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Ju S, Rokohl AC, Guo Y, Yao K, Fan W, Heindl LM. Personalized treatment concepts in extraocular cancer. Adv Ophthalmol Pract Res 2024; 4:69-77. [PMID: 38590555 PMCID: PMC10999489 DOI: 10.1016/j.aopr.2024.02.003] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
Background The periocular skin is neoplasms-prone to various benign and malignant. Periocular malignancies are more aggressive and challenging to cure and repair than those in other skin areas. In recent decades, immunotherapy has significantly advanced oncology, allowing the autoimmune system to target and destroy malignant cells. Skin malignancies, especially periocular tumors, are particularly sensitive to immunotherapy. This technique has dramatically impacted the successful treatment of challenging tumors. Main text Extraocular cancers, including eyelid (basal cell carcinoma, squamous cell carcinoma, melanoma, merkel cell carcinoma), conjunctival tumors (conjunctival melanoma, ocular surface squamous neoplasia) and other rare tumors, are unique and challenging clinical situations. Several genetic alterations associated with the pathogenesis of these diseases have been identified, and molecular mechanism are essential for the development of the immunotherapy agents, such as Hedgehog pathway inhibitors (vismodegib and sonidegib) for basal cell carcinoma, BRAF/MEK inhibitors (vemurafenib, dabrafenib, and encorafenib) for melanoma, and immune checkpoint inhibitors (Avelumab, pembrolizumab) for Merkel cell carcinoma. Conclusions The optimal treatment for periocular skin cancer depends on the type and size of the tumor and whether it involves orbital and adnexal structures. Adjuvant and neoadjuvant therapy with chemotherapy-targeted therapies and immune checkpoint inhibitors should be considered based on tumor type, tumor molecular profile, expected response rate, and candidacy for systemic treatment.
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Affiliation(s)
- Sitong Ju
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
| | - Alexander C. Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Yongwei Guo
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ke Yao
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wanlin Fan
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
| | - Ludwig M. Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
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Khalili Pour E, Mahmoudi T, Ahmadzadeh H, Rafizadeh SM, Riazi-Esfahani H. Quantitative analysis of the eyelid curvature in patients with blepharoptosis. BMC Med Imaging 2024; 24:97. [PMID: 38671380 PMCID: PMC11046864 DOI: 10.1186/s12880-024-01280-x] [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: 02/17/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the ability of two novel eyelid curvature measurements to distinguish between normal eyes and different severities of blepharoptosis. METHODS A comparative cross-sectional analysis of upper eyelid curvature was performed for different severities of patients with unilateral blepharoptosis (congenital and aponeurotic) and normal controls. Mean upper lid contour index (ULCI) and area circularity index (ACI) were calculated for each group by dividing the intercanthal distance by upper eyelid margin length (ULCI) and dividing the interpalpebral area by the area of a circle enclosing the eye (ACI). The ratio of each index for the study and fellow normal eye of each patient was also calculated and compared between groups. RESULTS A total of 106 eyes including 30 eyes in the control group and 25, 27, and 24 eyes in the mild, moderate, and severe ptosis groups were enrolled in the study. ULCI and ACI showed a statistically significant difference between the groups (p < 0.001, p < 0.001). The inter-eye ratio (ULCI-ratio and ACI-ratio) of indices was also significantly different between groups (p = 0.002, p < 0.001). Pairwise comparisons revealed that ACI and ACI-ratio were significantly different between all pairs of study groups. CONCLUSION The results of our study showed that ACI based on area measurements may distinguish blepharoptosis patients from normal controls and from each other. Including the data from the fellow normal eyes in the form of ratio indices may improve the differentiating power. These results can be useful in designing the optimal eyelid curvature measurements.
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Affiliation(s)
- Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Mahmoudi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Ahmadzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Orbital and Oculoplastics Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Navel V, Labetoulle M, Lazreg S, Brémond-Gignac D, Chiambaretta F. COVID-19 pandemic and impact of universal face mask wear on ocular surface health and risk of infection. J Fr Ophtalmol 2024; 47:104170. [PMID: 38569271 DOI: 10.1016/j.jfo.2024.104170] [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] [Received: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.
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Affiliation(s)
- V Navel
- CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - S Lazreg
- Centre d'ophtalmologie Lazreg, Blida, Algeria
| | - D Brémond-Gignac
- Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
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Sensoy E, Citirik M. Assessing the proficiency of artificial intelligence programs in the diagnosis and treatment of cornea, conjunctiva, and eyelid diseases and exploring the advantages of each other benefits. Cont Lens Anterior Eye 2024; 47:102125. [PMID: 38443209 DOI: 10.1016/j.clae.2024.102125] [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: 07/21/2023] [Revised: 12/19/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE It was aimed to determine the knowledge level of ChatGPT, Bing, and Bard artificial intelligence programs related to corneal, conjunctival, and eyelid diseases and treatment modalities, to examine their reliability and superiority to each other. METHODS Forty-one questions related to corneal, conjunctival, and eyelid diseases and treatment modalities were asked to the ChatGPT, Bing, and Bard chatbots. The answers to the questions were compared with the answer keys and grouped as correct or incorrect. Accuracy rates were compared. RESULTS ChatGPT gave the correct answer to 51.2 % of the questions asked, Bing gave the correct answer to 53.7 %, and Bard gave the correct answer to 68.3 %. There was no significant difference in the rate of correct or incorrect answers to the questions asked for the 3 artificial intelligence chatbots (p = 0.208, Pearson's chi-square test). CONCLUSION Although information about the cornea, conjunctiva, and eyelid diseases and treatment modalities can be accessed quickly and accurately using up-to-date artificial intelligence programs, the answers may not always be accurate and up-to-date. Care should be taken when evaluating this information.
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Alkatan HM, Fatani DR, Maktabi AMY, Alzahem TA. Clinicopathological study of ophthalmic cutaneous and mucocutaneous non-langerhans cell histiocytic lesions. BMC Ophthalmol 2024; 24:124. [PMID: 38504269 PMCID: PMC10949701 DOI: 10.1186/s12886-024-03388-8] [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: 09/21/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The "C group" of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG). METHODS This is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018). RESULTS Twenty patients were diagnosed as "Group C" disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans' histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers). CONCLUSION Among the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.
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Affiliation(s)
- Hind Manaa Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box 266, Riyadh, 11362, Saudi Arabia.
- Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Dalal R Fatani
- Oculoplasty and Orbit Surgery, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Tariq A Alzahem
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Pisano CE, Trager MH, Fan W, Samie FH. Surgical margins and outcomes for eyelid melanoma: a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:106. [PMID: 38489027 DOI: 10.1007/s00403-024-02834-3] [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: 11/29/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
No randomized trials exist to inform the peripheral surgical margins or depth of wide excision for eyelid melanoma. We performed a meta-analysis examining surgical margins and Breslow depth for eyelid melanomas. A systematic review was performed in August 2022 using PubMed, Cochrane, and Medline databases (1/1/1990 to 8/1/2022). Inclusion criteria included studies reporting surgical treatment of primary cutaneous melanomas of the eyelid with reported surgical margins. Ten articles were included. The studies were examined by surgical margin size (group 1: ≤ 0.5 cm; group 2 > 0.5 cm and ≤ 1.5 cm) and Breslow depth (group 1: ≤ 1 mm; group 2: > 1 mm). The odds ratio (OR) for local recurrence was 2.55 [95% CI 0.36-18.12], p = 0.18; regional metastasis was 0.70 [95% CI 0.00-23671.71], p = 0.48; and distant metastasis was 2.47 [95% CI 0.00-1687.43], p = 0.66. When examining by Breslow depth, the OR for local recurrence was 0.53 [95% CI 0.14-1.94], p = 0.34; regional metastasis was 0.14 [0.00-176.12], p = 0.54; and the OR for distant metastasis was 0.24 [95% CI 0.01-8.73], p = 0.46. There was a trend toward higher likelihood of recurrence and metastasis in the ≤ 0.5 cm group. Similarly, there is a trend toward higher likelihood of recurrence and metastasis with Breslow depth > 1 mm. A surgical margin of at least 0.5 cm and achievement of negative margins via permanent sections or MMS are likely needed to prevent adverse outcomes. En face sectioning may be a superior method of histological processing for eyelid melanoma.
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Affiliation(s)
| | - Megan H Trager
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 12th Floor, New York, NY, 10032, USA.
| | - Weijia Fan
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 12th Floor, New York, NY, 10032, USA
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Ahmad R, Rehman U, Sohaib Sarwar M, Ahmed Z, Adebayo O, Brennan PA. Use of autogenous fascia lata slings in the surgical correction of ptosis: a systematic review of the literature and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:128-139. [PMID: 38290862 DOI: 10.1016/j.bjoms.2023.11.013] [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: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
Ptosis is an abnormally low-positioned upper eyelid. Management depends on severity, aetiology, and function of the levator palpebrae superioris muscle (LPS). This review evaluates the success of autogenous fascia lata slings (AFLS) in the surgical management of ptosis, together with complication and reoperation/revision rates. A literature search was conducted on PubMed, Google Scholar PROSPERO, Dynamed, DARE, EMBASE, Cochrane, and BMJ databases (PROSPERO registration: CRD42023475090), and 30 studies (3690 patients and 5059 eyes) were included. The average age of the patients was 14.2 years with a ratio of male:female patients of 1:0.7. A total of 2532 eyes had undergone a fascial sling with autogenous fascia lata. The average follow-up period was 32.6 months. Improvement in the margin to reflex distance 1 (MRD1) with fascial sling surgery was 2.79 mm. The rate of complications from surgery involving autogenous fascia lata was 21.3%. The most common complications included lagophthalmos (19.8%), residual ptosis (11.5%), and corneal damage (10.4%). The reoperation rate was 13.4%. Most common indications for reoperation were cosmetic, with asymmetry (18%), lid crease abnormalities (30%), and upper eyelid trimming (18%). The overall complication rate in AFLS patients was 20% (95% CI: 6 to 35, p < 0.01; I2 = 89%) versus 27% (95% CI: 14 to 40, p < 0.01; I2 = 90%) in non-AFLS patients. AFLSs are prudent in the surgical management of ptosis. The results of this review demonstrate that their use is associated with similar complication rates but fewer reoperations than other traditional techniques.
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Affiliation(s)
- Reddin Ahmad
- Core Surgical Trainee 1, Plastic Department, University Hospitals Leicester NHS Trust, Leicester, United Kingdom.
| | - Umar Rehman
- Clinical Research Fellow, UCL Division of Surgery and Interventional Sciences, UCL, London, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Locum Clinical Fellow, Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Zahra Ahmed
- Medical Student, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
| | - Oluwasemilore Adebayo
- Foundation Doctor, Department of Surgery, Lister Hospital, Stevanage, United Kingdom.
| | - Peter A Brennan
- Honorary Professor of Surgery, Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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Shoji MK, Sengillo JD, Abou Khzam R, Dubovy SR, Rong AJ. Lymphoepithelioma-like carcinoma of the eyelid and ocular adnexa. Orbit 2024; 43:140-146. [PMID: 35733412 DOI: 10.1080/01676830.2022.2085305] [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: 03/30/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
A 93-year-old Caucasian woman presented to clinic for evaluation of a progressively enlarging left eyelid mass. Exam revealed a large, indurated, poorly mobile mass involving the left upper eyelid. Imaging demonstrated a crescentic enhancing soft-tissue mass in the left upper eyelid without evidence of deeper orbital involvement. Biopsy demonstrated tumor nests positive for cytokeratin AE1/AE3, P63, and P40 consistent with a diagnosis of eyelid lymphoepithelioma-like carcinoma (LELC). The patient underwent surgical resection with subsequent left upper eyelid reconstruction and adjuvant radiation. She had no clinical evidence of disease recurrence at follow-up. LELC is an uncommon tumor that rarely involves the eyelid and ocular adnexa. Early identification is important due to its malignant potential, as the majority of previously reported cases demonstrated local or distant metastatic spread. Future studies are needed to determine the optimum treatment regimen for this rare periorbital neoplasm.
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Affiliation(s)
- Marissa K Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jesse D Sengillo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rayan Abou Khzam
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew J Rong
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Hwang G, Kim JO, Paik JS, Yang SW, Cho WK. Chalazion-mimicked eyelid angiosarcoma in a young Asian with good prognosis: a case report. BMC Ophthalmol 2024; 24:1. [PMID: 38166705 PMCID: PMC10759663 DOI: 10.1186/s12886-023-03262-z] [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: 06/11/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Angiosarcoma is an extremely rare malignant tumor. So far, only about 42 cases of angiosarcoma involving the eyelids have been reported. Eyelid angiosarcoma occurs more frequently in elderly Caucasian males and is prone to misdiagnosis. We present a case report in a young Asian male patient with eyelid angiosarcoma that was misdiagnosed as a chalazion. CASE PRESENTATION A 46-year-old South Korean male with no underlying disease had a right lower lid mass. The lesion was initially misdiagnosed as a chalazion at a local clinic, but a diagnosis of eyelid angiosarcoma was made after the first biopsy trial. PET-CT was performed to ensure that there was no metastasis in the whole body. Surgical excision with enough surgical margin was used alone for treatment and reconstruction was performed with a tarsoconjunctival advancement flap (modified Hughes procedure), which helped ensure good cosmesis. No recurrence was observed 4 years and 5 months after the surgery. CONCLUSIONS The current study presents the first case of chalazion-mimicked eyelid angiosarcoma in a young Asian male aged under 50 years. This case shows that even if a benign eyelid disease is suspected in a young patient, an incisional biopsy must be performed to confirm whether the lesion is malignant. Since the prognosis is good for the case of eyelid angiosarcoma, if there is no clear evidence of distal metastasis, surgical resection should be performed with an enough safety margin.
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Affiliation(s)
- Gyudeok Hwang
- Department of Ophthalmology, Hangil Eye Hospital, #35 Bupyeong‑Daero, 21388, Bupyeong‑Gu, Incheon, Republic of Korea
| | - Jong Ok Kim
- Department of Pathology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Sun Paik
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Kyung Cho
- Department of Ophthalmology, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
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Al Ghulaiga FM, Alsulaiman AM, Maktabi AMY, Alkatan HM. Peri-ocular proliferative apocrine hidrocystoma (cystadenoma): A clinicopathological case series. Int J Surg Case Rep 2024; 114:109085. [PMID: 38086129 PMCID: PMC10726227 DOI: 10.1016/j.ijscr.2023.109085] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Apocrine cystadenomas are rare, benign tumors that might arise in the periocular region from glands of Moll. They characteristically demonstrate proliferative features on histopathological examination, which differentiate them from simple hidrocystomas. PRESENTATION OF CASES We retrospectively identified 4 consecutive cases of apocrine cystadenomas in male patients with a mean age of 48.5 years (range 20-62). One of the cases was a recurrent lesion. The Preoperative clinical diagnosis was mostly hidrocystoma. All patients agreed on complete surgical excision of their cystic lesions. Histopathological review of the excised cysts confirmed the diagnosis of apocrine cystadenoma based on the presence of proliferative features with no atypia or infiltrative behavior. Cases are summarized in Table 1 and the histopathological appearance is demonstrated in the included figure. DISCUSSION Apocrine cystadenoma is rare. It occurs in the areas of skin with hair follicles, such as the axilla, neck, and trunk, and may be mistaken for other skin lesions, such as nevi or syringomas. In the eyelid region, they are commonly missed and frequently diagnosed as simple hidrocystoma due to the presence of bluish hue such as in our series. Recurrence is rare but was found in one of our patients at initial presentation. Our series included unique locations of this lesion in the medial canthus in one patient and near the eyelid tarsus in another. CONCLUSION Ophthalmologist should be aware of the rare occurrence of this lesion in the periocular region. Further studies to explain the etiology of such proliferative nature in apocrine cysts would be interesting.
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Affiliation(s)
- Faris M Al Ghulaiga
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Pathology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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11
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Nitzan I, Derazne E, Afek A, Gur Z, Weinstein O, Twig G, Zloto O. Blepharoptosis and cognitive performance: a population-based study of 1.4 million adolescents. Eur J Pediatr 2024; 183:235-242. [PMID: 37870609 DOI: 10.1007/s00431-023-05294-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
The purpose of this study is to examine the association between blepharoptosis and cognitive performance in late adolescence. This population-based, retrospective, cross-sectional study included 1,411,570 Israeli-born adolescents (620,107 women, 43.9%) aged 16-19 years who were medically examined before compulsory military service between 1993 and 2017. The diagnosis of blepharoptosis was verified by an ophthalmologist. Cognitive performance was assessed by a validated intelligence-quotient-equivalent test, comprising four domains (problem-solving, verbal abstraction and categorization, verbal comprehension, and mathematical abilities). Cognitive Z-scores were calculated and categorized as high (≥ 1 standard deviation (SD)), medium (- 1 to < 1 SD), and low (less than - 1 SD). Relationships were analyzed using regression models adjusted for sociodemographic variables including sex, year of birth, residential socioeconomic status, education level, body mass index, and familial country of origin. A total of 577 (41 per 100,000, 32.2% women) adolescents were diagnosed with blepharoptosis. The proportions of unilateral and bilateral visual impairment among adolescents with blepharoptosis were 13.0% and 3.5%, respectively. In a multivariable analysis, blepharoptosis was associated with a 0.18 SD reduction in cognitive Z-score (p < 0.001). The adjusted odds ratios for low and high cognitive Z-scores in adolescents with blepharoptosis were 1.54 (1.25-1.89) and 0.80 (0.62-1.04), respectively. This relationship persisted when adolescents with normal best-corrected visual acuity or unimpaired health status were analyzed separately. Conclusions: Blepharoptosis is associated with reduced cognitive performance determined in late adolescence. Future prospective studies should investigate the causes of this link and their underlying mechanisms. What is Known: • While earlier investigations have examined the effects of blepharoptosis on vision and quality of life, the association between blepharoptosis and cognitive outcomes in youth has remained unexplored. What is New: • This nationwide study involving 1.4 million Israeli adolescents found a correlation between blepharoptosis and reduced cognitive performance. • Our findings suggest a potential interplay between blepharoptosis and cognitive development in the pediatric population, calling for increased focus on the educational needs of affected individuals.
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Affiliation(s)
- Itay Nitzan
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Zvi Gur
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Orly Weinstein
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
- Hospitals Division, Clalit Health Services, Tel Aviv, Israel
| | - Gilad Twig
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ofira Zloto
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel.
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12
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Toure M, Quintyn-Ranty ML, Saguet P, Bouchoucha R, Mouriaux F, Quintyn JC. [Recurrence of palpebral basal cell carcinoma according to histological margins]. J Fr Ophtalmol 2023; 46:1174-1181. [PMID: 37867122 DOI: 10.1016/j.jfo.2023.05.029] [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: 03/16/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Basal cell carcinomas (BCCs) represent 90% of malignant tumors of the eyelids, which can be locally invasive and destructive. The observation of histological safety margins (MHS) allows for the prevention of recurrence while maintaining a fair compromise between aesthetics and functionality. However, to date, there is no consensus or national recommendations concerning the MHS to be observed according to the various histological subtypes of BCCs. METHODS Through a retrospective analysis of patient records and corresponding excisional slides, we studied the 6-year recurrence rate of 98 patients who underwent surgery for palpebral BCC. RESULTS MHS were mostly absent in the excisional specimens of recurrent BCCs and significantly more narrow than in non-recurrent BCCs, on average over 2mm. CONCLUSION The results of our study suggest that an average MHS greater than 2mm prevents most recurrences.
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Affiliation(s)
- M Toure
- Service d'ophtalmologie, centre hospitalier universitaire Côte de nacre, avenue de la Côte de Nacre CS 300001, 14033 Caen cedex 9, France; Université de Normandie UNICAEN, Normandie, France
| | - M-L Quintyn-Ranty
- Service d'ophtalmologie, centre hospitalier universitaire Côte de nacre, avenue de la Côte de Nacre CS 300001, 14033 Caen cedex 9, France; Université de Normandie UNICAEN, Normandie, France
| | - P Saguet
- Service d'ophtalmologie, centre hospitalier universitaire Côte de nacre, avenue de la Côte de Nacre CS 300001, 14033 Caen cedex 9, France; Université de Normandie UNICAEN, Normandie, France
| | - R Bouchoucha
- Service d'ophtalmologie, centre hospitalier universitaire Côte de nacre, avenue de la Côte de Nacre CS 300001, 14033 Caen cedex 9, France; Université de Normandie UNICAEN, Normandie, France
| | - F Mouriaux
- Centre hospitalier universitaire de Rennes 1, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France; Université de Rennes 1, Rennes, France
| | - J-C Quintyn
- Service d'ophtalmologie, centre hospitalier universitaire Côte de nacre, avenue de la Côte de Nacre CS 300001, 14033 Caen cedex 9, France; Université de Normandie UNICAEN, Normandie, France.
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13
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Lokdarshi G. Indolent ulcer and discharging sinus on the eyelid of healthy Indian children and an adult: Orbital tuberculosis, a spot-diagnosis. Indian J Tuberc 2023; 70 Suppl 1:S118-S121. [PMID: 38110254 DOI: 10.1016/j.ijtb.2023.10.003] [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: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023]
Abstract
Five cases of tuberculous osteomyelitis of the fronto-zygomatic (F-Z) region presented with a non-healing ulcer or discharging sinus in the eyelid skin in healthy children and an adult. Lack of awareness about peri-ocular manifestations of extra-pulmonary tuberculosis and delayed referral to specialists, along with poor compliance to long-term ATT, could be the reason for its underreporting in India.
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Affiliation(s)
- Gautam Lokdarshi
- Oculoplasty and Ocular Oncology Services, IRIS Superspeciality Eye Hospital, Line Tank Road, Ranchi, India.
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14
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Yang MK, Kim N, Choung H, Kim JE, Khwarg SI. Prevalence of human papillomavirus in eyelid carcinoma among Koreans: a clinicopathological study. BMC Ophthalmol 2023; 23:390. [PMID: 37752463 PMCID: PMC10521399 DOI: 10.1186/s12886-023-03131-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has been detected in eyelid sebaceous gland carcinoma (SGC) and squamous cell carcinoma (SCC), and detection rates greatly varied across studies. This study aimed to investigate the presence of HPV in eyelid SGC and SCC among Koreans and its correlation with clinicopathological characteristics. METHODS Surgically resected eyelid samples diagnosed as SGC or SCC from January 1999 to June 2011 were identified from the pathology database of three referral centres in Korea. Clinicopathological information including origin (skin vs. tarsal conjunctiva) and treatment outcomes were retrospectively reviewed. Immunohistochemistry (IHC) for p16, HPV DNA in situ hybridisation (ISH), and polymerase chain reaction-based DNA microarray were performed in paraffin-embedded tissue sections. RESULTS Our cohort included 34 SGC and 12 SCC cases with Asian ethnicity. HPV was detected in 4 SGC and 6 SCC by DNA microarray, while 2 SCC (16.7%) showed positivity in ISH. SCC of tarsal conjunctival origin was significantly more common in HPV-positive SCC than in HPV-negative SCC (5 of 6 vs. 0 of 6, P = 0.015, Fisher's exact test). Among samples showing positive staining in p16 IHC, HPV positivity rates were 0.0% (0/19) in SGC and 100% (3/3) in SCC. There was no significant difference in overall and local recurrence rate in eyelid SGC and SCC according to the HPV status (P > 0.99). CONCLUSIONS HPV was found in a subset of eyelid SGC and SCC among Koreans and might be aetiologically related to SCC of tarsal conjunctival origin. Overexpression of p16 is considered to be inappropriate as an indicator of HPV infection in eyelid SGC. Further investigation is required to elucidate the transmission route and pathogenic roles of HPV.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Republic of Korea.
| | - Ji Eun Kim
- Department of Pathology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Seoul, Republic of Korea.
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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15
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Mitra S, Panda S, Singh CA, Thakar A. Modified Mustardé Flap for Lower Eyelid Reconstruction in Basal Cell Carcinoma: Revisited. Indian J Otolaryngol Head Neck Surg 2023; 75:2492-2495. [PMID: 37636662 PMCID: PMC10447676 DOI: 10.1007/s12070-023-03768-4] [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] [Received: 02/06/2023] [Accepted: 03/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background Full thickness defects of lower eyelid, following oncological resection, often pose a formidable challenge to the operating surgeon. Although a plethora of reconstructive options have been tried, the Mustardé flap has stood the test of time. Methods Our patient, a 57-year old lady, diagnosed with basal cell carcinoma of the left lower eyelid underwent full-thickness wide local excision and reconstruction using modified Mustardé flap. The anterior part of defect was reconstructed using the flap. The posterior part was reconstructed using septal mucoperichondrial-cartilage composite graft, sutured to remnant palpebral conjunctiva. Results The patient had an uneventful post-operative period. On serial follow-up, the patient had an acceptable scar. At 6 months follow-up, the facial scar was barely perceptible with normal lower lid disposition. Conclusion The modified Mustardé flap is a simple and reliable reconstructive option for full-thickness lower eyelid defects following oncological resection in carefully selected cases.
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Affiliation(s)
- Sandipta Mitra
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Room No- 4075, 4th floor, Teaching Block, New Delhi, 110029 India
| | - Smriti Panda
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Room No- 4075, 4th floor, Teaching Block, New Delhi, 110029 India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Room No- 4075, 4th floor, Teaching Block, New Delhi, 110029 India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Room No- 4075, 4th floor, Teaching Block, New Delhi, 110029 India
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16
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Zimmer DI, Wieland AM, Ku JA. Reconstruction After Skin Cancer Resection of the Head and Neck. Otolaryngol Clin North Am 2023:S0030-6665(23)00063-4. [PMID: 37277301 DOI: 10.1016/j.otc.2023.04.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Skin cancer defects of the head and neck region can vary greatly in their complexity. Reconstructive surgeons are tasked with maintaining or restoring function as well as providing an excellent aesthetic outcome. This article provides an overview of reconstructive options following skin cancer resection broken down by different aesthetic regions and subunits. Although not meant to serve as an all-encompassing source, it provides common indications for using different sections of the reconstructive ladder based on location of defects, tissues involved, and patient factors.
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Affiliation(s)
- David I Zimmer
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue A71, Cleveland, OH 44106, USA.
| | - Aaron M Wieland
- Division of Otolaryngology Head and Neck Surgery, Section of Head and Neck Surgical Oncology, University of Wisconsin, 600 Highland Avenue, BX7375 Clinical Science Center-K4, Madison, WI 53792-3284, USA
| | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue A71, Cleveland, OH 44106, USA
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17
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Pascali M, Marchese G, Diaspro A. Letter in reply to Letter to the Editor: Fat injection as a valuable tool for lower eyelid retraction management: a retrospective, observational, single blind, case-control study. Aesthetic Plast Surg 2023; 47:219-220. [PMID: 36820860 DOI: 10.1007/s00266-023-03276-4] [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: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/24/2023]
Abstract
DEAR EDITOR We have read Dr Riccardo Fondrini and Colleagues commentary on our paper, and we are grateful for their remarks. We herewith would clarify the critical points mentioned about fat reabsorption and survival, along with the risk of periorbital chronic oedema as per the recorded outcomes in the presented case series. Lastly, we have unfortunately to disagree with the commentary's point related to recommended injection depth as it is mandatory to point out that in our experience the superficial injection of nano-fat is a crucial step for lower eyelid retraction management, otherwise a retraction may persist due to the untreated scar in the anterior lamella, thus missing the therapeutic goal that we aim to achieve. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Michele Pascali
- Plastic and Reconstructive Surgeon, Plastic Surgery Academy, Rome, Italy
| | | | - Alberto Diaspro
- Rigeneralab Centre for Regenerative Medicine, Corso Unione Sovietica 159/a, 10134, Turin, Italy.
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18
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Hasmat S, Lovell NH, Low THH, Clark JR. Development of an implantable bionic for dynamic eye closure in facial nerve paralysis: Evolution of the design. Med Eng Phys 2023; 115:103977. [PMID: 37120171 DOI: 10.1016/j.medengphy.2023.103977] [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] [Received: 04/03/2022] [Revised: 01/03/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
Facial nerve paralysis (FNP) presents with a constellation of clinical problems but its most concerning consequence is corneal exposure from lack of blinking. Bionic lid implant for natural closure (BLINC) is an implantable solution for dynamic eye closure in FNP. It uses an electromagnetic actuator to mobilise the dysfunctional eyelid by means of an eyelid sling. This study highlights issues relating to device biocompatibility and describes its evolution to overcome some of these issues. The essential components of the device are the actuator, the electronics including energy storage, and an induction link for wireless power transfer. Effective arrangement of these components within the anatomical confines and their integration is achieved through a series of prototypes. The response of each prototype is tested in a synthetic or cadaveric model for eye closure with the final prototype designed for acute and chronic animal trials.
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Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, NSW 2052, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jonathan R Clark
- Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
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19
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Cohen SA, Kossler AL. The use of Google Trends and Twitter data as a tool for evaluating public interest in hyaluronic acid eyelid filler. J Clin Transl Res 2023; 9:76-83. [PMID: 37034000 PMCID: PMC10075089] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background Google Trends and the Twitter Academic Research Product Tract (TARPT) are free, online tools that can be used to evaluate public interest in plastic surgery procedures. Aim The aim of the study was to evaluate the correlation between online public interest in hyaluronic acid eyelid filler on two popular web platforms (Google and Twitter) and hyaluronic acid filler procedure volumes in the United States. Methods The Google Trends database and the TARPT tool were used to calculate the number of annual Google searches and Twitter tweets, respectively, related to 10 search terms associated with hyaluronic acid eyelid filler injections from January 2010 to December 2020. Annual procedure volumes for hyaluronic acid filler injections were obtained from the American Society of Plastic Surgery (ASPS). Univariate linear regression was used to correlate Google searches to ASPS procedure volumes and Twitter tweet volumes to ASPS procedure volumes. Results Significant positive correlations were found between Google Trends data and ASPS procedure volumes for 8/10 search terms and between Twitter tweet volumes and ASPS procedure volumes for 6/10 search terms, respectively. Online public interest in eyelid filler related search terms increased significantly over time according to an exponential model (P < 0.0001). Conclusions We observed statistically significant positive associations between public interest related to eyelid filler on two online platforms, Google and Twitter, and hyaluronic acid soft-tissue filler procedure volumes. The Google Trends and TARPT databases represent free information sources for surgeons that may be used to inform marketing and advertising decisions and to anticipate patient inquiries during the patient encounter. Relevance for Patients Information provided by the Google Trends and TARPT tools can be used by surgeons to (1) inform marketing and advertising strategies and (2) gain insight into which procedures patients are researching during a given time period, preparing them to best address the evolving needs of patients.
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Affiliation(s)
- Samuel A. Cohen
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University School of Medicine. Stanford, CA, United States of America
| | - Andrea L. Kossler
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University School of Medicine. Stanford, CA, United States of America
- Corresponding author: Andrea L. Kossler Director of Ophthalmic Plastic, Reconstructive Surgery, and Orbital Oncology, Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, United States of America. E-mail:
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20
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Naik MN, Bansal O, Palo M, Yashwanth B. Single-stage upper eyelid switch flap for the repair of post-traumatic contracted socket and lower eyelid coloboma. Orbit 2023; 42:189-191. [PMID: 34496729 DOI: 10.1080/01676830.2021.1974058] [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: 10/20/2022]
Abstract
The use of eyelid switch flap in the correction of lower eyelid coloboma in a post-traumatic contracted socket is described. The lower eyelid, inferior fornix and lateral canthus were successfully created in a single stage with a switch flap from the upper eyelid. A satisfactory cosmetic outcome and a stable fornix for placement of a custom ocular prosthesis was achieved.
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Affiliation(s)
- Milind N Naik
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, India
| | - Oshin Bansal
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Visakhapatnam, India
| | - Mansha Palo
- Ocular Prosthesis Fabricating Centre, Narayana Nethralaya, Bangalore, India
| | - B Yashwanth
- Ocular Prosthesis Service, LV Prasad Eye Institute, Hyderabad, India
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21
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Turkiewicz M, Shah A, Yang YW, Mangold A, Shen J. Allergic contact dermatitis of the eyelids: An interdisciplinary review. Ocul Surf 2023; 28:124-130. [PMID: 36898500 DOI: 10.1016/j.jtos.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/17/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE A review of the published literature on the pathogenesis and treatment of eyelid allergic contact dermatitis and ocular surface involvement. METHODS Literature search of MEDLINE (Ovid) was conducted using for allergic contact dermatitis and disease of the eyelid or periorbital skin. Dates included in search criteria were from January 1, 2010 to January 12, 2023. 120 articles were reviewed by at least two authors. RESULTS Allergic eyelid contact dermatitis(ACD) is a Type IV hypersensitivity reaction to chemical exposure of sensitized eyelid skin. Most patients improve with avoidance strategies. Understanding chemicals that may trigger eyelid ACD, identifying allergens with patch testing, and use of topical steroids can help patients with this challenging disease. CONCLUSIONS Recalcitrant allergic eyelid dermatitis can be addressed by an interdisciplinary team and avoidance strategies based on patch testing.
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Affiliation(s)
- Michal Turkiewicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Ami Shah
- Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA
| | - Yul W Yang
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Aaron Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA.
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22
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Pascali M, Marchese G, Diaspro A. Fat Injection as a Valuable Tool for Lower Eyelid Retraction Management: A Retrospective, Observational, Single Blind and Case-Control Study. Aesthetic Plast Surg 2023; 47:235-244. [PMID: 36253647 DOI: 10.1007/s00266-022-03114-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/16/2022] [Accepted: 09/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the use of autologous fat graft injection to correct lower eyelid position METHODS: A retrospective, observational, single blind, case-control study was carried out on 94 patients, presenting with lower eyelid retraction in 159 eyes. In the sub-population with monolateral eyelid retraction, the not affected site has been considered as a control and compared with the outcomes recorded after treatment of the contralateral side Follow-up at 12 months was performed with a subjective assessment carried out by a questionnaire administered to patients while objective result assessment was performed 12 months after surgery by two independent blind examiners. RESULTS The eyelid upward reposition has improved one year after fat grafting in both bilateral (1,52 mm) and unilateral (1,7 mm) population: the latter allowed to statistically validate (P<0.05) the result with respect to the not affected site. CONCLUSIONS This is the first paper that highlights the outcomes of sole fat injection in the treatment of lower eyelid retraction: blind objective evaluation of surgical outcomes along with a patient assessment of both functional and aesthetic improvement one year after surgery confirm its efficacy and reliability along with the first case/control outcome evaluation of the technique carried on in the sub-population of 29 patients affected by unilateral lower eyelid retraction that validate the average improvement of the retracted eyelid one year after fat grafting as statistically significant. Nevertheless, longer follow-up periods and a larger sample size are needed to thoroughly confirm surgical outcomes and statistical results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Michele Pascali
- , Rome, Italy
- Plastic Surgery Academy, Via Novara 53, 00198, Rome, Italy
| | | | - Alberto Diaspro
- Rigeneralab Centre for Regenerative Medicine, Corso Unione Sovietica 159/a, 10134, Turin, Italy.
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23
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Hakami S, Afifi Y, Azzagnuni Y, Makhoul D, Le A. Infestation of the Eyelid by an Egg-Laying Tick: Case Report. Case Rep Ophthalmol 2023; 14:278-281. [PMID: 37485246 PMCID: PMC10359679 DOI: 10.1159/000530751] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/12/2023] [Indexed: 07/25/2023] Open
Abstract
In this report, we describe a rare case of a tick egg-laying infestation of the eyelid. A 7-year-old girl consulted our hospital after a trip in Thailand for an itchy and painful eyelid. The first examination at the slit lamp showed the tick's body attached to the left superior eyelid margin, surrounded by its eggs. The tick detached itself afterward and a tobramycin prophylactic treatment was introduced. The patient was put under surveillance and no signs of a tick-borne disease were described during the follow-up.
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Affiliation(s)
- Sina Hakami
- Department of Ophthalmology, CHU Saint-Pierre, Brussels, Belgium
| | - Youssef Afifi
- Department of Ophthalmology, CHU Saint-Pierre, Brussels, Belgium
| | | | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Brussels, Belgium
| | - Aurélie Le
- Department of Ophthalmology, CHU Saint-Pierre, Brussels, Belgium
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24
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AlHazzani AA, Malaikah RH, Altahan FA, Arafah MA, Al-Faky YH. Eyelid Soft Tissue Chondroma: A Case Report. Case Rep Ophthalmol 2023; 14:358-362. [PMID: 37901648 PMCID: PMC10601829 DOI: 10.1159/000530956] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/12/2023] [Indexed: 10/31/2023] Open
Abstract
Soft tissue chondromas are rare benign tumors that occur in extraosseous and extra-synovial locations. We report herein a rare presentation of eyelid soft tissue chondroma in a 45-year-old male presented with a 2-year history of a slowly enlarging subcutaneous firm mass on the left upper eyelid, and complete excision of the lesion followed by histopathological examination rendered the diagnosis of soft tissue chondroma.
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Affiliation(s)
- Abeer A. AlHazzani
- Department of Ophthalmology, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
| | - Rawan H. Malaikah
- Department of Ophthalmology, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
| | - Faisal A. Altahan
- Department of Ophthalmology, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
| | - Maria A. Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H. Al-Faky
- Department of Ophthalmology, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- ETABE International Eye Hospital, Giza, Egypt
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25
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Wiffen J, Kalantary A, Ardakani NM, Turner A. Adult onset xanthogranuloma of the eyelid. Am J Ophthalmol Case Rep 2022; 29:101775. [PMID: 36544751 PMCID: PMC9762145 DOI: 10.1016/j.ajoc.2022.101775] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To report a rare case of an eyelid lesion in an adult, with histological features of juvenile xanthogranuloma (JXG). Observations Juvenile xanthogranuloma primarily affects the skin of infants and young children. It infrequently can involve the structures of the eye and orbit and rarely occurs in individuals beyond the second decade of life. We present a case of adult onset xanthogranuloma (AXG) involving the eyelid of a 29-year-old female. This lesion required management with multiple treatment modalities. Conclusions This is a rare example of an eyelid xanthogranuloma in an adult. As such, JXG-like lesions should be included as a differential diagnosis for lesions of the eye and orbit in adults. Surgical management may be required if there is no response to intralesional steroids.
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Affiliation(s)
- James Wiffen
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Corresponding author. Lions Outback Vision, 2 Verdun Street, Nedlands, Western Australia, 6009, Australia.
| | - Amy Kalantary
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia,College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Angus Turner
- The Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia,Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia, Australia
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Ramachandran V, Phan K. Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database. J Plast Reconstr Aesthet Surg 2022; 75:4410-4415. [PMID: 36257889 DOI: 10.1016/j.bjps.2022.08.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/18/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. METHODS A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. RESULTS A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan-Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310-2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047-5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE. CONCLUSION While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.
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Affiliation(s)
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, Sydney, Australia
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Alam MS, Shrirao N. Clinical Spectrum and Management Outcome of Ocular and Adnexal Rhinosporidiosis. J Curr Ophthalmol 2022; 34:341-346. [PMID: 36644476 PMCID: PMC9832447 DOI: 10.4103/joco.joco_33_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose To describe the clinical spectrum and management outcomes of ocular rhinosporidiosis. Methods All histopathologically diagnosed cases of ocular rhinosporidiosis between January 2000 and December 2016 were included in the study. The lesions were classified based on the site of involvement, namely conjunctiva, lacrimal sac, eyelid, and orbit. The frequency and percentages for each of the lesions and the different treatment modalities were noted and calculated. Any recurrence and its subsequent management were also noted. Results A total of 34 patients were included with a male-to-female ratio of 2.7:1. Conjunctiva was the most common site involved (19, 55.8%), followed by lacrimal sac (11, 32.3%) and eyelid (3, 8.82%). One patient had orbital involvement secondary to sinonasal extension. The mean duration of symptoms was 14.8 ± 19.1 months (range, 1-84 months). Seven (36.8%) patients in the conjunctival group needed scleral patch graft. Five patients (45.4%) with lacrimal sac rhinosporidiosis underwent dacryocystectomy and modified dacryocystorhinostomy (DCR). The mean follow-up period was 5.43 ± 7.9 months (range, 1-36 months). Five (14.7%) patients (2 conjunctival, 2 lacrimal, and 1 eyelid) had recurrence. Conclusions Conjunctiva is the most common site for ocular rhinosporidiosis, followed by lacrimal sac. While conjunctival lesions respond well to complete excision with cauterization of the base, lacrimal sac lesions can be managed by a modified DCR. Eyelid rhinosporidiosis can mimic a neoplasm and should be considered in differential diagnosis in suspicious lesions, especially in endemic areas.
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Affiliation(s)
- Md. Shahid Alam
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India,Address for correspondence: Md. Shahid Alam, Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India. E-mail:
| | - Neha Shrirao
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya Medical Research Foundation, Chennai, Tamil Nadu, India
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Bircan H, Yuksel N. A Rare Cause of Preseptal Cellulitis: Cutaneous Leishmaniasis. Beyoglu Eye J 2022; 7:320-3. [PMID: 36628085 DOI: 10.14744/bej.2022.32650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 01/13/2023]
Abstract
Cutaneous leishmaniasis (CL) is a protozoal disease that occurs in many parts of the world, usually caused by Leishmaniasis major and Leishmaniasis tropica and transmitted by sandfly bites. Eyelid involvement is rarely seen as the movement of the eyelids prevents the fly vector from biting the skin in this area. We report a case of cutaneous leishmaniasis with eyelid involvement causing preseptal cellulitis in a 71-year-old male patient.
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Habib SG, Ibrahim UY, Mohammed I, Umar SM. Power Plug of a Mobile Phone Charger in the Orbit: A Case Report of a Domestic Injury. J West Afr Coll Surg 2022; 12:122-125. [PMID: 36590777 PMCID: PMC9802591 DOI: 10.4103/jwas.jwas_144_22] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/27/2022] [Indexed: 01/03/2023]
Abstract
Background This is the case of a girl who sustained orbital injury while playing with a mobile phone charger. Case Report The patient presented to the tertiary hospital 5 h after she sustained a penetrating injury with the power plug of a mobile phone charger to the right upper lid. There was associated headache, tearing, bleeding, discharge, and inability to open the right eye. On Examination She was ill-looking and anxious, not febrile or pale. Systemic examination did not reveal any abnormality. Unaided visual acuity in the right eye (OD) could not be tested, left eye (OS)-6/9. The right eyelid was completely closed with a penetrating power plug of the phone charger in the supero-lateral aspect of the upper eyelid. A diagnosis of penetrating power plug of a charger in the right upper lid and orbit was made. Computed tomography scan showed the power plug of the charger in the right orbit with a little blood collection in the right maxillary sinus. She underwent examination under anaesthesia, foreign body removal, and repair of the lid penetration. The findings were right upper lid penetration with ptosis, corneal epithelial erosion, phone charger power plug in the medial orbital wall, and cataract. The foreign body was removed, and lid and conjunctival lacerations repaired. Eight weeks post-operatively, ptosis had resolved, leaving the anterior polar cataract (<3 mm) and a best corrected visual acuity of (OD) 6/6 and (OS) 6/5. About 6 months afterwards, the cataract matured with a visual acuity of 6/60 for which she had right phacoemulsification with posterior chamber intra-ocular lens implant insertion. Conclusion Prompt presentation and management lead to good visual outcomes in this patient.
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Affiliation(s)
- Saudat Garba Habib
- Department of Ophthalmology, Aminu Kano Teaching Hospital/Faculty of Clinical Sciences—College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Usman Yuguda Ibrahim
- Department of Ophthalmology, Aminu Kano Teaching Hospital/Faculty of Clinical Sciences—College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Isyaku Mohammed
- Department of Ophthalmology, Aminu Kano Teaching Hospital, Kano, Nigeria
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Young SM, Kim JH, Kim YD, Karnsiritanont V, Lang SS, Woo KI. Hyaluronic acid gel injection for dysthyroid upper eyelid retraction in Asian patients. Orbit 2022:1-8. [PMID: 36082627 DOI: 10.1080/01676830.2022.2117385] [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 evaluate the role of hyaluronic acid (HA) filler injection in the management of upper eyelid retraction (UER) in thyroid eye disease (TED). METHODS Retrospective interventional series of all patients with TED who had undergone HA injection, from February 2011 to April 2013 by a single surgeon (Y-DK) in a tertiary medical institution. Outcome measures: Mean margin reflex distance 1 (MRD1) pre- and post-filler. RESULTS There was a total of 13 patients and 17 eyes included in the study. The injection dosage for 15 eyes was 0.5 ml, one patient had 0.35cc on the right eye and 0.65cc on the left eye. Mean MRD1 at presentation was 6.21 mm. There was a mean decrease in MRD1 of 2.01 mm (p < .001) at 1 month post filler, 2.06 mm (p < .001) at 6 months post filler and 2.61 mm (p < .001) at 1 year post filler. There was no correlation between pre-filler MRD1 and change in MRD1 at various time points post-filler, nor any correlation between pre-filler upper scleral show (USS) and change in USS post-filler. There was also no correlation found between clinical activity score (CAS) and change in MRD1, as well as duration of thyroid eye disease (TED) and change in MRD1. Complications included mild upper lid lumpiness on downgaze (n = 4, 23.5%) which improved but persisted with time. There were no untoward intravascular or vision-threatening complications. CONCLUSION Transconjunctival HA injection is an effective treatment option for TED-related UER in both active and inactive TED patients in an East Asian population, with a potentially long-lasting effect.
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Affiliation(s)
| | - Jeong Hee Kim
- Department of Ophthalmology, Saevit Eye Hospital, Seoul, Korea
| | - Yoon-Duck Kim
- Department of Oculoplastics, Nune Eye Hospital, Seoul, Korea
| | | | | | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Centre, Seoul, Korea
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Yasuda S, Sumioka T, Miyajima M, Iwanishi H, Morii T, Mochizuki N, Reinach PS, Kao WWY, Okada Y, Liu CY, Saika S. Anomaly of cornea and ocular adnexa in spinster homolog 2 (Spns2) knockout mice. Ocul Surf 2022; 26:111-127. [PMID: 35988880 DOI: 10.1016/j.jtos.2022.08.007] [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] [Received: 02/24/2022] [Revised: 05/26/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
Spinster 2 (Spns2) is a transporter that pumps sphingosine-1-phosphate (S1P), a bioactive lipid mediator synthesized in the cytoplasm, out of cells into the inter cellular space. S1P is a signal that modulates cellular behavior during embryonic development, inflammation and tissue repair, etc. A Spns2-null (KO) mouse is born with failure of eyelid closure (eyelid-open-at birth; EOB) and develop corneal fibrosis in adulthood. It remains elusive whether corneal lesion is caused by exposure to keratitis (lagophthalmos) of EOB phenotype or the loss of Spns2 directly perturbs the corneal tissue morphogenesis and intra-eyelid structures. Therefore, we investigated differences between the cornea and ocular adnexa morphogenesis in KO and wild-type (WT) embryos and adults as well. The loss of Spns2 perturbs cornea morphogenesis during embryonic development as early as E16.5 besides EOB phenotype. Histology showed that the corneal stroma was thinner with less extracellular matrix accumulation, e.g., collagen and keratocan in the KO mouse. Epithelial stratification, expression of keratin 12 and formation of desmosomes and hemidesmosomes were also perturbed in these KO corneas. Lacking Spns2 impaired morphogenesis of the Meibomian glands and of orbicularis oculi muscles. KO glands were labeled for ELOVL4 and PPARγ and were Oil-Red O-positive, suggesting KO acinar cells possessed functionality as the glands. This is the first report on the roles of Spns2 in corneal and Meibomian gland morphogenesis. Corneal tissue destruction in an adult KO mouse might be due to not only lagophthalmos but also to an impaired morphogenesis of cornea, Meibomian glands, and orbicularis oculi muscle.
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Affiliation(s)
- Shingo Yasuda
- Department of Ophthalmology, Wakayama Medical University School of Medicine, Japan; Indiana University School of Optometry, USA.
| | - Takayoshi Sumioka
- Department of Ophthalmology, Wakayama Medical University School of Medicine, Japan
| | - Masayasu Miyajima
- Department of Ophthalmology, Wakayama Medical University School of Medicine, Japan
| | - Hiroki Iwanishi
- Department of Ophthalmology, Wakayama Medical University School of Medicine, Japan
| | - Tomoya Morii
- Department of Ophthalmology, Wakayama Medical University School of Medicine, Japan
| | - Naoki Mochizuki
- Department of Cell Biology, National Cerebral and Cardiovascular Center Research Institute, Japan
| | - Peter S Reinach
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Wenzhou, Zhejiang, China
| | - Winston W Y Kao
- Crawley Vision Research Center & Ophthalmic Research Laboratory, Department of Ophthalmology, College of Medicine University of Cincinnati, USA
| | - Yuka Okada
- Deaprtment of Ophthalmology, Kihoku Hospital, Wakayama Medical University School of Medicine, Japan
| | | | - Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University School of Medicine, Japan
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Watson AH, Akbani S, Homer N, Somogyi M, Durairaj V. Adnexal squamous cell carcinoma: incidence of eyelid margin involvement. Orbit 2022; 42:269-272. [PMID: 35766103 DOI: 10.1080/01676830.2022.2092156] [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: 10/17/2022]
Abstract
PURPOSE We aimed to perform a review of facial and periorbital squamous cell carcinoma (SCC) cases to assess the relative incidence of eyelid margin involvement. METHODS This is a retrospective review of all patients with biopsy-proven SCC who were evaluated at a single oculoplastic surgery practice from 2007 to 2019. The charts were reviewed for the anatomical location of the malignancy, and those involving the eyelid were further divided into marginal and non-marginal lesions. Statistical analysis was performed using a one proportion z-test. RESULTS A total of 76 patients with a diagnosis of biopsy-proven periorbital and facial SCC were identified, 67 involved the ocular adnexa. Thirty-nine (58.2%) patients had lesions located on the eyelid. Of these, 33 (84.6% p < 0.0001, 95% CI 69.45-94.13) had lesions located at the margin, six of the 39 lesions were non-marginal. The remaining lesions were present within the brow (n = 10, 14.9%), medial canthus (n = 10, 14.9%), palpebral conjunctiva (n = 1, 1.5%), or orbit (n = 1, 1.5%). In six patients (8.9%) lesions involved multiple anatomic subunits. CONCLUSION We present our investigation of the incidence of SCC of the marginal vs. non-marginal eyelid, revealing a statistically significant increased involvement of the eyelid margin. Future investigations are necessary to further elucidate the vulnerability of the eyelid margin to the development of SCC in particular in regards to the role of the unique genetic expression profile of eyelash follicular stem cells.
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Affiliation(s)
- Alison H Watson
- Wills Eye Hospital, Oculoplastic and Orbital Surgery, Philadelphia, Philadelphia, USA
| | - Sabah Akbani
- Dell Medical School, University of Texas, Austin, Texas, USA
| | - Natalie Homer
- Ophthalmology and Vision Science, UC Davis Health, Sacramento, California, USA
| | - Marie Somogyi
- TOC Eye and Face, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Vikram Durairaj
- TOC Eye and Face, Dell Medical School, University of Texas, Austin, Texas, USA
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Watson AH, Homer N, El-Hadad C, Durairaj V. Unilateral Favre-Racouchot of the Eyelid. Orbit 2022:1. [PMID: 35612527 DOI: 10.1080/01676830.2022.2025857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/23/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Alison H Watson
- Oculoplastic and Orbital Surgery Department, Wills Eye Hospital, Philadelphia, PA US
| | - Natalie Homer
- Ophthalmology and Vision Science, Uc Davis Health, Sacramento, California, US
| | - Christian El-Hadad
- Orbital Oncology, Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Science, McGill University, Montreal, Quebec, Canada
| | - Vikram Durairaj
- Oculoplastic and Orbital Surgery, TOC Eye and Face, Austin, Texas, US
- Dell Medical School, University of Texas, Austin, Texas, US
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Gün RD, Şimşek Ş. Effect of manual upper eyelid elevation on intraocular pressure measurement by noncontact tonometer. Int Ophthalmol 2022. [PMID: 35556201 DOI: 10.1007/s10792-022-02324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate whether manual upper eyelid elevation (MUEE) affects intraocular pressure (IOP) values obtained with a noncontact tonometer (NT). METHODS This cross-sectional study included 122 eyes of 122 non-glaucomatous adults. All patients underwent IOP measurement using both NT and Goldmann applanation tonometer (GAT). The order of measurements was NT without MUEE, NT with MUEE, and GAT. Both eyes of each patient were measured and one of the eyes was randomly selected for inclusion in the study. Central corneal thickness (CCT) and palpebral fissure height (PFH; distance between upper and lower eyelids) was recorded. RESULTS The patients' mean age was 43.91 ± 12.36 (20-61) years and 62.3% were women. Mean IOP values measured by NT without MUEE, NT with MUEE, and GAT were 15.98 ± 2.39, 15.84 ± 2.53, and 14.33 ± 2.3 mmHg, respectively. There was no statistically significant difference in mean IOP between NT without and with MUEE (p = 0.506). Mean IOP values obtained by NT with and without MUEE were significantly higher than those obtained by GAT (p < 0.001). The difference in IOP values measured by NT without and with MUEE was positively correlated with PFH (r = 0.214; p = 0.018). CCT and IOP values obtained by NT without MUEE and GAT were positively correlated (r = 0.300; p = 0.001 and r = 0.311; p = 0.001, respectively). CONCLUSION MUEE does not have a significant effect on IOP measurements by NT. The difference between IOP measured by NT without and with MUEE increases with greater PFH.
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Kocer AM, Sen EM, Caydere M, Yenigun S, Hucumenoglu S. The histopathological findings in excised upper eyelids of patients with dermatochalasis following collagen cross-linking treatment. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 35294639 DOI: 10.1007/s00417-022-05629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the histopathological effects of collagen cross-linking (CCL) on excised skin samples of patients undergoing upper eyelid blepharoplasty due to dermatochalasis. METHODS This study examined 74 excised eyelid skin samples from 37 dermatochalasis patients. Following an upper eyelid blepharoplasty, CCL with hypotonic riboflavin (0.1%) was applied. Both treated (right eyelid, CCL group) and untreated eyelid specimen (left eyelid, non-CCL group) sections were stained with hematoxylin-eosin and Masson's trichrome. The sections were evaluated for the following parameters: the collagen status (parallel, oblique, and perpendicular), the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers. RESULTS There were no statistically significant differences in the collagen status, the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers between the CCL and non-CCL groups (p > 0.05 for all). Although the lack of statistically significant differences, the structure of the treated eyelid collagen fibers was more parallel in 48% of the participants than in the untreated ones. For male patients, a statistically significant shorter distance between collagen fibers was observed in the CCL group (8.05 ± 2.04 µm) compared to the non-CCL group (9.97 ± 2.33 µm) (p = 0.042). CONCLUSION In this study, more parallel collagen structures and tightly packed collagen fibers were detected in eyelid samples following CCL treatment. The authors note that the results of this study may be promising for further research, so the effect of CCL therapy on the eyelid may be an interesting subject for the treatment of non-severe or surgically inadequately corrected dermatochalasis.
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Siadati S, Campbell AA, McCulley T, Eberhart CG. Clinicopathological Features of 19 Eyelid Pilomatrixomas. Ocul Oncol Pathol 2022; 8:30-34. [PMID: 35356601 PMCID: PMC8914276 DOI: 10.1159/000520219] [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] [Received: 06/08/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Pilomatrixoma is a relatively rare, benign tumor arising from the hair root matrix. It is found frequently on the head and neck, with most involving the eyebrow in the periocular region. In contrast, eyelid pilomatrixoma is less common, and often clinically misdiagnosed. Here, we present clinical and histological data from 19 pilomatrixomas arising in the eyelid. Methods The study represents a retrospective study of eyelid pilomatrixoma diagnosed at our institution since 1981. All slides were reviewed, and demographic as well as clinical data were obtained. Results Patient ages ranged from 2 to 63 years (mean 24 years), including 12 (63%) females and 7 (37%) males. Eight (42%) and 4 (21%) cases arose in the first and second decades of life, respectively. Upper eyelid involvement was found in 14 (74%) of cases. Microscopically, the tumors were characterized by basaloid and shadow cells accompanied by calcification and foreign body giant cells. Conclusions Eyelid pilomatrixoma is rarely suspected clinically, and can be mistaken for cyst, chalazion, sebaceous carcinoma, and other tumors. Physicians should consider the possibility of pilomatrixoma in the eyelid area, especially in children or young female patients. Complete excision is curative, and diagnosis can generally be established by histopathological examination.
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Affiliation(s)
- Sepideh Siadati
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ashley A. Campbell
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy McCulley
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles G. Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,*Charles G. Eberhart,
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Sakisaka S, Tanabe M, Imayama S, Zeze N, Yamana K, Yoshikawa H, Sonoda KH. Two Cases of Angiosarcoma with Persistent Unilateral Eyelid Swelling. Ocul Oncol Pathol 2022; 8:16-21. [PMID: 35356598 PMCID: PMC8914193 DOI: 10.1159/000520293] [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] [Received: 08/09/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023] Open
Abstract
Angiosarcoma is a widely known neoplasm with one of the poorest prognoses; however, such cases are rarely observed by the ophthalmologists in clinical practice. The tumor commonly develops on the face and scalp and may cause eyelid swelling. We present 2 such cases. Case 1 was an 82-year-old woman who presented with indulated swelling of the right eyelid that extended to the upper forehead. Biopsy revealed a poorly circumscribed tumor infiltrated throughout the dermis and fat tissue, exhibiting both angiomatous and solid patterns. Immunohistochemistry showed CD31(-) and D2-40/podoplanin(+), suggesting angiosarcoma. The patient had multiple lung metastases and died 14 months later. Case 2 was a 77-year-old man who presented with swelling of the left eyelid, and erythema on the left temporal skin developed ulcerated nodules. Biopsy showed proliferated tumor cells in a sheet form, extensively throughout the dermis. Angiosarcoma was preferred based on immunohistochemistry: CD31(+), CD34(+), and D2-40(-). The patient was treated with electron beam therapy and chemotherapy and died after 13 months. It would be difficult for an ophthalmologist to suspect such a rare neoplasm only from swelling of the eyelids. However, angiosarcoma should be considered if the swelling spreads steadily from a head rash with a nodule or ulcer nearby.
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Affiliation(s)
- Shinzo Sakisaka
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan,*Mika Tanabe,
| | - Mika Tanabe
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan,*Mika Tanabe,
| | | | - Nahoko Zeze
- Department of Dermatology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Kanako Yamana
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroshi Yoshikawa
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
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Go CC, Kim DH, Go BC, McGeehan B, Briceño CA. Clinicopathologic Characteristics and Prognostic Factors Impacting Survival in Melanoma of the Eyelid. Am J Ophthalmol 2022; 234:71-80. [PMID: 34343490 DOI: 10.1016/j.ajo.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine prognostic factors for survival in patients with melanoma of the eyelid. DESIGN Retrospective cohort study. METHODS This population-based study reviewed patients with primary melanoma of the eyelid diagnosed in the Surveillance, Epidemiology and End Results database between 1975 and 2016. The primary outcomes included survival rates estimated by Kaplan-Meier analysis and mortality hazard ratios (HRs) for overall survival and disease-specific survival (DSS). RESULTS The cohort consisted of 2257 patients with cutaneous melanoma of the eyelid, representing 1380 cases of melanoma in situ and 877 cases of invasive melanoma. For melanoma in situ and invasive melanoma respectively, at 5 years, the overall survival rates were 88.6% and 77.1%, while DSS rates were 99.4% and 91.0%. Cox regression analysis for eyelid melanoma indicated that for invasive melanoma, age at diagnosis ≥75 years (HR 2.17 [95% confidence interval {CI} 1.02-4.60]; P = .04), T4 staging (HR 8.45 [95% CI 2.96-25.31]; P < .001), lymph node involvement (HR 3.61 [95% CI 1.12-11.60]; P = .03), and nodular melanoma (HR 3.31 [95% CI 1.50-7.32]; P = .003) histologic subtype were associated with decreased rates of survival. Sex and tumor ulceration did not impact survival. CONCLUSIONS This study is the largest analysis to date that focuses on DSS for cutaneous melanoma of the eyelid. The most significant predictors for invasive melanoma survival are age ≥75 years at diagnosis, T4 staging, lymph node involvement, and the nodular melanoma histologic subtype. Patients with these attributes are at higher risk and should be counseled regarding prognosis.
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Oh SJ, Kim KS, Choi JH, Hwang JH, Lee SY. Scar formation after lower eyelid incision for reconstruction of the inferior orbital wall related to the lower eyelid crease or ridge in Asians. Arch Craniofac Surg 2022; 22:310-318. [PMID: 34974686 PMCID: PMC8721435 DOI: 10.7181/acfs.2021.00521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Transcutaneous lower eyelid approaches are associated with a risk of postoperative scarring depending on the distance between the incision line and the lower eyelid margin. The lower eyelid crease of Caucasians corresponds to a ridge-shaped fold in young Asians. However, this relationship has not been sufficiently evaluated in the latter. The authors, therefore, investigated the location of the scar and the lower eyelid crease or ridge to find the optimal location for the incision line. Methods This study included 60 out of 139 patients who underwent inferior orbital wall reconstruction through a lower eyelid skin incision between July 2019 and June 2020. According to the location of the scar, the patients were classified into three groups: group A ( ≥ 2 mm above the lower eyelid crease or ridge), group B (within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge), and group C (within the lower eyelid crease or ridge to 2 mm below the lower eyelid crease or ridge). At 6 or 12 months after surgery, the Patient and Observer Scar Assessment Scale (POSAS) score was obtained, the distance between the lower eyelid margin and the scar (DMS) and the distance between the margins of the peripheral pupil and the lower eyelid (DMPE) were measured, and the occurrence of ectropion was evaluated. Results Group B had the lowest POSAS score (A: 22.7 ± 8.0, B: 20.9 ± 2.4, C: 32.5 ± 4.1, p < 0.001). Linear regression analysis showed that the DMS was positively correlated with the POSAS score (p < 0.001) and that the risk of DMPE widening increased as the DMS decreased (p = 0.029). None of the patients had ectropion. Conclusion When using the transcutaneous approach for inferior orbital wall reconstruction, the optimal incision site is within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge.
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Affiliation(s)
- Seong Jin Oh
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Ho Choi
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
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Narinx F, Monclin S, Sauvage A, Vercruysse E, Heimann M, Alloway E, Vandersmissen M, Grauwels M. Identification of an ectopic periorbital lymph node in two horses. Open Vet J 2022; 12:768-773. [PMID: 36589395 PMCID: PMC9789756 DOI: 10.5455/ovj.2022.v12.i5.23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background To describe the clinical presentation and treatment of an ectopic periorbital lymph node in two young horses. Case Description Two warm-blood horses were presented at the equine clinic of the University of Liège with a periorbital non-painful mass. Differential diagnosis included neoplasm (lymphoma), (sterile) abscess, cyst, ectopic lacrimal gland tissue, hematoma, adipose tissue, or ectopic lymphoid tissue. Information collected included physical and ophthalmic examination findings, results of the ocular and periocular ultrasound, surgical procedure, histopathology, and follow-up. Masses of 2 × 2 cm and 3 × 2 cm subcutaneous, ovoid, smooth, and firm mass were observed in the zygomatic region of the head. On ultrasound, the mass appeared as a hypoechoic subcutaneous structure. Cytology showed a mixed lymphocytic cell population. No abnormal mitotic activity was observed. Histopathology revealed a chronic markedly reactive lymph node. Conclusion To the authors' knowledge, this is the first description of periorbital ectopic lymph nodes in veterinary medicine. Ectopic lymph nodes should therefore be included in the differential diagnosis of periocular masses in animals. Surgery was easily performed and was curative.
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Affiliation(s)
- Florine Narinx
- Department of Ophthalmology, Veterinary Teaching Hospital, University of Liège, Liège, Belgium,Corresponding Author: Florine Narinx. Department of Ophthalmology, Veterinary Teaching Hospital, University of Liège, Liège, Belgium.
| | - Sébastien Monclin
- Department of Ophthalmology, Veterinary Teaching Hospital, University of Liège, Liège, Belgium
| | - Aurélie Sauvage
- Department of Ophthalmology, Veterinary Teaching Hospital, University of Liège, Liège, Belgium
| | - Eline Vercruysse
- Department of Ophthalmology, Veterinary Teaching Hospital, University of Liège, Liège, Belgium
| | | | | | - Maxime Vandersmissen
- Department of Medical Imaging, Veterinary Teaching Hospital, University of Liège, Liège, Belgium
| | - Magda Grauwels
- Department of Ophthalmology, Veterinary Teaching Hospital, University of Liège, Liège, Belgium
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Adams SH, Huang NT, Bersani T, Alpert S. Lichen simplex chronicus of the eyelid: A case report and literature review. Am J Ophthalmol Case Rep 2021; 24:101237. [PMID: 34917854 PMCID: PMC8646120 DOI: 10.1016/j.ajoc.2021.101237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/07/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a case of lichen simplex chronicus (LSC) of the eyelid and to perform a literature review on this topic. Observations A 59-year-old African American man presents with chronic and recalcitrant recurrent chalazion of both upper eyelids despite aggressive medical management. An incision and drainage procedure was performed along with biopsy of the eyelid, which was found to be consistent with LSC. A thorough review of the English literature pertaining to LSC of the eyelids was performed by querying PubMed and Google Scholar. Though two clinical reports of LSC of the eyelid were found in older literature, only one such case confirmed by biopsy has been reported until now. Conclusions LSC of the eyelid is rare and this is the first reported case that is associated with chronic and recalcitrant chalazion.
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Affiliation(s)
- Steven H Adams
- College of Medicine, State University of New Yokr Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - Natalie T Huang
- Department of Ophthalmology and Visual Science, State University of New York Upstate Medical University, 750 E Adams Street, NY, 13210, USA
| | - Thomas Bersani
- Eye Plastic & Reconstructive Surgeons of Central New York, 3400 Vickery Rd, North Syracuse, NY, 13212, USA
| | - Samuel Alpert
- Department of Ophthalmology and Visual Science, State University of New York Upstate Medical University, 750 E Adams Street, NY, 13210, USA
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Hou X, Rokohl AC, Meinke MM, Liu J, Li S, Fan W, Lin M, Jia R, Guo Y, Heindl LM. Standardized Three-Dimensional Lateral Distraction Test: Its Reliability to Assess Medial Canthal Tendon Laxity. Aesthetic Plast Surg 2021; 45:2798-807. [PMID: 34232357 DOI: 10.1007/s00266-021-02440-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/19/2021] [Indexed: 02/05/2023]
Abstract
Background Assessment of MCT laxity is critical to the surgery options. Our study aimed to analyze the reliability of measuring medial canthal tendon (MCT) laxity by using a novel standardized three-dimensional lateral distraction test (3D-LDT). Methods Forty-eight Caucasian volunteers (25 males and 23 females, 96 eyes) between 22 and 84 years of age (55.6 ± 18.6 years old) were included in our study. From a neutral position, the lower eyelid was gently pulled laterally along a horizontal line to define the most distracted position of the lower punctum. Both in the neutral and distracted position, standardized 3D images were acquired for each subject by two observers, and each image were measured twice by two raters. Four landmarks and six corresponding linear measurements were evaluated for intra-rater, inter-rater, and inter-method reliability. Results Intra-rater, inter-rater and inter-method reliability analyses of 3D-LDT revealed an intraclass correlation of more than 95%, a mean absolute difference of less than 1 mm, and a technical error of measurement of less than 1 mm. Measurements of relative error (2.59–12.04%) and relative technical error (1.83–16.05%) for the inter-landmarks distance from pupil center to the lower punctum were higher than those from limbus nasal center to the lower punctum (6.13–30.39 and 4.34–26.85%, respectively). Conclusions This study provided high reliability of the three-dimensional lateral distraction test (3D-LDT) for assessing medial canthal tendon (MCT) laxity, which were never evaluated by digital imaging system. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Li G, Lin Z, Liu Y, Wang C, Zang H, Yang K. [Repair of eyelid and periocular soft tissue defects with Pacman flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:1463-1466. [PMID: 34779174 DOI: 10.7507/1002-1892.202106066] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects. Methods The clinical data of 12 patients who underwent repair of eyelid and periocular soft tissue defects with Pacman flap between April 2015 and September 2020 was retrospectively reviewed. There were 5 males and 7 females, aged from 18 to 87 years, with a median age of 63 years. The disease duration ranged from 6 months to 50 years, with a median time of 3 years. The defect was located on the lateral eyelid in 5 cases, inferior eyelid in 3 cases, inferior and medial eyelid in 2 cases, inferior and lateral eyelid in 2 cases, and lateral eyebrow in 1 case. Pathological diagnosis included 4 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma, 1 case of junction nevus, 1 case of intradermal nevus, 1 case of seborrheic keratosis, and 1 case of keratoacanthoma. The size of defects ranged from 1.4 cm×1.2 cm to 5.5 cm×5.0 cm. According to the skin mobility and toughness around the defects, Pacman flaps with the size of 1.6 cm×1.4 cm to 10.0 cm×6.0 cm were designed and advanced to repair the defects. Results All flaps survived completely with no necrosis. One patient had infection, and another patient had partial wound dehiscence, but the wounds healed after dressing change without further debridement. Other patients all recovered successfully. The follow-up time ranged from4 to 51 months, with a median time of 12 months. No recurrence and metastasis occurred, and the scars were invisible without deformity of eyelid and brow. All patients were satisfied with the aesthetic and functional outcomes of the eyes. Conclusion Pacman flap is a simple and feasible technique for repair of eyelid and periocular soft tissue defects, with satisfactory effectiveness.
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Affiliation(s)
- Guangxue Li
- Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Zhiyu Lin
- Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Yan Liu
- Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Cai Wang
- Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Huiran Zang
- Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
| | - Kai Yang
- Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China
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Yolcu D, Ozdogan S. A novel method to measure margin reflex distance using the autorefractometer. Int Ophthalmol 2021; 42:1241-1247. [PMID: 34738206 DOI: 10.1007/s10792-021-02110-7] [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] [Received: 03/26/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the margin reflex distance (MRD) in healthy subjects using autorefractometer front monitor images (ARFMI) and validate the accuracy of this method by comparing it with conventional methods. METHODS One hundred eyes of 50 healthy subjects aged 20-59 years were included in the study. Autorefractometer front monitor images were video-recorded using a smartphone camera, and screenshots were taken to analyze the MRD. The results were compared with those from conventional methods to determine the reliability of the method. To evaluate the repeatability and reproducibility of all measurement methods, we performed two different visits by two observers. RESULTS The mean MRD-1 of the autorefractometer image measurement was 4.29 ± 0.90 mm, mean MRD-1 of the of the digital photography image measurement was 3.78 ± 1.03 mm, and mean MRD-1 of the manual measurement was 4.02 ± 1.09 mm. The mean difference (MD) of MRD-1 was analyzed and it was found that MD of the autorefractometer image was significantly higher than the MD of other groups (p < 0.001). The best repeatability was found in the autorefractometer image measurement [intraclass correlation coefficients (ICC): 0.960], and substantial to excellent repeatability was found in the manual (ICC: 0.903) and digital photography image measurements (ICC: 0.843). The mean inter-eye difference of MRD-1 measured by the three methods was analyzed, and there was a statistically significant difference in the autorefractometer and digital image groups (p: 0.001, p: 0.002, respectively). CONCLUSION Margin reflex distance measurement using ARFMI analysis is a novel, simple, accurate, reliable, and objective method. The autorefractometer device is readily available and can be found in any ophthalmic clinic. Therefore, ophthalmologists can easily measure and record MRD values and use the accurate and reliable results for follow-up and medicolegal issues.
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Affiliation(s)
- Demet Yolcu
- Department of Ophthalmology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Demetevler, Vatan Cd., Yenimahalle, Ankara, 06200, Turkey.
| | - Sibel Ozdogan
- Department of Ophthalmology, Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Demetevler, Vatan Cd., Yenimahalle, Ankara, 06200, Turkey
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Chauvel-Picard J, Allavena J, Beuriat PA, Di Rocco F, Gleizal A, Paulus C. Lipofilling of the lower eyelids: A craniofacial tool to postpone the facial advancement in craniofacial syndromes. J Stomatol Oral Maxillofac Surg 2021; 123:448-451. [PMID: 34649014 DOI: 10.1016/j.jormas.2021.10.003] [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] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Many genetic diseases are responsible for a defect in the growth of the maxilla. Craniofacial syndromes such as Crouzon syndrome or Apert syndrome are typically associated with a major hypoplasia in the midface responsible for exophthalmos, leading to palpebral malocclusion and frequent corneal complications. Several treatments have been used to manage ocular protection in craniofacial syndromes such as tarsorrhaphy, a fronto-orbital advancement and/or a Lefort III osteotomy with or without distraction. We describe a new approach as a waiting solution to relieve exophthalmos: the autologous fat grafting of the lower eyelids. MATERIAL AND METHODS Children operated from lipofilling of the lower eyelids at the Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital in Lyon, were included. All the patients suffered from midface hypoplasia and exophthalmos with insufficient eyelid closure responsible of multiples episodes of keratitis and corneal ulcerations. RESULTS Four children were included: three suffered from Crouzon Syndrome and one suffered from Apert Syndrome. The fat was reinjected at the level of the infraorbital rim, the nasolabial fold or the palpebrojugal fold, in the different planes, according to the patients' needs. Six months after surgery, a second surgery was performed for the patients whose lagophtalmos persisted. Six months after the second procedure, the results are satisfactory with a good eyelid closure. CONCLUSION The lipofilling, well used in pediatric surgery to restore facial symmetry, can also be used, as a waiting solution or complement to treat complicated exophtalmos with visual prognosis involved in congenital craniofacial syndromes.
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Affiliation(s)
- Julie Chauvel-Picard
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France.
| | - Julie Allavena
- Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
| | - Arnaud Gleizal
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalo-Universitaire Nord, Avenue Albert Raimond, 42000 SAINT-ETIENNE, France
| | - Christian Paulus
- Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677 BRON, France
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Verma S, Kumar N, Meel R, Sen S, Kashyap S, Sharma S, Pushker N, Pushpam D, Bakhshi S. Neoadjuvant Systemic Chemotherapy in Sebaceous Gland Carcinoma of the Eyelid: A Retrospective Study. Ocul Oncol Pathol 2021; 7:251-256. [PMID: 34604196 DOI: 10.1159/000515857] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/14/2021] [Indexed: 11/19/2022] Open
Abstract
There are sparse data on neoadjuvant systemic chemotherapy (NACT) in eyelid sebaceous gland carcinoma (SGC). The aim of this study was to evaluate efficacy and outcomes with NACT in eyelid SGC. We retrospectively analyzed 8 patients who received platinum-based NACT. The median number of cycles per patient was 4 (range, 3-5). The mean percentage reduction of tumor diameter after NACT was 71% (range, 30-100%). Two patients had a radiological complete response (CR). After NACT, surgical treatment for residual tumor was performed in 5 cases. One patient had a pathological CR and is recurrence free for 11 years. After a mean follow-up period of 44.5 months (range, 9-109), tumor recurrence occurred in 4 cases. Among these 4 cases, 3 were rechallenged with the same regimen and all responded. Systemic NACT has a role in eyelid SGC, downstages the tumor, and allows less aggressive and organ-sparing surgeries, warranting a prospective study.
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Affiliation(s)
- Saurav Verma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nipun Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Ocular Radiology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Abstract
PURPOSE To report the ultrasound biomicroscopic features of normal lower eyelid structures. METHODS Thirty lower eyelids of fifteen healthy adults were randomized and prospectively subjected to Ultrasound Biomicroscopy (Quantel Aviso with 50 MHz transducer) by two independent observers (an ophthalmologist and an optometrist). The measurements were performed in upgaze, with the probe perpendicular to the lower eyelid margin in the mid-pupillary line, two limbal lines, and two canthal lines. The tarsus, orbicularis, capsulopalpebral fascia, and retractor-conjunctiva complex were assessed for two parameters: echogenicity (hyper/hypoechoic) and measurement in millimeters. RESULTS Mean age was 25 years (range 20-39 years), 15 (50%) were right lower eyelids and 8 were males. The first layer, skin-orbicularis complex appeared hyperechoic. The second layer was hypoechoic band which represents the tarsal plate superiorly and capsulopalpebral fascia inferiorly. This was noted to be continuous and of almost uniform thickness in the normal eyelids. The glandular structure of meibomian glands was identified in 100% cases. The hyperechoic layer below the capsulopalpebral fascia is the retractor-conjunctiva complex. The mean thickness of pretarsal and pre-septal orbicularis was 0.68 ± 0.18 mm and 0.89 ± 0.16 mm, respectively. The tarsal plate measured 0.57 ± 0.12 mm, capsulopalpebral fascia 0.42 ± 0.13 mm and the retractor-conjunctiva complex 0.79 ± 0.18 mm. On Bland-Altman analysis, the majority of the measurements had mean agreements between -0.14 mm and +0.12 mm. Anatomical differentiation was not useful in the canthal region. CONCLUSION Echogenicity and thickness of normal lower eyelid structures as measured by UBM are reported. The test is non-invasive, with a good inter-observer agreement.
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Affiliation(s)
| | - Purabita Saha
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Milind N Naik
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, India
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Hasmat S, Suaning GJ, Lovell NH, Hubert Low TH, Clark JR. Facial nerve paralysis: A review on the evolution of implantable prosthesis in restoring dynamic eye closure. J Plast Reconstr Aesthet Surg 2021:S1748-6815(21)00426-5. [PMID: 34635457 DOI: 10.1016/j.bjps.2021.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/10/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Facial nerve paralysis (FNP) is a debilitating condition that leaves those affected with disfigurement and loss of function. The most important function of the facial nerve is protecting the eye through eye closure and blinking. A series of reanimation techniques have been reported to restore dynamic function in FNP, but the lack of a universally accepted method that is reliable and reproducible with immediate effect has led to the introduction of several implantable devices. Most of these devices have been applied to assist blinking; however, the delicate anatomy and unique mechanics of eye closure are difficult to replicate. Lid loading is the most frequently used implant today, which is a passive device that can aid in volitional eye closure but has a limited effect on blinking. Dynamic action can be achieved with active prostheses but achieving successful long-term function remains elusive. Device action must also be coupled with a real-time feedback mechanism in order to capture the natural variation in facial muscle movements. This review discusses all prostheses used for restoring eye closure and blinking to date and explores their relative merits.
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Sigulinsky CL, Li X, Levine EM. Expression of Sonic Hedgehog and pathway components in the embryonic mouse head: anatomical relationships between regulators of positive and negative feedback. BMC Res Notes 2021; 14:300. [PMID: 34353359 PMCID: PMC8340441 DOI: 10.1186/s13104-021-05714-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The Hedgehog pathway is a fundamental signaling pathway in organogenesis. The expression patterns of the ligand Sonic Hedgehog (Shh) and key pathway components have been studied in many tissues but direct spatial comparisons across tissues with different cell compositions and structural organization are not common and could reveal tissue-specific differences in pathway dynamics. Results We directly compared the expression characteristics of Shh, and four genes with functional roles in signaling and whose expression levels serve as readouts of pathway activity in multiple tissues of the embryonic mouse head at embryonic day 15.5 by serial in situ hybridization. The four readout genes were the positive feedback regulator Gli1, and three negative feedback regulators, Patched1, Patched2, and Hedgehog Interacting Protein. While the relative abundance of Gli1 was similar across tissues, the relative expression levels and spatial distribution of Shh and the negative feedback regulators differed, suggesting that feedback regulation of hedgehog signaling is context dependent. This comparative analysis offers insight into how consistent pathway activity could be achieved in tissues with different morphologies and characteristics of ligand expression. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05714-5.
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Affiliation(s)
- Crystal L Sigulinsky
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Xiaodong Li
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, 1161 21st Ave S, B3307 MCN/2569, Nashville, TN, 37232, USA
| | - Edward M Levine
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. .,Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, 1161 21st Ave S, B3307 MCN/2569, Nashville, TN, 37232, USA. .,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN, USA.
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Almousa R. The Management of Periocular Basal Cell Carcinoma: Mohs Micrographic Surgery Versus Wide Excision with Later Reconstruction. Predictors for Margin of Resection >4 mm in Mohs Micrographic Surgery. ACTA ACUST UNITED AC 2021; 35:391-396. [PMID: 34344136 PMCID: PMC8521323 DOI: 10.3341/kjo.2021.0022] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose To determine the margin of resection (MOR) for periocular basal cell carcinoma (BCC) and compare the outcomes of BCC treatment, namely Mohs micrographic surgery (MMS) and wide excision with later reconstruction (WELR). Methods This is a retrospective, comparative, interventional study of patients who underwent surgical treatment of periocular BCC. One hundred forty-two patients were included. One hundred patients were treated with MMS and 42 with WELR. Inclusion criteria were primary periocular BCC with postoperative follow-up of ≥6 months, age more than 18-year-old. Exclusion criteria were, orbital extension, BCC origin outside the periocular area, or those associated with Gorling or nevoid BCC. The main outcome measure was variables associates with MOR >4 mm. Results There was a positive correlation between the preoperative tumor horizontal and vertical diameter with the corresponding MOR, of 0.27 (p = 0.01) and 0.28 (p = 0.007), respectively. Receiver operating characteristics suggest that a tumor with a horizontal diameter ≥5 mm or a vertical diameter of ≥6 mm, might need MOR >4 mm. One patient in the MMS group had BCC recurrence compared to none in the WELR group, and one patient in the WELR had a positive surgical margin, which was cleared during the reconstruction. Conclusions BCC tumor margins may extend far beyond clinical margins and the MOR required is often more than 3–4 mm. MMS ensures clear tumor margins but is not practical for all patients. A stratification system could help divide patients between the treatment strategies.
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Affiliation(s)
- Radwan Almousa
- Ophthalmology Department Barking, Havering and Redbridge University Hospitals
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