Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

Background: Idiopathic apical orbital inflammation (AOI) is used to describe inflammation involving the posterior third of the orbit where no specific cause can be identified. It is a rare entity in which the presentation can vary widely. We aim to describe a case series of patients with idiopathic AOI and their clinicoradiological features and visual outcomes.

Method: Retrospective multi-centre case series involving patients with idiopathic AOI.

Results: Seven patients were included. The mean age was 50.3 ± 18.4 years (range: 31-84 years). The left eye was involved in the majority of patients (4, 57.1%), with the most common presenting clinical symptoms and signs being limitation of extraocular movements (6, 85.7%), periorbital pain (4, 57.1%), and blurred vision (4, 57.1%). Optic neuropathy was present in 3 (42.9%) patients. Three patients (42.9%) underwent an orbital biopsy, which were all consistent with nonspecific inflammation. Medical treatment was used for all patients in the form of oral steroids (5, 71.4%) or nonsteroidal anti-inflammatories (1, 14.3%). Two (28.6%) patients had additional immunosuppression. At last follow-up, 2 (28.6%) patients had achieved complete resolution of all of their symptoms, 2 (28.6%) patients had significant clinical improvement with mild residual disease, 2 (28.6%) had stable disease, and 1 (28.6%) was lost to follow-up.

Conclusion: Idiopathic AOI is a rare condition that can present with a wide variety of symptoms and be potentially blinding. Patients responded well to oral corticosteroids, but biopsy and additional immunosuppressive agents should be considered in those with recurrent, poorly responsive, or atypical disease.

Objective: To assess the feasibility, accuracy, and safety of ultrasound (US)-guided coaxial core-needle biopsy (CNB) for histomolecular diagnosis of extra-ocular orbital soft tissue tumours as a minimally invasive alternative to surgical biopsy.

Methods: This retrospective study was conducted at a single Comprehensive Cancer Center and included all consecutive patients referred to our center between 2015 and 2023 for the diagnosis and treatment of orbital soft tissue tumours. All patients underwent US-guided transconjunctival coaxial CNB using a semiautomatic 18-gauge biopsy gun. Pathological analysis included morphological analysis, immunostainings, and molecular biology techniques when required.

Results: A total of 26 patients were included consisting of 21 adults (median age: 64 years, range: 24-93 years), 1 adolescent (17 years), and 4 children (aged 4 weeks, 5 weeks, 26 months, and 6 years). Tumour largest diameters ranged from 11 to 57 mm (median 23 mm). The overall feasibility of CNB was 88% (23/26), and it was 100% (5/5) in children. The histological accuracy was 91% (21/23), and its safety was 96% (25/26). Molecular biology analyses were requested in 9 out of 23 cases and were successful in all instances. The final diagnoses included hematological malignancies (n = 8), carcinomas (n = 5), metastases (n = 4), sarcomas (n = 4), and benign mesenchymal tumours (n = 5).

Conclusions: This study supports the use of US-guided coaxial CNB for the pathological and molecular diagnosis of orbital soft tissue tumours in both children and adults. This technique shows promise as a minimally invasive alternative to open surgical biopsy.

Objective: The aim of this study is to investigate the effects of preoperative parameters such as retinal nerve fiber layer (RNFL) thickness, visual acuity (VA), visual field (VF), and tumour volume on postoperative outcomes in patients with pituitary adenoma.

Design: Retrospective study.

Participants: Two-hundred and seventy-six eyes from 142 patients were included.

Methods: All patients underwent a comprehensive ophthalmological evaluation both before and 12 months after the surgery. RNFL thickness was analyzed using optical coherence tomography. VF testing was carried out using the automated Humphrey Visual Field Analyzer 3. Two primary visual field (VF) parameters, mean deviation (MD), and pattern standard deviation (PSD), were recorded. Patients were categorized into 2 groups based on their visual field outcomes: the MD recovery group and the nonrecovery group. MD recovery was defined as an MD value greater than -2 dB at the 12-month postoperative follow-up visit.

Results: The mean BCVA was significantly improved postoperatively compared with the preoperative values (P = 0.001). Preoperatively, the upper, temporal, and inferior RNFL values were significantly higher in patients with normal visual fields compared to those with abnormal visual fields (P = 0.001 for upper and temporal, P = 0.008 for inferior). Preoperative suprasellar tumour volume was found to be lower in the MD recovery group (P = 0.001). Multivariate logistic regression analyses revealed that preoperative inferior RNFL thickness were significantly associated with MD recovery (P = 0.023), and preoperative temporal RNFL thickness were significantly associated with VA recovery (P = 0.047).

Conclusion: RNFL thickness, VF parameters, and suprasellar tumour volume can serve as important prognostic indicators in patients with pituitary adenoma.

Objective: Competency-based medical education (CBME) requires a variety of assessments evaluating resident performance. Assessment form design may influence narrative feedback quality. To evaluate the effect of including targeted written comment prompts in entrustable professional activity (EPA) assessment forms on the quality of narrative feedback in CBME ophthalmology resident trainee assessments.

Methods: Transition to discipline (TTD) assessment data from three distinct time periods were anonymized; the first 2 groups contained assessments completed with the original form design, whereas the last group represented assessments completed after the introduction of revised EPA forms. Written feedback was scored using the Quality of Assessment for Learning (QuAL) score. One-way ANOVA and a Tukey post hoc test were used to compare mean QuAL scores of each group.

Results: One-thousand one-hundred and forty-five assessments were analyzed, including 680 Original EPA forms, 322 intermediate forms, and 143 revised forms. QuAL scores significantly increased after revisions were made to the assessment form, with original, intermediate, and revised form mean QuAL scores of 2.14 ± 1.76, 2.77 ± 1.75, and 4.33 ± 1.11; P < 0.001 for all comparisons, respectively.

Conclusions: Revising EPA form design to include targeted prompts and examples of evidence-based coaching words to guide written comments results in higher-quality narrative feedback in CBME assessments.

Objective: This study aimed to analyze the clinicopathological characteristics of a rare malignant tumour, primary orbital mesenchymal chondrosarcoma (MCS), and identify the risk factors influencing its prognosis.

Methods: A total of 15 patients with histologically confirmed primary orbital MCS were enrolled between April 2013 and October 2022. The relationships between clinicopathological features and outcomes, including recurrence and survival were analyzed.

Results: During the follow-up period, 9 patients (60%) experienced disease relapse, and 7 patients (46.7%) succumbed to the disease. Immunohistochemical analysis showed positive rates for SMA, CD-99, S-100, vimentin, and Bcl-2 at 60%, 60%, 53.3%, 100%, and 93.3%, respectively. The Ki67 index was positively associated with the recurrence and mortality rates.

Conclusion: Our study suggested that the Ki67 index could be a vital prognostic factor for MCS. Further follow-up studies are required to assess the efficacy of chemotherapy and radiotherapy in improving patient outcomes.