Ophthalmic Plastic and Reconstructive Surgery最新文献

We describe an oculofacial injury phenotype manifesting as a cleavage plane following the orbitomalar ligament in 5 cases. Across these cases, curvilinear wounds followed the course of the orbitomalar ligament, running clean planes through orbicularis oculi down to the infraorbital rim and arcus marginalis. One case involved bilateral orbitomalar ligaments, and 1 case involved the inferior canaliculus. Associated craniofacial injuries included orbital floor fracture, orbital hemorrhage, and zygomaticomaxillary complex fractures. Moderate-to-severe globe injuries were encountered, including hyphema, commotio retinae, retinal hemorrhages, cyclodialysis cleft, lens dislocation, and globe rupture. Wound closure included deep polyglactin sutures to recreate mid-facial support from the disrupted orbitomalar ligament; 1 case that did not receive deep, layered closure was associated with lower eyelid ectropion. These cases illustrate how orbitofacial ligaments may influence trauma phenotypes and inform subsequent repair.

The authors report a rare case of a 58-year-old female with mild right-sided hemifacial spasms and eyelid myokymia and a concomitant high-grade glial mass. This report outlines the clinical presentation, diagnostic approach, and management of right hemifacial spasms and eyelid myokymia. The patient had a 5-month history of gradually worsening right hemifacial spams accompanied by mild right lower eyelid twitching. Given the persistence and exacerbation of these symptoms, alongside episodes of dysphagia, an MRI was performed. Imaging revealed a heterogeneous, peripherally enhancing mass with central necrosis at the lateral aspect of the left precentral gyrus and posterior aspect of the left middle and inferior frontal gyri consistent with high-grade glial mass. The patient subsequently underwent an awake craniotomy with resection of a temporal lobe tumor. These initial episodes of isolated facial spasms may be attributed to epilepsia partialis continua, often indicative of subcortical lesions that can compress the motor cortex. Eyelid myokymia and hemifacial spasms, though common, present significant diagnostic and management challenges. Due to high rate of underdiagnosis or misdiagnosis of these conditions, increased clinical awareness and knowledge are essential for effective patient management.

Purpose: The aim of the study was to evaluate the environmental impact of a blepharoplasty as performed by a single surgeon at an office-based operating room (OR) versus at an ambulatory surgery center.

Methods: We employed life cycle analyses on routine, uncomplicated bilateral upper lid blepharoplasties as performed by a single surgeon. Life cycle phases of production, use, and end-of-life treatment were included. Study boundaries encompassed all waste products exiting the OR in addition to utility energy and water use. We conducted waste audits to collect data on surgical waste by item, material, and weight. Building energy and water use were approximated using data obtained from utility companies. Environmental impact is reported as global warming potential (GW100a; kg carbon dioxide equivalents).

Results: The office-based OR generated 784 g of physical waste per blepharoplasty as compared to 1323 g at the ambulatory surgery center. The life cycle analyses found that a blepharoplasty contributed a total of 6.42 kg carbon dioxide equivalents at the office-based OR and 7.78 at the ambulatory surgery center. The production phase contributed the majority of these carbon dioxide equivalents. Plastic supplies contributed the most waste by weight and emissions associated with production. Nonwoven polypropylene contributed the largest waste and emissions by material.

Conclusion: The ambulatory surgery center produces more waste and carbon dioxide equivalents per blepharoplasty than the office-based OR. Use of supplies including drapes and gowns made of nonwoven polypropylene can be reduced to increase the environmental sustainability of blepharoplasty.

The authors report a case of nontraumatic orbital subperiosteal hematoma after general anesthesia with patient in the prone position. The patient, who was on aspirin, clopidogrel, and subcutaneous heparin, presented immediately after sacral ulcer debridement with acute bilateral vision loss and periorbital edema. While the OD improved with conservative management, the OS continued to have 20/200 vision, decreased color vision, afferent pupillary defect, and extraocular movement limitation after lateral canthotomy and cantholysis. Imaging revealed bilateral subperiosteal hematomas in the superior orbital roof stretching the posterior optic nerve. Left orbitotomy with drainage of hematoma under anesthesia was then performed, with full resolution of symptoms and recovery of vision to 20/20 by postoperative week 2. While a few cases of orbital subperiosteal hematoma after nonophthalmic surgeries have been previously reported, the majority were in the supine position, unilateral, and resolved without surgical decompression. This case suggests that the increase in venous pressure from prone positioning, especially in patients on anticoagulation or antiplatelet therapy, could contribute to bleeding into the subperiosteal space. Furthermore, although the orbital compartment syndrome and elevated intraocular pressure resolved with canthotomy/cantholysis, there was persistent compressive optic neuropathy that required surgical intervention.

Benign essential blepharospasm is a focal dystonia characterized by involuntary contractions of the orbicularis oculi. Botulinum toxin type A injections are often first-line treatment, but patients may experience refractory symptoms or decreased response over time. DaxibotulinumtoxinA, a novel botulinum toxin type A product, has shown promise in cervical dystonia and facial rhytids but has not been previously reported for benign essential blepharospasm treatment. This case highlights a 57-year-old male with severe, poorly controlled benign essential blepharospasm despite high-dose injections of onabotulinumtoxinA and incobotulinumtoxinA. He subsequently received 100 units of daxibotulinumtoxinA in the same periorbital injection pattern with subjective faster onset, extended duration of effect, and improved symptom management compared to previous treatments. Notably, the patient experienced 50% to 75% efficacy retention at 3 months postinjection, significantly better than his response to other botulinum toxin type A products. This case suggests that daxibotulinumtoxinA may be an effective treatment for benign essential blepharospasm including patients experiencing poor symptom control with other botulinum toxin type A products.

Purpose: The purpose of this study is to assess the surgical costs of enucleations and eviscerations and their relation to current reimbursement rates using time-driven activity-based costing.

Methods: This is a retrospective study of patients undergoing enucleation and evisceration surgeries with attachment of muscles (Current Procedural Terminology 65105 and 65093) for a diagnosis of blind, painful eye, from January 1, 2019, to December 31, 2023, at a single, tertiary level, teaching hospital. A time-driven activity-based cost analysis for day of surgery was performed. Operative reports, perioperative times, and supply costs were extracted from the electronic medical record, and average reimbursement fees were taken from Center for Medicare and Medicaid Services data.

Results: In the 5-year study span, 110 patients underwent enucleation and 52 underwent evisceration for a primary indication of blind, painful eye by 10 different surgeons. The average operating room time and surgical time for enucleation was approximately 9 minutes longer compared with evisceration (p < 0.01). Both surgeries on average resulted in a negative margin with enucleations costing on average $624 more than eviscerations. The breakeven total operating room time for enucleation and evisceration surgery was approximately 86.3 and 83.1 minutes, respectively. From the sample, approximately 79% of enucleation and 60% of evisceration surgeries resulted in a net negative margin.

Conclusions: On average, the cost of enucleation and evisceration surgeries exceeded the reimbursement amount set by the Center for Medicare and Medicaid Services. Compared with enucleation, evisceration was more time and cost-effective by only a modest margin.

Purpose: To examine the effects of systemic hypothermia on retinal ganglion cell survival and visual outcomes after optic nerve trauma in a sonication-inducted traumatic optic neuropathy murine animal model.

Methods: Twenty mice underwent sonication-inducted traumatic optic neuropathy. Afterward, 10 mice were placed on a warming pad set to 36°C, and 10 mice were placed on a table. General anesthesia was maintained for 3 hours with subcutaneous injections of ketamine. The rectal temperature was measured every 15 minutes. Pattern electroretinograms were obtained at 2, 4, and 6 weeks. Mice were sacrificed at 6 weeks, and retinal ganglion cell counts were performed.

Results: The hypothermia group had an average rectal temperature of 23.1°C; the control group was 33.3°C. At 6 weeks, the hypothermia group had larger a-wave amplitudes (18.19 µV) than the control group (12.75 µV) (p < 0.05). At 6 weeks, retinal ganglion cell density over the entire retina was significantly higher in the hypothermia group versus the control (p < 0.0001).

Conclusions: The hypothermia treatment group had significantly higher retinal ganglion cell density and pattern electroretinogram a-wave amplitudes 6 weeks after injury than the control group. Systemic hypothermia may have a neuroprotective effect when initiated immediately after sonication-inducted traumatic optic neuropathy.

Purpose: Current treatment approaches aimed at resolving a chalazion vary greatly among practice settings and practitioners. Our objective is to provide a review of existing literature on treatment modalities aimed at resolving a chalazion.

Methods: We conducted a review of existing peer-reviewed publications that described treatment methods aimed at resolving chalazia in patients of any age. Literature searches were conducted using PubMed, Embase, and Cochrane. A 3-stage review process was conducted by 2 trained reviewers, including an initial screening, a full-text review, and data extraction. Articles were assessed for baseline study identifiers, study design, country of origin, number of patients, demographic characteristics, types and number of treatments administered, and resolution rates. Publications were graded using the Oxford Centre for Evidence-Based Medicine levels of evidence table.

Results: A total of 2814 articles were initially identified based on database queries; 39 studies met inclusion criteria for full-text review. The most represented study design was case series (15), followed by randomized controlled trials (14). Twenty-five publications discussed intralesional corticosteroid injections, 18 discussed incision or excision and curettage, 5 discussed conservative treatments, and 8 discussed topical antibiotic±steroid treatments. Both the definition of chalazion resolution and resolution rates for each treatment modality varied widely between publications.

Conclusions: Procedural management of chalazia, including corticosteroid injections and surgical management, is most often studied in the literature. Fewer publications exist on the efficacy of conservative and topical treatments.

Purpose: To compare regression rates, characteristics, and surgical outcomes of thyroid eye disease patients who underwent orbit, strabismus, or eyelid surgery at various times during or after teprotumumab treatment.

Design: Multicenter, retrospective, observational cohort study.

Participants: Adult patients (age >18) with a minimum of 4 infusions of teprotumumab treatment for thyroid eye disease who had had eye surgery during or after treatment.

Methods: Two groups were formed based on surgery timing: group 1 (G1) (<180 days since last infusion) and group 2 (G2) (≥180 days since last infusion).

Main outcome measures: The primary outcome was postoperative regression rates. Secondary outcomes were postoperative regression characteristics, regression treatment, and orbital decompression proptosis reduction.

Results: This study evaluated 53 patients (81% female) who underwent 78 surgeries. G1 comprised 24 individuals with 34 surgeries, while G2 comprised 29 patients with 44 surgeries. Regression rates did not significantly differ between G1 and G2 (20.8% vs. 14.7%, p = 0.611). Compared with G1 patients, patients in G2 who regressed showed a significant mean increase in Clinical Activity Score (4.2 vs. 6.1, p = 0.027) and a nonsignificant yet measured increase in proptosis when compared with those in G1 (2.9 vs. 4.25, p = 0.298) at the time of regression. Compared with G1 patients, G2 patients who regressed were equally likely to undergo a repeat course of teprotumumab as group 1 (p = 0.14) but underwent a higher number of additional surgical procedures (p = 0.057). Thyroid stimulating immunoglobin levels uptrended more often in patients who regressed.

Conclusion: Our study suggests that while the rate of regression may not differ significantly, the severity, clinical impact, and need for additional surgery might be more pronounced for patients who have surgery more than 6 months after their last teprotumumab dose.

Background: Severe dry eyes often require surgical intervention. Submandibular salivary and minor salivary gland transplantation are options for refractory dry eyes but have limitations. We innovatively designed an insular infraorbital neurovascular pedicle labial salivary gland transplantation (IINPLSGT) and validated its feasibility and safety through anatomical studies.

Methods: An anatomical study was conducted on 13 red-colored latex arterial-perfused cadavers (24 sides). Two specimens (4 sides) simulated IINPLSGT. We recorded the branching patterns and courses of the infraorbital artery, infraorbital nerve, and angular artery, as well as the distribution of nerves, vessels, and salivary glands in the upper lip. Infraorbital artery and angular artery were anatomically classified. The feasibility of the IINPLSGT was validated. Otolaryngologists and ophthalmologists performed IINPLSGT, transferring the labial mucosal flap to the lower eyelid conjunctival fornix to treat severe dry eye in 1 patient.

Results: Infraorbital artery exhibited 5 potential branches, classified into 5 types based on developmental patterns. Angular artery was classified into 3 types based on the courses. Patient symptoms significantly improved postoperatively, with Schirmer I increasing from 0 mm to 6 mm, noninvasive breakup time from 0 seconds to 6 seconds, and SPEED (Standard Patient Evaluation of Eye Dryness questionnaire) score decreasing from 10.5 to 3 in the OD 1 year after surgery. No severe complications were observed.

Conclusion: IINPLSGT is a safe and feasible method for treating severe dry eyes. The procedure is simple, with a high postoperative gland survival rate, stable secretion, and minimal complications.