Severity Identification of Graves Orbitopathy via Random Forest Algorithm.

This study aims to establish a random forest model for detecting the severity of Graves Orbitopathy (GO) and identify significant classification factors. This is a hospital-based study of 199 patients with GO that were collected between December 2019 and February 2022. Clinical information was collected from medical records. The severity of GO can be categorized as mild, moderate-to-severe, and sight-threatening GO based on guidelines of the European Group on Graves' orbitopathy. A random forest model was constructed according to the risk factors of GO and the main ocular symptoms of patients to differentiate mild GO from severe GO and finally was compared with logistic regression analysis, Support Vector Machine (SVM), and Naive Bayes. A random forest model with 15 variables was constructed. Blurred vision, disease course, thyroid-stimulating hormone receptor antibodies, and age ranked high both in mini-decreased gini and mini decrease accuracy. The accuracy, positive predictive value, negative predictive value, and the F1 Score of the random forest model are 0.83, 0.82, 0.86, and 0.82, respectively. Compared to the three other models, our random forest model showed a more reliable performance based on AUC (0.85 vs. 0.83 vs. 0.80 vs. 0.76) and accuracy (0.83 vs. 0.78 vs. 0.77 vs. 0.70). In conclusion, this study shows the potential for applying a random forest model as a complementary tool to differentiate GO severity.

Stepwise self-inflating hydrogel expansion for congenital anophthalmia and blind microphthalmia: Over 15 years' experience in China.

BACKGROUND: Self-inflating hydrogel expanders have been used to treat anophthalmia and blind microphthalmia. This study aimed to investigate the long-term outcomes of treatment with self-inflating hydrogel expanders for congenital anophthalmia and blind microphthalmia. METHODS: In this retrospective study, the medical records of 161 patients with anophthalmia and blind microphthalmia who underwent hydrogel expansion were reviewed. We measured the palpebral fissure height (PFH), palpebral fissure length (PFL), and distance between the inner canthal and mid-nasal line (ICMN) before and after surgery. Cox regression analysis was conducted to determine which variables were related to the implantation of spherical expanders following hemispherical expander implantation. RESULTS: After treatment, the PFH and PFL increased significantly (p < 0.001). Complications including expander migration and extrusion occurred in 15 cases. Five patients needed enucleation or further dermis fat graft implantation because of insufficient expansion. The necessity for further spherical expansion was substantially related to a relative axial length (rAL) <0.5 (p = 0.007). CONCLUSION: Self-inflating hydrogel expansion can significantly increase the lid fissure. The occurrence of complications is rare, and surgical intervention can effectively address them. Abnormal eyes with a rAL of less than 0.5 demonstrate a higher possibility of needing additional orbital expansion.

Three-dimensional soft tissue reconstruction and volume measurement used for the diagnosis of dysthyroid optic neuropathy.

PURPOSE: Dysthyroid optic neuropathy (DON) leads to vision loss. This study aimed to investigate a new method that can directly evaluate the change in muscle cone inner volume (MCIV) and distinguish DON orbits from non-DONs. MATERIALS AND METHODS: This study included 54 patients (108 orbits) who were diagnosed with thyroid eye disease and treated at the Beijing Tongren Hospital between December 2019 and September 2021. The extraocular muscle volume (EOMV), orbital fat volume (OFV), and bony orbit volume (BOV) of the patients were measured using three-dimensional reconstruction. MCIV was measured using artificially defined boundaries. The associations between these volumes and clinical indicators were studied, and the diagnostic efficacy of these volumes for DON was described using receiver operating characteristic (ROC) curves. RESULTS: The ROC curve showed that the area under the curve of MCIV/BOV (%) combined with EOMV/BOV (%) reached 0.862 (p < 0.001), with a sensitivity of 85.7% and a specificity of 76.1%. CONCLUSION: The combination of MCIV/BOV (%) and EOMV/BOV (%) is a good indicator for the diagnosis of DON, which aids in the early detection and intervention of DON.

Difference of anterior and posterior orbital development in patients with congenital microphthalmia: a retrospective cohort study from China.

AIM: To evaluate volume differences between anterior and posterior orbit and demographic characteristics of Chinese patients with congenital microphthalmia. METHODS: A retrospective cohort study, involving 169 unilateral congenital microphthalmia patients aged between 1 and 57 years old was conducted. Three-dimensional images of the orbit were generated from past CT scans, and digital orbital volume comprehensive measurement was done. The measured data included orbital volume (OBV), posterior orbital volume (POV), orbital width (OBW), orbital height (OBH), orbital depth (OBD), and posterior orbital area ratio. RESULTS: Significant differences were observed among OBV, POV, OBW, OBH, and OBD of the affected and unaffected eyes in different age-based groups (all P<0.001). Among them, OBH had the greatest different. The mean microphthalmic to contralateral ratio (MCR) of OBV, POV, OBW, and OBH continuously increased from 1 to 3 years old, whereas the MCR of POV decreased from 3 to 17 years old. The MCR of OBD was not found to be correlated to age. There was no significant difference between OBV, POV, OBW, and OBH in ages from 13 years old to adulthood (all P>0.05). The difference in posterior orbital area ratio between the affected and unaffected groups was not statistically significant (P>0.05). CONCLUSION: OBH is maximally affected, whereas OBD is minimally affected by microphthalmia. Posterior orbital retardation began 2y prior to orbital retardation and occurred at 3 years old in the affected eye, suggesting that intervention therapy should be done before the age of 4.

Combined Surgical Strategies Adjusted to Clinical Evaluations for Severe Upper Eyelid Cicatricial Entropion and Trichiasis.

BACKGROUND: The management of cicatricial entropion and trichiasis represents a therapeutic challenge. The authors determined the long-term stability of combined surgical procedures in severe cases. METHODS: The authors retrospectively studied consecutive patients with severe upper eyelid cicatricial entropion and trichiasis treated between 2019 and 2021 at Beijing Tongren Eye Center. Combined surgical procedures adjusted to clinical evaluations were performed. Clinical characteristics, procedures, and surgical outcomes were retrieved. RESULTS: The authors included data on 58 eyelids (25 left and 33 right) from 39 patients (19 males and 20 females). The mean age was 54.81 years. Follow-up averaged 20.67 months. Common diagnoses were chemical injury, trachoma, and chronic conjunctivitis. Seven eyelids with eyelid margin entropion were successfully treated using anterior lamellar recession and gray line split. Seven eyelids with eyelid margin entropion and posterior lamellar deficits were effectively treated using anterior lamellar recession, gray line split, and posterior lamellar lengthening. Thirty-eight eyelids with recalcitrant eyelid margin entropion were treated using anterior lamellar recession and gray line split with graft, with a success rate of 94.74% and 89.47%, 3 and 6 months after the operation, respectively. Six eyelids with recalcitrant eyelid margin entropion and posterior lamellar deficits were effectively treated using anterior lamellar recession, gray line split with graft, and posterior lamellar lengthening. Among various grafts, pediculated orbicularis muscle was significantly different from banked sclera or resected tarsus ( P = 0.011, P < 0.001). CONCLUSIONS: In severe upper eyelid cicatricial entropion and trichiasis, combined surgical procedures showed good functional and cosmetic results with excellent long-term stability.

Bidirectional tightening of the anterior lamella for involutional lower eyelid entropion.

OBJECTIVE: Involutional entropion of the lower eyelid is commonly encountered in the elderly population. An ideal surgical method is supposed to address the underlying horizontal and vertical lower lid laxity simultaneously. This study aims to assess the effectiveness of bidirectional tightening of the anterior lamella to correct involutional lower lid entropion. METHODS: A prospective, noncomparative interventional case series was conducted from January 2017 to June 2021. Patients with involutional lower eyelid entropion received procedures combining lateral canthus-sparing orbicularis suspension with marginal rotating sutures to tighten the anterior lamella horizontally and vertically. The aesthetic appearance, postoperative complications, and patient satisfaction were evaluated. RESULTS: A total of 50 patients (56 eyelids) with a mean age of 73.1 ± 10.5 years were included. The mean follow-up period was 23.7 ± 17.1 months. All patients had immediate resolution of entropion and associated ocular symptoms. There were no recurrences or other major postoperative complications. Mild temporary ectropion was observed in 4 patients (4 eyelids) without the need for surgical intervention. CONCLUSION: The procedure of bidirectional anterior lamellar tightening restores the tension balance of eyelid margin. It provides a simple, successful, and less invasive option to treat involutional lower eyelid entropion.

Using the Random Forest Algorithm to Detect the Activity of Graves Orbitopathy.

PURPOSE: The aim of this study is to establish a random forest model to detect active and quiescent phases of patients with Graves Orbitopathy (GO). METHODS: A total of 243 patients (486 eyes) diagnosed with GO in Beijing TongRen hospital were included in the study. The Clinical Activity Score of GO was regarded as the golden standard, whereas sex, age, smoking status, radioactive I131 treatment history, thyroid nodules, thyromegaly, thyroid hormone, and Thyroid-stimulating hormone receptor antibodies were chosen as predictive characteristic variables in the model. The random forest model was established and compared with logistic regression analysis, Naive Bayes, and Support vector machine metrics. RESULTS: Our model has a sensitivity of 0.81, a specificity of 0.90, a positive predictive value of 0.87, a negative predictive value of 0.86, an F1 score of 0.85, and an out-of-bag error of 0.15. The random forest algorithm showed a more precise performance compared with 3 other models based on the area under receiver operating characteristic curve (0.92 versus 0.77 versus 0.76 versus 0.75) and accuracy (0.86 versus 0.71 versus 0.69 versus 0.66). CONCLUSIONS: By integrating these high-risk factors, the random forest algorithm may be used as a complementary method to determine the activity of GO, with accurate and reliable performance.

Tear-derived exosomal biomarkers of Graves' ophthalmopathy.

Graves' ophthalmopathy (GO), the most frequent extrathyroidal manifestation of Graves' disease (GD), can lead to a significant decline in the quality of life in patients. Exosomes, which contain proteins, lipids and DNA, play important roles in the pathological processes of various diseases. However, their roles in Graves' ophthalmopathy are still unclear. We aimed to isolate exosomes and analyze the different exosomal proteins. Tear fluids were collected from twenty-four GO patients, twenty-four GD patients and sixteen control subjects. The numbers of tear exosomes were assayed using nanoparticle tracking analysis. A Luminex 200 kit and ELISA kit were used to confirm the different cytokine concentrations in serum. Extraocular muscle from GO patients and controls was extracted, and western blotting was used to assay the levels of Caspase-3 and complement C4A. Our study demonstrated that the number of tear exosomes differ from GD patients and control. The expression levels of cytokines, including IL-1 and IL-18, were significantly increased in the tear exosomes and serum from GO patients compared with GD patients and controls. The levels of the exosomal proteins Caspase-3, complement C4A and APOA-IV were significantly increased in GO patients compared to GD patients and controls. Orbital fibroblasts from GO patients showed significantly higher levels of Caspase-3 and complement C4A than those from controls. The levels of serum APOA-IV in GO patients were significantly higher than those in GD patients and controls. Specific proteins showed elevated expression in tear exosomes from GO patients, indicating that they may play important roles in GO pathogenesis.

Different Characteristics of Orbital Soft Tissue Expansion in Graves Orbitopathy: Extraocular Muscle Expansion is Correlated to Disease Activity While Fat Tissue Volume With Duration.

This study aimed to describe the correlation between some clinical features and orbital soft tissue volume in Graves orbitopathy (GO). The authors collected computed tomography scans from 56 untreated GO patients and measured fat volume (FV), intraorbital and extraorbital FV (IFV, EFV), bony cavity volume (BV), and extraocular muscle volume (MV) of the 112 orbits by using Mimics software. The ratio of soft tissue volume and BV were used to eliminate the individual variations. Outcomes were compared among groups and were correlated with clinical data, including age, sex, clinical activity score, duration, serum TSH receptor antibody (TRAb) level, body mass index and smoking status. Multivariate linear regression showed that higher MV/BV is associated with higher CAS and TRAb level ( P< 0.001, 0.005, res p ectively). No relationship was found between MV/BV and duration, sex, age, and body mass index. IFV/BV was related to duration (ß=0.138, 95% confidence interval: 0.076-0.201, P <0.001), and did not correlate to clinical activity. IFV and MV are positively associated with exophthalmometry ( P =0.009, <0.001, respectively), while orbital bony volume (BV) is negatively correlated with exophthalmometry ( P =0.025). Results suggested TRAb level can impact the severity of GO mainly by affecting extraocular muscle rather than fat tissue. MV of GO is associated with disease activity, whereas IFV is correlated with duration and increases over time.

Correlation between extent of lacrimal gland prolapse and clinical features of thyroid-associated ophthalmopathy: a retrospective observational study.

BACKGROUND: Studies on the factors related to lacrimal gland prolapse (LGP) in patients with thyroid-associated ophthalmopathy (TAO) are limited. This study aimed to assess the factors associated with LGP on magnetic resonance imaging (MRI) and its relation to TAO activity . METHODS: Thirty-six patients (72 orbits) with inactive TAO (43 orbits, Clinical Activity Score [CAS] < 3) or active TAO (29 orbits, CAS ≥3) were investigated retrospectively. All patients underwent ophthalmic evaluation and orbital magnetic resonance imaging. The severity of LGP and proptosis and the extraocular muscle (EOM) volume were measured. LGP and related factors were assessed by correlational and linear regression analyses. The value of LGP for discriminating the activity of TAO was evaluated by receiver-operating characteristic curve analysis. RESULTS: The mean LGP was significantly higher in the active TAO group than in the inactive TAO group (P < 0.001). There were significant positive correlations between LGP severity and the CAS (r = 0.51, P < 0.001), proptosis (r = 0.72, P < 0.001), and EOM volume (superior rectus [r = 0.49, P < 0.001], inferior rectus [r = 0.47, P < 0.001], lateral rectus [r = 0.59, P < 0.001], medial rectus [r = 0.62, P < 0.001], superior oblique [r = 0.48, P < 0.001], and all EOMs [r = 0.59, P < 0.001]). Receiver-operating characteristic curve analysis revealed an LGP of 13.65 mm (area under the curve, 0.824; sensitivity, 79.3%; specificity, 81.4%) to be the cut-off value that differentiated active and inactive TAO. CONCLUSIONS: LGP measurements obtained from orbital magnetic resonance images were positively correlated with CAS, proptosis and EOM volume. The extent of LGP appears to be a good indicator of disease activity in patients with TAO.

Orbital Volume and Axial Length Development in Individuals Ages 12 to 60 Years With Congenital Microphthalmia: A Retrospective Cohort Study.

OBJECTIVE: To analyze the stimulating effect of axial length development on orbital volume development in patients (ages 12-60 years) with congenital microphthalmia. METHODS: This retrospective cohort study included 43 patients (86 eyes) with congenital microphthalmia. Three-dimensional images of the orbit were generated from past computed tomography scans, and digital orbital volume and axial length measurements were taken. The patients were divided into four age groups for analyses. Paired t tests and one-way analysis of variance tests were used to compare orbital volume and axial length between the affected and unaffected eyes. Pearson correlation analyses and scatter plots were used to investigate the correlations between age, orbital volume, and axial length in the affected and unaffected eyes. Linear regression analysis was used to determine the association between orbital volume and axial length. RESULTS: The mean orbital volume in the affected and unaffected eyes was 17.08 ±â€Š2.88 and 20.80 ±â€Š2.55 cm3, respectively. The mean axis length in the affected and the unaffected groups was 12.73 ±â€Š3.54 and 23.84 ±â€Š1.43 mm, respectively. Significant differences were observed among orbital (t = 13.538, P < 0.001) volume and axial length (t = 21.339, P < 0.001) in the affected and the unaffected groups. There were no significant differences in affected orbital volume (F = 0.527, P > 0.05), unaffected orbital volume (F = 1.628, P > 0.05), affected axial length (F = 0.946, P > 0.05), and unaffected axial length (F = 2.217, P > 0.05) among the four age groups. According to the Pearson correlations, there were no significant correlations between age and affected volume, unaffected volume, affected axis, and unaffected axis (r = 0.095, 0.097, 0.084, and 0.022, respectively; all P > 0.05). Orbital volume was moderately correlated with axial length in the affected and unaffected groups (r = 0.470 and 0.410, respectively; both P < 0.01). Linear regression analysis revealed that a 1 mm change in axis length was associated with a 0.38 cm3 and 0.73 cm3 change in orbital volume in the affected and unaffected groups, respectively. CONCLUSIONS: In individuals ages 12 to 60 years old with congenital microphthalmia, the effect of axis length on the orbital volume growth of the affected eye is only half that of the unaffected eye. The eyeball, orbital tissue, and craniofacial development all play an important role in the growth of orbital volume.

Comparison of ocular axis and corneal diameter between entropion and non-entropion eyes in children with congenital glaucoma.

BACKGROUND: Children with congenital glaucoma are often accompanied by acquired epiblepharon in the lower eyelid, which causes entropion of the lower eyelid and damages the cornea. AIM: To infer the possible causes of lower eyelid entropion by comparing the difference of ocular axis and corneal diameter between inverted and non-inverted ciliary eyes in children with congenital glaucoma. METHODS: A total of 15 patients (11 males and 4 females) diagnosed with congenital glaucoma between July 2016 and January 2019 at Tongren Hospital were included. Five patients had bilateral glaucoma, and ten had unilateral glaucoma. Each patient had only one eye with lower eyelid entropion which is associated with congenital glaucoma. All the patients had no entropion in another eye. The clinical data were collected. Main outcome measures were the ocular axis and corneal diameter. RESULTS: The average age of the 15 patients was 1.85 ± 0.49 years. Paired t-test showed that the average ocular axis of congenital glaucoma eyes with lower eyelid entropion (24.86 ± 3.44 mm) was significantly longer than that of congenital glaucoma eyes without lower eyelid entropion (20.79 ± 1.34 mm; P < 0.001). The average corneal diameter of congenital glaucoma eyes with lower eyelid entropion (13.61 ± 0.88 mm) was also significantly greater than that of congenital glaucoma eyes without lower eyelid entropion (11.63 ± 0.48; P < 0.001). CONCLUSION: The rapid growth of the ocular axis and corneal diameter may be the main cause of congenital glaucoma with acquired lower eyelid entropion. Therefore, children with poor control of intraocular pressure and excessive growth of ocular axis and corneal diameter must be observed for the existence of acquired epiblepharon.

Distinguishing risk factors between congenital anophthalmia and microphthalmia using multivariable logistic regression.

BACKGROUND: Etiologies of congenital microphthalmia and anophthalmia are unclear and commonly thought to be homogenous. To test if risk factors are similar for these two diseases, we compared the risk factors between congenital microphthalmia and anophthalmia in a large Chinese cohort. METHODS: A total of 347 patients with congenital microphthalmia or anophthalmia diagnosed by magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound from 2011 to 2018 were enrolled. Patients' clinical information, used as potential risk factors, was retrospectively collected. A multivariable logistic regression model was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A total of 347 patients were affected by congenital microphthalmia or anophthalmia. A total of 324 cases were microphthalmia, and 23 cases were anophthalmia. Structural abnormalities, mother's age at initial pregnancy, whether the mother drinks, whether the mother was diseased during pregnancy and whether the father has systemic disease passed the univariate test. In the multivariable logistic regression model, whether the mother was diseased during pregnancy (OR =2.804, P=0.023) and whether the father had systemic disease (OR =4.795, P=0.027) are significant risk factors for anophthalmia over microphthalmia. Influenza or common cold infection accounted most of the mother's diseases during pregnancy. CONCLUSIONS: Mothers with diseases, mainly influenza or common cold infection, during pregnancy are more likely to have baby with anophthalmia than microphthalmia. Our study indicated that there might be different etiologies for anophthalmia and microphthalmia.

Management of congenital microphthalmos and anophthalmos with orbital cyst.

PURPOSE: To study the effects of an individualized treatment approach to children with congenital microphthalmos and anophthalmos. METHODS: Patients with congenital microphthalmos or anopthalmos with orbital cysts who were referred to Beijing Tongren Hospital between July 2009 and July 2017 were included in this retrospective case series study. For patients ≤6 years of age, the cyst was retained to promote orbital development unless a prosthesis could not be fitted at all or disproportionate orbital growth was detected. Hydrogel orbit expanders were implanted initially if orbital volume was poor. For patients >6 years of age, the cyst was removed if it caused cosmetic problems or unsatisfactory prosthesis fitting. Eyelid procedures were performed after puberty to improve appearance. RESULTS: The study included 26 orbits of 24 patients. Of the 14 patients ≤6 years, 3 underwent cyst excision, 8 were treated with conformers only, and 3 had hydrogel orbit expander implantation initially. Of the 10 patients >6 years, 1 had the cyst removed, 5 had eyelid surgeries without removing the cyst, 3 wore an artificial eye without any surgery, and 1 used no prosthesis. During the follow-up period (range, 6 months to 8 years), 23 patients had a good cosmetic outcome and were eventually able to retain an ocular prosthesis; 1 patient could not wear prostheses but refused further treatment. No procedure-related complications were noted. CONCLUSIONS: The individualized treatment of congenital microphthalmos and anophthalmos with orbital cysts depends on the patient's age at presentation, the growth pattern of the cyst, and the volume of the affected orbit.

Medial Canthoplasty Combined with Conjunctivodacryocystorhinostomy for the Treatment of Delayed Medial Telecanthal Deformity.

BACKGROUND: Rupture of the medial canthal ligament can be caused by many events. It remains a challenge to rebuild the drainage system and restore the function. The aim of this study was to evaluate the clinical efficacy of medial canthoplasty combined with conjunctivodacryocystorhinostomy (CDCR) in patients with medial telecanthal deformities and lacrimal drainage system damage. METHODS: Twenty-two patients (22 eyes) treated with medial canthoplasty and CDCR during June 2012 to June 2014 were included in this retrospective study. For all patients, a self-tapping, titanium, low-profile head microscrew was drilled into the solid bone on the posterior aspect of the anterior lacrimal crest at the attachment position of the medial canthal ligament. Medpor-coated tear drainage tubes were applied. Distance of patient's lateral displacement before and after operation was recorded and compared. The complications of CDCR were described. RESULTS: Before the surgery, distance of patient's canthal displacement was 4-6 mm. The canthal distance between two eyes of patients with surgery was 1 mm or less. Among patients with CDCR, four patients had proximal obstruction and two patients had distal obstruction. Five patients had tube malposition, for example, tube extrusion 1-3 months after surgery. CONCLUSIONS: Medial canthoplasty combined with CDCR is an effective surgical method for treatment of patients with medial telecanthal deformity and lacrimal drainage system obstruction. The study indicates that medial canthoplasty combined with CDCR surgery rebuilds normal appearance of eyelid and contour of the medial canthus and successfully repairs the function of the lacrimal drainage system.

Digital Evaluation of Orbital Cyst Associated with Microphthalmos: Characteristics and Their Relationship with Orbital Volume.

PURPOSE: To study the characteristics of orbital cyst associated with microphthalmos in a group of Chinese patients, and to analyze the relationship between orbital cyst and orbital volume. DESIGN: Cross-sectional comparative study. PARTICIPANTS: 120 patients who were diagnosed as unilateral clinical blind microphthalmos, in which 20 patients had orbital cyst in the affected eye. METHOD: Participants had computed tomography (CT) scan. CT images were analyzed with a computer-aided software. MAIN OUTCOME MEASURES: Volume and position of orbital cyst, microphthalmic to contralateral ratio (MCR) of orbital volume, height and depth and orbital rim displacement. RESULTS: 38.1% of the cysts located anterior to or at the equator of the globe, 75% of which located infratemporally and all of which were outside the muscle cone. Most (84.6%) of the posterior cysts were inside the muscle cone. The anterior cysts were larger than the posterior cysts (p = 0.005). MCR of orbital volume (p<0.001), height (p = 0.004) and width (p = 0.043) were significantly higher in patients with orbital cyst than controls. For patients with orbital cyst, larger cyst-plus-globe volume of the affected eye was associated with higher MCR of orbital volume (r = 0.630, p = 0.003). Patients with large cyst-plus-globe volume had higher MCR of orbital volume (p = 0.002), height (p = 0.014), width (p = 0.005) and depth (p = 0.002) and less displacement in inferior (p = 0.004) orbital rim, compared with patients with small cyst-plus-globe volume, but the differences between patients with small cyst-plus-globe volume and patients without cyst were not significant. CONCLUSIONS: Microphthalmic eyes with large cyst-plus-globe volume showed better similarity with the contralateral eyes, comparing with microphthalmic eyes without orbital cyst or with small cyst-plus-globe volume. It suggested that the existence of orbital cysts (especially large cysts) in microphthalmic eyes might play a positive role in the orbital development.

Digital evaluation of orbital development after self-inflating hydrogel expansion in Chinese children with congenital microphthalmia.

BACKGROUND: Assessment of the growth of bony orbit in children with blind microphthalmia is essential to its management. In this study, variables were measured to evaluate the development of the bony microphthalmic orbits after treatment with self-inflating hydrogel expanders. METHODS: This is a retrospective study with an interventional case series. Thirteen pediatric patients with congenital unilateral blind microphthalmia who had undergone tissue expansion with hydrogel expanders and computed tomography (CT) scanning before and after operation were included in the study. The orbital volume, depth, width, and height and retardation of the orbital rims before and after treatment were measured and analyzed using the iPlan Cranial Software. RESULTS: The mean age at the time of first implantation was 44 months (range, 3-113 months). Of the 13 patients, eleven received orbital expansion, while two received socket expansion. In the orbital expansion group, the mean microphthalmic/contralateral ratio (MCR) of orbital volume was 79.3% before surgery, which increased to 89.8% 3 years post operation (P < 0.001). The mean MCR of orbital width also increased from 88.8% to 91.8% (P = 0.003). The development of inferior and lateral rims showed the greatest retardation before treatment; the retardation of these two rims decreased significantly at the final measurement (P = 0.004). It is also noted that the development of the microphthalmic orbits was limited in the two patients who only underwent socket expansion. CONCLUSIONS: The affected orbit enlarged in children with congenital blind microphthalmia following treatment with hydrogel expanders; this suggested that microphthalmia-associated orbital asymmetry can be treated with self-inflating hydrogel expanders.

[Repair of full-thickness lower eyelid defect following surgical excision of malignant tumor using Hughes technique].

OBJECTIVE: To evaluate surgical outcome of reconstruction of full-thickness lower eyelid defect resulting from tumor excision. METHODS: A retrospective case series review of patients with lower eyelid malignant tumor who underwent surgical repair of full-thickness eyelid defect from June 2008 to May 2013 was made. The defect ranged from 50% to 80% of the lower eyelid after excision of tumor with frozen section control of the surgical margins. Hughes technique was used to reconstruct the posterior lamellar and local flap and free graft were fashioned to repair the anterior defect. The pedicle was divided at 1-3 months postoperatively. RESULTS: Of the 157 lower eyelid malignant tumors, the 3 most common types were basal cell carcinoma (107/157, 68.2%), sebaceous gland carcinoma (32/157, 20.4%), and malignant melanoma (10/157, 6.4%). Twenty-one eyelids of 21 patients (aged from 43 to 77 years old) were identified. No tumor recurred during follow-up period (8-60 months). There was only one case with squamous carcinoma metastasized to the parotid gland and then excised. The contour of all lower eyelids was satisfactory. No eyelid margin deformity or upper lid retraction was observed. Revision surgery was performed to treat lower lid entropion (3 patients), while mild lower lid retraction (2 patients) and temporary ectropion (one patient) required no management. CONCLUSION: Hughes flap, which is a posterior lamellar replacement for lower eyelid defect after removal of malignant tumor, achieves favorable functional and cosmetic results.

Management of extensive epibulbar choristoma associated with microphthalmos: a rare clinical entity.

IMPORTANCE: Extensive epibulbar choristomas associated with microphthalmia have rarely been reported. We report 2 cases and describe our experience in the diagnosis and management of this challenging entity. OBSERVATIONS: The clinical features, surgical and histopathologic findings, and aesthetic results of surgical treatment were recorded. CONCLUSIONS AND RELEVANCE: Surgical management of extensive epibulbar choristoma associated with microphthalmos using a simplified method of partial tumor excision and skin grafting can result in improved cosmetic outcomes.

Cosmetic shell fitting over a sensitive cornea in mild phthisis bulbi using total conjunctival flap.

BACKGROUND: Cosmetic scleral shells provide a superior alternative to enucleation or evisceration in the setting of phthisis bulbi. However, corneal irritation often minimizes the wearing time of a scleral shell. This study aimed to evaluate the clinical effectiveness of a total conjunctival flap covering in the management of mild phthisis bulbi with a sensitive cornea. METHODS: The surgical technique involved a total conjunctival flap covering combined with superficial lamellar keratectomy to allow the fitting of a cosmetic scleral shell over a sensitive cornea. The records of patients with mild phthisis bulbi who underwent this technique from September 2003 through July 2011 were reviewed. Postoperative and long-term complications were noted. Outcome measures included cosmetic appearance, complications, and patient satisfaction. RESULTS: A total of 58 patients (58 eyes) were identified. The mean age at surgery was 28.5 years (range=2-65 years) and the mean follow-up period (follow-up rate=66%) was 42.6 months (range=6-98 months). Postoperative complications like epithelial inclusion cyst (one eye), intolerance of scleral shell wear (2 eyes), and deterioration of phthisis bulbi (3 eyes) were observed during the follow-up interval. Surgical success was achieved in 52 subjects (90%) with the desired prosthetic appearance and motility and no further intervention was required. CONCLUSION: The total conjunctival flap is an easy and effective globe-conserving alternative to enucleation or evisceration in the cosmetic rehabilitation of patients with mild phthisis bulbi. 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 .