Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: The primary objective was to document change in postoperative marginal reflex distance-1 (MRD1) after Müller muscle conjunctival resection surgery. The secondary objective was to identify predictors of change in postoperative MRD1.

Methods: A multicenter prospective cohort study was performed on patients consecutively recruited for Müller muscle conjunctival resection. MRD1 was measured immediately after Müller muscle conjunctival resection, at the 1-week postoperative visit, and the ≥3-month postoperative visit. MRD1 at the immediate and 1-week time points were compared with MRD1 ≥3 months using descriptive statistics. Predictors of change in MRD1 were analyzed using multivariate regression analysis.

Results: A total of 150 patients (226 eyelids) were included. Regarding the immediate to ≥3-month interval, 53.8% of eyelids remained clinically similar (rise or fall ≤0.5 mm), 19.8% rose ≥1 mm, and 26.4% fell ≥1 mm. Regarding the 1-week to ≥3-month interval, 76.5% remained clinically similar, 17.3% rose ≥1 mm, and 6.2% fell ≥1 mm. No variable predicted change in MRD1 over either interval with both clinical and statistical significance.

Conclusions: Immediate postoperative MRD1 is likely to reflect the late result in only 54% of cases. However, 1-week postoperative MRD1 is similar to the late result in 77% of cases and is highly unlikely (6%) to fall by the final visit. No variable significantly impacts change in postoperative MRD1.

Purpose: Severe dry eyes often require surgical intervention. Submandibular salivary and minor salivary gland transplantation are options for refractory dry eyes but have limitations. The authors 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. The authors 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.

Purpose: To evaluate the impact over time of evolving upper respiratory pathogens, modified microbial terminology, and improved laboratory isolation on the bacteriology and management of sinusitis-related subperiosteal abscess of the orbit.

Methods: Comparative case series of pediatric patients with bacterial sinusitis-related subperiosteal abscess from 2012 to 2022. Outcomes, culture results, age-specific findings, and antibiotic duration were compared with those in 1977 to 1992, 1988 to 1998, 1999 to 2008, and 2002 to 2012 cohorts at the same institution.

Results: Ninety-one patients met the inclusion criteria. Forty-nine patients (53.8 %) recovered with medical therapy alone; 42 (46.2 %) underwent surgical drainage. There was increased representation in surgical cases of Streptococcus anginosus group (52.4%) and anaerobes (26.2%). Anaerobes were isolated from 2 patients <9 years of age, the youngest age 5; recovery in prior series was limited to patients ≥9 years old. Among 61 of 91 patients <9 years old, 41 (67.2%) were managed medically and 20 (32.8%) underwent surgery. Comparable proportions were 67.5%/32.5%, 85%/15%, and 72%/28% in prior cohorts. Among nonsurgical patients <9 years old, the mean duration of intravenous antibiotics was 4.02 ± 1.2 days. Four patients had multiple admissions. In cases positive for aggressive pathogens, initial findings prompted timely drainage. All patients had favorable visual and systemic outcomes.

Conclusions: This study extends to 45 years a unique analysis of the bacteriology and clinical course of subperiosteal abscess at a single center with comparatively stable patient demographics and environmental factors, using a relatively uniform treatment algorithm. Despite the increased representation of S. anginosus group and anaerobes, a multifactor protocol with minor modifications remains an effective strategy.

The authors report the first case of generalized lipodystrophy with orbital inflammatory symptoms. A 6-year-old female with hypothyroidism who developed hepatosplenomegaly, lymphadenopathy, and progressive loss of subcutaneous fat. Following flu vaccination, she developed orbital inflammatory symptoms. Imaging of the orbits demonstrated a paucity of retrobulbar fat and fat stranding. Systemic workup revealed insulin resistance and hepatosteatosis, consistent with generalized lipodystrophy. The authors discuss the typical history and examination findings in generalized lipodystrophy and review the etiology, treatment options, and outcomes.

Sebaceous gland hyperplasia is a benign cutaneous entity commonly seen in older men. Occasionally, it can develop in young patients on immunosuppression with cyclosporine or in adolescent boys in the peripubertal age group. It is extremely rare in young children with no reports of eyelid involvement. It is believed to have no systemic associations, unlike sebaceous adenoma, which is associated with Muir-Torre syndrome. Herein, the authors present a rare case of a young girl with recurrent and aggressive eyelid sebaceous hyperplasia who was treated by a wide local excision of the lesion. The histopathology showed intact nuclear expression of mismatch repair proteins MLH 1, MSH 2, MSH 6, and PMS 2, and the genetic testing revealed a missense mutation in the MSH2 gene.

Hydrogel scleral buckles are a hydrophilic explant that may lead to significant delayed complications. They can insidiously enlarge over decades and may mimic an orbital tumor or cyst. The authors report a case of an expansive hydrogel scleral explant in a previously eviscerated socket. A 58-year-old male presented with a 2-week history of severe pain in his left anophthalmic socket. And 31 years prior, he had sustained OS trauma and undergone a series of surgeries. Details of these procedures were unavailable; however, he had ultimately proceeded to globe evisceration. MRI revealed a large lobulated cyst-like orbital mass with internal calcification, which had expanded the left orbit with erosion of the medial wall, lateral wall, and roof. It extended to involve the ethmoid and frontal paranasal sinuses. He proceeded to a lateral orbitotomy, revealing the lesion to be an expanded hydrogel scleral buckle explant. Postoperatively, there was a significant improvement in his pain.