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

Purpose: To describe the clinical profile and imaging findings of orbital dirofilariasis and to describe the role of ultrasonography in its diagnosis.

Methods: Prospective study, over 4 years, included 14 patients based on clinical suspicion and biopsy proven periorbital dirofilariasis. All patients underwent orbital USG and MRI and analyzed their role in diagnosis.

Results: All patients had a unilateral involvement with a palpable periorbital mass. High resolution USG showed a well-defined cystic swelling, containing serpiginous structure with parallel echogenic walls in all cases. MRI showed hyperintense soft tissue swelling. On T1-weighted images, central tubular signal was visible in the lesion in 4 cases. Microscopic examination confirmed dirofilariasis in all these cases.

Conclusion: Periorbital filariasis can be a mimicker of most of the orbital diseases. It should be included in the differential of orbital inflammatory disease. Role of MRI scan is limited. USG has potential role in confirming the diagnosis.

Purpose: To analyze the need for adnexal surgeries in eyes implanted with Keratoprosthesis (KPro) and their long-term outcomes.

Methods: Retrospective analysis of 39 eyes implanted with KPro that underwent oculoplastic procedures following or before the KPro surgery from 2016 to 2024. Analyzed data included the indications, outcomes, KPro survival, and changes in visual acuity.

Results: Thirty-nine eyes (26 males) underwent oculoplastic procedures before or after type 1 KPro. KPro indications were Stevens-Johnson syndrome (n = 12), chemical injury (n = 20), chronic cicatrizing conjunctivitis (n = 3), corneal decompensation (n = 1), and trauma (n = 3). Oculoplastic indications were cicatricial entropion (n = 14), ectropion (n = 6), chronic dacryocystitis (n = 7), lagophthalmos (n = 12), trichiasis (n = 3), ptosis (n = 1), and endophthalmitis (n = 3). At a median of 27.9 months (IQR: 14.8-54.4) follow-up, KPro survived in 45% of eyes, and the oculoplastic procedure success rate was 94.9% after six repeat surgeries. Median BCVA improvement by 2 LogMAR (2.5-0.5) was noted in eyes where KPro survived. KPro survival rates are similar in eyes with chemical injuries or SJS. However, SJS eyes have more lacrimal drainage obstructions. KPro survival (62% vs. 53.3%) is better in eyes where adnexal surgeries are performed before than after the KPro implantation.

Conclusion: Various oculoplastic procedures are necessary for eyes with KPro, with cicatricial entropion and chronic dacryocystitis being the most common. The adnexal surgery success rate is good, and the KPro survival rate in such eyes is reasonable. Ocular surface and oculoplastic specialists should work closely together to enhance outcomes in these complex cases by conducting adnexal surgeries before KPro implantation.

Eyelid lesions with apocrine differentiation are uncommon. A retrospective review of 1,920 biopsied sweat gland lesions at a tertiary hospital's ocular pathology laboratory from 2006 to 2024 revealed seven unique cutaneous eyelid tumors with sweat gland apocrine differentiation. The distinct clinical presentation and histopathologic features of the selected eyelid tumors are described. The lesions were further differentiated based on immunohistochemical analysis. Seven patients were identified with enlarging unilateral eyelid sweat gland lesions. All lesions underwent excisional biopsy and demonstrated unique histopathologic findings of apocrine lesions. Key hallmark features in all lesions included bi- or multi-layered epithelium, decapitation secretion, and eosinophilic pink cytoplasms. However, each lesion also had its own distinct characteristics (e.g. pseudopapillary projections in cystadenoma) that guided in highlighting its benign or malignant apocrine-differentiation. Immunohistochemical staining was helpful in distinguishing the seven lesions as the following: apocrine cystadenoma, syringocystadenoma papilliferum, three tubular apocrine adenomas, and two apocrine adenocarcinoma of the glands of Moll. Lesions were managed with surgical excision. Eyelid sweat gland lesions with apocrine differentiation are less understood. They are frequently misdiagnosed, ranging from a benign chalazion to malignant basal cell carcinoma. If a biopsy reveals malignancy in an apocrine sweat gland lesion, it can be challenging to manage with surgical excision and adequate margins in the eyelid given the limited skin area. Early biopsy and detection of distinguishing histopathologic features can help reduce the growth of the lesion and prevent delayed diagnosis and treatment.

Purpose: To develop and evaluate orbital CT deep learning (DL) models in optic neuropathy (ON) prediction in patients diagnosed with thyroid eye disease (TED), using partial versus entire 2D versus 3D images for input.

Methods: Patients with TED ±ON diagnosed at a quaternary-level practice and who underwent orbital CT between 2002 and 2017 were included. DL models were developed using annotated CT data. The DL models were used to evaluate the hold-out test set. ON classification performances were compared between models and medical specialists, and saliency maps applied to randomized cases.

Results: 36/252 orbits in 126 TED patients (mean age, 51 years; 81 women) had clinically confirmed ON. With 2D image input for ON prediction, our models achieved (a) sensitivity 89%, AUC 0.86 on entire coronal orbital apex including bony walls, and (b) specificity 92%, AUC 0.79 on partial axial lateral orbital wall only annotations. ON classification performance was similar (p = 0.58) between DL model and medical specialists.

Conclusions: DL models trained on 2D CT annotations rival medical specialists in ON classification, with potential to objectively enhance clinical triage for sight-saving intervention and incorporate model variants in the workflow to harness differential performance metrics.

Trochleodynia is described as a headache caused by peritrochlear inflammation. It presents with tenderness in the trochlear area with exacerbation of vertical eye movements. It is principally idiopathic, but sometimes it is seen in association with other causes like sinusitis or rarely with immune mediated diseases.Cysticercosis is a tissue infection caused by the larval form of the parasite, Taenia solium. The parasite can infect the brain, muscle, eye and other tissues. The presenting features vary according to the site of lodgement of the larva. The extraocular muscles of the eye are the most common site of orbital form of cysticercosis.We report a case in which the lodgement of the cysticercus in the orbit, adjacent to the trochlea caused clinical features suggestive of trochleodynia. Neuroimaging was instrumental in arriving at the true diagnosis of cysticercosis.

Purpose: To demonstrate crisp, specific immunohistochemistry (IHC) for periostin and document its utility as a biomarker for nonspecific orbital inflammation (NSOI) and immunoglobulin G4-related orbital disease (IgG4-RD).

Methods: A multi-institutional retrospective study of both NSOI and IgG4-RD patients. Demographics, clinical disease location, and severity were recorded. Routine histologic sections of affected NSOI and IgG4-RD tissue and fibrocollagenous control tissue were interrogated with an anti-periostin antibody.

Results: Ten NSOI patients had orbital manifestations of variable severity involving the lacrimal gland, extraocular muscle, and diffuse or focal orbital tissue. 12 IgG4-RD disease patients had involvement of the lacrimal gland, multifocal orbital disease, or extra-orbital extension. Periostin IHC showed strong, diffuse positivity restricted to pathological fibrotic zones, sparing inflammatory and epithelial elements. This was observed in both the NSOI and IgG4 cases.

Conclusion: Periostin is highly expressed in zones of pathologic fibrosis, indicating its potential role in NSOI and IgG4 disease pathogenesis and as a disease biomarker.

Purpose: The social vulnerability index (SVI) is a community-level scoring system based on US Census tract, designed to assess vulnerability during disasters. Here, we evaluate the relationship of CDC-defined SVI with office visit compliance in an urban oculoplastic surgery clinic.

Methods: In this single-center retrospective study, age, gender, race/ethnicity, electronic accessibility status, residential address, and number of completed and no-show visits were collected of individuals treated at an oculoplastic clinic from Sept 2020 to Sept 2023. The 2020 Census Tract SVI scores were obtained using the residential addresses for the overall SVI, four thematic SVIs, and 16 social factors' SVIs. A greater SVI (range 0-1) indicates higher social vulnerability. Categorical, numerical, and logistic regression statistical tests were performed to determine factors predictive of unreliable visit attendance, defined as failure to attend >25% of scheduled appointments.

Results: The final analysis included 3,287 patients with a mean age of 52 ± 21 years, 61% of whom were female. In the study period, 787 patients (24%) were found to have unreliable attendance at their scheduled appointments. Having an overall SVI of 0.75 or higher was associated with an increased likelihood of unreliable visit attendance (OR 2.7, 95% CI 2.1-3.5, p < 0.001). Additionally, a thematic SVI of 0.75 or higher regarding racial and ethnic minority status resulted in an increased likelihood of unreliable attendance (OR 2.1, 95% CI 1.2-3.4, p = 0.008).

Conclusions: This is the first study showing that living in communities with high SVI scores is associated with poor oculoplastic surgery office visit attendance.

Orbital metastases from breast carcinoma are uncommon and often present diagnostic challenges. Fluorodeoxyglucose positron emission tomography - computed tomography (FDG PET-CT) is widely used in oncologic imaging, but may fail to detect small or metabolically inactive orbital lesions. We report a 41 -year-old female with a history of hormone receptor-positive invasive lobular breast carcinoma who presented with a painless progressive swelling of the lower eyelid and proptosis over 3 months. Magnetic resonance imaging (MRI) orbit revealed a lesion in the inferolateral aspect of the left lower eyelid and extraconal compartment of the left orbit. FDG PET-CT did not demonstrate any metabolic activity in the orbit. A biopsy was performed, confirming metastatic breast carcinoma. The patient underwent external beam radiotherapy directed at the eyelid and orbital region, resulting in a favorable clinical response. This case illustrates the limitations of FDG PET-CT in detecting orbital metastasis from breast carcinoma, particularly in lobular subtypes ,and emphasizes the importance of correlating imaging with clinical suspicion and biopsy in such clinical scenarios.Abbreviations: FDG PET-CT= Fluorodeoxyglucose positron emission tomography - computed tomography, MRI= Magnetic resonance imaging,ILC= Invasive lobular carcinoma, IDC= Invasive ductal carcinoma.

We describe the first case of a subperiosteal orbital hematoma complicating acute barotraumatic frontal sinusitis during a plane landing. A 38-year-old woman presented with a sudden-onset and intense left periorbital pain during a plane landing. Few hours after a commercial flight landing, she presented a delayed left periorbital ecchymosis and left subperiosteal orbital hematoma. An exclusively endoscopic approach effectively drained both the frontal submucosal and orbital subperiosteal hematomas. This approach not only resolved the sinus pathology but also restored ocular function, with significant improvement in visual acuity, normalization of intraocular pressure, and eye movements. The procedure demonstrated the safety and efficacy of endoscopic techniques for addressing complex sinus and orbital complications. The combination of a preexisting bony lysis caused by chronic frontal sinusitis and barometric pressure changes likely facilitated hematoma formation. The delayed onset of symptoms, including left periorbital ecchymosis, proptosis, and visual impairment, highlights the complex pathogenesis and diagnostic challenges of subperiosteal orbital hematoma in such cases.