Early detection of congenital ptosis is critical to prevent visual and psychosocial impairment in children, yet clinical assessment is challenged by limited patient cooperation and specialist availability. In this prospective, multicenter study, we developed and validated a smartphone-based system comprising three modules: morphological assessment, functional analysis, and a domain-adapted dialogue model, using 3164 blink clips and 1,229 facial images. The morphological module showed high measurement accuracy with intraclass correlation coefficients over 0.90 versus manual assessments. The functional module identified levator dysfunction with an area under the curve of 0.993, achieving robust functional stratification accuracy in both internal (0.91) and real-world (0.89) cohorts. The dialogue model demonstrated improved correctness and applicability over its baseline in addressing ptosis-related queries, achieving overall performance comparable to GPT-4o in expert evaluation and a patient satisfaction score of 4.93/5 in real-world deployment. This smartphone platform enables precise ptosis evaluation with patient-centered interaction, facilitating informed decision-making and personalized care in oculoplastic practice. ClinicalTrials.gov NCT07078552.

BACKGROUND:Fibrous dysplasia (FD) is a rare osseous disorder with limited understanding. This study aimed to evaluate the clinical characteristics of craniofacial FD (CFD) and orbital FD (OFD), explore vision impairment mechanisms, and identify recurrence risk factors. METHODS:A retrospective analysis was conducted on 54 CFD patients across three centers, including 30 patients with orbit involved. RESULTS:OFD patients exhibited higher prevalences of polyostotic FD and McCune-Albright syndrome, and more often underwent debulking rather than radical surgery. Vision impairment was primarily attributed to compressive and stretched optic neuropathy. Polyostotic involvement (p = 0.034) was a risk factor of subjective recurrence. Surgery age < 16 years (p = 0.046) and abnormal body mass index (p = 0.002) were associated with greater postoperative lesion regrowth volume. CONCLUSIONS:OFD patients exhibit distinct clinical features. Optic canal decompression is not required for all OFD-related vision loss patients. Recurrence risk should be thoroughly assessed before surgery.

Objective To analyze the clinical outcomes of preoperative lift testing combined with levator palpebrae superioris complex (LPSC) surgery in patients with ocular myasthenia gravis (OMG) and ptosis. Design Retrospective study. Subjects, Participants, and/or Controls Twenty-six patients (41 eyes) with OMG-associated ptosis were included. No control group was involved. Methods, Intervention, or Testing Patients underwent preoperative lift testing followed by LPSC surgery. Clinical outcomes were evaluated by margin reflex distance 1 (MRD1), eyelid closure and blinking function, incidence of exposure keratitis, and pathological examination of levator muscle tissue, with postoperative follow-up of 6 months. Main Outcome Measures Changes in MRD1, surgical correction rate, eyelid function, incidence of exposure keratitis, and pathological findings. Results Preoperative lift testing predicted surgical tolerance, with 90.24% of patients passing the test. The MRD1 value significantly improved from −0.93 ± 1.55 mm preoperatively to 2.43 ± 0.42 mm at 6 months postoperatively (p < 0.001), with a complete correction rate of 90.2%. Active eyelid closure in the awake state was retained in 75% of operated eyes, complete blinking was achieved in 86.5%, and the incidence of exposure keratitis was 10%. Pathological examination revealed characteristic “sandwich-like” levator muscle fat infiltration in 56.25% of patients. Conclusion In patients with OMG and ptosis, an integrated strategy combining preoperative lift testing with LPSC surgery effectively and safely corrected severe ptosis. This approach achieved satisfactory functional and cosmetic outcomes while reducing the risk of postoperative exposure keratitis, providing a tailored surgical option for this high-risk patient population.

Ocular surface chemical injuries often result in permanent visual impairment and necessitate complex, long-term treatments. Immediate and extensive irrigation serves as the first-line intervention, followed by various therapeutic protocols applied throughout different stages of the condition. To optimize outcomes, conventional regimens increasingly incorporate biological agents and surgical techniques. In recent years, nanotechnology has made significant strides, revolutionizing the management of ocular surface chemical injuries by enabling sustained drug release, enhancing treatment efficacy, and minimizing side effects. This review provides a comprehensive analysis of the etiology, epidemiology, classification, and conventional therapies for ocular chemical burns, with a special focus on nanotechnology-based drug delivery systems in managing ocular surface chemical injuries. Twelve categories of nanocarrier platforms are examined, including liposomes, nanoemulsions, nanomicelles, nanowafers, nanostructured lipid carriers, nanoparticles, hydrogels, dendrimers, nanocomplexes, nanofibers, nanozymes, and nanocomposite materials, highlighting their advantages in targeted delivery, biocompatibility, and improved healing efficacy. Additionally, current challenges and limitations in the field are discussed and the future potential of nanotechnology in treating ocular diseases is explored. This review presents the most extensive examination of this topic to date, aiming to link recent advancements with broader therapeutic strategies.

To analyze intraorbital Hydroxyapatite(HA) implant exposure occurring beyond ten years of implantation and suggest potential contributing factors. A retrospective cohort study based in the Shanghai Ninth People’s Hospital. One hundred and one Chinese patients with HA implant exposure were identified, from which 38 patients with implants exposure after ten years of insertion were selected and analyzed for demographic and medical records, clinical manifestations, surgery type, implant size, exposure area, follow-up duration, complications, details regarding prosthesis care, and treatment methods. All of the removed implants were sent for an HE pathologic examination. The 38 cases experienced exposure 10 to 19 years after implantation and presented to the clinic with increased secretions, proliferation of granulation tissue, visible suture exposure, and difficulty in wearing the external prosthesis. Other complications included implant forward position in 3 patients, eyelid retraction in 4 patients, and all the patients presented with post-enucleation socket syndrome. Reviewing the medical history, HA implant sizes ranged from 18 to 22 mm. Fourteen patients underwent implant repair surgery, of which 2 experienced recurrence, and ultimately, 26 implants were removed. Of the 26 removed implants, histologic examination showed that 17 exhibited chronic infection, and 12 had limited fibrovascular ingrowth. The questionnaires indicated that 26 patients did not renew the external prosthesis regularly. This study identified late complications and potential risk factors for implant exposure beyond ten years of implantation, including chronic infection, non-absorbable sutures, and low and delayed vascularization.

IgG4-Related Ophthalmic Disease (IgG4-ROD) is a chronic autoimmune-mediated fibrotic disease that predominantly affects the lacrimal glands, often leading to loss of function in the involved tissues or organs. Recent studies have demonstrated that MMP-12 is highly expressed in IgG4-ROD and plays a significant role in regulating immune responses. In this study, we reviewed nine patients diagnosed with IgG4-ROD based on clinical manifestations and histological analysis, and we investigated the expression of IL-33/ST2 and MMP-12 in IgG4-ROD lacrimal gland tissues using IHC. We found that IL-33 interacts with its specific receptor ST2, both of which are significantly overexpressed in IgG4-ROD tissues. Additionally, we successfully constructed a mouse model by introducing the LatY136F mutation into C57BL/6 mice to mimic IgG4-ROD lacrimal gland involvement, which helped elucidate the mechanisms involved in the induction of MMP-12. Furthermore, immunofluorescence staining confirmed that most MMP-12+ cells were derived from M2 macrophages, and an ELISA assay demonstrated that IL-33 upregulates MMP-12 in IgG4-ROD. Collectively, these data suggest that the IL-33/ST2/MMP-12 signaling pathway is activated in IgG4-ROD, with IL-33/ST2 potentially promoting M2 macrophage polarization and activation to produce MMP-12, which may serve as a novel therapeutic target for IgG4-ROD.

Objective: To evaluate the surgical outcomes of a modified technique for treating congenital cilial entropion in children, which involves reducing tension step by step in the epicanthus and lower eyelid incision. Methods: The observational group consisted of 153 pediatric patients (81 males and 72 females ) who were treated using the modified technique, whereas the control group included 124 patients (68 males and 56 females ) who were treated using the rotating suture surgery. All the participants were bilateral. Surgical outcomes were classified as good, fair, or poor, and the recurrence rate, scar condition, inferior eyelid position, and patient satisfaction were also assessed. Results: The mean follow -up period was 9.13 +/- 3.50 months (range: 3-14 months ) for the observational group and 6.93 +/- 4.51 months (range: 3-14 months ) for the control group. In the observational group, surgical success with "good" outcomes was achieved in 300 eyes (98.04% ), compared to 224 eyes (90.32% ) in the control group. No recurrence occurred in the observational group, whereas the recurrence rate in the control group was 4.43%. Postoperative scar formation was mild in the observational group. The average scar score was 1.27 +/- 0.96 in the observational group and 2.70 +/- 0.99 in the control group, with a statistically significant difference (P < 0.001 ). Neither overcorrection nor postoperative ectropion was observed in both groups. Conclusion: The modified technique effectively corrected medial entropion and trichiasis in the lower eyelid, resulting in stable postoperative outcomes, mild scar formation, quick recovery, flexible eyelid motility, and stable ocular surface. Therefore, it can be widely applied to children with congenital entropion and trichiasis. (c) 2024 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Background:With globalization, oculoplastic surgeons must understand the intricate morphological nuances of the periocular region across ethnicities to ensure precise treatment and avoid facial disharmony or dysfunction. Direct comparisons in two-dimensional (2D)-based periocular morphology between studies can be challenging due to the limited number of parameters and complicated variations in equipment, environments, measurement personnel, and methods. Therefore, it is imperative to explore the detailed three-dimensional (3D) periocular morphological disparities between young Caucasian and Chinese populations. This study aimed to establish gender- and ethnicity-specific 3D anthropometric data in periocular soft tissue for young Caucasian and Chinese adults and to determine the inter-racial and inter-gender differences. Methods:This descriptive, cross-sectional study enrolled 46 Asians and 101 Caucasians aged 18 to 30 years. 3D models were analyzed with 32 landmarks, yielding 21 linear distances, three curvatures, six angles, and three proportions. Comparisons were made across left and right eyes, ethnic groups, and sexes to assess ethnic disparities and sexual dimorphism. Results:Twenty-nine measurements were compared between the left and right sides revealing significant differences (P<0.002) in two measurements for Caucasian and Chinese females, respectively. However, these differences were submillimeter levels and potentially inconsequential in practical settings with left-right differences of -0.58 and -0.57 mm (P<0.001) for double-eyelid fold-palpebral margin distance (medial) (FPDm) and double-eyelid fold-palpebral margin distance (medial limbus) (FLmD) in Chinese females and -0.38 and -0.52 mm (P<0.001) for palpebral fissure width (PFW) and lower palpebral margin length (LPML) in Caucasian females. Caucasian males displayed significantly larger palpebral fissure height (PFH), iris diameter (ID), LPML, lateral canthal angle (LCA), canthal tilt (CT), palpebral fissure index (PFI), and canthal angular index (CAI), as well as smaller inner intercanthal distance (EnD), outer intercanthal distance (ExD), and canthal index (CI) than Chinese males (P<0.05). In contrast, Caucasian females showed significantly larger PFW, ID, LPML, LCA, CT, and CAI, as well as smaller EnD, ExD, CI, and medial canthal angle (MCA) than Chinese females (P<0.05). Furthermore, Caucasians showed more prominent double-eyelid folds, except at the pupil center in females. In eyebrow measurements, Caucasian males exhibited non-significant differences with Chinese males, while Caucasian females had significantly larger measurements at lateral positions but smaller ones at the endocanthion than Chinese females (P<0.05). Conclusions:This study established sex- and ethnicity-specific 3D anthropometric data for the periocular region of young Caucasian and Chinese adults. These findings must be considered for periocular disease diagnosis, surgical planning, and outcome evaluation across diverse sexual and ethnic populations.

Lacrimal adenoid cystic carcinoma (LACC) is one of the most common malignant epithelial tumors of the lacrimal gland, characterized by high rates of local recurrence, distant metastases, and tumor-related mortality. This malignancy impairs the lacrimal gland's ability to secret tears, thereby disrupting the normal function of the ocular surface. Due to ineffective diagnostic approaches and the complex anatomical location of the lacrimal gland within the orbit, many LACC patients are often diagnosed at the later stages. Therefore, it is urgent to develop a simple and convenient method for early detection of LACC through biomarker analysis by liquid biopsies, such as blood or tears. Various microRNAs (miRNAs) derived from liquid biopsies have been shown to serve as biomarkers for early diagnosis of tumors. In the present study, we screened LACC-specific miRNAs using miRNA microarray analysis in both primary and recurrent patient groups. We then validate their expression by qPCR experiments conducted in tissues, cell lines, tear fluid and serum to explore the association between these miRNAs and LACC development and prognosis. Our findings reveal that hsa-miR-200b-3p, hsa-miR-200c-3p and hsa-miR-141-3p are significantly upregulated in LACC, and the microarray data showed that these three miRNAs were significantly elevated in the recurrence group compared to the primary group. In conclusion, detecting miRNA expression in tear fluid and serum provides non-invasive biomarkers for the early diagnosis of LACC and may facilitate monitoring outcomes related to lacrimal gland diseases.

Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is an emerging, immune-mediated fibroinflammatory orbital disease, characterized by tumefactive lesions with noticeable IgG4+ plasma cell infiltration and distinctive pathohistological features. This disease is often associated with elevated serum IgG4 concentrations. IgG4-ROD may affect any ophthalmic tissues, particularly the lacrimal gland, extraocular muscles, and trigeminal nerves. Although the exact pathogenic role of IgG4 antibodies remains unclear, B-cell depleting agents have been reported to be an effective treatment. The diverse clinical manifestations of IgG4-ROD complicate diagnosis, and without prompt treatment, visual-threatening complications such as optic neuropathy may arise. Recent advances in understanding and managing IgG4-ROD have revolutionized the diagnosis and treatment of this emerging disease. This review article aims to provide a comprehensive overview of the latest advancements in the field of IgG4-ROD.

Background and Objective: Severe full-thickness eyelid defects seriously endanger the health and beauty of the ocular surface. It is the most challenging field of oculoplastic and reconstructive surgery to reconstruct eyelid’s natural appearance and function, in which the posterior eyelid lamella plays an essential role. Without enough substitute support in eyelids suffered sizeable posterior lamella defects, various complications may occur, e.g., entropion, ectropion, incomplete eyelid closure, corneal irritation, keratitis, corneal ulcers, and even vision loss, leading to failure of eyelid reconstruction. This manuscript aimed to summarize recent advances in posterior eyelid lamella substitutes and summarize the types, advantages, and disadvantages of the present posterior lamella substitutes in full-thickness eyelid reconstruction. Methods: A literature search was conducted in the PubMed database to identify relevant publications using the search algorithm “eyelid reconstruction”. The full-text publication reports about posterior substitutes from January 2016 to April 2021 in English were selected and reviewed. We also screened relevant research missed in this search algorithm from the reference lists of specific full-text papers. Key Content and Findings: A variety of autologous or allogeneic tissues have been reported as promising techniques for replacing the posterior eyelid lamella in full-thickness and more than 50% length eyelid defects, e.g., the auricular cartilage, hard palate mucosa, buccal mucosa, nasal septum, and periosteal flaps, among others. However, various disadvantages have to be considered, i.e., limited sources, surgical complexity, increased complications, poor mechanical properties, inflammatory immune response, and the spread of potential infectious diseases. Besides, it provides a novel perspective for posterior lamella reconstruction to develop new biomaterials with excellent biocompatibility and more physiological properties, as well as tissue-engineered tarsal and conjunctival tissues with appropriate structure, biomechanical properties, and specific secretory function similar to the human tarsus. Conclusions: In summary, our findings suggest that autologous and allogeneic tarsal substitutes are practical reconstructive technique in current condition, but in the future, in-depth study of new biomaterials and tissue engineering may provide a novel perspective for the research of tarsal substitutes in oculoplastic and reconstructive surgery.

Background Three-dimensional (3D) surface imaging and morphometrics are becoming the preferred craniofacial surface imaging modality. However, as a unique advantage of 3D imaging, areal and volumetric measurements have been rarely conducted and validated for evaluating soft tissue change in the periocular region, especially the upper eyelids. Therefore, based on an existing periocular landmark identification strategy, we proposed a novel modified method to define a standardized upper eyelid region for areal and volumetric measurements and validate its reliability for future clinical application. Methods Forty-four healthy adult volunteers were enrolled in this cross-sectional study. Three-dimensional facial images were taken with a 3D imaging system. Subsequently, the upper eyelid region selection and areal and volumetric measurements were conducted using a modified landmarks localization strategy to evaluate their intrarater, interrater, and intramethod reliability. Results Areal measurement of the upper eyelid revealed highly reliable outcomes for intraclass correlation coefficient (ICC), mean absolute difference (MAD), relative error measurement (REM), technical error of measurement (TEM), and relative technical error of measurement (%TEM) of 0.982, 0.1620 cm2, 2.9%, 0.1510 cm2, and 2.7% for intrarater reliability, respectively; 0.969, 0.2076 cm2, 3.7%, 0.1930 cm2, and 3.5% for interrater reliability, respectively; and 0.917, 0.3636 cm2, 6.5%, 0.3354 cm2, and 6.0% for intramethod reliability, respectively. Unsatisfactory results were found for the volumetric measurement of the upper eyelid: the ICC, MAD, REM, TEM, and %TEM estimates for intrarater reliability were 0.992, 0.2299 mL, 10.3%, 0.2414 mL, and 10.8%, respectively; for interrater reliability, these values were 0.985, 0.2749 mL, 12.3%, 0.3253 mL, and 14.6%, respectively; and for intramethod reliability, these values were 0.433, 1.6716 mL, 77.9%, 2.0615 mL, and 96.1%, respectively. Conclusions This is the first study to propose a standardized upper eyelid region selection strategy and simultaneously validate its reliability for 3D areal and volumetric measurements. This study confirmed the high-level reliability of areal measurement and poor reliability of volumetric measurement based on direct measurements using a single image, which may provide better results when this method is combined with the image overlapping and registration procedure. However, this is subject to further validation. Nonetheless, this method could provide quantitative areal and volumetric data on the upper eyelids and might have widespread application potential in the future.

A novel technique of using a sandwich-like structure, namely, an oral mucosa graft (OMG)–conjunctiva in situ–dermis-fat graft (DFG) (OMG-C-DFG), to reconstruct a contracted and low-capacity anophthalmic socket for a patient with ocular infection history was evaluated. This was retrospective case study of four patients (cases) who underwent anophthalmic socket reconstruction surgery in which the OMG-C-DFG technique was applied. The procedures were performed in the Department of Ophthalmology at the Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China). Postoperative cosmetic appearance, graft outcome, the ability to wear an ocular prosthesis, and postoperative complications were evaluated. The median (± standard deviation) age of patients was 41.5 ± 22.1 (range 10–60) years. All patients suffered from contracted and low-capacity anophthalmic sockets. Three patients had a history of orbital implant infection and one patient had a history of enucleation due to exogenous endophthalmitis after globe rupture. The DFG and OMG were harvested from the abdominal region and lower lip, respectively. All four patients achieved a good postoperative appearance, with dermal surfaces appearing pink and smooth, the orbital areas showing good fullness, the ocular prosthesis showing good wearability, and no narrowing of the sockets. There was no lipid secretion, fat lysate outflow, or infection in the graft bed. There were only small amounts of scars and no infection of the donor site. The sandwich-like structure can be effectively used to reconstruct the contracted and low-capacity anophthalmic socket with a history of orbital infection in one stage.

AIM To investigate the reliability of a modified three-dimensional distraction test (3D-DT) and three-dimensional pinch test (3D-PT) for assessing lower eyelid tension (LET). METHODS A cross-sectional study was conducted among 97 volunteers including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each participant, including two photographs obtained in a neutral position (NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT. RESULTS The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively; technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively; and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients (ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1; the ICCs of all the measurements obtained in all the positions (NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80. CONCLUSION Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre- and postoperative clinical evaluation.

To evaluate the surgical outcomes of pediatric congenital blepharoptosis with poor Bell’s phenomenon (BP) treated with modified levator muscle complex suspension. Forty-two pediatric congenital blepharoptosis patients with poor BP were treated with modified levator muscle complex suspension, and their major surgical outcomes such as marginal reflex distance1 (MRD1), palpebral fissure height (PFH), and postoperative lagophthalmos were retrospectively reviewed. The mean follow-up was 10.28 ± 9.89 months (range 3–32 Months). Surgical success was achieved in 54 (87.1%) of 62 eyelids at the final visit, including excellent results in 46 (74.2%) eyelids, good results in 8 (12.9%) eyelids, and poor results in 8 (12.9%) eyelids, respectively. The postoperative PFH of affected eyes (7.97 ± 1.47 mm) was significantly improved compared with that before surgery (3.58 ± 1.31 mm). The mean MRD1 was improved from − 1.48 ± 1.36 mm before surgery to 2.94 ± 1.46 mm after surgery. The postoperative MRD1 was ≥ 3 mm in 46 eyelids and < 3 mm in 16 eyelids. The mean lagophthalmos was 1.42 ± 1.20 mm 3 months after surgery. All of the patients presented complete blink postoperatively. Postoperative complications were rarely observed during follow-up. No patient had exposure keratitis, but blepharoptosis recurred in 6 patients (8 eyelids). All patients had satisfactory eyelid symmetry and contour. No complications were observed until the last visit. The modified method results complete blink, mild, and quick recovery of lagophthalmos, flexible eyelid motility, stable ocular surface, and it is simple to perform with few complications and a low recurrence rate at 12.9%, which is worth to wide application on poor Bell’s phenomenon blepharoptosis.

•A safe, effective, and economical option for involutional ectropion.•Decent aesthetical and functional improvement after lateral tarsal strip procedure.•The first review for lateral tarsal strip in correcting involutional ectropion.•Comprehensive treatment options of ectropion for oculoplastic surgeons.

BACKGROUND:Standardized pre-operative assessment of the lower eyelid tension is essential to determine the optimal surgical technique. However, quantitative analysis using the conventional distraction test is inaccurate and user-dependent. Our purpose was to introduce a novel, standardized three-dimensional distraction test for measuring lower eyelid tension and to determine its standard values in a Caucasian population.METHODS:In 94 participants (50 men and 44 women; age 21-85 years), a 15.9-g weighted eyelid hook was used to pull down the lower eyelid. Two three-dimensional images were acquired with a VECTRA M3 stereophotogrammetry device-one in the neutral position without a hook and the other in the distracted position with the eyelid hook. The images of all participants in both positions were measured twice by a single observer.RESULTS:There was no clinical (>1 mm) or statistically significant difference between the two repeated measurements of all the inter-landmark linear distances in both positions (P≥0.05, respectively). The mean distracted displacement between the neutral and distracted position for margin reflex distance was 5.50±1.53 mm, without any age-specific difference (P=0.08); however, a significant gender-specific difference was observed as men had significantly greater displacement than women (P<0.001).CONCLUSIONS:Our proposed standardized three-dimensional distraction test for assessing lower eyelid tension using an eyelid hook and a simple landmark-based system seems to provide high reliability. This novel and simple method might be helpful for the preoperative planning of eyelid surgeries.

AIM:To analyze the treatment of orbital Trapdoor fracture in children and the application of absorbable plate in surgery, so as to accumulate experience for clinical diagnosis and treatment.METHODS: Retrospective analysis of 55 cases(55 eyes)orbital Trapdoor fractures in children. The fracture site was simple orbital floor fracture. All patients were approached by palpebral conjunctiva of lower eyelid. During operations, the embedded extraocular muscles and orbital tissues were returned. A resorbable implant was implanted into the orbit after trimming to proper sizes and shaped according to the fracture defect range. The therapeutic effect was evaluated by preoperative and postoperative ocular examination and orbital CT scan. Repeated measure analysis of variance was used to compare the differences of postoperative outcome evaluation indexes among patients with different operation timing.RESULTS: No serious complications happened during and after surgeries in all patients. The postoperative CT scan showed that the fractures had good anatomical restoration. After the operation, diplopia and limitation of extraocular muscle movement(EOM)recovered obviously. The earlier the operation performed after the injury, the better the postoperative recovery effect was. At the same time, the resorbable implant could repair orbital Trapdoor fracture in children well. It serves as a better material of orbital fracture repairment.CONCLUSION: Operation is an effective method to treat orbital Trapdoor fracture in children, and should be performed as soon as possible after injury. The resorbable implant is a good orbital repair material.

Purpose The aim of this study was to explore the effect of congenital ptosis on the visual function of patients and observe the improvement in visual function after the correction of ptosis at different surgical times. Methods We performed a retrospective study of 265 patients (346 eyes) with congenital ptosis at the same hospital. Each patient underwent an ophthalmic examination, including optometry and measurement of the affected palpebral fissure height and upper eyelid margin reflex distance. Preoperative clinical and morphologic data were compared with postoperative data. Results The refractive error of the patient population was significantly different from that of the general population ( P < 0.01). The rates of strabismus and amblyopia were 12.45% and 36.98%, respectively, in the ptosis patients, both of which are higher than the rates in the general population ( P < 0.01), especially for unilaterally affected patients and patients with the optical axis covered. The refractive error of patients younger than 5 years was improved postoperatively ( P < 0.05). The number of cases of amblyopia and strabismus was reduced, as was the percentage of cases of with-the-rule astigmatism ( P < 0.05). Conclusion Congenital ptosis can result in refractive error, strabismus, and amblyopia, which could seriously impair the visual function of patients. The impairment is more pronounced in unilaterally affected patients. Surgery is conducive to the recovery of visual function, especially in patients younger than 5 years. Satisfactory curative effects can be obtained before the age of 3 years; thus, unilaterally affected patients, severely affected patients, and patients with impaired visual function should undergo surgery as soon as possible.

Objectives: To present the clinical features of and diagnostic methods used for macular coloboma (MC), and to analyze the factors associated with best-corrected visual acuity (BCVA) in patients with MC. Methods: A systematic review using the MEDLINE (PubMed), EMBASE, LILACS, and Cochrane databases was performed. The factors associated with BCVA were analyzed. Results: A total of 21 patients (mean age at diagnosis, 18.1 +/- 14.6 years) with 36 eyes affected by MC (5 unilateral, 16 bilateral) were included in the study. All 21 patients (100%) had undergone a good-quality fundus examination. The size of the MC lesions ranged from 1.0 x 1.2 to 4.0 x 4.0 disc diameters (DD). Twenty-seven (73%) eyes had pigmented MC, seven (19%) had non-pigmented MC, and one (3%) had an unspecific type. The diagnosis was confirmed using spectral-domain optical coherence tomography (SD-OCT) in 16 (43.2%) eyes. A positive correlation was found between BCVA and the type of MC (beta = 0.876, p = .006) and abnormal eye movement (beta = 0.087, p = .018), and a negative correlation was found between BCVA and a contributory medical history of ventricular septal defect (beta = -0.327, p = .001). Conclusions: Pigmented MC was the most common type and had the highest possibility of causing impaired vision in the affected eyes. Additionally, joint examinations should be applied for diagnostic confirmation of MC. Furthermore, fundoscopy, electroretinogram, electrooculography, fundus fluorescein angiography, and SD-OCT are all critical for differential diagnosis of MC-like lesions.