Ophthalmic Plastic and Reconstructive Surgery最新文献

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.

A 59-year-old female patient presented with a purple, fluid-filled lesion on her left upper eyelid that contained a solid component. Excisional biopsy revealed a diagnosis of mucinous adenocarcinoma. Extensive oncological workup was negative for a distant primary tumor or metastasis and confirmed a diagnosis of primary mucinous adenocarcinoma. Further excision and eyelid reconstruction were required. One year later, another suspicious, fluid-filled lesion was excised from the patients' left lower eyelid. Biopsy and subsequent oncological workup confirmed a mucinous adenocarcinoma in situ, a known precursor of primary mucinous adenocarcinoma. This case contributes to the limited literature reporting multicentric primary mucinous adenocarcinoma of the eyelids and suggests that there may be underlying factors that heighten a patient's risk for developing these tumors.

Purpose: To report the experience with an alternative to the upper eyelid pentagonal wedge resection technique which results in improved cosmesis due to a greater alignment of incisions with relaxed skin tension lines.

Methods: A retrospective review of all patients who underwent the T-shaped wedge resection by the authors from 2009 to 2017. A horizontal eyelid crease incision is made across the upper eyelid skin. A rectangular full-thickness excision extending to the eyelid crease anteriorly, with an additional superior triangle of posterior lamellar excision is performed. The anterior lamella above the eyelid crease is left intact and the eyelid crease incision is used to distribute the relative excess anterior lamellar tissue above the eyelid crease to the horizontally shortened tissue below the crease.

Results: One hundred and four eyelids of 102 patients were included. The mean patient age was 57 and the procedure was performed on 49 right upper eyelids and 55 left upper eyelids. The indications for eyelid resection were benign lesions (n = 57), basal cell carcinoma (n = 27), trichiasis (n = 15), and squamous cell carcinoma (n = 3). Two patients experienced mild postoperative lagophthalmos, which did not require surgical repair. All patients were satisfied with their postoperative appearance. No patients required reoperation related to their procedure.

Conclusion: The T-shaped wedge resection is an alternative to the traditional pentagonal wedge resection of the upper eyelid. This technique uses the natural upper eyelid crease to redistribute the relative excess skin above the defect, rather than extending the excision superior to the eyelid crease which can alter the contour of the crease and potentially create a vertical scar above the crease.

Purpose: To review the long history of wound management, including the methods of skin closure, asepsis, and anesthesia. Periocular techniques will be emphasized.

Methods: Literature searches and cross-referencing were used to identify historic reports addressing the management of wounds. Foreign language manuscripts were translated using online resources.

Results: The first written description of suturing dates to around 3000 BC and involved the repair of an eyebrow wound. A wide variety of materials have since been used as ligatures or stitches, including animal intestines, tendons, hair, silk, linen, plant fibers, and metal wire. For much of recorded history, sutures were a primary cause of wound infection and morbidity. There was a time when the resultant drainage was viewed as being beneficial (laudable pus). Many of the discoveries that ultimately led to the practice of asepsis were coincidental. Prior to the development of infiltrative anesthesia in 1894, patients had to endure the discomfort of surgery, occasionally with the sedative effects of wine or cannabis.

Conclusions: The history of wound closure is a fascinating tale. While there has been a constant evolution, silk and catgut sutures, ligatures, surgical knots, and layered closure have been used for several millennium. Advances in asepsis, in addition to the development of anesthesia, antibiotics, and synthetic sutures, ushered in the modern age of surgery. A knowledge of the past will give us, as oculofacial surgeons, a greater understanding and appreciation of the techniques we use today.

Purpose: This study aimed to analyze demographic, clinical, socioeconomic, and facility-specific factors affecting the survival outcomes of patients diagnosed with eyelid melanoma (EM) between 2004 and 2017 using data from the National Cancer Database.

Methods: Cases of EM diagnosed between 2004 and 2017 were identified using the National Cancer Database. Patient demographic data, tumor stage (American Joint Committee on Cancer TNM classification), treatment modalities, and socioeconomic variables were collected. Facility-specific variables included patient volume and academic status. Kaplan-Meier survival analyses and multivariate Cox regression models were used to assess 10-year survival and identify significant predictors of mortality.

Results: A total of 3,235 patients with EM were eligible for demographic analysis. The majority of patients were over 60 years of age and predominantly male. Kaplan-Meier analysis showed a significant decrease in 10-year overall survival with increasing age at diagnosis (p < 0.001), T clinical stage (p < 0.001), and male sex (p = 0.001). Additionally, patients with higher income (p = 0.01), private insurance (p < 0.001), and those treated at high-volume (p = 0.006) and academic facilities (p = 0.005) had improved 10-year overall survival. Multivariate Cox regression identifying independent predictors of EM mortality corroborated these findings.

Conclusions: Eyelid melanoma survival outcomes were significantly influenced by age, tumor stage, socioeconomic status, and facility characteristics. Treatment at high-volume centers confers a survival advantage, emphasizing the importance of specialized care. These findings underscore the need for early detection and equitable access to improve EM outcomes.

Eyelid malpositions as a complication of pregnancy, in the absence of associated trauma or injury, are rarely encountered. There are limited published reports on this phenomenon or subsequent surgical repair. We present the case of a 38-year-old female who experienced 3 separate episodes of eyelid malpositions, each occurring independently during 3 otherwise uncomplicated pregnancies, which persisted until surgical correction. Histological analysis of the patient's conjunctiva and tarsus revealed degeneration and loss of elastic tissue, crucial for eyelid anatomy. Surgical repair was performed in each instance, resulting in excellent cosmetic, anatomic, and visual outcomes.