PURPOSE: This study aims to investigate the distribution of payments made to oculofacial plastic surgeons who are members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons, and examine the regular...PURPOSE: This study aims to investigate the distribution of payments made to oculofacial plastic surgeons who are members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons, and examine the regularity of financial relationships between industries and oculofacial plastic surgeons. METHODS: This analysis included all American Society of Ophthalmic Plastic and Reconstructive Surgeons fellow members listed in the online directory. Annual statistical data were obtained from the Open Payments Database, and all general payments distributed to oculoplastic surgeons were recorded. Data are summarized by company and amounts distributed to the member. The main outcome is the cumulative payments made by the highest 3 individual industry companies to oculoplastic surgeons using data available from 2021 to 2023. Secondary outcomes looked at payments to leadership positions within the American Society of Ophthalmic Plastic and Reconstructive Surgeons. RESULTS: Six hundred twenty-seven surgeons received $13,069,190.03 over 6,831 payments. The average payment was $1,913.22, while the median payment was $117.12. The top 10 companies contributed a total of $11,540,952.07 (88.3%) of payments while the top 20 surgeons were paid $9,210,203.88 (70.5%) of all contributions. The top 3 companies contributed $9,088,333.48 (69.5%) of payments. In the $10,000 to $99,999 category, Horizon contributed $2,145,840.48 to 69 surgeons, while Galderma and Allergan contributed $113,355.12 to 3 surgeons and $298,972.96 to 11 surgeons, respectively. Between $1,000 and $9,999, Horizon made payments totaling $298,331.84 to 80 surgeons, Galderma contributed $24,289.64 to 7 surgeons, and Allergan contributed $72,768.35 to 27 surgeons. Fifty-six program directors took part in training fellows in oculofacial plastic surgery. The total payment volume for odd-year programs was $2,549,997.64 with an average of $87,930.95 and median of $6,841.28. The total for even-year programs was $1,511,807.29 with an average and a median of $55,992.86 and $1,326.70, respectively. Thirty-three members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons' current or past 10-year executive committee/board of directors were paid $3,975,434.02, with an average payment of $120,467.70 and a median payment of $3,706.88. CONCLUSIONS: The reporting of open payments to providers is important in providing transparency between physicians and industry. There exists a great discrepancy in the distribution of industry payment within oculofacial plastics, showing a very strong apical dominance with relatively few surgeons receiving a higher number of payments, larger total reimbursements, and from relatively few companies.
PURPOSE: To report the outcomes of a small case series of patients with periorbital necrotizing fasciitis (PONF) treated with high-dose intravenous antibiotics and dilute, pure hypochlorous acid (HOCL) irrigated through...PURPOSE: To report the outcomes of a small case series of patients with periorbital necrotizing fasciitis (PONF) treated with high-dose intravenous antibiotics and dilute, pure hypochlorous acid (HOCL) irrigated through affected tissues as well as sprayed topically, with no tissue debridement. METHODS: In this single-center, retrospective chart review, 6 patients were identified between May 1, 2022, and May 1, 2024, with PONF who had HOCL used during their treatment. The primary outcome measures included successful eradication of infection, acceptable aesthetic result with minimal or no reconstruction required, and little or no loss of vision. Results of treatment were compared with those PONF patients in the literature treated more traditionally with antibiotics and debridement, and those treated with antibiotics alone. RESULTS: Of the 6 patients identified with PONF, all 6 were treated with dilute, pure HOCL (0.033%). The median age of the patients was 51 (range 32-73). The female-to-male ratio was equal. The median follow-up time since the first presentation was 158 days (range 30-180). Streptococcus pyogenes was the most common causative organism, found in 80% of cases. No patient underwent tissue debridement in the periocular area. All patients recovered with minimal sequelae. No patient reported loss of vision on their final follow-up visit. There were no patients who required enucleation or exenteration and no patients died because of PONF. CONCLUSIONS: The authors describe a simple method of introducing dilute, pure HOCL (0.033%) without hypochlorite or sodium hypochlorite as impurities via irrigation and topical spray into the treatment plan for PONF. There was little if any loss of tissue with this treatment in this series. The outcomes compared favorably to those outcomes in the literature of PONF patients treated more traditionally with antibiotics and debridement, and those patients treated more conservatively with antibiotics alone. HOCL irrigation and spray techniques appear to be beneficial in the management of PONF and decrease the need to debride, allowing faster disease resolution and contributing to favorable outcomes.
Necrotizing periorbital Sweet syndrome is an uncommon mimic of necrotizing fasciitis that requires contrasting management. We describe a 60-year-old man with rapidly progressive unilateral eyelid edema, pain, and necrosi...Necrotizing periorbital Sweet syndrome is an uncommon mimic of necrotizing fasciitis that requires contrasting management. We describe a 60-year-old man with rapidly progressive unilateral eyelid edema, pain, and necrosis unresponsive to broad-spectrum antibiotics. Computed tomography showed periorbital soft-tissue swelling with gas. Two debridements for presumed necrotizing fasciitis yielded "dishwater" fluid; histopathology and special stains revealed a dense neutrophilic dermatosis without organisms, and cultures grew only commensals. He improved promptly after high-dose corticosteroids. Hematologic evaluation for escalating leukocytosis uncovered acute myeloid leukemia with t(6;9) and neuroblastoma RAS viral oncogene homolog mutation. A targeted literature synthesis showed frequent initial misdiagnoses as cellulitis or necrotizing fasciitis, unnecessary debridement, common association with myeloid neoplasia, and rapid steroid response. Periorbital sweet syndrome should be considered when cultures are sterile and clinical status worsens despite antibiotics; early biopsy and empiric corticosteroids can avert morbidity and unmask occult malignancy.
PURPOSE: This study aimed to assess the potential role of large language models in the postoperative management of lower lid blepharoplasty patients. METHODS: This study employed a cross-sectional design to evaluate the...PURPOSE: This study aimed to assess the potential role of large language models in the postoperative management of lower lid blepharoplasty patients. METHODS: This study employed a cross-sectional design to evaluate the content validity of ChatGPT-4's responses to common postoperative concerns following lower lid blepharoplasty: bleeding, diplopia, dry eyes, pain, lower lid retraction, and bruising/hematoma/orbital hemorrhage. Twelve American Society of Ophthalmic Plastic and Reconstructive Surgery physicians graded the responses for clinical accuracy on a 5-point Likert scale and assessed the appropriateness of management recommendations. Flesch Reading Ease scores and Flesch-Kincaid Grade Level were generated to assess readability. The Patient Education Materials Assessment Tool was utilized to evaluate understandability and actionability of each response. RESULTS: Average accuracy grades for the 6 responses ranged from 4.33 to 4.67 out of 5, with an overall average of 4.50 ± 0.63. The proportion of graders who deemed ChatGPT-4's patient management recommendations appropriate ranged from 75.0% to 100% across the 6 responses. Flesch Reading Ease scores ranged from 28.9 to 50.2, with Flesch-Kincaid Grade Level scores ranging from grade 9.4 to 13.4 for reading level. The average Patient Education Materials Assessment Tool understandability score was 91.67 ± 0.52%, while all 6 responses received an actionability score of 60%. CONCLUSIONS: ChatGPT-4 showed promise as a supportive tool for postoperative care following lower lid blepharoplasty, with generally accurate and appropriate responses. However, further refinement is needed before it can be considered a reliable clinical resource. Ongoing physician involvement in the development and evaluation of medical AI will be critical to ensuring these technologies are safe, accurate, and capable of meaningfully enhancing patient care.
We describe a novel application of the nasal Superficial Musculoaponeurotic System flap for medial orbital wall reconstruction following orbital exenteration. A 64-year-old woman underwent type IIa exenteration for moder...We describe a novel application of the nasal Superficial Musculoaponeurotic System flap for medial orbital wall reconstruction following orbital exenteration. A 64-year-old woman underwent type IIa exenteration for moderately differentiated squamous cell carcinoma of the right medial canthus, requiring resection of the lamina papyracea. A pedicled nasal Superficial Musculoaponeurotic System flap incorporating perichondrium and based on the dorsal nasal artery was harvested through a midline nasal incision to close a 1.5-cm communication between the orbit and nasal cavity. To provide additional stability and coverage, a contralateral supratrochlear artery-based paramedian forehead flap was employed. Postoperative evaluation confirmed flap viability and satisfactory anatomical separation between the orbit and nasal cavity. To our knowledge, this is the first reported use of a nasal Superficial Musculoaponeurotic System flap in orbital reconstruction. This case highlights its potential as a reliable and well-vascularized option for selected medial orbital wall defects.
PURPOSE: To examine our current understanding of insulin-like growth factor-1 receptor's (IGF-1R) role in female reproductive physiology and identify the mechanisms that underlie commonly reported new-onset menstrual abn...PURPOSE: To examine our current understanding of insulin-like growth factor-1 receptor's (IGF-1R) role in female reproductive physiology and identify the mechanisms that underlie commonly reported new-onset menstrual abnormalities in premenopausal women following initiation of teprotumumab, an IGF-1R antagonist, for treatment of thyroid eye disease. METHODS: This is a narrative review. First, studies were identified that reported menstrual changes with the use of teprotumumab. Then, literature regarding IGF-1R signaling and female reproductive physiology was explored to generate a hypothesis on how IGF-1R antagonism may be causative of the menstrual abnormalities attributable to teprotumumab. RESULTS: Reported rates of menstrual abnormalities, predominantly amenorrhea, attributable to IGF-1R antagonism range from 5% to 50%. Cellular expression of IGF-1R is documented across the spectrum of tissues that are critical to the successful functioning of the female reproductive system, including the hypothalamus, pituitary, ovary, and the endometrium. CONCLUSIONS: The likely mechanisms through which menstrual abnormalities occur with IGF-1R antagonism are through disruption of ovarian processes of folliculogenesis, steroidogenesis, and ovulation. Ultimately, further basic and clinical research is warranted to better understand the mechanisms whereby IGF1-R antagonism disrupts female reproductive functioning, as well as to examine if there is any lasting detriment beyond cessation of exposure to IGF1-R antagonists such as teprotumumab.
Syringocystadenocarcinoma papilliferum is an exceptionally rare malignant adnexal neoplasm of sweat gland origin, with fewer than 90 cases reported in the literature, most arising within the head and neck region. Periocu...Syringocystadenocarcinoma papilliferum is an exceptionally rare malignant adnexal neoplasm of sweat gland origin, with fewer than 90 cases reported in the literature, most arising within the head and neck region. Periocular involvement is exceedingly uncommon, with only 3 previously documented cases, one of which was confined to the eyelid. The authors describe an 80-year-old man who presented with new onset erythema, irritation, and growth of a long-standing upper eyelid lesion. Incisional biopsy was interpreted as squamous cell carcinoma with papillary morphology. Subsequent excision and histopathologic examination of the entire lesion led to a diagnosis of syringocystadenocarcinoma papilliferum arising in a background of syringocystadenoma papilliferum. This case adds to the limited literature of syringocystadenocarcinoma papilliferum in the periocular region, highlighting the clinical presentation, pathologic features, and biologic behavior of this rare tumor in the ocular adnexa.
PURPOSE: To report the clinical characteristics and surgical outcomes of patients with dumbbell-shaped orbital dermoid cysts that were managed without osteotomy. METHODS: Retrospective review of patients with histologica...PURPOSE: To report the clinical characteristics and surgical outcomes of patients with dumbbell-shaped orbital dermoid cysts that were managed without osteotomy. METHODS: Retrospective review of patients with histologically confirmed dumbbell-shaped orbital dermoid cysts (characterized as bilobed cysts with intra and extraorbital components, connected through an osseous cleft) that, between 1997 and 2024, were excised without lateral osteotomy. RESULTS: Eighteen patients (11 female; 61%) presented at a mean age of 25 years (median 28; range 2-45 years), the main features being eyelid swelling (83%), orbital discomfort (61%), and proptosis (39%). All cysts involved the superotemporal quadrant and extended through the frontozygomatic or zygomaticosphenoidal sutures into the temporalis fossa. Seventeen patients (94%) were managed with an upper eyelid crease incision, and 2/17 (12%) of them had removal of tough fibrous tissues that were closing a rim-cleft; the lesion in 1 other patient was managed through a lateral canthotomy incision. Significant spillage of contents occurred in 6/18 (33%) cases, and this was managed with copious saline irrigation. Histology confirmed a chronic granulomatous inflammation in all specimens. Transient postoperative complications occurred in 3 patients (17%), and no persistent inflammation was observed at a mean follow-up of 21 months (median 6; range 2-197 months). CONCLUSIONS: Most dumbbell-shaped orbital dermoid cysts can be excised through an upper-lid skin-crease incision without lateral osteotomy. Meticulous dissection, curettage, or fulguration of the intraosseous tract, and careful management of spilled cyst contents reduce complications. This minimally invasive strategy offers excellent outcomes with low morbidity and fast recovery.