International Ophthalmology Clinics最新文献

{"title":"A Major Review of Fungal Lacrimal Drainage Infections.","authors":"Valerie Juniat, Mohammad J Ali","doi":"10.1097/IIO.0000000000000622","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000622","url":null,"abstract":"<p><strong>Purpose: </strong>Lacrimal system infections, such as canaliculitis and dacryocystitis, are usually of bacterial etiology. We present a review of fungal lacrimal drainage infections.</p><p><strong>Methods: </strong>A literature review was conducted using Medline and Embase databases following PRISMA guidelines. Twenty-seven studies met the inclusion criteria and were synthesized narratively. Data obtained include demographics, clinical presentation, types of fungal infection, location of the infection, investigations, medical and surgical treatment (acute and delayed), and symptom resolution.</p><p><strong>Results: </strong>A total of 118 cases of fungal lacrimal infections have been reported so far. The most commonly reported species were Candida (27.1%) and Aspergillus (23.7%). The majority [74.6% (88/118)] involved the lacrimal sac and the nasolacrimal duct. Of these, 42.0% (37/88) had concurrent casts or dacryoliths. A total of 14.4% (17/118) involved only the canaliculus. Where specified, nearly all patients reported local symptoms of epiphora (77.4%, 24/31). A total of 66.7% (12/18) of patients had risk factors, including immunosuppression, trauma, concurrent fungal infection elsewhere, and lacrimal sac diverticulum. Where specified, all cases (56/56) showed improvement or resolution of symptoms. Of these, 66.1% (37/56) required only medical or conservative management.</p><p><strong>Conclusion: </strong>Fungal lacrimal infections are uncommon but should be suspected in patients presenting with new epiphora in the context of dacryocystitis, especially in the presence of casts or dacryoliths, while a smaller proportion causes canaliculitis. Diagnosis is challenging, requiring a combination of clinical suspicion, risk factor assessment (eg, immunosuppression), and laboratory confirmation. Treatment approaches range from conservative medical management to surgical interventions. Further research is needed to better understand their pathogenesis, especially regarding their relationship with dacryolith formation.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"99-103"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Orbital Melanoma: A Systematic Review of Clinical Characteristics, Management and Outcomes.","authors":"Antonia Vieira Vender, Kaveh Vahdani, Geoffrey E Rose","doi":"10.1097/IIO.0000000000000638","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000638","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical characteristics, management, and outcomes for histopathologically confirmed primary orbital melanoma (POM).</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. Studies reporting 1 or more patients with histopathologically confirmed POM and extractable data were included; secondary orbital involvement and nonoriginal reports were excluded. Data were extracted for demographics, clinical features, treatment, and outcomes. Tumors were classified as either melanocytosis/nevus-associated (MATs) or de novo melanomas. Outcomes for local recurrence, metastasis, overall survival (OS), and recurrence-free survival (RFS) were analyzed using Kaplan-Meier methods.</p><p><strong>Results: </strong>A total of 112 patients were included, of whom 49 (44%) had POMs that arose de novo, 34 (30%) were MATs, and the remainder were unclassified. Patients with MATs were slightly younger (40.1 vs. 47.9 y; P=0.078) and had shorter symptom duration (5.3 vs. 13.1 mo; P=0.158). Globe-sparing surgery was performed in 47% of cases, exenteration in 53%, and adjunctive radiotherapy in 37%. At a mean follow-up of 26.9 months, local recurrence occurred in 21% and metastasis in 39%. Estimates of 5-year OS showed a nonsignificant trend that favored MATs (74% vs. 44%; P=0.058), whereas recurrence-free survival was longer with melanocytosis-associated tumors (P=0.048). Adjuvant radiotherapy was associated with improved survival (HR=0.23; 95% CI: 0.08-0.66; P=0.006).</p><p><strong>Conclusions: </strong>POM is a rare malignancy. MATs may represent a distinct subset with more favorable outcomes, although interpretation is limited by the many small and heterogeneous data sets. Globe-sparing management appears to be valuable in some cases.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiopathogenesis, Classification, and Management of Eyelid, Lacrimal, and Orbital Fistulas: A Comprehensive Review.","authors":"Hatem A Tawfik","doi":"10.1097/IIO.0000000000000626","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000626","url":null,"abstract":"<p><p>Fistulas involving the eyelid, lacrimal system, and orbit represent a diverse group of pathologies characterized by abnormal epithelialized communications between 2 separate epithelial-lined tissue elements. They arise from a wide range of etiologies, including congenital defects, trauma, surgery, infection, inflammation, and neoplasia. Although individually rare, their cumulative clinical burden is significant due to diagnostic delays, recurrent infection, cosmetic deformity, and the potential for functional impairment. This review synthesizes data from the current literature to (1) provide a structured classification based on anatomic location or etiopathogenesis, (2) delineate the mechanisms underlying fistula formation, (3) discuss the clinical presentation, (4) diagnostic evaluation, and (5) management strategies for each subtype, with emphasis placed in the management section on the importance of performing complete excision of the epithelialized tract, and employing appropriate reconstructive techniques to achieve durable closure.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"36-48"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dacryoscintigraphy (DSG): Has it outlived its utility?","authors":"Hatem A Tawfik, Mohammad Javed Ali","doi":"10.1097/IIO.0000000000000619","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000619","url":null,"abstract":"","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Levator Synkinesis: Clinical Spectrum, Pathophysiology, and Surgical Management.","authors":"Mostafa M Diab, Adel H Alsuhaibani","doi":"10.1097/IIO.0000000000000624","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000624","url":null,"abstract":"<p><p>Congenital levator synkinesis represents a complex spectrum of neurodevelopmental disorders characterized by involuntary coupling of eyelid movement with activation of extraocular or masticatory muscles. This review proposes a clinical classification of levator synkinesis into excitatory, inhibitory, and combined phenomena, based on whether synkinetic input results in eyelid elevation, depression, or a combination of both. The underlying pathophysiology is most consistent with a developmental dysinnervation process, likely involving aberrant neural connectivity \"miswiring\" or, supranuclear release of latent primitive pathways. Histopathologic evidence further supports a neurogenic etiology rather than primary myopathy. Surgical management, largely derived from experience with Marcus Gunn jaw-winking syndrome remains individualized and debated, ranging from levator-disabling procedures with frontalis suspension to more conservative levator-preserving approaches. Recognition of these entities is essential for accurate diagnosis, differentiation from simple congenital ptosis and acquired mimics, and appropriate surgical planning.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"62-69"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Trial Updates in Biological Treatment of Thyroid Eye Disease.","authors":"Abdulrahman M Alfarhan, Bobby S Korn","doi":"10.1097/IIO.0000000000000642","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000642","url":null,"abstract":"<p><p>Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves' disease, causing proptosis, diplopia, and, in severe cases, vision loss. The 2020 approval of the first insulin-like growth factor 1 receptor (IGF-1R) inhibitor for TED introduced disease-specific pharmacotherapy and prompted accelerated development of additional biological agents across multiple mechanistic classes. This review summarizes the clinical trial evidence for biological agents currently approved or in late-stage development for TED, drawing on peer-reviewed publications, conference presentations, and sponsor disclosures through early 2026. Among the mechanistic classes evaluated, IGF-1R inhibition has accumulated the largest randomized trial evidence base. Multiple IGF-1R-directed agents, delivered by intravenous, subcutaneous, and oral routes, have demonstrated statistically significant reductions in proptosis in placebo-controlled trials, with responder rates that vary by agent, route, and disease activity. Interleukin-6 receptor (IL-6R) antagonism produced discordant Phase 3 primary endpoint outcomes across 2 parallel pivotal trials. Neonatal Fc receptor (FcRn) inhibition and selective interleukin-17A blockade each failed to meet primary endpoints in Phase 2 or Phase 3 studies. B-cell directed therapies and other off-label agents have produced inconsistent results in smaller, generally nonrandomized studies. In parallel, the use of orbital decompression has declined in the era following IGF-1R inhibitor approval, reflecting the changing role of surgery in pathways that initially lead with medical therapy. As comparative trial data emerge and the field moves toward treatment selection based on phenotype, clinicians will be better equipped to individualize biological therapy by disease stage, severity, safety profile, and patient preference.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"81-90"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic and Racial Variations in Thyroid Eye Disease: Clinical Features and Management.","authors":"Fatema M A Aljufairi, Fatema A Almenow, Maha Alhoda, Kenneth Ka Hei Lai, Clement Chee Yung Tham, Chi Pui Pang, Kelvin Kam Lung Chong","doi":"10.1097/IIO.0000000000000637","DOIUrl":"10.1097/IIO.0000000000000637","url":null,"abstract":"<p><strong>Background: </strong>Thyroid eye disease (TED) is an autoimmune orbital disorder with a broad clinical spectrum, ranging from mild symptoms to sight-threatening complications. Increasing evidence demonstrates variation in disease presentation and severity across populations, with implications for diagnosis and management.</p><p><strong>Methods: </strong>This narrative review synthesizes published literature from PubMed, Web of Science, MEDLINE (via EBSCOhost and Ovid), and the Cochrane Library to examine ethnic and racial differences in the epidemiology, orbital anatomy, clinical phenotype, immunologic profile, diagnosis, and management of TED across diverse populations.</p><p><strong>Results: </strong>Female predominance is highest in African and Western populations and lower in Asian cohorts, while thyroid status varies most in South Asia. Smoking rates are higher in Western populations and lower in South Asian and African cohorts. Asian populations more commonly exhibit muscle-predominant disease with increased risk of apical crowding, whereas Western populations more frequently present with prominent proptosis and eyelid signs; South Asian and Middle Eastern populations show more variable patterns. Inflammatory activity is often low at presentation, although a \"low-CAS progressive\" phenotype has been described in Asian cohorts. TRAb positivity is consistently high across populations, but is highest in South Asian cohorts. Diagnostic interpretation is influenced by population-specific anatomic differences and limitations of standard assessment tools. Management varies by region, with greater reliance on antithyroid medications in Asian and African populations and wider access to advanced therapies in Western settings.</p><p><strong>Conclusion: </strong>Ethnic differences in TED have important clinical implications. Population-specific interpretation of clinical findings is essential, as standard assessment tools may not fully reflect disease severity.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"91-98"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on Secondary Acquired Nasolacrimal Duct Obstructions (SALDO).","authors":"Nandini Bothra, Mohammad Javed Ali","doi":"10.1097/IIO.0000000000000625","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000625","url":null,"abstract":"<p><p>Secondary acquired lacrimal duct obstructions (SALDO) are a diverse group of disorders which encompasses epiphora due to mechanical causes, trauma, neoplasms, infections and inflammatory causes. The present manuscript describes a few updates based on recent research on the varied types of SALDO, their identification, assessment, treatment and outcomes.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"76-80"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibition in Locally Advanced Periocular Squamous Cell Carcinoma (POLA-SCC).","authors":"Yuval Tal, Daphna Landau-Prat, Or Gil, Shirly Grynberg, Guy J Ben-Simon","doi":"10.1097/IIO.0000000000000621","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000621","url":null,"abstract":"<p><strong>Purpose: </strong>To review the existing literature on the use of immune checkpoint inhibitors in the management of locally advanced periocular squamous cell carcinoma (POLA-SCC) and to contextualize current evidence through a representative clinical case.</p><p><strong>Methods: </strong>A narrative review of published studies evaluating programmed cell death protein-1 (PD-1) inhibition for advanced periocular cutaneous squamous cell carcinoma was performed. In addition, a detailed case of recurrent upper eyelid squamous cell carcinoma treated with multiple surgical excisions followed by PD-1 inhibitor therapy is presented to illustrate real-world clinical challenges and outcomes.</p><p><strong>Results: </strong>A 75-year-old man with upper eyelid SCC experienced rapid local recurrence despite repeated margin-controlled excisions and complex reconstructive procedures, resulting in significant eyelid dysfunction, ocular surface disease, and visual decline. Subsequent treatment with the PD-1 inhibitor cemiplimab achieved meaningful tumor control and disease stabilization. Review of the current literature demonstrates consistently high response rates to PD-1 inhibition in locally advanced periocular SCC, even in the presence of tumors with perineural invasion and orbital involvement, frequently allowing avoidance of mutilating surgical procedures such as orbital exenteration. Immune checkpoint inhibitors were generally well tolerated, with ocular adverse events being uncommon and typically manageable.</p><p><strong>Conclusions: </strong>Accumulating evidence supports immune checkpoint inhibition as an effective, eye-sparing, and vision-sparing therapeutic strategy for locally advanced periocular squamous cell carcinoma. Integration of PD-1 inhibitors into multidisciplinary management paradigms may reduce surgical morbidity, preserve ocular function, and shift treatment toward more conservative approaches in appropriately selected patients.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"27-30"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Lacrimal Gland Tumors.","authors":"Sara Kamali Zonouzi, Patricia Chavez-Barrios, Maria de la Garza, J Matthew Debnam, Bita Esmaeli","doi":"10.1097/IIO.0000000000000640","DOIUrl":"https://doi.org/10.1097/IIO.0000000000000640","url":null,"abstract":"<p><p>Epithelial lacrimal gland tumors are rare but important to diagnose early. The initial surgical decision to do an incisional biopsy versus gross total resection depends largely on the radiologic characteristics of the lacrimal gland mass. Until recently, orbital exenteration was considered the standard surgical approach for malignant epithelial tumors of the lacrimal gland. However, more recently, eye-sparing surgical resection followed by radiation therapy has gained popularity in selected patients. In this manuscript, we will review the typical clinical and radiologic features of pleomorphic adenoma of the lacrimal gland compared with those of lacrimal gland carcinoma, and we will review published data regarding local control and survival for malignant lacrimal gland tumors with eye-sparing surgery and radiation.</p>","PeriodicalId":14338,"journal":{"name":"International Ophthalmology Clinics","volume":"66 4","pages":"18-26"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}