BACKGROUND:Severe visual impairment and blindness are significant disabilities, impacting the lives of individuals and placing economic and psychosocial burden on society. Blind schools provide specialized education and rehabilitation services for individuals with visual impairment/blindness. Limited data exist on the causes of blindness in children in Jammu province, highlighting the need for this study to understand local trends and form targeted healthcare strategies. OBJECTIVES:This study aimed to evaluate the causes of blindness among residents of blind schools in Jammu province; categorize them into preventable, treatable, and unavoidable causes; and explore vocational interests of the residents to support societal integration. METHODS:This cross-sectional observational study was conducted in two blind schools (one for boys and one for girls) in Jammu province. A total of 82 residents underwent detailed ophthalmological examination by trained doctors using standardized protocols, including visual acuity assessment and anterior and posterior segment evaluations. The etiology of blindness was categorized into congenital, acquired, and undetermined causes. RESULTS:The study included 82 participants (mean age: 14.3 ± 3.9 years; 57.32% males). A positive family history of blindness was noted in 12.19%. The majority of cases (67%) were due to congenital causes, 27% were acquired, and 6% had undetermined etiology. Anatomically, the most affected sites were the whole globe (26.8%), retina (26.8%), and cornea (19.6%). Avoidable causes formed a significant proportion (35%), emphasizing the importance of public health interventions. CONCLUSION:The findings highlight congenital anomalies, retinal dystrophies, and corneal scarring as significant contributors to blindness in this population. These data can be helpful for the policy makers to take adequate action for reducing the burden of avoidable blindness.
PURPOSE:To evaluate the efficacy of secondary bony decompression following primary fat decompression. DESIGN:Retrospective interventional case series. METHODS:Setting: A tertiary university hospital. STUDY POPULATION:A total of 27 eyes from 17 patients who underwent secondary inferomedial orbital wall decompression following primary orbital fat decompression were included. Patients with a history of trauma, extraocular muscle surgery, prior orbital irradiation, or eyelid or orbital inflammation within 6 months prior to decompression were excluded. INTERVENTION PROCEDURE:Secondary inferomedial orbital wall decompression performed for recurrent proptosis or compressive optic neuropathy after primary fat decompression. MAIN OUTCOME MEASURE:Changes in Hertel value, and best corrected visual acuity (BCVA). RESULTS:Primary orbital fat decompression achieved an initial proptosis reduction of 3.4 ± 0.1 mm in 27 eyes. Secondary bony decompression was subsequently performed in 15 eyes from 9 patients with recurrent proptosis and in 12 eyes from 8 patients with dysthyroid optic neuropathy. Secondary bony decompression resulted in a reduction in Hertel measurement by 4.5 ± 2.1 mm, improving from 21.7 ± 2.8 mm to 17.3 ± 1.6 mm ( P < 0.001) at a follow-up period of 40.6 ± 28.7 months. BCVA in patients with dysthyroid optic neuropathy improved from 0.43 ± 0.3 to 0.12 ± 0.15 logMAR ( P = 0.005). Diplopia occurred in 12 of 17 patients (70%), including five with new-onset diplopia. Preoperative diplopia predicted postoperative diplopia in regression analysis. CONCLUSION:Secondary inferomedial orbital wall decompression following primary orbital fat decompression effectively reduces proptosis and improves vision.
Oculoplasty and orbital surgeries demand high precision due to confined anatomy and nearby critical structures. Recent innovations in orbital surgeries include augmented reality, robotic assistance, and computer-assisted navigation. These technologies are increasingly being explored to enhance surgical accuracy, improve outcomes, and reduce complications. Augmented reality provides real-time visualization of patient-specific anatomy, supporting preoperative planning and intraoperative guidance. Robotic systems offer tremor-free manipulation, enhanced dexterity in restrictive spaces, and minimally invasive reconstructions. Navigation enables accurate localization of deep orbital structures, thereby aiding orbital surgery. This review aims to provide current evidence on clinical practices, advantages, and limitations of newer technologies.
PURPOSE:To measure and compare the ostium size following external and endoscopic dacryocystorhinostomy (DCR) using an innovative, noninvasive immersion B-scan ultrasonography technique and to correlate ostium dimensions with functional patency assessed by the fluorescein dye disappearance test (FDDT). METHODS:This prospective comparative study included 50 patients with nasolacrimal duct obstruction who underwent either external (n = 25) or endoscopic DCR (n = 25) between September 2022 and February 2024. Intraoperative ostium size was measured using Castroviejo's calipers for external DCR and Schirmer's strips for endoscopic DCR. Postoperative ostium dimensions (length, width, and area) were assessed on days 15, 30, and 90 using an immersion B-scan probe. Functional patency was evaluated by FDDT. Data were analyzed with ANOVA and multilinear regression. RESULTS:The mean age was 54.9 ± 13.26 years in the external DCR group and 51.76 ± 13.79 years in the endoscopic group, with female predominance (78%). At 3 months, the external DCR group showed a significantly larger ostium size (length: 11.66 ± 2.12 mm; width: 7.09 ± 1.28 mm; area: 78.91 ± 24.47 mm 2 ) compared to the endoscopic group (length: 9.84 ± 0.88 mm; width: 6.46 ± 1.14 mm; area: 58.95 ± 16.25 mm 2 ) ( P < 0.05). External DCR demonstrated superior functional patency with an FDDT sensitivity of 91% and better F1 scores throughout follow-up. CONCLUSION:Immersion B-scan ultrasonography is a reliable, noninvasive tool for postoperative assessment of ostium dimensions. External DCR results in a larger ostium size and better functional patency than endoscopic DCR.
PURPOSE:Eyelid sebaceous gland carcinoma (SGC) is a rare and aggressive malignancy of the eyelids. Dysregulated cholesterol metabolism has been found to be involved in pathogenesis of various cancers including glioblastoma, breast, prostate, and pancreatic cancer. The role of cholesterol metabolism in SGC and its molecular characterization remains unexplored. This study evaluates the clinical significance of the expression of a key enzyme involved in cholesterol metabolism, acyl-CoA cholesterol acyltransferase 1 (ACAT1) in eyelid SGC. METHODS:A cohort of 50 eyelid SGC cases diagnosed over a period of 12 years were selected. Cholesterol quantification, immunohistochemistry (IHC), and real-time PCR to determine the protein and mRNA expression of ACAT were performed. RESULTS:Increased concentration of total cholesterol, free cholesterol, and cholesteryl esters was observed in SGC tumor tissues. Overexpression of ACAT1 at protein and mRNA levels was observed in 66% of the eyelid SGC patients. Significant association of high ACAT1 mRNA expression was observed in patients with lymph node metastasis ( P = 0.03) and advanced (III/IV) tumor stage ( P = 0.02). SGC patients with a high ACAT immunoexpression also had reduced disease-free survival. CONCLUSION:Overexpression of ACAT1 is a frequent event in the pathogenesis of eyelid SGC and is associated with high risk clinicopathological features. It could serve as a reliable poor prognostic biomarker.
BACKGROUND:Theoretically, robotic surgical platforms offer advantages in precision, tremor elimination, and certain degree of visualization for periocular surgeries. However, there are no published studies where a direct comparative assessment of two independent robotic systems has been performed for the creation of common eyelid incisions. We report, to our knowledge, the first head-to-head comparison of the Medtronic Hugo RAS® and Intuitive da Vinci® surgical systems for this purpose. METHODS:Six standard periocular incisions were first decided and then performed using both platforms on fresh goat eyelid specimens. A single oculoplastic surgeon, who had also received training in robotic surgical systems, performed the procedures and then rated each incision. The parameters included time to completion, ease of execution, size control, and shape control. A composite quality score was derived. Statistical comparison was performed using the Wilcoxon signed-rank test. RESULTS:All six incision types were successfully executed on both platforms. Hugo RAS® and Da Vinci® achieved nearly identical quality scores across all six incisions (composite mean 9.00 ± 2.00 for both; P = 1.00). The durations for incision created were marginally shorter with the Da Vinci (mean 28.5 ± 18.7 seconds vs. 32.0 ± 21.4 seconds; mean difference 3.5 seconds; P = 0.06). Hair-bearing sites required 3.4-3.7 times longer than hairless-region incisions on both platforms. CONCLUSION:Both platforms demonstrated equivalent technical capability and quality for all six standard eyelid incisions. The Da Vinci® system showed a nonsignificant trend toward faster execution.
PURPOSE:To assess the diagnostic efficacy of the 18 MHz Color Doppler ultrasound (CDU) probe (L8-18i) in distinguishing benign and malignant preorbital masses and compare its performance with the 11 MHz probe (L3-12). METHODS:A retrospective study analyzed ultrasound data from 17 patients (7 male, 10 female; age 5-80 years) with preorbital masses between May 2021 and April 2024. Patients underwent imaging with both probes, assessing mass size, internal echo characteristics, and blood flow parameters. Results were compared with postoperative pathology using Wilcoxon signed-rank and Mann-Whitney U tests. RESULTS:Mass locations included the upper eyelid (4), lower eyelid (10), inner canthus (1), brow (1), and conjunctiva (1). Anteroposterior diameters measured by both probes showed no significant difference ( P = 0.320), nor did internal echo characteristics ( P = 0.891). However, blood flow signals differed significantly ( P = 0.014). Pathology revealed benign lesions (chronic inflammation, nevi, cysts, hemangiomas) and malignant tumors (sebaceous gland carcinoma, basal cell carcinoma, squamous cell carcinoma). The L8-18i probe detected significant differences in peak systolic and end-diastolic velocities between benign and malignant masses ( P = 0.048), while the L3-12 probe did not. CONCLUSIONS:The 18 MHz CDU probe demonstrated superior visualization of mass structure and blood flow, improving differentiation between benign and malignant lesions. It enhanced clarity in detecting hemorrhage, necrosis, and septation, offering higher sensitivity and accuracy than the 11 MHz probe, aligning more closely with pathological findings.
INTRODUCTION:Eyelid deformities can come from birth defects or other causes, and they often need full thickness reconstruction. The Cutler-Beard and Hughes techniques are still the best methods for repairing upper eyelid colobomas. However, there are not many choices available when the eyelid margin is still intact. Here, we report the clinical outcomes of a novel modification of the Cutler-Beard flap surgery in eyelid deformity for these difficult cases. METHODS:Design: Retrospective study. Setting: Tertiary care hospital. Study Population: All patients who presented with significantly deficient full-thickness eyelid tissue and severe exposure keratopathy due to lagophthalmos in the last 6 months were studied. Intervention: Patients underwent double-bridge novel modification of the original Cutler-Beard surgery. Main Outcome Measures: The flap survival, correction of eyelid deformity, lagophthalmos, symptomatic improvement, and patient satisfaction were assessed retrospectively. The patients were also followed up for postoperative complications such as lid contour, margin abnormalities, residual lagophthalmos, lymphedema, and donor site complications. RESULTS:Postoperatively, there was satisfactory coverage of the ocular surface in all patients. None of the patients had complications such as flap/bridge necrosis, infection, or excessive secondary contraction of the flap. Chronic lymphedema was observed in one patient due to severe periorbital fibrosis. CONCLUSION:The Cutler-Beard technique remains a cornerstone in the field of eyelid reconstruction due to its versatility and effectiveness in managing large full-thickness defects of the upper eyelid. The described novel modification adds a new indication to the armamentarium of the modified Cutler-Beard procedures for eyelid reconstruction.
PURPOSE:To evaluate the role of preoperative ultrasound biomicroscopy (UBM) in diagnosing invasive ocular surface squamous neoplasia (OSSN). METHODS:This retrospective single institution-based study included surgical cases of OSSN, in which UBM was performed preoperatively. The UBM characteristics of OSSN and signs of invasion were studied. The preoperative UBM imaging findings were correlated with the postoperative histopathological examination (HPE). The performance of UBM was studied in predicting invasive OSSN, considering HPE as the gold standard. RESULTS:Fifteen patients were included in the study, with an average age of 61 ± 12.8 years and an 80% male preponderance (n = 12). A clear plane between the lesion and the sclera was considered as episcleral or 'non-invasive,' and disruption of this interface was interpreted as 'invasive OSSN.' Compared to postoperative HPE, UBM interpretation predicted invasive OSSN with an accuracy of 73.3%, a sensitivity of 71.4%, and 100% specificity. CONCLUSIONS:UBM is a useful adjunctive tool for assessing the invasion, lesion height, and depth of invasion in OSSN. On correlating with HPE, UBM showed a good performance in preoperative detection of invasive OSSN.
PURPOSE:To assess the early complications and functional and esthetic outcomes of using quilting sutures and Steri-strips for full-thickness skin grafts (FTSGs) in the periocular region. METHODS:A retrospective, noncomparative, single-center review of patients who underwent FTSG with quilting sutures and Steri-strips splinting. Functional outcomes were assessed using MRD1 (margin reflex distance) and lagophthalmos on gentle closure for upper eyelid grafts, and MRD2 for lower eyelid grafts. Esthetic outcomes were determined using standardized photographs and a specific grading scale for eyelid FTSGs. RESULTS:Our study included 67 patients (males: 42, females: 25) who underwent 70 FTSG procedures, with a mean age of 69.7 years (range: 18-96). The average initial postoperative visit was at 14.2 days, and patients had an average of 1.2 clinical visits in the first 6 weeks. The improvements in MRD1, MRD2, and lagophthalmos were 1.7 mm (P = 0.002), 1.9 mm (P < 0.001), and 2.5 mm (P = 0.015), respectively. Esthetic outcomes were graded as "perfect" to "good" in 52 (74%) patients for graft color and edge, 50 (71.4%) for graft contour, and 64 (91.4%) for graft size and lid margin contour. Graft survival was 98.6%. The complication rate was 14.3%, with a mean follow-up of 13 months (range: 3-50). CONCLUSION:Various techniques are described in the literature with good results, some requiring extra costs, theater time, or clinical visits. Our technique replaces Frost sutures and bolsters, minimizing immediate postoperative visits while achieving high graft success with favorable functional and esthetic outcomes.
OBJECTIVE:To analyse the clinicopathological features, diagnostic pitfalls, and unusual presentations of eyelid eccrine tumors. Methods: Retrospective case series of 25 histopathologically confirmed eyelid eccrine tumors surgically excised between 2016 and 2023. Clinical records, histopathology (H&E with selective PAS staining), and follow-up data were reviewed. Results: Eccrine hidrocystoma was the most common subtype (80%, n=20), followed by eccrine hidradenoma (16%, n=4) and eccrine spiradenoma (4%, n=1). Mean patient age was 43.8 years, with a 4:1 male predominance. Clinical misdiagnosis occurred in 84% of lesions, most commonly as sebaceous cysts (64%). cases demonstrated unusual features, including three giant hidrocystomas (>2 cm), one giant hidradenoma (3.0 cm) with ulceration and mechanical ptosis clinically suspicious for squamous cell carcinoma, and one spiradenoma with maggot infestation mimicking malignancy. All giant tumors required excision with reconstruction (e.g., staged Cutler-Beard procedure). No recurrences were observed during follow-up (mean 14 months; range 6-24 months). Conclusion: Eyelid eccrine tumors present a broad clinical spectrum, from small cysts to large masses mimicking malignancy. Giant lesions, though rare, cause diagnostic confusion and functional impairment. Histopathological examination remains the gold standard for definitive diagnosis, and heightened clinical awareness is essential to avoid misdiagnosis.
PURPOSE:To assess use of the novel spacer filamentous knitted polyester fabric (FKPF) in lid retraction correction in thyroid eye disease (TED) as an effective surgical method to preserve eyelid function and cosmesis. METHODS:A prospective, non-comparative interventional study of surgical outcomes in 30 patients with TED cases over a period of 3 years. The upper and lower eyelid retraction was corrected surgically with FKPF material. All intervention performed in the inactive phase of Rundle's curve plotting. LPS was partially recessed and resected from the central part of the tarsal plate to implant the FKPF material. Pre- and post-operative evaluation parameters were marginal reflex distance-1 (MRD-1), MRD-2, upper and lower scleral show, palpebral fissure height (PFH), and LPS action. All the patients were post-operatively followed up on the 1 st week, 3 months, 6 months, and 1 year. RESULTS:Pre-operative measurements to post-operative results revealed: MRD-1 was reduced from 9.73 ± 0.71 mm to 3.85 ± 0.51 mm; scleral show of upper lid reduced from 3.70 ± 0.71 mm to no scleral show; MRD-2 was reduced from 6.40 ± 1.18 mm to 5.38 ± 0.41 mm; scleral show of lower lid improved from 1.93 ± 0.36 mm to no scleral show. PFH was reduced from 16.07 ± 1.42 mm to 9.23 ± 0.73 mm. LPS action was pre-operatively 19.08 ± 1.20 mm to 14.40 ± 0.73 mm post-operatively. CONCLUSION:FKPF is an inert, readily available, cost-effective material that shows promise in lid retraction correction. In our study, all lid retractions were repaired with no post-operative complications and met the functional and cosmetic purposes of the intervention. All patients reported high satisfaction with the outcome of the procedure. Due to its availability and non-reactive nature, FKPF offers a potential alternative to underserved areas to increase accessibility.
