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

Purpose: To describe an upper eyelid swinging approach (U-Swing) that is suitable for the surgical excision of a large benign encapsulated lesions located in the intraconal space superolateral to the optic nerve.

Methods: This is a retrospective case series. The study included a review of five patients' records who had large encapsulated intraconal masses, superolateral to the optic nerve, and who underwent surgical excision with the U-Swing approach in the authors' institute over the last 10 years. This approach entailed a planned upper temporal fornix-based conjunctival flap and a lateral canthotomy. Preoperative radiological investigations, pre- and post-operative vision testing, and photographs were presented with at least 6 months follow-up.

Results: All patients within the 1st postoperative month had minimal postoperative edema, minimal conjunctival redness, no visible conjunctival or skin scar, normal pupil size and pupil reaction, full extra ocular motility, recovered upper eyelid position and excursion.

Conclusions: The U-Swing approach provides a horizontally expandable surgical window that allows safe removal of a large, encapsulated intraconal mass, superolateral to the optic nerve with low morbidity and rapid recovery.

Purpose: To determine the risk factors impacting the surgical success of endonasal dacryocystorhinostomy (eDCR) in pediatric patients.

Methods: This is a retrospective interventional case series of patients 18 years and younger treated over a 16-year period via eDCR for nasolacrimal duct obstruction (NLDO). Data were extracted on surgical outcomes, follow-up duration, and comorbidities (i.e. punctal agenesis, trisomy 21, dacryocystitis). Functional success was defined as the resolution of NLDO symptoms postoperatively.

Results: Of 356 cases in 281 patients (median age: 3.32 years), 78.9% of cases in 79.0% of patients achieved functional success after initial eDCR. The median follow-up duration without tearing symptoms as observed by an ophthalmologist and non-ophthalmology trained clinician was 11.0 months and 62.1 months, respectively. Patients with punctal agenesis and those requiring bilateral surgery had significantly higher rates of failure (p = .01; p < .001, respectively). Age at operation was not significantly associated with failure (p = .30). Excluding cases of trisomy 21 and punctal agenesis, functional success was achieved in 82.7% of 295 cases.

Conclusions: Endonasal DCR is effective in resolving NLDO symptoms in pediatric patients, with success rates comparable to the adult population and to an external approach. Despite a higher reoperation rate in patients with trisomy 21 and punctal agenesis, trisomy 21 and age at operation were not significant risk factors for failure.

Two patients, a 38-year-old woman and, a 74-year-old man, had ulceronodular basal cell carcinoma at the lower eyelid margin, directly opposite a nodular intradermal nevus at the upper lid margin. Both patients had the nevi for decades and the tumors for 2 and 3 years, respectively. The size of the tumors were 9 × 4 mm and 10 × 15 mm. When the eyelids were closed, the nevus corresponded to the ulcerated tumor cavity in both cases. The lesions were excised, and the defects were repaired. It is well-established that chronic mechanical irritation can increase sensitivity to epidermal carcinogenesis. In the cases described here, it remains speculative whether nevus-related trauma on the opposite eyelid played a role in the development of basal cell carcinoma.

Purpose: To describe the clinical presentation, management, and outcomes of orbital and adnexal rhabdomyosarcoma (RMS) in an Asian-Indian cohort and analyze the factors predictive of outcomes.

Methods: Retrospective interventional case series of 54 patients of histopathology-proven RMS.

Results: The mean age of presentation with RMS was 10 years (median, 7 years; range, <1-54 years). The most common tumor location was the superonasal quadrant (n = 21, 39%). Extensions beyond the orbit into the sinuses, temporal fossa, and brain were seen in 15 (28%), 3 (6%), and 8 (15%), respectively. First-line treatment modalities included a combination of surgical debulking, chemotherapy, and external beam radiotherapy in 20 (37%) patients; chemotherapy and radiation in 20 (37%); complete surgical excision and chemotherapy in 3 (6%); orbital exenteration, chemotherapy, and external beam radiotherapy in 1 (2%); chemotherapy alone in 1 (2%) patient, and 9 (17%) patients were lost to follow up. By Intergroup Rhabdomyosarcoma Study Group (IRSG) grouping, tumors belonged to groups I (n = 2,4%), II (n = 13, 29%), and III (n = 30, 67%). Kaplan-Meier survival estimates for tumor recurrence, lymph node metastasis, systemic metastasis, and death (n = 45) were 84%, 82%, 95%, and 95% at 1 year, 69%, 76%, 81%, and 77% at 5 years, 69%, 76%, 81%, and 77% at 10 years, respectively. On multivariate regression, age >18 years was found to have a significantly increased risk of locoregional LN metastasis (p = 0.005).

Conclusion: Despite aggressive treatment modalities, the 5-year disease-specific survival rate was 77% in Asian-Indian cohort. Age > 18 years at presentation was associated with a poorer prognosis.

Purpose: To evaluate matrix metalloprotease-1 (MMP-1), matrix metalloprotease-3 (MMP-3), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6) levels in the eyelid skin and fibroadipose tissue in patients with inactive moderate-to-severe Graves' orbitopathy (GO).

Methods: This prospective study included 23 patients with inactive moderate-to-severe GO who underwent upper blepharoplasty and medial fat excision, and 22 age- and sex-matched healthy subjects. MMP-1, MMP-3, TNF-α, and IL-6 levels in the skin and fibroadipose tissue obtained during surgery were measured using the ELISA method.

Results: The mean MMP-1 level in the eyelid skin (p = .003) and the mean MMP-3 level in the fibroadipose tissue (p = .04) were significantly lower in the GO group compared to the healthy control group. There were no differences in other mediators in both tissues between the two groups (p > .05).

Conclusions: The lower levels of proteolytic enzymes such as MMP-1 and MMP-3 in the eyelid skin and orbital fibroadipose tissue of patients with chronic inactive GO may play a role in the increase of collagen and glycosaminoglycans in orbital soft tissues.

Purpose: Blepharocheilodontic (BCD) syndrome is a rare condition with eyelid ectropion, euryblepharon, lagophthalmos, congenital cleft lip/palate, and oligodontia. BCD syndrome is an autosomal dominant inherited disorder and has multiple associations with systemic diseases. We present three new cases of BCD syndrome and a literature review of the periocular manifestations of BCD and their management.

Methods: A multi-institutional retrospective case series of patients with BCD syndrome. Clinical characteristics, imaging findings, surgical management, and outcomes were analysed. Further, a comprehensive review of the literature identified all previously published cases of BCD syndrome.

Results: Three cases of BCD syndrome in children with autosomal dominant inheritance were included. Periocular manifestations in BCD syndrome include lower lid ectropion, euryblepharon, and lagophthalmos. Systemic manifestations including cleft lip or palate and dental abnormalities were also observed. Multiple surgical procedures including lateral canthoplasty, tarsorrhaphy, and midface augmentation may be necessary for correction of eyelid malposition and achieving cosmetic and functional improvements.

Conclusions: BCD syndrome presents with a spectrum of periocular manifestations requiring multidisciplinary management. Children that present with cleft lip and palate, dental, and eyelid abnormalities should be suspected to have BCD syndrome. Surgical management of the eyelid in BCD remains challenging. Ophthalmologists should be aware of BCD syndrome and its systemic associations.

Purpose: The aim of this retrospective case review is to present a novel surgical technique used in the treatment of recalcitrant lower eyelid retraction.

Methods: This study was performed as a retrospective case review of 4 patients who have failed standard conservative surgical interventions for lower eyelid retraction repair. 3 patients developed lower eyelid retraction following surgical intervention for orbital trauma and 1 patient developed lower eyelid retraction in the setting of granulomatosis with polyangiitis. The surgical technique was identical in each patient and performed by an oculofacial plastic surgeon, sometimes together with an oral and maxillofacial surgeon. Follow-up results for all patients were assessed at 1 week, 1 month, and 3 months.

Results: All four patients demonstrated initial improvement in lower eyelid position, fullness, and height. A common finding was mild lateral postoperative entropion, which was easily overcome with an upper eyelid tarsoconjunctival flap. There were no surgical complications sustained in any of the cases.

Conclusions: This retrospective case review provides a novel surgical option for the correction of recalcitrant lower eyelid retraction. The excellent vascularity provided by this flap, location, and easy access support its use. A prospective study comparing alternative solutions would be useful in comparing the buccal fat pad vascularized pedicle to alternative methods used to correct refractory and cicatricial lower eyelid retraction.