Ophthalmic Plastic and Reconstructive Surgery最新文献

{"title":"Latissimus Dorsi Free Flap Reconstruction After Bilateral Orbital Exenteration Following Extensive Facial Thermal Burns.","authors":"Bethany M Erb, Courtney Kelly, Clayton Booth, Brett W Davies, Wesley L Brundridge, Rodney Chan, Donovan S Reed","doi":"10.1097/IOP.0000000000003076","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003076","url":null,"abstract":"<p><p>Extensive periorbital burns pose profound reconstructive challenges, particularly those that leave a composite orbitocranial defect lacking adequate local tissue for coverage. We report a case of a 40-year-old man who suffered severe facial soft-tissue burn injury, bilateral Roper-Hall grade IV ocular injury, and progressive periorbital necrosis who ultimately required bilateral orbital exenteration and multidisciplinary reconstructive efforts. To the authors' knowledge, this is the first description of a single-stage latissimus dorsi myocutaneous free flap reconstruction after bilateral orbital exenteration following extensive periorbital thermal burns and affirms the reliability of the latissimus dorsi myocutaneous flap for orbitocranial defect repair.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125185","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":"Orbital Infarction Syndrome Following Hyaluronic Acid Lip Filler Injection.","authors":"Fitz Gerald I Diala, Brian S Biesman, Jonathan M Pargament, Louise A Mawn","doi":"10.1097/IOP.0000000000003075","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003075","url":null,"abstract":"<p><p>A 31-year-old female presented with an acute onset of vision loss in the OS. On arrival to the hospital, OS ocular vitals were notable for no light perception vision, relative afferent pupillary defect, elevated intraocular pressure, ophthalmoplegia, and ptosis. Interval history was notable for lip filler injection. Emergent neuroimaging did not demonstrate large vessel occlusion. Ophthalmic artery occlusion resulting in orbital infarction syndrome was suspected. Patient received intravenous solumedrol, verapamil, aspirin, and lateral canthotomy/cantholysis, topical and intravenous antibiotics, and periorbital and orbital injections of hyaluronidase. With improvement in ptosis and extraocular motility, but vision remaining no light perception, the patient was discharged 5 days after presentation. However, a month later, the patient was enucleated due to intractable pain. This is the foremost report of orbital ischemic syndrome in the setting of ophthalmic artery occlusion secondary to hyaluronic acid filler injection to the lip.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125179","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":"Subconjunctival Lesion in VEXAS Syndrome: Expanding the Ocular Disease Spectrum.","authors":"Jai Paris, Abdullah Almater, Terence Ang, Dinesh Selva","doi":"10.1097/IOP.0000000000003030","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003030","url":null,"abstract":"<p><p>Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic, syndrome is a newly recognized autoinflammatory disorder. We report a novel case presenting with a subconjunctival lesion as an ocular manifestation. A 77-year-old man presented with bilateral orbital swelling, peripheral edema, weight loss, respiratory decline, and transfusion-dependent anemia. Ocular examination revealed periorbital edema, restricted motility, significant OS conjunctival injection and chemosis, particularly focused around a superotemporal subconjunctival lesion. Laboratory results showed raised inflammatory markers and normocytic anemia. MRI showed left periorbital edema without postseptal involvement. Treatment with broad-spectrum antibiotics was commenced; however, inflammation and deterioration progressed. Biopsy of the subconjunctival lesion revealed nonspecific fibrinous material without infection or malignancy. Diagnosis of Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic was confirmed by detecting a somatic ubiquitin-like modifier activating enzyme 1 mutation (c.121A>G, p.Met41Val). The patient deteriorated and died of multiorgan failure. This case adds to the expanding spectrum of ophthalmic manifestations in Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic, and highlights the need for thorough ocular evaluation in suspected cases.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125197","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":"Immediate and Intermediate Adjuvant Wound Therapy Following Partial-Thickness Thermal Burn Injury in a Porcine Model.","authors":"Donovan S Reed, Hunter Phillips, Joshua Hohlbein, Brett Davies, Wesley Brundridge, Tanuj Nakra, Vikram Durairaj","doi":"10.1097/IOP.0000000000003067","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003067","url":null,"abstract":"<p><strong>Purpose: </strong>A porcine model was utilized to determine the clinical and histological impact of several currently available therapies for wound healing modification following partial-thickness thermal burn injury.</p><p><strong>Methods: </strong>A prospective study in a porcine model of partial-thickness thermal burn injury was performed, assessing immediate adjuvant wound therapy with amniotic membrane grafting, onabotulinum toxin A injection, and verteporfin injection compared with intermediate wound adjuvant therapy by intralesional 5-fluorouracil with microneedling, verteporfin injection, and triamcinolone injection with and without 5-fluorouracil. Clinical assessments were conducted by blinded plastic surgeons utilizing a validated porcine burn scar scale. Histologic analysis was accomplished with hematoxylin and eosin stains and Masson's trichrome stains. A repeated measures mixed model analysis of variance was performed to identify clinical or histological statistical significance.</p><p><strong>Results: </strong>Comparing immediate versus intermediate treatments, a statistically significant difference in regards to mean clinical grade at the postinjury day 14 and postinjury day 28 time points was identified, yielding a 0.57 scale difference (p = 0.0096) and 0.7 scale difference (p = 0.0006), respectively. A statistically significant difference in regards to decreased mean histologic grade at the postinjury day 28 time points was identified for epithelial hyperplasia (-30.532 mean difference, p-value <0.0001), inflammatory response (-11.472 mean difference, p = 0.0133), and dermal remodeling (-13.78 mean difference, p = 0.0058).</p><p><strong>Conclusions: </strong>The results of this study suggest immediate treatment of partial-thickness thermal injury with adjuvant wound therapy decreases subsequent burn scar formation when compared with adjuvant wound therapy applied in the intermediate phase of healing.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131523","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":"Comparison of Crawford and Nunchaku Tubes in Dacryoendoscopy-Guided Silicone Intubation for Primary Acquired Nasolacrimal Duct Obstruction.","authors":"Seong Jung Ha, Min Kyu Yang, Ho-Seok Sa","doi":"10.1097/IOP.0000000000003027","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003027","url":null,"abstract":"<p><strong>Purpose: </strong>To compare surgical outcomes and complications between Crawford and Nunchaku-style tubes in dacryoendoscopy-guided silicone intubation for primary acquired nasolacrimal duct obstruction.</p><p><strong>Methods: </strong>We retrospectively reviewed 24 consecutive patients with bilateral primary acquired nasolacrimal duct obstruction who underwent dacryoendoscopy-guided silicone intubation with >6 months of follow-up. Crawford and Nunchaku-style tubes were used for OD and OS, respectively, and both were removed 6 months postoperatively. Surgical success was assessed at 9 months based on irrigation patency and epiphora relief. Complications, including tube extrusion and punctal slit, were monitored. We compared success rates and complications between groups and analyzed extrusion impact and punctal slit on surgical outcomes, and risk factors for punctal slit in the Nunchaku group.</p><p><strong>Results: </strong>Surgical success rates were 83.3% and 88.9% in the Crawford and Nunchaku groups, respectively (p = 1.000). Tube extrusion was more common in the Crawford group (29.2% vs. 0.0%, p = 0.009), whereas punctal slit was more frequent in the Nunchaku group (41.7% vs. 0.0%, p < 0.001). Neither tube extrusion nor punctal slit significantly affected surgical outcomes (p = 1.000 and p = 0.477, respectively). Diffuse obstruction observed on dacryoendoscopy was associated with a higher risk of punctal slit in the Nunchaku group, though not statistically significant (odds ratio = 6.000, p = 0.071).</p><p><strong>Conclusions: </strong>Crawford and Nunchaku-style tubes showed similar success rates. Nunchaku-style tubes reduce the need for nasal manipulation and extrusion risk but increase punctal slit risk. Clinicians should consider these differences when choosing tube type and optimizing surgical techniques.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070101","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":"Conjunctival TFG::ROS1 Fusion Positive Inflammatory Myofibroblastic Tumor Treated With Crizotinib.","authors":"Liesl Bourdeaud'huy, Celine Jacobs, Ciel De Vriendt, Jo Van Dorpe, Dimitri Roels","doi":"10.1097/IOP.0000000000003035","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003035","url":null,"abstract":"<p><p>This case describes the clinical course and management of a conjunctival inflammatory myofibroblastic tumor with a transforming growth factor::ROS proto-oncogene 1 fusion in a 33-year-old woman presenting with a progressively enlarging subconjunctival mass. Diagnosis was confirmed by biopsy and RNA next-generation sequencing. Treatment with the tyrosine kinase inhibitor crizotinib led to complete tumor resolution; however, therapy was discontinued due to a sarcoid-like granulomatous reaction. Visual acuity remained stable at 20/20 throughout, and no recurrence was observed. This case highlights the diagnostic challenges of conjunctival inflammatory myofibroblastic tumor, the therapeutic potential of targeted kinase inhibition, and the critical role of genomic profiling in guiding personalized treatment for rare ocular tumors such as inflammatory myofibroblastic tumor.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070191","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":"Eyelid Retraction Following Combined Frontalis Flap and Levator Advancement Surgery.","authors":"Victoria Blaga, Francesca Nesi-Eloff, Lauren D Mileo","doi":"10.1097/IOP.0000000000003034","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003034","url":null,"abstract":"<p><p>An 84-year-old female with a history of bilateral congenital ptosis presented with pain in the OD. The patient had undergone bilateral frontalis flap and levator advancement for decompensated congenital ptosis 18 months prior. On examination, the patient demonstrated significant retraction and contour abnormalities of the right upper eyelid. Slit lamp exam revealed superficial punctate keratitis of the OD. The patient underwent ptosis revision of the right upper eyelid, which revealed scarring of the orbital septum to the advanced levator muscle and a severely fibrotic levator muscle. Following revision of the orbital septum and levator, the patient demonstrated significant improvement in eyelid closure with minimal residual ptosis, recurrent eyelash ptosis, and improved ocular surface comfort.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070144","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":"A Safer and Easier Method to Open the Orbital Septum: Septal Ballooning.","authors":"Junghoon Kim, Yeshin Kim, Kyung In Woo","doi":"10.1097/IOP.0000000000003031","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003031","url":null,"abstract":"<p><strong>Purpose: </strong>To introduce a novel septal ballooning technique for orbital septum dissection during surgery.</p><p><strong>Methods: </strong>The study comprised 18 patients (30 eyes) who underwent septal ballooning at Gachon Gil Hospital, Incheon, South Korea, between September 2023 and January 2024. The technique involves injecting room air beneath the orbital septum, a pneumodissection, to separate it from surrounding structures, enhancing visualization during dissection. Data collected included patient demographics, preoperative diagnoses, and postoperative complications. Intraoperative levator aponeurosis injury and postoperative complications were reported.</p><p><strong>Results: </strong>Septal ballooning was successfully performed on all patients, with no intraoperative injuries to the levator aponeurosis. Postoperative CT imaging revealed minor orbital emphysema in 3 cases (4 eyes), which resolved spontaneously without intervention. There were no reports of significant complications such as visual sequelae or infections. The technique facilitated clear identification and dissection of the orbital septum, reducing intraoperative difficulty.</p><p><strong>Conclusions: </strong>The septal ballooning technique is an effective alternative method for orbital septum dissection, offering improved anatomical visualization and reduced intraoperative complexity. This method enhances the precision and safety of procedures involving the orbital septum and is a valuable addition to surgical practice.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070120","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":"Angle-Closure Glaucoma due to Lens Subluxation Associated With Orbital Arteriovenous Malformation.","authors":"Rungroj Angwatcharaprakan, Eun Jung Lee, Keon Ha Kim, Kyung In Woo","doi":"10.1097/IOP.0000000000003016","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003016","url":null,"abstract":"<p><p>Orbital arteriovenous malformations (AVMs) are rare vascular anomalies that typically progress gradually. This case presents an unusual acute presentation of orbital AVM causing angle-closure glaucoma in a 48-year-old Korean male. He presented with severe left ocular pain, proptosis, and vision loss for 2 days. Examination revealed elevated intraocular pressure associated with crystalline lens subluxation into the anterior chamber and restricted extraocular movement. Imaging studies confirmed an intraorbital AVM. Urgent endovascular embolization using Onyx was performed, followed by phacoemulsification with scleral-fixated intraocular lens implantation. His condition gradually improved, with the resolution of strabismus and normalization of intraocular pressure. Long-term follow-up 6 years postintervention demonstrated stable visual acuity, normal intraocular pressure, and no AVM recurrence. This case underscores the importance of considering orbital AVMs in acute unilateral proptosis with angle-closure glaucoma. It emphasizes the possible coincidence of AVM and lens-induced angle closure and the importance of early diagnosis and intervention for optimal outcomes.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041008","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":"Tarsoconjunctival Rotational Flap in Second-stage Modified Hughes Reconstruction for Lower Eyelid Full-thickness Defects.","authors":"Keegan B Mechels, Ji Kwan Park, Hui Bae Harold Lee","doi":"10.1097/IOP.0000000000003060","DOIUrl":"https://doi.org/10.1097/IOP.0000000000003060","url":null,"abstract":"<p><strong>Purpose: </strong>Unrefined eyelid margin is a known complication following the second-stage modified Hughes eyelid reconstruction. Lateral canthal malposition, phimosis, or eyelid laxity can occur when the tarsoconjunctival flap extends to cover the defects in the inferior crus of the lateral canthus. This study presents a novel surgical technique that prevents lower eyelid margin distortions, lower eyelid laxity, and lateral canthal complications after the second-stage modified Hughes reconstruction.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent second-stage modified Hughes reconstructions with a lateralized tarsoconjunctival rotational flap from July 2021 to August 2024 was performed. The study outcomes included postreconstruction complications, such as eyelid malposition, eyelid margin changes, lateral canthus distortions, flap dehiscence, and eyelid-related complaints. Postoperative photographs were reviewed to evaluate eyelid position, flap, and lateral canthus contour.</p><p><strong>Results: </strong>Nineteen patients underwent repair using a tarsoconjunctival rotational flap as part of the second-stage modified Hughes reconstruction. The average time between the first and second-stage modified Hughes reconstruction was 61.5 ± 10.6 days. Postoperative photos showed no cases of hyperemic eyelid margins, hypertrophic eyelid margins, inferior canthal tendon laxity, lateral canthus phimosis, lateral canthus imbrications, flap dehiscence, or lateral canthal irritations. One patient complained of persistent lower eyelid irritation and discharge, and 1 patient had persistent edema, both of which resolved at the last follow-up.</p><p><strong>Conclusion: </strong>The lateralized tarsoconjunctival rotational flap has favorable surgical outcomes in the second-stage modified Hughes reconstruction of lower eyelid defects.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040962","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}