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

How reliable is the lacrimal scintigraphy report? An inter-observer agreement and reliability study

AIM: To assess the inter-observer agreement and reliability as well as intra-observer repeatability for lacrimal scintigraphy (LS) reports with and without considering the irrigation test results. � METHODS: A prospective, observational, cross sectional study. Two masked clinicians (lacrimal surgeon and nuclear medicine specialist) independently reported 100 LS images (50 patients of >6 years of age with unilateral anophthalmic socket) in a university hospital. The lacrimal surgeon performed a diagnostic irrigation test and repeated the report of the same LS images 2y after the first report (intra-observer agreement). A weighted Kappa analysis was performed to determine inter-observer agreement and reliability as well as intra-observer repeatability for the type (normal, partial and complete obstruction) and location (presac, preduct, and intraduct) of the obstruction. Subgroup analysis was also performed with consideration of irrigation test results. � RESULTS: A significantly moderate agreement was found between lacrimal surgeon and nuclear medicine specialist for both the type (Kappa=0.55) and location (Kappa=0.48) of obstruction. Agreement values were higher for the type (Kappa=0.61 vs 0.41) and location (Kappa=0.56 vs 0.31) of obstruction in cases with normal than abnormal irrigation test. Strong and significant intra-observer (lacrimal surgeon) repeatability was found for both the type (Kappa=0.66) and location (Kappa=0.69) of obstruction. LS showed no to slight reliability based on irrigation test. � CONCLUSION: A moderate agreement is found between lacrimal surgeon and nuclear medicine specialist regarding the interpretation of LS suggesting the importance of consensus groups among nuclear medicine specialists and lacrimal surgeons to create a common language for interpretation of LS. Intra-observer repeatability is strong for the lacrimal surgeon. © 2019, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved

The relationship between processing speed and regional white matter volume in healthy young people

Processing speed is considered a key cognitive resource and it has a crucial role in all types of cognitive performance. Some researchers have hypothesised the importance of white matter integrity in the brain for processing speed; however, the relationship at the whole-brain level between white matter volume (WMV) and processing speed relevant to the modality or problem used in the task has never been clearly evaluated in healthy people. In this study, we used various tests of processing speed and Voxel-Based Morphometry (VBM) analyses, it is involves a voxel-wise comparison of the local volume of gray and white, to assess the relationship between processing speed and regional WMV (rWMV). We examined the association between processing speed and WMV in 887 healthy young adults (504 men and 383 women; mean age, 20.7 years, SD, 1.85). We performed three different multiple regression analyses: we evaluated rWMV associated with individual differences in the simple processing speed task, word–colour and colour–word tasks (processing speed tasks with words) and the simple arithmetic task, after adjusting for age and sex. The results showed a positive relationship at the whole-brain level between rWMV and processing speed performance. In contrast, the processing speed performance did not correlate with rWMV in any of the regions examined. Our results support the idea that WMV is associated globally with processing speed performance regardless of the type of processing speed task

Intralesional Injection of Interferon-α2b in Orbital Eosinophilic Granuloma

Considering the immune system dysfunction in unifocal orbital eosinophilic granuloma; possible complications of surgery, intralesional steroid, and radiotherapy; immunomodulatory and cytoreductive effects of interferon-α2b; and its safety profile in treatment of ocular surface neoplasia, intralesional interferon-α2b was first commenced in treatment of 3 cases (8-, 25-, and 43-year-old men) with biopsy proven orbital eosinophilic granuloma (2007-2014). Three intralesional injections of interferon-α2b (1.5 million units/0.5 ml) were given every other day. Cases 1 and 3 showed a rapid response with no recurrence in 86 and 29 months follow up. Case 2, however, required a second course of injection 2 months after the first one due to a partial response to the first injections with no recurrence at last follow up (57 months). Transient flulike symptom was the only side effect that was observed in Cases 2 and 3. © Copyright 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc

Autoimmune hyperthyroidism and thyroid eye disease: What is the role of pro-oxidants and antioxidants?

There is a growing evidence that increased reactive oxygen generation plays an important role in pathogenesis of autoimmune disorders, including Graves' hyperthyroidism. It has been shown that decreased level of antioxidant vitamins (A, C and E) return to normal after the achievement of euthyroidism. Combined antioxidant treatment of patients with Graves' hyperthyroidism showed the same improvement effect as thyrostatic medications in terms of clinical symptoms. Thyroid eye disease (TED) is autoimmune in origin and does not result directly from endocrine hormonal imbalance. It has been proven that derangements of pro-/anti-oxidant enzymes occurs in TED and may stay for a long time after correction of hormonal imbalance. Increased levels of oxidative stress and decreased levels of the antioxidant reserve have been reported in the setting of TED. There are a few studies showing the beneficial effect of different singular or combined antioxidants treatment in patients with TED. © 2015 Informa UK Ltd