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

We report a rare case of orbital wall change following the successful treatment of an orbital abscess in a 13-year-old boy. Initially presenting with left eye proptosis and eyelid puffiness, the patient was diagnosed with orbital cellulitis secondary to sinusitis and treated with intravenous antibiotics and surgical drainage. Although the infection resolved completely, six months later, the patient developed persistent upper eyelid swelling, ptosis, and mild proptosis. Imaging revealed significant thickening of the left orbital roof without active inflammation or lesions. Surgical exploration and histopathological analysis confirmed reactive hyperostosis of the orbital roof, likely due to periosteal elevation during abscess drainage. Unlike chronic rhinosinusitis (CRS) or orbital exenteration, where prolonged inflammation drives bone remodeling, no evidence of significant inflammation was observed in this case. Instead, the disruption of normal periosteal regulation may have triggered localized neo-osteogenesis. This case highlights an unusual occurrence for post-infectious orbital hyperostosis and emphasizes the importance of considering periosteal changes as a potential cause of late complications following orbital surgery or infection.

Orbital cellulitis is a serious vision and potentially life-threatening condition. In this case report, we present a 3-year-old boy who was admitted with orbital cellulitis, complicated by an intraconal orbital abscess, cavernous sinus thrombosis, petrous apicitis, labyrinthitis, and mastoiditis. There was no paranasal sinusitis, which is the most common cause of orbital cellulitis. His condition initially did not improve with intravenous antibiotics, but gradually improved after drainage of the orbital abscess with anticoagulant followed by corticosteroid therapy. We illustrate the importance of having a broad differential in atypical cases of orbital cellulitis, as well as the value of having a multidisciplinary approach to maximize favorable outcomes in these complex cases.

A rare case of a 78-year-old male with posterior orbital amyloidosis and cavernous sinus involvement is reported. He presented with 1 year of worsening binocular diplopia with left eye motility restriction in all directions except abduction. Magnetic resonance imaging of the brain demonstrated a well-defined mass in the posterior medial orbit extending into the left optic canal and cavernous sinus, with low T1 and high T2 signaling and minimal contrast enhancement. Given his worsening diplopia, the patient underwent surgery to decompress the left orbital apex and confirm the diagnosis. Histopathology exhibited red-green dichroism under polarization microscopy with Congo red dye, suggesting amyloidosis. Orbital amyloidosis should be considered in patients presenting with apex lesions with posterior extension. An approach to biopsy and decompression of the apex may be facilitated with a combined trans-orbital and endonasal endoscopic approach, but complete surgical excision may not be feasible. Adjunctive radiation can help stabilize disease and prevent progression in cases of orbital amyloidosis with cavernous sinus involvement.

Purpose: To compare the efficacy of punctal occlusion and artificial tears combined with lid hygiene in the treatment of dry anophthalmic socket syndrome (DASS).

Methods: A prospective, randomized, parallel group-controlled trial enrolled 40 patients with DASS. Patients were randomized to receive punctal occlusion (group A) or artificial tears and eyelid wipes (group B). Standard Patient Evaluation of Eye Dryness (SPEED) score, tear meniscus height (TMH) and Schirmer I test (ST) were assessed at baseline visit and follow-up visit at 3 months.

Results: At the 3-month evaluation, mean SPEED, TMH and ST showed significant improvement from baseline in group A (p < .001 for all comparisons) and group B (p < .001 for all comparisons). Comparing both groups, the results were in favor punctal occlusion group in TMH (p = .012), and ST (p = .005). No statistically significant differences were found comparing SPEED score between both groups (p = .055).

Conclusions: Both punctal occlusion and the combination of lubricant artificial tears with eyelid wipes may help in the treatment of DASS.

Purpose: This study reports on patient outcomes associated with the placement of a new, porous, ultra-high molecular weight polyethylene (UHMWPE) orbital implant with an innovative suturing platform (EZYPOR (PP)) after primary or secondary enucleation.

Methods: This was a descriptive, retrospective study of patients who underwent EZYPOR (PP) orbital implantation after primary or secondary enucleation for over a 36-month period done at the University of Santo Tomas Hospital (USTH), Manila, Philippines. The data collected included demographics, surgical indications, implant-associated postoperative outcomes, and follow-up duration.

Results: A total of 21 patients were eligible for this study. The most common surgical indications for enucleation were phthisis bulbi (33%), absolute glaucoma (23.81%) and endophthalmitis (14.29%). No postoperative complications, such as conjunctival thinning, implant exposure, enophthalmos, ptosis, or eyelid malposition, were noted throughout the follow-up period (MD = 811 days).

Conclusion: The EZYPOR (PP) orbital implant is a new and reliable porous orbital implant with advantages over existing porous orbital implants that are widely used today. It is designed and manufactured to increase tolerability, is easy to implant, and has good patient outcomes, such as satisfactory socket motility, good cosmetic appearance, and no postoperative complications related to the EZYPOR (PP) orbital implant in the 36 months follow-up, albeit with a limited number of patients. This study offers important baseline information for ophthalmologists' evidence-based guidance in the adoption of new porous orbital implants with an innovative suturing platform. Finally, the EZYPOR (PP) orbital implant is 30% less expensive than other major commercially available porous orbital implants.

Purpose: To evaluate the dacryocystorhinostomy (DCR) ostia via nasal endoscopy using the FICI-grading system following external and endoscopic DCRs.

Methods: Our prospective study evaluated all DCR ostia following single surgeon (MS) surgeries. The FICI grading system includes the Fluorescein endoscopy dye test (FEDT), internal common opening (ICO) dynamicity, cicatricial ostium closure, and ICO threats. A score of 5 means excellent (no intervention required), 3-4 is good (rarely needs intervention), and 0-2 is poor (needs definitive intervention). The DCR ostium score (FICI grading) was obtained at each postoperative visit, i.e. 4 weeks (simultaneous stent removal), 3 months, 6 months, and 12 months follow-up. The patients who had previously undergone dacryocystectomy or did not complete the follow-up protocol visits and follow-up of <12 months were excluded from the study.

Results: A total of 310 (67.98%) eyes had external DCR and 146 (32.02%) eyes underwent an endoscopic DCR procedure. The mean age of patients at surgery was 48.5 years. Out of these 456 ostia (400 patients), 309 (67.76%) patients fall within excellent grades, 74 (16.23%) in good, and 29 (6.36%) in poor grades. Failure of the DCR surgery was predicted and experienced in 16 eyes (3.51%) for which revision surgery was suggested.

Conclusion: The FICI grading system of DCR ostium is a user-friendly, quick, and effective method of monitoring the ostium in the postoperative period, for both external and endoscopic DCRs. It also provides a structured and simple method to predict the success after DCR surgery.

Purpose: Mechanisms that modulate the immune response hold great potential as viable strategies for combating cancer. Among these, novel molecular compounds that inhibit IDO1 have emerged as one of the most promising therapeutic opportunities for impeding tumor growth. The present objective is to describe the expression of indoleamine-2,3-dioxygenase 1 (IDO1) in sebaceous glands and study its role in diagnosing sebaceous carcinoma of the eyelid.

Methods: We conducted a clinical-pathologic study of IDO1 expression in healthy sebaceous glands, sebaceous adenomas (SA), sebaceous hyperplasia (SH), and sebaceous carcinoma (SC). A comparison of immunohistochemical staining intensity and distribution for IDO1 was performed between all groups. Clinical data was correlated with IDO1 staining.

Results: The study included 38 patients: 6 controls, 5 SA, 6 SH, and 18 SC. The mean H-scores of the control group, SA, SH, and SC were 0, 110, 127.5, and 201.9, respectively. There was a significant relationship between IDO1 h-scores and both patient age and tumor stage (p-values <0.001). There was a significant increase in IDO1 expression between SC and all other groups.

Conclusions: Our study demonstrated a statistically significant upregulation and reactivity of IDO1 in sebaceous gland tumors. Prior to these findings, clinical management centered around surgical excision. The use of molecular compounds such as indoximob, epacadostat, BMS-986205 and navoximod, that directly target IDO1 opens new possibilities for targeting these tumors, improving clinical outcomes, and minimizing the morbidities often associated with surgery.

Purpose: To determine the literature-pooled prevalence of phantom eye syndrome (PES) following eye removal, including phantom vision (PV), phantom pain (PP), or phantom non-visual non-painful (PNVNP) sensations.

Methods: Databases were searched from inception to March 12 2025. A systematic review and meta-analysis of PES prevalence and risk factors was conducted.

Results: Seven studies were identified (775 patients). The literature-pooled prevalence of PES, defined as having at least one constitutive symptom, was 58.9% (95% CI [50.4, 66.9], I² = 78%, five studies). The most common constitutive symptom was PV in 35.6% (95% CI [29.5, 42.3], I² = 71.1%, six studies), followed by PP in 26.4% (95% CI [20.8, 32.9], I² = 76.1%, seven studies) and PNVNP in 19.9% (95% CI [7.9, 42.0], I² = 91.2%, six studies) sensations. The pooled prevalence of reporting all three constitutive symptoms simultaneously was 4.8% (95% CI [2.2, 10.1], I² = 67.3%, three studies). Commonly reported risk factors in the literature included mental health comorbidities and preoperative pain, though some studies did not conduct multivariable analysis to control for confounding factors.

Conclusions: Low certainty evidence supports that over 50% of patients may develop at least one constitutive PES symptom. Patients may benefit from PES screening, reassurance, and early treatment of postoperative pain.

Horner's syndrome (HS) is a condition characterized by ptosis, miosis, and facial anhidrosis. The causes include trauma and surgical procedures in the cervical, thoracic, or cranial regions, which can impair sympathetic fibers. In the cases presented, both patients - a infant and an adolescent - developed HS after cervical manipulations. In the first case, a child presented with ptosis and miosis in the right eye following venous puncture in the cervical region, with spontaneous resolution. In the second case, an adolescent developed HS after the removal of the submandibular gland and lymph nodes, presenting with ptosis that required surgical correction. These cases highlight the importance of a comprehensive diagnostic evaluation, including pharmacological tests and imaging studies, to confirm Horner's syndrome and rule out underlying severe causes. The therapeutic approach should be individualized, considering the clinical characteristics of each patient and the potential for recovery from the condition.

Purpose: This study presents the clinical features and management of paediatric TED patients in an Australian population, together with the longitudinal trend of TRAb and TSI over time.

Methods: A retrospective case series study was conducted on patients with paediatric TED between 2003 and 2023. A comprehensive dataset was collected and analysed for each case, encompassing patient demographics, clinical features and management of their TED, as well as their thyroid antibody levels over the study period.

Results: Thirty-four patients were included, with a female preponderance. The age at diagnosis of thyroid dysfunction (mean age 12.1 years, range 3-17 years, SD ± 3.6 years) tended to slightly precede the age at diagnosis of TED (mean age 12.7 years, range 3-17 years, SD ± 3.59 years). The most common main TED symptom at presentation was prominent eyes in 25 patients (73.5%), and the most common presenting sign of TED was proptosis in 32 patients (94%). No patients had dysthyroid optic neuropathy. The majority (88%) of our paediatric TED patients had mild disease with a mean presenting VISA score of 1.76, and a CAS score of 1.71. During the follow up period, the average peak TRAb reached 44.2 IU/L (SD ± 96.94 IU/L), and over an average time period of 42.4 months, the most recent average TRAb level settled to 6.6 IU/L (SD ± 7.76 IU/L). The TSI levels also followed a downward trend over time.

Conclusions: Paediatric TED is rarer than adult TED with milder clinical presentations. TRAb and TSI levels in paediatric TED patients tend to follow the disease course, with a downward trend over time.