrectomy and removal of epipapillary vitreous may result in improvement of visual acuity. © 2007 American Academy of Ophthalmology

The effect of rocker shoe on the ground reaction force parameters in patients with rheumatoid arthritis

Objectives: Foot and ankle problems are common complications in rheumatoid arthritis disease. Gait pattern such as normal foot and ankle rocker is impaired in patients with rheumatoid arthritis. Rocker sole as an external shoe modification is commonly prescribed in this pathology. The aim of this study was to investigate the effect of rocker shoe on vertical ground reaction force parameters during walking in patients with rheumatoid arthritis. Methods: Sixteen female participants with rheumatoid arthritis were recruited in this study. All patients were prepared with a pair of high-top, heel-to-toe rocker shoe and were asked to wear the shoes for one month. Ground reaction force parameters including peak forces and peak force times were evaluated in the first session, and after seven days and thirty days follow up were carried on. Results: First maximal vertical force was significantly increased with rocker shoe compared to barefoot after 7 days follow up. Walking with rocker shoe reduced the minimal vertical force after 7 days. The second maximal vertical force showed to be statistically lower with rocker shoe than barefoot after 7 and 30 days. Furthermore, stance time decreased with rocker shoe after one month. Discussion: Results of this study revealed that vertical ground reaction force parameters changed in rheumatoid arthritis patients with heel-to-toe rocker shoe, both immediately and after one month follow up. This might suggest the effectiveness of rocker shoes in improving gait in rheumatoid arthritis patients

Vitreopapillary traction in nonarteritic anterior ischemic optic neuropathy

Purpose: To describe the association between vitreous traction on the optic disc and nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Eighty three eyes of 83 patients with NAION were evaluated by optical coherence tomography (OCT) for detecting vitreous adhesion to the optic nerve head with separation from the adjacent retina (partial posterior vitreous detachment). Eyes which were negative for such adhesion underwent ultrasonography to detect complete posterior vitreous detachment (PVD). Results: Fifty male and 33 female subjects with mean age of 51.9±10 years were studied. Partial PVD with optic nerve head adhesion was found in 54 patients (65.1) using OCT. Ultrasonography detected complete PVD in all other eyes with optically empty spaces on OCT. Conclusion: Vitreous traction on the optic nerve head from partial PVD may play a causative role in some cases of NAION. This traction may impair vascular supply and/or axoplasmic flow leading to signs and symptoms of NAION

Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review

Purpose: To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients� clinical and laboratory characteristics. Methods: We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study. Results: The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p <0.001). Seventeen patients (14.9) had a positive biopsy. Although the mean post-fixation specimen length in the biopsy-positive group (18.35 ± 6.9 mm) was longer than that in the biopsy-negative group (15.62 ± 8.4 mm), the difference was not statistically significant (P = 0.21). There was no statistically significant difference between the groups in terms of sex, serum hemoglobin, platelet count, and erythrocyte sedimentation rate. There were statistically significant differences between the biopsy-negative and biopsy-positive groups with respect to patients� age and C-reactive protein level (P < 001 and P = 0.012, respectively). Conclusion: The majority of TABs were negative. Reducing the number of redundant biopsies is necessary to decrease workload and use of medical services. We suggest that the diagnosis of GCA should be dependent on clinical suspicion. © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARC

Subarachnoid hemorrhage following uneventful thyroid orbital decompression

A 24-year-old woman developed subarachnoid hemorrhage and left frontal lobe ischemia following uneventful right transconjunctival orbital decompression for thyroid-related immune orbitopathy. CT, MRI, CT angiography, and carotid angiography confirmed subarachnoid hemorrhage and brain ischemia on the left side without any cerebral vascular abnormalities on either side. All tests were unremarkable. She fully recovered at last follow-up, 4 months after surgery. We did not find any reason for the subarachnoid hemorrhage and left frontal lobe ischemia. This complication should be considered after orbital surgery for patients with thyroid-related immune orbitopathy. ©2007The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc