The magnitude and short-term recovery of residual objective myopic bias after a brief, clinically plausible over-minus exposure during distance refraction remain insufficiently quantified. This study quantified the short-term residual objective myopic shift following 10 s of transient myopic overcorrection of 0.50 D or 1.00 D in young adults with myopia. Twenty healthy young adults with myopia and low astigmatism underwent open-field automated objective over-refraction (OR) while viewing a high-contrast 5 m target. After trial lenses induced a moderate myopic state, each participant completed three randomized 10 s lens conditions: 0.50 D undercorrection, 0.50 D overcorrection, and 1.00 D overcorrection. The primary endpoint was OR at 5 s after restoration of the objective neutral correction. Both overcorrection conditions produced significantly more negative OR than undercorrection at 5 s; exploratory analyses showed the same pattern at 10 s. The shift was evident at 5 and 10 s after restoration of the objective neutral correction and, by 30 s, was no longer statistically significant and appeared clinically negligible. This bias should be considered when OR measurements obtained shortly after over-minus lens exposure are used to inform subsequent subjective refinement.

This case series describes the surgical technique and early postoperative outcomes of transcutaneous levator aponeurosis recession without spacer grafts or newly created flaps for upper eyelid retraction. We report five consecutive Japanese patients (five eyelids) who underwent this procedure at Kanemori Eye Plastic Surgery Clinic between July 2017 and February 2026. Preoperative and three-month postoperative images were analyzed using ImageJ (National Institutes of Health; Bethesda, Maryland, United States). Palpebral fissure height ratio (PFHR) and upper eyelid margin height ratio (UEMHR) were calculated by normalizing palpebral fissure height and upper eyelid margin height to the white-to-white distance (WTW). Each image was measured three times, and the mean value was used for descriptive analysis. The median PFHR of the operated eyelid decreased from 111.18% (range, 63.57-132.16%) preoperatively to 89.93% (range, 59.50-99.71%) postoperatively. The median UEMHR decreased from 57.59% (range, 28.20-77.38%) to 37.72% (range, 25.17-50.09%). PFHR and UEMHR decreased in all five operated eyelids, and intereye asymmetry in both indices decreased. Exposure-related superficial punctate keratopathy in Cases 2, 3, and 5 and lagophthalmos in Case 4 resolved postoperatively. During the three-month follow-up, no infection, hematoma, diplopia, new severe lagophthalmos, or overcorrection/undercorrection requiring reoperation was observed. These early findings suggest that this spacer-free technique is feasible in selected cases and may provide consistent eyelid lowering when assessed with WTW-normalized eyelid height indices; however, these non-standard photographic indices are not substitutes for prospectively measured margin reflex distance 1 (MRD1). Larger prospective studies with longer follow-up, standardized MRD1 and ocular surface assessment, masked independent graders, and formal measurement reproducibility analysis are needed to assess durability, recurrence, late eyelid contour changes, measurement reliability, and etiology-specific suitability.

Objective: To evaluate the changes of binocular visual function and patient satisfaction after small-incision lenticule extraction (SMILE) with micro-monovision in myopic patients with presbyopia. Methods: This was a single-arm clinical trial. Myopic patients with presbyopia who underwent micro-monovision SMILE at Beijing Tongren Hospital, Capital Medical University, from January 2019 to March 2021 were enrolled. The surgical design principle was full correction of the dominant eye for distance vision, with the non-dominant eye undercorrected by -1.50 D to -0.50 D for near vision. Best corrected distance visual acuity and best corrected near visual acuity (CNVA) for the dominant eye, non-dominant eye, and both eyes were measured before surgery. Uncorrected distance and near visual acuity (UDVA, UNVA), CDVA, and CNVA for the dominant eye, non-dominant eye, and both eyes were measured at 1, 3, 6 months, 3 years, and 5 years after surgery. Accommodative function parameters were measured preoperatively and at each postoperative follow-up visit, including binocular accommodative amplitude (AMP) measured by the push-up method, accommodative response (BCC) measured by the binocular cross-cylinder method, negative relative accommodation (NRA), and positive relative accommodation (PRA), as well as distance and near stereopsis and Worth 4-dot tests. A visual satisfaction questionnaire was administered after surgery. Results: A total of 51 patients (102 eyes) with myopia and presbyopia were included, comprising 19 males and 32 females, aged (41.68±2.47) years. Sixteen patients (32 eyes) completed the 5-year follow-up. The binocular UDVA and UNVA were (-0.02±0.06) logMAR and (0.01±0.09) logMAR at 5 years after surgery, respectively. The spherical equivalent of the dominant and non-dominant eyes was (-0.24±0.22) D and (-0.80±0.37) D, respectively. The binocular AMP decreased from (5.66±0.28) D before surgery to (4.36±0.19) D at 1 month after surgery, and returned to the preoperative level at 3 months after surgery; The PRA decreased from (-1.93±0.17) D before surgery to (-1.33±0.13) D at 1 month after surgery, and returned to the preoperative level at 6 months after surgery. The BCC increased at 1 month after surgery and returned to the preoperative level at 6 months after surgery (differences across time points were all statistically significant, P<0.05). These indicators slightly decreased at 3 and 5 years postoperatively compared with their respective recovered levels. There were no statistically significant differences in NRA and near stereopsis at any postoperative follow-up time point compared with preoperative values. All patients achieved 60″ distance and near stereopsis at each postoperative follow-up visit point, and the Worth 4-dot tests showed both central and peripheral fusion function in both eyes. The subjective satisfaction score was (9.06±1.18) (out of 10) at 5 years after surgery, with a satisfaction rate of 15/16. Conclusions: SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage. The AMP, PRA, and BCC returned to preoperative levels at 3 and 6 months postoperatively, with a slight decrease at 3 to 5 years. The procedure did not affect binocular visual functions such as fusion and stereopsis. At 5 years after surgery, patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction.

Metopic craniosynostosis occurs due to premature fusion of the metopic suture, preventing normal lateral expansion of the frontal bones and resulting in trigonocephaly and hypotelorism. Metopic craniosynostosis with trigonocephaly is commonly treated with open fronto-orbital advancement and cranial vault remodeling (FOA/CVR). Although this procedure improves cranial contour, it does not directly widen the medial orbital walls, and its effect on hypotelorism remains uncertain. This study evaluated changes in bony interorbital distance (BIOD) and related craniometric parameters after standard FOA/CVR in patients with isolated metopic craniosynostosis. A retrospective single-institution study was performed of 19 pediatric patients with isolated metopic craniosynostosis who underwent open FOA/CVR from 2012 to 2019. Patients with syndromic craniosynostosis, multisuture synostosis, or minimally invasive repair were excluded. Pre- and postoperative CT scans were reviewed, and axial measurements were obtained, including BIOD/interdacryon distance, interzygomaticofrontal suture distance, bilateral orbital rim angles, and endocranial bifrontal angle. Pre- and postoperative values were compared, and interdacryon distance was compared with age-matched normative values using t tests. Mean age at surgery was 299 days, and mean postoperative imaging follow-up was 469 days. Interdacryon distance increased significantly after FOA/CVR from 13.35 mm to 14.81 mm (P=0.0296), and interzygomaticofrontal distance increased from 68.46 mm to 77.54 mm (P=0.0005). Orbital rim angles and endocranial bifrontal angle did not significantly change. Despite improvement, interdacryon distance remained significantly below age-matched normative values. Standard open FOA/CVR produces measurable improvement in BIOD; however, undercorrection of hypotelorism remains common at least 1 year postoperatively.