Orbit-The International Journal on Orbital Disorders-Oculoplastic and Lacrimal Surgery最新文献

Purpose: To evaluate associations between treatment modality and survival in patients with eyelid lymphoma using the SEER national cancer registry, and to identify demographic predictors of prognosis.

Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021) were analyzed for patients with histologically confirmed eyelid lymphoma. Demographic, histologic, and treatment variables were assessed using Kaplan-Meier and Cox proportional hazards models for 5 year and overall survival respectively.

Results: Among 509 cases, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT; 47.5%) was most common, followed by follicular lymphoma (19.6%) and diffuse large B-cell lymphoma (DLBCL; 12.0%). Radiation therapy was associated with improved survival in patients with MALT lymphoma (p < 0.05) but not in other subtypes. Chemotherapy was not independently associated with improved survival. Increased age at diagnosis and male gender were independent predictors of decreased survival (p < 0.05). Race, income, and marital status were not associated with altered five-year survival.

Conclusions: This population-based analysis demonstrates that survival in eyelid lymphoma varies by histologic subtype and is independently associated with age, sex, and radiation therapy use in MALT lymphoma. Findings should be interpreted in light of inherent limitations of registry data, including incomplete treatment and staging information.

A 69-year-old man presented to eye casualty for increasing binocular diplopia and a superonasal orbital mass. In 2006, he had an accidental injury to the right eye with a pool cue under the right upper lid. Facial X-ray showed no fractures, and the patient was discharged. Five years later, he developed a cystic lesion at the site of the injury which was excised. In 2023, the mass reappeared causing double vision but was initially ignored. On examination, there was a solid lesion under the right upper lid causing hypoglobus and restriction to elevation. Intraoperatively, the mass was firmly attached to the globe and was extending to the intraconal space. While trying to mobilize it, it ruptured with release of mucopurulent material. Inside the lesion, there was the tip of a snooker cue. Histopathology confirmed the presence of a traumatic conjunctival inclusion cyst.

Conjunctivodacryocystorhinostomy (CDCR) with Jones tube placement is a standard treatment for symptomatic canalicular obstruction but often complicated by tube extrusion. We report two rare cases where patients maintained a patent, functional ostium following Jones tube loss or removal. Both patients had a history of multiple lacrimal surgeries. After tube extrusion or removal, endoscopic assessments and follow-up confirmed continued tear drainage without recurrent epiphora. These cases demonstrate that, under certain conditions, CDCR tracts can remain stable and functional without stenting.

Intraosseous cavernous venous malformations of the facial bones, though rare, pose significant surgical challenges due to the high risk of intraoperative hemorrhage. Preoperative embolization can decrease vascular flow to the lesion and mitigate the risk of hemorrhage during resection. However, access to an appropriate feeder vessel is not always possible. In such cases, alternative approaches to embolization must be explored. We report a case of a 74-year-old woman with a long-standing zygomaticomaxillary intraosseous cavernous venous malformation who underwent surgical debulking after direct percutaneous intralesional injection of Onyx-18 (6% ethylene-vinyl alcohol copolymer, Medtronic Neurovascular, Irvine, CA). The procedure resulted in minimal intraoperative bleeding and facilitated successful debulking of the lesion to improve the patient's symptoms and cosmesis. This case highlights the utility of direct ethylene vinyl alcohol copolymer embolization of intraosseous vascular malformations as a safe and effective alternative when standard embolization techniques are not viable.

Purpose: Climate change poses a significant threat to global public health, with the healthcare sector contributing substantially to greenhouse gas emissions. Ophthalmic surgeries, particularly in operating rooms (ORs), generate significant waste and carbon emissions. This study compares the environmental impact of a single bilateral upper lid blepharoplasty performed in a privately owned versus a hospital-based ambulatory surgery center (ASC).

Methods: A material flow analysis and waste audit were conducted for blepharoplasty procedures performed between June and July 2024 in two surgical settings: a privately owned ASC and a hospital-based ASC. Surgical supply inventories and utility usage were recorded through direct observation and post-operative audits. A cradle-to-grave life cycle assessment (LCA), following ISO 14,040 standards, was used to evaluate environmental impact in kilograms of carbon dioxide equivalents (kg CO₂e). Impact equivalencies were calculated for context.

Results: The hospital-based ASC generated 2,744.5 grams of waste per blepharoplasty versus 1,429.6 grams in the privately owned ASC - a 47.9% reduction. Carbon emissions were 9.7 kg CO₂e per case at the hospital-based ASC (equivalent to burning 12.1 pounds of coal), versus 5.0 kg CO₂e at the privately owned ASC (6.3 pounds of coal) - a 48.5% decrease.

Conclusions: The hospital-based ASC produces more waste and emissions per blepharoplasty than the privately owned ASC.

VEXAS syndrome is a rare disorder marked by systemic inflammation and blood disorders, caused by somatic mutations in the UBA1 gene of hematopoietic stem cells. Ocular manifestations are common in VEXAS syndrome. This study reports a 63-year-old male presenting with recurrent periorbital and orbital inflammation, dacryoadenitis, and orbital myositis. He first developed orbital inflammation in the right orbit, later in the left orbit. He was treated with systemic corticosteroid therapy. During a 2-year follow-up, he developed multi-organ inflammatory disorder and recurrence of orbital inflammation whenever the systemic corticosteroid dose fell below 20 mg/day. Ultimately, he was diagnosed with VEXAS syndrome. Identification of VEXAS syndrome in elder male patients with orbital inflammation is essential for tailored management. Treatment typically involves corticosteroids and, in refractory cases, Janus kinase inhibitors like ruxolitinib or IL-6 inhibitors. This case highlights the importance of considering VEXAS syndrome in the differential diagnosis of orbital inflammation, particularly in elderly males with concurrent inflammatory and hematologic abnormalities.

Purpose: To examine how type 2 diabetes mellitus influences the presentation and management of preseptal and orbital cellulitis.

Methods: A retrospective study at a tertiary care center identified patients presenting with preseptal and orbital cellulitis between 2000 to 2022. Data collected included demographics, presentation, management, and follow-up characteristics.

Results: Of the 382 patients, 187 (49.0%) had preseptal cellulitis and 195 (51.0%) had orbital cellulitis. Diabetes was present in 19.8% and 23.6% of patients with preseptal and orbital cellulitis, with similar mean A1C levels (8.24 versus 7.96, p = .410). In the preseptal cellulitis cohort, diabetic patients were more likely to be admitted (56.8% versus 35.3%, p = .045). In the orbital cellulitis cohort, diabetic patients had longer hospital stays (median 6.0 versus 4.0 days, p = .004), longer intravenous antibiotics duration (median 4.0 days, p = .005), and received steroids later (median day 2.0 versus 1.0, p = .018). Patients with diabetes presented with worse visual acuity (median 0.40 versus 0.18 logMAR, p = .005) and a higher rate of relative afferent pupillary defect (47.2% versus 18.5%, p = .001). Extraocular movement (EOM) restriction was significantly more common in diabetic patients at follow-up (47.6% vs. 14.1%, p < .0001). The overall readmission rate was higher in diabetic patients (19.6% vs. 8.7%, p = .043).

Conclusions: Patients with diabetes and preseptal cellulitis had a higher inpatient admission rate and longer duration stays than patients without diabetes. Patients with diabetes and orbital cellulitis had longer hospital stays, longer intravenous antibiotics duration, worse visual acuity at diagnosis, and a higher EOM restriction rate at follow-up compared to patients without diabetes.

Purpose: To evaluate the role of blood perfusion and revascularization during the healing process of periocular defects treated with laissez-faire following tumor excision.

Methods: Ten patients with periocular basal cell carcinomas underwent excision, followed by laissez-faire wound management. Blood perfusion was measured using laser speckle contrast imaging postoperatively.

Results: Immediately after excision, perfusion increased in the wound edge and the peri-wound tissue, reaching approximately 157% of reference values (p < 0.01), reflecting immediate effects of surgery. At 1 week, perfusion increased further, likely driven by inflammation and angiogenesis (193%, p < 0.001). Perfusion gradually decreased at 6-8 weeks, aligning with active tissue remodeling, and continued to normalize at 4-5 months (123%, p > 0.05). By 12 months, perfusion returned to baseline levels, reflecting wound maturation (109%, p > 0.05). In cases with directing sutures, perfusion initially decreased to 64% at the wound edge, presumably due to tension-induced hypoperfusion, but returned to baseline after 6-8 weeks.

Conclusion: This study highlights the critical role of blood perfusion in the healing of periocular defects treated with laissez-faire. The vascular network is preserved, enabling an immediate increase in perfusion, facilitating revascularization and wound healing. Further studies are needed to evaluate efficacy and long-term outcomes in comparison with reconstructive surgery.