Summary The aim of the study was to readdress basal cell carcinoma (BCC) in the periocular region to prove the efficacy of histologically controlled surgical treatment and to identify high-risk characteristics. Retrospective analysis of 451 microscopically controlled BCC excisions in the periocular region. Tumor location, tumor size, AJCC 7 classification, and histological results were recorded. The same procedure was followed for recurrences. A recurrence rate of 5.0% was observed after the first microscopically controlled excision. Recurrent BCCs show a shift from nodular to sclerosing BCC as the primary histological type as well as a change in primary location from lower eyelid to medial canthus. The frequency of BCC with deep extension increased from 7.3% to 24.7%, and 57.1% after the second and third operations, respectively. The recurrence rate increased to 9.5% and 42.9%, after the second and third operations, respectively. In conclusion, we are facing the same challenges in surgical BCC treatment as 30 years ago. The distribution of periocular BCC location, histologic subtype and recurrence rates mirror the literature und the general consensus. The recurrence rate increases with every operation needed. Sclerosing BCCs with deep extension at the medial canthus bear the greatest risk for recurrence. In such cases, centers of expertise should be consulted and additional treatment options should be considered.

Background /Objectives To compare two suturing techniques in patients undergoing upper eyelid blepharoplasty by using the FACE-Q™ Eye Module questionnaire to assess patient-reported outcomes and by blinded Likert-scale gradings of two experienced surgeons. Methods 90 patients undergoing bilateral blepharoplasty were randomly assigned to a suturing technique (running cutaneous or subcuticular closure) using Prolene 6.0. Patients completed the FACE-Q eye module questionnaire before surgery and 7 days and 3 months after surgery. Further, two trained oculoplastic surgeons assessed the outcome. FACE-Q ratings were RASCH-transformed, and linear models were fitted for appraisal and satisfaction results. Intraclass correlation coefficient (ICC) was calculated to assess the surgeons’ rating agreement. Results There was no statistically significantly difference in patients’ FACE-Q self-assessments regarding satisfaction with eyes and appraisal of upper eyelids between the two suturing techniques investigated, both 7 days and 3 months after blepharoplasty. The more content the patient at baseline, the less the increase in satisfaction after 3 months. There was good agreement between blinded graders in outcome assessment expressed by an ICC of 0.86. Dry-eye symptoms increased after surgery, independent of the suturing technique, patient age or sex. Conclusion In conclusion, this study shows that post operative patient satisfaction is independent of suturing technique, but depends on baseline FACE-Q reports. These findings are valuable in patient communication and selection and are in line with observer-based assessments. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Summary Background The aim of this study was to profile patients with simple and complex congenital nasolacrimal duct obstruction (CNLDO) and to determine the success rates of interventions at a third-level referral center. Methods In this retrospective and comparative study, medical records of patients with CNLDO were reviewed. Demographic data, types of CNLDO, surgical approach, type of silicone intubation, as well as outcome were recorded up to 3 months after the intervention. Obstruction location was identified by probing and irrigation following the American Academy of Ophthalmology (AAO) approach. Success rates were calculated for treatment approach and age group. Results Based on the outcome of 130 eyes with CNLDO, the overall success rate was 96%. The mean age of patients was 2.5 ± 2.2 months; 73% of cases were simple and 27% were complex CNLDO. Five children had to undergo reoperation; consequently, there was a lower success rate in the complex CNLDO (91%) than in the simple CNLDO subgroup (97%). There was a male predominance (61.5%), which was also present in the simple and complex CNLDO subgroups. The most frequent type of CNLDO was complete nasolacrimal duct obstruction (NLDO, 55.4%), followed by partial (17.7%) and bony NLDO (11.5%). In 87% of eyes, initial probing was performed followed by dacryocystorhinostomy (10%). Mono- or bi-canalicular lacrimal drainage system intubation was used in 86% of eyes. Conclusion The AAO-based diagnostic approach followed by an individualized treatment regimen yielded excellent success rates of 96% in unselected patients with CNLDO. These success rates were independent of patient age or gender.

Das Basalzellkarzimon (BCC) gehört zu den häufigsten Tumoren in der periorbitalen Region. Aufgrund lokal fortgeschrittener und metastasierender BCC Fälle rückte eine neue Therapieform ins Zentrum klinischer Forschung. Die Entdeckung des Hedgehog Signalwegs führte zu einem neuen Therapieansatz.

Die Evaluation funktioneller Blepharoplastikoperationen der Oberlider durch Objektivierung und Vergleich der superioren und temporalen Gesichtsfeldeinschränkung prä- und postoperativ, die Korrelation zwischen subjektiven Patientenangaben und objektivierbaren, postoperativen Gesichtsfeldänderungen sowie die Untersuchung des Einflusses von periorbitalen Strukturen auf das Gesichtsfeld.

Die Leitlinien der Kommission für Okuloplastik (Orbita + Dakryologie) sollen einen systematischen Überblick über konservatives und chirurgisches Management von Lid-, Orbita-, und Tränenwegserkrankungen geben. Lidfehlstellungen sowie Tumoren der Lider und der Orbita werden klassifiziert und diagnostische Verfahren und Therapieformen der Lid-, Orbita-, und Tränenwegschirurgie werden dargestellt. Außerdem wird ein Überblick über die ästhetische Lidchirurgie und die Indikationen dafür gegeben, und die konservative und chirurgische Therapie der Endokrinen Orbitopathie beschrieben. Ein abschließendes Kapitel informiert über die aktuellen Therapiemöglichkeiten beim Trockenen Auge.

Objective: Evaluation of central and midperipheral vaulting of the posterior chamber phakic intraocular Collamer lens (ICL; Staar Surgical Inc., Monrovia, CA) in eyes with moderate to high myopia.Design: Retrospective analysis of prospectively collected data.Participants: Eighty-four eyes treated with the latest ICL (V4 model) and 27 eyes treated with early ICL models were examined.Methods: After standardized ICL implantation, patients underwent complete ophthalmologic examinations before surgery and at 1 week, 1 month, 3 months, 6 months, and at yearly intervals thereafter. Central vaulting was measured using the Jaeger device (Haag-Streit, Bern, Switzerland). From 2006 onward, vaulting was measured additionally by optical coherence tomography (Visante OCT; Carl Zeiss Meditec, Jena, Germany). Using the Visante OCT, the crystalline lens rise and the midperipheral vaulting of the ICL were assessed.Main Outcome Measures: Central vaulting after ICL implantation.Results: The mean duration of follow-up was 74.1 +/- 23.1 months and 96.3 +/- 50.2 months in eyes treated with V4 and early models, respectively. Postoperative central vaulting was 466 +/- 218 mu m (range, 30-900 mu m) in eyes treated with the V4 models and 321 +/- 200 mu m (range, 150-900 mu m) in those treated with early ICL models. From the 6-month follow-up onward, a continuous and nearly linear reduction of central vaulting was observed. At the 10-year follow-up, the mean central vaulting was reduced to 184 +/- 159 mu m (range, 6-500 mu m) and 138 +/- 218 mu m (range, 0-820 mu m) in eyes treated with V4 or early models, respectively. Eyes with total vaulting had a mean central vaulting of 407 +/- 202 mu m (range, 180-730 mu m), whereas those with midperipheral contact had a significantly lower central vaulting of 105 +/- 87 mu m (range, 0-200 mu m).Conclusions: This study revealed consistent reduction of central vaulting over a 10-year period and provides further evidence that insufficient vaulting of the ICL is responsible for the development of anterior subcapsular cataract. A minimum central vaulting of 230 mu m seems to be necessary to ensure total vaulting of the ICL. If an ICL is chosen for the correction of myopia, targeting for the greatest possible postoperative central vaulting is advised to achieve safe and complete vaulting for several years.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010; 117: 1506-1511 (C) 2010 by the American Academy of Ophthalmology.

Purpose. The purpose of this study was to determine the validity and repeatability of anterior chamber depth (ACD) measurements obtained with a novel rotating Scheimpflug camera (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany) to scanning slit topography (Orbscan; Bausch & Lomb, Rochester, NY). Methods. ACD in 60 healthy eyes was measured twice by two independent observers with each modality in random order. A total of eight measurements was performed on each eye. The mean differences between measurements, between observers, and between modalities were calculated, and 95% limits of agreement (LoA) were given as mean ± 1.96 * standard deviation (SD) of the mean. Results. The mean ACD values as determined with the different modalities (± SD) were 3.18 ± 0.38 mm for Pentacam imaging and 3.23 ± 0.40 for Orbscan. The mean difference between the two modalities was 0.047 mm (LoA: 0.176 to -0.081 mm). Within each modality, the limits of agreement of the differences between individual measurements and between different observers were within 0.073 mm or 4% of total ACD. The total variance in the observed data was 0.145. The variance resulting from interindividual differences in ACD was 85%, as a result of the two different modalities 15%, as a result of different observers 0.007%, and as a result of different measurements 0.007%. Conclusions. In the assessment of normal eyes, the differences of ACD values measured with Orbscan and Pentacam were within clinically acceptable levels, and inter- and intraobserver variability was considerably below clinically significant levels. Thus, these two modalities can be regarded as interchangeable.

Patienten mit Orbitafrakturen sind häufig schwer verletzt. Eine direkte, konventionelle koronale Computertomographie (CT) ist aufgrund der dafür nötigen Positionierung in Bauchlage mit überstreckten Nacken in der Regel nicht möglich. Die Diagnostik beruht demnach nur auf konventionellen axialen Schichten, da koronal rekonstruierte Bilder eine stark eingeschränkte Bildqualität besitzen.

Ziel der Untersuchungen war ein Vergleich der Tiefenschärfe und der Kontrastsehschärfe einer diffraktiven und refraktiven Multifokallinse.