Ophthalmic Plastic and Reconstructive Surgery最新文献

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.

Purpose: To evaluate the subjective assessment of 8 orbital CT features for predicting dysthyroid optic neuropathy (DON).

Methods: Scan montages from 137 orbits without DON and 121 with DON were each graded independently by 3 observers for 8 imaging features: namely, degree of apical crowding, extraocular muscle enlargement, expansion of orbital fat, clarity of the superior orbital fissure, fat prolapse through the superior orbital fissure, medial wall bowing, general orbital vascular congestion, and dilation of the superior ophthalmic vein. Gradings were analyzed individually and also averaged across observers. Associations with DON were assessed using univariate and multivariate logistic regression, and performance of the latter was assessed using area under the receiver-operating-characteristic curve, sensitivity, specificity, and calibration plots.

Results: Unadjusted models showed apical crowding ( p < 0.001), extraocular muscle enlargement ( p < 0.001), vascular congestion ( p = 0.001), and medial wall bowing ( p < 0.001) were each associated with DON, across all observers. Models for observers 1 and 3 included only apical crowding, with a 1-unit grading-increase giving, respectively, a 2.88-fold and 3.04-fold increase in DON odds ( p < 0.001). The observer 2 model included extraocular muscle enlargement (odds ratio: 2.95; p < 0.001) and vascular congestion (odds ratio: 2.57; p = 0.023). The "averaged-score" model for all observers included only apical crowding, with a 3.76-fold increased odds per unit increase in grading ( p < 0.001). The models showed borderline-acceptable discrimination (area under the receiver-operating-characteristic curve: 0.68-0.75) and good calibration, with the averaged-score model performing best.

Conclusions: Apical crowding, extraocular muscle enlargement, vascular congestion, and medial wall bowing are key predictors of DON, with apical crowding being the most influential.

Purpose: To evaluate clinical presentation, imaging patterns, histopathology, and predictors of malignancy in patients with enlargement of a single extraocular muscle.

Methods: Retrospective review, with imaging categorized into 3 groups: single-muscle only (SMO), single excessively-enlarged muscle, and single-muscle with lacrimal gland enlargement (SMLG). Histopathology was classified as specific or nonspecific myositis, atypical thyroid eye disease, malignancy, or other diagnosis.

Results: Among 142 patients (54% female), 60/142 (43%) had SMO, 53 (37%) single excessively-enlarged muscle, and 29 (20%) single-muscle with lacrimal gland. The commonest diagnoses were myositis (43%), atypical thyroid eye disease (27%), and malignancy (27%). Malignancy-mainly lymphoma or metastases-was commonest in SMO (43%), while atypical thyroid eye disease predominated in single excessively-enlarged muscle (49%), and myositis in the single-muscle with lacrimal gland group (69%). From univariate analysis, predictors of malignancy included age ≥60 years (odds ratio [OR]: 2.6; p = 0.012), prior malignancy (OR: 15.6; p < 0.001), subjective visual impairment (OR: 3.5; p = 0.024), LogMAR ≥0.5 (OR: 9.0; p = 0.009), ≥3 mm relative exophthalmos (OR: 3.1; p = 0.008), SMO (OR: 4.8; p < 0.001), lateral rectus involvement (OR: 3.7; p = 0.008), the "amphora sign" (OR: 28.2; p < 0.001), and maximum muscle diameter ≥10 mm (OR: 35.5; p < 0.001). Multivariate analysis confirmed prior malignancy (OR: 27.7; p = 0.013) and muscle diameter ≥10 mm (OR: 24.8; p = 0.005) as independent predictive variables. The prevalence of pain or diplopia and symptom duration were not significantly different in patients with myositis or those with malignancy.

Conclusion: Excessive enlargement of a single extraocular muscle poses a diagnostic challenge due to the overlap of inflammatory and neoplastic features. Given the substantial proportion of malignancies, a high index of suspicion and early biopsy should be considered, particularly with SMO, a muscle diameter ≥10 mm, or prior history of cancer.

Purpose: To analyze adverse events and failures associated with lacrimal stents, intubation sets, and balloon catheters using reports from the Food and Drug Administration's Manufacturer and User Facility Device Experience database over a decade.

Methods: A retrospective analysis was conducted on 86 medical device reports from the Manufacturer and User Facility Device Experience database between May 27, 2014 and February 24, 2024. Data on adverse events, device types, and patient demographics were extracted. Descriptive statistics summarized the frequency and types of events.

Results: A total of 86 device-related and 46 patient-related adverse events were reported. Among the patient-related events, 43 involved foreign body retention, 2 involved bloody tears, and one of slight bleeding. Regarding device-related events, 73.3% were tube-related, with the most common issues being tube penetration due to a missing stainless-steel ring (38.4%), followed by tube tip breakage (8.1%) and leaks (7%). Issues with the dilation process comprised 5.8%. Balloon-related problems, primarily balloon tears (10.5%), accounted for 20.9% of device-related events. The reports revealed demographic gaps, with complete patient information available in less than half of the cases. The findings highlight recurrent failure modes linked to specific device brands and insertion techniques.

Conclusion: This study offers a comprehensive overview of failure scenarios and associated risk factors for lacrimal stents, intubation sets, and balloon catheters. Detailing adverse events and device-specific issues, it aims to assist clinicians in anticipating potential complications and improving management strategies. Enhanced reporting and rigorous postmarket surveillance are crucial to further optimize device safety and effectiveness.