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Article ; Online: The Effect of Supine Versus Upright Positioning on Eyelid Height in the Nonsurgical Patient.

Wier, Garrison P / Legocki, Alex T / Radke, Phillip M A / Sires, Bryan S

Ophthalmic plastic and reconstructive surgery

2024

Abstract: Purpose: To directly compare margin-reflex distance 1, margin-reflex distance 2, and palpebral fissure in the upright versus supine positions in nonsurgical patients.: Methods: A total of 43 patients (31 female, 12 male, and age range 26-96) were ... ...

Abstract	Purpose: To directly compare margin-reflex distance 1, margin-reflex distance 2, and palpebral fissure in the upright versus supine positions in nonsurgical patients. Methods: A total of 43 patients (31 female, 12 male, and age range 26-96) were enrolled. Photos were taken in the clinic in the upright and supine position with a ruler placed vertically in the same plane as the eyelid, and the above computer-analyzed measurements were obtained. Results: Among the 86 eyes observed, the average upright margin-reflex distance 1 was 2.97 mm (95% confidence interval [CI], 2.70-3.24), while the average supine margin-reflex distance 1 was 2.38 mm (95% CI, 2.13-2.63). These differences were statistically significant (p < 0.001). Similarly, statistically significant differences were seen with margin-reflex distance 2 (p < 0.001), where upright measurements averaged 5.57 mm (95% CI, 5.33-5.81), and supine measurements averaged 5.01 mm (95% CI, 4.73-5.28). Finally, palpebral fissure showed similar significance (p < 0.001). Upright measurements averaged 8.54 mm (95% CI, 8.19-8.90), while supine measurements averaged 7.38 mm (95% CI, 7.00-7.76). Conclusions: Supine positioning provides a decrease in margin-reflex distance 1, margin-reflex distance 2, and palpebral fissure when compared with upright positioning in nonsurgical patients. This contradicts a previous study on intraoperative patients when lidocaine with epinephrine was used. This study helps us better understand the normal physiologic response to position changes with regard to eyelid height in the nonsurgical patient. As such, this study may function as a control for future studies comparing anesthetic/surgical parameter effects on intra- and post-operative eyelid heights.
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	632830-1
ISSN	1537-2677 ; 0740-9303
ISSN (online)	1537-2677
ISSN	0740-9303
DOI	10.1097/IOP.0000000000002665
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Article: Fishing for Trouble: A Novel Surgical Technique for Penetrating Fishhook Injuries of the Eyelid.

Brown, Nathan J / Legocki, Alex T / Tam, Emily K / Baran, Francine M

Cureus

2023 Volume 15, Issue 3, Page(s) e36478

Abstract: Fishhook injuries commonly occur and may present as ophthalmic surgical emergencies. Choosing the appropriate removal technique is critical and depends on the involved extra- and intra-ocular structures and hook characteristics. We describe the case of a ...

Abstract	Fishhook injuries commonly occur and may present as ophthalmic surgical emergencies. Choosing the appropriate removal technique is critical and depends on the involved extra- and intra-ocular structures and hook characteristics. We describe the case of a challenging fishhook removal where a novel surgical technique was developed. An eight-year-old boy presented with a full-thickness fishhook injury to the eyelid. During removal surgery, the thickness and density of the fishhook prevented surgical tools from transecting the shank. A novel approach was deemed necessary for safe removal, termed the clamp and retract technique. To our knowledge, this is its first documented use in the literature.
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.36478
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Article ; Online: Anisocoria Due to Ocular Ischemic Syndrome.

Legocki, Alex T / Davis, John A / Francis, Courtney E

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society

2022 Volume 43, Issue 4, Page(s) e251–e252

MeSH term(s)	Humans ; Anisocoria/diagnosis ; Anisocoria/etiology ; Pupil ; Eye Diseases
Language	English
Publishing date	2022-03-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	1189901-3
ISSN	1536-5166 ; 1070-8022
ISSN (online)	1536-5166
ISSN	1070-8022
DOI	10.1097/WNO.0000000000001539
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Article: Considerations in Orbital Reconstruction for the Oncologic Surgeon: Critical versus Optimal Objectives.

Legocki, Alex T / Miles, Brett A

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India

2019 Volume 52, Issue 2, Page(s) 231–237

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2019-08-29
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2118680-7
ISSN	1998-376X ; 0970-0358
ISSN (online)	1998-376X
ISSN	0970-0358
DOI	10.1055/s-0039-1696624
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Article: Considerations in Orbital Reconstruction for the Oncologic Surgeon: Critical versus Optimal Objectives

Legocki, Alex T. / Miles, Brett A.

Indian Journal of Plastic Surgery

2019 Volume 52, Issue 02, Page(s) 231–237

Abstract: Background: Orbital reconstruction following oncologic midface resection is uniquely challenging, and makes critical contributions to patient aesthetics, function, and identity. Approach is largely dependent on surgeon and patient preferences, and there ...

Abstract	Background: Orbital reconstruction following oncologic midface resection is uniquely challenging, and makes critical contributions to patient aesthetics, function, and identity. Approach is largely dependent on surgeon and patient preferences, and there exists no consensus on defect characterization. Objective: The goal of the study is to provide a mental framework for the reconstructive oncologic surgeon to use as a foundation during his or her approach to the orbit. Design: The design of the study is based on the review of current literature and expert opinion. Conclusions: Critical versus optimal objectives must be set in orbital reconstruction, and a systematic approach should be followed. We approach orbital reconstruction by first deciding whether globe-sparing surgery is possible, or if orbital exenteration will be necessary. We then set critical and optimal objectives for our chosen pathway. Critical goals in globe-sparing reconstruction include maintaining orbital volume and preserving visual function, and an optimal goal includes preservation of the nasolacrimal system. Critical goals in orbital exenteration include obliterating the defect, sealing the skull base and nasal cavities, and allowing eye protection to be worn over the contralateral eye postoperatively. Optimal goals in exenteration include preparation for prosthetics, volume and bony replacement, eyelid-sparing technique, and consideration of postoperative radiation.
Keywords	orbit ; globe ; reconstruction ; midface ; exenteration ; flap ; approach ; planning
Language	English
Publishing date	2019-05-01
Publisher	Thieme Medical and Scientific Publishers Private Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2118680-7
ISSN	1998-376X ; 0970-0358
ISSN (online)	1998-376X
ISSN	0970-0358
DOI	10.1055/s-0039-1696624
Database	Thieme publisher's database

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Article ; Online: Multivariate Models to Diagnose Early Referral-Warranted Retinopathy of Prematurity With Handheld Optical Coherence Tomography.

Legocki, Alex T / Lee, Aaron Y / Ding, Leona / Moshiri, Yasman / Zepeda, Emily M / Gillette, Thomas B / Grant, Laura E / Shariff, Ayesha / Touch, Phanith / Lee, Cecilia S / Tarczy-Hornoch, Kristina / Cabrera, Michelle T

Translational vision science & technology

2023 Volume 12, Issue 5, Page(s) 26

Abstract: Purpose: The purpose of this study was to create multivariate models predicting early referral-warranted retinopathy of prematurity (ROP) using non-contact handheld spectral-domain optical coherence tomography (OCT) and demographic data.: Methods: ... ...

Abstract	Purpose: The purpose of this study was to create multivariate models predicting early referral-warranted retinopathy of prematurity (ROP) using non-contact handheld spectral-domain optical coherence tomography (OCT) and demographic data. Methods: Between July 2015 and February 2018, infants ≤1500 grams birth weight or ≤30 weeks gestational age from 2 academic neonatal intensive care units were eligible for this study. Infants were excluded if they were too unstable to participate in ophthalmologic examination (2), had inadequate image quality (20), or received prior ROP treatment (2). Multivariate models were created using demographic variables and imaging findings to identify early referral-warranted ROP (referral-warranted ROP and/or pre-plus disease) by routine indirect ophthalmoscopy. Results: A total of 167 imaging sessions of 71 infants (45% male infants, gestational age 28.2+/-2.8 weeks, and birth weight 995.6+/-292.0 grams) were included. Twelve of 71 infants (17%) developed early referral-warranted ROP. The area under the receiver operating characteristic curve (AUC) was 0.94 for the generalized linear mixed model (sensitivity = 95.5% and specificity = 80.7%) and 0.83 for the machine learning model (sensitivity = 91.7% and specificity = 77.8%). The strongest variables in both models were birth weight, image-based Vitreous Opacity Ratio (an estimate of opacity density), vessel elevation, and hyporeflective vessels. A model using only birth weight and gestational age yielded an AUC of 0.68 (sensitivity = 77.3% and specificity = 63.4%), and a model using only imaging biomarkers yielded 0.88 (sensitivity = 81.8% and specificity = 84.8%). Conclusions: A generalized linear mixed model containing handheld OCT biomarkers can identify early referral-warranted ROP. Machine learning produced a less optimal model. Translational relevance: With further validation, this work may lead to a better-tolerated ROP screening tool.
MeSH term(s)	Infant ; Infant, Newborn ; Male ; Humans ; Female ; Retinopathy of Prematurity/diagnostic imaging ; Tomography, Optical Coherence ; Birth Weight ; Machine Learning ; Ophthalmoscopy
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2674602-5
ISSN	2164-2591 ; 2164-2591
ISSN (online)	2164-2591
ISSN	2164-2591
DOI	10.1167/tvst.12.5.26
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Article ; Online: Benefits and Limitations of Entry-Level 3-Dimensional Printing of Maxillofacial Skeletal Models.

Legocki, Alex T / Duffy-Peter, Andrew / Scott, Andrew R

JAMA otolaryngology-- head & neck surgery

2017 Volume 143, Issue 4, Page(s) 389–394

Abstract: Importance: A protocol for creating exceptionally low-cost 3-dimensional (3-D) maxillofacial skeletal models does not require proficiency with computer software or intensive labor. Small and less affluent centers can produce models with little loss in ... ...

Abstract	Importance: A protocol for creating exceptionally low-cost 3-dimensional (3-D) maxillofacial skeletal models does not require proficiency with computer software or intensive labor. Small and less affluent centers can produce models with little loss in accuracy and clinical utility. Objectives: To highlight the feasibility and methods of introducing in-house, entry-level additive manufacturing (3-D printing) technology to otolaryngologic craniofacial reconstruction and to describe its clinical applications and limitations, including a comparison with available vendor models. Design, setting, and participants: This case series of 6 models (3 pairs) compared cost, side-by-side anatomical model fidelity, and clinical versatility using entry-level, in-house 3-D pediatric mandible model production vs high-end, third-party vendor modeling, including a review of the literature. Comparisons were made at an urban pediatric otolaryngology practice among patients who had previously undergone pediatric craniofacial reconstruction with use of a commercially produced medical model for surgical planning. Each vendor model had been produced using computed tomographic imaging data. With the use of this same data source, in-house models were printed in polylactic acid using a commercially available printer. Data were collected from November 1 to December 30, 2015. Main outcomes and measures: Models created from these 2 methods of production were assessed for fidelity of surface anatomy, resilience to manipulation and plate bending, cost of production, speed of production, sterilizability, virtual surgical planning options, and alveolar nerve canal and tooth root visibility in mandibles. Results: For the quantitative comparisons between in-house models (1 neonatal, 1 pediatric, and 1 adult model) and their commercial counterparts, the mean value of 7 independent measurements was analyzed from each of 3 model pairs. Caliper measurements from models produced through entry-level, in-house manufacturing were comparable to those taken from commercially produced counterparts, suggesting an acceptable degree of accuracy (0.54 mm; 95% CI, 0.36-0.72 mm). Fixed costs for in-house production included acquiring an entry-level printer (retail $2899) and an annual software subscription ($699 per year). After purchase of these initial assets, the printing cost for an in-house mandible was approximately $90, with 98% of that cost related to labor. Physical qualities of entry-level, in-house models such as nerve canal visibility, tooth root visibility, and sterilizability were inferior compared with commercially-produced stereolithic renderings. Conclusions and relevance: This low-cost method of in-house, entry-level 3-D printing of straightforward, skeletal models may suit a general otolaryngology practice that performs maxillofacial reconstruction. Although commercial modeling offers several unique features, such as sterilizable materials and advanced virtual planning, in-house modeling also produces renderings with high fidelity, which may be used as tools for education and surgical planning, including preoperative plate bending. Level of evidence: 4.
MeSH term(s)	Humans ; Mandible ; Maxilla ; Models, Anatomic ; Printing, Three-Dimensional
Language	English
Publishing date	2017-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2016.3673
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Article ; Online: Choroidal Thickness by Handheld Swept-Source Optical Coherence Tomography in Term Newborns.

Huang, Laura C / Zhou, Hao / Legocki, Alex T / Scoville, N Max / Zhong, Junping / Ding, Leona / Wang, Ruikang K / Cabrera, Michelle T

Translational vision science & technology

2021 Volume 10, Issue 2, Page(s) 27

Abstract: Purpose: To describe normative values for choroidal thickness in newborns and characterize their relationship to vitreoretinal features.: Methods: Term newborns underwent awake, handheld swept-source optical coherence tomography (SS-OCT) in this ... ...

Abstract	Purpose: To describe normative values for choroidal thickness in newborns and characterize their relationship to vitreoretinal features. Methods: Term newborns underwent awake, handheld swept-source optical coherence tomography (SS-OCT) in this prospective cohort study. An automated segmentation algorithm followed by manual adjustments measured choroidal thickness at the fovea and five perifoveal locations. Two masked, trained graders, with a third mediating disagreements, analyzed scans for vitreoretinal findings. OCT vitreoretinal findings, including dome-shaped macula, subretinal fluid, punctate hyperreflective vitreous opacities, persistent inner retinal layers, foveal ellipsoid zone, tractional and non-tractional vitreous bands, epiretinal membrane, cystoid macular edema, vessel elevation, scalloped retinal layers, hyporeflective vessels, and retinal spaces, were assessed and correlated with foveal choroidal thickness using a generalized linear mixed model. Results: Fifty-nine eyes of 39 infants (mean gestational age, 39.5 weeks; 18 male, 46%) were included. Mean foveal choroidal thickness was 455.5 ± 93.9 µm. Choroid was thinner inferonasally (343.6 ± 106.2 µm) compared to superonasally (368.4 ± 92.9 µm; P = 0.03) and superotemporally (369.6 ± 100.6 µm; P = 0.02). Thinner foveal choroidal thickness was associated with absence of a foveal ellipsoid zone (437.1 ± 78.5 µm vs. 553.7 ± 93.9 µm; P = 0.02). Choroidal thickness was not significantly associated with other OCT findings. Conclusions: We identified an association between thinner choroid and foveal immaturity. Additional study is needed to determine whether choroidal development impacts visual outcomes. Translational relevance: Handheld SS-OCT achieved normative measurements for choroidal thickness across the macula in term newborns, providing a foundation for future investigations into the role of choroidal development in infancy.
MeSH term(s)	Choroid/diagnostic imaging ; Fovea Centralis ; Humans ; Infant ; Infant, Newborn ; Macula Lutea ; Male ; Prospective Studies ; Tomography, Optical Coherence
Language	English
Publishing date	2021-06-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2674602-5
ISSN	2164-2591 ; 2164-2591
ISSN (online)	2164-2591
ISSN	2164-2591
DOI	10.1167/tvst.10.2.27
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Article ; Online: Choroidal Morphology and Vascular Analysis in Eyes With Neovascular Age-Related Macular Degeneration Using Spectral-Domain Optical Coherence Tomography.

Legocki, Alex T / Adhi, Mehreen / Weber, Marissa L / Duker, Jay S

Ophthalmic surgery, lasers & imaging retina

2016 Volume 47, Issue 7, Page(s) 618–625

Abstract: Background and objective: To describe morphology and vascular layer thickness of the choroid in eyes with neovascular age-related macular degeneration (AMD) using spectral-domain optical coherence tomography (SD-OCT).: Patients and methods: Cross- ... ...

Abstract	Background and objective: To describe morphology and vascular layer thickness of the choroid in eyes with neovascular age-related macular degeneration (AMD) using spectral-domain optical coherence tomography (SD-OCT). Patients and methods: Cross-sectional, retrospective analysis of 15 eyes with neovascular AMD and 11 healthy age-matched eyes that underwent single horizontal, high-definition raster line imaging using high-definition SD-OCT. Two independent graders assessed choroid morphology and measured the thickness of individual vascular layers of the choroid beneath the fovea. Results: Normal concave choroidal contour was found in 13.3% of eyes with neovascular AMD and 100% of healthy eyes. The thickest point of the choroid was located beneath the foveal center in 20% of eyes and focal thinning was observed in 40% of eyes with neovascular AMD, compared to 91% and 0% of healthy eyes, respectively. Subfoveal total choroidal thickness, large choroidal vessel layer thickness, and the medium choroidal vessel/choriocapillaris layer thickness were reduced in eyes with neovascular AMD compared to healthy eyes (205.7 µm ± 17.08 µm versus 281.3 µm ± 19.29 µm, P = .007; 174.1 µm ± 16.34 µm versus 244.5 µm ± 19.51 µm, P = .01; and 31.53 µm ± 3.67 µm verus 51.9 µm ± 1.94 µm, P = .0002, respectively). Conclusion: Choroidal morphology is altered in eyes with neovascular AMD as assessed on SDOCT. Choroidal thinning in neovascular AMD involves all its vascular layers. These morphological and vascular changes may have clinical implications in the diagnosis and monitoring of eyes with neovascular AMD. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:618-625.].
MeSH term(s)	Aged ; Choroid/blood supply ; Choroidal Neovascularization/diagnosis ; Choroidal Neovascularization/etiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Retinal Vessels/pathology ; Retrospective Studies ; Tomography, Optical Coherence/methods ; Visual Acuity ; Wet Macular Degeneration/complications ; Wet Macular Degeneration/diagnosis
Language	English
Publishing date	2016-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701167-7
ISSN	2325-8179 ; 2325-8160
ISSN (online)	2325-8179
ISSN	2325-8160
DOI	10.3928/23258160-20160707-02
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Article ; Online: Nasal fractures in children and adolescents: Mechanisms of injury and efficacy of closed reduction.

Liu, Clive / Legocki, Alex T / Mader, Nicholas S / Scott, Andrew R

International journal of pediatric otorhinolaryngology

2015 Volume 79, Issue 12, Page(s) 2238–2242

Abstract: Objectives: To determine the most common mechanisms of traumatic nasal deformity referred to pediatric otolaryngology. To examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents' and surgeons' ratings ...

Abstract	Objectives: To determine the most common mechanisms of traumatic nasal deformity referred to pediatric otolaryngology. To examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents' and surgeons' ratings of post-reduction nasal symmetry. Methods: Case series and chart review within an urban, tertiary pediatric otolaryngology practice. Results: 100 cases of traumatic nasal deformity met inclusion criteria over a 3-year study period. The mean age at presentation was 13 years (4 weeks-18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports-related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%) and alcohol-related (2%). Of these 100 cases, 22% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. 21 of 22 post-reduction patients were assessed for nasal symmetry at the postoperative visit (7-10 days following surgery). The operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) satisfied in 81% of cases. Both parent and surgeon were satisfied with post-reduction symmetry 33% of the time. Conclusion: The most common sources of traumatic nasal deformity in children and adolescents vary by age. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases, however a result in which both parent and surgeon agree with successful re-establishment of symmetry occurs in only one-third of cases.
MeSH term(s)	Accidents, Traffic ; Adolescent ; Athletic Injuries/complications ; Attitude of Health Personnel ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Nasal Bone/injuries ; Nose Deformities, Acquired/etiology ; Parents/psychology ; Patient Satisfaction ; Retrospective Studies ; Skull Fractures/etiology ; Skull Fractures/therapy ; Treatment Outcome ; Violence
Language	English
Publishing date	2015-12
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2015.10.011
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