PURPOSE: The purpose is to characterize the tumor microenvironment and investigate molecular mechanisms underlying perineural invasion (PNI) in lacrimal gland adenoid cystic carcinoma (LGACC) for the discovery of targete...PURPOSE: The purpose is to characterize the tumor microenvironment and investigate molecular mechanisms underlying perineural invasion (PNI) in lacrimal gland adenoid cystic carcinoma (LGACC) for the discovery of targeted therapies and biomarkers to improve clinical management. METHODS: Spatial transcriptomics was performed on histopathologically confirmed LGACC with pronounced PNI. Cellular components were identified using gene signatures, and molecular pathways associated with PNI were analyzed through Gene Ontology analysis of differentially expressed genes between tumor and stromal components. Immunostaining for low-affinity p75NTR ( NGFR ) was conducted on archival LGACC cases with PNI. RESULTS: Spatial transcriptomics yielded an average of 33,885 reads per spot, with 98.6% mapping quality and detection of 17,567 genes. Analyses revealed significant intratumor heterogeneity and identified pathways associated with PNI and treatment resistance, including the upregulation of metallothioneins and heat shock proteins. A distinct p75NTR expression pattern was observed in the spatial cluster involving tumor cells and nerve, which was confirmed by diffuse p75NTR staining in the nerve perineurium in all 10 (100%) LGACC cases with PNI. CONCLUSIONS: This study provides novel insights into the complex tumor microenvironment of LGACC PNI, uncovering mechanisms that may drive PNI and treatment resistance. The identification of p75NTR as a potential mediator of neurotropism underscores its relevance as both a therapeutic target and biomarker for PNI in LGACC. Elucidating these molecular factors is critical for developing targeted therapeutics to improve outcomes for patients with this aggressive malignancy.
Hong A, Shoji MK, Villatoro GA
… +12 more, Radha-Saseendrakumar B, Baxter SL, Dolman PJ, Kazim M, Harrison AR, Lucarelli MJ, Garrity JA, Selva D, Ediriwickrema LS, Liu CY, Korn BS, Kikkawa DO
PURPOSE: This study assesses intersurgeon variability in proptosis reduction after orbital decompression for thyroid eye disease. METHODS: This multicenter retrospective study included patients with thyroid eye disease w...PURPOSE: This study assesses intersurgeon variability in proptosis reduction after orbital decompression for thyroid eye disease. METHODS: This multicenter retrospective study included patients with thyroid eye disease who underwent orbital decompression from 1 of 7 surgeons at 7 different institutions between January 2002 and December 2018. Data were included if a single decompression technique was performed on ≥10 patients by ≥2 surgeons. The primary outcome was postoperative change in proptosis with emphasis on comparison among surgeons utilizing similar surgical techniques. Statistical analysis was performed with χ 2 and ANOVA testing, and a multivariable logistic regression model was generated. RESULTS: Six hundred thirty-three orbits that underwent orbital decompression were included. Five different decompression techniques were analyzed: medial wall (n = 29), fat + lateral wall (n = 113), medial wall + floor (n = 123), fat + lateral wall + medial wall (n = 140), and fat + lateral wall + medial wall + floor (n = 228), without significant difference in proptosis reduction among surgeons. Surgeons did not demonstrate significant differences in outcomes at different time points compared with each other or themselves. Outcomes when comparing endoscopic versus open medial wall decompression varied among surgery types. Multivariate modeling revealed a statistically significant association between postoperative change in proptosis with preoperative proptosis ( p < 0.001). CONCLUSIONS: Postoperative change in proptosis did not differ significantly between surgeons utilizing similar orbital decompression techniques for patients with thyroid eye disease. This study may strengthen the statistical validity of multicenter clinical trials assessing orbital decompression outcomes performed by surgeons employing uniform surgical techniques, thereby advancing our understanding of optimal surgical management strategies for thyroid eye disease.
Mycobacterium chimaera (M. chimaera ) is a slow-growing nontuberculous mycobacterium, which, in humans, is mainly associated with cardiothoracic surgical infections and rarely presents with ocular involvement. This repor...Mycobacterium chimaera (M. chimaera ) is a slow-growing nontuberculous mycobacterium, which, in humans, is mainly associated with cardiothoracic surgical infections and rarely presents with ocular involvement. This report describes a unique case of orbital infection presenting as an inflammatory mass in a healthy 66-year-old white female, without prior trauma, surgery, or significant medical history. Imaging revealed a diffuse mass, with heterogeneous enhancement, medially in the left orbit, and CT of the trunk revealed mediastinal lymphadenopathy. Histopathology of orbital tissue and mediastinal lymph nodes showed necrotizing granulomatous inflammation, cultures from endobronchial lymph node biopsy isolated M. chimaera , and targeted antimicrobial treatment for nontuberculous mycobacterium resulted in marked clinical improvement. This case highlights the importance of considering atypical infections in the differential diagnosis of orbital inflammatory syndromes.
PURPOSE: The purpose is to evaluate the safety and outcomes of a minimally invasive "hook-and-lift" technique for intact excision of large extraconal orbital tumors without the use of osteotomy. METHODS: Retrospective re...PURPOSE: The purpose is to evaluate the safety and outcomes of a minimally invasive "hook-and-lift" technique for intact excision of large extraconal orbital tumors without the use of osteotomy. METHODS: Retrospective review of patients with histologically confirmed solitary fibrous tumors or Schwannomas excised macroscopically intact using a "hook-and-lift" technique. Inclusion criteria were noncompressible lesions ≥25 mm in maximum dimension and/or occupying more than two-thirds of the orbit, those predominantly in the extraconal space, and those amenable to circumferential dissection. RESULTS: Twenty patients (13 solitary fibrous tumors and 7 Schwannomas) met the inclusion criteria with 11 (55%) females presenting at a mean age of 48.2 (range, 23-78) years. Most presented with nonaxial globe displacement (90%) and reduced ocular motility (65%), while visual acuity was preserved (mean LogMAR, 0.08). The largest tumor dimension was an average of 29.3 (range, 25-40) mm, and the mean estimated volume was 6.1 (range, 1.1-15.7) mL. Depending on location, macroscopically intact without osteotomy was performed through an upper eyelid skin-crease incision (13/20), lower lid swinging flap (5/20), or retrocaruncular approach (2/20). Postoperative complications include persistent moderate ptosis (2) and motility deficit (2), including an acquired Brown syndrome; there was no impairment of vision; and no tumor recurrences were observed at a mean follow-up of 4.2 years. CONCLUSIONS: In appropriately selected cases, the "hook-and-lift" technique provides a safe and effective method for macroscopically intact excision of large and firm extraconal orbital tumors. The technique avoids the morbidity associated with periorbital osteotomy and can yield excellent functional outcomes.
PURPOSE: To assess the effects of glucagon-like peptide-1 (GLP-1) receptor agonist on facial landmarks. METHODS: A retrospective case-control study with age-, sex-, ethnicity-, and diagnosis-matching of patients in one i...PURPOSE: To assess the effects of glucagon-like peptide-1 (GLP-1) receptor agonist on facial landmarks. METHODS: A retrospective case-control study with age-, sex-, ethnicity-, and diagnosis-matching of patients in one institution under the care of one oculofacial plastic surgeon from 2022 to 2024. Inclusion criteria were patients over 18 years old with high-resolution frontal full-face photographs. Exclusion criteria were prior oculofacial aesthetic or reconstructive procedures, trauma, paresis, or thyroid eye disease. These facial landmarks were measured: total face, upper-facial, mid-facial and lower-facial heights, palpebral fissure width and height, upper eyelid height, nasal width and height, palpebral fissure slant, philtrum width and height, upper and lower lip heights, upper and lower vermillion heights, mouth width, and upper and lower vermillion angles. RESULTS: Eighteen patients taking GLP-1 agonists and 18 matched patients not taking GLP-1 agonists (control) were identified. The average age was 68 ± 11 years for both groups. There were 8 males and 10 females in each group. Half had a diagnosis of bilateral upper eyelid blepharoptosis, and half had bilateral upper eyelid dermatochalasis. Average duration of GLP-1 agonist use was 324 days, with an average change in weight -3.4 kg and change in body mass index -1.5. There was no statistically significant difference in body mass index in the GLP-1 agonist group (29.6 ± 7.6) and the control group (28.2 ± 7.1) ( p = 0.57). Patients taking GLP-1 agonists had statistically significantly increased philtrum width, upper vermillion height, lower lip height, and mouth width ( p ≤ 0.05). CONCLUSIONS: Patients taking GLP-1 agonists had statistically significant increases in orolabial measurements.
Parinaud's oculoglandular syndrome is an uncommon manifestation of Bartonella henselae infection presenting with granulomatous conjunctivitis, marked preauricular lymphadenopathy, and occasional necrotizing lesions. The...Parinaud's oculoglandular syndrome is an uncommon manifestation of Bartonella henselae infection presenting with granulomatous conjunctivitis, marked preauricular lymphadenopathy, and occasional necrotizing lesions. The most common cause of Parinaud's oculoglandular syndrome is due to direct contact with contaminated cat saliva or scratches near the eye. While Parinaud's oculoglandular syndrome has been linked to cat scratch disease, it has not been associated with necrotizing soft tissue infections due to a distinct bacterial process, such as necrotizing fasciitis due to Group A Streptococcus . The authors present a pediatric patient who was coinfected with Bartonella henselae and Group A Streptococcus and presented clinically with both Parinaud's oculoglandular syndrome and necrotizing fasciitis. The patient was successfully treated with antibiotics without surgical debridement.
Orbital fungal infections are initially misdiagnosed, typically only considered in immunocompromised patients, and may be empirically treated with systemic corticosteroids-potentially exacerbating disease progression. Th...Orbital fungal infections are initially misdiagnosed, typically only considered in immunocompromised patients, and may be empirically treated with systemic corticosteroids-potentially exacerbating disease progression. The authors report the third case described in medical literature of Cryptococcus neoformans invading the orbit in an immunocompetent host and the first in a child with bilateral presentation.
PURPOSE: Transorbital endoscopic approaches to the skull base provide minimally invasive access with decreased surgical morbidity in appropriately selected cases. This study expands on the current understanding of transo...PURPOSE: Transorbital endoscopic approaches to the skull base provide minimally invasive access with decreased surgical morbidity in appropriately selected cases. This study expands on the current understanding of transorbital neurological surgery by expanding the cohort, duration of follow-up, detailed ophthalmologic outcomes, and analysis. METHODS: A retrospective consecutive case review was performed. Included subjects underwent lateral transorbital endoscope-assisted surgical approaches at a single center between 2016 and 2024. Subjects were stratified into 4 groups based on pathology (and/or) location: intradural, extradural, cavernous sinus and Meckel cave, and sphenoid wing meningiomas ± hyperostosis. Demographic information and ophthalmologic data were collected. RESULTS: Thirty-five subjects were included: intracranial intradural (n = 8), intracranial extradural (n = 8), cavernous sinus and Meckel cave (n = 11), and sphenoid wing meningioma (n = 8). On average, visual acuity (VA) trended toward improvement in all groups except sphenoid wing meningioma; however, this trend did not reach statistical significance ( p = 0.39). Fifteen patients completed preoperative and postoperative Humphrey visual field testing. Overall, mean deviation scores trended toward improvement from -3.59 ± 4.28 to -1.82 ± 2.82 dB; however, this trend did not reach statistical significance ( p = 0.35). A similar trend was seen in all groups except the extradural group. There were statistically significant improvements in diplopia ( p = 0.01), extraocular motility ( p = 0.04), and exophthalmos ( p = 0.04) in all groups. Dyschromatopsia trended toward a decrease from 23% to 10% and, however, did not reach statistical significance ( p = 0.06). Transient diplopia, ptosis, and extraocular motility deficits were common but generally resolved; however, 66% of subjects had persistent postoperative V1 or V2 hypoesthesia. CONCLUSIONS: Visual outcomes were stable or improved in almost all patients. However, patients should be alerted to the possibility of persistent facial hypoesthesia. These results provide evidence that lateral transorbital endoscope-assisted approaches may have favorable ophthalmological morbidity profiles when performed by expert, multidisciplinary teams in carefully selected cases.
Bermudez-Castellanos I, Cruz Velasco A, Garcia DM
… +5 more, de la Hoz Montañana MR, Bengoa González A, Sanchez Tocino H, Castro-Portillo E, Galindo-Ferreiro A
PURPOSE: The purpose is to objectively evaluate changes in upper eyelid height and contour after intravitreal injections. METHODS: A prospective, observational, multicentre study was carried out on naive patients undergo...PURPOSE: The purpose is to objectively evaluate changes in upper eyelid height and contour after intravitreal injections. METHODS: A prospective, observational, multicentre study was carried out on naive patients undergoing unilateral intravitreal injection of anti-vascular endothelial growth factor from January 2021 to February 2023. Injected eyes were considered cases, and noninjected contralateral eyes were used as controls. Data collected included demographics, cause of injection, drug used, use of a speculum, history of previous topical treatments, postinjection prophylaxis, and complications. A photograph was taken at baseline and at 6 and 12 months. ImageJ software was used to fit Bézier lines to the eyelid contour and upper eyelid margin reflex distance (MRD) 1, and 7 mid-pupil to eyelid margin distances were calculated. Clinically significant ptosis was defined as a decrease in MRD1 of ≥0.5 mm from baseline. ANOVA was used to compare MRD1 and mid-pupil to eyelid margin distance values. The p values of <0.05 were considered significant. RESULTS: Sixty-one patients (mean age, 74.61 ± 12.30 years; 59% women) were included. Fifty-three (86.9%) patients received aflibercept, and 8 (13.1%) received ranibizumab. A speculum was used in all cases. Complications included 1 case (1.6%) of mild subconjunctival hemorrhage and 1 case (1.6%) of mild corneal epithelial defect. In injected eyes, MRD1 decreased by 0.43 ± 0.59 mm (6 months) and 0.60 ± 0.61mm (12 months; p < 0.01), as well as all mid-pupil to eyelid margin distances ( p < 0.05). Clinically significant ptosis occurred in 57.4% of patients at 12 months. No significant changes were observed in control eyes. CONCLUSIONS: Repeated anti-vascular endothelial growth factor intravitreal injections are associated with a decrease in MRD1 and upper eyelid contour at 6 and 12 months. The use of a speculum may contribute to postinjection ptosis.
Phosphaturic mesenchymal tumors (PMTs) are rare benign neoplasms that are often associated with tumor-induced osteomalacia. The authors present a rare case of a PMT with primary origin in the orbit. A 53-year-old female...Phosphaturic mesenchymal tumors (PMTs) are rare benign neoplasms that are often associated with tumor-induced osteomalacia. The authors present a rare case of a PMT with primary origin in the orbit. A 53-year-old female presented with diffuse bone pain and deficiency fractures throughout the body on x-ray imaging. Antinuclear antibody, immunoglobulin G4, and parathyroid hormone were elevated at that time. An incidental apical orbital mass with medial rectus and superior oblique involvement was found on MRI of the brain. Histologic examination confirmed fibroblast growth factor 23 positivity following biopsy. At postoperative week 6, bone pain and double vision resolved. Patient chose to undergo curative treatment with external beam radiation treatment with close follow up by oculoplastic surgery, endocrinology, and radiation oncology. At postoperative month 6, the ophthalmologic examination was within normal limits and repeat MRI demonstrated significant reduction in tumor size relative to post biopsy scans. PET scan did not demonstrate further lesions systemically. The prognosis for PMTs is favorable with adequate treatment. For patients with diffuse nonspecific skeletal pain and concurrent ocular symptomatology, this rare condition should remain on the differential diagnosis.
Inflammatory bowel disease (IBD) is an autoimmune inflammatory condition of the gastrointestinal tract and encompasses 2 major subtypes: Crohn's disease and ulcerative colitis. Orbital myositis is an uncommon ophthalmic...Inflammatory bowel disease (IBD) is an autoimmune inflammatory condition of the gastrointestinal tract and encompasses 2 major subtypes: Crohn's disease and ulcerative colitis. Orbital myositis is an uncommon ophthalmic extraintestinal manifestation of IBD and may be associated with an internal necrotic collection. The presence of a necrotic collection in orbital myositis narrows the diagnostic differential to several infectious and noninfectious etiologies. The distinction between an infectious and noninfectious etiology is of significant therapeutic consideration, as management differs greatly. The authors present a case of a 17-year-old female presenting with a left lateral rectus orbital myositis associated with an internal necrotizing collection of the left lateral rectus. Histopathology demonstrated severe nonspecific chronic orbital myositis with features suggestive of focal granulomatous inflammation. She had an elevated fecal calprotectin and proceed to a colonoscopy, ultimately confirming a diagnosis of Crohn's disease. She was subsequently commenced on oral azathioprine and an oral prednisolone tapering course with ongoing follow-up. Her orbital disease remains quiescent at 6 months following her diagnosis.
PURPOSE: The aim of this article is to provide a concise literature review highlighting the current clinical applications of dermal matrix templates in periocular and orbital reconstructive surgery. The authors include w...PURPOSE: The aim of this article is to provide a concise literature review highlighting the current clinical applications of dermal matrix templates in periocular and orbital reconstructive surgery. The authors include well-established surgical techniques as well as novel applications reported on individual patients or small case series. The hope is that this review will give the reader a better understanding of the biological properties of dermal matrix templates and their emerging uses within the field of oculoplastic and reconstructive surgery. METHODS: Literature search. A PubMed search was performed using the search terms "dermal matrix AND periocular," "dermal matrix template AND orbital," "dermal matrix AND eyelid," "integra AND eyelid," "acellular dermal AND eyelid." A full review of the literature using the PubMed database was conducted up until January 11, 2025. The articles used were written in English, with all articles accessed in full. Both review articles and original articles were used for this review. RESULTS: Current applications of dermal matrix templates within periocular and orbital reconstruction include in periocular tissue loss, eyelid surgery, conjunctival surgery, and in socket reconstruction following exenteration. Novel uses include anophthalmic socket augmentation, orbital wall reconstruction, nasolacrimal duct reconstruction, and lower lid blepharoplasty. CONCLUSIONS: Dermal matrix templates are a useful addition to the oculoplastic surgeon's armamentarium, offering an alternative to traditional reconstructive techniques utilizing local tissue flaps or skin grafts.
Ophthalmic Plast Reconstr Surg
· 2026 Jul-Aug 01 · PMID 40990206
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Periorbital necrotizing fasciitis (PONF) is a severe skin and soft tissue infection that corrupts the body's natural immune response, leading to extensive tissue necrosis that can result in exenteration or death. Reactiv...Periorbital necrotizing fasciitis (PONF) is a severe skin and soft tissue infection that corrupts the body's natural immune response, leading to extensive tissue necrosis that can result in exenteration or death. Reactive oxygen species, such as hypochlorous acid, are among the elements employed by the immune system in fighting bacterial infection. In necrotizing fasciitis this immune response is thwarted, as the responsible pathogens produce enzymes that eliminate these reactive oxygen species. The host immune response can be augmented by the external application of hypochlorous acid to severely infected tissues. This report presents a case series of 18 orbits from 15 patients treated with a novel treatment approach in the orbit-local administration of hypochlorous acid-in addition to traditional treatment with surgical debridement and intravenous antibiotics. Patients in this series were diagnosed with periorbital necrotizing fasciitis and received local hypochlorous acid administration via an orbital catheter and a Penrose drain to allow for flow-through of the bacterial toxins. Hypochlorous acid was well tolerated in all patients. Zero patients underwent exenteration, and zero patients died. Further investigation into hypochlorous acid treatment in periorbital necrotizing fasciitis is warranted.
PURPOSE: A porcine model was utilized to determine the clinical and histological impact of several currently available therapies for wound healing modification following partial-thickness thermal burn injury. METHODS: A...PURPOSE: A porcine model was utilized to determine the clinical and histological impact of several currently available therapies for wound healing modification following partial-thickness thermal burn injury. METHODS: A prospective study in a porcine model of partial-thickness thermal burn injury was performed, assessing immediate adjuvant wound therapy with amniotic membrane grafting, onabotulinum toxin A injection, and verteporfin injection compared with intermediate wound adjuvant therapy by intralesional 5-fluorouracil with microneedling, verteporfin injection, and triamcinolone injection with and without 5-fluorouracil. Clinical assessments were conducted by blinded plastic surgeons utilizing a validated porcine burn scar scale. Histologic analysis was accomplished with hematoxylin and eosin stains and Masson's trichrome stains. A repeated measures mixed model analysis of variance was performed to identify clinical or histological statistical significance. RESULTS: Comparing immediate versus intermediate treatments, a statistically significant difference in regards to mean clinical grade at the postinjury day 14 and postinjury day 28 time points was identified, yielding a 0.57 scale difference ( p = 0.0096) and 0.7 scale difference ( p = 0.0006), respectively. A statistically significant difference in regards to decreased mean histologic grade at the postinjury day 28 time points was identified for epithelial hyperplasia (-30.532 mean difference, p -value <0.0001), inflammatory response (-11.472 mean difference, p = 0.0133), and dermal remodeling (-13.78 mean difference, p = 0.0058). CONCLUSIONS: The results of this study suggest immediate treatment of partial-thickness thermal injury with adjuvant wound therapy decreases subsequent burn scar formation when compared with adjuvant wound therapy applied in the intermediate phase of healing.
Diala FGI, Biesman BS, Pargament JM
… +1 more, Mawn LA
Ophthalmic Plast Reconstr Surg
· 2026 Jul-Aug 01 · PMID 40985358
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A 31-year-old female presented with an acute onset of vision loss in the OS. On arrival to the hospital, OS ocular vitals were notable for no light perception vision, relative afferent pupillary defect, elevated intraocu...A 31-year-old female presented with an acute onset of vision loss in the OS. On arrival to the hospital, OS ocular vitals were notable for no light perception vision, relative afferent pupillary defect, elevated intraocular pressure, ophthalmoplegia, and ptosis. Interval history was notable for lip filler injection. Emergent neuroimaging did not demonstrate large vessel occlusion. Ophthalmic artery occlusion resulting in orbital infarction syndrome was suspected. Patient received intravenous solumedrol, verapamil, aspirin, and lateral canthotomy/cantholysis, topical and intravenous antibiotics, and periorbital and orbital injections of hyaluronidase. With improvement in ptosis and extraocular motility, but vision remaining no light perception, the patient was discharged 5 days after presentation. However, a month later, the patient was enucleated due to intractable pain. This is the foremost report of orbital ischemic syndrome in the setting of ophthalmic artery occlusion secondary to hyaluronic acid filler injection to the lip.
PURPOSE: Facial photographs are invaluable medical teaching tools, but patient privacy must be respected. The degree to which unilateral cropped upper face photos are recognizable is not known. METHODS: Oculofacial surge...PURPOSE: Facial photographs are invaluable medical teaching tools, but patient privacy must be respected. The degree to which unilateral cropped upper face photos are recognizable is not known. METHODS: Oculofacial surgeons were canvassed on a societal email to participate in an online study in February 2025. The surgeons were shown 4 famous individuals. Each of the 4 celebrities was presented initially as a cropped unilateral periorbital photograph with an iris mask, then without an iris mask, and then finally as a full face photograph. For each photograph, the surgeons were asked to identify the celebrity and rate how confident they were in the identification. RESULTS: Eighty-seven surgeons completed the study with a response rate of 62%. Overall, the cropped, unilateral upper face photographs of famous celebrities were correctly identified on average 4.9% of the time, with a mean prediction confidence level of 69 ± 15%. Unmasking the iris did not improve recognition. Mistaken identification of the cropped, iris-masked, unilateral upper face photographs occurred approximately 20% of the time. On average, there was a 16.8-fold increase in recognition of the full face of famous celebrities compared with the cropped unilateral upper face photo. CONCLUSION: In the vast majority of cases, the identity of cropped unilateral periorbital photos is not discernible. Notwithstanding, patient informed consent remains mandatory to obtain and use photos for publication.
PURPOSE: To discuss the outcomes of nonincisional punctal dilatation and monocanalicular stent intubation in patients with acquired punctal stenosis. METHODS: Retrospective interventional study of patients with symptomat...PURPOSE: To discuss the outcomes of nonincisional punctal dilatation and monocanalicular stent intubation in patients with acquired punctal stenosis. METHODS: Retrospective interventional study of patients with symptomatic punctal stenosis over a study period of 4 years (July 2018-July 2022). All patients underwent nonincisional punctal dilation with monocanalicular stenting at 2 tertiary institutes in India and the United States. Procedures were performed as an office procedure with local anesthesia. Topical antibiotics and tapering doses of topical steroids were prescribed in the postoperative period. Stent extubation was done at 4 to 6 weeks. A minimum follow-up of 6 months postoperatively was required to be included in the study. Anatomic success was defined as a patent grade 3 punctum, while functional success was defined as absent or only occasional epiphora (Munk ≤ 1). RESULTS: A total of 198 puncta of 163 patients were included in the study. About 71.8% of patients were women, and the mean age was 53 years (range: 12-82 years). At a mean follow-up of 9.1 months (range: 6-60 months), a significant postoperative improvement in the Munk score (3.71-1.49, p < 0.01) was noted. At postoperative month 6, anatomic success was achieved in 189 (95.5%) puncta, and functional success was achieved in 185 (93.4%) puncta. Recurrent stenosis was noted in 16 (8%) puncta. CONCLUSION: Nonincisional punctal dilation with a monocanalicular stent demonstrates high anatomical and functional success rates and low restenosis rate, while preserving the punctal integrity and lacrimal pump function.
Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic, syndrome is a newly recognized autoinflammatory disorder. The authors report a novel case presenting with a subconjunctival lesion as an ocular manifestation. A 7...Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic, syndrome is a newly recognized autoinflammatory disorder. The authors report a novel case presenting with a subconjunctival lesion as an ocular manifestation. A 77-year-old man presented with bilateral orbital swelling, peripheral edema, weight loss, respiratory decline, and transfusion-dependent anemia. Ocular examination revealed periorbital edema, restricted motility, significant OS conjunctival injection and chemosis, particularly focused around a superotemporal subconjunctival lesion. Laboratory results showed raised inflammatory markers and normocytic anemia. MRI showed left periorbital edema without postseptal involvement. Treatment with broad-spectrum antibiotics was commenced; however, inflammation and deterioration progressed. Biopsy of the subconjunctival lesion revealed nonspecific fibrinous material without infection or malignancy. Diagnosis of Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic was confirmed by detecting a somatic ubiquitin-like modifier activating enzyme 1 mutation (c.121A>G, p.Met41Val). The patient deteriorated and died of multiorgan failure. This case adds to the expanding spectrum of ophthalmic manifestations in Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic, and highlights the need for thorough ocular evaluation in suspected cases.
PURPOSE: This study aimed to evaluate the association of neighborhood-level disadvantage with periocular basal cell carcinoma (BCC) sizes and time to surgery for patients treated with Mohs micrographic surgery (MMS). MET...PURPOSE: This study aimed to evaluate the association of neighborhood-level disadvantage with periocular basal cell carcinoma (BCC) sizes and time to surgery for patients treated with Mohs micrographic surgery (MMS). METHODS: Periocular BCC treated with MMS were identified from a prospectively maintained database from a single institution over 17 years. The Area Deprivation Index (ADI) was used to rank neighborhoods by socioeconomic disadvantage with higher national ADI scores indicative of greater neighborhood-level deprivation. Primary outcomes included pre- and postoperative defect size and time to surgery from diagnosis date. RESULTS: This study included a total of 1,592 patients. There were greater percentages of non-White ( p < 0.001) and Hispanic or Latino ( p < 0.001) patients in the higher ADI quartiles. Higher ADI was associated with larger preoperative BCC size ( p < 0.001), larger postoperative BCC size ( p < 0.001), and longer time between diagnosis to surgery ( p < 0.001). CONCLUSIONS: To the best of the authors' knowledge, this is the first study to analyze associations between periocular BCC treated with MMS and neighborhood-level deprivation in the United States. Disparities in tumor sizes at presentation and delays in surgery for patients with periocular BCC, provide opportunities for further study to promote timely diagnosis and treatment of periocular cutaneous malignancies.