Manhattan Eye, Ear and Throat Hospital

Purpose To report five cases of structural weakness at the haptic-optic junction of the CT Lucia 602 intraocular lens (IOL) (Carl Zeiss Meditec Inc., Dublin, CA), including two optic breakages and three optic microfractures, while using the Yamane flanged intrascleral haptic fixation surgery (FIHFS).MethodsA retrospective chart review of five cases that underwent Yamane FIHFS by the same surgeon between 2020 and 2022 was performed. Patients' demographics, operative technique, postoperative outcomes, and adverse events were recorded over a 12-month follow-up period.ResultsOne case of optic breakage, noted on postoperative week 1 (POW1), had the optic with the trailing haptic suspended in the vitreous while both haptic flanges remained secured to the sclera, requiring IOL exchange. The second case of optic breakage was noted intraoperatively and required explantation of the IOL with subsequent placement of an iris-fixated IOL. Three cases of optic microfractures were observed with no long-term complications. All five fractures occurred at the junction of the leading haptic.ConclusionOptic breakage and microfractures at the haptic-optic junction are unusual complications of intrascleral fixated IOL using the Yamane technique. To the best of our knowledge, this has not been previously reported with the CT Lucia 602 IOL. The authors recommend careful selection of the IOL material for this technique to prevent possible complications.

Skin quality is a multidimensional concept encompassing four emergent perceptual categories (EPCs): firmness, surface evenness, tone evenness, and glow. Microfocused Ultrasound with Visualization (MFU-V; Ulthera System) is a non-invasive device FDA-cleared for lifting and tightening of the skin in specific areas. Through the generation of thermal coagulation points at defined depths, MFU-V initiates neocollagenesis and elastin remodeling, which may support improvements in features related to overall skin quality. To evaluate clinical and preclinical evidence for the impact of MFU-V across the four EPCs of skin quality, including firmness, surface evenness, tone evenness, and glow. A structured narrative review was conducted across PubMed, Google Scholar, and Cochrane databases. Of 703 unique records screened, 67 studies met inclusion criteria. Eligible studies evaluated MFU-V, alone or in combination, reporting outcomes mapped to one or more EPCs of skin quality. MFU-V demonstrated consistent improvements in firmness (n = 52 studies), including elasticity and tautness, with sustained effects beyond 6 months. Improvements in surface evenness (n = 35) included wrinkle reduction, pore refinement, and scar remodeling. Effects on tone evenness (n = 4) were observed in melasma and erythema models, with good tolerance in Fitzpatrick skin types III-VI. Glow (n = 4) was indirectly supported by improved texture and structure. Combination protocols involving MFU-V and fillers or neuromodulators reported positive outcomes. Adverse events were rare and transient. MFU-V provides a safe and versatile platform for enhancing multiple aspects of skin quality. Its effects are well supported in firmness and texture, with emerging evidence for tone and glow. The integration of EPC-based outcomes may inform individualized treatment planning and future research.

To evaluate outcomes of rhegmatogenous retinal detachment treated with a scleral buckle (SB) without external drainage of subretinal fluid during the modern vitrectomy era. The records of 107 eyes of 107 patients who underwent treatment with nondrainage SB surgery for primary rhegmatogenous retinal detachment with at least 3 months of follow-up were reviewed. SB surgery included segmental elements (radial, 44.9%; circumferential, 23.4%) and encircling procedures (31.8%). Most patients (68.2%) were aged younger than 60 years, and most eyes (89.7%) were phakic. Single breaks were present in 53.3% of the eyes. The macula was attached preoperatively in 66 eyes (61.7%). Myopia > 5.5 diopters (35.5%) and lattice degeneration (48.6%) were notable risk factors. Posterior vitreous detachment was present in 37.4% of the eyes. Single surgery retinal reattachment was achieved in 104 eyes; three of these eyes also received pneumatic gas injections postoperatively. Four eyes underwent anatomically successful repeat surgery, including one eye that developed a recurrent rhegmatogenous retinal detachment after release of an encircling element. One eye underwent removal of an exposed SB without sequelae, and one eye developed persistent diplopia treated with prism. With proper case selection, nondrainage SB remains an excellent surgical procedure for repair of rhegmatogenous retinal detachment in the modern vitrectomy era.

Smoking's impact on tissue perfusion and wound healing is particularly relevant in rhinoplasty, where precise tissue healing is crucial for functional and aesthetic outcomes. Although the nasal region's robust vascular supply mitigates smoking's detrimental effects, concerns remain about postoperative complications. This study investigates whether smoking should be contraindicated for rhinoplasty by comparing infection and revision rates between smokers and nonsmokers. A retrospective review was conducted on 1884 rhinoplasty cases from 2014 to 2022. Patients were categorized as active smokers, former smokers, or nonsmokers. Only patients with at least 12 months of follow-up were included. All procedures were open rhinoplasties conducted under general anesthesia. Primary outcomes analyzed included infection and revision rates. Between-group statistical comparisons were performed. A total of 1884 patients consisted of 80 active smokers, 39 former smokers, and 1765 nonsmokers. Average follow-up was 23.8 months. The overall revision rate was 3.3%, with 3.8% in smokers and 3.3% in nonsmokers; 3.8% of smokers required additional antibiotics for cellulitis compared with 1.6% of nonsmokers; all cases resolved without long-term complications. There were no significant differences between smoker and nonsmoker rhinoplasty patients in rates of revision, postoperative infection, or wound complications. Active smoking does not appear to be a strict contraindication for rhinoplasty. Smoker and nonsmoker primary and revision rhinoplasty patients exhibited similar revision, postoperative infection, and wound complication rates. This suggests that, with proper perioperative optimization, rhinoplasty can be safely performed in smokers. Although smoking cessation should still be recommended, it may not be mandatory for satisfactory outcomes.

Abstract Goals/Purpose The nasal dorsum is a cornerstone of rhinoplasty aesthetics, playing a vital role in achieving facial harmony and balance. Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, acellular dermal matrices, and silicone implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum after dorsal reduction. Methods/Technique The senior surgeon exclusively utilizes an open approach to rhinoplasty, and all cases are performed under general anesthesia. After performing a dorsal hump reduction with a bone rasp, the MBG is stored on the back table for later use in the same case. After addressing other components of the rhinoplasty procedure, attention is turned back to the nasal dorsum, wherein any contour irregularities are filled with the MBG paste. A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases in which autologous MBG was used for dorsum refinement and contouring with a minimum of 12 months of follow-up. 953 patients met the inclusion criteria and were included in the study. Outcomes of interest included the rate of postoperative infection, defined as patients with signs of infection requiring antibiotics after completing their standard course of prophylactic antibiotics, and the rate of operative revisions. Results/Complications The mean age of our study group was 31.6 years old, with 869 female patients. 640 cases were primary rhinoplasties. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision, among whom 4 (23.5%) patients were revision cases. There were no patients who sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique in camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, as there is no additional equipment required and minimal operative time added when performing this technique, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction. Future steps will involve performing a five-year follow-up on this cohort of patients to assess for long-term dorsal aesthetics following MBG use.

The aim of this study was to describe novel findings seen on optical coherence tomography angiography (OCTA) and indocyanine green angiography in a young male patient presenting with bilateral topiramate-induced choroidal effusion. This is a retrospective case report. A comprehensive ophthalmic examination was conducted and multimodal imaging techniques, including B-scan ultrasound, OCT, OCTA, and indocyanine green angiography were analyzed. A male patient in his 30s presented with a myopic shift due to bilateral choroidal effusion induced by a medication containing topiramate prescribed for weight loss. Indocyanine green angiography showed multiple hypofluorescent spots within the choroid corresponding to areas of reduced OCTA flow signal in both the inner and deeper en face choroidal slabs. Symptoms and abnormal imaging findings resolved within 5 days of discontinuing the medication. Findings observed with OCTA and indocyanine green angiography together suggest multifocal reversible areas of reduced choroidal vascular flow occurring in a topiramate-induced choroidal effusion. The authors propose that this transient hypoperfusion is due to compression from deeper choroidal vessels with a congested choroid.

Abstract Goals/Purpose Traditional rhinoplasty tip grafts often lead to visibility issues, prompting patients to seek revision surgery. The mastoid fascia tissue graft (MFTG) provides a natural-looking alternative with fewer complications. MFTG remains less visible through the skin, enhancing long-term aesthetic results. This eight-year study on 193 patients examines MFTG's effectiveness in nasal tip refinement, evaluating revision and infection rates. Methods/Technique A retrospective analysis of MFTG use for nasal tip refinement during open rhinoplasty in the senior author's practice was conducted from July 2014 to June 2022. Inclusion criteria encompassed open rhinoplasty cases using mastoid tissue for tip refinement with at least 12 months of follow-up. Among 2003 cases, 193 met these criteria and were evaluated for subsequent revision and infection rates. Results/Complications The average patient age was 34.2 years (175 females, 18 males). Primary rhinoplasties were done on 114 patients, with 79 receiving revision surgeries. Average follow-up was 14.8 months. 6 patients (3.1%) needed extended antibiotics. Overall, 6 (3.1%) patients required revision rhinoplasty, comprising of 2 (1.8%) primary and 4 (5.1%) secondary rhinoplasty patients. These revisions were unrelated to the use of MFTG for nasal tip refinement. Conclusion MFTG use for nasal tip refinement is associated with low revision rates for both primary and secondary rhinoplasty compared to rates in current literature, without increase in complications or prolonged operative durations. MFTG for nasal tip refinement is a safe and convenient technique delivering excellent aesthetic outcomes with minimal morbidity.