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Advances in Ophthalmic Plastic and Reconstructive Surgery
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Advances in Ophthalmic Plastic and Reconstructive Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (25 December 2024) | Viewed by 6949

Special Issue Editor

Dr. Santiago Ortiz-Perez

E-Mail Website
Guest Editor
1. Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
2. Department of Surgery, Faculty of Medicine, University of Granada, 18010 Granada, Spain
3. Granada Vision and Eye Research Team (VER), Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
4. Oculoplastics and Aesthetic Surgery Unit, Vithas Hospital, Granada, Spain
Interests: oculoplastics; eyelid tumours; periocular reconstructive surgery; thyroid-associated ophthalmopathy; orbital surgery; eyelid ptosis; orbital inflammation; orbital imaging

Special Issue Information

Dear Colleagues,

Ophthalmic plastic and reconstructive surgery is a growing ophthalmological discipline dedicated to the study and treatment of eyelid, lacrimal pathway, and orbital pathologies, as well as surgical and non-surgical aesthetic treatments for this anatomical region. The relationship between the periocular area and the critical sense of vision, as well as its impact on facial aesthetics, have made this discipline one of the fastest growing in recent years.

Research in ophthalmic plastic and reconstructive surgery is experiencing rapid growth, which is increasingly guiding our treatments towards personalized medicine. The use of minimally invasive surgeries supported by technologies such as surgical microscopes, endoscopes, neuro-navigators, research on biomaterials and disease biomarkers, and individualized treatments seeking to modify the course of diseases and potentially cure them have had a significant impact. The recent advances in bioinformatics and the emergence of artificial intelligence are also exerting their effects on this discipline, and this is only the beginning.

In this Special Issue, we aim to provide an updated review of eyelid, lacrimal pathway, and ocular orbit pathologies, as well as aesthetic procedures regarding the periocular region.

Dr. Santiago Ortiz-Perez
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • eyelid reconstruction
  • eyelid ptosis
  • eyelid tumours
  • lacrimal surgery
  • thyroid-associated ophthalmopathy
  • orbital tumours
  • anophthalmic socket
  • orbital imaging
  • blepharoplasty

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Published Papers (6 papers)

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Research

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13 pages, 4323 KiB  
Article
Novel Reconstructive Technique for Lower Eyelid Defects: Marginal Approach for Releasing the Lid with Closure Handling Technique (MARCH Technique)
by Anna March De Ribot, Santiago Ortiz-Pérez and Francesc March De Ribot
J. Clin. Med. 2025, 14(3), 836; https://doi.org/10.3390/jcm14030836 - 27 Jan 2025
Viewed by 755
Abstract
Background: This study introduces a novel surgical approach, the Marginal Approach for Releasing the lid with Closure Handling technique (MARCH technique), a single-step sparing tissue technique, for the reconstruction of medium to large full-thickness lower eyelid defects and its outcomes. Methods: [...] Read more.
Background: This study introduces a novel surgical approach, the Marginal Approach for Releasing the lid with Closure Handling technique (MARCH technique), a single-step sparing tissue technique, for the reconstruction of medium to large full-thickness lower eyelid defects and its outcomes. Methods: The research considers a single-centre case series with a description of the MARCH technique. Patients with a full-thickness medium to large lower eyelid defect underwent this technique, which combines inferior cantholysis, splitting of lamellae and island or advancement flaps. Demographic data, lid defect size, histology and postoperative outcomes were collected. Results: The surgical procedure was performed in fifteen patients (nine males and six females). The mean age was 73.9 years (range 48–95 years old). Local anaesthesia was used in 86.7% of cases. The mean defect size was 68.7% (range 50% to 79%) of the lid length. All patients presented good results with no significant complications. Conclusions: The MARCH technique seems to be an excellent first-line approach in reconstructing medium to large full-thickness lower eyelid defects. Its single-step approach, tissue-sparing and minimally aggressive nature and ability to potentially guide eyelash positioning and restore the lacrimal system with a more anatomical position make it a promising option. Enrolling more patients and a longer follow-up would provide a better assessment. Full article
(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)
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13 pages, 1964 KiB  
Article
Effects of Aging on Orbicularis Oculi Muscle Strength and Ultrastructure in Dermatochalasis: A Pilot Study
by Larysa Krajewska-Węglewicz, Paulina Felczak and Małgorzata Dorobek
J. Clin. Med. 2025, 14(1), 162; https://doi.org/10.3390/jcm14010162 - 30 Dec 2024
Viewed by 755
Abstract
Background: Age-related changes to the orbicularis oculi muscle include impaired eyelid function, such as lagophthalmos, alterations in tear film dynamics, and aesthetic changes like wrinkles, festoons, and the descent of soft tissue. To date, the structural and functional changes that would comprehensively increase [...] Read more.
Background: Age-related changes to the orbicularis oculi muscle include impaired eyelid function, such as lagophthalmos, alterations in tear film dynamics, and aesthetic changes like wrinkles, festoons, and the descent of soft tissue. To date, the structural and functional changes that would comprehensively increase our understanding of orbicularis aging have not been analyzed. This study aims to investigate functional outcomes using surface electromyography and correlate them with ultrastructural changes in orbicularis during aging. Methods: This study enrolled 26 patients aged 37 to 78 years with a clinical diagnosis of dermatochalasis. Patients were divided into two age groups (<60 years; ≥60 years). Ultrastructural and electromyographical examinations were performed, and the electromyographical signals were correlated with the ultrastructural damage in the orbicularis. Results: This study revealed significantly lower values of average voluntary contraction and RMS of the surface electromyography signals in the older age group compared to the younger age group (p = 0.029 and p = 0.045, respectively). There was no statistically significant association between age and muscle damage (χ2(2) = 2.86, p > 0.05). There was no correlation between average voluntary contraction and the degree of ultrastructural damage in both groups (Spearman’s coefficient equaled 0.06923 and 0.64366, respectively). Conclusions: sEMG measurements are valuable for monitoring age-related functional changes in the orbicularis. Aging diminishes the functional capacity of the orbicularis, as evidenced by reduced contraction strength. This study, the first to compare ultrastructural and electromyographical changes in the orbicularis among dermatochalasis patients of different ages, finds that ultrastructural damage to muscle fibers is not directly responsible for the contraction strength decline. Full article
(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)
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9 pages, 710 KiB  
Article
The Impact of Systemic Inflammation on Recurrence in Patients with Congenital Nasolacrimal Duct Obstruction
by Hüseyin Findik, Feyzahan Uzun, Muhammet Kaim, Mehmet Birinci, Metin Çeliker, Murat Okutucu and Mehmet Gökhan Aslan
J. Clin. Med. 2024, 13(22), 6834; https://doi.org/10.3390/jcm13226834 - 13 Nov 2024
Viewed by 798
Abstract
Background/Objective: Congenital nasolacrimal duct obstruction (CNLDO) is commonly treated by probing, but recurrence remains a clinical issue. This study investigates the potential role of inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in predicting [...] Read more.
Background/Objective: Congenital nasolacrimal duct obstruction (CNLDO) is commonly treated by probing, but recurrence remains a clinical issue. This study investigates the potential role of inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in predicting recurrence after probing in children with CNLDO. Methods: This retrospective cohort study included 172 patients who underwent initial probing for unilateral CNLDO. The patients were then categorized into two groups: those who experienced the complete resolution of symptoms after primary probing, and those who required Ritleng tube intubation due to recurrence following primary probing. Blood samples for calculating inflammatory biomarkers in all subjects were collected during general anesthesia preparation prior to initial probing. NLR, MLR, and PLR values were compared between the groups using the independent samples t-test. The predictive performance of the inflammatory biomarkers for recurrence was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 110 patients were included in the probing group, while 62 patients were in the recurrence group. The mean age at the time of the initial probing procedure was 15 ± 4.06 months in the probing group and 15.83 ± 4.02 months in the recurrence group. There was no difference in the duration of the probing procedure between the groups. The mean age at the time of Ritleng tube intubation in the recurrence group was 37.80 ± 13.34 months. The recurrence group exhibited significantly higher values in all analyzed inflammatory markers compared to the probing group, including the NLR (1.12 ± 0.56 vs. 0.86 ± 0.39, p = 0.002), MLR (0.16 ± 0.06 vs. 0.14 ± 0.06, p = 0.005), and PLR (95.13 ± 24.34 vs. 82.23 ± 22.77, p < 0.001). ROC curve analysis indicated that these inflammatory biomarkers demonstrated moderate performance in predicting recurrence. Conclusions: Recurrence following probing in children with CNLDO was associated with complete blood cell count-derived inflammatory biomarkers. The preoperative assessment of these biomarkers may aid in the individualization of disease management and inform the development of new therapeutic strategies. Full article
(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)
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11 pages, 1503 KiB  
Article
A Comparison between 2-Octyl Cyanoacrylate and Conventional Suturing for the Closure of Epiblepharon Incision Wounds in Children: A Retrospective Case–Control Study
by Chia-Chen Hsu, Lung-Chi Lee, Hsu-Chieh Chang, Yi-Hao Chen, Meng-Wei Hsieh and Ke-Hung Chien
J. Clin. Med. 2024, 13(12), 3475; https://doi.org/10.3390/jcm13123475 - 14 Jun 2024
Viewed by 1126
Abstract
Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing [...] Read more.
Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing surgery for lower lid epiblepharon. Methods: This is a single-center retrospective case-control study. Surgical correction for epiblepharon was performed on 22 patients from November 2019 to May 2023. A total of 20 patients who were followed up for at least 1 month were included for analysis. After standardized epiblepharon surgery, group A underwent wound closure with a subcuticular suture and 2-octyl cyanoacrylate, and group B underwent closure with a 6-O fast-absorbing surgical gut suture. Patients were followed up at 1, 4, and 12 weeks post-surgery. Results: A total of 10 patients (20 eyes) underwent skin closure with tissue adhesives (group A), and 10 patients (18 eyes) underwent wound closure using conventional suture material (group B). No significant differences in the sex ratio, mean age at operation, pre- and postoperative best-corrected visual acuity (BCVA), or average surgical time were observed between groups. Both groups exhibited improved postoperative BCVA, with symptom relief and a significant decrease in the severity of keratopathy after surgery. Neither recurrence nor complications were reported during follow-up. The aesthetic results were similar between groups, while caregivers of children in the tissue adhesive group expressed high satisfaction regarding the ease of postoperative care. Conclusions: Successful closure of lower lid epiblepharon surgery wounds in children can be performed using 2-octyl cyanoacrylate (SurgiSeal®). This method is simple, safe, and effective when compared to conventional sutures. Full article
(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)
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Review

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10 pages, 2210 KiB  
Review
Ectropion Repair Techniques and the Role of Adjunctive Superotemporal Skin Transposition for Tarsal Ectropion
by Brendan K. Tao, Thanansayan Dhivagaran, Fahad R. Butt, Michael Balas, Ahsen Hussain, Navdeep Nijhawan, Georges Nassrallah and Edsel Ing
J. Clin. Med. 2025, 14(3), 827; https://doi.org/10.3390/jcm14030827 - 27 Jan 2025
Viewed by 979
Abstract
Background: Ectropion is a common eyelid problem and is defined as eversion of the eyelid margin and typically involves the lower eyelid. The main acquired causes of ectropion include involutional, cicatricial, paralytic, and mechanical. A severe manifestation of ectropion is tarsal ectropion, where [...] Read more.
Background: Ectropion is a common eyelid problem and is defined as eversion of the eyelid margin and typically involves the lower eyelid. The main acquired causes of ectropion include involutional, cicatricial, paralytic, and mechanical. A severe manifestation of ectropion is tarsal ectropion, where much of the tarsal conjunctiva is visible, often with keratinization of the conjunctiva. causes. Common techniques for ectropion repair include horizontal tightening of the lid with lateral tarsal strip or Bick procedure, lateral tarsorraphy, inverting sutures and the sub-orbicularis oculi fat lift. However, all surgical techniques are prone to ectropion recurrence. We review the techniques for ectropion repair and describe a novel adjunctive technique called the superotemporal skin transposition (STS), which is well suited for patients with recurrent or tarsal ectropion. Methods: The STS is combined with a lateral tarsal strip or Bick procedure. For the STS, all of the anterior lamellae of the lateral lower lid is retained. The posterior lamellae is sutured to the lateral orbital tubercle. A triangular bed of skin is excised superotemporally, and the lower lid anterior lamellae is transposed and secured with multiple sutures. The STS can be combined with inverting sutures, or skin graft for cicatricial cases. Results: We used the STS with Bick procedure and optional inverting sutures on 23 patients, 4 of whom required bilateral ectropion repair. At 1–6 month followup all patients achieved satisfactory outcomes with a well-positioned eyelid and improved symptoms. The STS had more lateral cutaneous scarring than with a Bick procedure alone, but patients did not find this objectionable. No reoperations were required. Conclusion: The STS is a straightforward and useful adjunct for patients with severe, recurrent or tarsal ectropion. Further studies are needed to determine the long-term efficacy of this technique. Full article
(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)
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19 pages, 1530 KiB  
Review
Periocular Aging Across Populations and Esthetic Considerations: A Narrative Review
by Brendan K. Tao, Fahad R. Butt, Thanansayan Dhivagaran, Michael Balas, Navdeep Nijhawan, Georges Nassrallah, Ahsen Hussain and Edsel B. Ing
J. Clin. Med. 2025, 14(2), 535; https://doi.org/10.3390/jcm14020535 - 16 Jan 2025
Viewed by 1614
Abstract
As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial [...] Read more.
As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial aging that are observed across populations, including variations in periorbital hollowing, eyelid ptosis, and skin elasticity. Evidence indicates significant variability in aging patterns between sex- and race-based subgroups. Nonetheless, there remains a paucity of research on the progression of aging in some under-studied demographic groups. Signs of oculofacial aging often become apparent to patients well before these changes reach full maturity in later years, leading many to seek early esthetic interventions. Others may present with more advanced signs of aging, motivating a diverse range of therapeutic options. We discuss minimally invasive esthetic interventions to mitigate the signs of aging, which may include botulinum toxin injections, dermal fillers, applied energy-based treatments (e.g., lasers), and emerging techniques such as micro-focused ultrasound and platelet-rich plasma therapies. We review evidence on outcomes related to patient satisfaction and quality of life following esthetic interventions for oculofacial aging. Finally, we outline ethical considerations and challenges faced with the delivery of esthetic surgery, including treatment complications and the influence of social media. This review provides a comprehensive overview of oculofacial aging patterns, its management, and important considerations for the provision of esthetic oculofacial treatment. Full article
(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)
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