Ophthalmic Plastic and Reconstructive Surgery最新文献

Orbital compartment syndrome due to rhabdomyolysis and subsequent ischemic reperfusion injury is an extremely rare event. Treatment consists of decreasing intraorbital pressure, which may include emergent surgical decompression and addressing the underlying cause, which in these cases was skeletal muscle injury in the setting of prolonged immobilization. Despite intervention, acute orbital compartment syndrome with visual acuity loss has a poor prognosis if effective therapy is not initiated promptly. To the authors' knowledge, there is only 1 previously reported case of orbital apex syndrome, and no cases of orbital compartment syndrome caused by rhabdomyolysis after drug-induced loss of consciousness. Here, the authors describe the course of 2 patients with rhabdomyolysis after drug overdose, after tricyclic antidepressant and opiate use, respectively. These patients were suspected of having compressive orbital ischemia that led to extraocular muscle swelling and rebound hyperperfusion, which exacerbated already elevated compartment pressures.

Purpose: Retinoblastoma (RB) is the most common intraocular tumor in childhood. Survivors of RB are at risk of developing secondary malignancies. Prior radiotherapy substantially increases the risk of malignancy in the orbit, brain, and nasal cavities. The authors report 2 new cases of secondary sino-orbital malignancies in RB survivors who underwent radiotherapy during early childhood. A literature review on secondary sinonasal and orbital malignancies in RB is presented.

Methods a: case series and literature review of relevant publications on the topic was performed, with appropriate data extracted.

Results: Twelve cases of secondary sinonasal and orbital malignancies in RB survivors have been reported, including 5 cases of adenocarcinoma, 2 cases of sinonasal neuroendocrine carcinoma, and 2 cases of olfactory neuroblastoma were also reported. Single cases each of leiomyosarcoma and squamous cell carcinoma were reported. Secondary malignancies are more common in hereditary RB with germline mutations in the RB1 gene. Radiotherapy significantly increases the risk of secondary malignant neoplasms. Secondary sinonasal malignancies are rare in RB survivors.

Conclusions: Ophthalmologists should be vigilant of the increased risk of developing secondary orbital and sinonasal malignancies in patients with retinoblastoma, especially in germline mutations and postradiotherapy. Life-long follow-up in RB survivors is recommended to detect and effectively manage these rare but fatal secondary malignant neoplasms.

Necrotizing periorbital Sweet syndrome is an uncommon mimic of necrotizing fasciitis that requires contrasting management. We describe a 60-year-old man with rapidly progressive unilateral eyelid edema, pain, and necrosis unresponsive to broad-spectrum antibiotics. Computed tomography showed periorbital soft-tissue swelling with gas. Two debridements for presumed necrotizing fasciitis yielded "dishwater" fluid; histopathology and special stains revealed a dense neutrophilic dermatosis without organisms, and cultures grew only commensals. He improved promptly after high-dose corticosteroids. Hematologic evaluation for escalating leukocytosis uncovered acute myeloid leukemia with t(6;9) and neuroblastoma RAS viral oncogene homolog mutation. A targeted literature synthesis showed frequent initial misdiagnoses as cellulitis or necrotizing fasciitis, unnecessary debridement, common association with myeloid neoplasia, and rapid steroid response. Periorbital sweet syndrome should be considered when cultures are sterile and clinical status worsens despite antibiotics; early biopsy and empiric corticosteroids can avert morbidity and unmask occult malignancy.

Purpose: To report the outcomes of a small case series of patients with periorbital necrotizing fasciitis (PONF) treated with high-dose intravenous antibiotics and dilute, pure hypochlorous acid (HOCL) irrigated through affected tissues as well as sprayed topically, with no tissue debridement.

Methods: In this single-center, retrospective chart review, 6 patients were identified between May 1, 2022, and May 1, 2024, with PONF who had HOCL used during their treatment. The primary outcome measures included successful eradication of infection, acceptable aesthetic result with minimal or no reconstruction required, and little or no loss of vision. Results of treatment were compared with those PONF patients in the literature treated more traditionally with antibiotics and debridement, and those treated with antibiotics alone.

Results: Of the 6 patients identified with PONF, all 6 were treated with dilute, pure HOCL (0.033%). The median age of the patients was 51 (range 32-73). The female-to-male ratio was equal. The median follow-up time since the first presentation was 158 days (range 30-180). Streptococcus pyogenes was the most common causative organism, found in 80% of cases. No patient underwent tissue debridement in the periocular area. All patients recovered with minimal sequelae. No patient reported loss of vision on their final follow-up visit. There were no patients who required enucleation or exenteration and no patients died because of PONF.

Conclusions: The authors describe a simple method of introducing dilute, pure HOCL (0.033%) without hypochlorite or sodium hypochlorite as impurities via irrigation and topical spray into the treatment plan for PONF. There was little if any loss of tissue with this treatment in this series. The outcomes compared favorably to those outcomes in the literature of PONF patients treated more traditionally with antibiotics and debridement, and those patients treated more conservatively with antibiotics alone. HOCL irrigation and spray techniques appear to be beneficial in the management of PONF and decrease the need to debride, allowing faster disease resolution and contributing to favorable outcomes.

Purpose: This study aims to investigate the distribution of payments made to oculofacial plastic surgeons who are members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons, and examine the regularity of financial relationships between industries and oculofacial plastic surgeons.

Methods: This analysis included all American Society of Ophthalmic Plastic and Reconstructive Surgeons fellow members listed in the online directory. Annual statistical data were obtained from the Open Payments Database, and all general payments distributed to oculoplastic surgeons were recorded. Data are summarized by company and amounts distributed to the member. The main outcome is the cumulative payments made by the highest 3 individual industry companies to oculoplastic surgeons using data available from 2021 to 2023. Secondary outcomes looked at payments to leadership positions within the American Society of Ophthalmic Plastic and Reconstructive Surgeons.

Results: Six hundred twenty-seven surgeons received $13,069,190.03 over 6,831 payments. The average payment was $1,913.22, while the median payment was $117.12. The top 10 companies contributed a total of $11,540,952.07 (88.3%) of payments while the top 20 surgeons were paid $9,210,203.88 (70.5%) of all contributions. The top 3 companies contributed $9,088,333.48 (69.5%) of payments. In the $10,000 to $99,999 category, Horizon contributed $2,145,840.48 to 69 surgeons, while Galderma and Allergan contributed $113,355.12 to 3 surgeons and $298,972.96 to 11 surgeons, respectively. Between $1,000 and $9,999, Horizon made payments totaling $298,331.84 to 80 surgeons, Galderma contributed $24,289.64 to 7 surgeons, and Allergan contributed $72,768.35 to 27 surgeons. Fifty-six program directors took part in training fellows in oculofacial plastic surgery. The total payment volume for odd-year programs was $2,549,997.64 with an average of $87,930.95 and median of $6,841.28. The total for even-year programs was $1,511,807.29 with an average and a median of $55,992.86 and $1,326.70, respectively. Thirty-three members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons' current or past 10-year executive committee/board of directors were paid $3,975,434.02, with an average payment of $120,467.70 and a median payment of $3,706.88.

Conclusions: The reporting of open payments to providers is important in providing transparency between physicians and industry. There exists a great discrepancy in the distribution of industry payment within oculofacial plastics, showing a very strong apical dominance with relatively few surgeons receiving a higher number of payments, larger total reimbursements, and from relatively few companies.