Ophthalmic Plastic and Reconstructive Surgery最新文献

Oncocytic carcinoma is a rare malignant neoplasm of oncocytic cells, such cells being characterized by abundant granular eosinophilic cytoplasm, invasive growth, and pronounced cellular pleomorphism. It may arise de novo, or through malignant transformation of a pre-existing benign oncocytoma. Oncocytic carcinoma most commonly occurs in the salivary glands, with rare involvement of the ocular adnexa where it mainly affects caruncle, conjunctiva, and lacrimal sac, and only very arises in the lacrimal gland. This report presents a unique case of a 77-year-old male with lacrimal gland oncocytic carcinoma that probably arose from a pre-existing pleomorphic adenoma; local tumor control was achieved with local excision and adjuvant radiotherapy, but he developed metastasis and died 3 years later. Together with a literature review, this case underlines the aggressive biological behavior of lacrimal gland oncocytic carcinoma, with its high propensity for local and distant recurrence.

Purpose: To examine microscopically the progress of baggy eyelid formation in the lower eyelid.

Methods: Histological evaluation of 17 central lower eyelids (11 right and 6 left) from 13 Japanese cadavers (age range: 36-97 years, average: 73.0 years) was performed. The specimens were fixed in 10% formalin and stained with Masson's Trichrome. The following characteristics were examined: 1) presence of baggy eyelid, 2) thickness of the orbital septum, 3) presence of anterior protrusion of fat and/or orbicularis oculi muscle (OOM), 4) thickness of OOM and subcutaneous tissue at the widest anterior protrusion, and 5) skin thickness.

Results: The findings were divided into 4 stages: stage 0 (2 eyelids in 1 specimen) absent baggy eyelid, all tissues normal, stage 1 (1 eyelid in 1 specimen) absent baggy eyelid, intermediate orbital septum, anterior dome-like protrusion of fat but minimal OOM projection, thick OOM, subcutaneous tissue, and skin, stage 2 (9 eyelids in 7 specimens) absent or minimal baggy eyelid, intermediate orbital septum, anterior dome like protrusion of fat and OOM, intermediate OOM, with thick subcutaneous tissue and skin, stage 3 (5 eyelids in 4 specimens) with present baggy eyelid, thin orbital septum, severe anterior dome like protrusion of fat and OOM, with thin OOM, subcutaneous tissue and thick skin in mild type, with thin skin in severe type.

Conclusions: Baggy eyelid appears to be triggered by the anterior protrusion of fat, followed by thinning of the orbital septum, OOM, and subcutaneous tissue in order. Thinner skin may promote severe entity.

Purpose: The study aimed to assess the efficacy and recurrence rate of everting sutures as a sole procedure in entropion repair, its impact on quality of life during the coronavirus disease pandemic, and to determine if this procedure remains an option to offer after the pandemic.

Design: Retrospective clinical cohort study.

Methods: Retrospective study of 58 patients who had everting sutures for entropion repair over a 1-year period. Patients who had everting sutures combined with another procedure were excluded from the study. The study evaluated the effectiveness of the procedure by examining eyelid positioning during follow-up, complication rate, and the 1-year recurrence rate. Patients were also contacted to describe their symptoms before and after surgery and to complete The European Quality of Life questionnaire.

Results: The mean age was 79 years and 68.9% were male. The immediate success rate was 95.3% with a complication rate of 1.5%. The 1-year recurrence rate was 23.4%. After surgical intervention, 95.1% of patients experienced symptom relief. An improvement in quality of life was reported in 76.2%, which was predominantly attributed to a reduction in eye pain or discomfort (p < 0.05).

Conclusions: Everting sutures are a quick and safe procedure that can be performed by any general ophthalmologist. This procedure is effective and improves the quality of life; however, it is associated with a higher recurrence rate compared with other entropion repair surgeries. Nonetheless, it remains an attractive option for older patients who want to avoid long and invasive procedures.

Loss of periocular skin due to cancer, trauma, or surgery is a major reconstructive challenge; resultant tissue contracture can cause eyelid malposition with poor functional and aesthetic outcomes. We describe the successful use of cryopreserved umbilical cord amniotic membrane as a wound covering and scaffold for periorbital anterior lamellar defects. This is a retrospective case series of 4 patients (mean 21 years, range 9-30 years, 3 male) who underwent periocular reconstruction with umbilical cord amniotic membrane of 9 different sites. Follow-up time ranged from 10 to 22 months. All wounds healed successfully with a good functional eyelid position. Umbilical cord amniotic membrane is readily available, has antibacterial and anti-inflammatory properties, provides a structural scaffold for cell adhesion and growth, and contains biological factors that promote cell proliferation/remodeling. We demonstrate that the umbilical cord amniotic membrane is an effective substitute for full-thickness skin grafting in the periocular area, particularly with skin loss secondary to burns and/or trauma.

Purpose: Soft-tissue filler injections, particularly hyaluronic acid, are popular for temple volume restoration. Although uncommon, this area poses risk for vision loss from embolic occlusion. Guidelines recommend injecting into the supraperiosteal plane for safety; however, the deep temporal arteries (DTAs) in this plane pose a risk. This study investigates potential pathways from the DTA to the ophthalmic artery (OA) and mechanisms of filler travel.

Methods: Retrospective analysis of carotid angiograms from patients with marked carotid artery stenosis or vascular malformations, given that collaterals are more visible in the presence of vascular blockages. Select cases were identified by the neurosurgery team.

Results: Four anastomotic pathways between the DTA and OA were identified, displaying a combination of anterograde and retrograde flow. Case 1 shows direct DTA-lacrimal artery anastomosis. In cases 2 to 4, the DTA is shown originating from the internal maxillary artery (IMAX) following its anatomical course. Retrograde flow from the DTA into the IMAX can then lead to anterograde flow into branches connecting to the IMAX including the superficial temporal artery, infraorbital artery, and middle meningeal artery. These arteries then form collaterals with the OA.

Conclusions: Our study is the first to elucidate 4 potential routes for filler-induced OA occlusion originating from DTAs in the supraperiosteal plane. These pathways involve retrograde flow, a mechanism previously suggested for filler-induced occlusion. Notably, the likelihood of these pathways being traversed may be low due to their length and amount of filler volume required; however, it is not impossible.

Purpose: To evaluate the surgical techniques used in the management of eyelid burns among pediatric patients below 18 years old, focusing on the timing of interventions and patient outcomes.

Methods: This systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A comprehensive literature search was performed using PubMed, Embase, and Web of Science, targeting studies published between January 2000 and August 2024. Search terms included "burn," "injury," "release," "scar," "children," "pediatric," "eyelid," "contracture," and "reconstruction." A total of 51 studies were identified, of which 6 met the inclusion criteria and were selected for detailed review. All focused on pediatric patients with severe eyelid burns.

Results: The review identified a range of surgical techniques, including antegrade foreheadplasty, Double Frost Suture technique, and early versus delayed surgical release. Antegrade foreheadplasty was effective in addressing upper eyelid contracture deformities, providing significant functional and aesthetic improvements. The Double Frost Suture technique was successful in preventing graft retraction and enhancing graft stability. The timing of surgical intervention was found to be crucial, with early release showing better outcomes in terms of ocular protection and faster recovery compared with delayed interventions.

Conclusions: The findings underscore the importance of a tailored approach in the surgical management of pediatric eyelid burns, with careful consideration of the timing and technique. While early surgical release generally yields better outcomes, the choice of technique should be guided by the specific needs of each patient. Further research is needed to refine these techniques and to better understand the long-term outcomes, particularly in complex cases involving extensive burns.

Purpose: To analyze the national epidemiologic trends of squamous cell carcinoma of the conjunctiva (SCCC) over 4 decades, providing the largest report on disease-specific survival (DSS) outcomes and investigating the risk of developing second primary neoplasms in these patients.

Methods: This retrospective, population-based cohort study analyzed 1,172 patients diagnosed with SCCC from January 1, 1975, through December 31, 2016. Data were extracted from the US Surveillance, Epidemiology, and End Results database. Incidence, DSS, and the relative risk (95% confidence interval) of developing second primary neoplasms were studied.

Results: SCCC incidence (0.45/million/year) increased during the study's time period (regression coefficient = 0.004, p = 0.002), primarily due to an increasing incidence in women (regression coefficient = 0.004, p = 0.003) and in White (regression coefficient = 0.006, p = 0.007) patients. The 5-year DSS was 95.4%. Sex and race did not impact survival. Patients residing in the Midwestern United States exhibited the lowest survival compared with other regions with a 5-year DSS of 85.2% (p = 0.008). White male SCCC patients are at an increased risk, compared with the general population, of developing second primary neoplasms of the liver (relative risk = 4.8 [1.3-12.4]; p < 0.05), respiratory tract (relative risk = 2.3 [1.4-3.6]; p < 0.05), and skin (relative risk = 3.7 [1.8-6.9]; p < 0.05).

Conclusions: SCCC incidence has been increasing in the United States. DSS is substantially higher than the overall survival previously reported in the literature. The area of residence significantly impacts survival. White men with SCCC are at an increased risk of developing second primary neoplasms of different organ systems.

A 2-year-old girl initially presented with an enlarging and fluctuating mass resembling a bruise several months after orbital trauma. CT imaging showed soft tissue contusion and possible hematoma, without cystic characteristics. Surgical excision was conducted and immunohistochemistry staining revealed CD34+ endothelium. The clinical and histopathologic findings were consistent with an orbital varix. To date, there are no published cases of posttraumatic extraconal orbital varix formation in the pediatric population.

Myxoma is a rare tumor that can be challenging to diagnose, with imaging findings that can be nonspecific. We present a case of a 21-year-old man who presented with a subacute history of right visual deterioration and proptosis. Imaging showed a large right superomedial orbital mass of 43 × 31 × 24 mm, which enhanced heterogeneously and was eroding the adjacent orbital roof and medial wall. An excisional biopsy was performed via a lid crease approach under transorbital endoscopic guidance. We review the clinical, radiological, and histological characteristics of myxoma. In addition, we highlight important associations with genetic syndromes including Carney complex and Mazabraud syndrome.