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Papers by MIDORI OSAKI

International Ophthalmology

The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The ... more The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The purpose of this study was to identify particularities in individuals under 40 years of age affected by eyelid malignancies. Clinical charts of patients under 40 years of age who underwent eyelid tumor excision from 2014 to 2020 in two reference centers, one in Brazil and one in the USA, were reviewed. Demographic and outcome measures included: age, gender, skin phototype, comorbidities, diagnosis, time until diagnosis, lesion location, recurrence and metastasis. In addition, associated characteristics, including chronic sun exposure, intentional tanning (outdoor or artificial), history of smoking, use of sunscreen, family history of skin cancer and exposure to pesticides or herbicides, were reviewed. A total of 24 malignant eyelid tumors from 17 patients were identified. Twelve (70.6%) patients were female, and the most prevalent tumor was basal cell carcinoma (62.5%). Three (17.6%) patients had xeroderma pigmentosum and presented with multiple lesions. Family history of skin cancer was reported by 47% of patients. Prolonged sun exposure was reported by 41.2%; history of smoking and intentional tanning were reported by 23.5 and 17.6%, respectively, and might have played a role in carcinogenesis. Although uncommon in young subjects, eyelid malignancies present some peculiarities in individuals under 40 years of age. Our results suggest that women with family history of skin cancer and history of chronic exposure to ultraviolet radiation are at risk. Association with genetic syndromes is also relevant among younger age groups.

Ophthalmic Plastic & Reconstructive Surgery, 2020

To the Editor: The sub-brow skin excision technique, whether performed in conjunction with upper ... more To the Editor: The sub-brow skin excision technique, whether performed in conjunction with upper blepharoplasty or as a standalone procedure, has been described as a good option to address lateral hooding in Asian ancestry patients. 1-3 Nevertheless, this technique can also be performed in non-Asians, such as in patients of African or Latino descent. African and Asian eyelids share certain similarities, such as a lower eyelid crease as compared to Caucasian eyelids (in general, 6-8 mm from the ciliary margin), soft tissue fullness, and thicker skin resulting from a thick stratum corneum and more active fibroblasts in the epidermis. 4,5 Other studies have demonstrated that Latino eyelids can have intermediate characteristics between Caucasian and East Asian, reflective of the mixed-race ancestry of Latinos, who often have Caucasian, Indigenous Native American, and even African and other ancestries. 6 In patients with significant dermatochalasis and thicker skin, if a standard upper blepharoplasty is performed, suturing the thick upper skin to the thin pretarsal skin can result in upper lid fullness and persistent edema. Furthermore, excision of the lateral dermatochalasis as part of a standard blepharoplasty can result in a visible scar extending beyond the lateral canthus. 2,3 In order to address lateral hooding in select non-Asian patients, the authors performed sub-brow skin excision with or without concurrent upper blepharoplasty in 6 female patients of African and Latino descent who presented with lateral hooding, thick skin and no brow ptosis. T.H.O. and M.H.O. have performed this technique in their private practice. This study adhered to the tenets of the Declaration of Helsinki and was Health Insurance Portability and Accountability Act-compliant. Patients who had prominent lateral hooding with minimal dermatochalasis underwent a standalone sub-brow procedure (4 patients), whereas those presenting with significant dermatochalasis and lateral hooding with thick skin underwent the combined procedure (2 patients). The procedure was performed according to a previously published technique in Asians. 3 The mean age was 71.17 ± 4.79 years (63-79 years). Aesthetic improvement, with increase in the tarsal platform show and resolution of lateral hooding, was observed in all cases. At 3 months after surgery, the sub-brow scar was almost unnoticeable in all patients. No complications related to wound dehiscence, lagophthalmos, sensory changes, hematoma, infection, or hypertrophic scars were observed (Fig.). Since selected patients had relatively high lateral brow positions, significant lowering of the brow position or induced brow ptosis was not observed. It has been suggested that brow ptosis occurs to a lesser degree in people of African descent, when compared to Caucasians, due to increased skin tonus. 5 Furthermore, at least 20 mm of skin was preserved between the Sub-Brow Skin Excision as an Alternative to Classic Blepharoplasty in Select Non-Asian Patients A, Sub-brow skin marking. B, A 68-year-old female of African ancestry presented with prominent lateral hooding. C, At post-op month 3 following sub-brow skin excision, the patient shows improvement in lateral hooding with a well-concealed scar.

The Journal of craniofacial surgery, Jan 14, 2018

The management of cicatricial entropion represents a therapeutic challenge especially when the un... more The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period) were extracted from these patients' charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4 ± 46.1 months ...

Rev Soc Bras Cir Plast, Jun 1, 2007

Journal of Cataract & Refractive Surgery, 2016

To evaluate the effect of eyelid spasm treatment with botulinum toxin-A (BTX-A) on corneal curvat... more To evaluate the effect of eyelid spasm treatment with botulinum toxin-A (BTX-A) on corneal curvature assessed with Scheimpflug (Pentacam) and Placido (Atlas) systems. Federal University of São Paulo, São Paulo, Brazil. Prospective interventional case series. Patients with hemifacial spasm were evaluated. Steep keratometry (K) and corneal astigmatism (magnitudes and treatment-induced astigmatism) obtained with the Placido and Scheimpflug systems were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. The study evaluated 48 eyes (24 affected and 24 normal contralateral eyes) of 24 patients. The mean steep K and astigmatism values obtained with the Placido system on the affected side before treatment were 46.91 diopters (D) ± 3.57 (SD) and 2.63 ± 2.46 D, respectively. A significant decrease in steep K (45.14 ± 1.20 D) and astigmatism (1.01 ± 0.58 D) was observed 2 months (P = .003 and P = .0004, respectively) and 3 months (45.64 ± 1.77 D and 1.36 ± 1.31 D, respectively) (P = .03 and P = .01, respectively) after treatment. The Scheimpflug system did not show significant changes in steep K measurements during the 4-month period. The mean astigmatism in the affected eye before treatment was 1.27 ± 0.88 D. A significant reduction was observed at 15 days (1.16 ± 1.16 D) and at 4 months (0.91 ± 0.59 D) (P = .02 and P = .03, respectively). The Placido system was more sensitive in detecting a temporary reduction in corneal curvature after eyelid-spasm treatment. None of the authors has a financial or proprietary interest in any material or method mentioned.

Ophthalmic Plastic & Reconstructive Surgery, 2017

Purpose: In Asian patients, lateral hooding in the aging upper eyelid is prominent and frequently... more Purpose: In Asian patients, lateral hooding in the aging upper eyelid is prominent and frequently seen. Removal of the redundant skin of this region during classic blepharoplasty tends to produce a resultant prolonged scar. Furthermore, as the height of the eyelid skin excision increases, suturing of the thick upper skin to the thin pretarsal skin can result in upper lid fullness. This study documents the combination of infrabrow skin excision and upper blepharoplasty to address lateral hooding in select patients of Asian ancestry. Methods: This study is a retrospective chart review of patients who underwent infrabrow skin excision associated with upper blepharoplasty. The inclusion criteria were moderate and severe upper eyelid dermatochalasis in patients with high eyebrows and lateral hooding; residual lateral hooding following previous blepharoplasty. Results: Thirty-two eyelids of 16 female patients of Japanese ancestry underwent infrabrow skin excision associated with upper blepharoplasty. The mean age of patients was 68.87 ± 7.88 years (57-82 years). Mean follow up was 37.25 ± 18.96 months (9-72 months). Patients were evaluated at 1, 3, 6, and 9 months at least. The Strasser system for evaluation of surgical results was applied at 3 months. All patients had scores indicating good results and were satisfied with the cosmetic outcome and improvement of visual field after surgery. No complications related to wound dehiscence, lagophthalmos, hypertrophic scars, or sensory changes were observed. Conclusion: The combination of infrabrow skin excision and upper blepharoplasty was effective to address moderate and severe dermatochalasis with lateral hooding in select patients of Japanese ancestry.

Cornea, 2016

To investigate possible temporary differences in corneal topographic parameters between affected ... more To investigate possible temporary differences in corneal topographic parameters between affected and normal eyes in patients with hemifacial spasm (HFS) treated with botulinum toxin-A (BTX-A), over the course of 1 treatment cycle. This prospective study evaluated corneal topographic differences between affected and normal contralateral eyes during a 4-month period in patients with HFS treated with BTX-A (the duration of action of BTX-A for HFS ranges from 2 to 4 months). Corneal topographic analysis was performed using a conventional topographer (Atlas; Carl Zeiss Meditec, Dublin, CA). Steep K and astigmatism measurements were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. Twenty-four patients (16 women and 8 men) were evaluated. Steep K [46.9 ± 3.6 diopters (D)] and astigmatism values (2.6 ± 2.5 D) were significantly higher in affected eyes of HFS patients than in nonaffected eyes (45.0 ± 1.4 D and 0.9 ± 0.6 D) before treatment (P = 0.001 for steep K a...

Dermatologic Surgery, 2016

Univ Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Div Ophthalm Plast & Reconstruct Surg, ... more Univ Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Div Ophthalm Plast & Reconstruct Surg, Sao Paulo, Brazil

British Journal of Ophthalmology, 2015

Background/aims In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the ... more Background/aims In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the affected side, thus changes in corneal topography and eyelid morphometry may be observed after treatment. We aimed to evaluate these parameters during a 4-month period in patients with HFS treated with botulinum toxin A (BTX-A). Methods This prospective study evaluated eyelid morphometric and corneal topographic changes in patients with HFS before onabotulinum toxin A application, and after 15 days and 2, 3 and 4 months. Results 24 patients were treated with BTX-A. On the normal side, the mean palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and astigmatism values were 8.7±1.98 mm, 122.09± 39.37 mm 2 , 44.99±1.45 D and 0.9±0.64 D, respectively, before treatment. A statistically significant difference was not observed in these parameters after treatment (p>0.05). On the affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77 mm, 67.68±28.49 mm 2 , 46.91±3.57 D and 2.63±2.46 D, respectively, before treatment. We observed a statistically significant (p<0.05) increase in the mean PF and ISA on the affected side 15 days (8.36±1.91 mm and 115.92 ±34.44 mm 2 , respectively), 2 months (8.18±1.80 mm and 112.22±33.57 mm 2 , respectively) and 3 months (7.27±1.65 mm and 95.48±27.80 mm 2 , respectively) after treatment. A statistically significant decrease in steep K and astigmatism was observed at 2 months (45.14±1.20 D and 1.01±0.58 D, respectively) and 3 months (45.64±1.77 D and 1.36±1.31 D, respectively) after treatment. Conclusions The results suggest that treatment with BTX-A in patients with HFS leads to eyelid and corneal changes on the affected eye that are significant during the known period of action of the toxin. Thus, caution should be taken when performing ophthalmological examination in patients with HFS, since it may vary according to BTX-A period of action.

Rev. Soc. Bras. Cir. …, 2006

... Orbital fat prolapse GIOVANNI ANDRÉ P. VIANA1, MIDORI OSAKI2, ANA ESTELA SANT'ANNA3, LIL... more ... Orbital fat prolapse GIOVANNI ANDRÉ P. VIANA1, MIDORI OSAKI2, ANA ESTELA SANT'ANNA3, LILIAM OHKAWARA3, PATRÍCIA MIYASATO3 ... 1987;3(2): 83-6. 9. Lessa S, Sebastia R, Flores EE, Pitanguy I, Gonçalves Filho P. Hérnia gordurosa subconjuntival. ...

Journal of Neuro-Ophthalmology, 2019

Ophthalmic Plastic & Reconstructive Surgery, 2020

Anais da SBCPO: 28º Congresso Internacional de Oculoplástica e 7º Congresso Internacional de Estética Periocular, V.1, 2021

Anais da SBCPO: 28º Congresso Internacional de Oculoplástica e 7º Congresso Internacional de Estética Periocular, V.1, 2021

Aesthetic surgery journal, Jan 8, 2017

Transient blepharoptosis is a feared complication after botulinum toxin-A (BTX-A) cosmetic inject... more Transient blepharoptosis is a feared complication after botulinum toxin-A (BTX-A) cosmetic injections into the upper third of the face. Alpha-adrenergic agonist eyedrops are usually employed to address this adverse effect. 1-3 However, response may vary among patients and their use may be associated with ocular adverse effects. 2-4 The use of eyelid make-up might be an alternative approach to manage temporary upper eyelid ptosis. The authors had previous experience using a similar approach to conservatively manage severe myopathic blepharoptosis cases when surgical correction was contraindicated. 5 A retrospective case series was conducted and the authors have complied with the principles of the Declaration of Helsinki. Cases were collected from January 2012 to December 2016. After performing a skin testing at the retroauricular region 24 hours before, in order to rule out allergies to the product, six patients, who had received cosmetic BTX-A injections elsewhere, were treated using a hypoallergenic eyelid make-up (Double eyelid glue, Elizabeth, Japan) as an alternative to manage transient blepharoptosis. This product is water soluble and can be easily removed. The product was applied daily by the patient at the eyelid crease with a swab and allowed to dry for one minute. Then, a plastic Y-shaped stick that comes with the product was placed within the eyelid crease and the upper lid was pushed upward. Thus, a deeper eyelid crease was induced, temporarily elevating the upper eyelid (Figure 1 and Video, which is available online as Supplementary Material at www.aestheticsurgeryjournal.com). Patients were asked to remove the product every night.

Arquivos Brasileiros de Oftalmologia, 2017

A progressão do ceratocone não é inibida reduzindo a força palpebral com o uso da toxina botulíni... more A progressão do ceratocone não é inibida reduzindo a força palpebral com o uso da toxina botulínica tipo A: ensaio clínico randomizado

Aesthetic Surgery Journal, 2017

Arquivos Brasileiros de Oftalmologia, 2011

A síndrome de frouxidão palpebral é caracterizada pela fácil eversão da pálpebra que ocorre espon... more A síndrome de frouxidão palpebral é caracterizada pela fácil eversão da pálpebra que ocorre espontaneamente durante o sono causando exposição dos olhos, com consequente conjuntivite papilar crônica. Sua patogênese ainda não está totalmente definida e é mais comum em pacientes masculinos, obesos, de meia idade e está associada a doenças sistêmicas como apnéia obstrutiva do sono, hipertensão arterial e diabetes. Quando o tratamento clínico não apresenta boa resposta, procedimentos cirúrgicos apresentam bons resultados, com técnicas em constante evolução.

Aesthetic Surgery Journal, 2015

JAMA ophthalmology, Jan 23, 2015

Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The l... more Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The literature regarding antibiotic use for eyelid surgery is lacking. To determine standard care and assess factors influencing antibiotic prescribing practices for eyelid surgery. A survey study was conducted from February 2, 2014, to March 24, 2014. The survey was distributed to 2397 oculoplastic surgeons in private and academic oculoplastic surgery practices in 43 countries. All surgeons were members of ophthalmic plastic and reconstructive surgery societies. Data were analyzed by geographic location. Linear regression was performed to quantify contributions to rates of prescribing postoperative antibiotics for routine eyelid surgical procedures. Rates of prescribing prophylactic intravenous, oral, and topical antibiotics as well as factors that influence surgeons' prescribing practices. A total of 782 responses were received from 2397 surgeons (average response rate, 36.7%; 2.5% marg...

International Ophthalmology

The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The ... more The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The purpose of this study was to identify particularities in individuals under 40 years of age affected by eyelid malignancies. Clinical charts of patients under 40 years of age who underwent eyelid tumor excision from 2014 to 2020 in two reference centers, one in Brazil and one in the USA, were reviewed. Demographic and outcome measures included: age, gender, skin phototype, comorbidities, diagnosis, time until diagnosis, lesion location, recurrence and metastasis. In addition, associated characteristics, including chronic sun exposure, intentional tanning (outdoor or artificial), history of smoking, use of sunscreen, family history of skin cancer and exposure to pesticides or herbicides, were reviewed. A total of 24 malignant eyelid tumors from 17 patients were identified. Twelve (70.6%) patients were female, and the most prevalent tumor was basal cell carcinoma (62.5%). Three (17.6%) patients had xeroderma pigmentosum and presented with multiple lesions. Family history of skin cancer was reported by 47% of patients. Prolonged sun exposure was reported by 41.2%; history of smoking and intentional tanning were reported by 23.5 and 17.6%, respectively, and might have played a role in carcinogenesis. Although uncommon in young subjects, eyelid malignancies present some peculiarities in individuals under 40 years of age. Our results suggest that women with family history of skin cancer and history of chronic exposure to ultraviolet radiation are at risk. Association with genetic syndromes is also relevant among younger age groups.

Ophthalmic Plastic & Reconstructive Surgery, 2020

To the Editor: The sub-brow skin excision technique, whether performed in conjunction with upper ... more To the Editor: The sub-brow skin excision technique, whether performed in conjunction with upper blepharoplasty or as a standalone procedure, has been described as a good option to address lateral hooding in Asian ancestry patients. 1-3 Nevertheless, this technique can also be performed in non-Asians, such as in patients of African or Latino descent. African and Asian eyelids share certain similarities, such as a lower eyelid crease as compared to Caucasian eyelids (in general, 6-8 mm from the ciliary margin), soft tissue fullness, and thicker skin resulting from a thick stratum corneum and more active fibroblasts in the epidermis. 4,5 Other studies have demonstrated that Latino eyelids can have intermediate characteristics between Caucasian and East Asian, reflective of the mixed-race ancestry of Latinos, who often have Caucasian, Indigenous Native American, and even African and other ancestries. 6 In patients with significant dermatochalasis and thicker skin, if a standard upper blepharoplasty is performed, suturing the thick upper skin to the thin pretarsal skin can result in upper lid fullness and persistent edema. Furthermore, excision of the lateral dermatochalasis as part of a standard blepharoplasty can result in a visible scar extending beyond the lateral canthus. 2,3 In order to address lateral hooding in select non-Asian patients, the authors performed sub-brow skin excision with or without concurrent upper blepharoplasty in 6 female patients of African and Latino descent who presented with lateral hooding, thick skin and no brow ptosis. T.H.O. and M.H.O. have performed this technique in their private practice. This study adhered to the tenets of the Declaration of Helsinki and was Health Insurance Portability and Accountability Act-compliant. Patients who had prominent lateral hooding with minimal dermatochalasis underwent a standalone sub-brow procedure (4 patients), whereas those presenting with significant dermatochalasis and lateral hooding with thick skin underwent the combined procedure (2 patients). The procedure was performed according to a previously published technique in Asians. 3 The mean age was 71.17 ± 4.79 years (63-79 years). Aesthetic improvement, with increase in the tarsal platform show and resolution of lateral hooding, was observed in all cases. At 3 months after surgery, the sub-brow scar was almost unnoticeable in all patients. No complications related to wound dehiscence, lagophthalmos, sensory changes, hematoma, infection, or hypertrophic scars were observed (Fig.). Since selected patients had relatively high lateral brow positions, significant lowering of the brow position or induced brow ptosis was not observed. It has been suggested that brow ptosis occurs to a lesser degree in people of African descent, when compared to Caucasians, due to increased skin tonus. 5 Furthermore, at least 20 mm of skin was preserved between the Sub-Brow Skin Excision as an Alternative to Classic Blepharoplasty in Select Non-Asian Patients A, Sub-brow skin marking. B, A 68-year-old female of African ancestry presented with prominent lateral hooding. C, At post-op month 3 following sub-brow skin excision, the patient shows improvement in lateral hooding with a well-concealed scar.

The Journal of craniofacial surgery, Jan 14, 2018

The management of cicatricial entropion represents a therapeutic challenge especially when the un... more The management of cicatricial entropion represents a therapeutic challenge especially when the underlying causes are progressive cicatricial diseases that affect the ocular surface. The authors aimed to report long-term efficacy of labial mucous membrane graft to manage severe cicatricial entropion of the upper eyelid. This study is a retrospective chart review of patients who underwent tarsotomy associated with labial mucous membrane graft to treat severe cicatricial entropion of the upper eyelid. Surgeries were performed over a 16-year period. Clinical data (age, gender, etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period) were extracted from these patients' charts. Etiology of the cicatricial entropion, improvement of symptoms, eyelid position, recurrence, complications, and follow-up period were evaluated. Sixty-three eyelids from 44 patients underwent surgery. Mean follow-up was 48.4 ± 46.1 months ...

Rev Soc Bras Cir Plast, Jun 1, 2007

Journal of Cataract & Refractive Surgery, 2016

To evaluate the effect of eyelid spasm treatment with botulinum toxin-A (BTX-A) on corneal curvat... more To evaluate the effect of eyelid spasm treatment with botulinum toxin-A (BTX-A) on corneal curvature assessed with Scheimpflug (Pentacam) and Placido (Atlas) systems. Federal University of São Paulo, São Paulo, Brazil. Prospective interventional case series. Patients with hemifacial spasm were evaluated. Steep keratometry (K) and corneal astigmatism (magnitudes and treatment-induced astigmatism) obtained with the Placido and Scheimpflug systems were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. The study evaluated 48 eyes (24 affected and 24 normal contralateral eyes) of 24 patients. The mean steep K and astigmatism values obtained with the Placido system on the affected side before treatment were 46.91 diopters (D) ± 3.57 (SD) and 2.63 ± 2.46 D, respectively. A significant decrease in steep K (45.14 ± 1.20 D) and astigmatism (1.01 ± 0.58 D) was observed 2 months (P = .003 and P = .0004, respectively) and 3 months (45.64 ± 1.77 D and 1.36 ± 1.31 D, respectively) (P = .03 and P = .01, respectively) after treatment. The Scheimpflug system did not show significant changes in steep K measurements during the 4-month period. The mean astigmatism in the affected eye before treatment was 1.27 ± 0.88 D. A significant reduction was observed at 15 days (1.16 ± 1.16 D) and at 4 months (0.91 ± 0.59 D) (P = .02 and P = .03, respectively). The Placido system was more sensitive in detecting a temporary reduction in corneal curvature after eyelid-spasm treatment. None of the authors has a financial or proprietary interest in any material or method mentioned.

Ophthalmic Plastic & Reconstructive Surgery, 2017

Purpose: In Asian patients, lateral hooding in the aging upper eyelid is prominent and frequently... more Purpose: In Asian patients, lateral hooding in the aging upper eyelid is prominent and frequently seen. Removal of the redundant skin of this region during classic blepharoplasty tends to produce a resultant prolonged scar. Furthermore, as the height of the eyelid skin excision increases, suturing of the thick upper skin to the thin pretarsal skin can result in upper lid fullness. This study documents the combination of infrabrow skin excision and upper blepharoplasty to address lateral hooding in select patients of Asian ancestry. Methods: This study is a retrospective chart review of patients who underwent infrabrow skin excision associated with upper blepharoplasty. The inclusion criteria were moderate and severe upper eyelid dermatochalasis in patients with high eyebrows and lateral hooding; residual lateral hooding following previous blepharoplasty. Results: Thirty-two eyelids of 16 female patients of Japanese ancestry underwent infrabrow skin excision associated with upper blepharoplasty. The mean age of patients was 68.87 ± 7.88 years (57-82 years). Mean follow up was 37.25 ± 18.96 months (9-72 months). Patients were evaluated at 1, 3, 6, and 9 months at least. The Strasser system for evaluation of surgical results was applied at 3 months. All patients had scores indicating good results and were satisfied with the cosmetic outcome and improvement of visual field after surgery. No complications related to wound dehiscence, lagophthalmos, hypertrophic scars, or sensory changes were observed. Conclusion: The combination of infrabrow skin excision and upper blepharoplasty was effective to address moderate and severe dermatochalasis with lateral hooding in select patients of Japanese ancestry.

Cornea, 2016

To investigate possible temporary differences in corneal topographic parameters between affected ... more To investigate possible temporary differences in corneal topographic parameters between affected and normal eyes in patients with hemifacial spasm (HFS) treated with botulinum toxin-A (BTX-A), over the course of 1 treatment cycle. This prospective study evaluated corneal topographic differences between affected and normal contralateral eyes during a 4-month period in patients with HFS treated with BTX-A (the duration of action of BTX-A for HFS ranges from 2 to 4 months). Corneal topographic analysis was performed using a conventional topographer (Atlas; Carl Zeiss Meditec, Dublin, CA). Steep K and astigmatism measurements were evaluated before BTX-A application and after 15 days and 2, 3, and 4 months. Twenty-four patients (16 women and 8 men) were evaluated. Steep K [46.9 ± 3.6 diopters (D)] and astigmatism values (2.6 ± 2.5 D) were significantly higher in affected eyes of HFS patients than in nonaffected eyes (45.0 ± 1.4 D and 0.9 ± 0.6 D) before treatment (P = 0.001 for steep K a...

Dermatologic Surgery, 2016

Univ Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Div Ophthalm Plast & Reconstruct Surg, ... more Univ Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Div Ophthalm Plast & Reconstruct Surg, Sao Paulo, Brazil

British Journal of Ophthalmology, 2015

Background/aims In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the ... more Background/aims In patients with hemifacial spasm (HFS), treatment relieves eyelid spasms on the affected side, thus changes in corneal topography and eyelid morphometry may be observed after treatment. We aimed to evaluate these parameters during a 4-month period in patients with HFS treated with botulinum toxin A (BTX-A). Methods This prospective study evaluated eyelid morphometric and corneal topographic changes in patients with HFS before onabotulinum toxin A application, and after 15 days and 2, 3 and 4 months. Results 24 patients were treated with BTX-A. On the normal side, the mean palpebral fissure height (PF), interpalpebral surface area (ISA), steep K and astigmatism values were 8.7±1.98 mm, 122.09± 39.37 mm 2 , 44.99±1.45 D and 0.9±0.64 D, respectively, before treatment. A statistically significant difference was not observed in these parameters after treatment (p>0.05). On the affected side, the mean PF, ISA, steep K and astigmatism were 5.5±1.77 mm, 67.68±28.49 mm 2 , 46.91±3.57 D and 2.63±2.46 D, respectively, before treatment. We observed a statistically significant (p<0.05) increase in the mean PF and ISA on the affected side 15 days (8.36±1.91 mm and 115.92 ±34.44 mm 2 , respectively), 2 months (8.18±1.80 mm and 112.22±33.57 mm 2 , respectively) and 3 months (7.27±1.65 mm and 95.48±27.80 mm 2 , respectively) after treatment. A statistically significant decrease in steep K and astigmatism was observed at 2 months (45.14±1.20 D and 1.01±0.58 D, respectively) and 3 months (45.64±1.77 D and 1.36±1.31 D, respectively) after treatment. Conclusions The results suggest that treatment with BTX-A in patients with HFS leads to eyelid and corneal changes on the affected eye that are significant during the known period of action of the toxin. Thus, caution should be taken when performing ophthalmological examination in patients with HFS, since it may vary according to BTX-A period of action.

Rev. Soc. Bras. Cir. …, 2006

... Orbital fat prolapse GIOVANNI ANDRÉ P. VIANA1, MIDORI OSAKI2, ANA ESTELA SANT'ANNA3, LIL... more ... Orbital fat prolapse GIOVANNI ANDRÉ P. VIANA1, MIDORI OSAKI2, ANA ESTELA SANT'ANNA3, LILIAM OHKAWARA3, PATRÍCIA MIYASATO3 ... 1987;3(2): 83-6. 9. Lessa S, Sebastia R, Flores EE, Pitanguy I, Gonçalves Filho P. Hérnia gordurosa subconjuntival. ...

Journal of Neuro-Ophthalmology, 2019

Ophthalmic Plastic & Reconstructive Surgery, 2020

Anais da SBCPO: 28º Congresso Internacional de Oculoplástica e 7º Congresso Internacional de Estética Periocular, V.1, 2021

Anais da SBCPO: 28º Congresso Internacional de Oculoplástica e 7º Congresso Internacional de Estética Periocular, V.1, 2021

Aesthetic surgery journal, Jan 8, 2017

Transient blepharoptosis is a feared complication after botulinum toxin-A (BTX-A) cosmetic inject... more Transient blepharoptosis is a feared complication after botulinum toxin-A (BTX-A) cosmetic injections into the upper third of the face. Alpha-adrenergic agonist eyedrops are usually employed to address this adverse effect. 1-3 However, response may vary among patients and their use may be associated with ocular adverse effects. 2-4 The use of eyelid make-up might be an alternative approach to manage temporary upper eyelid ptosis. The authors had previous experience using a similar approach to conservatively manage severe myopathic blepharoptosis cases when surgical correction was contraindicated. 5 A retrospective case series was conducted and the authors have complied with the principles of the Declaration of Helsinki. Cases were collected from January 2012 to December 2016. After performing a skin testing at the retroauricular region 24 hours before, in order to rule out allergies to the product, six patients, who had received cosmetic BTX-A injections elsewhere, were treated using a hypoallergenic eyelid make-up (Double eyelid glue, Elizabeth, Japan) as an alternative to manage transient blepharoptosis. This product is water soluble and can be easily removed. The product was applied daily by the patient at the eyelid crease with a swab and allowed to dry for one minute. Then, a plastic Y-shaped stick that comes with the product was placed within the eyelid crease and the upper lid was pushed upward. Thus, a deeper eyelid crease was induced, temporarily elevating the upper eyelid (Figure 1 and Video, which is available online as Supplementary Material at www.aestheticsurgeryjournal.com). Patients were asked to remove the product every night.

Arquivos Brasileiros de Oftalmologia, 2017

A progressão do ceratocone não é inibida reduzindo a força palpebral com o uso da toxina botulíni... more A progressão do ceratocone não é inibida reduzindo a força palpebral com o uso da toxina botulínica tipo A: ensaio clínico randomizado

Aesthetic Surgery Journal, 2017

Arquivos Brasileiros de Oftalmologia, 2011

A síndrome de frouxidão palpebral é caracterizada pela fácil eversão da pálpebra que ocorre espon... more A síndrome de frouxidão palpebral é caracterizada pela fácil eversão da pálpebra que ocorre espontaneamente durante o sono causando exposição dos olhos, com consequente conjuntivite papilar crônica. Sua patogênese ainda não está totalmente definida e é mais comum em pacientes masculinos, obesos, de meia idade e está associada a doenças sistêmicas como apnéia obstrutiva do sono, hipertensão arterial e diabetes. Quando o tratamento clínico não apresenta boa resposta, procedimentos cirúrgicos apresentam bons resultados, com técnicas em constante evolução.

Aesthetic Surgery Journal, 2015

JAMA ophthalmology, Jan 23, 2015

Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The l... more Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The literature regarding antibiotic use for eyelid surgery is lacking. To determine standard care and assess factors influencing antibiotic prescribing practices for eyelid surgery. A survey study was conducted from February 2, 2014, to March 24, 2014. The survey was distributed to 2397 oculoplastic surgeons in private and academic oculoplastic surgery practices in 43 countries. All surgeons were members of ophthalmic plastic and reconstructive surgery societies. Data were analyzed by geographic location. Linear regression was performed to quantify contributions to rates of prescribing postoperative antibiotics for routine eyelid surgical procedures. Rates of prescribing prophylactic intravenous, oral, and topical antibiotics as well as factors that influence surgeons' prescribing practices. A total of 782 responses were received from 2397 surgeons (average response rate, 36.7%; 2.5% marg...