Ophthalmic Plastic and Reconstructive Surgery最新文献

{"title":"Primary Orbital Presentation of Mycobacterium chimaera Infection.","authors":"Gabriella Guevara, Kaveh Vahdani, Sepideh Amin, Geoffrey E Rose","doi":"10.1097/IOP.0000000000003064","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003064","url":null,"abstract":"<p><p>Mycobacterium chimaera (M. chimaera) is a slow-growing nontuberculous mycobacterium, which, in humans, is mainly associated with cardiothoracic surgical infections and rarely presents with ocular involvement. This report describes a unique case of orbital infection presenting as an inflammatory mass in a healthy 66-year-old white female, without prior trauma, surgery, or significant medical history. Imaging revealed a diffuse mass, with heterogeneous enhancement, medially in the left orbit, and CT of the trunk revealed mediastinal lymphadenopathy. Histopathology of orbital tissue and mediastinal lymph nodes showed necrotizing granulomatous inflammation, cultures from endobronchial lymph node biopsy isolated M. chimaera, and targeted antimicrobial treatment for nontuberculous mycobacterium resulted in marked clinical improvement. This case highlights the importance of considering atypical infections in the differential diagnosis of orbital inflammatory syndromes.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Alemtuzumab-Induced Thyroid-Associated Orbitopathy: A Systematic Review and Meta-Analysis.","authors":"Edward Tran, Ali Hadi, Gautham Nair, Lulu L C D Bursztyn, J Alexander Fraser, Edsel B Ing","doi":"10.1097/IOP.0000000000003017","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003017","url":null,"abstract":"<p><strong>Purpose: </strong>Alemtuzumab is a monoclonal antibody that targets CD52 and is commonly used to treat multiple sclerosis. Thyroid dysfunction occurs in 20% to 30% of patients treated with alemtuzumab. This may lead to thyroid-associated orbitopathy (TAO), which can cause debilitating dry eye, diplopia, proptosis, ocular pain, and vision loss. This meta-analysis aims to quantify the incidence of alemtuzumab-induced TAO (AI-TAO) and to characterize its clinical features.</p><p><strong>Methods: </strong>Studies were extracted from Cochrane, Embase (Ovid), Medline (Ovid), and additional gray literature. Using R version 4.4.1 on RStudio, the meta-analysis was conducted using the meta package. Depending on the level of heterogeneity, either a fixed-effects or random-effects model was used to pool the data. Funnel plots were used to assess publication bias.</p><p><strong>Results: </strong>Meta-analysis of 1545 patients across 12 studies revealed that the incidence of alemtuzumab-induced Graves' disease was 25% (95% confidence interval [CI]: 11-46%) and AI-TAO was 6% (95% CI: 3-10%). Of the patients with established alemtuzumab-induced Graves' disease, 20% (95% CI: 12-30%) developed TAO. Pooled analysis of 8 studies (n = 556), revealed that the mean onset of AI-TAO was 37.38 months (95% CI: 28.90-46.76). In summary, 51/65 (78.5%) of TAO patients were managed conservatively, and 22/65 (33.9%) were managed surgically. Orbital decompression was required in only 5/65 (7.7%) patients.</p><p><strong>Conclusions: </strong>The incidence of AI-TAO is 6% which is less common than the estimated incidence of 20% to 30% of alemtuzumab-induced thyroid dysfunction. This finding emphasizes the need for patient counseling, baseline ophthalmic examination, and interdisciplinary follow-up for early detection and management of AI-TAO.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersurgeon Variability in Proptosis Reduction After Orbital Decompression for Thyroid Eye Disease: A Multicenter Analysis.","authors":"Ashley Hong, Marissa K Shoji, George A Villatoro, Bharanidharan Radha-Saseendrakumar, Sally L Baxter, Peter J Dolman, Michael Kazim, Andrew R Harrison, Mark J Lucarelli, James A Garrity, Dinesh Selva, Lilangi S Ediriwickrema, Catherine Y Liu, Bobby S Korn, Don O Kikkawa","doi":"10.1097/IOP.0000000000003090","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003090","url":null,"abstract":"<p><strong>Purpose: </strong>This study assesses intersurgeon variability in proptosis reduction after orbital decompression for thyroid eye disease.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with thyroid eye disease who underwent orbital decompression from 1 of 7 surgeons at 7 different institutions between January 2002 and December 2018. Data were included if a single decompression technique was performed on ≥10 patients by ≥2 surgeons. The primary outcome was postoperative change in proptosis with emphasis on comparison among surgeons utilizing similar surgical techniques. Statistical analysis was performed with χ2 and ANOVA testing, and a multivariable logistic regression model was generated.</p><p><strong>Results: </strong>Six hundred thirty-three orbits that underwent orbital decompression were included. Five different decompression techniques were analyzed: medial wall (n = 29), fat + lateral wall (n = 113), medial wall + floor (n = 123), fat + lateral wall + medial wall (n = 140), and fat + lateral wall + medial wall + floor (n = 228), without significant difference in proptosis reduction among surgeons. Surgeons did not demonstrate significant differences in outcomes at different time points compared with each other or themselves. Outcomes when comparing endoscopic versus open medial wall decompression varied among surgery types. Multivariate modeling revealed a statistically significant association between postoperative change in proptosis with preoperative proptosis (p < 0.001).</p><p><strong>Conclusions: </strong>Postoperative change in proptosis did not differ significantly between surgeons utilizing similar orbital decompression techniques for patients with thyroid eye disease. This study may strengthen the statistical validity of multicenter clinical trials assessing orbital decompression outcomes performed by surgeons employing uniform surgical techniques, thereby advancing our understanding of optimal surgical management strategies for thyroid eye disease.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatially Resolved Molecular Investigation of Perineural Invasion in Lacrimal Gland Adenoid Cystic Carcinoma.","authors":"Michelle M Maeng, Ryan A Gallo, Acadia H M Moeyersoms, Madison E Weiss, Rayan Abou Khzam, Qikai Wang, Sander R Dubovy, David T Tse, Daniel Pelaez","doi":"10.1097/IOP.0000000000003086","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003086","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose is to characterize the tumor microenvironment and investigate molecular mechanisms underlying perineural invasion (PNI) in lacrimal gland adenoid cystic carcinoma (LGACC) for the discovery of targeted therapies and biomarkers to improve clinical management.</p><p><strong>Methods: </strong>Spatial transcriptomics was performed on histopathologically confirmed LGACC with pronounced PNI. Cellular components were identified using gene signatures, and molecular pathways associated with PNI were analyzed through Gene Ontology analysis of differentially expressed genes between tumor and stromal components. Immunostaining for low-affinity p75NTR (NGFR) was conducted on archival LGACC cases with PNI.</p><p><strong>Results: </strong>Spatial transcriptomics yielded an average of 33,885 reads per spot, with 98.6% mapping quality and detection of 17,567 genes. Analyses revealed significant intratumor heterogeneity and identified pathways associated with PNI and treatment resistance, including the upregulation of metallothioneins and heat shock proteins. A distinct p75NTR expression pattern was observed in the spatial cluster involving tumor cells and nerve, which was confirmed by diffuse p75NTR staining in the nerve perineurium in all 10 (100%) LGACC cases with PNI.</p><p><strong>Conclusions: </strong>This study provides novel insights into the complex tumor microenvironment of LGACC PNI, uncovering mechanisms that may drive PNI and treatment resistance. The identification of p75NTR as a potential mediator of neurotropism underscores its relevance as both a therapeutic target and biomarker for PNI in LGACC. Elucidating these molecular factors is critical for developing targeted therapeutics to improve outcomes for patients with this aggressive malignancy.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Poor Response to Lifitegrast in Patients With Idiopathic Canalicular Inflammatory Disease (ICID).","authors":"Sumer Doctor, Mohammad Javed Ali","doi":"10.1097/IOP.0000000000003058","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003058","url":null,"abstract":"","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blepharoptosis After Intravitreal Anti-VEGF Injections: A Prospective Study.","authors":"Irene Bermudez-Castellanos, Augusto Cruz Velasco, Denny Marcos Garcia, Maria Rosa de la Hoz Montañana, Alvaro Bengoa González, Hortensia Sanchez Tocino, Enrique Castro-Portillo, Alicia Galindo-Ferreiro","doi":"10.1097/IOP.0000000000003085","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003085","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose is to objectively evaluate changes in upper eyelid height and contour after intravitreal injections.</p><p><strong>Methods: </strong>A prospective, observational, multicentre study was carried out on naive patients undergoing unilateral intravitreal injection of anti-vascular endothelial growth factor from January 2021 to February 2023. Injected eyes were considered cases, and noninjected contralateral eyes were used as controls. Data collected included demographics, cause of injection, drug used, use of a speculum, history of previous topical treatments, postinjection prophylaxis, and complications. A photograph was taken at baseline and at 6 and 12 months. ImageJ software was used to fit Bézier lines to the eyelid contour and upper eyelid margin reflex distance (MRD) 1, and 7 mid-pupil to eyelid margin distances were calculated. Clinically significant ptosis was defined as a decrease in MRD1 of ≥0.5 mm from baseline. ANOVA was used to compare MRD1 and mid-pupil to eyelid margin distance values. The p values of <0.05 were considered significant.</p><p><strong>Results: </strong>Sixty-one patients (mean age, 74.61 ± 12.30 years; 59% women) were included. Fifty-three (86.9%) patients received aflibercept, and 8 (13.1%) received ranibizumab. A speculum was used in all cases. Complications included 1 case (1.6%) of mild subconjunctival hemorrhage and 1 case (1.6%) of mild corneal epithelial defect. In injected eyes, MRD1 decreased by 0.43 ± 0.59 mm (6 months) and 0.60 ± 0.61mm (12 months; p < 0.01), as well as all mid-pupil to eyelid margin distances (p < 0.05). Clinically significant ptosis occurred in 57.4% of patients at 12 months. No significant changes were observed in control eyes.</p><p><strong>Conclusions: </strong>Repeated anti-vascular endothelial growth factor intravitreal injections are associated with a decrease in MRD1 and upper eyelid contour at 6 and 12 months. The use of a speculum may contribute to postinjection ptosis.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory Bowel Disease-Associated With Orbital Myositis and an Internal Necrotizing Collection.","authors":"Terence Ang, Gabriella McCray, Clare Quigley, Dinesh Selva, James Slattery, Grainne Murray","doi":"10.1097/IOP.0000000000003089","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003089","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is an autoimmune inflammatory condition of the gastrointestinal tract and encompasses 2 major subtypes: Crohn's disease and ulcerative colitis. Orbital myositis is an uncommon ophthalmic extraintestinal manifestation of IBD and may be associated with an internal necrotic collection. The presence of a necrotic collection in orbital myositis narrows the diagnostic differential to several infectious and noninfectious etiologies. The distinction between an infectious and noninfectious etiology is of significant therapeutic consideration, as management differs greatly. We present a case of a 17-year-old female presenting with a left lateral rectus orbital myositis associated with an internal necrotizing collection of the left lateral rectus. Histopathology demonstrated severe nonspecific chronic orbital myositis with features suggestive of focal granulomatous inflammation. She had an elevated fecal calprotectin and proceed to a colonoscopy, ultimately confirming a diagnosis of Crohn's disease. She was subsequently commenced on oral azathioprine and an oral prednisolone tapering course with ongoing follow-up. Her orbital disease remains quiescent at 6 months following her diagnosis.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intact Excision of Large Extraconal Orbital Tumors Without Osteotomy: A \"Hook-and-Lift\" Technique.","authors":"Kaveh Vahdani, Geoffrey E Rose","doi":"10.1097/IOP.0000000000003084","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003084","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose is to evaluate the safety and outcomes of a minimally invasive \"hook-and-lift\" technique for intact excision of large extraconal orbital tumors without the use of osteotomy.</p><p><strong>Methods: </strong>Retrospective review of patients with histologically confirmed solitary fibrous tumors or Schwannomas excised macroscopically intact using a \"hook-and-lift\" technique. Inclusion criteria were noncompressible lesions ≥25 mm in maximum dimension and/or occupying more than two-thirds of the orbit, those predominantly in the extraconal space, and those amenable to circumferential dissection.</p><p><strong>Results: </strong>Twenty patients (13 solitary fibrous tumors and 7 Schwannomas) met the inclusion criteria with 11 (55%) females presenting at a mean age of 48.2 (range, 23-78) years. Most presented with nonaxial globe displacement (90%) and reduced ocular motility (65%), while visual acuity was preserved (mean LogMAR, 0.08). The largest tumor dimension was an average of 29.3 (range, 25-40) mm, and the mean estimated volume was 6.1 (range, 1.1-15.7) mL. Depending on location, macroscopically intact without osteotomy was performed through an upper eyelid skin-crease incision (13/20), lower lid swinging flap (5/20), or retrocaruncular approach (2/20). Postoperative complications include persistent moderate ptosis (2) and motility deficit (2), including an acquired Brown syndrome; there was no impairment of vision; and no tumor recurrences were observed at a mean follow-up of 4.2 years.</p><p><strong>Conclusions: </strong>In appropriately selected cases, the \"hook-and-lift\" technique provides a safe and effective method for macroscopically intact excision of large and firm extraconal orbital tumors. The technique avoids the morbidity associated with periorbital osteotomy and can yield excellent functional outcomes.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Eyelid Necrotizing Fasciitis in a Pediatric Patient With Concurrent Parinaud's Oculoglandular Syndrome.","authors":"Nikhita S Mummaneni, George A Villatoro, Kimberly G Yen, Katherine J Williams","doi":"10.1097/IOP.0000000000003078","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003078","url":null,"abstract":"<p><p>Parinaud's oculoglandular syndrome is an uncommon manifestation of Bartonella henselae infection presenting with granulomatous conjunctivitis, marked preauricular lymphadenopathy, and occasional necrotizing lesions. The most common cause of Parinaud's oculoglandular syndrome is due to direct contact with contaminated cat saliva or scratches near the eye. While Parinaud's oculoglandular syndrome has been linked to cat scratch disease, it has not been associated with necrotizing soft tissue infections due to a distinct bacterial process, such as necrotizing fasciitis due to Group A Streptococcus. We present a pediatric patient who was coinfected with Bartonella henselae and Group A Streptococcus and presented clinically with both Parinaud's oculoglandular syndrome and necrotizing fasciitis. The patient was successfully treated with antibiotics without surgical debridement.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phosphaturic Mesenchymal Tumor Originating in the Orbit.","authors":"Jordan N Cornwell, Matthew J Lee, Katherine M Lucarelli, Ben J Glasgow, Daniel B Rootman","doi":"10.1097/IOP.0000000000003087","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003087","url":null,"abstract":"<p><p>Phosphaturic mesenchymal tumors (PMTs) are rare benign neoplasms that are often associated with tumor-induced osteomalacia. We present a rare case of a PMT with primary origin in the orbit. A 53-year-old female presented with diffuse bone pain and deficiency fractures throughout the body on x-ray imaging. Antinuclear antibody, immunoglobulin G4, and parathyroid hormone were elevated at that time. An incidental apical orbital mass with medial rectus and superior oblique involvement was found on MRI of the brain. Histologic examination confirmed fibroblast growth factor 23 positivity following biopsy. At postoperative week 6, bone pain and double vision resolved. Patient chose to undergo curative treatment with external beam radiation treatment with close follow up by oculoplastic surgery, endocrinology, and radiation oncology. At postoperative month 6, the ophthalmologic examination was within normal limits and repeat MRI demonstrated significant reduction in tumor size relative to post biopsy scans. PET scan did not demonstrate further lesions systemically. The prognosis for PMTs is favorable with adequate treatment. For patients with diffuse nonspecific skeletal pain and concurrent ocular symptomatology, this rare condition should remain on the differential diagnosis.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}