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PurposeMethodsResultsConclusionsAssessment of the frontalis muscle flap eyelid reanimation surgical technique for adults with severe ptosis and apraxia of eyelid opening.A retrospective case series of 30 eyes with severe ptosis or apraxia of eyelid opening. Outcomes were assessed for margin to reflex distance 1 (MRD1), lagophthalmos, complications, and need for subsequent surgical intervention. A paired t-test was used to compare preoperative and postoperative scores of a quality-of-life questionnaire.Thirty eyes of 19 patients underwent surgery, 16 (53%) with combined frontalis + levator-Muller muscle flap and 14 (46%) with frontalis muscle flap alone. There were 14 female and 5 male patients, with an average age of 55 years (range, 18–76). Mean preoperative MRD1 was −0.6 mm (range, −5 to 2) with mean levator excursion of 7.1 mm. Seventeen eyes had a myogenic etiology, five had a paralytic etiology, six had blepharospasm with apraxia of lid opening, and two had a neurodegenerative etiology. Nineteen eyes (63%) had previously undergone ptosis repair. Mean postoperative MRD1 was 2.5 mm (range, 0.5 to 5) at mean follow-up of 63.3 days. There were no serious surgical complications; minor complications included ocular surface keratopathy and one patient who required surgical revision. Results of the QOL questionnaire indicated significant improvement in vision-related symptoms postoperatively (p = 0.02).Use of the frontalis muscle flap eyelid reanimation technique, with or without a levator-Muller retractor muscle flap, was very effective in this case series and provided good upper eyelid position with acceptable corneal protection and high patient satisfaction. [ABSTRACT FROM AUTHOR]

A 14-year-old female presented with 2 weeks of progressive right eye pain, erythema, and proptosis. Examination demonstrated an enlarged palpable mass along the right superior lateral orbit and bilateral conjunctival petechiae. Of note, she was asymptomatic on the left side, and the petechiae were present only on the superior bulbar conjunctiva with eyelid eversion. Imaging demonstrated bilateral lacrimal gland enhancement. Testing was significant for elevated inflammatory markers, but otherwise negative workup. Biopsy of the right lacrimal gland demonstrated acute-on-chronic inflammation without evidence of lymphoproliferative disease. On repeat testing, myeloperoxidase antibody levels (MPO/p-ANCA) were elevated, indicative of an underlying immune-mediated vasculitis. This case illustrates a rare presentation of ANCA-associated vasculitis in a pediatric patient. It further demonstrates the phenomenon of initial negative serology and subsequent auto-antibody seroconversion in a patient with localized granulomatosis with polyangiitis. [ABSTRACT FROM AUTHOR]

Purpose: To assess antibiotic prescribing patterns among ophthalmologists and optometrists from 2018 to 2021. Methods: This is an observational, retrospective cohort study of the Medicare Part D prescriber public use files from 2018 to 2020. Prescription trends were analyzed with analysis of variance and negative binomial regression tests based on specialty, region, and types of antibiotics. Results: From 2018 to 2021, the number of ophthalmologists in the Medicare Part D database decreased from 18,452 to 18,285, and the number of optometrists increased from 23,071 to 24,734. Throughout the study period, the total number and proportion of antibiotic prescriptions by ophthalmologists and optometrists stayed almost constant with a dip in 2020, likely reflecting the effects of the COVID-19 pandemic. Both ophthalmologists and optometrists demonstrated geographic regional differences in prescribing patterns. The South consistently had the highest average number of claims per provider. Of the antibiotics prescribed by ophthalmologists in 2021, 48.6% are from the fluoroquinolone class, 20.5% are from the aminoglycoside class, and 18.2% are from the macrolide class. Optometrists were found to be more likely to prescribe antibiotics in a formulation combined with a corticosteroid throughout the study period. Conclusions: Our results have shown that prescribing patterns among ophthalmologists and optometrists have demonstrated significant changes in prescriptions of microbial resistance-promoting antibiotics. These patterns persist despite nation-wide attempts to control antimicrobial resistance. [ABSTRACT FROM AUTHOR]