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PubMed | South Australian Institute of Ophthalmology and Royal Adelaide Hospital, Seirei Hamamatsu Hospital, Kyoto Prefectural University of Medicine and Tokyo Medical and Dental University
Type: Journal Article | Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS | Year: 2015

To evaluate the outcomes of a modified auricular cartilage sling for paralytic ectropion.We treated 17 eyelids of 17 patients (average 67 years old) with an auricular cartilage sling between 2004 and 2012. All patients had paralytic ectropion with lower eyelid ptosis. Cartilage was harvested via an incision just inside the anterior rim of the helix. Skin incisions were made at the subciliary, medial and lateral canthal regions. The auricular cartilage graft was sutured to the medial canthal tendon medially, lateral orbital rim laterally, inferior tarsus superiorly, and lower eyelid retractors inferiorly. Average follow-up period was 40 months (range 16-60months).The median L-MRD (mm) was improved from 8.4 preoperatively (interquartile range 7.5-8.9) to 5.2 postoperatively (4.8-5.3). The median lagophthalmos (mm) was improved from 5.8 preoperatively (4.7-7.0) to 2.2 postoperatively (1.6-2.6). 16 patients had corneal exposure preoperatively and this resolved completely in 12 patients. All patients experienced good anatomical and functional results with relief of their preoperative pain/discomfort symptoms without complications. No patients required reoperation and none experienced infection, exposure of the cartilage graft, or recurrence of lower eyelid malpositions. Postoperatively, all lower eyelids moved downward with down-gaze. The auricular scar left no significant cosmetic deformity.The modified auricular cartilage sling with 4 point fixation for paralytic ectropion appears to maintain normal eyelid mobility with down-gaze and avoids the problem of lower eyelid fixation.


Watanabe A.,Kyoto Prefectural University of Medicine | Selva D.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | Kakizaki H.,Aichi Medical University | Oka Y.,Kyoto Prefectural University of Medicine | And 4 more authors.
Investigative Ophthalmology and Visual Science | Year: 2015

PURPOSE. To evaluate long-term changes in tear volume by using video meniscometry following blepharoptosis surgery and upper blepharoplasty.METHODS. Forty-three eyes of 27 patients with blepharoptosis and 29 eyes of 18 patients with dermatochalasis without lacrimal duct obstruction or other eyelid diseases underwent anterior approach levator advancement or blepharoplasty. Tear volume was evaluated by measurement of tear meniscus radius (R), using video meniscometry preoperatively and at 1.5, 3, and 6 months postoperatively. Margin reflex distance-1 (MRD-1) was measured before and after surgery by using photographs.RESULTS. After blepharoptosis surgery, the mean MRD-1 was significantly increased: 0.45 mm preoperatively, 3.64mmat1.5months, 3.56mmat3months, and 3.57at6monthspostoperatively (P<0.001), and the averageRvaluewas significantly decreased:0.29mmpreoperatively, 0.22mm at 1.5 months, 0.23 mm at 3months, and 0.24 mm at 6 months postoperatively (P < 0.05). PreoperativeRwas significantly correlated to the reductionrate ofR(DR).AhigherpreoperativeR was more likely to be decreased (P < 0.01). Postoperative MRD-1 and change in MRD-1 were not correlated to DR. After blepharoplasty, the preoperativemean MRD-1 (3.11mm)was significantly decreased at 1.5months (2.47mm;P<0.01) and 3months (2.71mm; P<0.05) but recovered at 6 months (3.14mm).However, the average R was not changed: 0.31mmpreoperatively, 0.34mmat 1.5 months, 0.31 mm at 3 months, and 0.33 mm at 6 months postoperatively.CONCLUSIONS. Long-term tear volume was not changed after blepharoplasty but was decreased after blepharoptosis surgery, and even more so in cases with an initial high tear volume. © 2015 The Association for Research in Vision and Ophthalmology, Inc.


Sun M.T.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | Pham D.T.,Flinders University | O'Connor A.J.,University of Melbourne | Wood J.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | And 7 more authors.
Journal of Biomechanics | Year: 2015

Reconstruction of the eyelid remains challenging due to the unique properties of the tarsal plate, which is a fibrocartilagenous structure within the eyelid providing structural support and physical form. There are no previous studies investigating the biomechanical properties of tarsus tissue, which is vital to the success of bioengineered tarsal substitutes. We therefore aimed to determine the biomechanical properties of human tarsus tissue, and used a CellScale BioTester 5000 (CellScale, Waterloo, Canada) to perform uniaxial tensile tests on ten samples of healthy eyelid tarsus. All samples were tested 'fresh' within two hours of harvest. A tensile preload of 50. mN was applied for 10. min before the sample was subjected to uniaxial tension under linear ramp displacement control. Maximum strain was 30% of the original tissue length and thirty dynamic cycles were performed at a strain rate of 1%/s using a triangular waveform. Of the samples tested, the mean (SD) width was 5.51. mm (1.45. mm) whilst mean thickness was 1.6. mm (0.51. mm). The mean toe modulus was 0.14 (0.10) MPa, elastic modulus was 1.73 (0.61) MPa, with an extensibility of 15.8 (2.1)%, and phase angle of 6.4° (2.4)°. After adjusting for the initial tissue slack, the maximum strain ranged from 23.8% to 30.0%. At maximum strain, it was observed that the linear region of the stress-strain curve was reached without the sample slipping out of the clamps. Our results establish a benchmark for native tarsus tissue, which can be used when evaluating tissue engineered tarsal substitutes in the future. © 2015 Elsevier Ltd.


Sun M.T.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital
Ophthalmic Plastic and Reconstructive Surgery | Year: 2016

PURPOSE:: Bioengineering aims to produce functional tissue replacements to repair defects and has been widely investigated over the past few decades. We aimed to review the available literature on the application of tissue engineering in ophthalmology, with a particular focus on ophthalmic plastic surgery and potential applications for eyelid reconstruction. METHODS:: A literature search was performed on the MEDLINE database using the keywords “bioengineering,” “tissue engineering,” and “ophthalmology.” Articles written in English were included. RESULTS:: There is a substantial body of work on tissue engineering of the cornea. Other structures in ophthalmology investigated include the conjunctiva, lacrimal gland, and orbital bone. We also discuss the potential application of tissue engineering in eyelid reconstruction. CONCLUSION:: Tissue engineering represents the future of regenerative and reconstructive medicine, with significant potential applications in ophthalmic plastic surgery. © 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.


Sun M.T.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | Chan W.O.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | Selva D.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital
EMA - Emergency Medicine Australasia | Year: 2014

Background: Orbital compartment syndrome (OCS) is an ophthalmic emergency that requires urgent surgical decompression to preserve vision. Objective: To describe the clinical presentation, management and outcomes for patients with traumatic OCS. Methods: Retrospective case series of eight patients with OCS secondary to blunt trauma presenting to the Royal Adelaide Hospital between 2004 and 2013. Results: All patients had acute, painful decrease in visual acuity and proptosis. Common examination findings included a relative afferent pupillary defect, periorbital oedema, ophthalmoparesis and chemosis. All patients underwent surgical decompression in the form of a lateral canthotomy or cantholysis. Three patients who were decompressed within 2h after injury recovered fully. One patient who sustained a macular hole at the time of injury recovered four lines of Snellen acuity after being decompressed within 1h. Another patient recovered three lines of Snellen acuity after undergoing decompression at 2.5h post-injury. The remaining patients had minimal visual recovery, with postoperative visual acuities ranging from hand movements to no perception to light. Of these patients, one was decompressed at 2h, while the remaining underwent decompression at 4 and 6h post-injury. Conclusions: Prompt decompression is essential for visual recovery in OCS, which appears maximal if performed within 2h of injury. All patients presenting with history and examination findings suggestive of OCS should undergo emergency canthotomy and cantholysis prior to any additional investigations to minimise visual loss. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.


Sun M.T.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | Pham D.T.,Flinders University | O'Connor A.J.,University of Melbourne | Wood J.,South Australian Institute of Ophthalmology and Royal Adelaide Hospital | And 3 more authors.
Journal of Biomechanics | Year: 2015

Reconstruction of the eyelid remains challenging due to the unique properties of the tarsal plate, which is a fibrocartilagenous structure within the eyelid providing structural support and physical form. There are no previous studies investigating the biomechanical properties of tarsus tissue, which is vital to the success of bioengineered tarsal substitutes. We therefore aimed to determine the biomechanical properties of human tarsus tissue, and used a CellScale BioTester 5000 (CellScale, Waterloo, Canada) to perform uniaxial tensile tests on ten samples of healthy eyelid tarsus. All samples were tested 'fresh' within two hours of harvest. A tensile preload of 50. mN was applied for 10. min before the sample was subjected to uniaxial tension under linear ramp displacement control. Maximum strain was 30% of the original tissue length and thirty dynamic cycles were performed at a strain rate of 1%/s using a triangular waveform. Of the samples tested, the mean (SD) width was 5.51 mm (1.45 mm) whilst mean thickness was 1.6 mm (0.51 mm). The mean toe modulus was 0.14 (0.10) MPa, elastic modulus was 1.73 (0.61) MPa, with an extensibility of 15.8 (2.1)%, and phase angle of 6.4° (2.4)°. After adjusting for the initial tissue slack, the maximum strain ranged from 23.8% to 30.0%. At maximum strain, it was observed that the linear region of the stress-strain curve was reached without the sample slipping out of the clamps. Our results establish a benchmark for native tarsus tissue, which can be used when evaluating tissue engineered tarsal substitutes in the future. © 2015 Elsevier Ltd.


PubMed | South Australian Institute of Ophthalmology and Royal Adelaide Hospital
Type: Clinical Trial, Phase II | Journal: Clinical & experimental ophthalmology | Year: 2012

To assess the efficacy of a new nanopulse laser, retinal regeneration therapy for the treatment of diabetic macular oedema. Randomized, non-inferiority, trial. 20 eyes of 17 subjects in the retinal regeneration therapy group and 18 eyes of 14 subjects in the conventional group were analysed. The treatment group received retinal regeneration therapy laser, and the control group received photocoagulation. The primary outcome was the optical coherence tomography-measured change in central retinal thickness at 6 months. A secondary outcome was the change in logarithm of minimum angle of resolution visual acuity at 6 months. Non-inferiority required the one-sided 95% confidence interval of the mean retinal thickness reduction after retinal regeneration therapy to be within 35m of the reduction after control laser. When outliers were included in the dataset, the difference in retinal thickness reduction by analysis of covariance was 10.9 (standard deviation 17.6) mm in favour of the control laser. The difference between groups in retinal thickness reduction was 40.8mm. If two extreme outliers were excluded, the difference was 5.6 (standard deviation 14.2) mm in favour of the retinal regeneration therapy laser, and the D optical coherence tomography was 18.5mm. The visual acuity difference between groups was 0.059, meeting non-inferiority requirements. Although retinal thickness reduction was not unambiguously non-inferior, in the short-term, retinal regeneration therapy approximates the clinical efficacy of conventional photocoagulation, stabilizing visual acuity and providing motivation for larger trials assessing retinal regeneration therapy.

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