Ophthalmic Plastic and Reconstructive Surgery最新文献

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.

A 61-year-old female patient with a previous diagnosis of Graves disease and mild orbitopathy presented with bilateral optic nerve calcifications and multiple areas of intracranial calcification. Neuro-ophthalmological evaluation did not detect any functional or anatomical compromise of the optic nerves. Her renal function and serum levels of calcium, phosphorus, and parathyroid hormone were normal. Two CT scans of the orbits, performed 7 years apart, showed stable intracranial and bilateral optic nerve calcifications.

Purpose: To describe the gross morphology of the levator palpebrae superioris (LPS) muscle complex in severe congenital ptosis with poor levator function (LF) and to evaluate the surgical outcomes when levator surgery was performed based on intraoperative factors.

Methods: This is a retrospective, interventional case series that includes children having simple severe congenital ptosis with LF ≤ 4 mm for whom levator muscle surgery was performed rather than preplanned frontalis suspension based on the intraoperative LPS muscle evaluation. The collected data included: demographics; ptosis measurements, including margin reflex distance 1 and LF; morphological appearance of LPS muscle and its aponeurosis (levator aponeurosis); surgical technique, and outcomes. Fatty infiltration of the LPS muscle belly was graded, based on its ratio to the muscle's normal width, as minimal (<5%), mild (5-25%), moderate (25-50%), or severe (>50%).

Results: A total of 109 eyelids met the inclusion criteria. Levator aponeurosis, distal and proximal (orbital) zones of the LPS muscle belly were evaluated. Levator aponeurosis was thin in 56.9% of the eyelids and thick with dense fibrotic changes in 43.1%. The distal zone showed extensive fatty infiltration and abnormal blood vessels in all eyelids. The proximal zone appeared fleshy red with minimal to moderate fatty infiltration in about three-fourths of the eyelids (n = 78, 71.6%). Securing this proximal zone to the tarsal plate resulted in a significant improvement in margin reflex distance 1 and LF (median, 4.0 mm and 7.0 mm, respectively, p < 0.001) during a median follow-up period of 8 months (range, 6-96 months).

Conclusions: Intraoperative assessment of the LPS muscle complex, rather than preoperative LF, resulted in a change in surgical planning from frontalis suspension to a levator-based surgery with surgical success.

Purpose: This study examines the characteristics of upper eyelid thickness in Asians microscopically.

Methods: Histological evaluations of 20 upper eyelids (10 right and 10 left) from 14 Japanese cadavers (age range, 36-97, years; average, 68.9 years) were performed. Specimens were fixed in 10% formalin, stained with Masson trichrome and Elastica van Gieson, and analyzed for anterior protrusion of preaponeurotic fat and skin and subcutaneous tissue thickness at 10 mm from the eyelid margin. Statistical analyses included 1-way ANOVA and the Tukey multiple comparison test, with significance set at p < 0.05.

Results: Upper eyelid thickness was classified into 3 types: very thick, moderately thick, and thin types. The very thick type (7 eyelids in 6 cadavers) showed significant anterior protrusion of preaponeurotic fat beyond the superior tarsal edge, pushing the orbicularis oculi muscle anteriorly, with thick subcutaneous tissue. The moderately thick type (5 eyelids in 4 cadavers) exhibited preaponeurotic fat fully reaching the septum-aponeurosis junction with minimal anterior muscle displacement, with less thick subcutaneous tissue. The thin type (8 eyelids in 6 cadavers) demonstrated preaponeurotic fat failing to reach the septum-aponeurosis junction, with thinner subcutaneous tissue. Subcutaneous tissue was significantly thicker in very thick types compared with moderately thick types ( p = 0.002) and thin types ( p = 0.000). It was similar in the moderately thick type and the thin type ( p = 0.356). Skin thickness did not differ significantly between groups ( p = 0.078).

Conclusions: Upper eyelid thickness in Asians is primarily influenced by the anterior protrusion of preaponeurotic fat and subcutaneous tissue thickness, with significant variations across the 3 identified types.

Purpose: To analyze existing literature for presentation, management, and outcomes of penetrating transorbital intracranial injury due to ballpoint pen with emphasis on multidisciplinary management and report an additional case of this rare entity with significant abscess.

Methods: A systematic literature review was conducted using PubMed, Embase, and MEDLINE with keywords "orbit," "transorbital," or "intracranial" and "pen" or "ballpoint pen." Individual cases were included if both transorbital and intracranial injury were present and if the underlying intraorbital foreign body was whole or parts of a pen. We additionally describe a case from our institution with penetrating transorbital intracranial injury due to a ballpoint pen.

Results: Sixteen prior cases were identified, with 1 additional case presenting to our institution for 17 patients total. The mean age was 33.2 years (1.83-60 years). Most were male and adults, although 4 were children. Common etiologies were self-inflicted suicide attempts (n = 11), falls (n = 3), and assaults (n = 3), the latter including our patient. Vascular involvement was noted in 3 cases, and 2 patients had intracranial abscess. Patients frequently underwent combination surgery with neurosurgery and oculoplastic surgery, but persistent neurologic or vision defects remained present postoperatively in most patients (58.8%) at a mean of 6.4 ± 8.1 months. Our patient was only the second adult case due to assault and the only case with an extensive culture-positive abscess but fortunately had a good neurological outcome.

Conclusions: Ballpoint pens may rarely be associated with penetrating transorbital intracranial injury. Prompt diagnosis, careful evaluation, and multidisciplinary collaboration for surgical removal and management are critical.

Nodular fasciitis is a benign, pseudoneoplastic condition often misdiagnosed as sarcoma due to its rapid growth, high cellularity, and mitotic activity. Herein is reported a case of a 7-year-old patient with a painless, enlarging nodule in the left superolateral orbit. Ultrasound revealed a 7.5 mm cystic mass, which was excised via an upper eyelid crease anterior orbitotomy. Histopathologic studies showed benign spindle cells, and molecular testing identified a UBC::USP6 fusion, confirming the diagnosis of nodular fasciitis. Nodular fasciitis is most common in the limbs, trunk, and head or neck region, with fewer than 1% of cases occurring in the orbit. Molecular testing is critical in differentiating this condition from malignancies. Complete surgical excision is the preferred treatment, with a low recurrence rate of 1% to 2%. This is the first reported pediatric case of orbital nodular fasciitis with a UBC::USP6 fusion mutation.

Canaliculitis is a rare lacrimal disorder often caused by Streptococcus species, Staphylococcus species, or Actinomyces . In cases associated with punctal plugs, Pseudomonas species are often implicated. Fungal etiology of canaliculitis has been exceedingly uncommon. The authors present the first report of canaliculitis secondary to Scedosporium , a group of filamentous fungi containing the 2 medically pathogenic species Scedosporium prolificans and Scedosporium apiospermum. Scedosporium spp. are found in soil and water and often infect immunocompromised hosts. The patient responded to punctoplasty with curettage, topical voriconazole, and systemic azole therapy. To the best of the authors' knowledge, there have been no reported cases of fungal canaliculitis due to Scedosporium spp. The collection and evaluation of protected patient health information was Health Insurance Portability and Accountability Act compliant. This report adhered to the tenets of the Declaration of Helsinki as amended in 2013.