Recurrent corneal erosion caused by retained sutures in blepharoplasty

The small incisions combined with interrupted buried suture blepharoplasty: flexible-rigid fixation

Background

The traditional full incision blepharoplasty is the most commonly used in Asia. However, it has significant drawbacks like long recovery period, excessive surgical marks etc. We offer a new suture idea and combine it with interrupted suture buried blepharoplasty to improve these disadvantages.

Methods

In our procedure, the orbital septum is opened and separating the levator aponeurosis-the retro-orbital septum complex under this 3-5 millimeters small incision, a flexible-rigid fixation would be made: suture fixation was made to the tarsus-the complex-lower lip orbicularis oculi muscle. We interrupted bury the sutures in the uncut skin between the two small incisions.

Results

This paper included 333 patients divided into small incision groups using flexible-rigid fixation (n = 244, 73.3%) and full incision groups using rigid fixation (n = 89, 26.7%). Both at 6-month and at 5-year postoperative follow-up, the satisfaction of small incision group was statistically higher than the full incision group. The overall postoperative complication rate was statistically significantly less in the small incision. The permanence was not statistically different. For Assignment of Postoperative Effort Score (PES) results, at 6 months postoperatively, the mean score was 8.29 ± 1.32 in the small incision group, 7.86 ± 1.54 in the full incision group. At 5 years postoperatively, the mean score was 7.48 ± 1.45 in the small incision group, 7.51 ± 1.73 in the full incision group. None were statistically different.

Conclusion

The small incisions group achieves a higher level of patient satisfaction and more mild trauma in the surgical area, has a low complication rate, and a decent degree of durability.

Beyond the Surface: A Systematic Review of Perforating and Penetrating Globe Injuries From Blepharoplasty

PURPOSE

This study aims to address the infrequent but serious complication of globe injuries in blepharoplasty.

METHODS

A case series of 3 patients with globe injuries postblepharoplasty is presented, along with a systematic literature review that revealed 13 previously reported cases. Quantitative and comparative analysis is described.

RESULTS

Injuries ranged from deep thermal burns to full-thickness corneal or scleral lacerations, with one instance of traumatic cataract. The median time from surgery to symptom onset was 1 day, with a concerning median delay of 7 days to presentation to an ophthalmologist. Visual outcomes were generally poor, with nearly all patients experiencing permanent visual morbidity. The systematic review revealed 3 cases of endophthalmitis following perforating scleral injuries. Comparative analysis showed no significant differences in visual outcomes between penetrating and perforating injuries.

CONCLUSIONS

The findings of this study emphasize the need for increased vigilance for globe injuries that require prompt ophthalmological evaluation following blepharoplasty, especially considering the observed delay in presentation and the extent of visual morbidity. The study advocates for improved practitioner training in recognizing and managing these complications and underscores the importance of patient education regarding the potential risks and the necessity of timely postoperative care.

Late-Onset Traumatic Corneal Conjunctival Epithelial Disorders due to Granular Formation After Cosmetic Suture Blepharoplasty

PURPOSE

The purpose of this study was to report conjunctival granular formation as one of the causative factors of a traumatic corneal conjunctival epithelial disorder after plastic suture blepharoplasty.

METHODS

Clinical charts of 7 patients who had visited Ohshima Eye Hospital with a symptomatic corneal epithelial disorder and history of suture blepharoplasty were reviewed. Clinical evidence of conjunctival granular formations was observed in all patients at the tarsal conjunctiva facing to corneal conjunctival traumatic epithelial disorders. The desired outcome was to alleviate the disorder. The assessment included tabulating results after the placement of a soft contact lens bandage and subsequent partial tarsal plate resection of the granular formation.

RESULT

Seven women (mean age 45.0 ± 10.9 years) enrolled in this study had previously undergone suture blepharoplasty (mean 18.3 ± 6.9 years before). Soft contact lens bandages relieved all of the patients' complaints immediately. After resecting the granular formation, the traumatic corneal conjunctival epithelial disorder disappeared, and no recurrence was observed after surgery.

CONCLUSIONS

The conjunctival granular formation within the tarsal conjunctiva after suture blepharoplasty caused the late-onset traumatic corneal conjunctival epithelial disorder. A complete cure was obtained after resection of the granular formation at the tarsal conjunctiva. To the best of our knowledge, this is the first report to identify the removal of granular formations in 7 patients with late-onset traumatic corneal conjunctival disorders many years after blepharoplasty. The resection of these lesions is a promising procedure to treat late-onset ocular epithelial disorder after suture blepharoplasty.

Recurrent corneal erosions related to an ocular injury 15 years before presentation

Purpose

To report the case of a patient who presented with recurrent corneal erosions caused by an undetected plastic foreign body in the upper eyelid, which had remained asymptomatic for nearly 15 years following an ocular injury.

Observations

A 39-year-old patient presented with recurrent corneal erosions and frontal headaches of unknown aetiology over the preceding eight months. The patient had previously been seen by twelve different ophthalmologists and had been treated over a 6-month period with a bandage contact lens, and therapeutic corneal scraping had been performed twice. However, the corneal erosion had repeatedly reappeared after removal of the bandage contact lens. On clinical examination prior to a planned phototherapeutic keratectomy, we extracted a 1.5 cm plastic foreign body, localised in the subtarsal area of the upper conjunctival fornix. Upon specific questioning, the patient denied any recent trauma, but reported a work-related accident with an accompanying eye injury 15 years before presentation.

Conclusions and importance

Posttraumatic foreign bodies in the eye may remain asymptomatic for prolonged periods before giving rise to clinical signs such as recurrent corneal erosions. Hence, a thorough clinical examination with meticulous eyelid eversion should always be performed in such patients.

Clinical Comparison of 3 Different Double Eyelid Surgeries

OBJECTIVE

Double blepharoplasty or double eyelid surgery is a common plastic surgery in Asians. Our study aimed to evaluate the advantages and disadvantages of the minimally invasive 3-point subcutaneous tunnel double eyelid surgical technique relative to other commonly used approaches.

METHOD

The study compared 852 single eyelid patients electing 1 of 3 double eyelid surgical options; minimally invasive 3-point subcutaneous tunnel, minimally invasive 3-point embedding, or incision double eyelid surgery. Evaluation criteria included postoperative swelling, hyperemia, pain, scarring, single eyelid recurrence, and patient satisfaction after 2 years.

RESULTS

All surgical methods effectively achieved double eyelids. Directly after the procedure, the minimally invasive 3-point embedding method produced the mildest degree of swelling and congestion, followed by the 3-point subcutaneous tunnel method and then the incision method (F = 523.908, P = 0.000). The incision method also resulted in more serious postoperative pain, whereas the other 2 methods were equivalent (F = 83.117, P = 0.000). Patients in the incision group had the most severe scars compared with the other 2 groups with milder scarring (F = 882.102, P = 0.000). The minimally invasive 3-point embedding method group had the highest single eyelid recurrence rate (5.88%), whereas the recurrence rates for the other 2 methods were less than 1%. Patients satisfaction after 2 years was highest in the minimally invasive 3-point subcutaneous tunneling method, followed by the 3-point embedding method and lastly the incision method (F = 25.931, P = 0.00).

CONCLUSIONS

Minimally invasive 3-point subcutaneous tunnel double eyelid surgery has advantages over other techniques, and its clinical application is worth promoting for suitable patients.

Cause and Management of Suture-related Ocular Complications after Buried-suture Double-eyelid Blepharoplasty

BACKGROUND

Buried-suture double-eyelid blepharoplasty is very popular in Asia, especially in China, but there are few reports related to the cause, management, and prevention of suture-related complications of corneal injury and other damages to the eye. The study aims to determine the cause, management, and prevention of suture-related complications after buried-suture double-eyelid blepharoplasty.

METHODS

A retrospective study was conducted from January 2016 to January 2019 on 12 patients with corneal and other injuries to the eye after they underwent buried-suture double-eyelid blepharoplasty. The study included patients who underwent intermittent and continuous buried-suture double-eyelid blepharoplasty with the following symptoms: red eye, foreign body sensation, photophobia, pain, tears, and decreased vision. The clinical characteristics, examination method, and treatment were noted.

RESULTS

The patients were all females. Ocular injuries included: corneal epithelial punctate or diffuse injury in nine patients, corneal ulcer in two patients, and a perforating eye injury in one patient. The corneal injury was repaired after exposed nylon thread ends were removed. A suture on the surface of the eye penetrating the sclera was detected in one patient, who then had a vitrectomy caused by endophthalmitis.

CONCLUSION

Suture-removal surgery is indicated to treat suture-related complications. Less experienced clinicians should use an eyelid protection plate to protect the cornea and eyeball during surgery. The conjunctiva of the fornix should be examined after surgery. The clinician should inquire about the operation history in detail and check the conjunctiva of the fornix with an eyelid retractor to avoid misdiagnosis.