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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 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.


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 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.

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