Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: Lacrimal sac malignancies are rare, with squamous cell carcinoma (SCC) being the most common type. High-risk human papillomavirus (HR-HPV) is a known driver of SCC in the oropharynx and other head and neck sites. This study investigated the prevalence of HR-HPV in primary lacrimal sac SCC using p16 immunohistochemistry and RNA in situ hybridization.

Methods: The pathology databases of the Florida Lions Eye Bank Ocular Pathology Laboratory and the Department of Pathology and Laboratory Medicine at the University of Miami Miller School of Medicine were reviewed for cases of primary lacrimal sac SCC with sufficient tissue for HR-HPV testing. P16 positivity was defined as strong, diffuse staining in >70% of tumor cells. RNA in situ hybridization was used to detect transcriptionally active HR-HPV.

Results: Fifteen patients (mean age 63 years; 7 men and 8 women) with nonkeratinizing, papillary lacrimal sac SCC were identified. Twelve cases (80%) were positive for both p16 and HR-HPV by RNA in situ hybridization. All 3 HR-HPV negative cases were also p16-negative. Among HR-HPV-positive patients, 92% were Caucasian, with equal gender distribution. The most common presenting symptoms were epiphora (83%), erythema/edema (42%), and pruritus (33%). Most patients were treated with surgery and multimodal therapy. At follow-up (range 5-83 months), 92% of HR-HPV-positive patients were alive.

Conclusions: Primary lacrimal sac SCCs are frequently associated with HR-HPV and typically show nonkeratinizing, papillary morphology. p16 is a reliable surrogate marker for transcriptionally active HR-HPV in these tumors, supporting a potential etiologic role and diagnostic utility.

Purpose: To perform a systematic review of the literature on thyroid eye disease-like (TED-like) orbitopathy occurring as part of paraneoplastic syndromes or associated with immune checkpoint inhibitors and report a case of paraneoplastic TED-like orbitopathy.

Methods: A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases up to July 2025 using predefined keywords related to orbitopathy, malignant neoplasms, paraneoplastic syndromes, and immune checkpoint inhibition. Only full-text articles were included. Eligible studies were independently screened, and data were extracted regarding patient demographics, oncologic diagnosis, immune checkpoint inhibitor exposure, clinical presentation, and imaging features.

Results: Thirty-nine reports were retrieved in the literature; among those, 21 patients developed TED-like orbitopathy following immune checkpoint inhibitor therapy, most commonly with anticytotoxic T-lymphocyte-associated protein 4 or antiprogrammed cell death protein 1/programmed cell death protein ligand 1 agents. The clinical pattern was remarkably consistent, characterized by bilateral proptosis, inflammatory signs, and extraocular muscle enlargement, while upper eyelid retraction was present in only 16% of cases. In addition, 18 paraneoplastic cases mimicking TED were retrieved, mainly associated with seminomas, lymphomas, and pulmonary carcinomas. Imaging findings were similar to those seen in classic TED, yet thyroid autoimmunity was absent. We also present a patient with a hepatosplenic T-cell lymphoma who developed bilateral inflammatory orbitopathy and lateral rectus muscle hypertrophy.

Conclusion: TED-like orbitopathy represents a rare but increasingly recognized manifestation in oncology, occurring either as a paraneoplastic phenomenon or as an immune-related adverse event of checkpoint inhibition. The absence of TRAb positivity and thyroid dysfunction highlights a possible alternative immune mechanism underlying orbital inflammation mediated by cytotoxic T lymphocytes.

Purpose: To review current management strategies for severe simple congenital ptosis, highlight technical refinements that optimize levator surgery outcomes, and propose an intraoperative algorithm to enhance surgical predictability.

Methods: A comprehensive PubMed-based literature review was conducted to identify studies on severe congenital ptosis, preoperative determinants of surgical planning, and operative techniques. Emphasis was placed on intraoperative anatomical variability of the levator palpebrae superioris complex, modifications of levator-based surgery (LBS), and the role of combined procedures.

Results: Recent studies demonstrate considerable intraoperative variability in the levator palpebrae superioris complex morphology, including the aponeurosis, muscle belly, and Whitnall's ligament. Traditional reliance on preoperative metrics and standardized resection formulas in LBS often fails to account for this intraoperative variability and the heterogeneity of congenital ptosis. The unpredictability of LBS in severe ptosis has led some surgeons to favor frontalis suspension for its relative consistency, albeit at the cost of physiologic dynamics. Several technical modifications of LBS have been described, including septal debulking, fibrosis release, and direct intraoperative levator assessment. Combined procedures integrating levator advancement with adjunctive lifting tissues have been reported to further enhance eyelid elevation.

Conclusion: Advances in LBS, including intraoperative levator exploration, fibrosis release, and adjunctive use of neighboring elevator structures, have broadened the potential for functional and aesthetic success in severe congenital ptosis. These findings underscore the importance of dynamic, anatomy-based intraoperative judgment over rigid preoperative formulas. A flexible intraoperative algorithm is proposed to guide surgical choice and improve predictability.

We present a patient with left orbital metastasis of cutaneous melanoma, treated with 30 Gy in 10 fraction radiation therapy followed by a combination of programmed death-1 inhibitor, nivolumab, and lymphocyte-activation gene inhibitor, relatlimab. The patient achieved a complete response to treatment, with no evidence of recurrence of the orbital mass, 17 months after treatment initiation.

Three patients with locally advanced conjunctival squamous cell carcinoma originating in the inferior fornix were treated with immunotherapy: a 74-year-old male was treated with 4 cycles of cemiplimab, a 54-year-old female was treated with 3 cycles of pembrolizumab, and a 69-year-old female was treated with 2 cycles of pembrolizumab. Tumor progressed in all 3 patients on immunotherapy, requiring orbital exenteration for disease control. Tumor mutational burden was low in all 3 patients: 1.2, 8.1, and 7.1 mut/Mb. Review of the literature reveals 18 cases of invasive conjunctival squamous cell carcinoma treated with immunotherapy in addition to the 3 cases reported herein, with tumors of responders tending to have a higher tumor mutational burden than those of nonresponders. There is increasing evidence that conjunctival squamous cell carcinoma originating in the sun-protected inferior fornix/inferior palpebral conjunctiva has low tumor mutational burden and is less likely to respond to immunotherapy than squamous cell carcinoma of bulbar conjunctival origin.

Purpose: To characterize the clinical, imaging, and pathological spectrum of pediatric ocular adnexal lymphomas tumors (OAL), including both primary and secondary lesions, using contemporary World Health Organization Haematolymphoid (5th edition) classification.

Methods: This retrospective case series included patients <18 years with biopsy-proven lymphoma of the orbit or ocular adnexa managed by a single oculoplastic surgeon over a 30-year period. Demographic, clinical, imaging, histopathological, treatment, and outcome data were collected. Lesions were categorized as primary (confined to ocular adnexa with or without regional lymph nodes) or secondary (ocular adnexa involved as part of systemic lymphoproliferative disease).

Results: Eleven patients (median age 11 years; 6 male) were identified. Five (45%) had precursor B-cell lymphoblastic leukemia/lymphoma, and 3 (27%) had mature B-cell tumors, including 2 extranodal marginal zone lymphomas and 1 diffuse large B-cell lymphoma. Three (27%) had mature natural killer/T-cell neoplasms, including 1 primary cutaneous anaplastic large cell lymphoma, 1 anaplastic large cell lymphoma, and 1 extranodal natural killer/T-cell lymphoma, nasal type. Six patients (55%) presented with ocular adnexal involvement secondary to systemic disease, most commonly in the orbit. Periorbital swelling, proptosis, and palpable masses were the predominant ocular signs. Management ranged from surgical excision or topical interferon to systemic chemotherapy, radiotherapy, and hematopoietic stem-cell transplantation. At the last follow-up, outcomes varied with histological subtype and disease stage.

Conclusions: Pediatric ocular adnexal lymphomas displays striking clinicopathologic heterogeneity, with a predominance of precursor lymphoblastic neoplasms and a notable proportion of high-grade mature B- and T/NK-cell lymphomas. Recognizing both primary and secondary lesions and applying accurate histopathological classification are critical for timely diagnosis and to guide modern targeted therapies. This series expands the evidence base for a rare disease and underscores the importance of integrating ophthalmic assessment with contemporary World Health Organization diagnostic frameworks.

Orbital conjunctival inclusion cysts are uncommon lesions that may develop as congenital choristomatous rests or as a result of traumatic or iatrogenic implantation of conjunctival epithelium. Depending on their size and location, they can be asymptomatic or cause proptosis, diplopia, mechanical ptosis, and ocular motility disturbances. We report a rare case of a 63-year-old female patient who developed marked upper eyelid retraction due to a conjunctival inclusion cyst associated with a retinal detachment procedure performed 20 years before presentation. A literature review did not disclose any case of upper eyelid retraction associated with orbital conjunctival inclusion cysts.

Purpose: Cutaneous squamous cell carcinoma has a propensity for perineural invasion. Treating perineural spread has involved surgery and adjuvant chemoradiation, and more recently, immune checkpoint inhibitors. This study aims to evaluate motor and sensory functional outcomes in patients with cranial neuropathies from perineural spread of squamous cell carcinoma, particularly those undergoing immunotherapy.

Methods: This was a multicenter case series and literature review.

Results: Eighteen patients with cranial neuropathies from perineural spread had a mean age of 72.5 ± 9.7 years. Cranial nerves V and VII were most often involved. Treatments included radiotherapy (8/18; 44.4%), chemotherapy (7/18; 38.9%), and/or immunotherapy (11/18; 61.1%), with many receiving a combination of modalities (8/18; 44.4%). Of those receiving immunotherapy, 72.7% (8/11) demonstrated at least partial clinical and/or radiologic tumor response. Among those with functional outcomes documented, half had improvement in sensory/motor nerve function following immunotherapy (4/8; 50%). A literature review identified 55 articles describing 449 patients total with cranial neuropathies from squamous cell carcinoma perineural spread. Combinations of surgery, chemotherapy, and/or radiotherapy were employed, with immunotherapy used in 16 patients. From 5 patients on immunotherapy with documented functional outcomes, all demonstrated at least some improvement.

Conclusion: Immunotherapy plays an evolving role in managing advanced squamous cell carcinoma. Functional improvements in cranial neuropathy were demonstrated in 50% of patients receiving treatment with immunotherapy at a mean of 32.6 months of follow-up. This may hold important implications for the timing of surgical intervention, particularly in the case of cranial nerves V and VII palsies.

Purpose: This study explores the demographics, presentation, and anatomic features associated with involutional entropion, offering insight into the etiology of the condition. Surgical techniques and results are presented.

Methods: A retrospective chart/photographic review was performed on patients treated between 2005 and 2024.

Results: Demographic analysis was limited to 405 patients without prior surgery. Incidence increased with age, with only 1.7% ≤60 years old. Males were more frequently affected than predicted using population data. Unilateral right (57%, p = 0.015) was more common than left entropion. Unilateral entropion was associated with an ipsilateral larger or inferiorly positioned orbit, findings more common on the right. Throughout the study, 30.6% of patients showed signs of bilateral disease.Five hundred nineteen procedures (612 eyelids) were performed. Most included a lateral tarsal strip and posterior retractor attachment. Twenty-one percent of lids had insufficient laxity for a standard lateral tarsal strip. Recurrent cases more commonly involved males (63%, p = 0.018) and the right side (63%, p = 0.047). Postoperative ectropion was more frequent after anterior (p < 0.001) and chemosis after posterior surgery (p < 0.001). Recurrence developed in 8 study eyelids (1.3%). Preoperative ipsilateral ptosis (≥1 mm) was present in 33.4% of unilateral cases and often improved after repair.

Conclusions: Incidence of involutional entropion increases with age and is greater in males and on the right. Enophthalmos, retractor laxity, and canthal instability are likely predisposing anatomic factors. Significant horizontal laxity is seldom present. The lateral tarsal strip reestablishes canthal stability, and when combined with posterior retractor attachment to tarsus and orbicularis is highly effective. Complications are uncommon and usually apparent soon after surgery.