Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: Acquired punctal stenosis (APS) represents a common cause of epiphora and a reason for attendance at oculoplastic clinics. The three-snip punctoplasty is the mainstay of APS treatment, although perforated punctal plugs (PPPs) represent an alternative, offering reversibility and less burden on minor-operation lists. This study aimed to identify if PPPs are an acceptable alternative to the three-snip punctoplasty through comparison of functional, anatomical, and quality of life outcomes.

Methods: Participants with APS were randomized to receive either a three-snip punctoplasty or PPP in this assessor-masked study. Participants were followed up for 1 to 2 years, with a total of 3 follow-up visits. Data collected included patient demographics, slit-lamp examination findings, punctum dimensions on punctal optical coherence tomography, and results of Watery Eye Quality of Life questionnaire assessment.

Results: Forty-seven patients were recruited, with 25 attending the first postoperative visit and 32 providing final follow-up data via a telephone questionnaire. Both groups had significant reductions in weekly eye watering episodes and total Watery Eye Quality of Life scores, with no significant difference between groups. Only the three-snip group had a significant improvement in their simple 1 to 10 quality-of-life rating, with a significantly greater improvement than the PPP group. Following the intervention, three-snip had wider punctal optical coherence tomography and Kashkouli grade.

Conclusions: Both punctoplasty and PPPs are effective APS interventions. Despite greater enlargement to punctal anatomy following three-snip punctoplasty, PPPs, and three-snip punctoplasty both improve epiphora, although three-snip punctoplasty may provide a greater improvement to quality of life.

Orbital cellulitis (OC) is a rare diagnosis in infants, with limited numbers of cases reported in the literature to date. We report a 34‑day‑old female who presented with severe left-sided periorbital swelling and proptosis. Imaging confirmed a large orbital abscess with associated ethmoid sinusitis, and she underwent urgent exploration and drainage and initiation of broad‑spectrum intravenous antibiotics. Cultures grew methicillin‑sensitive Staphylococcus aureus. Postoperatively, she developed leukocytosis, eosinophilia, and recurrent skin abscesses, prompting immunologic evaluation. Genetic testing identified a novel STAT3 mutation in the SH2 domain consistent with Hyper‑IgE syndrome. This case highlights both the importance of prompt surgical and medical intervention in infantile orbital cellulitis and the need to consider underlying immune dysregulation when atypical clinical or laboratory findings are present. To our knowledge, this is the first reported case of infantile orbital cellulitis associated with Hyper-IgE syndrome, and the first report of this specific STAT3 variant causing hyper‑IgE syndrome.

Purpose: Congenital anophthalmia/microphthalmia are developmental eye disorders with variable severity. The absence of a normal-sized eye can cause facial asymmetry. Outcome is often reported as relative horizontal palpebral fissure (rHPF) and/or orbital dimensions. Yet, the predictive value of these measurements is unknown. This study aims to test the relation between facial and ultrasound measurements and subjective outcomes.

Methods: In this retrospective study, 3D facial scans of 31 patients with unilateral an/microphthalmia were analyzed. The scans were obtained using the Vectra scanner, and measurements were taken using GOM Inspect software. Various facial landmarks were identified, including horizontal palpebral fissure (HPF), lower lid, upper eyelid, lid crease, and inferior eyebrow margin. Orbital width, orbital height, and axial eye length were measured using ultrasonography. Ratios between the affected and unaffected sides were calculated from these measurements. Faces were also subjectively rated for the degree of asymmetry on a scale of 1 to 5.

Results: Average subjective judgment showed a significant association with, respectively, rHPF ( p < 0.001), caudal placement of the eye ( p < 0.001), orbital width ( p = 0.001), pretarsal show asymmetry ( p = 0.003), and axial length ( p = 0.003). After a forward selection procedure, only rHPF predicted the subjective outcome. rHPF was strongly correlated with the other significant factors.

Conclusion: The results indicate that the rHPF is best associated with subjective outcome. The forward selection procedure showed that adding ultrasound or other facial measurements did not result in a better association.