Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: This study explores the demographics, presentation, and anatomic features associated with involutional entropion, offering insight into the etiology of the condition. Surgical techniques and results are presented.

Methods: A retrospective chart/photographic review was performed on patients treated between 2005 and 2024.

Results: Demographic analysis was limited to 405 patients without prior surgery. Incidence increased with age, with only 1.7% ≤60 years old. Males were more frequently affected than predicted using population data. Unilateral right (57%, p = 0.015) was more common than left entropion. Unilateral entropion was associated with an ipsilateral larger or inferiorly positioned orbit, findings more common on the right. Throughout the study, 30.6% of patients showed signs of bilateral disease.Five hundred nineteen procedures (612 eyelids) were performed. Most included a lateral tarsal strip and posterior retractor attachment. Twenty-one percent of lids had insufficient laxity for a standard lateral tarsal strip. Recurrent cases more commonly involved males (63%, p = 0.018) and the right side (63%, p = 0.047). Postoperative ectropion was more frequent after anterior (p < 0.001) and chemosis after posterior surgery (p < 0.001). Recurrence developed in 8 study eyelids (1.3%). Preoperative ipsilateral ptosis (≥1 mm) was present in 33.4% of unilateral cases and often improved after repair.

Conclusions: Incidence of involutional entropion increases with age and is greater in males and on the right. Enophthalmos, retractor laxity, and canthal instability are likely predisposing anatomic factors. Significant horizontal laxity is seldom present. The lateral tarsal strip reestablishes canthal stability, and when combined with posterior retractor attachment to tarsus and orbicularis is highly effective. Complications are uncommon and usually apparent soon after surgery.

Purpose: Reconstruction of upper eyelid defects is challenging due to paucity of fungible local tissue and a lack of adequate tarsal substitutes. Cartilage is too stiff to be directly implanted in the posterior lamella due to the risk of corneal damage with blinking. Since elastin is a key structural element in elastic cartilage, we hypothesized that elastase treatment of cartilage may reduce cartilage's stiffness sufficiently to make it a feasible posterior eyelid lamella substitute.

Methods: Porcine auricular cartilage was treated with elastase or buffer control. Histopathology, electron microscopy, and mechanical testing were performed. Young's modulus was calculated using the Hertzian method for mechanical indentation testing at baseline, 2, and 24 hours. Group 1 (buffer control auricular cartilage), Group 2 (elastase-treated auricular cartilage), and Group 3 (native tarsus) were compared.

Results: Grossly, elastase treatment increased cartilage flexibility, and microscopically increased chondrocyte lacunae and decreased the density of the interterritorial matrix, relative to controls. Electron microscopy revealed elastin fiber degradation with empty channels preplacing elastin fibers. At 2 hours, cartilage stiffness showed minimal differences between Groups 1 and 2 for both instantaneous modulus (1.34 vs. 1.37 MPa; p = 0.92) and equilibrium modulus (0.31 vs. 0.36 MPa; p = 0.71). By 24 hours, the equilibrium modulus of elastase-treated cartilage (0.055 MPa) resembled native tarsus (0.016 MPa; p = 0.76).

Conclusions: Grossly, elastase treatment increased cartilage flexibility and, microscopically, increased chondrocyte lacunae and decreased the density of the interterritorial matrix, relative to controls.

Purpose: This study aimed to evaluate the efficacy of various treatment modalities for periocular cutaneous squamous cell carcinoma (pcSCC) with perineural spread (PNS), including immunotherapy, targeted therapy, radiation therapy (RT), and observation.

Methods: A retrospective review of 21 patients with pcSCC and PNS treated with immunotherapy, targeted therapy, RT, or observation over the past decade at a single center.

Results: Twelve cases were treated with immunotherapy: 6 patients received cemiplimab, 1 pembrolizumab, and 5 combined with chemotherapy/epidermal growth factor receptor (EGFR) blocker/RT (mean follow-up 32 months). MRI showed improvement in 92% of patients (complete response 42% and partial response 50%). Trigeminal neuralgia improved in 92%. Motor and sensory nerve recovery were noted in 50%. Survival rates were 100% in 1 year, 88% in 2 years, and 75% in 3 years. Three patients received EGFR blocker (cetuximab) with RT: 2 patients experienced clinical regression, and 1 had stable disease (mean follow-up 31 months). Neuropathic pain improved in all cases, but no motor or sensory nerve recovery was observed. Survival rates were 100% at 1 year, and 33% at 2 years. Four patients received RT-only (3 had progressive disease, 1 stable disease) and 2 patients opted for observation. No clinical improvement or nerve function recovery was observed in both groups. Both mean survivals were less than 2 years. The 2-year survival rates were 88% in the immunotherapy group, 33% in the EGFR + RT group, and 0% in the RT-only and observation groups.

Conclusions: Immunotherapy demonstrated superior clinical outcomes in pcSCC with PNS, improving symptoms, nerve function, MRI findings, and survival rates compared to other treatment modalities.

Congenital arrhinia and hemi-arrhinia can present with varying degrees of nasal hypoplasia. There are significant anatomical consequences to the lacrimal system, and treatment of epiphora in these cases is challenging, with few reports of successful external dacryocystorhinostomy or combined endoscopic and external dacryocystorhinostomy. A 12-year-old girl with left hemi-arrhinia presented with left-sided epiphora and chronic dacryocystitis due to an incompletely formed nasolacrimal system. She underwent a left endoscopic dacryocystorhinostomy via a right-sided transnasal approach in conjunction with otorhinolaryngology, with complete resolution of symptoms postoperatively. This is the first reported case in the literature demonstrating that epiphora in the setting of hemi-arrhinia may be successfully treated in a completely endoscopic fashion with a multidisciplinary team and stereotactic navigation.

Purpose: This study aimed to evaluate the accuracy of different large language models (LLMs) in generating differential diagnoses for oculoplastic cases.

Methods: Differential diagnoses were generated for 20 oculoplastic cases sourced from University of Iowa EyeRounds.org using 6 LLMs: Chat Generative Pre-Trained Transformer (ChatGPT) 3.5, ChatGPT 4.0, OcuSmart/EyeGPT, Google Gemini 1.5, Claude 3.5, and Microsoft CoPilot. Outputs were compared against the EyeRounds expert-curated differentials examining (1) top diagnosis match rate (2) inclusion of the correct diagnosis within the generated list, as well as (3) recall and (4) precision, calculated to assess the overlap and conciseness of LLM outputs.

Results: OcuSmart/EyeGPT achieved the highest top diagnosis match rate (85 ± 36%), while Claude 3.5 demonstrated the highest rate of inclusion of correct diagnosis in differential, as well as recall rate (100 ± 0% and 55 ± 27%, respectively). Google Gemini produced the most precise differentials at 43 ± 24%. Claude 3.5 generated the largest but least concise lists. LLM performance varied by case; for example, idiopathic orbital inflammation cases yielded highest recall and top diagnosis match across all models, while floppy eyelid syndrome cases demonstrated lowest performance.

Conclusions: LLMs show promising potential in diagnosing oculoplastic cases, with OcuSmart/EyeGPT and Claude 3.5 performing best for determining the case diagnosis and recall, and ChatGPT 3.5, OcuSmart/EyeGPT, and Gemini generating concise and relevant differentials. However, further research and development are necessary to validate LLMs' capabilities and integrate them into the clinical workflow.