Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: To evaluate long-term complications of osseointegrated orbitofacial prosthetic implantation following exenteration.

Methods: This retrospective review included 40 patients who received orbital reconstruction with osseointegrated orbitofacial prosthetics between 2008 and 2024. Patient demographics, exenteration indication, orbitofacial radiation exposure, osseointegration approach, and postoperative complications were recorded. Collection and evaluation of protected patient health information were Health Insurance Portability and Accountability Act compliant. This manuscript adheres to the tenets of the Declaration of Helsinki.

Results: A total of 134 implants were placed after orbital exenteration (average per orbit: 3). Most patients (75.0%, n = 30) had no implant failure/replacement within the follow-up period (range: 5 months to 16 years). Ten of the 134 placed implants failed (7.46%). Nine patients (22.5%) had an implant replaced within 5 years of implantation, and 1 patient (2.5%) had an implant replaced after 16 years. Implant failure was most often due to peri-implant bone instability (n = 6, 60.0%). Implants placed in the inferolateral orbital rim were most likely to fail (30%, n = 3). One failed implant (10%) was associated with a patient history of radiation treatment. General orbitofacial prosthetic discomfort (n = 22, 55%) was the most cited patient concern. Other common long-term complications included peri-implant discharge (n = 15, 37.5%), malodor (n = 15, 37.5%), and soft tissue dermatitis (n = 13, 32.5%).

Conclusions: There are long-term complications associated with osseointegrated orbitofacial prosthetics. There are practical perioperative and intraoperative opportunities to improve the outcome of osseointegrated orbitofacial prosthetic rehabilitation. Postoperative daily implant hygiene is critical for successful long-term rehabilitation.

We report a case of a 66-year-old woman with 8 years of progressive bilateral periorbital fullness, eyelid edema, and skin laxity. She had a history of thyroid cancer, smoldering myeloma, and systemic amyloidosis. The exam demonstrated significant bilateral periorbital fullness with mild limitation of extraocular motility in all directions bilaterally without double vision. The patient also reported regions of skin excess and edema throughout her body, not just isolated to her eyelids. Progressive dyspnea on exertion, lower extremity edema, and cough lead to cardiac workup, resulting in a diagnosis of cardiac amyloidosis. Given persistent and progressive eyelid swelling, MRI of her orbits was obtained, which demonstrated thickening of the extraocular muscles. Orbitotomy with biopsy of the right medial rectus muscle along with periocular eyelid skin was performed with pathology consistent with orbital and periocular amyloidosis. Amyloidosis is a rare cause of orbital-mass lesions and may appear clinically similar to IgG4-related disease, lymphoma, and thyroid eye disease. This case highlights the importance of considering amyloidosis, especially in the setting of plasma cell dyscrasia, with presentation with persistent periocular edema and cutis laxa.

Purpose: To study the metagenomics of microbes isolated from the lacrimal sacs of patients with congenital nasolacrimal duct obstruction (CNLDO).

Methods: A prospective study was performed on 10 consecutive lacrimal sac samples obtained for the metagenomic analysis from the patients with CNLDO who underwent endoscopic dacryocystorhinostomy at a tertiary care dacryology service. Immediately after a full-length lacrimal sac marsupialization, the samples were collected and transported on ice to the laboratory. A whole shotgun metagenome sequencing was performed on the Illumina platform following DNA extraction and library preparation. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in the SqueezeMeta pipeline, and the functional annotation was performed using the MetaCerberus, v1.3.1.

Results: The taxonomic hit distribution across the samples showed that bacteria were the most common isolates, followed by fungi and viruses. The major bacterial phyla identified across the samples of CNLDO were proteobacteria, firmicutes, actinobacteria, and bacteroidetes. The prevalent organisms include Haemophilus influenzae, Streptococcus pneumoniae, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Staphylococcus aureus, and Ochrobactrum anthropi, among others. The predominant fungal species identified include Botrytis cinerea, Aspergillus oryzae, and Fusarium fujikuroi. Several species of pandoravirus were the common viruses recognized.

Conclusions: This is the first whole metagenome sequencing of the lacrimal sac contents from patients with CNLDO, which showed that the sacs harbored diverse microbial communities of bacteria, fungi, and viruses. Further work is needed to decipher the polymicrobial interactions and their relationship with CNLDO.

A 2-year-old male patient was presented with a bilateral optic nerve tumor diagnosed as a glioma, which extended to his entire optic pathways bilaterally. Previous treatment with conventional chemotherapy was unsuccessful. As his OS had no light perception, a biopsy of the optic nerve was performed through a transconjunctival approach. Histopathological examination of the specimen was compatible with ganglioglioma, an extremely rare neoplasm of the optic nerve. Genome sequencing of the tumor specimen revealed a BRAF V600E point mutation with activation of the MAPK/ERKkinase signaling pathway. The tumor was significantly reduced 3 months after targeted therapy.

Purpose: To define the clinical entity of "isolated canalicular pseudoepitheliomatous hyperplasia."

Methods: A retrospective interventional case series that included biopsy-proven cases of pseudoepitheliomatous hyperplasia of the canaliculi. Dacryoendoscopy was performed before the surgical procedure to determine the extent of the lesion. A punctoplasty was performed to access the lesion, followed by an excision biopsy. Parameters assessed include patient demographics, clinical presentation, imaging features, operative techniques, histopathological features, and outcomes.

Results: Four canaliculi of 3 patients presented with canalicular mass lesions with secondary acquired lacrimal drainage obstructions. Epiphora without discharge was the universal presentation. On examination, an elevated pinkish mass lesion was noted to arise from the vertical canalicular walls, filling up the punctal opening without disturbing the integrity of the outer and inner punctal rims (3/4 canaliculi). The surface of the lesion showed either a speckled pigmentation or a membrane-like grayish appearance. One canaliculus presented with noninflammatory and diffuse canalicular swelling clinically mimicking canaliculops. Dacryoendoscopy revealed that the lesion was arising from the vertical canaliculus, not extending beyond the ampulla. A rectangular punctoplasty approach provided good access to achieve complete excision of the lesion. Histopathology confirmed the diagnosis of canalicular pseudoepitheliomatous hyperplasia.

Conclusion: The present study described the clinical spectrum, anterior segment optical coherence tomography, dacryoendoscopy, surgical technique, histopathology, and outcomes of a previously not-recognized entity-"isolated canalicular pseudoepitheliomatous hyperplasia." The study is the first step in further characterizing the clinical and radiological aspects of isolated canalicular pseudoepitheliomatous hyperplasia and improving the surgical techniques.

Purpose: To describe a single-hospital experience with the reconstruction of broad and deep periorbital defects with perforator island flaps (PIFs).

Methods: Twenty cases of reconstruction of complex defects in the periocular region using PIF were selected and revised. All cases were performed in the university hospital of the University of São Paulo, Ribeirão Preto, Brazil, from September 2018 to July 2024. Data collected included intraoperative and postoperative photographic documentation, lesions diagnoses, defect sizes and locations, PIF sizes and axes of mobilization, postoperative follow-up duration, and complications.

Results: All patients underwent periorbital reconstruction with PIF after tumor resection. In 7 cases, the defects involved the lower lid cheek junction, and in 10 cases, they extended into the medial canthus, including 3 cases of orbital exenteration. The lateral periorbital region was affected in 2 patients. The mobilization of the flaps was from the lower cheek toward the lower eyelid in 7 patients, toward the medial canthal area in 10 patients, and horizontally to cover defects in the medial and temporal regions in 2 cases. The size of the resultant defect averaged 7.9 cm2. The mean follow-up time was 40 months. The flap remained viable in 100% of cases.

Conclusion: PIFs are a versatile option for reconstructing large periorbital defects and extended exenterations, and this technique should be included in the repertoire of procedures for managing mid-facial tumors.

Purpose: To assess the reproducibility of subjective interpretation of computed x-ray tomography for 8 features associated with thyroid eye disease.

Methods: Patients with confirmed thyroid eye disease had 3 distinct orbital computed x-ray tomography sections presented as anonymized montages to 3 masked observers (#1 orbital radiologist, #2 general radiologist, and #3 orbital surgeon). Eight features were graded: superior orbital fissure clarity, degree of orbital fat prolapse through the superior orbital fissure, loss of fat space at the apex, muscle enlargement, increase in orbital fat volume, vascular congestion, superior ophthalmic vein size, and lamina papyracea bowing. Thirty montages were randomly triplicated within the completed image-testing-file.

Results: Each observer provided 3296 assessments of montages from 146 patients (68% female). Observer #2 had the highest rate of "indeterminate" gradings (13.3%), while #1 had the lowest (6.7%). For intraobserver agreement, the kappa statistics were "substantial" to "almost perfect" for apical crowding, muscular enlargement, and medial bowing, whereas orbital fat expansion and vascular congestion showed only "slight" to "moderate" agreement. Excluding superior ophthalmic vein size (where indeterminacy was too great for statistical analysis), there was a wide and statistically significant interobserver variation for the other 7 features, with no consistent ranking of observer scores.

Conclusions: Subjective interpretation of computed x-ray tomography images for patients with thyroid eye disease has high variability, particularly for interobserver comparisons. Only the assessment of apical crowding, muscular enlargement, and bowing of the lamina papyracea showed fairly consistent intraobserver gradings. The results suggest that variability in the interpretation of such images might only be improved with the use of objective measures applied to the computed x-ray tomography images.

Purpose: To review the treatment response of advanced conjunctival squamous cell carcinoma (SCC) to systemic immune checkpoint inhibitor (ICI) therapy at a single institution.

Methods: A retrospective review of patients treated at a single institution from 2015 to 2024 was conducted to identify those with advanced conjunctival SCC who had been treated with ICI therapy. Advanced disease included patients with orbital invasion of tumors, unresectable disease, or metastatic disease. Computed tomography imaging and tumor mutational burden data were evaluated for all patients.

Results: Five patients with advanced conjunctival SCC were treated with ICIs. All patients had the American Joint Committee on Cancer stage cT3N0M0. All patients had best corrected visual acuity in the affected eye of 20/30 or better at presentation. All patients progressed while on ICIs, with 3 ultimately requiring exenteration at a median time of 6 months from initial diagnosis. One patient had progressive metastatic disease, and one had direct intracranial extension. All patients had low tumor mutational burden.

Conclusions: Unlike prior reports demonstrating complete treatment response while on ICI therapy in patients with advanced conjunctival SCC, the current study demonstrates that 5 of 5 patients had disease progression while on ICI therapy. All patients also had low tumor mutational burden. Tumor mutational burden may be important in predicting disease response to ICI in patients with conjunctival SCC; however, given the small number of patients with conjunctival SCC treated with ICI to date, more data are needed to understand the role of ICIs in conjunctival SCC.