Computational protocol: Relationship between lower eyelid epiblepharon and epicanthus in Korean children

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Protocol publication

[…] The Samsung Medical Center Institutional Review Board approved the retrospective review, and the study complied with the tenets of the Declaration of Helsinki. Written informed consent was provided by the children’s parents or guardians for their clinical records and facial photographs to be used in this study for analysis and for publication.We retrospectively reviewed 119 Korean children who underwent lower eyelid epiblepharon repair by a single surgeon (K.I.W.) at the Samsung Medical Center between January 2010 and December 2012.Surgical criteria included the presence of lash-corneal touch due to epiblepharon in the primary position with punctate corneal erosion or severe irritative symptoms. Consecutive patients aged ≤18 years were included. For each patient with epiblepharon, we selected an age and sex-matched control patient from among those who underwent strabismus surgery for intermittent exotropia. To select matched cases, the surgical log of strabismus surgery at Samsung Medical Center was searched from January 2010 to December 2012. Matches were made based on age and sex. When manifest exotropia or esotropia was noted on a photograph, the corresponding patient was replaced with another patient with no visible deviation. The exclusion criteria were as follows: lack of a preoperative photograph, a history of previous trauma or eyelid surgery, Down syndrome, and a congenital craniofacial anomaly. Age and sex and the presence of an upper eyelid crease were noted.Epicanthus was defined as present when a skin fold covered the medial canthal angle and hid the caruncle vertically. To quantify the severity of epicanthus, the ratio of the inner intercanthal distance (IICD) to interpupillary distance (IPD) (IICD/IPD ratio) and the ratio of the IICD to outer intercanthal distance (OICD) (IICD/OICD ratio) were calculated. The prevalence of epicanthus, severity of epicanthus (as determined by the IICD/IPD and IICD/OICD ratios), configuration of epicanthus, and the prevalence of an upper eyelid crease in the epiblepharon and control groups were compared.The IICD, OICD, and IPD were measured on digital photographs that were taken before surgery (). A single blinded observer measured the IICD, OICD, and IPD using ImageJ (NIH, Bethesda, MD, USA) on magnified images. Measurements were standardized using by assuming a horizontal corneal diameter of 11.5 mm.Epicanthal fold configuration was categorized according to its insertion pattern onto the lower eyelids. In type 1, a skin fold from the upper eyelid was inserted onto the lower eyelid inferior to the lower eyelid margin (). In type 2, the skin fold from the upper eyelid formed a confluent fold with the skin fold from the lower eyelid in the interpalpebral region (). We also assessed correlations between sex or age and epicanthal fold configuration in both groups.After a pilot study, we calculated that a sample of 44 patients was required to detect a difference in the IICD/IPD ratio between two groups. We had 80% power and a two-sided type I error of 0.05, allowing for a 10% rate of crossover between groups. The IICD/IPD and IICD/OICD ratios of the epiblepharon and control groups were compared using the independent samples t-test. Pearson’s correlation coefficients were used to access correlations between age, the IICD/IPD ratio, and the IICD/OICD ratio in both groups. Univariate analysis was conducted using the chi-square test to compare epicanthal fold configurations between the groups. P values of <0.05 were considered statistically significant, and analyses were performed using SPSS for Windows (version 18.0, SPSS Inc., Chicago, IL). […]

Pipeline specifications

Software tools ImageJ, SPSS
Applications Miscellaneous, Microscopic phenotype analysis
Organisms Homo sapiens