Ophthalmic Plastic and Reconstructive Surgery最新文献

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.

Purpose: Reconstruction of upper eyelid defects is challenging due to paucity of fungible local tissue and a lack of adequate tarsal substitutes. Cartilage is too stiff to be directly implanted in the posterior lamella due to the risk of corneal damage with blinking. Since elastin is a key structural element in elastic cartilage, we hypothesized that elastase treatment of cartilage may reduce cartilage's stiffness sufficiently to make it a feasible posterior eyelid lamella substitute.

Methods: Porcine auricular cartilage was treated with elastase or buffer control. Histopathology, electron microscopy, and mechanical testing were performed. Young's modulus was calculated using the Hertzian method for mechanical indentation testing at baseline, 2, and 24 hours. Group 1 (buffer control auricular cartilage), Group 2 (elastase-treated auricular cartilage), and Group 3 (native tarsus) were compared.

Results: Grossly, elastase treatment increased cartilage flexibility, and microscopically increased chondrocyte lacunae and decreased the density of the interterritorial matrix, relative to controls. Electron microscopy revealed elastin fiber degradation with empty channels preplacing elastin fibers. At 2 hours, cartilage stiffness showed minimal differences between Groups 1 and 2 for both instantaneous modulus (1.34 vs. 1.37 MPa; p = 0.92) and equilibrium modulus (0.31 vs. 0.36 MPa; p = 0.71). By 24 hours, the equilibrium modulus of elastase-treated cartilage (0.055 MPa) resembled native tarsus (0.016 MPa; p = 0.76).

Conclusions: Grossly, elastase treatment increased cartilage flexibility and, microscopically, increased chondrocyte lacunae and decreased the density of the interterritorial matrix, relative to controls.