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

Purpose: Foreign body suture reaction ("suture granuloma") is a complication faced by all surgeons. The purpose of this study was to examine the incidence and risk factors of suture granulomas in canthal surgery.

Methods: An IRB-approved retrospective review of medical records identified patients who had canthal surgery. Statistical analysis was performed on multiple data points to determine associations with granuloma formation. Summary statistics were reported as a mean and standard deviation for continuous variables, and as frequencies or proportions for categorical variables. Effect estimates were reported as odds ratios. A p-value of less than .05 was deemed statistically significant.

Results: A total of 758 procedures were included. Seven commonly used suture materials were encountered including uncoated polyester, polyester coated with polytetramethylene adipate (PTMA), nylon, polydioxanone, polyester coated with polytetrafluoroethylene (PTFE), polypropylene, and polyglactin 910. Eighteen total granulomas were observed (2.4%). Fifteen granulomas were associated with uncoated polyester, two with polyester coated with PTFE, and one with polypropylene. The odds of developing a suture granuloma with uncoated polyester were 25.4 times as likely as polyglactin 910 (p = .04). The odds of developing a suture granuloma with a non-absorbable, braided suture were 23.2 times as likely as absorbable, braided suture (p = .04). There was no significant association identified between the other collected variables.

Conclusions: Foreign body suture granulomas occur at a low rate following canthal surgery and can be largely avoided through careful selection of resorbable or monofilament sutures.

Purpose: This study aimed to quantify the proportion of patients with bilateral epiphora and suspected nasolacrimal obstruction who self-reported improved epiphora bilaterally following unilateral dacryocystorhinostomy and investigate predictive factors.

Methods: A retrospective cohort study of patients from an Australian lacrimal clinic was performed. Eligible patients were at least 18 years of age, complained of bilateral epiphora, underwent unilateral dacryocystorhinostomy between 2012 and 2022 and followed-up. Outcome groups were created by grouping self-reported epiphora improvement levels for each eye. Two-sided confidence intervals were calculated for the proportion of participants in each outcome group. Ordinal elastic net regression identified clinical features associated with outcome groups and estimated their effect sizes.

Results: Of 243 patients, the median post-operative follow-up duration was 3 months. Fifty-eight percent (95% CI 52-64%, n = 141) reported significant improvement (≥50% ipsilateral and any contralateral improvement), 5% (95% CI 3-9%, n = 13) reported small improvement (<50% ipsilateral and any contralateral improvement) and 26% (95% CI 20-31%, n = 62) reported ipsilateral improvement only. Eleven percent had functional or anatomical failure. Older age (OR 1.01), contralateral nasolacrimal duct narrowing (OR 1.37), contralateral nasolacrimal duct obstruction (OR 0.93) and longer follow-up time (OR 0.85) predicted outcome groups.

Conclusions: After unilateral DCR, many patients with bilateral epiphora and suspected nasolacrimal obstruction report an improvement of their symptoms bilaterally in the early postoperative period. Contralateral nasolacrimal system diagnosis, patient age and follow-up duration were associated with outcomes. Further study using validated epiphora assessment tools may quantify this observation, and we suggest a potential underlying mechanism of contralateral effects after unilateral treatment.

Purpose: To characterize trends in orbital cellulitis (OC) severity and management from 2016 through 2022, including assessment of effects from the COVID-19 pandemic.

Methods: A retrospective chart review was conducted at a tertiary care center using an electronic medical record search of OC from January 1 2016 to January 1 2023. Radiography was used to categorize patients into three cohorts - OC without abscess, OC with subperiosteal abscess (SPA), and OC with orbital abscess (OA). Infection cohort and age group [pediatric (<9 years old), adolescent (9-18 years), adult (>18 years)] were compared across years. Subgroup analysis was performed in the SPA cohort. Comparisons were made between the time periods prior to and after the start of the COVID-19 pandemic.

Results: From 2016-2022, there were 247 (67.3%) cases of OC, 103 (28.1%) SPA, and 17 (4.6%) OA. The year 2022 incurred higher rates of SPA and OA (p = 0.035), pediatric infections (p = 0.008), and co-morbid sinusitis (p = 0.005) compared to all preceding years. Rates were similar from 2016 through 2021. Within the SPA cohort, rates of surgical intervention and outcomes were similar across all years. Rate of abscess formation was significantly higher during the COVID-19 pandemic compared to the pre-pandemic era (p = 0.033).

Conclusion: The severity of OC leading up to the COVID-19 pandemic appeared steady. After pandemic onset, a delayed increase in abscess formation, predominantly affecting pediatric patients and correlating with a greater rate of sinusitis, was observed in 2022.

Purpose: A levator dissection-resection technique (LDR) in which the levator is dissected free from all fibrous attachments including Whitnall's ligament was compared to two commonly used frontalis-based procedures in the management of congenital ptosis with poor levator function.

Methods: Thirty patients having congenital ptosis with poor levator function were randomized to one of the three surgical groups (ten patients for each group), namely, frontalis sling (FS), frontalis advancement flap (FAF), and (LDR) technique. Marginal reflex distance-one (MRD-1), levator function, symmetry in different levels of vertical gaze, lagophthalmos, and any other surgical complications were assessed 6 months following the intervention.

Results: Patients in the three groups achieved statistically significant improvement in MRD-1 in the primary position of gaze (p = 0.001 for FS, 0.003 for FAF, 0.001 for LDR). Patients who underwent a frontalis-based procedure acquired an additional ability to elevate the upper eyelid by using their eyebrows. Patients who underwent LDR technique have acquired an additional mean of 5.79 ± 1 mm improvement in levator function with better symmetry during up and down gaze in unilateral cases. Patients from all groups had an equal degree of lagophthalmos with forced eyelid closure, and during sleep.

Conclusion: Patients with ptosis and poor levator function who were managed with LDR technique achieved a similar degree of eyelid elevation in the primary gaze to that of frontalis-based procedures, acquired additional levator function, achieved more symmetry in up and down gaze in unilateral cases, and had no additional risk to the cornea.

Purpose: To investigate the prevalence of fatty infiltration in normal orbits using magnetic resonance imaging (MRI) and its impact on muscle diameters.

Methods: A retrospective analysis was conducted on normal orbits in patients who underwent coronal T1-weighted MRI. Fatty infiltration was defined by a hyperintense signal within the extraocular muscle. Fatty infiltration area was calculated by dividing the cross-sectional fat area by the sum of the muscle and fat area in the coronal plane. Muscle diameters were measured perpendicular to the muscle belly at their maximum and the mean diameters of the infiltrated muscles were compared with the non-infiltrated muscles.

Results: Seventy-six orbits from 76 participants with a mean age of 55.7 ± 18 years were included. Fatty infiltration in at least one muscle was seen in 57 (75%) of participants. When infiltration was present, inferior rectus was most commonly involved (98%). The area of fatty infiltration ranged from 6% to 42%, with 5 participants in the <10% group, 36 in the 10-20% group, 20 in the 20-30% group, 9 in the 30-40% group and 2 in the 40-50% group. Participants with fatty infiltration were significantly older (mean 61 ± 15 years vs 40 ± 16 years, p < .01) and had a higher proportion of males (56% vs 16%, p < .01). No significant difference in muscle diameters were found between infiltrated and healthy muscles.

Conclusion: Fatty infiltration of the extraocular muscles is a reasonably common finding in normal orbits, most commonly involves the inferior rectus muscle and is associated with increasing age.

An understanding of the complexity of the surgical anatomy of the upper eyelid and the surrounding structures is mandatory when trying to minimize complications and achieve excellent cosmetic results during eyelid surgery. Postoperative upper eyelid asymmetry is one of the most common causes of patients' dissatisfaction, and several parameters should be taken into consideration when performing cosmetic blepharoplasties and ptosis surgery. Tarsal platform show and brow fat span are two of the most important variables pertaining to the perception of beauty and youthfulness that every oculoplastic and facial plastic surgeon should address when performing such surgery. The aim of this review paper is to provide a detailed anatomy of the upper eyelid and the surrounding structures, to highlight all the relevant factors that contribute to the perception of beauty and the changes that occur to the aging face and to address the preoperative factors that need to be carefully examined before performing upper eyelid surgery.

Purpose: To identify and evaluate the risk factors for ptosis repair failure.

Methods: Retrospective, case-controlled study evaluating adult patients with ptosis who underwent ptosis surgery by external levator advancement/resection (ELR) or Müller muscle conjunctival resection (MMCR) with at least 3 months postoperative follow-up. Regression analyses were performed of ptosis repair outcomes comparing preoperative and perioperative risk factors for failure.

Results: A total of 240 patients (404 eyelids) met the inclusion criteria for the study. Surgical outcomes were measured categorically by success rate and measured quantitively over time using Kaplan-Meier survival analysis. Success was categorically achieved in 101/112 (90%) eyelids after MMCR and 231/292 (79%) eyelids after ELR (p = .0088). Success as measured over 5 years of follow-up was significantly better in eyelids following MMCR compared to ELR (p = .0469). In terms of surgical failure, the following variables were found to be predictive in order of decreasing risk: chronic topical prostaglandin use, chronic topical corticosteroid use, surgical approach, lower preoperative margin reflex distance 1, prior intraocular surgery, age, lower preoperative levator function, concomitant blepharoplasty, presence of a glaucoma filtering bleb, and female gender.

Conclusions: Ptosis repair surgery is a complex and challenging procedure. This study provides the largest comparative analysis of ELR versus MMCR to date with findings suggesting MMCR to be more a successful surgery than ELR. Topical prostaglandin analogue use appears to be the highest known risk factor for MMCR and ELR ptosis repair failure.