1
|
Serefoglu Cabuk K, Cengiz SK, Guler MG, Topcu H, Cetin Efe A, Ulas MG, Poslu Karademir F. Chasing the objective upper eyelid symmetry formula; R 2, RMSE, POC, MAE, and MSE. Int Ophthalmol 2024; 44:303. [PMID: 38954051 DOI: 10.1007/s10792-024-03157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/15/2024] [Indexed: 07/04/2024]
Abstract
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.
Collapse
Affiliation(s)
- Kubra Serefoglu Cabuk
- Department of Ophthalmology, University of Health Sciences Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Said Kemal Cengiz
- Defence Technologies, Istanbul Technical University, Istanbul, Turkey
| | - Mehmet Guray Guler
- Department of Industrial Engineering, Faculty of Management, Istanbul Technical University, Istanbul, Turkey
| | - Husna Topcu
- University of Health Sciences Beyoglu Eye Hospital, Istanbul, Turkey
| | - Ayse Cetin Efe
- University of Health Sciences Beyoglu Eye Hospital, Istanbul, Turkey
| | | | | |
Collapse
|
2
|
Khalili Pour E, Mahmoudi T, Ahmadzadeh H, Rafizadeh SM, Riazi-Esfahani H. Quantitative analysis of the eyelid curvature in patients with blepharoptosis. BMC Med Imaging 2024; 24:97. [PMID: 38671380 PMCID: PMC11046864 DOI: 10.1186/s12880-024-01280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the ability of two novel eyelid curvature measurements to distinguish between normal eyes and different severities of blepharoptosis. METHODS A comparative cross-sectional analysis of upper eyelid curvature was performed for different severities of patients with unilateral blepharoptosis (congenital and aponeurotic) and normal controls. Mean upper lid contour index (ULCI) and area circularity index (ACI) were calculated for each group by dividing the intercanthal distance by upper eyelid margin length (ULCI) and dividing the interpalpebral area by the area of a circle enclosing the eye (ACI). The ratio of each index for the study and fellow normal eye of each patient was also calculated and compared between groups. RESULTS A total of 106 eyes including 30 eyes in the control group and 25, 27, and 24 eyes in the mild, moderate, and severe ptosis groups were enrolled in the study. ULCI and ACI showed a statistically significant difference between the groups (p < 0.001, p < 0.001). The inter-eye ratio (ULCI-ratio and ACI-ratio) of indices was also significantly different between groups (p = 0.002, p < 0.001). Pairwise comparisons revealed that ACI and ACI-ratio were significantly different between all pairs of study groups. CONCLUSION The results of our study showed that ACI based on area measurements may distinguish blepharoptosis patients from normal controls and from each other. Including the data from the fellow normal eyes in the form of ratio indices may improve the differentiating power. These results can be useful in designing the optimal eyelid curvature measurements.
Collapse
Affiliation(s)
- Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Mahmoudi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Ahmadzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Orbital and Oculoplastics Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Mahmoudi T, Riazi-Esfahani H, Montazeriani Z, Yaseri M, Mehdipour Namdar Z, Jamali M, Rafizadeh SM, Khalili Pour E. Sector area index: a novel supporting marker for blepharoptosis screening and grading. Int Ophthalmol 2023; 43:4967-4978. [PMID: 37910299 DOI: 10.1007/s10792-023-02899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To introduce a new supporting marker for discriminating different grades of ptosis called Sector Area Index (SAI) and a semi-automated technique to calculate it. METHODS In this cross-sectional comparative case series, a circle enclosing the intercanthal distance was automatically drawn after choosing two points as the medial and lateral canthus and manually selecting the palpebral fissure region. Finally, 15-degree apart sectors are applied to the enclosed circle. SAI was measured automatically by dividing the area of each 15-degree sector marked with the upper eyelid contour by the total area of the sector marked with the edge of the surrounding circle. SAI values and inter-eye SAI differences were compared between patients with different grades of ptosis as well as normal patients. RESULTS In the current study, 106 eyes were recruited (30, 25, 27, and 24 in the control, mild, moderate, and severe ptosis groups, respectively). Mean values of SAI in all sectors showed a decreasing trend from normal individuals toward patients with severe ptosis. The mean difference values of SAI between study eyes and fellow eyes in all four groups of patients showed a statistically significant difference (p < 0.05). In a pairwise comparison between groups, mean values of SAI in all nasal sectors from 15° to 60° showed a statistically significant difference between all groups (p < 0.05). CONCLUSION The mean difference of SAI between study eyes and fellow eyes, including eyelid curvature, especially in 15°-60° and 120°-165° sectors, can demonstrate differentiating performance for detecting and discriminating varying grades of ptosis.
Collapse
Affiliation(s)
- Tahereh Mahmoudi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zahra Montazeriani
- Department of Medical Physics and Biomedical Engineering, Sciences and Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical, Tehran, Iran
| | - Mehdi Yaseri
- Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Jamali
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seyed Mohsen Rafizadeh
- Orbital and Oculoplastics Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Ophthalmic Plastic & Reconstructive Surgery, Farabi Eye Hospital, Qazvin Square, Tehran, Iran.
| | - Elias Khalili Pour
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
A Fully Automatic Postoperative Appearance Prediction System for Blepharoptosis Surgery with Image-based Deep Learning. OPHTHALMOLOGY SCIENCE 2022; 2:100169. [PMID: 36245755 PMCID: PMC9560561 DOI: 10.1016/j.xops.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
|
5
|
Aytogan H, Ayıntap E. Comparing the symmetry of upper eyelid following unilateral ptosis correction. BMC Ophthalmol 2021; 21:438. [PMID: 34930168 PMCID: PMC8686600 DOI: 10.1186/s12886-021-02208-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background Margin Reflex Distance 1(MRD 1) only describes the central height of upper eyelid and relies on the examiner’s experience and disregards eyelid contour abnormalities. Therefore MRD 1 may not be sufficient for an acceptable result to evaluate the outcomes of ptosis surgery. The primary purpose of this study was to assess outcomes of unilateral ptosis correction based on parameters including degree of symmetry, MRD 1, peak height of the upper lid, temporal and nasal ocular surface area, and temporal/nasal area ratio with an objective, quantitative, and repeatable method. Methods This study was designed as a retrospective non-randomized case-control study. Medical records of the patients with unilateral ptosis between October 2015 and December 2020 were reviewed. Patients with unilateral ptosis who underwent surgical correction and levator function of 5 mm or greater were included in the study. Two groups were defined; ptotic eye was case group and contralateral eye was control group. Data analysis was performed Image J and Matlab softwares. Results Thirty-four patients were included in the study. Mean age of patients was 58.8 ± 12.7 years (range 15–75 years). Mean follow-up time was 19.5 ± 7.3 months (range 8–40 months). Four patients were diagnosed with congenital ptosis and 30 patients aponeurotic ptosis. Mean preoperative degree of symmetry for overall eyelid contour was 36.6 ± 27.5% (range 1–92%). Mean postoperative degree of symmetry for overall eyelid contour was 72.4 ± 16.5% (range 55–92%). Temporal/Nasal (T/N) area ratios for contralateral normal eye was 1.19 pre-postoperative, and it was 1.11 preoperatively, 1.15 postoperatively for operated ptotic eye. Conclusions This study primarily demonstrated a quantitative, objective, and repeatable method to investigate the degree of symmetry after eyelid surgeries. Secondly, this study suggested that T/N ratio may not be a reliable parameter to evaluate the eyelid symmetry. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02208-7.
Collapse
Affiliation(s)
- Hasan Aytogan
- Izmir Tepecik Training and Research Hospital, Yenisehir, Konak, Izmir, Turkey.
| | - Emre Ayıntap
- Izmir Tepecik Training and Research Hospital, Yenisehir, Konak, Izmir, Turkey
| |
Collapse
|
6
|
Serefoglu Cabuk K, Asik Nacaroglu S, Ozturk Karabulut G, Fazil K, Arslan MS, Guler MG, Taskapili M. Muller muscle conjunctival resection or external levator advancement; a quantitative comparison of symmetry in unilateral ptosis. Eur J Ophthalmol 2021; 32:2125-2132. [PMID: 34704509 DOI: 10.1177/11206721211049057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare muller muscle conjunctival resection (MMCR) and external levator advancement (ELA) in terms of objective and subjective symmetry in unilateral ptosis. METHODS The patients who underwent unilateral MMCR (group1, n = 25) and ELA (group2, n = 25) were reviewed retrospectively. With the written algorithm, margin reflex distance-1 (MRD1), localization of the contour peak, and the percentage of overlapping curvatures (POC) of both upper eyelid curves were calculated. Semi-automated measurements were compared with the manual measurements. The correlation between objective and subjective symmetry was evaluated. RESULTS Preoperative levator functions were similar in both groups (13.93 ± 3.25 mm and 13.3 ± 2.86 mm, respectively). We found strong correlations between manual and semi-automated measurements (ICC: 0.942, 95% CI = 0.924-0.956, p < 0.001). Preoperative MRD1 (2.15 ± 0.90 vs 1.51 ± 1.01, p = 0.022) and POC was lower in group 2 (66% vs 47.2%, p = 0.01). In the postoperative period, the increase in MRD1 and POC were similar in both groups (p = 0.2 and p = 0.7 respectively), and the contour peak displaced temporally (p < 0.01) providing a symmetric peak in both groups. Subjective symmetry increased as the difference in MRD1 between two eyes decreased (r = -0.456, p = 0.001), and POC increased (r = 0.396, p = 0.004). CONCLUSIONS Besides subjective symmetry, MMCR and ELA are equally effective in ensuring symmetry objectively, as measured with MRD1 and contour peak symmetry and POC in unilateral ptosis. POC may be used as a criterion of symmetry in the evaluation of ptosis.
Collapse
Affiliation(s)
- Kubra Serefoglu Cabuk
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Senay Asik Nacaroglu
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Gamze Ozturk Karabulut
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Korhan Fazil
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| | - Mehmet Selcuk Arslan
- 52999Yildiz Technical University, Department of Mechatronics Engineering, Istanbul, Turkey
| | - Mehmet Guray Guler
- 52999Yildiz Technical University, Department of Industrial Engineering, Istanbul, Turkey
| | - Muhittin Taskapili
- 147017University of Health Sciences Beyoglu Eye Training and Research Hospital, Ophthalmic Plastic and Reconstructive Surgery, Istanbul, Turkey
| |
Collapse
|
7
|
Konopińska J, Lisowski Ł, Mariak Z, Wojnar M, Obuchowska I, Rękas M. A prospective, randomised study of the effect of fixation sutures during phacotrabeculectomy on intraocular pressure and incidence of ptosis. Sci Rep 2021; 11:548. [PMID: 33436700 PMCID: PMC7804261 DOI: 10.1038/s41598-020-79635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022] Open
Abstract
We investigated the effects of different intraoperative eyeball fixation techniques (superior rectus muscle suture [MS] and traction suture at the corneal limbus [CS]), on intraocular pressure (IOP) and the incidence of ptosis after phacotrabeculectomy. Forty-one eyes with different glaucoma types which qualified for phacotrabeculectomy were included. Twenty-three and eighteen patients were included in the CS and MS groups, respectively. The IOP, best-corrected visual acuity (BCVA), and margin reflex distance were assessed preoperatively and 3, 6, and 12 months post-operatively. Preoperatively, the mean IOPs (± standard deviation) in the CS and MS groups were 23.6 ± 7.3 mmHg and 24.3 ± 6.6 mmHg (p > 0.05), respectively. At 3 and 6 months post-surgery, the mean IOPs were significantly lower in the CS group than in the MS group: 13.9 ± 3.0 mmHg vs. 17.7 ± 3.5 mmHg (p = 0.001), and 13.9 ± 4.9 mmHg vs. 17.2 ± 3.5 mmHg (p = 0.005), respectively (mean difference: 3.9, 95% confidence interval 1.7–6.1). At 12 months, the mean postoperative IOPs were 15.2 ± 3.5 mmHg and 14.9 ± 3.6 mmHg in the CS and MS groups, respectively (p > 0.05). At 6 months, the BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; BCVAs were 0.91 ± 0.15 and 0.71 ± 0.3 (p = 0.029) in the CS and MS groups, respectively; the difference was non-significant 12 months post-surgery (0.78 ± 0.32 vs. 0.74 ± 0.30, p = 0.553). Postoperative ptosis was observed in 4 (17%) and zero patients in the CS and MS groups, respectively, but the difference was not statistically significant (p = 0.118). The study was not powered sufficiently to detect statistically significant changes in exploratory endpoints. The study was not powered sufficiently to detect statistically significant differences between groups in exploratory endpoints.
Collapse
Affiliation(s)
| | - Łukasz Lisowski
- Department of Ophthalmology, Medical University, Białystok, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University, Białystok, Poland
| | | | - Iwona Obuchowska
- Department of Ophthalmology, Medical University, Białystok, Poland
| | - Marek Rękas
- Department of Ophthalmology, Wojskowy Instytut Medyczny, Warsaw, Poland
| |
Collapse
|
8
|
Mohammed NM, Kamal MA, Abdelhafez MA, Diab MM. Single-triangle versus Fox pentagon frontalis suspension for unilateral severe congenital ptosis correction. J AAPOS 2020; 24:295.e1-295.e6. [PMID: 33045376 DOI: 10.1016/j.jaapos.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the functional and cosmetic outcomes of two different frontalis sling techniques for correction of severe unilateral congenital ptosis: single triangle and Fox pentagon techniques using expanded polytetrafluoroethylene (ePTFE) suture. METHODS This randomized controlled trial included 60 eyes of 60 patients with severe unilateral simple congenital ptosis and poor levator function (≤4 mm). Participants were randomly assigned for either single triangle or Fox pentagon frontalis suspension using ePTFE suture. Functional outcome measures were margin reflex distance (MRD1), palpebral fissure height (VFH), and lagophthalmos. Cosmetic outcome parameters (lid contour, lid crease, and height symmetry) were graded as 3 (excellent), 2 (good), or 1 (poor), with a minimum of 18 months' follow-up. RESULTS At final follow-up, there was a significant improvement in the MRD1 and VFH in both groups, with no statistical difference (P = 0.9). Both groups showed comparative cosmetic results regarding lid height symmetry, crease, and contour. The patients in the single-triangle group showed more rapid recovery of postoperative edema and lagopthalmos with less visible forehead scarring. There were no serious ePTFE sling-related complications. CONCLUSIONS In our study cohort, the single-triangle and Fox pentagon frontalis suspension techniques had similar outcomes with respect to MRD1 and VFH and comparable cosmetic results. However, the single-triangle technique avoids two forehead incisions and was associated with less postoperative edema, lagophthalmos, and scarring.
Collapse
Affiliation(s)
- Nora Mahmoud Mohammed
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mahmoud Ahmed Kamal
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | | | - Mostafa Mohammed Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt.
| |
Collapse
|
9
|
Frontalis Linkage Without Intraoperative Eyelid Elevation for the Management of Myopathic Ptosis. Ophthalmic Plast Reconstr Surg 2019; 36:258-262. [PMID: 31809486 DOI: 10.1097/iop.0000000000001525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the effect of frontalis linkage without intraoperative eyelid elevation for the management of myopathic ptosis. METHODS Retrospective analysis of 21 (42 eyelids) myopathic patients with bilateral ptosis who were operated between 1999 and 2017. All patients had orbicularis weakness and poor or absent Bell's phenomenon. Surgery consisted of using an autogenous fascia sling to link the tarsal plate to the frontalis muscle without any degree of intraoperative eyelid elevation. The main outcome measures were margin reflex distance, brow height and degree of brow excursion and degree of lagophthalmos, and exposure keratitis. RESULTS After surgery, there were significant changes (p <0.0001) in both margin reflex distance and brow position. Mean margin reflex distance increased to 1.4 mm ± 1.34 DP and with full frontalis contraction, it reached 3.0 mm ± 1.73 DP, while mean brow position decreased 1.6 mm ± 1.59 SD, p < 0.0001. Postoperative lagophthalmos was not detected in 31 (74%) eyes. In the remaining 11 eyes (26%), lagophthalmos ranged from 1.2 to 5.2 mm (mean = 1.7 mm ± 0.74 DP). Mild inferior superficial keratitis was detected in 14 eyes (33.3%) of 7 patients only 3 of which had lagophthalmos. One patient needed additional surgery to correct unilateral eyelid retraction. Overall, 81.81% of the patients were pleased with the procedure. CONCLUSIONS Myopathic ptosis can be alleviated with a minimal amount of lagophthalmos by just linking the tarsal plate to the frontalis muscle without lifting the eyelid margin intraoperatively.
Collapse
|