Faculty Bibliography

BACKGROUND: Nasojugal groove and tear trough are interchangeably used terms by many authors in the literature despite the fact that they describe distinct and different anatomic entities. In the same vein, there are multiple descriptions of treatments and techniques for the cosmetic improvement of these anatomic areas without specifically addressing the anatomic difference between them. OBJECTIVE: This study aims to define the anatomic characteristics of the tear trough and describe a novel classification scale for the evaluation of the tear trough deformity. METHODS: The tear trough rating scale (TTRS) was applied to a representative sample of our patient population. Five of the authors evaluated each patient using the TTRS, and the numeric results were tabulated and compared. Results The TTRS provided an effective, reproducible method for evaluating tear trough deformities, and there was very little interobserver variability. CONCLUSION: The tear trough should be defined as the depression of the medial lower eyelid just lateral to the anterior lacrimal crest and limited in its inferior aspect by the inferior orbital rim. The TTRS is a reliable tool for the classification of the tear trough and evaluation of therapeutic and cosmetic interventions

The combination of noninvasive treatments in the periorbital area can be used to achieve dramatic and long-lasting results. New technologies and current therapies may supplement or even delay traditional surgical procedures

Injectable fillers have become an important component of minimally invasive facial rejuvenation modalities. Their ease of use, effectiveness, low morbidity, and fast results with minimal downtime are factors that have made them popular among patients. Soft tissue augmentation has evolved to a unique combination of medicine and art. A wide selection of available agents and new products, each one with unique properties, may be used alone or in combination. The physician acquires the tools to rebalance facial characteristics not only by filling wrinkles but also by having the ability to shape the face and restore bony contours and lines. Careful selection of candidates, realistic expectations, and an understanding of the limitations of fillers are crucial for a successful result

An 89-year-old female patient with a history of a left orbital floor fracture repair with synthetic implant 12 years prior, presented with a three-week history of blurry vision, inferior conjunctival chemosis and proptosis of the left eye. CT scan revealed a well-circumscribed subperiosteal lesion with superior elevation of the orbital floor implant. The patient underwent transconjunctival orbital surgery with removal of the implant and drainage of the subperiosteal hemorrhagic cyst. The patient had an uncomplicated postoperative course, with resolution of the proptosis, chemosis, and return of normal vision. This case represents an unusual late complication of orbital fracture repair with associated reduced visual acuity

PURPOSE: Contact transscleral neodymium:yttrium-aluminum-garnet (Nd:YAG) laser cyclophotocoagulation (CYC) is a treatment option for advanced glaucoma refractory to alternative treatments. This study determined the long-term efficacy and risks of contact transscleral Nd:YAG laser CYC. DESIGN: A prospective study was performed with patients with advanced, uncontrolled glaucoma who received CYC from 1988 through 1989. PARTICIPANTS: Records for 68 eyes of 64 patients were obtained and reviewed for the 10-year follow-up. METHODS: A transscleral continuous-wave Nd:YAG laser was used for photocoagulation of the ciliary body. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, and second intervention. Failure was defined as the need for second intervention, IOP of more than 25 mmHg, or IOP of less than 3 mmHg. RESULTS: The mean follow-up period was 5.85+/-4.0 years (range, 0.1-10 years). The mean preoperative IOP of 36.3+/-10.1 mmHg decreased to 22.6+/-11.3 mmHg at 1 year of follow-up (P<0.001). The mean postoperative IOP at 5 years was 21.8+/-13.3 mmHg (P<0.001) and was 18.9+/-12.2 mmHg at 10 years of follow-up (P<0.001). A second intervention after CYC was required in 30 eyes (44.1%). Six eyes (8.8%) with initial visual acuity of counting fingers or worse progressed to no light perception, and 5 of 8 eyes (62.5%) with visual acuity better than 20/200 lost 2 or more Snellen lines. Hypotony developed in 3 eyes (4.4%). Overall, the failure rate by 10 years of follow-up was 51.5% (35/68 eyes). CONCLUSIONS: Cyclophotocoagulation resulted in a significant reduction of IOP after surgery at 1, 5, and 10 years of follow-up; however, 51.5% of eyes failed by the end of 10 years, with most failures occurring within the first year (40%). Although CYC provides a useful method to lower IOP significantly, this study suggests that its success in controlling IOP is tempered by its failure rate and risk of complications, including visual loss, phthisis, and loss of light perception

OBJECTIVE: To evaluate the effectiveness of nonanimal stabilized hyaluronic acid as an injectable filling agent. DESIGN: Nonrandomized, retrospective, interventional case series. RESULTS: A total of 1446 consecutive patients (1029 women and 417 men) underwent intradermal injection of commercially available nonanimal stabilized hyaluronic acid (2242 treatments) for the enhancement of lip volume and contour and the reduction of visible facial rhytids. Almost 61% of all patients remained satisfied with their results after 9 months. The effect was longest in the glabellar and nasolabial fold areas. Minimal transient sequelae were noted. CONCLUSIONS: Nonanimal stabilized hyaluronic acid is an effective and safe facial soft tissue expander. Its duration varies with each facial area treated

PURPOSE: To determine differences in wearing patterns of sunglasses and/or photochromic lenses in spectacle and contact lens wearers, to assess patient awareness of the indications for the use of tinted lenses, and to identify wearers' lens tint preferences. METHODS: A total of 100 individuals wearing some combination of contact lenses and spectacles participated in a survey questionnaire composed of 14 questions. Participants were asked if they used sunglasses/photochromic lenses, why they used them, their preferred lens tints, and temporal and seasonal patterns of use. They were also queried on their awareness of the potential adverse effects of ultraviolet radiation (UVR) exposure on the health of the eye and appropriate protective measures. Participants were categorized based on their use of spectacles and/or contact lenses. Demographic characteristics of sex and age were taken into account for the analysis. The data were imported and analyzed using commercial statistical analysis software. RESULTS: A total of 52% of the participants wore spectacles exclusively, while 48% wore some combination of spectacles and contact lenses. In the spectacle group, 36% and 20% wore sunglasses and photochromic lenses, respectively. In the contact lens group, 20% and 10% wore sunglasses and photochromic lenses, respectively. Overall gray was the preferred lens tint, especially in the younger age groups. Summer was the primary season for use of tinted lenses. Approximately one-third of the sample were not aware of the UVR protective properties of their eyewear. A total of 77% believed that UVR could be harmful to the eyes, but only a small percentage of the participants wore sunglasses or photochromic lenses specifically for UVR protection. CONCLUSION: There was no statistically significant difference (P = 0.07) for preference between sunglasses versus photochromic lenses and in seasonal patterns for tinted lens use among spectacles and contact lens wearers. Spectacle wearers (as well as contact lens wearers) used sunglasses more than photochromic lenses (P = 0.004). Most of the participants wore sunglasses in the summer and to protect their eyes from bright light. Overall gray was the preferred lens tint. Potentially adverse effects of UVR exposure to the eye and the importance of proper UVR eye protection were not generally appreciated by the subjects queried