The first edition of this slim paperback appeared in 1983. Although the author states that the main change in the second edition is the addition of a chapter on lacrimal surgery by R. A. N. Welham, in fact, most chapters have been modified, and the discussion of trauma and cosmetic surgery has been expanded substantially. The first edition consisted of 134 pages with eight chapters and 92 illustrations. The second edition has 166 pages with 10 chapters and 119 illustrations. After an introductory review of pertinent anatomy, subsequent chapters deal with major topics, such as entropion and trichiasis, ectropion, ptosis, and socket surgery. Collin's approach to each problem is based on his extensive experience as director of the Lid Clinics at Moorfields Eye Hospital in London, England. Most chapters contain one or more flow charts summarizing Collin's "system" for a particular problem. The flow charts lead the reader through a

A manual of systematic eyelid surgery

Plastic surgery of the face

Critical review: Typical and atypical optic neuritis.

OBJECTIVE: The time taken to reach maximal haemostatic effect following local anaesthesia with epinephrine is generally believed to be <10 min. This is based on clinical experience and indirect measurements of perfusion using methods such as laser Doppler flowmetry and oxygen spectroscopy. However, the only study in which bleeding has been measured quantitatively in an intra-operative setting in humans showed that the full haemostatic effect was not achieved until 30 min after anaesthesia. The aim of this study was to determine the time taken to reach maximum haemostatic effect when using epinephrine for local anaesthesia in oculoplastic surgery.METHODS: Intra-operative bleeding following infiltration anaesthesia with either lidocaine 20 mg/ml (2%) or lidocaine + epinephrine 12.5 μg/ml (1:80 000) was measured after 7, 15 and 30 min in the eyelids of 16 patients undergoing upper eyelid blepharoplasty.RESULTS: Bleeding was decreased by 74.6% (with 95% CI, 6.16-87.6%) 7 min after the injection of lidocaine + epinephrine (p = 0.0048) compared with lidocaine without epinephrine. There was no further decrease in bleeding after 15 or 30 min (p = n.s.).CONCLUSION: The optimal time for skin incision in eyelid surgery is within 7 min of injection of lidocaine with epinephrine. Waiting longer does not lead to a further decrease in bleeding. (Less)

A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia.

Background The Breslow depth is an important parameter to determine the excision margin and prognosis of melanoma. However, it is difficult to accurately determine the actual Breslow depth before surgery using the existing ocular micrometer and biopsy technique. Objectives To evaluate the use of 3D wide-field multispectral photoacoustic imaging to non-invasively measure depth and outline the boundary of melanomas for optimal surgical margin selection. Methods Six melanoma patients were examined in vivo using the 3D multispectral photoacoustic imaging system. For five cases of melanomas (one in situ, three nodular, and one acral lentiginous type melanoma), the spectrally unmixed photoacoustic depths were calculated and compared against histopathological depths. Results Spectrally unmixed photoacoustic depths and histopathological depths match well within a mean absolute error of 0.36 mm. In particular, the measured minimum and maximum depths in the in situ and nodular type of melanoma were 0.6 and 9.1 mm, respectively. In the 3D photoacoustic image of one metastatic melanoma, feeding vessels were visualized in the melanoma, suggesting the neovascularization around the tumour. Conclusions The 3D multispectral photoacoustic imaging not only provides well-measured depth and sizes of various types of melanomas, it also visualizes the metastatic type of melanoma. Obtaining accurate depth and boundary information of melanoma before surgery would play a useful role in the complete excision of melanoma during surgery.

3D wide-field multispectral photoacoustic imaging of human melanomas in vivo: a pilot study

The aim was to investigate the relationship between the dimensions (length, width, and thickness) of random advancement skin flaps and retained tissue perfusion and oxygenation.

Perfusion and Oxygenation of Random Advancement Skin Flaps Depend More on the Length and Thickness of the Flap Than on the Width to Length Ratio.

Photoacoustic imaging for three-dimensional visualization and delineation of basal cell carcinoma in patients

OBJECTIVE:: This study investigates the hypoperfusion effects of epinephrine in local anesthesia in eyelid surgery. A novel form of extended-wavelength diffuse reflectance spectroscopy was evaluated. METHODS:: Blood perfusion in porcine eyelid flaps was measured using laser Doppler velocimetry and laser speckle contrast imaging, whereas the tissue response was measured using diffuse reflectance spectroscopy with a broad spectrum (450–1550 nm). Epinephrine was either injected cumulatively, 0.1 (1:10,000,000), 1.0 (1:1,000,000), 10 (1:100 000), and 100 μg/ml (1:10 000), to determine the dose–response relation, or given as a single dose (10 μg/ml). Control experiments were performed with saline or lidocaine. RESULTS:: Increasing concentrations of epinephrine resulted in a gradual decrease in tissue perfusion, measured by laser Doppler velocimetry and laser speckle contrast imaging, approaching a minimum after the injection of 10 μg/ml. Similar tissue response was observed with diffuse reflectance spectroscopy. The time from the injection of epinephrine (10 μg/ml) to the stabilization of hypoperfusion was 75 seconds. After administration of 10 μg/ml epinephrine, about 20% of the blood perfusion remained, supporting the use of epinephrine in eyelid flaps with a narrow pedicle. CONCLUSIONS:: 10 μg/ml epinephrine appears to be adequate for vasoconstriction before oculoplastic surgery. Incisions need only be delayed for about 1 minute. Extended-wavelength diffuse reflectance spectroscopy appears to be a promising technique for monitoring the tissue response following changes in blood perfusion in plastic surgery reconstructions. However, more rigorous validation of the technique is required before it can be implemented in clinical practice. (Less)

Optimal Epinephrine Concentration and Time Delay to Minimize Perfusion in Eyelid Surgery : Measured by Laser-Based Methods and a Novel Form of Extended-Wavelength Diffuse Reflectance Spectroscopy

The objective was to provide a clinical setup for photoacoustic imaging (PAI) of the temporal artery in humans and to describe the challenges encountered and methods of overcoming them. The temporal artery was examined in seven patients with suspect giant-cell arteritis (GCA), both in vivo and ex vivo , and the results were compared to that of histology. To adapt PAI to the human studies, the transducer was fixed to an adjustable arm to reduce motion artifacts, and a stepping motor was developed to enable 3-D scanning. Risks associated with the use of lasers, ultrasound, and electrical equipment were evaluated by measuring energy levels, and safety precautions were undertaken to prevent injury to the patients and staff. The PAI spectra obtained clearly delineated the artery wall, both in vivo and ex vivo , although the latter was of high quality due to the lack of artifacts. The results could be compared to that of histology. The involved energy levels were found to be below the limits given in regulatory standards. Eye protectors prevented irradiation of the patient’s eyes, and visual function after the procedure was found not to be affected. The patients reported no discomfort during the investigations. PAI provides images of the temporal artery wall that may be used for the future diagnosis of GCA in humans. The technique could be further refined by addressing the specific problems of motion artifacts and interference from blood and other chromophores. This study paves the way for other clinical applications of PAI.

Rafi Sheikh

Papers

A waiting time of 7 min is sufficient to reduce bleeding in oculoplastic surgery following the administration of epinephrine together with local anaesthesia.

Perfusion and Oxygenation of Random Advancement Skin Flaps Depend More on the Length and Thickness of the Flap Than on the Width to Length Ratio.

Photoacoustic imaging for three-dimensional visualization and delineation of basal cell carcinoma in patients

Optimal Epinephrine Concentration and Time Delay to Minimize Perfusion in Eyelid Surgery : Measured by Laser-Based Methods and a Novel Form of Extended-Wavelength Diffuse Reflectance Spectroscopy

Clinical Translation of a Novel Photoacoustic Imaging System for Examining the Temporal Artery