Ophthalmic Plastic and Reconstructive Surgery最新文献

{"title":"Assessment of Differential Diagnoses for Oculoplastics Cases Produced by Large Language Models.","authors":"Jeffrey C Peterson, Sruti S Rachapudi, Sasha Hubschman, Kevin Heinze, Thomas Oetting, Sean M Rodriguez, Pete Setabutr, Ann Q Tran","doi":"10.1097/IOP.0000000000002984","DOIUrl":"10.1097/IOP.0000000000002984","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the accuracy of different large language models (LLMs) in generating differential diagnoses for oculoplastic cases.</p><p><strong>Methods: </strong>Differential diagnoses were generated for 20 oculoplastic cases sourced from University of Iowa EyeRounds.org using 6 LLMs: Chat Generative Pre-Trained Transformer (ChatGPT) 3.5, ChatGPT 4.0, OcuSmart/EyeGPT, Google Gemini 1.5, Claude 3.5, and Microsoft CoPilot. Outputs were compared against the EyeRounds expert-curated differentials examining (1) top diagnosis match rate (2) inclusion of the correct diagnosis within the generated list, as well as (3) recall and (4) precision, calculated to assess the overlap and conciseness of LLM outputs.</p><p><strong>Results: </strong>OcuSmart/EyeGPT achieved the highest top diagnosis match rate (85 ± 36%), while Claude 3.5 demonstrated the highest rate of inclusion of correct diagnosis in differential, as well as recall rate (100 ± 0% and 55 ± 27%, respectively). Google Gemini produced the most precise differentials at 43 ± 24%. Claude 3.5 generated the largest but least concise lists. LLM performance varied by case; for example, idiopathic orbital inflammation cases yielded highest recall and top diagnosis match across all models, while floppy eyelid syndrome cases demonstrated lowest performance.</p><p><strong>Conclusions: </strong>LLMs show promising potential in diagnosing oculoplastic cases, with OcuSmart/EyeGPT and Claude 3.5 performing best for determining the case diagnosis and recall, and ChatGPT 3.5, OcuSmart/EyeGPT, and Gemini generating concise and relevant differentials. However, further research and development are necessary to validate LLMs' capabilities and integrate them into the clinical workflow.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":"51-57"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817192","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":"Reply Re: \"The Preaponeurotic Fat Advancement Pedicle for Correction of Upper Eyelid Volume Asymmetry: A Case Series\".","authors":"Jordan R Conger, Margaret L Pfeiffer, Christopher Lo, David B Samimi","doi":"10.1097/IOP.0000000000003116","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003116","url":null,"abstract":"","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":"42 1","pages":"e29"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906316","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":"Reply Re: \"A Safer and Easier Method to Open the Orbital Septum: Septal Ballooning\".","authors":"Junghoon Kim, Yeshin Kim, Kyung In Woo","doi":"10.1097/IOP.0000000000003144","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003144","url":null,"abstract":"","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":"42 1","pages":"e36"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906344","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":"Re: \"Risk of Blindness from Temple Filler Injections: Investigating Vascular Anastomoses Between the Deep Temporal and Ophthalmic Arteries\".","authors":"Kenneth D Steinsapir","doi":"10.1097/IOP.0000000000003117","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003117","url":null,"abstract":"","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":"42 1","pages":"e29-e30"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906382","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":"Subjective Assessment of Eight CT Features in the Prediction of Dysthyroid Optic Neuropathy.","authors":"Isobel Landray, Kaveh Vahdani, James Carpenter, Katherine Miszkiel, Lakshmi A Ratnam, Geoffrey E Rose","doi":"10.1097/IOP.0000000000003007","DOIUrl":"10.1097/IOP.0000000000003007","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the subjective assessment of 8 orbital CT features for predicting dysthyroid optic neuropathy (DON).</p><p><strong>Methods: </strong>Scan montages from 137 orbits without DON and 121 with DON were each graded independently by 3 observers for 8 imaging features: namely, degree of apical crowding, extraocular muscle enlargement, expansion of orbital fat, clarity of the superior orbital fissure, fat prolapse through the superior orbital fissure, medial wall bowing, general orbital vascular congestion, and dilation of the superior ophthalmic vein. Gradings were analyzed individually and also averaged across observers. Associations with DON were assessed using univariate and multivariate logistic regression, and performance of the latter was assessed using area under the receiver-operating-characteristic curve, sensitivity, specificity, and calibration plots.</p><p><strong>Results: </strong>Unadjusted models showed apical crowding ( p < 0.001), extraocular muscle enlargement ( p < 0.001), vascular congestion ( p = 0.001), and medial wall bowing ( p < 0.001) were each associated with DON, across all observers. Models for observers 1 and 3 included only apical crowding, with a 1-unit grading-increase giving, respectively, a 2.88-fold and 3.04-fold increase in DON odds ( p < 0.001). The observer 2 model included extraocular muscle enlargement (odds ratio: 2.95; p < 0.001) and vascular congestion (odds ratio: 2.57; p = 0.023). The \"averaged-score\" model for all observers included only apical crowding, with a 3.76-fold increased odds per unit increase in grading ( p < 0.001). The models showed borderline-acceptable discrimination (area under the receiver-operating-characteristic curve: 0.68-0.75) and good calibration, with the averaged-score model performing best.</p><p><strong>Conclusions: </strong>Apical crowding, extraocular muscle enlargement, vascular congestion, and medial wall bowing are key predictors of DON, with apical crowding being the most influential.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":"71-78"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817201","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":"Marked Enlargement of a Single Extraocular Muscle: Clinical and Imaging Patterns in the Prediction of Malignancy.","authors":"Kaveh Vahdani, Katharina Kampik, Jimmy M Uddin, David H Verity, Geoffrey E Rose","doi":"10.1097/IOP.0000000000002988","DOIUrl":"10.1097/IOP.0000000000002988","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate clinical presentation, imaging patterns, histopathology, and predictors of malignancy in patients with enlargement of a single extraocular muscle.</p><p><strong>Methods: </strong>Retrospective review, with imaging categorized into 3 groups: single-muscle only (SMO), single excessively-enlarged muscle, and single-muscle with lacrimal gland enlargement (SMLG). Histopathology was classified as specific or nonspecific myositis, atypical thyroid eye disease, malignancy, or other diagnosis.</p><p><strong>Results: </strong>Among 142 patients (54% female), 60/142 (43%) had SMO, 53 (37%) single excessively-enlarged muscle, and 29 (20%) single-muscle with lacrimal gland. The commonest diagnoses were myositis (43%), atypical thyroid eye disease (27%), and malignancy (27%). Malignancy-mainly lymphoma or metastases-was commonest in SMO (43%), while atypical thyroid eye disease predominated in single excessively-enlarged muscle (49%), and myositis in the single-muscle with lacrimal gland group (69%). From univariate analysis, predictors of malignancy included age ≥60 years (odds ratio [OR]: 2.6; p = 0.012), prior malignancy (OR: 15.6; p < 0.001), subjective visual impairment (OR: 3.5; p = 0.024), LogMAR ≥0.5 (OR: 9.0; p = 0.009), ≥3 mm relative exophthalmos (OR: 3.1; p = 0.008), SMO (OR: 4.8; p < 0.001), lateral rectus involvement (OR: 3.7; p = 0.008), the \"amphora sign\" (OR: 28.2; p < 0.001), and maximum muscle diameter ≥10 mm (OR: 35.5; p < 0.001). Multivariate analysis confirmed prior malignancy (OR: 27.7; p = 0.013) and muscle diameter ≥10 mm (OR: 24.8; p = 0.005) as independent predictive variables. The prevalence of pain or diplopia and symptom duration were not significantly different in patients with myositis or those with malignancy.</p><p><strong>Conclusion: </strong>Excessive enlargement of a single extraocular muscle poses a diagnostic challenge due to the overlap of inflammatory and neoplastic features. Given the substantial proportion of malignancies, a high index of suspicion and early biopsy should be considered, particularly with SMO, a muscle diameter ≥10 mm, or prior history of cancer.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":"58-64"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554072","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":"Analysis of Lacrimal Stents and Balloon Catheters Complications: A 10-Year Review of the FDA MAUDE Database.","authors":"Ibraheem M Alkhawaldeh, Alina Ghazou, Suhel F Batarseh, Tejus Pradeep, Hashem Abu Serhan","doi":"10.1097/IOP.0000000000002982","DOIUrl":"10.1097/IOP.0000000000002982","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze adverse events and failures associated with lacrimal stents, intubation sets, and balloon catheters using reports from the Food and Drug Administration's Manufacturer and User Facility Device Experience database over a decade.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 86 medical device reports from the Manufacturer and User Facility Device Experience database between May 27, 2014 and February 24, 2024. Data on adverse events, device types, and patient demographics were extracted. Descriptive statistics summarized the frequency and types of events.</p><p><strong>Results: </strong>A total of 86 device-related and 46 patient-related adverse events were reported. Among the patient-related events, 43 involved foreign body retention, 2 involved bloody tears, and one of slight bleeding. Regarding device-related events, 73.3% were tube-related, with the most common issues being tube penetration due to a missing stainless-steel ring (38.4%), followed by tube tip breakage (8.1%) and leaks (7%). Issues with the dilation process comprised 5.8%. Balloon-related problems, primarily balloon tears (10.5%), accounted for 20.9% of device-related events. The reports revealed demographic gaps, with complete patient information available in less than half of the cases. The findings highlight recurrent failure modes linked to specific device brands and insertion techniques.</p><p><strong>Conclusion: </strong>This study offers a comprehensive overview of failure scenarios and associated risk factors for lacrimal stents, intubation sets, and balloon catheters. Detailing adverse events and device-specific issues, it aims to assist clinicians in anticipating potential complications and improving management strategies. Enhanced reporting and rigorous postmarket surveillance are crucial to further optimize device safety and effectiveness.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":"45-50"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626883","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":"Idiopathic Bilateral Optic Nerve Sheath Calcification.","authors":"Paulo Roberto M Passarini, Renata Fernandes Cunha, Gustavo S Boasquevisque, Antonio Augusto Velasco E Cruz","doi":"10.1097/IOP.0000000000002999","DOIUrl":"10.1097/IOP.0000000000002999","url":null,"abstract":"<p><p>A 61-year-old female patient with a previous diagnosis of Graves disease and mild orbitopathy presented with bilateral optic nerve calcifications and multiple areas of intracranial calcification. Neuro-ophthalmological evaluation did not detect any functional or anatomical compromise of the optic nerves. Her renal function and serum levels of calcium, phosphorus, and parathyroid hormone were normal. Two CT scans of the orbits, performed 7 years apart, showed stable intracranial and bilateral optic nerve calcifications.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":"e18-e20"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817198","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":"Levator Muscle Complex Exploration During Surgery for Simple Severe Congenital Ptosis.","authors":"Yomna A Alahmadawy, Rania A Ahmed, Richard C Allen, Mostafa M Diab","doi":"10.1097/IOP.0000000000003015","DOIUrl":"10.1097/IOP.0000000000003015","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the gross morphology of the levator palpebrae superioris (LPS) muscle complex in severe congenital ptosis with poor levator function (LF) and to evaluate the surgical outcomes when levator surgery was performed based on intraoperative factors.</p><p><strong>Methods: </strong>This is a retrospective, interventional case series that includes children having simple severe congenital ptosis with LF ≤ 4 mm for whom levator muscle surgery was performed rather than preplanned frontalis suspension based on the intraoperative LPS muscle evaluation. The collected data included: demographics; ptosis measurements, including margin reflex distance 1 and LF; morphological appearance of LPS muscle and its aponeurosis (levator aponeurosis); surgical technique, and outcomes. Fatty infiltration of the LPS muscle belly was graded, based on its ratio to the muscle's normal width, as minimal (<5%), mild (5-25%), moderate (25-50%), or severe (>50%).</p><p><strong>Results: </strong>A total of 109 eyelids met the inclusion criteria. Levator aponeurosis, distal and proximal (orbital) zones of the LPS muscle belly were evaluated. Levator aponeurosis was thin in 56.9% of the eyelids and thick with dense fibrotic changes in 43.1%. The distal zone showed extensive fatty infiltration and abnormal blood vessels in all eyelids. The proximal zone appeared fleshy red with minimal to moderate fatty infiltration in about three-fourths of the eyelids (n = 78, 71.6%). Securing this proximal zone to the tarsal plate resulted in a significant improvement in margin reflex distance 1 and LF (median, 4.0 mm and 7.0 mm, respectively, p < 0.001) during a median follow-up period of 8 months (range, 6-96 months).</p><p><strong>Conclusions: </strong>Intraoperative assessment of the LPS muscle complex, rather than preoperative LF, resulted in a change in surgical planning from frontalis suspension to a levator-based surgery with surgical success.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":"90-96"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963830","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":"The Establishment of a Standardized International Classification of Diseases Code for Thyroid Eye Disease.","authors":"Lilly H Wagner, Nishanth S Iyengar, Elizabeth A Bradley, Andrea A Tooley, Marius N Stan","doi":"10.1097/IOP.0000000000003105","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003105","url":null,"abstract":"","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":"42 1","pages":"e27"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906347","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}