Kubra Serefoglu Cabuk

Frontalis sling surgery (FSS) is the standard treatment for congenital blepharoptosis with poor levator function; however, long-term failure and material-related complications are common, particularly with silicone slings. Evidence regarding optimal revision strategies after failed silicone FSS remains limited. This study evaluated the anatomical outcomes, ocular surface safety, and patient satisfaction following maximal levator resection surgery (MLRS) performed after silicone frontalis sling removal. This retrospective study included 20 eyes of 17 patients who underwent MLRS following silicone frontalis sling removal between 2019 and 2023. Preoperative and postoperative assessments included best-corrected visual acuity, margin reflex distance-1 (MRD-1), levator function, lagophthalmos, corneal fluorescein staining, punctate epithelial keratopathy, and patient satisfaction. Postoperative evaluations were performed at 1 week, 1 month, 3 months, and 6 months. Statistical analyses were conducted using paired and repeated-measures tests, with a significance level set at p < 0.05. The mean age at the time of MLRS was 11.05 ± 5.94 years, and the mean preoperative levator function was 4.85 ± 2.49 mm. Revision surgery was indicated for undercorrection in 18 eyes (90%) and conjunctival complications in 2 eyes (10%). Mean MRD-1 increased significantly from 0.25 ± 0.85 mm preoperatively to 2.55 ± 0.60 mm at 6 months postoperatively (p < 0.001), with stable values across follow-up visits. Lagophthalmos increased slightly postoperatively but did not differ significantly from preoperative measurements (p > 0.05). Mild corneal surface changes were observed in the early postoperative period and were successfully managed with medical treatment. Additional revision surgery was required in 2 eyes (10%). Most patients and their parents reported high satisfaction, with dissatisfaction primarily related to insufficient postoperative eyelid elevation. MLRS following silicone frontalis sling removal is associated with significant and stable improvement in eyelid position, with acceptable ocular surface safety and high patient satisfaction in selected patients across a range of levator function values. However, given the retrospective design, small sample size, and lack of a comparative control group, these findings should be interpreted with caution. MLRS may be considered as a potential revision option rather than a definitive or superior approach.

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Purpose: To assess the retinal and choroidal microvascular changes in patients with benign essential blepharospasm (BEB) and to investigate the factors that may be effective on microvascularity. Methods: This study included patients with BEB and healthy controls. All participants underwent a comprehensive examination followed by optical coherence tomography angiography (OCTA). Macular vascular perfusion density (VPD), foveal avascular zone (FAZ), and subfoveal choroidal thickness (CT) were measured. The clinical findings of the BEB group and the administration of botulinum toxin A (BTx-A) prior to OCTA imaging were recorded retrospectively from the medical records. Results: A total of 16 patients with BEB and 20 healthy controls were included in this study. VPD values in all quadrants of the superficial and deep macular capillary plexus were significantly different in the BEB group compared to the control group (each p-value <0.05). In the choriocapillaris layer, VPD was significantly higher in the superior, nasal, and temporal quadrants compared to the control group (each p-value <0.05). The BEB group exhibited significantly smaller superficial and deep FAZ values compared to the control group, consistent with the observed increase in vascular density (each p-value 0.05) Conclusion: Benign essential blepharospasm may be associated with increased retinal vascular density in the superficial and deep capillary plexus and decreased FAZ area.

Purpose Investigate the most appropriate mathematical formula to objectively express upper eyelid contour symmetry. Methods 62 eyes of 31 patients were included in the study. The upper eyelid contour symmetry of the patients was classified subjectively (independent of MRD1) as poor, acceptable, and good by three oculoplastic specialists (senior, expert, and junior surgeon). Bézier curves of the upper lid contour were drawn with ImageJ software (NIH, Bethesda, MA, USA). Using the algorithms created by Author SKC in Spyder (Python 3.7.9.), the symmetry of the Bézier curves of the left eyelids were obtained according to the y-axis, and the mid-pupils of both eyes were superimposed. The lower curve moved vertically to the equal height of the other curve to equalize MRD1’s. R² (Coefficient of determination), RMSE (Root-mean-square error), MSE (Mean squared error), POC (Percentage of co-efficiency), and MAE (Mean absolute error) were calculated. We evaluated the correlation between these objective formulas and the subjective grading of three surgeons using Spearman’s rho (ρ). Results The correlation coefficient of RMSE and MSE were the same for all surgeons grading. There was a strong correlation between the senior surgeon’s subjective scoring (N; poor = 8, acceptable = 16, good = 8) and R², RMSE, POC, MAE (ρ = 0.643, p < 0.001, ρ = −0.607, p < 0.001, ρ = 0.562, p < 0.001, ρ = −0.517, p < 0.001, respectively). We found a strong relationship between the expert surgeon’s subjective scoring (N; poor = 9, acceptable = 13, good:10) and R² (ρ = 0.611, p < 0.001), RMSE (ρ = −0.549, p < 0.001), POC (ρ = 0.511, p < 0.001), and MAE (ρ = −0.450, p < 0.05). We found a strong correlation between junior surgeon’s subjective scoring (N; poor = 6, acceptable = 18, good = 8) and R², RMSE, and POC (ρ: −0.517, p < 0.001; ρ: −0.470, p < 0.001; ρ: 0.521, p < 0.001; respectively) and moderate correlation between MAE (ρ:-0.394, p < 0.05). The highest correlation is observed with R². Conclusions RMSE, MSE, POC, MAE, and especially R², may quantitatively express upper eyelid contour symmetry, comparable with the oculoplastic surgeon. The highest correlation was observed between the senior surgeon and R², and decreases with the experience of the surgeon.

Purpose This report presents the results of using cryopreserved umbilical amniotic membrane (cUAM) as an alternative mucosal graft for ocular surface reconstruction in cases of anophthalmic socket contracture (ASC), cicatricial entropion (CE), and conjunctival-scleral defects. Methods The study included patients who underwent non-commercial implantation of cUAM grafts (prepared by corneal banking methods) for ASC, CE, conjunctival defect, and scleral melting. The main success criteria for this study were the comfortable fitting of the ocular prosthesis in ASC patients, the natural eyelid position in CE patients, and the degree of conjunctivalisation in melting patients. Results cUAM transplantation was performed in 2 patients who could not use a prosthetic eye due to conjunctival contracture, 2 patients with CE, and 1 patient with conjunctival defect and 1 patient with conjunctival-scleral melting. The primary outcome was achieved in 83.3% (5/6) of patients. In one patient with CE, partial healing was achieved due to the persistence of CE in the medial upper eyelid. Conclusions cUAM is a viable alternative to mucosal grafting for reconstructing the bulbar and palpebral conjunctival surface, fornix, and orbit, with reduced donor morbidity and shorter surgical time. Its regenerative ability allows for tissue defect healing and improves cosmetic appearance through epithelialization within weeks.

Amaç: Üst ve alt lakrimal drenaj sistemi (LDS) tıkanıklığı olan olgularda preoperatif kan testlerinden sistemik inflamasyon belirteçlerini araştırmak ve gruplar arasında bu inflamatuar belirteçleri ve uygulanan cerrahi tedavilerin başarısını karşılaştırmak amaçlandı. Gereç ve Yöntemler: Bu retrospektif çalışmada 2021-2023 yılları arasında LDS tıkanıklığı olan olguların dosyaları incelendi. Üst LDS tıkanıklığı olan olgular Grup 1'e ve alt LDS tıkanıklığı olan olgular Grup 2'ye dahil edildi. Tüm hastaların ameliyat öncesi tam kan sayımından, sistemik inflamatuar belirteçler olan nötrofil-lenfosit oranı (NLR), platelet-lenfosit oranı (PLR) ve ortalama platelet hacmi (MPV) elde edildi. Nötrofil (N), lenfosit (L) ve platelet (P) sayılarına (NxP/L) dayanan sistemik immün inflamasyon indeksi (SII) bir biyobelirteç olarak hesaplandı. Her iki grubun sistemik inflamasyon belirteçleri ve cerrahi tedavi başarısı karşılaştırıldı. Bulgular: Çalışmaya 46 (Grup 1=26, Grup 2=20) olgunun 57 (Grup 1= 37, Grup 2=20) gözü dahil edildi. Grup 1'deki olguların yaş ortalaması 52,3±9,4 yıl iken; Grup 2'de 47,1±9,0 yıl idi (p=0,067). Cinsiyet dağılımı Grup 1’de 18 kadın, 8 erkek; Grup 2’de 15 kadın 5 erkek idi (p=0,749). Grup 1'de ortalama nötrofil sayısı 4,98±2,36 10^3/uL, NLR 2,25±1,19 ve PLR 114,7±29,2 idi. Bu değerler Grup 2'de sırasıyla 3,91±0,85 10^3/uL, 1,57±0,48 ve 95,5±27,9 idi (p

Purpose Investigate the most appropriate mathematical formula to objectively express upper eyelid contour symmetry. Methods 62 eyes of 31 patients were included in the study. Upper eyelid contour symmetry of the patients was classified subjectively (independent of MRD1) as poor, acceptable, and good by three oculoplastic specialists (senior, expert, and junior surgeon). Bézier curves of the upper lid contour were drawn with ImageJ software (NIH, Bethesda, MA, USA). Using the algorithms created by Author SKC in Spyder (Python 3.7.9.), the symmetry of the Bézier curves of the left eyelids were obtained according to the y-axis, and the mid-pupils of both eyes are superimposed. The lower curve moved vertically to the equal height of the other curve (to equalize MRD1’s. R² (Coefficient of determination), RMSE (Root-mean-square error), MSE (Mean squared error), POC (Percentage of co-efficiency), and MAE (Mean absolute error) were calculated. We evaluated the correlation between these objective formulas and subjective grading of three surgoens using the Spearman’s rho (ρ). Results The correlation coefficient of RMSE and MSE were the same for all surgeons grading. There was a strong correlation between the senior surgeon’s subjective scoring (N; poor = 8, acceptable = 16, good = 8) and R², RMSE, POC, MAE (ρ = 0.643, p < 0.001, ρ =-0.607, p < 0.001, ρ = 0.562, p < 0.001, ρ =-0.517, p < 0.001, respectively). We found a strong relationship between the expert surgeon’s subjective scoring (N; poor = 9, acceptable = 13, good:10) and R² (ρ = 0.611, p < 0.001), RMSE (ρ=-0.549, p < 0.001), POC (ρ = 0.511, p < 0.001), and MAE (ρ =-0.450, p < 0.05). We found a strong correlation between junior surgeon’s subjective scoring (N; poor = 6, acceptable = 18, good = 8) and R², RMSE, and POC (ρ:-0.517, p < 0.001; ρ:-0.470, p < 0.001; ρ: 0.521, p < 0.001; respectively) and moderate correlation between MAE (ρ:-0.394, p < 0.05). The highest correlation is observed with R². Conclusions RMSE, MSE, POC, MAE, and especially R², may quantitatively express upper eyelid symmetry, comparable with the oculoplastic surgeon. The highest correlation was observed between the senior surgeon and R² and decreases with the experience of the surgeon.