Purpose: To evaluate the effect of unilateral Mueller’s muscle conjunctival resection (MMCR) on the contralateral upper eyelid position in patients without preoperative Hering’s effect. Methods: This retrospective study analyzed 33 patients who underwent unilateral MMCR for mild to moderate ptosis at Shiley Eye Institute, University of California, San Diego. Patients with additional procedures or preoperative Hering’s effect were excluded. Margin Reflex Distance (MRD1) was measured using Image J software from standardized digital images. Five masked researchers independently measured MRD1, with the average of the middle three values used for analysis. Results: The mean preoperative and postoperative MRD1 of the operated eye were 1.20 mm (SD 0.92) and 3.35 mm (SD 0.83), respectively. For the nonoperated eye, preoperative MRD1 was 3.15 mm (SD 0.85) and postoperative MRD1 was 3.28 mm (SD 0.8). There was a statistically significant improvement in the operated eyelid MRD1 ( P < 0.001) but no statistically significant change in the nonoperated eyelid position ( P = 0.704). One patient (3%) experienced an MRD1 drop >1 mm in the fellow eye. Thirty-two patients (97%) had ≤1 mm difference between operated and nonoperated eyelids postoperatively. Interestingly, 18 patients (54.5%) showed a paradoxical increase in contralateral MRD1 (mean 0.66 mm, range 0.02–2.39 mm). All patients achieved acceptable symmetry without requiring additional procedures. Conclusion: MMCR effectively corrects mild to moderate unilateral upper eyelid ptosis with minimal impact on the contralateral eyelid in patients without preoperative Hering’s effect. While the procedure resulted in no significant changes to the contralateral eyelid in 97% of cases, the unexpected finding of paradoxical contralateral lid elevation in over half the patients warrants further investigation.

Purpose: To investigate the postoperative effect of intralesional steroid injection during incision and curettage of chalazia.Methods: From January 2015 to January 2021, patients who underwent incision and curettage for the diagnosis of chalazia were divided into groups: with or without intralesional steroid injection during incision and curettage. Incision and curettage were performed in 88 eyes, and concurrent intralesional steroid injection, incision, and curettage were performed in 44 eyes. Each group was further divided according to the incision site: subconjunctival or skin incisions. The degree of erythema, recurrence, and recurrence rate were reviewed in patients who underwent skin incisions, while the degree of swelling, recurrence, and recurrence rate, in those who underwent subconjunctival incisions.Results: In the group that underwent incision and drainage through skin incisions, no significant difference was observed in the degree of erythema reduction 1 week after surgery between patients treated with steroid injections and those without (p = 0.609). No difference was observed in the degree of swelling reduction 1 week after surgery between the two groups that underwent incision drainage with steroid injection and the group that did not (p = 0.502). No significant difference was observed between the two groups, with a rate of 0.04% of remaining chalazia after 1 month in patients who underwent incision and drainage alone and 0.02% in patients who received both incision drainage and steroid injections (p = 0.414).Conclusions: In the treatment of chalazia, concurrent intralesional steroid injections were not effective in the regression of postoperative lesional erythema and swelling.

The purpose of this study was to investigate the effects of intraoperative fibrin glue use on surgery for blepharoptosis. This retrospective study included patients with acquired blepharoptosis who underwent surgical correction and were followed for at least one month. Patients were classified into two groups depending on whether treated with antithrombotic agents or otherwise. All patients taking antithrombotic agents discontinued with the treatment one week prior to surgery in accordance with our clinical guidelines. Preoperative and postoperative marginal reflex distance 1(MRD1) and ecchymosis grade were evaluated and compared. The subjects were 56 patients (111 eyes) who discontinued antithrombotic agents before surgery and 59 patients (117 eyes) who had never taken antithrombotic agents. Fibrin glue was used in 13 patients (26 eyes, 23.4%) in the antithrombotic group, and 11 patients (21 eyes, 17.9%) in the non-antithrombotic group. The rate of severe ecchymosis was significantly lower in patients who used fibrin glue in the antithrombotic group at 1 week (11.5 vs 40.0%, p = 0.008). However, in non-antithrombotic group, there was no difference in the rate of severe ecchymosis according to the use of fibrin glue at 1 week (14.3 vs 30.2%, p = 0.181). In patients with a history of taking antithrombotic agents, the intraoperative use of fibrin glue is thought to be helpful as it could significantly reduce significant ecchymosis.

Purpose: We investigated the impact of the COVID-19 pandemic on myopia progression in pediatric patients who received low-dose atropine (0.01%) eye drops.Methods: We retrospectively analyzed the medical records of pediatric patients who received ≥ 12 months of low-dose atropine (atropine sulfate 0.01%) eye drops for myopia. The beginning of the COVID-19 pandemic was defined as February 2020. Patients were divided into two groups for comparative analysis. Patients in group A received low-dose atropine for ≥ 12 months between July 2013 and January 2020, whereas patients in group B received low-dose atropine between February 2020 and July 2021; atropine eye drops were administered once daily. The spherical equivalent and axial length of the right eye were measured at the initiation of treatment and after 12 months.Results: Among the 72 patients, 34 in group A received low-dose atropine before the COVID-19 pandemic, whereas 38 in group B received low-dose atropine after the COVID-19 pandemic. After 12 months of treatment with low-dose atropine eye drops, the changes in spherical equivalent were -0.58 ± 0.47 diopters (D) in group A and -0.84 ± 0.56 D in group B (p = 0.045). Moreover, the changes in axial length were 0.30 ± 0.23 mm in group A and 0.50 ± 0.31 mm in group B (p = 0.011).Conclusions: The efficacy of low-dose atropine eye drops in pediatric myopia patients has decreased since the beginning of the COVID-19 pandemic.

PURPOSE:To evaluate the prevalence of dry eye symptoms after endoscopic dacryocystorhinostomy (EDCR) for patients with primary acquired nasolacrimal duct obstruction (PANDO) combined with dry eye syndrome.METHODS:The patients diagnosed with PANDO combined with dry eye syndrome who underwent EDCR were divided into two groups according to the questionnaire about dry eye symptoms after surgery. The medical records were retrospectively analyzed. Before and after surgery, we compared the tear meniscus height, tear breakup time, and the presence of corneal punctuate epithelial erosion. The level of dry eyes of patients after surgery was assessed by using the Korean guidelines for the diagnosis of dry eye.RESULTS:At 6 months after EDCR, the proportion of patients with dry eye symptoms was 30% in a total of 80 patients. The duration of epiphora and tear breakup time after EDCR were higher in the group without dry eye symptoms and the proportion of eyes with corneal punctuate epithelial erosion after EDCR was higher in the group with dry eye symptoms. About 15% of total patients started treatment with a dry eye of level 2 or higher.CONCLUSIONS:About 15% of patients who underwent EDCR for PANDO combined with dry eye syndrome developed significant dry eye syndrome after surgery. The short onset of epiphora was associated with the development of the dry eye symptoms. Therefore, it is necessary to evaluate dry eye syndrome before surgery, and surgeons should be careful about this.

PURPOSE:To evaluate the effects of discontinuing anticoagulants (ACs)/antiplatelets (APs) preoperatively on surgery for blepharoptosis.METHOD:A retrospective analysis included patients with acquired blepharoptosis who underwent surgical correction, and were followed for more than 1 month. Patients were classified into 2 groups depending on AC/AP treatment or otherwise. All patients taking AC/AP discontinued with the treatment 1 week prior to surgery in accordance with our clinical guidelines. Preoperative and postoperative marginal reflex distance 1 (MRD1) and ecchymosis grade were evaluated and compared.RESULTS:Group 1 (AC/AP treatment cessation) included 47 patients with 93 eyelids, and group 2 (control) included 51 patients with 98 eyelids. The preoperative MRD1 showed no significant difference between groups. Group 1 showed a significantly higher rate of severe ecchymosis (41.8 versus 22.4%, P = 0.004) at 1 week of surgery as well as persistent ecchymosis (58.8 versus 7.3%, P = 0.000) compared with group 2 postoperatively at 1 month. Postoperative MRD1 was significantly lower in group 1 at 1 week (P = 0.019). However, the MRD1 and degree of improvement in lid height (postoperative MRD1 "preoperative MRD1) was not significantly different between the 2 groups (P = 0.499, P = 0.058) at 1 month postoperatively.CONCLUSIONS:Postoperative ecchymosis was more severe in group 1 at 1 month after ptosis surgery even though the ACs/APs were discontinued. Surgeons should be careful about this before operation.THE SYNOPSIS:Significant ecchymosis could occur even after discontinuation of antithrombotic agents in patients with a history of taking medication in ptosis surgery. Surgeons should be careful about this before operation.

Purpose: To compare outcomes of Mueller’s Muscle Conjunctival Resection (MMCR) between 2 groups of patients with different anatomy due to ethnic heritage. Methods: The medical records of patients who underwent MMCR between 2013 and 2018 were retrospectively reviewed. Patients who underwent additional procedures, such as upper blepharoplasty and browplasty, were excluded from the study. Patients were divided in 2 groups based on self-identified ethnic groups (Asian and Caucasian). Image J software was used to calculate MRD1 from digital images. The improvement of MRD1 (net MRD1) after surgery was evaluated and compared between 2 groups. Results: Eighty-three eyes of 68 patients were included in this study. The Asian group consisted of 41 eyelids from 28 patients. The Caucasian group consisted of 42 eyelids from 40 patients. The average age was 52.18 (SD 20.176) in the Asian group compared with the 66.45 years (SD 9.22, p < 0.005) in the Caucasian group. The mean improvement of MRD1 was 1.96 ± 0.75 mm in Asian group and 2.05 ± 0.72 mm in Caucasian group, which was not statistically significant (p = 0.62). The incidence of ptosis overcorrection and undercorrection between the groups was also not statistically significant. Conclusions: There was no statistically significant difference in the surgical outcomes among the 2 study groups. Despite differences in the anatomy of Caucasian and Asian eyelids, MMCR is a successful procedure in patients self-identified from both ethnic groups. Despite significant changes in eyelid anatomy and appearance among different ethnic groups, Mueller’s muscle conjunctival resection is a successful procedure with equal efficacy in Asian and Caucasian populations.

Purpose:To determine factors influencing postoperative enophthalmos after reconstruction of orbital wall fracture.Method:Data of consecutive patients who were diagnosed with unilateral medial or inferior orbital wall fracture from March 2013 to February 2020 were retrospectively reviewed. Forty-three patients were included in this study (24 with medial orbital wall fracture and 19 with inferior orbital wall fracture). Their medical records including Hertel exophthalmometry, preoperative computed tomography (CT) scan, and postoperative CT scan were reviewed. The degree of enophthalmos developed was calculated by measuring exophthalmos before surgery and at 6 months after surgery. Patients were classified into 2 groups depending on whether reduction was good after surgery or not. Data (eg, age, gender, onset, fracture size, and so on) were then compared between these 2 groups.Results:A total of 43 patients were included in the study. Their mean age was 40.1 years. There were 34 (79.1%) males. The mean onset from trauma to surgery was 8.1 days. Insufficient soft tissue reduction was found in 9 patients through postoperative CT scan. Preoperative mean enophthalmos was - 1.70 mm. Postoperative mean enophthalmos was -0.45 mm after 6 months. The mean fracture size was 213.74 mm2. There was no statistically significant difference in enophthalmos at 6 months after surgery regardless whether the reduction was good or not. Enophthalmos at 6 months after surgery was associated with preoperative fracture size and onset.Conclusions:Postoperative enophthalmos development might be associated with preoperative fracture size and onset. Delayed operation in case of large orbital wall fracture might lead to undesired result. Thus, surgeons should keep that in mind.

This paper proposes a novel generative model called PUGAN, which progressively synthesizes high-quality audio in a raw waveform. Progressive upsampling GAN (PUGAN) leverages the progressive generation of higher-resolution output by stacking multiple encoder-decoder architectures. Compared to an existing state-of-the-art model called WaveGAN, which uses a single decoder architecture, our model generates audio signals and converts them to a higher resolution in a progressive manner, while using a significantly smaller number of parameters, e.g., 3.17x smaller for 16 kHz output, than WaveGAN. Our experiments show that the audio signals can be generated in real time with a comparable quality to that of WaveGAN in terms of the inception scores and human perception.

Purpose To evaluate the effectiveness of preoperative lacrimal endoscopic evaluation (LEE) of lacrimal duct system (LDS). Design Retrospective comparative case series Methods From March 2016 to February 2020, the charts of patients chosen to undergo endoscopic dacryocystorhinostomy (EDCR) or silicone tube intubation (STI) were reviewed retrospectively. Group 1 included patients that underwent EDCR, and group 2 included patients that underwent STI. Preoperative LEE was performed for all patients. In group 1, we compared the functional success rate for patients who had been converted to STI with the patients who had undergone EDCR. In group 2, we compared the functional success rate of STI with those who had had STI without LEE. Results In group 1, 19 (54.3%) eyes were converted to STI following LEE, and the functional success rate was 84.2%, which is not significantly different from that of the EDCR group following LEE ( p = 0.608). The functional success rate of EDCR without LEE was not different from that of STI following LEE ( p = 1.000). In group 2, five eyes (26.3%) were converted to EDCR following LEE. The group undergoing STI following LEE showed a significantly higher functional success rate (95.7%) than the group without LEE (66.6%, p = 0.023). Conclusion Preoperative LEE enables direct visualization of the LDS and helps to obtain more accurate diagnosis. This allows for the best surgical option based on LEE findings, which can contribute to better results. Therefore, LEE would be expected to change the paradigm of the classical management of LDS.

The objective of this cross-sectional study was to evaluate the association between periodontitis and glaucoma. This prospective cohort study used epidemiological data from the Korean Genome and Epidemiology Study performed between 2004 and 2016. Among 173,209 participants, 9572 patients with periodontitis and 115,332 controls (nonperiodontitis) were selected. We analysed the history of glaucoma in periodontitis and control participants. The participants were interviewed regarding their history of hypertension, diabetes mellitus, hyperlipidaemia, periodontitis, glaucoma, smoking, and alcohol consumption by trained interviewers. A logistic regression model was created to analyse the odds ratio of having a history of glaucoma among patients with periodontitis. Two-tailed analyses using chi-square and independent t-tests were used for statistical analysis. The adjusted odds ratio of periodontitis as a risk factor for glaucoma was 3.44 (95% confidence interval = 2.99–3.97, p<0.001). This study demonstrated that glaucoma was associated with periodontitis.

This paper proposes a novel generative model called PUGAN, which progressively synthesizes high-quality audio in a raw waveform. PUGAN leverages on the recently proposed idea of progressive generation of higher-resolution images by stacking multiple encode-decoder architectures. To effectively apply it to raw audio generation, we propose two novel modules: (1) a neural upsampling layer and (2) a sinc convolutional layer. Compared to the existing state-of-the-art model called WaveGAN, which uses a single decoder architecture, our model generates audio signals and converts them in a higher resolution in a progressive manner, while using a significantly smaller number of parameters, e.g., 20x smaller for 44.1kHz output, than an existing technique called WaveGAN. Our experiments show that the audio signals can be generated in real-time with the comparable quality to that of WaveGAN with respect to the inception scores and the human evaluation.

Recently, a new breed of mobile virtual reality (dubbed as "EasyVR" in this work), has appeared in the form of conveniently clipping on a non-isolating magnifying lenses on the smartphone, still offering a reasonable level of immersion to using the isolated headset. Furthermore, such a form factor allows the fingers to touch the screen and select objects quite accurately, despite the finger(s) being seen unfocused over the lenses. Many navigation techniques have existed for both casual smartphone 3D applications using the touchscreen and immersive VR environments using the various controllers/sensors. However, no research has focused on the proper navigation interaction technique for a platform like EasyVR which necessitates the use of the touchscreen while holding the display device to the head and looking through the magnifying lenses. To design and propose the most fitting navigation method(s) with EasyVR, we mixed and matched the conventional touchscreen based and headset oriented navigation methods to come up with six viable navigation techniques-more specifically for selecting the travel direction and invoking the movement itself-including the use of head-rotation, on-screen keypads/buttons, one-touch teleport, drag-to-target, and finger gestures. These methods were experimentally compared for their basic usability and the level of immersion in navigating in 3D space with six degrees of freedom. The results provide a valuable guideline for designing/choosing the proper navigation method under different navigational needs of the given VR application.

PurposeTo evaluate the clinical usefulness of the dacryoscintigraphy in patients with nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy.MethodsOne hundred thirty-five lacrimal views of endoscopic dacryocystorhinostomy (DCR) with a single surgeon for primary nasolacrimal duct obstruction (PANDO) were included. These were assigned into three groups according to the type of dacryoscintigraphy. Group 1 was a pre-sac obstruction pattern. Group 2 was an intra-sac obstruction pattern. Group 3 was post-sac obstruction pattern. Each group was evaluated for an anatomical and functional surgical success, presence of complications including granuloma, synechiae, and tube-induced inflammation at least 12months after the surgery.ResultsBoth anatomical and functional success rate showed no significant difference among the three groups (P=.297 and .472 linear by linear association). Functional failure rate (functional failure/total failure) also showed no clinically significant differences between groups. Logistic regression analysis was performed to determine the factors associated with functional success. There were no statistically significant factors in age, sex, scintigraphy type, pre-operative endoscopic grade, post-operative granuloma, and synechiae.ConclusionIn patients with nasolacrimal duct obstruction, preoperative evaluation of obstruction level using dacryoscintigraphy may be not useful for predicting the functional success of the endoscopic dacryocystorhinostomy.

PURPOSE:To report adverse hemorrhagic outcomes in patients who received intravenous (IV) ketorolac during oculofacial plastic surgical procedures.METHODS:The medical records of 111 consecutive patients who underwent lacrimal or orbital surgery, between the years 2016 and 2018, performed by a single surgeon under general anesthesia were retrospectively reviewed. Patients were excluded if they had history of a bleeding coagulopathy, anticoagulant use prior to surgery, or insufficient follow up. Patients were divided into 2 groups based on whether they received intravenous ketorolac. The primary outcome measure was the occurrence of a major postoperative bleeding event, and the secondary outcome measures were the evaluation of postoperative ecchymosis graded at 1 week after surgery and the incidence of persistent ecchymosis beyond 4 weeks.RESULTS:A total of 111 patients were analyzed further, including 31 patients who received intraoperative IV ketorolac and 80 control patients who did not. The demographic characteristics between the 2 groups were similar. No major bleeding events occurred in either group. And there was no statistically significant difference between the 2 groups in terms of ecchymosis grade and the incidence of development of persistent ecchymosis. Comparing the subgroups of lacrimal and orbital cases, there was also no significance difference between these groups.CONCLUSIONS:This study suggests that intraoperative ketorolac use does not increase the risk of postoperative bleeding complications in oculofacial procedures. This alternative to opioids may assist with pain control and lessen the narcotic burden.

Purpose: To present the first report describing lesions of osteoma cutis on the upper eyelid and medial canthus. Case summary: A 4-year-old female complained of a right upper eyelid mass. The examination showed a well-delineated, mild bluish-colored, hard mass over the upper eyelid and the medial canthus measuring 10 x 10 mm and 2 x 2 mm. During the cutaneous examination, her forearm, left shin, right dorsum of the foot, neck, and abdominal wall also showed well-delineated, mild bluish-colored, immobile hard masses, similar to the upper eyelid mass. A right upper eyelid and medial canthus mass excision was performed and a biopsy specimen was collected. Hematoxyline and eosin staining showed a mature bone in the dermis with spicules of bone and osteoblasts. She was finally diagnosed with osteoma cutis on the upper eyelid and the medial canthus. Conclusions: Osteoma cutis is a rare, benign skin disorder characterized by bone formation in the skin. Albright hereditary osteodystrophy, which causes a metabolic disorder, should also be considered to prevent complications.

Onomatopoeia refers to a word that phonetically imitates, resembles the sound, or depict an event at hand. In languages like Korean and Japanese, it is used in everyday conversation to emphasize certain situation and enrich the prose. In this poster, we explore if the use of onomatopoeia, visualized and added to the usual sound feedback, could be taken advantage to increase or alter the perceived realism of the sound feedback itself, and furthermore of the situation at hand in virtual reality. A pilot experiment was run to compare the user's subjective perceived realism and experience under four test conditions of presenting a simple physical interaction, accompanying it with: (1) just the "as-is" sound (baseline), (2) "as-is" sound and onomatopoeia, (3) a representative sound sample (e.g. one for all different collision conditions), and (4) a representative sound sample and onomatopoeia. Our pilot study has found that the use of onomatopoeia can alter and add on to the perceived realism/naturalness of the virtual situation such that the experiences of the single representative sound added with the onomatopoeia and "as-is" sound were deemed similar.

Conventional methods of real time sound effects in 3D graphical and virtual environments relied upon preparing all the needed samples ahead of time and simply replaying them as needed, or parametrically modifying a basic set of samples using physically based techniques such as the spring-damper simulation and modal analysis/synthesis. In this work, we propose to apply the generative adversarial network (GAN) approach to the problem at hand, with which only one generator is trained to produce the needed sounds fast with perceptually indifferent quality. Otherwise, with the conventional methods, separate and approximate models would be needed to deal with different material properties and contact types, and manage real time performance. We demonstrate our claim by training a GAN (more specifically WaveGAN) with sounds of different drums and synthesizing the sounds on the fly for a virtual drum playing environment. The perceptual test revealed that the subjects could not discern the synthesized sounds from the ground truth nor perceived any noticeable delay upon the corresponding physical event.

Purpose:To determine the relationship between the optical density of biofilms on silicone tubes and surgical outcomes.Methods:A total of 43 silicone tubes from 33 patients with nasolacrimal duct stenosis were enrolled at 6 months after bicanalicular silicone tube intubation. The removed silicone tubes were divided into 2 segments. One segment of silicone tube was cultured while the other segment was used to measure optical density of biofilm. Each segment was divided into 3 pieces according to average normal human nasolacrimal anatomy. The first piece was located from puncta to lacrimal sac. The second piece was inside the nasolacrimal duct. The third piece was in the nasal cavity. Surgical outcome was evaluated at postoperative 12 months based on Munk score and fluorescein dye disappearance test.Results:A total of 31 (72.1%) patients were surgically successful while 12 (27.9%) patients had surgical failure with persistent epiphora. In the second piece of silicone tube, the mean optical density of biofilm was 0.2654nm in the surgical success group and 0.4472nm in the surgical failure group. These results showed statistically significant (P<0.01) difference. The most frequently isolated organism was Staphylococcus aureus in the surgical success group (7 of 31 patients, 22.6%). It was Pseudomonas aeruginosa in the surgical failure group (6 of 12 patients, 50%).Conclusion:This is the first study that determines the relationship between biofilm on silicone tube and surgical outcome. Biofilm formed on silicone tubes in nasolacrimal duct might cause surgical failure.