This study suggests that Alloderm acellular human dermis can be used safely and effectively in multiple types of oculofacial procedures. Smoking, congenital anomaly etiologies, and previous graft/flap were associated with poor cosmetic and functional outcomes.

Therapeutic study, level IV; epidemiologic study, level III.

We investigated the time and location of retinal perfusion recovery after surgical intraocular pressure (IOP) lowering in glaucoma by using optical coherent tomography angiography (OCTA). Seventeen patients were analyzed. The 4.5 × 4.5-mm OCTA scans centered on the disc were performed preoperatively and postoperatively at 6 weeks, 3 months, and 6 months. The peripapillary retinal nerve fiber layer (NFL) thickness, NFL plexus capillary density (NFLP-CD) and visual field (VF) were measured overall and in 8 corresponding sectors. The low-perfusion area (LPA) was used to assess the cumulative area where local NFLP-CD was significantly below normal. At 6 months, the average IOP decreased 5.3 mmHg (P = 0.004), LPA decreased by 15% (P = 0.005), and NFLP-CD improved by 12% (P < 0.001). The NFL thickness and VF mean deviation didn’t change significantly at any time point. Among the sectors with significant preoperative NFLP-CD loss, the recovery at 6 months was greatest in sectors with minimal preoperative NFL thinning (P < 0.001). In conclusion, surgical IOP lowering may improve NFLP capillary perfusion after 6 months. The perfusion recovery tended to occur in areas with minimal NFL thinning at baseline. OCTA parameters may have potential usefulness as pharmacodynamic biomarkers for glaucoma therapy.

Purpose: Photic retinal toxicity induced by exposure to arc welding can lead to irreversible vision loss. Serial multimodal imaging is characterized in a patient with outer retinal damage secondary to welder's maculopathy.Methods: A single case was retrospectively reviewed.Results: Spectral domain optical coherence tomography acutely revealed disruption of the ellipsoid zone, hyperreflective bands through the outer nuclear layer, and outer retinal cavitation consistent with phototoxicity. Subsequently, disruption and hypertrophy of the subfoveal retinal pigment epithelium developed. Autofluorescence depicted central hypoautofluorescence. Conclusion:We report serial multimodal imaging in welder's maculopathy to better characterize the evolution of lesions. Multimodal imaging including spectral domain optical coherence tomography in arc welding phototoxicity may share features with other forms of phototoxicity such as hand-held laser maculopathy.

The purpose of this study was to compare rates of clinically significant complications between 23-and 25-gauge pars plana vitrectomy (PPV) in vitreoretinal surgery. Methods: Demographics, PPV indication, and surgical complications were reviewed. Patients with prior PPV or other retina surgery; cases requiring silicone oil removal, keratoplasty, or glaucoma valve implant; patients <18 years old; or patients with <4 months of follow-up were excluded. Comparative and descriptive statistics were used to evaluate the data. Results: A total of 579 eyes met inclusion criteria, and their charts were reviewed. Demographics, PPV indication, follow-up time, and lens status were similar (P > .05). A 23-gauge PPV was performed more frequently than a 25-gauge PPV (328 vs 251 eyes, respectively). Although rates of eyes with a clinically significant postoperative complication requiring surgical intervention were higher in 23-gauge PPV (112/325, 34.4%) than in 25-gauge PPV (54/250, 21.6%), PPVs indicated by rhegmatogenous retinal detachment were more common with 23-gauge PPVs (155/325, 47.7%) than with 25-gauge PPVs (37/250, 14.8%; P <.001) and were more likely to have postoperative complications; however, rates of recurrent retinal detachments were not different in the 2 cohorts (P ¼ .862). When controlling for differences in indication, there was a moderately higher rate of postoperative complications following 23-gauge PPV (P ¼ .063). Conclusions: This retrospective review suggests that clinically significant complications are moderately more likely following 23-gauge PPV compared with 25-gauge PPV, even when the differences in surgical indication are considered.

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A 60-year-old man who had Parkinson's disease for 25 years became unable to maintain the upright position of the trunk while standing or walking. Because of a loss of postural fixation, his trunk sank forward until his back was horizontal. Fifteen years before, a bifocal implantation of radioactive yttrium-90 had been performed by a stereotaxic procedure at the level of the globus pallidus (GP) and the ventrolateral thalamus, respectively on the right side. A second operation, 2 years later, had been made by electrocoagulation in the left ventrolateral thalamus. Postmortem examination showed the following features (a) neuronal cell loss in the pigmented nuclei of the brainstem with intracellular Lewy bodies and gliosis. These data corresponded with the usual pathology of idiopathic Parkinson's disease; (b) surgical lesions resulting from the previous stereotaxic operations in the right GP and the ventrolateral thalamus on both sides and (c) neuronal cell loss without gliosis in the right GP that was evident in regions spared by the surgical lesion. Moreover, these degenerative changes were particularly seen in the left GP, which was surgically unlesioned. The ansa lenticularis was demyelinated on both sides. These data might be consistent with a retrograde degenerative process affecting the pallidothalamic projections. Beside the role of the neuronal cell loss affecting the pars compacta of the substantia nigra (SN) in akinesia, the role of the lesions affecting the G.P. in the genesis of postural disorders is suggested.