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

Kimura disease (KD) is a rare chronic inflammatory disorder characterized by benign subcutaneous masses primarily in the head and neck region, often accompanied by regional lymphadenopathy, elevated serum immunoglobulin E (IgE) levels, and peripheral eosinophilia. The management of peri-orbital KD poses a challenge due to its infiltrative nature and potential aesthetic concerns. We present a case of a 19-year-old male with nephrotic syndrome who developed a painless, slowly enlarging mass in the left peri-orbital region. Imaging showed a well-defined soft tissue mass with no intraorbital extension. Histopathology confirmed KD. Following incisional biopsy, the patient received monthly intralesional corticosteroid injections (2 ml of triamcinolone acetonide, 20 mg/ml) for six months. There was a significant reduction in mass size, with no recurrence over a one-year follow-up period. This case highlights the effectiveness of intralesional corticosteroids as a minimally invasive treatment option for peri-orbital KD, particularly when complete surgical resection is not feasible.

Purpose: This study aimed to report the performance of the large language model DeepSeek^TM (DeepSeek TM, Hangzhou, China) and perform a head-to-head comparison with ChatGPT^TM (OpenAI, San Francisco, USA) in the context of lacrimal drainage disorders.

Methods: Questions and statements were used to construct prompts to include common and uncommon aspects of lacrimal drainage disorders. Prompts avoided covering new knowledge beyond February 2024. Prompts were presented at least twice to the latest versions of DeepSeek^TM and ChatGPT^TM [Accessed February 15-18, 2025]. A set of assessed prompts for ChatGPT^TM from 2023 (ChatGPT-2023) was utilized in this study. The responses of DeepSeek^TM and ChatGPT^TM were analyzed for evidence-based content, updated knowledge, specific responses, speed, and factual inaccuracies. The responses of the current ChatGPT^TM were also compared with those of 2023 to assess the improvement of the artificial intelligence chatbot. Three lacrimal surgeons graded the responses into three categories: correct, partially correct, and factually incorrect. They also compared the overall quality of the response between DeepSeek^TM and ChatGPT^TM based on the overall content, organization, and clarity of the answers.

Results: 25 prompts were presented to the latest versions [February 2025] of DeepSeek^TM and ChatGPT^TM. There was no significant difference in the speed of response. The agreement among the three observers was high (96%) in grading the responses. In terms of the accuracy of the responses, both AI models were similar. DeepSeek's responses were graded as correct in 60% (15/25), partially correct in 36% (9/25), and factually incorrect in 4% (1/25). ChatGPT-2025 responses were graded as correct in 56% (14/25), partially correct in 40% (10/25), and factually incorrect in 4% (1/25). Compared to 2023, ChatGPT-2025 gave responses which were more specific, more accurate, less generic with lesser recycling of phrases. When confronted with inaccuracies, both admitted and corrected the mistakes in subsequent responses. Both the AI models demonstrated the capability of challenging incorrect prompts and premises.

Conclusion: DeepSeek^TM was not superior but comparable to ChatGPT^TM in the context of lacrimal drainage disorders. Each had unique advantages and could complement each other. They need to be specifically trained and re-trained for individual medical subspecialties.

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory condition caused by hyperactive T cells and macrophages, which release pro-inflammatory cytokines. The diagnosis is based on eight criteria: fever, bi- or tri-lineage cytopenias, splenomegaly, hyperferritinemia, hypofibrinogenemia or hypertriglyceridemia, elevated soluble CD25 levels, low or absent NK cell cytotoxicity, and hemophagocytosis. We report a 1-month-old male infant who was being treated in the pediatric intensive care unit for neonatal infection when he developed six of the eight criteria for HLH, along with bilateral upper eyelid edema that progressed to bilateral sino-nasal-orbital necrosis. MRI revealed a large area of contrast loss involving the nose and both orbits, consistent with fungal necrosis. Biopsy and culture identified Aspergillus fumigatus. Despite antifungal and immunosuppressive treatment, the infant died one week later. We emphasize the need to consider opportunistic fungal infections in HLH patients, particularly when there is rapid and severe clinical deterioration.

Purpose: To develop a deep learning model using orbital computed tomography (CT) imaging to accurately distinguish thyroid eye disease (TED) and orbital myositis, two conditions with overlapping clinical presentations.

Methods: Retrospective, single-center cohort study spanning 12 years including normal controls, TED, and orbital myositis patients with orbital imaging and examination by an oculoplastic surgeon. A deep learning model employing a Visual Geometry Group-16 network was trained on various binary combinations of TED, orbital myositis, and controls using single slices of coronal orbital CT images.

Results: A total of 1628 images from 192 patients (110 TED, 51 orbital myositis, 31 controls) were included. The primary model comparing orbital myositis and TED had accuracy of 98.4% and area under the receiver operating characteristic curve (AUC) of 0.999. In detecting orbital myositis, it had a sensitivity, specificity, and F1 score of 0.964, 0.994, and 0.984, respectively.

Conclusions: Deep learning models can differentiate TED and orbital myositis based on a single, coronal orbital CT image with high accuracy. Their ability to distinguish these conditions based not only on extraocular muscle enlargement but also other salient features suggests potential applications in diagnostics and treatment beyond these conditions.

Orbital angioleiomyomas are rare benign tumors that can mimic orbital cavernous venous malformations (OCVM) due to overlapping radiological and histopathological features. We present the case of a 42-year-old woman with an apical orbital angioleiomyoma incidentally discovered during evaluation for migraines. Magnetic resonance imaging revealed a well-defined, gadolinium-enhancing intraconal mass, initially suggestive of OCVM. Surgical excision was performed via an endonasal endoscopic approach, achieving complete removal without recurrence. Histopathological analysis and molecular testing confirmed the diagnosis, identifying a somatic GJA4 (p.Gly41Cys) mutation.This case highlights the diagnostic challenge of distinguishing orbital angioleiomyomas from OCVM and emphasizes the importance of immunohistochemistry and molecular analysis, particularly GJA4 mutation screening, in achieving diagnostic accuracy. The identification of GJA4 mutations may assist clinicians and pathologists in better characterizing true angioleiomyomas, especially in cases where the distinction between OCVM and the cavernous subtype of angioleiomyoma is histologically ambiguous. Angioleiomyomas may be underrecognized in orbital pathology and could represent a subset of lesions previously classified as OCVM or intracranial meningiomas. A comprehensive, multimodal diagnostic approach is essential for appropriate classification and management of these tumors.

Superior ophthalmic vein thrombosis (SOVT) is a rare and potentially sight threatening condition that arises from infectious, autoimmune, hypercoagulable, or traumatic causes. With timely diagnosis and treatment, the prognosis for visual and functional recovery is good, though permanent functional and visual loss can occur. We report a case of left septic SOVT in a pediatric patient with radiographic evidence of a small caliber ipsilateral superior ophthalmic vein on MR imaging, 2 and 4 months after full clinical recovery. This radiographic appearance of the superior ophthalmic vein after treatment, in a patient with full recovery, has not previously been reported. Recognition of this persistent change in the caliber of the ipsilateral vein is important to avoid radiographic confusion with contralateral venous congestion.

Purpose: To evaluate the rate of orbital implant extrusion and exposure following enucleation or evisceration in patients with endophthalmitis or panophthalmitis, and to assess the influence of infectious etiology, implant type, and surgical technique on extrusion risk.

Methods: A systematic review was conducted using MEDLINE, CINAHL, Embase, and Scopus for studies published between January 1980 and December 2024. Studies were included if they evaluated implant extrusion or exposure following eye removal surgery in patients diagnosed with endophthalmitis or panophthalmitis. Fourteen retrospective cohort studies met the inclusion criteria.

Results: Extrusion or exposure rates ranged from 0% to 53%. Pseudomonas aeruginosa was the most frequently implicated pathogen. Non-porous implants, especially silicone, were more commonly associated with extrusion, while porous implants, particularly hydroxyapatite, demonstrated lower complication rates. No clear difference was observed between evisceration and enucleation in terms of extrusion risk.

Conclusions: Implant extrusion is a significant postoperative complication in the setting or endophthalmitis or panophthalmitis. Pseudomonas aeruginosa and the use of non-porous implants may increase extrusion risk. The use of porous implants and appropriate prophylactic antibiotics may be associated with lower risk of extrusion. Further prospective studies are required to standardize risk assessment and prevention strategies.

Purpose: To systematically evaluate evidence-based interventions aimed at reducing postoperative edema and ecchymosis in eyelid and periocular surgery, with the goal of improving patient outcomes and recovery.

Methods: A systematic review of 29 randomized controlled trials (RCTs), involving 2,287 patients undergoing eyelid and periocular surgery, was conducted. A comprehensive search was performed across Embase, MEDLINE, Cochrane Central, and Google Scholar up to April 2025. Studies assessing interventions for postoperative edema and ecchymosis were included. Study quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool.

Results: Tranexamic acid was the most consistently effective intervention for reducing ecchymosis. Vessel-preserving surgical techniques significantly reduced edema and hematoma, while skin-only excision led to less swelling than combined skin and muscle excision. Carbon dioxide laser - assisted blepharoplasty improved hemostasis and reduced chemosis. Magnesium sulfate dressings were more effective for edema than ice packs, though cold compresses provided short-term relief. Anesthesia modifications (pre-cooling, buffered lidocaine) reduced injection pain but had variable effects on swelling. Herbal and adjunctive therapies, including Arnica montana and bromelain, showed no significant benefits.

Conclusion: Tranexamic acid, vessel-preserving surgical methods, and magnesium sulfate dressings are among the most effective strategies for minimizing ecchymosis and edema in eyelid and periocular surgery. Further RCTs should explore optimized combinations of these interventions and assess long-term patient-reported outcomes.