Background The present study sought to introduce clinical characteristics and stepwise surgical strategies of isolated complete cryptophthalmos, a rare, congenital ocular anomaly. Case presentation Retrospective, noncomparative, clinical study. Six patients with isolated complete cryptophthalmos were diagnosed at the Beijing Tongren Hospital between 2010 to 2018. The presentation age of patients ranged from 1 month to 68 years. This study includes two males and four females, and involvement was noted to be bilateral in two cases and unilateral in four cases. According to orbital CT scan and ocular CDI results, two patients were combined with ocular cyst. Reconstruction surgeries were performed in three patients, involving the eyeball enucleation, creation of fornix, eyelid reconstruction with skin flaps/amniotic membrane, and implantation of prosthesis. Besides, implantation of hydroxyapatite was performed in one pediatric patient to promote orbit development. Good outcomes in terms of cosmetic satisfaction were achieved in all patients during follow-up. Conclusions Surgical intervention could only improve the cosmetic appearance in isolated complete cryptophthalmos. The surgical strategies may be planned to use three-stage approaches described in this study. Meanwhile, orbital development must be taken into consideration in pediatric cases.
Background To investigate the expression of elastin in the conjoint facial sheath (CFS) in patients with severe unilateral congenital blepharoptosis in different age groups. Methods Twenty-seven cases of severe unilateral congenital blepharoptosis (27 eyes) were treated with CFS + LM complex suspension from January 2020 to July 2020. Within that sample, 9 patients were over 18 years old, 9 patients were 13 to 17 years old and 9 patients were 5 to 12 years old. CFS and LM specimens were collected during CFS + LM complex suspension surgery. In the CFS specimens, the elastic fibers were observed by Victoria Blue staining. The elastin expression levels of the three groups of specimens were determined and analyzed by immunofluorescent staining and Western blotting. Results Victoria Blue staining showed that elastic fibers were abundant in CFS tissue. Moreover, immunofluorescent staining showed strong positive expression of elastin in the CFS and LM. Furthermore, in the child group, the Western blot results demonstrated that the expression of elastin was higher in the CFS than in the LM (P < 0.05). Additionally, the expression of elastin was significantly higher in the CFS of children than in that of adults or adolescents (P < 0.001). Conclusions The CFS and LM are rich in elastic fibers and elastin, although elastin expression in the CFS decreases with age. Thus, it is feasible to apply CFS + LM complex suspension to cure severe unilateral congenital blepharoptosis.
The current study investigated the anti-inflammatory effect of 0.1% tacrolimus eye drops for the treatment of therapeutic penetrating keratoplasty (TPK) for severe infectious keratitis during early disease stages and reported the long-term clinical outcomes. The present retrospective study included 20 eyes from patients diagnosed with severe keratitis who underwent TPK surgery. Patients were followed-up for up to 12-18 months. Tacrolimus eye drops were administered 4 times/day starting on the first day post-surgery. Glucocorticoid eye drops were subsequently added to treatment plans one-month post-surgery. All patients were followed-up for the first 3 post-operative days, then examined once a week thereafter for the first month. In early post-operative stages, the states of the grafts (ΔS) and the absorption of intraocular inflammation (S) were observed. ΔS was defined as the difference between the states of the grafts on the first post-operative day (SS1d) and those at one month post-surgery (SS1m). S was calculated as the difference between the inflammation score mean one day post-surgery (T1d) and the mean one-month post-surgery (T1m). For long term clinical outcomes, graft failure rates and complications were recorded. Among the 20 eyes analyzed, the mean T1d, T1m and S were 7.4±2.06, 2.0±2.47 and 5.4±2.13 (P<0.01), respectively. The mean SS1d, SS1m and ΔS were 5.3±1.56, 3.8±1.24 and 1.5±1.5 (P<0.01), respectively. During follow-up, there were 6 cases of corneal graft failure, 4 of which were due to immune rejection and 2 of which were due to complications. The current study concluded that tacrolimus eye drops facilitated the absorption of intraocular inflammation in the early post-operative period of TPK and may extend long term survival of grafts in cases of severe infectious keratitis.
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