Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: Keloid (KD) and hypertrophic scars are prevalent and result from excessive growth of dermal tissue after skin damage. This review focused on the clinical application of the ultra-pulsed CO 2 fractional laser combined with recombinant human epidermal growth factor (rHEGF) gel in patients with eyelid KD.

Methods: Patients (N = 98) with KD who underwent surgery were randomly divided into a study group (ultra-pulsed CO 2 fractional laser combined with rHEGF gel therapy, N = 49) and a control group (ultra-pulsed CO 2 fractional laser therapy, N = 49). Besides, 5 cases dropped out of the study, including 2 cases in the study group and 3 cases in the control group. Finally, 47 cases of the study group and 46 cases of the study group were included in the analysis. The clinical baseline data such as sex, age, body mass index, scar area, etiology, Vancouver Scar Scale score, Patient and Observer Scar Assessment Scale score, four-item itch questionnaire score, serum interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α level expression were recorded in the study group (N = 47) and the control group (N = 46).

Results: There was no significant difference in gender, age, body mass index, scar area, etiology, Vancouver Scar Scale score, Patient and Observer Scar Assessment Scale score, 4-item itch questionnaire score, IL-6, IL-10, and tumor necrosis factor-α levels between the patients treated with ultra-pulse CO 2 fractional laser + rHEGF gel and those only treated with ultra-pulse CO 2 fractional laser ( p > 0.05). Vancouver Scar Scale scores, Patient and Observer Scar Assessment Scale scores, and four-item itch questionnaire scores of patients with eyelid KD decreased to a greater extent than those treated with ultra-pulsed CO 2 fractional laser combined with rHEGF gel ( p <0.01). Compared with ultra-pulsed CO 2 fractional laser treatment, ultra-pulsed CO 2 fractional laser combined with rHEGF gel was more efficacious in treating patients with eyelid KD, with a lower incidence of adverse effects and a 1-year recurrence rate.

Conclusions: Ultra-pulsed CO 2 fractional laser combined with rHEGF gel can significantly improve the scar status and scar itching in patients with eyelid KD, with an obvious therapeutic effect, a low incidence of adverse effects, a 1-year recurrence rate, and high safety, which is worthy of popularization and application.

The global outbreak of Mpox has resurged, leading to a significant increase in cases across numerous countries. Mpox infections are associated with potential ophthalmologic complications, such as periorbital skin lesions, blepharoconjunctivitis, keratitis, and vision impairment. Here, the authors present a retrospective case report of an atypical Mpox in an HIV-positive patient with a persistent 5 × 5 cm ulcerated, round, plaque-like eyelid lesion refractory to multiple treatment regimens. Upon serologic Mpox identification, the patient was promptly started on antiviral therapy with the resolution of symptoms. This case demonstrates the importance of considering Mpox in the differential diagnosis of atypical periorbital lesions in HIV-positive patients. The authors also highlight the potential bias toward focusing on opportunistic infections in those with HIV, which can delay diagnosis.

Purpose: Punctal agenesis (PA) is a rare congenital anomaly that can occur in isolation or as part of an underlying syndrome. The benefit of genetic assessment in individuals with PA and clinical features that should prompt molecular workup has not been systematically studied. The aim of this study was to identify ocular and extraocular features associated with PA and determine its association with an underlying syndrome.

Methods: A retrospective medical records review of ocular and extraocular medical histories in all patients diagnosed with PA at the Children's Hospital of Philadelphia between 2009 and 2023 was conducted.

Results: Forty-four patients were included, ages 3.3 ± 3.3 years. The cohort was 31 males (70%). Twenty patients had isolated PA (45.5%), while 24 patients (54.5%) had other associated ocular or extraocular abnormalities. The most common ocular comorbidities were refractive disorders (n = 8, 33%), ptosis (n = 8, 33%), strabismus (n = 7, 29%), other eyelid disorders (n = 9, 38%), and amblyopia (n = 6, 25%). Nineteen (43%) individuals had systemic disorders and 18 (41%) underwent genetic testing. An associated genetic diagnosis was found in 17 (39%) individuals. The most common associated syndrome was ectodermal dysplasia. Systemic disorders were more prevalent in individuals with syndromic PA (4, 20% isolated PA vs. 15, 63%, PA-plus, p = 0.005).

Conclusions: The presence of additional ocular abnormalities was associated with an increased rate of systemic disorders (63%). In individuals with PA who also exhibit additional ocular disorders, systemic evaluation and genetic workup should be considered.

Solitary eyelid neurofibroma is a rare condition, and there have been no reported cases of solitary eyelid neurofibroma involving the proximal lacrimal drainage system. A 6-year-old male presented with recurrent painless swelling in the medial part of the left lower eyelid. The patient was misdiagnosed as eyelid polyp and underwent excision biopsy twice elsewhere. Subsequently, the patient presented with a recurrence of swelling and was treated with full-thickness eyelid resection and reconstruction by direct closure. Histopathology showed the presence of spindle cells with hyperchromatic nuclei in a myxoid background. These cells showed S100 and CD 34 positivity. The systemic evaluation did not show any signs of neurofibromatosis.

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.

Sinonasal malignancy is a rare but recognized cause for nasolacrimal obstruction leading to epiphora. While direct mucosal spread through the nasolacrimal duct can occur in benign sinonasal tumors such as inverting papilloma, the same phenomenon has not been described in malignant lesions. The authors present a case of a low-grade nonintestinal type sinonasal adenocarcinoma centered on the inferior meatus of the sinonasal cavity, showing mucosal invasion into the nasolacrimal duct with bony expansion but no erosion of the nasolacrimal canal. The lesion was excised en bloc with a combined endoscopic and external approach with clear margins.

Lymphomatoid granulomatosis, a rare lymphoproliferative disorder, was previously defined by categorical pulmonary involvement with possible invasion into the skin, central nervous system, liver, and kidneys. However, recent reports have documented confirmed cases of lymphomatoid granulomatosis without lung involvement. Here, the authors describe a 70-year-old male with rheumatoid arthritis on methotrexate who presented with an ulcerating lesion on the right lower eyelid, initially suspicious for a basal cell carcinoma. Biopsy and immunohistochemical staining revealed grade 3 lymphomatoid granulomatosis. Further workup showed no systemic involvement. The patient's presentation was thought to be secondary to chronic immunosuppression with methotrexate. Upon withdrawal of the medication, the lesion regressed. To the authors' knowledge, this is the first case report of methotrexate-induced lymphomatoid granulomatosis presenting with a singular periocular cutaneous lesion.

Purpose: The purpose of this study is to investigate the association between cannabis usage and thyroid eye disease (TED) in patients with autoimmune hyperthyroidism. While the association between cigarette smoking and TED is well established, the effect of cannabis on TED is unclear.

Methods: This cohort study examined data from TriNetX, an electronic health record platform, for patients with autoimmune hyperthyroidism between December 1, 2003, and December 1, 2023. Primary outcomes were TED presentation (exophthalmos, eyelid retraction, eyelid edema, orbital edema, strabismus, and optic neuropathy) and treatment (teprotumumab, methylprednisolone, tarsorrhaphy, and orbital decompression) in cannabis users, nicotine users, and control patients. Propensity matching was performed to control for characteristics such as age, sex, race, prior thyroidectomy, and/or radio ablation. Relative risk between cohorts was calculated for each outcome in 6-month, 1-year, and 2-year intervals following diagnosis of autoimmune hyperthyroidism.

Results: Of 36,186 patients with autoimmune hyperthyroidism, 783 were cannabis users, 17,310 were nicotine users, and 18,093 were control patients without cannabis or nicotine usage. Compared with control patients, cannabis users were more likely to be younger, male, and Black/African American and have anxiety or depression. After propensity matching, cannabis users were 1.9 times more likely to develop exophthalmos ( p = 0.03) and 1.6 times more likely to develop any TED presentation ( p = 0.049) in the 1-year interval although these differences did not remain statistically significant in the 2-year interval.

Conclusions: Cannabis users had a significantly increased risk for TED outcomes in the 1-year interval. Further research is needed to inform TED management.