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

Purpose: Tranexamic acid (TXA) is an antifibrinolytic agent effective in reducing extensive blood loss and mortality. However, it lacks significant clinical evidence in peri-ocular procedures, including dacryocystorhinostomy (DCR). This study aims to assess the effectiveness of TXA in reducing intraoperative hemorrhage and improving surgical outcomes.

Methods: We searched PubMed, Medline, ClinicalTrials.gov, and the Cochrane Library, along with grey literature sources from the year 2000 onwards for randomized controlled trials (RCTs). We used the revised Cochrane Risk of Bias tool (RoB 2.0) to assess quality. RevMan 5.4 was used to conduct all statistical analyses using a random-effects model.

Results: A meta-analysis was performed on 448 patients from 5 RCTs. Between TXA and placebo group, a statistically significant reduction in intraoperative bleeding, a statistically non-significant reduction in total surgical time and recovery time, a statistically significant increase in surgeon satisfaction, and no statistically significant difference in anesthesia time were observed. A comparison of topical TXA with placebo in one study showed a statistically significant reduction in intraoperative bleeding and total surgical time. Between TXA and the other interventions, including remifentanil and hydralazine, no statistically significant differences in intraoperative bleeding, total surgical time, recovery time, surgeon satisfaction, and anesthesia time were observed.

Conclusion: Evidence shows the superiority of TXA in reducing intraoperative bleeding and increasing surgeon satisfaction in patients undergoing DCR, improving surgical outcomes and recovery time. Further studies are needed to evaluate the effectiveness of TXA in ocular procedures.

Purpose: The purpose of this study is to evaluate the association between the blepharospasm disability index (BSDI) and botulinum neurotoxin (BTX) dosage for patients affected by either benign essential blepharospasm or hemifacial spasm.

Methods: Cross-sectional cohort study evaluating adult patients diagnosed with benign essential blepharospasm or hemifacial spasm who completed a BSDI evaluation prior to receiving same-day therapeutic BTX injections. Primary outcome measures included BSDI score and number of BTX units. Simple and multivariable linear regression analyses were utilized to assess the relationship between BSDI score and BTX dosage.

Results: For patients with benign essential blepharospasm, BTX dosage was significantly and positively correlated to BSDI score (R²=0.16, β=1.15, p=0.007). This relationship remained robust when controlling for age, sex, disease duration, interval since previous BTX injection, and injecting provider (β=1.11, p=0.010). No significant correlation was identified between BSDI score and BTX dosage for patients affected by hemifacial spasm (R²=0.05, β=0.39, p=0.379).

Conclusions: This study demonstrates that BTX dosage is significantly and positively correlated to BSDI score for patients affected by benign essential blepharospasm, but not for those affected by hemifacial spasm. Incorporating BSDI score may support more individualized and efficient clinical management of benign essential blepharospasm.

Purpose: To present outcomes of a lateral orbitotomy technique with periosteal coverage of the osteotomized segment instead of traditional fixation with a plate and screws.

Methods: This retrospective interventional case series presents the outcomes of lateral orbitotomy with periosteal coverage of the osteotomized segment. We included all patients who underwent the lateral orbitotomy technique for intraorbital tumor removal between January 2005 and January 2021. Data on demographics, presenting signs and symptoms, clinical and histological diagnoses, and intraoperative and postoperative complications were collected and analyzed.

Results: A total of 40 patients were eligible for inclusion. The mean age was 38.8 ± 17.08 years (range: 6 months to 65 years), and the mean follow-up period was 46.73 ± 24.15 months (range: 12-91 months). In all patients, the mass was completely excised, and the lateral orbital wall was successfully replaced using the "periosteal covering technique" without the need for K-wires or mini-plates for fixation. Postoperatively, there were no cases of non-union or malunion. Rare skin scars and occasional pain or tenderness at the surgical site were noted, along with a non-visible but palpable small bony step-off at the orbital rim edge.

Conclusions: The periosteal covering technique appears to be a safe, simple, and time-efficient method for replacing osteotomized segments in cases of lateral orbitotomy with osteotomy during orbital tumor excision.

Purpose: To evaluate the real-world efficacy, safety, and outcomes of cemiplimab for advanced periocular conjunctival and cutaneous squamous cell carcinoma (SCC).

Methods: Retrospective case series of adults treated with cemiplimab for periocular conjunctival or cutaneous SCC at Moorfields Eye Hospital (2021-2025).

Results: We included 9 patients (mean age 66, range 43-79; 56% female; 78% Caucasian). Prior treatments included surgery (44%), radiotherapy (22%), and one exenteration. Tumour origin was conjunctival (56%), cutaneous (33%), or unknown (11%). 8 (89%) showed orbital invasion, including 2 with intracranial spread. Cemiplimab was indicated when surgery was refused or as palliative treatment in cases not amenable to localized treatment. Mean cemiplimab duration was 12.3 months (range 2.1-36.4). Immune-related adverse events included grade 2 hypothyroidism (n = 2, continued therapy) and grade 2 hepatitis (n = 1, discontinued). Complete and partial responses were seen in 22% and 33%, respectively; 44% progressed. No significant difference in response was observed between conjunctival and cutaneous SCC (p = 1.00). 2 patients (22%) underwent exenteration after starting treatment. Average total follow-up was 50.8 months (range 17.4-130.6). One recurrence occurred 12 months after treatment cessation; no new metastases were reported during follow-up. Two patients died from unrelated causes.

Conclusion: To our knowledge, this is the largest single case series of cemiplimab used in conjunctival SCC. Our results underscore the potential of cemiplimab as globe-sparing and vision-preserving treatment in advanced periocular conjunctival and cutaneous SCC, including more aggressive and complex cases with intracranial involvement or perineural spread, both as primary treatment and after previous surgery in recurrent cases.

We report a case of unilateral Morbihan's disease (MD) in a 55-year-old male presenting to a private oculofacial practice in San Francisco. Successful treatment with a series of triamcinolone injections to the upper and lower eyelids was achieved after several unsuccessful therapies. The authors provide a comprehensive review of the literature from 2022 to 2025 on MD.

Sphenoid wing dysplasia and plexiform neurofibromas are among the diagnostic criteria for neurofibromatosis 1 (NF1), an autosomal dominant neurocutaneous disorder. It has been called by different names based on the involved anatomic areas such as orbito-palpebral, orbito-temporal, and orbito-facial plexiform neurofibromatosis. Management of the deformity in plexiform neurofibromatosis is challenging given the ill-defined, infiltrative, and vascular nature of the lesion, associated with a defect in the greater wing of sphenoid, resulting in pulsatile proptosis. A staged multidisciplinary approach has been described in literature to correct the bony dysplasia followed by correction of the soft tissue components. Craniofacial bony deformities have been mostly described to be managed via craniotomy approach by neurosurgeons whereas the periorbital debulking of tumor and correction of canthal dystopia and blepharoptosis is done by ophthalmic plastic surgeons at a later stage. Bony defects have been traditionally managed with the help of bone grafts or titanium mesh or a combination of both, but, more recently, the use of patient specific implants has also been described which offer bespoke reconstruction. A single staged transorbital approach to reconstruct the skull base defect and orbital aperture along with palpebral debulking and levator resection has not been described till date to the best of the authors' knowledge. Here, the authors describe a case of orbitopalpebral plexiform neurofibromatosis with pulsatile proptosis managed via a single staged transorbital approach using computer-assisted 3 dimensional (3D) virtual surgical planning.

Purpose: This systematic review and meta-analysis compares the effectiveness of bone grafts versus titanium mesh implants in managing orbital fractures, focusing on diplopia, enophthalmos, postoperative complications, and aesthetic outcomes.

Methods: A systematic search of MEDLINE, EMBASE, CINAHL, and CENTRAL databases was conducted as per PRISMA guidelines. Studies directly comparing bone grafts and titanium mesh in orbital fracture management were included. Primary outcomes included diplopia, enophthalmos, complications. Aesthetic outcomes were qualitatively assessed. Meta-analyses were performed using fixed and random-effects models and risk of bias was evaluated using the ROBINS-I tool.

Results: Eight studies involving 291 patients were included. No significant difference in diplopia incidence was observed between groups (OR: 1.87; 95% CI: 0.52-6.71; p = 0.34). Titanium mesh was associated with a significantly lower risk of enophthalmos (OR: 2.83; 95% CI: 1.19-6.75; p = 0.02). Complication rates were comparable (OR: 2.39; 95% CI: 0.55-10.35; p = 0.25). Aesthetic outcomes were favourable with both materials but insufficiently reported for meta-analysis.

Conclusion: Both bone grafts and titanium mesh implants are effective options for orbital fracture repair. Titanium mesh offers advantages in restoring orbital volume and preventing enophthalmos, supporting its preferential use in high-risk cases. Material selection should consider patient factors, defect characteristics, surgeon expertise and material availability.

Systemic sarcoidosis rarely presents as tattoo granulomas. We present a case of an eyelid tattoo granuloma as a prodrome to the diagnosis of sarcoidosis; this case is unique in its onset being several decades following the initial tattooing event, in addition to its resolution with intralesional triamcinolone. A 63-year-old female presented with ipsilateral upper and lower lid margin tattoo granulomas, 6 months post bilateral conjunctivitis. A punch biopsy of the granuloma revealed dermal non-caseating granulomatous inflammation. Serum angiotensin-converting enzyme levels were elevated, and a computed tomography scan revealed pulmonary lymphadenopathy, in keeping with a diagnosis of sarcoidosis. The granulomas resolved with a combination of intralesional triamcinolone and topical hydrocortisone ointment. The differential diagnosis for tattoo-associated granulomatous lesions is broad. This case report highlights the importance of biopsy and appropriate investigations for tattoo granulomas, as it may be the only sign of a systemic condition such as sarcoidosis.

Purpose: To evaluate diagnostic tests and patient characteristics associated with specific diagnoses of orbital inflammation to optimize cost-effectiveness.

Methods: A retrospective, observational case series, including 121 adult patients who underwent work-up for a clinically inflamed orbit. Chart review collected demographic and clinical information. Cost of testing was estimated based on publicly available data. Logistic regression was used to identify factors associated with a specific diagnosis.

Results: The median patient age was 49 years, and a majority were female (63%) and White (51%). A mean of five laboratory tests was ordered per patient. Two-thirds of the expenditure on diagnostic testing did not provide key diagnostic information. A specific diagnosis was reached for 31% of patients. Specific final diagnosis was significantly associated (p < 0.05) with older age (OR 1.6 per decade), male gender (OR 2.9), bilateral disease (OR 4.8), diffuse inflammation (OR 11.6), and bone involvement (OR 20.9).

Conclusions: Orbital inflammation was associated with a broad diagnostic work-up that led to a nonspecific diagnosis in the majority of cases. Cost savings may be achieved by judicious use of tests that provide limited diagnostic information (ANA, anti-dsDNA, ACE, anti-CCP, ESR, CRP, platelets) and reserving comprehensive work-up for patients with risk factors.

Epstein-Barr Virus-associated smooth muscle tumors (EBV-SMTs) are rare neoplasms that primarily occur in immunocompromised individuals. Orbital EBV-SMTs are an exceptionally rare subset of these tumors which may cause mass effect that leads to functional impairment. We report a case of a patient with systemic lupus erythematosus on long-term corticosteroids who was later found to have T cell deficiency and markedly reduced CD4 and CD8 counts. She presented with a rapidly enlarging right orbital mass causing proptosis, optic nerve compression, and visual dysfunction. Imaging revealed an extraconal lesion with bony erosion and sinus extension. Histopathology confirmed the diagnosis of EBV-SMT. The patient was managed by a multidisciplinary team including Ophthalmology (Oculoplastic Surgery) and Otorhinolaryngology (Rhinology). Pre-operative 3D-printed models were used for surgical planning. Tumor debulking was then performed using a combined transorbital and endoscopic endonasal approach, together with intraoperative CT and MRI-based image guidance to maximize safety and preserve optic nerve function. Systemic screening identified additional EBV-SMT lesions requiring surgical intervention, and sirolimus therapy was initiated as a possible immunomodulatory adjunct to slow the growth of these multifocal tumors. There is currently no standardized treatment for orbital EBV-SMTs. Surgical resection or debulking remains the mainstay, but complete excision may be limited by anatomical constraints. Immune reconstitution, together with targeted therapies such as sirolimus and bevacizumab offer additional options. This case highlights the importance of considering EBV-SMT in immunocompromised patients with rapidly enlarging orbital masses. Multidisciplinary management, including surgery, systemic evaluation, and immune modulation, is crucial to optimize outcomes.