Ophthalmic Plastic and Reconstructive Surgery最新文献

Purpose: This systematic review aims to consolidate evidence on ophthalmological manifestations of angiolymphoid hyperplasia with eosinophilia, focusing on its presentation, diagnosis, and management.

Methods: Preferred reporting items for systematic reviews and meta-analyses-adherent systematic review was conducted across 3 databases from inception until September 2024. Case reports and series detailing angiolymphoid hyperplasia with eosinophilia in ocular structures were included. Data on demographics, clinical presentation, diagnostic methods, and treatment outcomes were extracted and analyzed.

Results: A total of 86 patients from 52 case reports/series were included. The median age was 41 years (IQR: 22-54), with a slight male predominance (51.16%, n = 44/86). The majority of patients (94.18%, n = 81/86) presented with unilateral eye involvement. The orbit was the most frequently involved location (45.35%, n = 39/86), followed by the upper eyelid (27.91%, n = 24/86). Clinical symptoms included proptosis (36.04%, n = 31/86), ptosis (26.74%, n = 23/86), and diplopia (11.67%, n = 10/86). Surgical excision was performed in 54.65% (n = 47/86) of cases, with biopsy done for diagnostic purposes in all patients. Recurrence occurred in 13.95% (n = 12/86), with risk factors including incomplete excision and prior angiolymphoid hyperplasia with eosinophilia in the same or opposite eye. Steroid therapy was used in 18.6% (n = 16/86) but showed limited success. Newer treatment strategies with propranolol showed efficacy in recurrent cases, with no recurrence reported in patients receiving this therapy.

Conclusion: Angiolymphoid hyperplasia with eosinophilia in ocular structures presents diagnostic and therapeutic challenges. Surgical excision remains the mainstay of treatment, though recurrence is common. Therapeutic strategies with propranolol may offer alternative management options in recurrent cases.

Purpose: To characterize the clinical, radiological, and pathological features of patients with metastases to the lacrimal gland from distant primaries.

Methods: Multicentre retrospective case series and a review of the literature of cases of metastases to the lacrimal gland.

Results: We present 4 cases of lacrimal gland metastases, with the primaries being renal cell (n = 2) and breast (n = 2) carcinoma. The literature review identified 40 additional cases (19 male, mean age, range 21-84 years) of lacrimal gland metastasis. Based on these 44 cases, including 4 from the present study, 2 patterns of metastasis were identified: 23 cases (52.3%, 23/44) with lacrimal gland enlargement without bony erosion, and 21 cases (47.7%, 21/44) with associated bony erosion of the superolateral orbit of whom 12 (57.1%, 12/21) had intracranial extension. The most common primary for lacrimal gland metastasis without bony erosion was breast cancer (56.5%, 13/23), whereas hepatocellular carcinoma was the most common cause of lacrimal gland metastasis with bony erosion (52.4%, 11/21). Lacrimal gland metastasis was the first presentation of cancer in 15 cases (34.1%, 15/44) and was the first presentation of metastasis in 12 cases (27.3%, 12/44).

Conclusions: Metastasis to the lacrimal gland is a potential cause of lacrimal gland enlargement. It may be the initial sign of distal occult cancer or occult metastatic disease. Different patterns of metastasis may be seen with different underlying primaries.

Ocular involvement of lymphoma may present as a primary orbital or intraocular lymphoma or as a manifestation of metastatic disease. Involvement of various ocular structures may be difficult to diagnose due to its rarity and nonspecific clinical presentation. Primary high-grade B-cell lymphoma with MYC and BCL2 rearrangements of the orbit has rarely been reported in the adult population and has not previously been reported in the pediatric population. Herein we present a unique case of orbital high-grade B-cell lymphoma in a pediatric patient, initially diagnosed as preseptal cellulitis. Careful observation and escalation of care ultimately led to the accurate diagnosis and complete remission of the disease.

Purpose: Teprotumumab, a novel human monoclonal antibody, has been shown to reverse the clinical manifestations of thyroid eye disease. Previous reports have suggested that it demonstrates disease-modifying properties through the reduction of orbital fat and muscle volumes. This study aims to analyze orbital volumetric change following treatment and to identify clinical and radiological predictors of response.

Methods: This was a prospective longitudinal study with 35 consecutive patients who had available pre- and posttreatment orbital imaging. Three-dimensional volumetric calculations of orbital fat, extraocular muscles, and proptosis were measured using previously validated image processing software. This information was used with demographic data to create a multivariate regression model to review which baseline clinical or radiological factors were predictors of proptosis response.

Results: In the study orbit, 20 patients (57%) had a proptosis reduction of ≥2 mm. In the fellow orbit, 18 patients (51%) had a proptosis reduction of ≥2 mm. Regression modeling revealed that baseline proptosis and baseline muscle volumes were significant predictors of proptosis response (p < 0.01 and p < 0.05, respectively). Further, changes in muscle volume and fat volume were significantly associated with proptosis response (r = 0.5, p < 0.001 and r = 0.3, p = 0.012, respectively).

Conclusion: Teprotumumab significantly reduces orbital fat and muscle volumes. This is manifested by a significant reduction in proptosis. Baseline proptosis and muscle volumes are significant predictors of proptosis response.

Purpose: This study aims to compare the lateral brow-eyelid contour following traditional blepharoplasty versus blepharoplasty with brassiere sutures using 3D imaging.

Methods: This prospective, randomized, comparative, parallel-group trial involved 56 female patients with dermatochalasis. Patients with an odd number of letters in their first names underwent traditional upper blepharoplasty (group A), while the rest underwent blepharoplasty with orbicularis oculi muscle fixation (group B). All procedures were performed by a single surgeon. Postoperative 3D photographs were standardized in a three-quarter view and analyzed using textured overlays.

Results: In traditional blepharoplasty, 64.5% of patients exhibited flatter eyelid contours with shorter lower convexity. In contrast, the brassiere suture group showed increased convexity above and below the eyelid crease and increased tarsal platform show in 60% of patients.

Conclusion: The authors recommend preserving and repositioning fat in upper blepharoplasty for its safety and aesthetic benefits.

Purpose: Periorbital necrotizing fasciitis (NF) and sinusitis-related orbital cellulitis (OC) present with common clinical features, although the management algorithms for these ailments vary considerably. Previous investigations have failed to identify biomarkers that distinguish between these entities. This study was designed to explore the role of the derived neutrophil-to-lymphocyte and neutrophil-to-platelet ratios in discerning NF from OC.

Methods: The derived neutrophil-to-lymphocyte and neutrophil-to-platelet ratios were calculated in nonimmunocompromised adult patients with NF and OC from the first blood draw upon presentation to the emergency department at a single academic medical center. Mann-Whitney nonparametric analyses and the area under the receiver-operator curve were analyzed via a dedicated computerized software package.

Results: A total of 16 patients with NF (mean age = 54.5 years) and 12 patients with OC (mean age = 50.8 years) were identified. The mean derived neutrophil-to-lymphocyte ratios were 5.74 (standard deviation = 4.20) and 2.36 (standard deviation = 1.75) for NF and OC, respectively (p = 0.0037), resulting in an area under the receiver-operator curve of 0.82 (95% confidence interval = 0.66-0.98). The mean neutrophil-to-platelet ratios were 0.073 (standard deviation = 0.044) and 0.020 (standard deviation = 0.0084) for NF and OC, respectively (p < 0.001), yielding an area under the receiver-operator curve of 0.92 (95% confidence interval = 0.80-1.00).

Conclusions: In nonimmunocompromised adult patients, the derived neutrophil-to-lymphocyte ratio and neutrophil-to-platelet ratio both appear to distinguish NF from OC. While further study is required in larger cohorts to ensure the robustness of these findings, these initial results suggest that these biomarkers may be coupled with appropriate examinations to diagnose patients with these conditions and initiate the appropriate steps in the management of patients with orbital infectious disease.

Purpose: To describe and characterize shortened fornix syndrome (SFS), a rare complication following posterior-approach ptosis repair using conjunctival Müller muscle resection.

Methods: This retrospective case series evaluates 4 patients who developed SFS after conjunctival Müller muscle resection. Clinical characteristics, surgical histories, management, and outcomes are reviewed.

Results: A total of 4 patients (2 females, 2 males; aged 61-74 years old) presented with ptosis associated with fornix shortening and symblepharon following conjunctival Müller muscle resection performed at outside hospitals. Potential contributing factors included intraoperative complications and multiple posterior-approach surgeries. Management strategies varied, including 5-fluorouracil and triamcinolone injections into the symblepharon, ocular surface reconstruction with symblepharon lysis and amniotic membrane grafting, and external levator advancement. All patients showed improvement in the SFS and eyelid height with treatment.

Conclusion: SFS, characterized by symblepharon, fornix shortening, and associated functional issues including ptosis and restricted eye movements, is a rare but significant complication of posterior-approach ptosis repair. Only one prior report has documented a similar entity in patients after conjunctival Müller muscle resection using glaucoma drops; interestingly, our cases occurred in patients without significant ocular surface or topical ocular medication use, suggesting SFS can develop independently of such treatments. Prevention strategies include meticulous intraoperative technique and a cautious approach to large resections or repeat posterior-based surgeries, with consideration of anterior-based techniques if appropriate. Management of SFS via a staged approach involving ocular surface reconstruction followed by anterior-based ptosis repair may lead to satisfactory outcomes. Awareness of this complication is crucial for proper patient selection and management of ptosis.

Increasing life expectancy and an aging population have preserved quality of life decisions into older adulthood, defined by some clinical standards as greater than 75 years of age. While teprotumumab may represent a breakthrough in the treatment of thyroid eye disease, the teprotumumab phase III trial included only 2 patients aged over 75. Four female patients between the ages of 78 and 86-of whom 3 completed 8 infusions and 1 completed 7 infusions before discontinuation-were included in our study with a mean initial Clinical Activity Score score of 5.5, subjective diplopia, and proptosis. All patients experienced reduction in Clinical Activity Score with teprotumumab treatment. Two patients were subjective diplopia responders. Of the 6 eyes with collected measurements, all demonstrated a ≥2 mm reduction in post-treatment Hertel measurements. Most common adverse events were hyperglycemia, dysgeusia, fatigue, and alopecia. One patient with diabetes experienced an A1C rise requiring insulin. One patient had recurrence with increasing proptosis and recurrence of diplopia.

Purpose: To characterize symptoms and signs for patients with tearing eye(s) and ipsilateral nasolacrimal duct stenosis (NLDS), as defined by delayed fluorescein disappearance test and ocular reflux of saline during gentle irrigation of a patent drainage system.

Methods: Retrospective case-note review of a consistent grading of 4 symptoms and 7 signs, together with estimates of the degree of fluid reflux and nasal fluid passage on gentle saline syringing. Characteristics, including gender differences, were compared for unilateral or bilateral symptoms. A side-to-side comparison was performed in unilateral cases, and assessed for concordance of signs and/or symptoms.

Results: The average age of presentation was 62.4 years in 386 patients (37% male), with a third having unilateral symptoms. Systemic atopy (22%) and chronic nasal disease (27%) were frequent. Patients with unilateral symptoms were significantly younger (males 9.5, females 5.5 years; p < 0.000001) and had shorter symptom duration (p = 0.0025). Three-quarters of asymptomatic sides had objective evidence of nasolacrimal duct stenosis, and there was significant side-to-side concordance for 7/9 clinical signs. Among 640 symptomatic systems, many of the presenting (subjective) symptoms and/or objective signs showed a significant direct or inverse correlation.

Conclusion: The lack of laterality- or gender bias for symptoms and signs suggests that patients with nasolacrimal duct stenosis might seek treatment for the epiphora per se, rather than for issues with ocular dominance or visual requirements. The close correlation between subjective symptom-severity and objective estimates of signs suggests that thorough clinical assessment can be very reliable, and that several factors probably contribute to symptoms in these patients.

Purpose: Euryblepharon is a rare congenital eyelid malformation characterized by symmetrical horizontal enlargement of the palpebral fissure. The eyelid is shortened vertically compared with the horizontal dimension. The lateral canthus is most commonly affected. It can be isolated or associated with other anomalies and it is unclear what causes this appearance. Conservative treatment is the mainstay of treatment; however, in some severe cases, surgery is necessary. Surgery has been reported with varying degrees of success with failure of the resolution of the functional or cosmetic elements.

Methods: In a retrospective case review, 7 patients were identified with euryblepharon. Some had mild changes and were asymptomatic with no concerns regarding the appearance of their eyelids, while others suffered from ocular irritation and dry eyes and were bothered by the cosmesis. Three opted to go ahead with surgery as they found conservative measures to be unsatisfactory.

Results: For those patients who opted for surgery, the authors performed lower eyelid bone fixation canthoplasty with septoretractor recession with or without a mucograft spacer. This technique corrected both their functional and cosmetic elements.

Conclusion: The success in normalizing the lower lid position and contour without skin augmentation suggests that the underlying pathology is related to middle lamellar retraction and lateral canthal dystopia rather than skin deficiency. This new technique corrects both the functional and aesthetic issues without compromising on either element which has been the case in previous studies. It is also tissue-sparing and can be done as a day-case procedure.