Ophthalmic Plastic and Reconstructive Surgery最新文献

A 55-year-old Japanese woman presented with a 2-year history of right-sided epiphora and mucoid discharge. Slit-lamp examination revealed the presence of an additional punctum in the medial canthus. Dacryoendoscopic examination was performed to assess the connectivity of the supernumerary punctum, confirming its direct communication with the upper lacrimal canaliculus. Fistulectomy was subsequently performed under local anesthesia with complete excision of the supernumerary punctum. Histopathological examination of the excised specimen revealed a fistula lined with stratified squamous epithelium, similar to the normal lacrimal canaliculus. At 6-month follow-up, symptoms resolved, and the supernumerary punctum was completely closed.

Purpose: To relate dacryoscintillographic features to presenting symptoms and signs for watery-eyed patients with patent drainage systems.

Methods: Retrospective case note and imaging review for patients with watering eye(s) and clinical evidence of impaired tear drainage who underwent dacryoscintillography (DSG). Three DSG features were graded, along with 4 symptoms, 7 signs, and the degree of fluid reflux and nasal fluid passage on gentle syringing. For symptomatic systems, the DSG characteristics were compared with the presenting symptoms and signs, and a side-to-side comparison was made for unilateral cases.

Results: DSGs were reviewed for 65 patients (43% males), presenting at a mean age of 62.8 years, and 57/65 (88%) having bilateral symptoms. The objective increase in tear lake was inversely related to all 3 DSG measures in 122 symptomatic drainage systems, whereas fluorescein disappearance correlated directly with tracer entry into the lacrimal sac (p < 0.05). Tracer entry into the nasolacrimal duct mirrored nasal fluid passage on lacrimal irrigation (p = 0.00055) and was inversely related to ocular fluid reflux (p = 0.0086). In 8 patients with unilateral symptoms, some DSG parameters on the symptomatic side were related to clinical signs; in contrast, on the asymptomatic side, only the nasal entry of tracer was (inversely) related to an objective increase in the tear lake (p < 0.05).

Conclusion: Abnormal DSG tracer clearance occurs at various levels in watery-eyed patients with patent lacrimal systems, but the findings do not add significantly to the results of a thorough clinical examination. Abnormalities of clearance were also often present in asymptomatic fellow eyes.

The authors present a case of an orbital apex venous malformation that presented with an intermittent oculomotor nerve palsy over a 15-year period. Radiologically, the lesion presented as a well-circumscribed orbital mass with T2 hyperintensity and enhancement that could only be demonstrated on 2-hour delayed phase imaging. The venous malformation was initially steroid-responsive but eventually became refractory to medical treatment alone. This necessitated a medial apical decompression, followed by a deep lateral orbitotomy 18 months later.

Purpose: Microcystic adnexal carcinoma (MAC) is a locally aggressive adnexal carcinoma of the head and neck, which has a high tendency for recurrence. MAC rarely has distant metastasis, with only one previously reported case originating from the periorbital region. We present a patient with periorbital MAC with distant metastasis and a review of all reported patients with metastatic disease.

Method: We present a patient with the youngest reported periorbital MAC with metastases along with a major review of metastatic MAC using PubMed/MEDLINE databases. Case reports or case series that described a case of MAC with metastases were included.

Results: A 37-year-old man with left periorbital MAC had local resection and subsequent exenteration for orbital recurrence. Distal metastases were noted between 8 and 13 years postexenteration in the left parotid gland, left sartorius muscle, and right brachialis and trapezius muscles. There are 7 patients, including our patient, with distant metastasis in MAC, of which 2 were of periorbital origin. The median age was 62 with a male predominance (n = 5/7). Our patient is the youngest reported patient with metastatic MAC. The median time to metastasis was 8 years. Strategies to control disease included radiotherapy (n = 4/7) and chemotherapy (n = 4/7). Six of 7 cases passed away with disease or have ongoing disease.

Conclusion: Periorbital MAC is a locally aggressive disease with potential for metastatic spread and all patients need long-term surveillance for local recurrence and distant metastases.

Purpose: There is no current standard treatment regimen for carcinoma ex pleomorphic adenoma (CXPA) of the lacrimal gland. Neoadjuvant intraarterial cytoreductive chemotherapy (IACC) followed by multimodal therapy has achieved good locoregional control in adenoid cystic carcinoma of the lacrimal gland. We reviewed our experience with neoadjuvant IACC followed by multimodal therapy for CXPA of the lacrimal gland.

Methods: Three patients with CXPA of the lacrimal gland treated with neoadjuvant ICAA therapy followed by multimodal therapy at the University of Michigan were retrospectively reviewed.

Results: Three patients had stage T4cN0M0 CXPA of the lacrimal gland (American Joint Committee on Cancer 8th ed). The first patient underwent 2 cycles of neoadjuvant IACC followed by multimodal therapy (exenteration, chemoradiotherapy, and adjuvant systemic chemotherapy). At 10 years of follow-up, there was no local recurrence or systemic metastasis. The second patient underwent 1 cycle of neoadjuvant IACC with multimodal therapy (systemic chemotherapy, globe-sparing orbital surgery, and chemoradiotherapy). After 5-year follow-up, there was no local recurrence or systemic metastasis. The third patient underwent 2 cycles of neoadjuvant IACC followed by multimodal therapy (globe-sparing orbital surgery, chemoradiotherapy, and adjuvant systemic chemotherapy). After 2 years, he developed parotid and retromandibular metastasis and underwent total parotidectomy with total neck dissection followed by chemoradiation and systemic anti-androgen therapy. After 7 years, he did not have any local recurrence or systemic metastasis.

Conclusions: Neoadjuvant IACC with multimodal therapies can achieve favorable outcomes with locoregional control and improve disease-specific survival in patients with locally invasive advanced-stage CXPA of the lacrimal gland.

Preoperative volume asymmetry in the upper eyelid sulci can pose a challenge in achieving symmetry after upper eyelid blepharoplasty. Reported methods to improve volume asymmetry include the use of soft tissue filler and various surgical techniques. The authors present 6 cases where a central preaponeurotic fat advancement pedicle was utilized during upper eyelid blepharoplasty for improved upper eyelid symmetry (Fig. 1A-L). No complications or need for postoperative filler or other interventions were noted in all cases, and all patients reported satisfaction with the preaponeurotic fat advancement pedicle procedure. The technique is technically easy, cost-effective, adds minimal operative time to standard upper blepharoplasty, and is associated with high patient satisfaction in this small case series.

We describe a case of orbital cellulitis with abscess formation following eyebrow piercing complicated by internal jugular vein thrombosis and subretinal abscesses requiring enucleation with orbital abscess drainage. The popularity of body piercing is increasing and physicians should be familiar with the possibility and management of vision-threatening complications of facial piercing. Following left eyebrow piercing, a 20-year-old female experienced increasing periorbital swelling, erythema, chemosis, orbital pain, decreased vision, and concomitant fever, chills, and rhinorrhea. She was found to have left orbital cellulitis with multiple orbital abscesses, intracranial thromboses, internal jugular vein thrombosis, and septic pulmonary emboli consistent with Lemierre syndrome. Treatment of her condition included broad-spectrum intravenous antibiotics, anticoagulation, orbital abscess drainage, and ultimately OS enucleation. To the authors' knowledge, this is the first case of orbital infection and Lemierre syndrome following eyebrow piercing.

Kabuki syndrome is a rare genetic disease with multisystemic effects including ocular manifestations. The authors report a patient with known Kabuki syndrome who presented with bilateral euryblepharon, bilateral ptosis, OD hypotropia, and blue sclera. A bilateral lateral tarsal strip procedure was performed followed by a left frontalis sling with a silicone implant and a right external levator advancement with success. Two hours after the case conclusion, the patient developed a right upper eyelid hematoma. The hematoma was emergently expressed, and the wound was cauterized and sutured. On careful review of prior labs, the patient may have had chronic immune thrombocytopenia, a known comorbidity of Kabuki syndrome. This report not only describes a novel pathogenic variant in KMT2D causing Kabuki syndrome, but also details the surgical approaches to congenital ptosis, underscores the bleeding risk in patients with Kabuki syndrome, and reviews the approach to perioperative hematoma management.

Purpose: This study aimed to compare the effectiveness of 3 artificial intelligence language models-GPT-3.5, GPT-4o, and Gemini, in delivering patient-centered information about thyroid eye disease (TED). We evaluated their performance based on the accuracy and comprehensiveness of their responses to common patient inquiries regarding TED. The study did not assess the repeatability of artificial intelligence responses, focusing on single-session evaluations per model.

Methods: Five experienced oculoplastic surgeons assessed the responses generated by the artificial intelligence models to 12 key questions frequently asked by TED patients. These questions addressed TED pathophysiology, risk factors, clinical presentation, diagnostic testing, and treatment options. Each response was rated for correctness and reliability on a 7-point Likert scale, where 1 indicated incorrect or unreliable information and 7 indicated highly accurate and reliable information. Correctness referred to factual accuracy, while reliability assessed trustworthiness for patient use. The evaluations were anonymized, and the final scores were averaged across the surgeons to facilitate model comparisons.

Results: GPT-3.5 emerged as the top performer, achieving an average correctness score of 5.75 and a reliability score of 5.68, excelling in delivering detailed information on complex topics such as TED treatment and surgical interventions. GPT-4o followed with scores of 5.32 for correctness and 5.25 for reliability, generally providing accurate but less detailed information. Gemini trailed with scores of 5.10 for correctness and 4.70 for reliability, often providing sufficient responses for simpler questions but lacking detail in complex areas like second-line immunosuppressive treatments. Statistical analysis using the Friedman test showed significant differences between models (p < 0.05) for key topics, with GPT-3.5 consistently leading.

Conclusions: GPT-3.5 was the most effective model for delivering reliable and comprehensive patient information, particularly for complex treatment and surgical topics. GPT-4o provided reliable general information but lacked the necessary depth for specialized topics, while Gemini was suitable for addressing basic patient inquiries but insufficient for detailed medical information. This study highlights the role of artificial intelligence in patient education, suggesting that models like GPT-3.5 can be valuable tools for clinicians in enhancing patient understanding of TED.