Overriding of the preseptal orbicularis oculi muscle in Caucasian cadavers

We aimed to microscopically examine whether Caucasian eyelids demonstrate overriding of preseptal orbicularis oculi muscle (OOM) over the pretarsal OOM in both lower and upper eyelids. Full thickness sections of 13 lower eyelids and 11 upper eyelids from seven Caucasian cadavers were examined. In the lower eyelids, all 13 specimens demonstrated clear overriding of preseptal OOM over the pretarsal OOM. The overriding part extended almost to the level of lower eyelid margin. However, in the upper eyelids, only one of the 11 eyelids demonstrated overriding, and the overriding part only extended to the level of mid-tarsal plate. Our result strongly supports the hypothesis of overriding of the preseptal OOM over the pretarsal OOM as an etiology of involutional lower eyelid entropion. The relatively low frequency of upper eyelid overriding preseptal OOM in our study reflects and may explain the rare occurrence of involutional upper eyelid entropion

Factors affecting success in endoscopic dacryocystorhinostomy.

This thesis is based on a large prospective, observational study on the various factors affecting the success of endoscopic dacryocystorhinostomy (endo DCR). There are 3 components to this study. Canalicular closure has long been thought to be a major cause for early failure and the reason behind routine silicone intubation. The first component investigated the incidence of canalicular closure in patient who underwent endo DCR without silicone intubation. In our prospective series of non-intubation for primary nasolacrimal duct obstruction, there were no cases of canalicular closure or stenosis at 12 months. Ostium closure is another major cause for failure and the degree of ostium shrinkage has been inconclusive in the literature. The second component investigated the degree of ostium shrinkage following endo DCR and if ostium shrinkage affects success of endo DCR. Following endoscopic DCR, the final ostium size on average is 35% of the original at 12 months post-operation. The majority of the ostium shrinkage occurs within 4 weeks post-operatively with a lesser degree of shrinkage between 1-12 months post-operatively. We found that ostium size was not predictive of overall surgical outcome. Finally while endo DCR has traditionally been performed under general anesthetics, there are various perioperative and cost benefits of a local anesthetic approach. We investigated the tolerability of endo DCR under local anesthesia. We found 98% of patients are happy to have powered endoscopic DCR performed again under assisted local anaesthetic.Thesis (M.Phil.) -- University of Adelaide, School of Medicine, 201

CLINICAL FEATURES AND SURGICAL OUTCOMES OF SCLERAL BUCKLE SURGERY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT: MOORFIELDS BUCKLE STUDY.

PURPOSE Long-term study to evaluate the clinical and surgical outcomes of SB surgery for primary rhegmatogenous retinal detachment (RRD) at a large tertiary eye center. METHODS Non-comparative, retrospective case series of 589 eyes of 569 patients with primary RRD who underwent SB surgery between 2004 and 2022 with median follow-up of 6 months. Main outcome measures were best-corrected visual acuity (BCVA), surgical outcomes, complications, and classification of RRD. RESULTS At baseline, 447/589 (76.1%), round hole-RRD and 133/589 (22.7%) retinal dialysis-RRD. Overall primary SB success rate was 83.7% for all RD subtypes, with round hole-RD 84.8% and dialysis-RRD 81.2%. Overall, Baseline BCVA was logMAR 0.42 and final logMAR 0.26 (p<0.0001). In macula-OFF RRD, the BCVA significantly improved from 0.79 to 0.48 logMAR (p<0.0001). Macula-ON RRD patients improved from 0.19 to 0.12 logMAR (p=0.014). Binary logistic regression showed registrar surgeon grade (OR 0.09,95% CI 0.01- 0.55), and partial or complete PVD (OR 0.21,95% CI 0.10 - 0.49) associated with reduced odds of primary success. Higher surgical failure associated with low pre-fellowship SB surgeon experience (p=0.024). CONCLUSION We report favourable visual and functional outcomes in a large series of SB for primary retinal detachment, mainly for round hole and retinal dialysis RRD patients