Hwa Lee

Clinical effectiveness of monocanalicular and bicanalicular silicone intubation for congenital nasolacrimal duct obstruction.

Background Numerous surgical techniques of silicone tube intubation in congenital nasolacrimal duct obstruction (CNLDO) have been described; these techniques can be divided into monocanalicular intubation (MCI) and bicanalicular intubation (BCI). The aim of this study was to compare the clinical effectiveness of MCI versus BCI of CNLDO. Methods In a prospective, nonrandomized, comparative case study, patients with CNLDO underwent probing under endoscopic control and either BCI or MCI under general anesthesia. Demographic data, including age and sex, duration of preoperative symptoms, method of previous treatment, operative time, timing of silicone tube removal, follow-up periods, complications, and outcomes, were analyzed. Results The study included 30 eyes from 22 patients for BCI and 30 eyes from 24 patients for MCI. The mean age in the BCI group was 23.3 months and in the MCI group was 23.1 months. Mean follow-up was 16.4 ± 5.9 weeks for BCI group and 11.6 ± 8.2 weeks for MCI group. Operation time was slightly longer in the BCI group. Tubes were most often removed in the operating room under general anesthesia for BCI (66.7%) and in an office setting under topical anesthesia for MCI (100%). Overall, BCI had a 93.3% success rate (28/30), and MCI had a 90.0% success rate (27/30). Conclusions Although there was no significant difference between the success rates of the 2 groups, MCI allowed technical ease of insertion and tube removal. Moreover, the tubing does not threaten the unprobed part of the lacrimal drainage system. These advantages of MCI should be considered when selecting treatment methods for CNLDO.

Change in brow position after upper blepharoplasty or levator advancement.

AbstractBrow position after blepharoplasty is somewhat controversial. Some authors insist that brow position remains unchanged after surgery. On the other hand, there is also an opinion that brow position changes after surgery.We evaluate the influence of upper blepharoplasty or correction of ptosis on brow position in East Asians. Sixty patients (120 eyes) who underwent upper blepharoplasty or levator advancement were evaluated for change in brow position. Marginal reflex distance 1, brow height from medial canthus, upper eyelid margin on midpupillary level, lateral canthus, and brow height from the center of the pupil were measured before surgery and 6 months after surgery. The distance between the upper lid margin and the brow was shortened after upper blepharoplasty or levator advancement, which could cause brow depression. Change in brow height was greater after levator advancement than after blepharoplasty. These findings might be helpful for the prediction of brow position after surgery. Our study also implies that the possibility of a change in postoperative brow position change should be explained to patients before surgery, particularly ptosis patients.

Histopathologic Findings of the Orbicularis Oculi in Upper Eyelid Aging: Total or Minimal Excision of Orbicularis Oculi in Upper Blepharoplasty

OBJECTIVE It is well known that gradual loss of elastic fibers and skin relaxation cause the aging process, but whether changes in the orbicularis oculi muscle may contribute to the aging of the upper eyelid is not known. The aim of the present study was to use histopathologic examination to investigate whether the orbicularis oculi contributes to upper eyelid aging. METHODS Full-thickness upper eyelids, which were removed during blepharoplasty using en bloc resection, were stained with hematoxylin-eosin and examined. Eleven patients with oriental eyelid, 14 patients with bilateral dermatochalasia, and 2 patients with facial nerve palsy and contralateral dermatochalasia were included in this study. RESULTS Patients ranged in age from 21 to 73 years (median age, 55.8 years). Histologic results revealed that changes in the aging upper eyelid were mainly in the skin and subcutaneous layers with large masses of deranged elastic fibers in the papillary dermis, which was characterized as solar elastosis. CONCLUSIONS Our study revealed that the entire orbicularis oculi muscle layer remained morphologically intact with aging. Moreover, our findings suggests that a minimally invasive surgical approach with muscle sparing in upper blepharoplasty in selected patients could yield good results in terms of cosmetic outcomes and upper eyelid function while minimizing postoperative complications.

The volumetric change of orbital fat with age in Asians.

Lower eyelid prominence occurs as an aging process. Several causes of age-related lower eyelid prominence including herniated excessive intraorbital fat or fat atrophy, weakening of supporting components, and globe descent have been proposed. However, actual occurrence of excessive intraorbital fat herniation is still controversial. We measured volume of total orbital fat (OF) and fat anterior to the inferior orbital rim (IORF) using computed tomography (CT) to evaluate volumetric change of orbital fat with age in Asians. A total of 130 patients (65 men and 65 women) were evaluated, and volumes of OF and IORF were measured. OF and IORF volumes increased until the 60 years of age, and then decreased in both male and female groups. IORF/OF ratio increased with age, and, unlike fat volume, there was no decline after 70 years of age. Increase of orbital fat volume contributed to lower eyelid prominence. Reduction of anterior orbital fat volume could improve age-related lower eyelid prominence, and conservative fat excision in lower blepharoplasty can be useful in management of lower eyelid prominence.

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

Purpose:  This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes.

Analysis of lid contour change with aging in asians by measuring midpupil lid distance

Background: The purpose of this study was to analyze the upper eyelid contour of normal adults and differences of these contour according to sex and age in Asians using a software program that measures multiple radial midpupil lid distance. Methods: Conventional and 12 oblique midpupil lid distances every 15 degrees across the temporal (105, 120, 135, 150, 165, and 180 degrees) and nasal (75, 60, 45, 30, 15, and 0 degrees) fields of the lid fissure of 360 healthy Korean subjects older than 20 years and younger than 80 years in both sexes (30 subjects in each group) were measured using custom software. Midpupil lid distances and angles of the medial and lateral canthal ends were also analyzed, and the palpebral fissure inclination was measured. Results: Midpupil lid distances decreased in all angles with advancing age. When midpupil lid distances at the same angles were compared, the mean differences between those in their 20s, 60s, and 70s at 0° and 180° were statistically significant in males (p = 0.039 and 0.045, respectively). In women, the mean differences in all directions between participants in their 20s and those in their 60s and 70s were statistically significant (p < 0.05). Conclusions: Normal eyelid contour in Asians was the shape of an arch that has higher temporal lid contour than the nasal one. There were remarkable decreases in midpupil lid distances in the temporal sectors of the lid fissure with aging, especially at the lateral canthal end. Consideration of the normal shapes and parameters of eyelid contour may improve preoperative planning in aesthetic and reconstruction procedures of the eyelid to restore youthful eyelids.

Anatomical and morphometric study of the bony nasolacrimal canal using computed tomography.

Aims: To determine the diameters, angles and sectional area of the bony nasolacrimal canal using computed tomography for obtaining detailed anatomical knowledge of the drainage system and utilizing these measurements in planning interventions for nasolacrimal duct obstruction in adults and children. Methods: Using standard computed tomographic images, we measured the diameters, angles and sectional area of the bony nasolacrimal duct in 228 patients without nasolacrimal duct disease. Results: There was no statistically significant difference in other parameters between males and females. In particular, age had a significant effect on the angle between the bony nasolacrimal canal and the nasal floor in the pediatric patients (<10 years; p = 0.00), and pediatric patients had more acute angles than adult patients (>10 years old). Conclusions: In nasolacrimal probing of congenital nasolacrimal duct obstruction, the probe should be passed more to the posterior part of the nasal cavity. In other words, the distal part of the probe should form a more obtuse angle with the forehead in pediatric patients than in adults. This study may contribute to the establishment of a detailed anatomical and morphometric baseline of the bony nasolacrimal canal and provide useful information for the planning of interventions for nasolacrimal duct obstruction in adults and children.

Clinical Outcomes of Initial and Repeated Nasolacrimal Duct Office-Based Probing for Congenital Nasolacrimal Duct Obstruction

Purpose To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children. Methods The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later. Results Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 ± 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fishers exact test). Conclusions While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.

Computed tomographic dimensions of the lacrimal gland in healthy orbits.

PurposeThe aims of this study were to evaluate the normal range of the dimensions of lacrimal glands in the healthy orbits of Korean subjects and to evaluate their association with clinical findings. MethodsA retrospective survey of patients who had visited the Korea University Medical Center and had undergone orbital computed tomographic scan was performed. One hundred eighty Korean patients (90 men and 90 women) who were older than 20 years and without orbital disease were included. Patients with trauma to the orbits or any known lacrimal gland disease were excluded. The length and width of the lacrimal gland were measured in axial and coronal sections using the largest image. The primary outcome was a descriptive analysis of the distribution of dimensions in normal orbits. We analyzed the results and identified associations with age, sex, and laterality and compared our results with a previous study on normal white lacrimal gland dimensions. ResultsThe mean lacrimal gland axial length was 14.9 mm in the right orbit and 14.7 mm in left orbit. Coronal lengths averaged 20.9 mm in the right orbit and 20.7 mm in the left orbit. The axial width was 4.1 mm in the right orbit and 4.3 mm in the left orbit. The coronal width averaged 3.6 mm in the right orbit and 3.8 mm in the left orbit. A significant inverse linear relationship was observed in both orbits between gland size and age in all dimensions, with the exception of axial width. ConclusionsThis study presents a normal range of Korean lacrimal gland dimensions as measured by computed tomography. This range can aid in differentiating diseased and nondiseased lacrimal glands, especially when used in combination with physical examination. These data may also be useful in clinical trials that involve lacrimal gland size.

Surgical correction of epiblepharon using thermal cauterization of the orbital septum and lash-rotating sutures.

Background: Epiblepharon is a congenital eyelid anomaly frequently encountered in Asian infants and children. The purpose of this study was to describe the surgical technique of epiblepharon correction by applying both lash-rotating sutures in the inferior tarsus and the subcutaneous tissue of the upper skin flap and thermal cauterization in the septum. Methods: A retrospective, interventional study was performed on 75 patients who underwent surgical correction of epiblepharon between August 2006 and July 2007 by 1 surgeon. The upper skin incisional line was just below the eyelash line, and the delineated ellipse extended from just lateral to the punctum to the site of lash inversion. Dissection was carried out between the tarsal plate and orbital septum and the skin-pretarsal and preseptal orbicularis oculi muscle flap, thus exposing the tarsal plate and orbital septum. Thermal cauterization was applied to the orbital septum to create a cicatricial barrier adhesion between the preseptal orbicularis oculi muscle and the septum to minimize vertical overriding of the orbicularis oculi muscle. Three to 4 interrupted sutures were placed in the inferior tarsus and the subcutaneous tissue of the upper skin flap to rotate the direction of the lashes. The small amount of pretarsal orbicularis oculi muscle and redundant skin overlying the lower lid margin were removed. Results: A total of 150 eyes (75 patients) were followed for 24.1 weeks (range, 4-12 months). Patients ranged in age from 2 to 13 years (median age, 7.3 years). All patients were diagnosed with bilateral epiblepharon, and surgery was performed on both eyelids. After a mean follow-up period of 14.1 weeks, no patients had recurrence, and all patients had good cosmetic results. Symptoms disappeared in all patients. There were no cases of lid retraction, wound dehiscence, or ectropion. Conclusions: Thermal cauterization of the orbital septum and lash-rotating sutures were very useful and effective for treating epiblepharon.