Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: The Cornea, Asymmetry, Dynamic, Synkinesis (CADS) score is a validated grading score for periocular involvement in facial nerve palsy (FNP). We conducted a retrospective review of FNP cases, including initial CADS scores and subsequent ophthalmic interventions. The results were used to inform the development of an oculoplastic management algorithm for FNP.

Methods: Single-center retrospective cohort study of patients with FNP referred to a tertiary unit between 2016 and 2022. Data collected included demographic data, etiology of FNP, treatment initiated, and CADS grading at each visit. Adult patients with ≥6 months of follow-up were included, and cases were excluded if ocular surface or oculoplastic procedures were performed elsewhere prior to the initial review by the unit.

Results: Of 408 consecutive new patients with FNP, 80 fulfilled inclusion criteria (mean age 57 years, range 21-83 years). Presentations of FNP were unilateral in 98.8% (79/80), with an underlying preganglionic etiology in 75.0% (60/80). At the initial review, surgery was recommended for 61.3% (49/80) of cases. Subgroup analysis of surgical cases for each CADS domain showed 46.9% (23/49) had C-score ≥2, which was predictive of upper lid surgery requirement (e.g., upper lid platinum segment chain; levator recession). About 63.2% (31/49) had an A-score ≥1 which predicted for lower lid surgery requirement (e.g., retractor recession, lower lid sling, medial canthal tendon plication, and lower lid full thickness skin graft) as well as a brow lift. Almost 79.6% (39/49) had a D-score ≥2, which was associated with both upper lid and lower lid surgery requirements. Also, 59.2% (29/49) had an S-score of ≥1 however, this was not associated with the surgical requirement, highlighting a different approach compared with the other CADS domains.

Conclusion: This study represents a large cohort of patients followed up with a validated ophthalmic-specific FNP grading scale. This was utilized to develop a CADS-based management algorithm to help guide decision-making for surgical intervention versus medical management in FNP.

A 19-month-old boy presented with eyelid swelling, proptosis, and upgaze limitation in the OD. The radiological study showed a homogeneous mass enclosing the lacrimal gland. Near-total tumor excision revealed IgG4-related orbital disease. Eosinophilia, serum IgG4, and IgE elevations were detected without extraorbital involvement. The patient received oral prednisolone for 4 months postoperatively and remained relapse-free for 27 months. Among the 17 well-documented pediatric cases of IgG4-related orbital disease in the literature (including this case), 59% were female, and the median age was 10 years; 2 patients were under 2 years old. The disease was unilateral in 82% of the patients and caused a soft tissue mass in 88%, involving the lacrimal gland in 53%. Nine patients received immunosuppression only, 4 surgery and immunosuppression, and 2 only surgical excision. Treatment results were reported in 13 patients, and all were favorable. IgG4-related dacryoadenitis with a fibrous mass may occur in very young children, responding well to surgical excision and steroids. Although pediatric IgG4-related orbital disease is not well-characterized yet, it may manifest differently from its adult variant.

Localized orbital amyloidosis is a rare clinical entity. Periocular and orbital amyloid deposits are mainly located at the lacrimal apparatus, eyelid, conjunctiva, ocular adnexa, extraocular muscles, and levator palpebrae muscle. In this article, we report an unusual case of optic nerve amyloid deposition in an 82-year-old African American woman who presented with vertical diplopia. MRI revealed an enhancing mass from the optic nerve sheath, and CT showed foci of calcifications suggestive of optic nerve meningioma. However, an incisional biopsy demonstrated lymphoproliferative disease with focal optic nerve sheath amyloid deposition confirmed by histologic Congo red staining and immunohistochemistry.

An uncommon case of an intratarsal keratinous cyst at the lid margin is described in a 73-year-old Asian man using long-term antiglaucoma eye drops. There was no history of trauma or surgery of the upper eyelid. A yellow solid mass attached to the tarsal plate had been located there for about 3 years. It imitated a sebaceous gland carcinoma or steatocystoma simplex. Excision biopsy showed cystic formation and leaked yellow creamy substance without hair. Histopathological and immunological findings helped make the diagnosis of an intratarsal keratinous cyst. To the best of our knowledge, this is the first case report of an intratarsal keratinous cyst at the lid margin.

Nerve sheath myxomas are extremely rare myxoid peripheral nerve sheath tumors with a predilection for the distal extremities, particularly common in the fingers and knees. Here, we report a 60-year-old male patient with a subconjunctival epibulbar nerve sheath myxoma, which was clinically diagnosed as an orbital fat prolapse. The lesion was successfully debulked without clinical recurrence over more than 3 years. To our knowledge, this is the first case with subconjunctival presentation and fourth orbital reported case.

Purpose: The osteologic anatomy of the orbit is still a field of intense research, particularly as far as vascular channels are concerned. Among them, ethmoidal foraminas (EFs) are certainly those that have more clinical importance and indeed have been deeply investigated. Unfortunately, the vast production of articles, far from clarifying their anatomy, generated a certain degree of confusion.

Methods: A search on Pubmed and Scopus databases updated up to December 31, 2023, has been carried out with the keyword "ethmoidal foramen" yielding a list of 357 items. With a careful screening process, 31 articles were enlisted to be included in the present review.

Results: A critical review process confirmed that many results published over the years appear inconsistent, particularly as far as EFs topography is concerned. The possible reasons for this lack of consistency can be traced back to inter-ethnical differences, uncertainty on the anterior bony landmarks employed in the investigations, and lack of a general consensus over EFs classification. A novel approach, based on the normalization of the distance of the anterior landmarks relative to the length of the orbit (relative depth index), should overcome some of the major problems encountered so far.

Conclusions: Novel and clear guidelines to classify EFs and to locate them on the medial wall are required. Determining the relative depth index of EFs may be an interesting approach to solve the matter. Other methods can be also devised. However, direct measurements from bony landmarks, without any further analysis seem inadequate and possibly misleading.

Purpose: This case series and literature review evaluated the baseline variables, clinical symptoms, pathological characteristics, and prognosis of patients with orbital oncocytic carcinoma.

Methods: This retrospective case series collected the medical histories and other related data from 13 patients pathologically diagnosed with oncocytic carcinoma.

Results: The average age of patients with orbital oncocytic carcinoma was 64.8 years, with a significantly higher rate of males than females. Furthermore, unilateral disease was more common than bilateral disease. All patients had surrounding tissue invasion, most commonly to extraocular muscles (69.2%) and bones (53.8%). The clinical manifestations were proptosis (30.8%), swelling of the lesion area (23.1%), vision loss (23.1%), diplopia (23.1%), periocular mass (23.1%), tears (15.4%), eye pain (7.7%), ptosis (7.7%), and visual field loss (7.7%). Microscopic examination revealed many large eosinophilic cells. There were obvious nuclei and abundant mitotic figures. The cancer cells expressed cytokeratin, but not P63 or S-100. The follow-up duration was 2-53 months, and the metastasis rate was 16.7%. The patients exhibited a good prognosis. The main treatment methods included surgical resection, surgery combined with radiotherapy, and the enucleation of ocular contents.

Conclusions: Orbital oncocytic carcinoma has the immunohistochemical characteristics of eosinophilic tumor cells, with expression of cytokeratin but not P63 or S-100. The prognosis is favorable. Surgical resection, surgery combined with radiotherapy, and enucleation of intraocular material are effective treatment options. Nevertheless, long-term follow-up and close observation for metastases are required.