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Ting MAJ, Topilow NJ, Ediriwickrema LS, Yoon JS, Liu CY, Korn BS, Kikkawa DO. A comparison of proptosis reduction with teprotumumab versus surgical decompression based on fat-to-muscle ratio in thyroid eye disease. Orbit 2024; 43:222-230. [PMID: 37978819 DOI: 10.1080/01676830.2023.2282509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To explore if orbital fat-to-muscle ratio (FMR) is predictive of whether surgical decompression or teprotumumab leads to greater proptosis reduction in thyroid eye disease (TED). METHODS A single-center retrospective cohort study comparing surgical decompression with teprotumumab according to FMR. All TED patients completing an 8-dose course of teprotumumab between January 2020 and September 2022 and all patients undergoing bony orbital decompression from January 2017 to December 2019 were included. Subjects were excluded if they were <18 years, received both surgical decompression and teprotumumab, or lacked orbital imaging. The primary exposure variable was teprotumumab or surgical decompression. The secondary exposure variable was baseline FMR. The primary outcome measure was change in proptosis (mm). RESULTS Thirty-eight patients, mean age 53.5 years (±11.4), were included in the teprotumumab group and 160 patients, mean age 48 years (±11.1), in the surgical group. Average proptosis reduction after teprotumumab and surgical decompression was 3 mm (±1.44) and 5 mm (±1.75), respectively. The FMR was stratified at the median of 1.80. In subjects with FMR < 1.80, teprotumumab showed equivalent proptosis reduction compared to surgical decompression, -0.33 mm (SE 1.32) p = .802. In subjects with FMR ≥ 1.80, surgical decompression led to significantly more proptosis reduction than teprotumumab, 3.01 mm (SE 0.54), p < .001. CONCLUSIONS Baseline FMR can be used to counsel patients as to proptosis reduction with teprotumumab versus surgery. Subjects with low FMR obtain comparable proptosis reduction with teprotumumab or surgery, whereas high FMR is associated with more significant proptosis reduction following surgery over teprotumumab.
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Affiliation(s)
- Michelle A J Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
| | - Lilangi S Ediriwickrema
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, USA
| | - Jin Sook Yoon
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, San Diego, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, University of California San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, San Diego, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, San Diego, California, USA
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Al-Sharif EM, Penteado RC, Dib El Jalbout N, Topilow NJ, Shoji MK, Kikkawa DO, Liu CY, Korn BS. Evaluating the Accuracy of ChatGPT and Google BARD in Fielding Oculoplastic Patient Queries: A Comparative Study on Artificial versus Human Intelligence. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00314. [PMID: 38215452 DOI: 10.1097/iop.0000000000002567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE This study evaluates and compares the accuracy of responses from 2 artificial intelligence platforms to patients' oculoplastics-related questions. METHODS Questions directed toward oculoplastic surgeons were collected, rephrased, and input independently into ChatGPT-3.5 and BARD chatbots, using the prompt: "As an oculoplastic surgeon, how can I respond to my patient's question?." Responses were independently evaluated by 4 experienced oculoplastic specialists as comprehensive, correct but inadequate, mixed correct and incorrect/outdated data, and completely incorrect. Additionally, the empathy level, length, and automated readability index of the responses were assessed. RESULTS A total of 112 patient questions underwent evaluation. The rates of comprehensive, correct but inadequate, mixed, and completely incorrect answers for ChatGPT were 71.4%, 12.9%, 10.5%, and 5.1%, respectively, compared with 53.1%, 18.3%, 18.1%, and 10.5%, respectively, for BARD. ChatGPT showed more empathy (48.9%) than BARD (13.2%). All graders found that ChatGPT outperformed BARD in question categories of postoperative healing, medical eye conditions, and medications. Categorizing questions by anatomy, ChatGPT excelled in answering lacrimal questions (83.8%), while BARD performed best in the eyelid group (60.4%). ChatGPT's answers were longer and potentially more challenging to comprehend than BARD's. CONCLUSION This study emphasizes the promising role of artificial intelligence-powered chatbots in oculoplastic patient education and support. With continued development, these chatbots may potentially assist physicians and offer patients accurate information, ultimately contributing to improved patient care while alleviating surgeon burnout. However, it is crucial to highlight that artificial intelligence may be good at answering questions, but physician oversight remains essential to ensure the highest standard of care and address complex medical cases.
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Affiliation(s)
- Eman M Al-Sharif
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rafaella C Penteado
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
| | - Nahia Dib El Jalbout
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
| | - Marissa K Shoji
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego School of Medicine, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego School of Medicine, La Jolla, California, U.S.A
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Villatoro GA, Topilow NJ, Korn BS, Liu CY. Millet-Seed Tarsal Conjunctivitis in Eyelid Sarcoid. Ophthalmic Plast Reconstr Surg 2023; 39:e214. [PMID: 37351855 DOI: 10.1097/iop.0000000000002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- George A Villatoro
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, U.S.A
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Shoji MK, Chen Y, Topilow NJ, Abou Khzam R, Dubovy SR, Johnson TE. Orbital Involvement in Multiple Myeloma. Ophthalmic Plast Reconstr Surg 2023; 39:347-356. [PMID: 36661857 DOI: 10.1097/iop.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To characterize clinical and radiographic features, management, and outcomes of patients with orbital involvement of multiple myeloma (MM). METHODS A retrospective chart review identified patients with MM and orbital involvement confirmed by histopathology at a single institution between 1995 and 2021. A comprehensive literature review was performed via PubMed to identify all previously reported cases of orbital MM. RESULTS Retrospective review identified 7 patients (43% male, mean age 68.7 years). Presenting symptoms included proptosis and diplopia. Orbital lesions were primarily located laterally (42.8%) with associated extraocular muscle (57.1%) or lacrimal gland (42.9%) involvement. Five patients (71.4%) had a previous diagnosis of systemic MM. Six patients received chemoradiation (85.7%). All patients had improvement of orbital disease with 2 patients deceased due to disease at follow-up (mean 8.9 months). Literature review identified 111 cases (46.8% male, mean age 58.6 years). 48.6% presented with orbital disease as the first manifestation of systemic MM. Lesions were most commonly located superolaterally (20.2%) with extraocular muscle infiltration (25.2%), lacrimal gland involvement (7.2%), and orbital bony destruction (39.6%). Treatments included chemoradiation, chemotherapy, or radiation alone. Approximately half (51.4%) of patients experienced improvement in orbital disease following treatment, and 48.6% were deceased at follow-up (mean 20.1 months). CONCLUSIONS This study provides a new retrospective study and updated comprehensive literature review regarding orbital MM. Given its poor prognosis, characterization of orbital MM is essential for early diagnosis. Orbital MM is often unilateral, located superolaterally, and may represent the first manifestation of systemic disease. Treatment includes chemotherapy and radiation, which may improve orbital disease; however, the overall prognosis remains poor.
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Affiliation(s)
- Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
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Delavar A, Saseendrakumar BR, Lee TC, Topilow NJ, Ting MA, Liu CY, Korn BS, Weinreb RN, Kikkawa DO, Baxter SL. Associations Between Thyroid Eye Disease and Glaucoma Among Those Enrolled in the National Institutes of Health All of Us Research Program. Ophthalmic Plast Reconstr Surg 2023; 39:336-340. [PMID: 36394556 PMCID: PMC10188653 DOI: 10.1097/iop.0000000000002310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the association between thyroid eye disease (TED) and glaucoma. METHODS Patients 18 years of age and over enrolled in the NIH All of Us Research Program, a nationwide cohort, were extracted. Those with conditions relating to TED were identified and compared with 2020 US Census-matched controls without a diagnosis of TED in a 1:4 ratio. The authors used Pearson's χ 2 tests to study demographics by TED status, and logistic regression to generate odds ratios and 95% confidence intervals to evaluate the association between TED and glaucoma (any type, including glaucoma suspect), using those without TED as the reference group. Multivariable models were adjusted for age, gender, race/ethnicity, eye doctor visits, and smoking status. RESULTS A total of 393 cases of TED and 1,572 US Census-matched controls were identified. The median age of the cohort was 63 years (interquartile range: 48-73 years). Age, gender, and race/ethnicity varied by TED status ( p < 0.001). Overall, 114 (29.0%) of TED cases had a diagnosis of glaucoma, compared with 94 (6.0%) of non-TED controls. On bivariate logistic regression models, those diagnosed with TED were significantly more likely to be diagnosed with glaucoma compared with controls (odds ratio: 6.42; 95% confidence interval: 4.76-8.70; p < 0.001). This trend persisted on multivariable logistic regression controlling for confounding factors (odds ratio: 3.37; 95% confidence interval: 1.85-6.20 p < 0.001). CONCLUSIONS Individuals with TED were significantly more likely to be diagnosed with glaucoma. Clinicians caring for patients with TED should be aware of this elevated risk and arrange glaucoma evaluation, accordingly.
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Affiliation(s)
- Arash Delavar
- Division of Biomedical Informatics, Department of Medicine,
University of California San Diego, La Jolla, CA
- Division of Ophthalmology Informatics and Data Science,
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of
California San Diego, La Jolla, CA
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Bharanidharan Radha Saseendrakumar
- Division of Biomedical Informatics, Department of Medicine,
University of California San Diego, La Jolla, CA
- Division of Ophthalmology Informatics and Data Science,
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of
California San Diego, La Jolla, CA
| | - Tonya C. Lee
- Division of Biomedical Informatics, Department of Medicine,
University of California San Diego, La Jolla, CA
- Division of Ophthalmology Informatics and Data Science,
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of
California San Diego, La Jolla, CA
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Nicole J. Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Michelle A. Ting
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Catherine Y. Liu
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Bobby S. Korn
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Robert N. Weinreb
- Division of Ophthalmology Informatics and Data Science,
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of
California San Diego, La Jolla, CA
- Hamilton Glaucoma Center, Viterbi Family Department of
Ophthalmology and Shiley Eye Institute, University of California San Diego, La
Jolla, CA
| | - Don O. Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery,
Viterbi Family Department of Ophthalmology, University of California San Diego, La
Jolla, CA
| | - Sally L. Baxter
- Division of Biomedical Informatics, Department of Medicine,
University of California San Diego, La Jolla, CA
- Division of Ophthalmology Informatics and Data Science,
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of
California San Diego, La Jolla, CA
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Abstract
Carcinoma ex pleomorphic adenoma (CEPA) of the lacrimal gland is a rare malignant tumor that arises from a pre-existing pleomorphic adenoma. Lacrimal gland CEPA with mucoepidermoid histological subtype is exceedingly rare. Diagnosis can be aided by radiographic findings, though the gold standard is histopathological analysis following excisional biopsy. Management options include complete surgical excision with or without adjuvant radiation therapy based on tumor grade and invasiveness. We present a 76-year-old woman with 6 months of diplopia and unilateral proptosis. Her initial exam was remarkable for hypoglobus, proptosis, and limited elevation of the right eye. Computed tomography (CT) scan demonstrated a superior, well-circumscribed, extraconal orbital mass. An excisional biopsy was performed, and histopathological findings were consistent with mucoepidermoid carcinoma ex pleomorphic adenoma with positive margins in the tumor capsule. The patient received radiation therapy and remains markedly improved with no disease recurrence at 5 months post-operatively.
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Affiliation(s)
- Nicole J Topilow
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shanlee M Stevens
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ying Chen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Umangi Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas E Johnson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Lee TC, Radha-Saseendrakumar B, Delavar A, Ye GY, Ting MA, Topilow NJ, Bass J, Korn BS, Kikkawa DO, Baxter SL, Liu CY. Evaluation of Depression and Anxiety in a Diverse Population With Thyroid Eye Disease Using the Nationwide NIH All of Us Database. Ophthalmic Plast Reconstr Surg 2023; 39:281-287. [PMID: 36727790 DOI: 10.1097/iop.0000000000002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the prevalence of depression and anxiety among individuals with thyroid eye disease (TED) and identify sociodemographic risk factors using the NIH All of Us database. METHODS Three hundred ninety eight cases with TED were compared with 1,592 controls with demographics matching the 2020 US Census. Primary outcomes were diagnosed depression or anxiety; Patient Health Questionnaire-9 (PHQ-9) scores and General Anxiety Disorder-7 (GAD-7) scores were included as secondary outcomes. We performed multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TED and depression and anxiety. RESULTS Patients with TED were more likely to have depression (OR 2.72, 95% CI 2.08-3.56, p < 0.001) and anxiety (OR 2.82, 95% CI 2.16-3.70, p < 0.001) than controls. In patients with TED, female gender was an independent risk factor for both depression (OR 1.72; 95% CI 1.00-5.07, p = 0.05) and anxiety (OR 2.17, 95% CI 1.25-3.85, p = 0.006). Unemployment (OR 1.72, 95% CI 1.03-2.94, p = 0.04) and lower income (OR 0.88 for income as a continuous variable, 95% CI 0.79-0.99, p = 0.03) were risk factors for anxiety. Risk factors for more severe depression as assessed by PHQ-9 included lower income (OR 0.70, 95% CI 0.57-0.85, p < 0.001), and protective factors included Black race (OR 0.12, 95% CI 0.02-0.45, p = 0.002). Lower income was associated with more severe anxiety as assessed by GAD-7 (OR 0.77, 95% CI 0.64-0.94, p = 0.009). CONCLUSIONS Patients with TED were more likely to develop depression and anxiety compared with controls. This study highlights the psychosocial impact of TED and associated socioeconomic risk factors.
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Affiliation(s)
- Tonya C Lee
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
| | - Bharanidharan Radha-Saseendrakumar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Arash Delavar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Gordon Y Ye
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Jeremy Bass
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
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Lee TC, Topilow NJ, Ting MA, Estrella M, Liu CY, Korn BS, Ferguson CJ, Kikkawa DO. Ectopic Fibrous Dysplasia Presenting As a Well-Circumscribed Orbital Mass. Ophthalmic Plast Reconstr Surg 2023; 39:e40-e43. [PMID: 36700847 DOI: 10.1097/iop.0000000000002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The authors present the case of a middle-aged woman with subacute progressive swelling of the OD associated with pain and severely limited duction in all gazes. MRI demonstrated a ~3 cm circumscribed mass in the extraconal space, which displaced and distorted the globe and impinged upon ocular adnexa. She underwent lateral orbitotomy with bone osteotomy to remove the mass, and subsequent histopathologic examination showed woven bone set within a fibrotic background, microscopic features of fibrous dysplasia. Fibrous dysplasia is characterized by abnormal scar-like bony proliferation, typically within a preexisting structure of the skeletal system. To the authors' knowledge, this represents the first example of fibrous dysplasia presenting as an orbital mass unconnected to the craniofacial skeleton.
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Affiliation(s)
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Melanie Estrella
- Division of Neuropathology, Department of Pathology, University of California San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Cole J Ferguson
- Division of Neuropathology, Department of Pathology, University of California San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute
- Division of Plastic and Reconstructive Surgery, Department of Surgery
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9
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Ting MA, Ozzello DJ, Topilow NJ, Yoon JS, Liu CY, Korn BS, Kikkawa DO. Differential effects of teprotumumab treatment based on fat-to-muscle ratio in patients with thyroid eye disease. Orbit 2022:1-8. [PMID: 36097675 DOI: 10.1080/01676830.2022.2122515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To characterize the distribution of fat-to-muscle ratio (FMR) across patients with thyroid eye disease (TED) and to assess the association between FMR and therapeutic response to teprotumumab. METHODS A retrospective cohort study of patients completing a full course of teprotumumab for TED between January 2020 and March 2022 at a single tertiary referral center. Patients without baseline orbital imaging were excluded. Quantitative analysis of FMR was performed by manual segmentation of patients' imaging using OsiriX software. The primary outcome measure was change in clinical measurement of proptosis. Linear regression modelled change in proptosis against FMR. Statistical significance was set at p < .05. RESULTS Twenty-two patients (3 M:19F) were included with a mean age of 49.4 ± 15.5 years. The FMR ranged from 1.11 to 6.54, mean 3.15 ± 1.30. The data did not deviate from a normal distribution (Shapiro-Wilk test for normality, p = .18). Pre- and post-treatment average proptosis measurements were 21.72 ± 3.56 mm and 18.81 ± 3.07 mm, respectively. Univariable linear regression demonstrated a 0.78 ± 0.36 mm greater reduction in proptosis for every 1 unit decrease in FMR (p = .038). CONCLUSIONS Contrary to the traditional dichotomous characterization of TED into type 1 and type 2 phenotypes, orbital FMR may represent a continuum of disease manifestation, more closely following a normal rather than bimodal distribution. Furthermore, pre-treatment FMR is associated with response to teprotumumab; those with lower FMR experiencing a greater reduction in proptosis. This has implications for patient selection and counselling regarding the expected treatment outcome.
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Affiliation(s)
- Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Daniel James Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Jin Sook Yoon
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
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10
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Stevens SM, Topilow NJ, Chen Y, Johnson TE. Response to Miles Kiernan Re: a rare case of mucoepidermoid carcinoma ex pleomorphic adenoma of the lacrimal gland. Orbit 2022; 41:524. [PMID: 35635140 DOI: 10.1080/01676830.2022.2056205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 06/15/2023]
Abstract
Our goal is to contribute to the medical literature with our case of CEPA and hope to better help fellow clinicians diagnose and treat these rare tumors.
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Affiliation(s)
- Shanlee M Stevens
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicole J Topilow
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ying Chen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas E Johnson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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11
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Kloosterboer A, Yannuzzi NA, Topilow NJ, Patel NA, Kuriyan AE, Sridhar J. Assessing the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Age-Related Macular Degeneration. Semin Ophthalmol 2021; 36:400-405. [PMID: 33646928 PMCID: PMC8328874 DOI: 10.1080/08820538.2021.1893761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
IMPORTANCE One of the top ten causes of disability in the United States is vision loss, primarily due to age-related eye diseases such as age-related macular degeneration. With an aging population, the number of people affected by this condition is expected to rise. Patients increasingly turn to the internet for health-related information, but no standard exists across published websites. OBJECTIVE To assess the quality, content, accountability and readability of information found online for age-related macular degeneration. DESIGN This cross-sectional study analyzed 12 freely available medical sites with information on age-related macular degeneration and used PubMed as a gold standard for comparison. Thirty-four questions were composed to include information most relevant to patients and each website was independently evaluated by one vitreoretinal surgeon, two vitreoretinal fellows and one ophthalmology resident. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the accountability of each site. SETTING Freely available online information was used in this study. RESULTS The average questionnaire score for all websites was 90.23 (SD 17.56, CI 95% ±9.55) out of 136 possible points. There was a significant difference between the content quality of the websites (P = .01). The mean reading grade for all websites was 11.44 (SD 1.75, CI 95% ±0.99). No significant correlation was found between content accuracy and the mean reading grade or Google rank (r = 0.392, P = .207 and r = 0.133, P = .732, respectively). Without including PubMed, only one website achieved the full 4 JAMA benchmarks. There was no correlation between the accuracy of the content of the website and JAMA benchmarks (r = 0.344, P = .273). The interobserver reproducibility was similar among 3 out of 4 observers (r = 0.747 between JS and NT, r = 0.643 between JS and NP, r = 0.686 between NP and NT, r = 0.581 between JS and NY; P ≤ 0.05). CONCLUSION AND RELEVANCE The freely available information online on age-related macular degeneration varies by source but is generally of low quality. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme we used to support the patient in making medical decisions.
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Affiliation(s)
- Amy Kloosterboer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida 33136
| | - Nicolas A. Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida 33136
| | - Nicole J. Topilow
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida 33136
| | - Nimesh A. Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida 33136
| | - Ajay E. Kuriyan
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street Suite 1020, Philadelphia, PA 19107
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida 33136
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12
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Abstract
Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.
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Affiliation(s)
- Nicole J Topilow
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Ann Q Tran
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Eubee B Koo
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Chrisfouad R Alabiad
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
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