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

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.

Purpose: To develop and validate a deep learning model for the detection of functional blepharoptosis from external ocular photographs, and to quantify the impact of augmenting the training data with synthetic images on model performance.

Methods: External ocular photographs of 771 eyes from patients aged ≥ 21 years seen at a tertiary oculoplastic clinic. including 639 with clinically diagnosed functional blepharoptosis and 132 without, were obtained and cropped. These were then randomly assigned into training (n = 539), validation (n = 76) and test (n = 156) subsets, to train and evaluate a baseline deep learning model. Additional synthetic data from a pretrained StyleGAN model was then used to augment the training set (n = 2000), to train and evaluate an augmented deep learning model. Analysis of the performance of both models was then performed.

Results: Accuracy of the deep learning models was assessed in terms of sensitivity and specificity in identifying eye images with functionally significant blepharoptosis. A sensitivity of 0.68 (0.60-0.76), specificity of 0.89 (0.77-1.00) and AUC of 0.87 (0.81-0.93) was obtained by the baseline model, and a sensitivity of 0.95 (0.92-0.99), specificity of 0.67 (0.49-0.84) and AUC of 0.91 (0.86-0.96) by the GAN augmented model.

Conclusions: Functional blepharoptosis can be detected from external ocular photographs with high confidence, and the use of synthetic data from generative models has the potential to further improve the model performance.

Purpose: To perform a systematic literature review on major complications of orbital decompression and describe our experience with three new unpublished cases.

Methods: The PubMed and Embase databases were searched using the keywords ("orbital decompression") AND (Graves) or (thyroid eye disease) in January 2025. Only articles in English, Spanish, or French were included. Major complications were defined as cerebrospinal fluid leaks, intracranial complications, and vision loss. The authors also reviewed all medical records of patients who underwent orbital decompression over 34 years (1990-2024) for Graves' orbitopathy at the teaching hospital of the School of Medicine of Ribeirão Preto, Brazil.

Results: Cerebrospinal fluid leaks occurring during medial and lateral decompressions have been reported in 22 articles, with an estimated rate ranging from 1.0% to 2.0%. Several severe neurological side effects were reported in 14 articles, most occurring during medial decompression. Blindness after orbital decompression was documented in nine papers as a multifactorial event.

Conclusions: The surgical factors involved in major complications associated with orbital decompression have not been discussed in detail. The analysis of the three new cases, along with those cited in the literature, shows that careful multiplanar radiological reconstruction of the olfactory fossa and posterior ethmoid pneumatization is an essential step to avoid intracranial complications during medial decompression. In deep lateral decompressions, the risk of major complications is minimized with careful bleeding control and avoidance of dural exposure.

Purpose: Traffic accidents are a common cause of orbital fractures. In The Netherlands, the number of traffic accidents as well as the use of electronic bicycles (e-bikes) is increasing. The aim of this study was to investigate changes in the etiology of orbital fractures, especially the role of e-bikes and population ageing.

Methods: A retrospective cohort study at the Leiden University Medical Center (LUMC) was performed to identify the causes of orbital fractures in a single center. Medical records of patients presenting with periorbital trauma in the period 2011-2022 were reviewed to identify patients with orbital fracture. For each year and for different age categories the number of fractures, and causes per year were analyzed.

Results: From 1099 patient records, 495 patients with orbital fracture were identified. We found a statistically significant increase of orbital fractures: 35 in 2012 and 82 in 2022. Most orbital fractures were caused by bicycle accidents (men 31%, women 44%). The highest increase in orbital fractures due to e-bikes was in patients aged between 50 and 75 years.

Conclusion: The number of orbital fractures is increasing, especially orbital fractures due to e-bike accidents and mostly in patients aged 50 years and older.

Immunoglobulin G4 (IgG4)-related ophthalmic disease (IgG4-ROD) typically affects the lacrimal glands, trigeminal nerves, and extraocular muscles. Although imaging and serology aid in diagnosis, histopathological confirmation is crucial. Recent updates to the diagnostic criteria have incorporated labial salivary gland biopsy as a biopsy site. We report a case of IgG4-ROD with optic neuropathy diagnosed via labial salivary gland biopsy. A 69-year-old male patient presented with progressive right-eye visual loss. Imaging revealed an orbital mass, enlarged extraocular muscle, and enlarged infraorbital nerve. Serum IgG4 level was elevated, and a labial salivary gland biopsy was performed due to the absence of accessible biopsy sites, confirming the diagnosis. Oral corticosteroid therapy resulted in rapid visual and imaging improvement with no recurrence. This case emphasizes the diagnostic value of infraorbital nerve enlargement and the utility of labial salivary gland biopsy in IgG4-ROD, highlighting the importance of early recognition and treatment to prevent irreversible visual damage.

A 44-year-old man with uncontrolled diabetes mellitus (A1C: 9.9%), a well-established risk factor for infection, presented with acute onset of complete vision loss in the right eye (OD) associated with periorbital swelling, pain, and proptosis. Visual acuity was no light perception OD with intraocular pressure of 45 mmHg. Clinical examination revealed significant right sided proptosis and orbital inflammation. Emergent canthotomy and cantholysis were performed. He was then taken to the operating room where biopsy revealed a rapidly progressive orbital necrotizing fasciitis (ONF) involving Prevotella baroniae. Due to clinical worsening despite broad spectrum antibiotics and surgical debridement, the patient ultimately required orbital exenteration. The identification of Prevotella baroniae in the orbit is rare. This case highlights the aggressive nature of ONF and its potential for progression to orbital compartment syndrome, emphasizing the need for high clinical suspicion of these conditions. Timely surgical and medical interventions are imperative for preserving visual function and preventing mortality.

To describe a rare case of crocodile tears and lower lid sialocele formation secondary to a misdirected Stensen's duct in a patient with Treacher Collins Syndrome (TCS), emphasizing the diagnostic and surgical challenges. We reviewed the clinical course, diagnostic imaging, and surgical management of a 28-year-old woman with TCS presenting with lower lid and cheek swelling and epiphora exacerbated by eating. The patient's outcomes were monitored over 3 years post-surgery. The patient presented with recurrent swelling in the right lower lid and cheek, worsened by eating. Work up of the patient confirmed a sialocele secondary to a misdirected Stensen's duct. She underwent superficial parotidectomy with duct ligation, followed by successful lower eyelid reconstruction. Long-term follow-up revealed resolution of symptoms with no recurrence. This case highlights the importance of recognizing rare salivary gland complications in TCS patients following facial surgeries. A multidisciplinary approach is essential for accurate diagnosis and optimal outcomes.

Purpose: To highlight possible vertical globe position changes following levator muscle resection surgery for simple congenital ptosis.

Methods: A retrospective chart review was conducted on patients who developed overcorrection with alleged hypoglobus following unilateral levator resection. Margin reflex distance 1 (MRD1) and vertical palpebral fissure (VPF) were measured, and vertical globe displacement was determined by comparing globe positions between both eyes, using the Image-J 1.54k software.

Results: Twenty-eight patients (12 males and 16 females) with a mean age of 9.07   ±   4.15 years were included. Eleven (39.3%) had prior ptosis surgery. The median preoperative MRD1 was 0 mm (range:  - 2 to 2), which increased to 7.7 mm (3.1-9.9), 5.75 mm (3.4-8.0), and 4.7 mm (3.0-6.3) at the 1st, 2nd, and 3rd follow-ups, respectively (p < 0.001). The median VPF was 5.7 mm (3.8-8.5) preoperatively, peaking at 12.2 mm (7.3-14.9) at 1 week before decreasing to 10.2 mm (8.1-12.9) and 9.5 mm (8.0-12.5) at subsequent visits (p < 0.001). The median inferior globe displacement was 2.5 mm (0.7-3.6) at 1 week, improving to 1.1 mm (0.0-2.4) and 0 mm (0.0-1.4) at later follow-ups (p < 0.001). Reverse Bell's phenomenon was observed in 42.9% of eyes; conjunctival fornix prolapse in 17.9%.

Conclusions: Maximal/supramaximal levator resection surgery could result in translational descent of the globe (hypoglobus) possibly due to injury of the conjoint fascial sheath. Alternatively, transient superior rectus muscle dysfunction could lead to a rotational movement of the globe (hypotropia).

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.