Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: To test a novel early polytherapy treatment strategy targeting mitochondrial bioenergetics, glutamate excitotoxicity, and sterile inflammatory response molecular pathways associated with retinal ganglion cell survival following optic nerve trauma.

Methods: Twenty C57BL/6J mice were subjected to sonication-induced traumatic optic neuropathy injury. The control group (n = 10) received intravitreal, retrobulbar, and subcutaneous phosphate buffered saline injections on days 0 and 3 (no repeat retrobulbar vehicle). On day 0, the treatment group (n = 10) received injections of intravitreal interleukin-1 receptor antagonist with ketamine, retrobulbar ropivacaine, and subcutaneous etanercept. Treatment group animals had 1% (wt/vol) N-acetylcysteine ad libitum supplemented in drinking water from day 1. On day 3, intravitreal pan-ephrin receptor antagonist peptide and subcutaneous elamipretide and etanercept injections were given. Pattern electroretinogram assessments continued at weeks 0, 1, 2, 4, 6, 8, 10, and 12. Optical coherence tomography retinal layer thickness was measured on naive, control, and treatment groups at week 12. The whole mount retinas were harvested for retinal ganglion cell quantitation.

Results: At 12 weeks, the averaged retinal ganglion cell density count in the control group was lower (413.37 ± 41.77 cells/mm2) compared with treatment (553.97 ± 18.00 cells/mm2; p < 0.001) and naive (595.94 ± 30.67cells/mm2; p < 0.001) groups. Ganglion cell complex layer thicknesses showed control group (49.29 ± 5.48 μm) thinner than the treated (61.00 ± 2.57 μm; p = 0.004) and naive (67.00 ± 6.12 μm; p = 0.004) groups. No significant difference was seen at 12 weeks between the treated and naive groups. Pattern electroretinogram recordings in the control group revealed a statistically significant decrease in amplitudes for all time points. Apart from week 8, the amplitudes in the treatment group did not significantly differ from the baseline at any time point.

Conclusions: Early combinatorial therapeutic intervention to address disparate molecular pathways following optic nerve trauma effectively halts retinal neurons' progressive structural and functional degeneration.

Epithelioid hemangioendotheliomas (EHs) are rare vascular tumors originating from bone or soft tissue. An 81-year-old woman with inoperable EH of the right orbit presented with right-sided decreased vision, proptosis, and facial numbness secondary to a frontotemporal soft tissue mass. Imaging revealed a heterogeneous enhancing mass surrounding the right sphenoid bone extending into the right orbit and right temporal intracranial fossa. The biopsy of the lesion was consistent with EH. The patient received orbital radiation with improvement in her proptosis, vision, and tumor size. However, 20 months later, she developed metastatic spread and her brief improvement rapidly worsened to require eventual enucleation. Orbital EH is rare, with few case reports in the literature. Treatment typically involves complete excision, although adjuvant radiation has been rarely reported. This case highlights rare orbital EH treated initially with radiotherapy with good effect, potentially indicating a role for this palliative therapy in extensive disease.

Purpose: Bacterial dacryoadenitis with abscess is rare. There is limited evidence examining the clinical course, and there is no consensus on evidence-based management protocols. The authors aim to systematically review the current literature on bacterial dacryoadenitis with abscess, examining etiology, clinical and radiological features, management, and outcomes.

Methods: A systematic search of the databases PubMed/MEDLINE, Embase, and CENTRAL was performed to July 2024, prior to data collection and risk of bias analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Twenty-five articles met the inclusion criteria. Fifty-one cases of bacterial dacryoadenitis complicated by abscess were identified, mean age 34.5 ± 22.3 years including n = 17 females (40.4%, subgroup with full demographic data, n = 42). Methicillin-sensitive Staphylococcus aureus was identified as the most common causative organism (25.4%), followed by methicillin-resistant Staphylococcus aureus (17.9%) and Haemophilus influenzae (12.8%). Clinical features included upper eyelid swelling (74.5%) and pain (39.2%), along with extraocular movement restriction (58.8%), gaze-evoked pain (39.2%), erythema (45%), chemosis (41.1%), and lacrimal gland protrusion (19.6%). A well-defined, rim-enhancing lesion within an enlarged lacrimal gland was typical on imaging (seen in 33.3%). The majority were managed with abscess drainage with concurrent intravenous antibiotics (66.6%). Only 1 patient among the included studies suffered a recurrence. Abscess drainage was not associated with patient age (p = 0. 8) or with Staphylococcus aureus as the causative organism (p = 0.7).

Conclusions: Bacterial dacryoadenitis with abscess is a rare but potentially sight-threatening entity. Requirement for abscess drainage in bacterial dacryoadenitis was not associated with patient age, nor with the most common causative bacteria. Clinicians should be aware of the potential for compressive optic neuropathy, and alert to signs that may indicate surgical drainage, in particular, inadequate response to antibiotics.

Purpose: This study aimed to evaluate the effectiveness of minimally invasive partial orbicularis myectomy in treating benign essential blepharospasm while assessing the utility of the Jankovic Rating Scale and Blepharospasm Disability Index as comprehensive outcome measures.

Methods: A retrospective study was conducted on 18 patients (36 eyes) with benign essential blepharospasm who underwent partial orbicularis myectomy between 2018 and 2022. All patients had previously shown inadequate response to botulinum toxin injections. Jankovic Rating Scale and Blepharospasm Disability Index scores were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively to capture both symptom severity and functional impact. Statistical analysis was performed using the Wilcoxon signed-rank test.

Results: The median preoperative Jankovic Rating Scale score of 7.5 decreased to 3 one year postoperatively, reflecting a 50% improvement in symptom severity. Concurrently, the median Blepharospasm Disability Index score reduced from 20 to 9.5, indicating a 47.22% enhancement in functional capacity at 1 year. Both reductions were statistically significant (p < 0.001) and sustained throughout the 1-year follow-up period. No significant complications were reported.

Conclusion: Minimally invasive partial orbicularis myectomy demonstrates significant and sustained improvement in both symptom severity and functional disability in patients with benign essential blepharospasm refractory to botulinum toxin treatment. The combined application of Jankovic Rating Scale and Blepharospasm Disability Index proves to be an effective approach in evaluating surgical outcomes, offering valuable insights into both the clinical efficacy of partial orbicularis myectomy and its impact on patients' daily functioning.

Purpose: While silicone has been shown to be effective on scars on the sternum, foot, and other areas with thicker skin, the effect of silicone on scars in the thin periocular skin has not yet been evaluated in a prospective, randomized, and double-blinded fashion.

Methods: This prospective, randomized, double-blinded study enrolled patients undergoing bilateral upper eyelid blepharoplasty or bilateral upper eyelid ptosis repair. Subjects were randomized to apply silicone gel to 1 eyelid incision site and placebo (petrolatum ointment) to the other side twice daily postoperatively. Outcome measures were physician-graded scar erythema, elevation, and pigmentation, as well as patient-reported satisfaction, itching, pain, and firmness. These were assessed postoperatively at 1 week, 1 month, 3 months, and 6 months.

Results: Of 192 eyelids from 96 patients, there were no significant (p ≤ 0.05) differences in any outcomes between silicone gel and placebo across any measure or time point. Patient satisfaction and blinded doctor and patient appearance preferences did not show any significant difference between the 2 treatments at any time point. Average follow-up was 11 weeks (range: 1-136 weeks).

Discussion: This clinical trial suggests that topical silicone may not offer significant advantages over petrolatum ointment in improving eyelid scar healing. Overall results indicate similar efficacy between treatments. These results underscore the importance of evidence-based medicine in choosing beneficial and cost-effective interventions.

Purpose: To compare a novel disposable ptosis visual field device to conventional perimetry devices for the evaluation of dermatochalasis and/or blepharoptosis.

Methods: Forty patients from a single academic center participated in this prospective, observational study. Patients with dermatochalasis (skin resting on the eyelashes) and/or blepharoptosis (marginal reflex distance 1 ≤2 mm) were included. Each subject underwent untaped and taped perimetry using 4 visual field devices in random order: Goldmann visual field (GVF), automated Humphrey visual field (HVF), tangent screen (TS), and the novel visual field device (NVF). One eye was randomly selected, and McNemar tests and paired t tests were used to establish comparisons between devices.

Results: The mean difference between untaped and taped central perimetry (in °) in the GVF, NVF, HVF, and TS was 26.5° ± 14.0°, 12.4° ± 8.5°, 9.6° ± 6.5°, and 9.6° ± 5.8°. The novel device detected a mean 2.9° greater difference than both the HVF (p = 0.083) and the TS (p = 0.062). The GVF, NVF, HVF, and TS detected a ≥12° difference in 90%, 50%, 39%, and 32.5% of eyes, respectively. The GVF detected a mean 14.1° greater difference than the novel device (p < 0.001). The GVF, NVF, HVF, and TS detected a ≥30% superior field occlusion in 98%, 73%, 55%, and 50% of eyes, respectively. There was no statistical difference in the ability of the NVF to detect a >12° difference or ≥30% superior field restriction compared with HVF or TS.

Conclusions: The NVF is as reliable as the commonly used HVF and TS for the evaluation of visual obstruction due to blepharoptosis and dermatochalasis. The GVF is more sensitive than the other 3 devices. The novel disposable visual field device could allow for virtual visual field testing.

A 73-year-old male with a history of incidentally diagnosed Paget disease of bone affecting the skull and left orbit 2 years prior presented with 3 months of vision loss, proptosis, and periorbital swelling of the OS. Examination showed best-corrected Snellen visual acuity of 20/150 in the affected eye, intact motility, 7 mm of relative proptosis, significant dilated and tortuous "corkscrew" conjunctival vessels, serous choroidal and retinal detachments, optic nerve hyperemia, and venous tortuosity and dilation. Although the bony lesions in the left orbit were stable from 1 year prior on imaging, the diagnostic angiogram demonstrated osseous blush and hypervascularity of the lesion. It was thus determined that the abnormal bone of the left orbit with enhanced blood flow was adversely affecting the blood flow in the orbit and eye. The patient underwent coil embolization of the feeding vessels and external blood supply to the lateral orbital wall and hyperostotic Paget lesion via coil embolization of the left internal maxillary artery and left middle meningeal artery with improvement of the choroidal effusions and subretinal fluid, followed by bony orbital decompression with improvement in the proptosis. This is a novel case of orbital and ocular vascular congestion due to Paget disease.

Purpose: To update the epidemiological patterns of facial nerve palsy (FNP) in Olmsted County, MN.

Methods: A retrospective chart review using the Rochester Epidemiology Project database was conducted. Patients aged ≥18 years receiving a diagnosis of FNP within the Rochester Epidemiology Project database from the years 2000 to 2010 were included in the study. Data collected included age, gender, cause of FNP, degree of paralysis, medical and/or surgical management, and outcomes. Overall incidence rates were determined using gender-specific population figures for Olmsted County. Incidence trends were compared with previous Rochester Epidemiology Project studies.

Results: The most common cause for FNP was Bell palsy (70.3% of cases). The overall incidence rate for Bell palsy in Olmsted County from 2000 to 2010 was 39.9 (95% CI, 36.1-43.7) per 100,000 person-years. This is an absolute increase of 14.9 per 100,000 person-years and a 60% relative increase in Bell palsy compared with a previous study performed at Mayo Clinic using the Rochester Epidemiology Project database population data from 1968 to 1982. Patients were infrequently evaluated by an ophthalmologist (8.4% of cases), and surgical intervention to address ophthalmic sequelae was rare (1.7% of cases).

Conclusions: The incidence of Bell palsy has increased dramatically over previous studies, which has occurred in the setting of declining herpes simplex virus type 1 seropositivity trends and increasing herpes zoster incidence in the United States. Few patients with FNP are referred to ophthalmologists, which may represent a gap in care for both acute and long-term ophthalmic sequelae.

Purpose: This study reviews all reported cases of lacrimal gland chronic lymphocytic leukemia (CLL) to identify patterns in clinical presentation, diagnosis, and management to aid in early recognition and treatment of this uncommon occurrence.

Methods: A comprehensive search of medical literature databases was performed to identify studies reporting lacrimal sac involvement in CLL from 1970 to 2024. Data were extracted regarding demographics, symptoms, diagnostic methods, treatment, and outcomes.

Results: Thirty-three cases of CLL lacrimal sac infiltration were identified. The median age was 71, with a slight female predominance of 54.5%. The most common symptoms were epiphora (63.6%) and pseudo-dacryocystitis or symptoms of dacryocystitis (48.5%). A significant proportion of patients (87.9%) had a known history of CLL at presentation. Chemotherapy combined with surgery was the most frequent treatment, 48.4%, with a positive response in 93.3% of patients. Local recurrence occurred in 10.3% of cases, predominantly in those treated with chemotherapy and surgery, or surgery alone.

Conclusions: Lacrimal sac CLL, though rare, should be considered in patients with nasolacrimal duct obstruction, especially those with a prior CLL diagnosis. Early diagnosis can be aided by imaging and histopathological evaluation, and treatment typically results in favorable outcomes with low recurrence rates. Tailoring treatment based on individual patient factors is essential for optimal management.

Purpose: To describe and evaluate the efficacy and safety of lacrimal sac to conjunctiva reconstructive ostomy for proximal lacrimal system reconstruction.

Methods: This retrospective study included 41 patients (32 cancer and 9 trauma; 36 primary and 5 secondary) who underwent lacrimal sac to conjunctiva reconstructive ostomy. The technique involves creating a direct connection between a surgical opening in the lacrimal sac, which maintains its bony attachments to prevent ostomy occlusion, and the medial conjunctiva (medial fornix, bulbar, and palpebral). Interrupted 7-0 polyglactin 910 sutures were used to form a 3- to 5-mm-diameter lined conduit. Stenting was not employed. When necessary, oral mucosa or mucoperiosteal grafts and local flaps were utilized for reconstruction. Outcomes were assessed by epiphora prevention, the functional patency of the lacrimal ostomy, and the patient-reported nasolacrimal duct obstruction symptom score.

Results: On examination, all patients demonstrated canalization of the lacrimal sac to the conjunctival reconstructive ostomy, as evidenced by unobstructed tear drainage. Complications occurred in 17% of cases, including periorbital edema, chemosis, diplopia, and conjunctival granuloma. The average nasolacrimal duct obstruction symptom score for lacrimal-ocular symptoms was 3.1/10 and for nasal symptoms was 2.3/10 (0 best, 10 worst). Tearing was the least prominent complaint (0.8/10), with 1 patient reporting permanent tearing (6/10).

Conclusion: Lacrimal sac to conjunctiva reconstructive ostomy proves to be a valuable procedure for immediate and delayed proximal lacrimal system reconstruction in cancer and trauma cases due to its straightforward and stent-free approach and its favorable 8-year outcomes.