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Shu Q, Pang J, Liu Z, Liang X, Chen M, Tao Z, Liu Q, Guo Y, Yang X, Ding J, Chen R, Wang S, Li W, Zhai G, Xu J, Li L. Artificial Intelligence for Early Detection of Pediatric Eye Diseases Using Mobile Photos. JAMA Netw Open 2024; 7:e2425124. [PMID: 39106068 PMCID: PMC11304122 DOI: 10.1001/jamanetworkopen.2024.25124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/31/2024] [Indexed: 08/07/2024] Open
Abstract
IMPORTANCE Identifying pediatric eye diseases at an early stage is a worldwide issue. Traditional screening procedures depend on hospitals and ophthalmologists, which are expensive and time-consuming. Using artificial intelligence (AI) to assess children's eye conditions from mobile photographs could facilitate convenient and early identification of eye disorders in a home setting. OBJECTIVE To develop an AI model to identify myopia, strabismus, and ptosis using mobile photographs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at the Department of Ophthalmology of Shanghai Ninth People's Hospital from October 1, 2022, to September 30, 2023, and included children who were diagnosed with myopia, strabismus, or ptosis. MAIN OUTCOMES AND MEASURES A deep learning-based model was developed to identify myopia, strabismus, and ptosis. The performance of the model was assessed using sensitivity, specificity, accuracy, the area under the curve (AUC), positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (P-LR), negative likelihood ratios (N-LR), and the F1-score. GradCAM++ was utilized to visually and analytically assess the impact of each region on the model. A sex subgroup analysis and an age subgroup analysis were performed to validate the model's generalizability. RESULTS A total of 1419 images obtained from 476 patients (225 female [47.27%]; 299 [62.82%] aged between 6 and 12 years) were used to build the model. Among them, 946 monocular images were used to identify myopia and ptosis, and 473 binocular images were used to identify strabismus. The model demonstrated good sensitivity in detecting myopia (0.84 [95% CI, 0.82-0.87]), strabismus (0.73 [95% CI, 0.70-0.77]), and ptosis (0.85 [95% CI, 0.82-0.87]). The model showed comparable performance in identifying eye disorders in both female and male children during sex subgroup analysis. There were differences in identifying eye disorders among different age subgroups. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the AI model demonstrated strong performance in accurately identifying myopia, strabismus, and ptosis using only smartphone images. These results suggest that such a model could facilitate the early detection of pediatric eye diseases in a convenient manner at home.
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Affiliation(s)
- Qin Shu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiali Pang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Zijia Liu
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyi Liang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Moxin Chen
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Zhuoran Tao
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qianwen Liu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yonglin Guo
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefeng Yang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jinru Ding
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Ruiyao Chen
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Sujing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Guangtao Zhai
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Xu
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Lin Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Zhao Y, Fu J, Hao J. Eyelid retraction during smiling in a patient with monocular congenital ptosis: a case report. BMC Ophthalmol 2024; 24:232. [PMID: 38822301 PMCID: PMC11143675 DOI: 10.1186/s12886-024-03485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/15/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Blepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis. CASE DESCRIPTION A 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn't have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation. CONCLUSION Blepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid.
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Affiliation(s)
- Yiyang Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Jie Hao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
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Marcasciano M, Vittori E, Ciriaco AG, Torto FL, Giannaccare G, Scorcia V, D'Alcontres FS, Chang C, Colica C, Greco M. A Systematic Quality Assessment of Online Resources on Eyelid Ptosis Using the Modified Ensuring Quality Information for Patients (mEQIP) Tool. Aesthetic Plast Surg 2024; 48:1688-1697. [PMID: 38360956 DOI: 10.1007/s00266-024-03862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Eyelid ptosis is an underestimated pathology deeply affecting patients' quality of life. Internet has increasingly become the major source of information regarding health care, and patients often browse on websites to acquire an initial knowledge on the subject. However, there is lack of data concerning the quality of available information focusing on the eyelid ptosis and its treatment. We systematically evaluated online information quality on eyelid ptosis by using the "Ensuring Quality Information for Patients" (EQIP) scale. MATERIALS AND METHODS Google, Yahoo and Bing have been searched for the keywords "Eyelid ptosis," "Eyelid ptosis surgery" and "Blepharoptosis." The first 50 hits were included, evaluating the quality of information with the expanded EQIP tool. Websites in English and intended for general non-medical public use were included. Irrelevant documents, videos, pictures, blogs and articles with no access were excluded. RESULTS Out of 138 eligible websites, 79 (57,7%) addressed more than 20 EQIP items, with an overall median score of 20,2. Only 2% discussed procedure complication rates. The majority fail to disclose severe complications and quantifying risks, fewer than 18% clarified the potential need for additional treatments. Surgical procedure details were lacking, and there was insufficient information about pre-/postoperative precautions for patients. Currently, online quality information has not improved since COVID-19 pandemic. CONCLUSIONS This study highlights the urgent requirement for improved patient-oriented websites adhering to international standards for plastic and oculoplastic surgery. Healthcare providers should effectively guide their patients in finding trustworthy and reliable eyelid ptosis correction information. 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)
- Marco Marcasciano
- Department of Experimental and Clinical Medicine, Unit of Plastic and Reconstructive Surgery, Magna Graecia University, Catanzaro, Italy.
| | - Emanuele Vittori
- Department of Plastic and Reconstructive Surgery, University Hospital of Messina AOU Gaetano Martino, Messina, Italy
| | - Antonio Greto Ciriaco
- Department of Experimental and Clinical Medicine, Unit of Plastic and Reconstructive Surgery, Magna Graecia University, Catanzaro, Italy
| | - Federico Lo Torto
- Unit of Plastic and Reconstructive Surgery, Department of Surgery, "Sapienza" University of Rome, P. Valdoni Policlinico Umberto I, Rome, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Cantanzaro, Italy
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Cantanzaro, Italy
| | - Francesco Stagno D'Alcontres
- Department of Plastic and Reconstructive Surgery, University Hospital of Messina AOU Gaetano Martino, Messina, Italy
| | - Chad Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Caterina Colica
- Unità Operativa Complessa Oculistica Ospedale Grassi, ASL Roma-3 Ostia, Roma, Italy
| | - Manfredi Greco
- Department of Experimental and Clinical Medicine, Unit of Plastic and Reconstructive Surgery, Magna Graecia University, Catanzaro, Italy
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Nuliqiman M, Xu M, Sun Y, Cao J, Chen P, Gao Q, Xu P, Ye J. Artificial Intelligence in Ophthalmic Surgery: Current Applications and Expectations. Clin Ophthalmol 2023; 17:3499-3511. [PMID: 38026589 PMCID: PMC10674717 DOI: 10.2147/opth.s438127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Artificial Intelligence (AI) has found rapidly growing applications in ophthalmology, achieving robust recognition and classification in most kind of ocular diseases. Ophthalmic surgery is one of the most delicate microsurgery, requiring high fineness and stability of surgeons. The massive demand of the AI assist ophthalmic surgery will constitute an important factor in boosting accelerate precision medicine. In clinical practice, it is instrumental to update and review the considerable evidence of the current AI technologies utilized in the investigation of ophthalmic surgery involved in both the progression and innovation of precision medicine. Bibliographic databases including PubMed and Google Scholar were searched using keywords such as "ophthalmic surgery", "surgical selection", "candidate screening", and "robot-assisted surgery" to find articles about AI technology published from 2018 to 2023. In addition to the Editorials and letters to the editor, all types of approaches are considered. In this paper, we will provide an up-to-date review of artificial intelligence in eye surgery, with a specific focus on its application to candidate screening, surgery selection, postoperative prediction, and real-time intraoperative guidance.
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Affiliation(s)
- Maimaiti Nuliqiman
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Mingyu Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Yiming Sun
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Jing Cao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Pengjie Chen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Qi Gao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Peifang Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China
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Fan J, Yan Y, Huang R, Guo R, Yang J. Temporal-fasciae-complex sheet suspension for correction of severe recurrent blepharoptosis. J Plast Reconstr Aesthet Surg 2023; 85:65-71. [PMID: 37478652 DOI: 10.1016/j.bjps.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/26/2023] [Accepted: 04/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Multiple surgical methods were performed to correct the blepharoptosis. However, the recurrence of blepharoptosis is not uncommon in clinical practice. The Temporal-Fasciae-Complex Sheet (TFC sheet) was an ideal autologous material in correcting the severe blepharoptosis. In the present retrospected study, we introduced our experience in the correction of severe recurrent blepharoptosis with the technique of TFC sheet suspension, and describe the follow-up results to illustrate its effectiveness and practicality. METHODS A total of 16 patients (23 eyes) with severe recurrent blepharoptosis were enrolled in this study. All the patients were performed with temporal-fasciae-complex sheet suspension surgeries for revision> 12 months after the primary surgeries by the same treatment group. The margin-to-reflex distance 1 (MRD1), correction effect, and eyelid symmetry were used to evaluate clinical outcomes. RESULTS 19 eyelids (82.6%) showed good correction results, and 5 eyelids (21.7%) showed fair correction results. The average value of preoperative-MRD1(pre-MRD1) was - 0.17 ± 0.97, and the average value of postoperative-MRD1(post-MRD1) was 4.01 ± 1.24. There was a statistically significant difference between pre-MRD1 and post-MRD1 (p < 0.0001). Good symmetry was observed in 13 patients (81.3%). All patients enrolled were satisfied with the surgical results. CONCLUSION The Temporal-Fasciae-Complex Sheet Suspension is an effective and safe method for correcting the recurrent blepharoptosis.
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Affiliation(s)
- Jincai Fan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Yucheng Yan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Rong Huang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Rui Guo
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jifan Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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Telich-Tarriba JE, Villate P, Moreno-Aguirre C, Gomez-Villegas T, Armas-Girón LF, Fentanes-Vera A, Cardenas-Mejia A. Dynamic reanimation of severe blepharoptosis using the neurotized omohyoid muscle graft. J Plast Reconstr Aesthet Surg 2023; 80:86-90. [PMID: 36996505 DOI: 10.1016/j.bjps.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft. METHODS Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019. RESULTS Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0 mm and levator function was< 1 mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5 mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve. CONCLUSION This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery.
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Hosseini SS, Yamini B, Ichkitidze L, Asadi M, Fernandez J, Gholampour S. Enhanced Ionic Polymer-Metal Composites with Nanocomposite Electrodes for Restoring Eyelid Movement of Patients with Ptosis. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:473. [PMID: 36770434 PMCID: PMC9920823 DOI: 10.3390/nano13030473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
The present study aims to use enhanced ionic polymer-metal composites (IPMC) as an artificial muscle (a soft-active actuator) to restore eyelid movement of patients with ptosis. The previous eyelid movement mechanisms contained drawbacks, specifically in the lower eyelid. We used finite element analysis (FEA) to find the optimal mechanism among two different models (A and B). In addition to common electrodes of IPMC (gold and platinum), the bovine serum albumin (BSA) and microcrystalline cellulose (MCC) polymers, with optimal weight percentages of carbon nanotube (CNT) nanofiller, were also utilized as non-metallic electrodes to improve the efficiency of the IPMC actuator. In both models, IPMC with nanocomposite electrodes had higher efficiency as compared to the metallic electrodes. In model A, which moved eyelids indirectly, IPMC with MCC-CNT electrode generated a higher force (25.4%) and less stress (5.9 times) as compared to IPMC with BSA-CNT electrode. However, the use of model A (even with IPMCs) with nanocomposite electrodes can have limitations such as possible malposition issues in the eyelids (especially lower). IPMC with MCC-CNT nanocomposite electrode under model B, which moved eyelids directly, was the most efficient option to restore eyelid movement. It led to higher displacements and lower mechanical stress damage as compared to the BSA-CNT. This finding may provide surgeons with valuable data to open a window in the treatment of patients with ptosis.
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Affiliation(s)
- Sara Sadat Hosseini
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Bakhtiar Yamini
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Levan Ichkitidze
- Institute of Biomedical Systems of National Research University of Electronic Technology (MIET), 124498 Moscow, Russia
- Institute of Bionic Technologies and Engineering of I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Majid Asadi
- Northern Michigan University, Marquette, MI 49855, USA
| | - Julie Fernandez
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Seifollah Gholampour
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
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Keene KR, Kan HE, van der Meeren S, Verbist BM, Tannemaat MR, Beenakker JM, Verschuuren JJ. Clinical and imaging clues to the diagnosis and follow-up of ptosis and ophthalmoparesis. J Cachexia Sarcopenia Muscle 2022; 13:2820-2834. [PMID: 36172973 PMCID: PMC9745561 DOI: 10.1002/jcsm.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022] Open
Abstract
Ophthalmoparesis and ptosis can be caused by a wide range of rare or more prevalent diseases, several of which can be successfully treated. In this review, we provide clues to aid in the diagnosis of these diseases, based on the clinical symptoms, the involvement pattern and imaging features of extra-ocular muscles (EOM). Dysfunction of EOM including the levator palpebrae can be due to muscle weakness, anatomical restrictions or pathology affecting the innervation. A comprehensive literature review was performed to find clinical and imaging clues for the diagnosis and follow-up of ptosis and ophthalmoparesis. We used five patterns as a framework for differential diagnostic reasoning and for pattern recognition in symptomatology, EOM involvement and imaging results of individual patients. The five patterns were characterized by the presence of combination of ptosis, ophthalmoparesis, diplopia, pain, proptosis, nystagmus, extra-orbital symptoms, symmetry or fluctuations in symptoms. Each pattern was linked to anatomical locations and either hereditary or acquired diseases. Hereditary muscle diseases often lead to ophthalmoparesis without diplopia as a predominant feature, while in acquired eye muscle diseases ophthalmoparesis is often asymmetrical and can be accompanied by proptosis and pain. Fluctuation is a hallmark of an acquired synaptic disease like myasthenia gravis. Nystagmus is indicative of a central nervous system lesion. Second, specific EOM involvement patterns can also provide valuable diagnostic clues. In hereditary muscle diseases like chronic progressive external ophthalmoplegia (CPEO) and oculo-pharyngeal muscular dystrophy (OPMD) the superior rectus is often involved. In neuropathic disease, the pattern of involvement of the EOM can be linked to specific cranial nerves. In myasthenia gravis this pattern is variable within patients over time. Lastly, orbital imaging can aid in the diagnosis. Fat replacement of the EOM is commonly observed in hereditary myopathic diseases, such as CPEO. In contrast, inflammation and volume increases are often observed in acquired muscle diseases such as Graves' orbitopathy. In diseases with ophthalmoparesis and ptosis specific patterns of clinical symptoms, the EOM involvement pattern and orbital imaging provide valuable information for diagnosis and could prove valuable in the follow-up of disease progression and the understanding of disease pathophysiology.
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Affiliation(s)
- Kevin R. Keene
- CJ Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Hermien E. Kan
- CJ Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Duchenne CenterThe Netherlands
| | - Stijn van der Meeren
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
- Orbital Center, Department of OphthalmologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Berit M. Verbist
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Jan‐Willem M. Beenakker
- CJ Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Radiation OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jan J.G.M. Verschuuren
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Duchenne CenterThe Netherlands
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Pérez-Navarro L, Sánchez-Miranda Román I, Martín Santana I, Malo de Molina Zamora R. Ptosis palpebral bilateral: ¿Cuándo sospechar causa vascular? Neurologia 2022. [DOI: 10.1016/j.nrl.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Yang Y, Lyu J, Wang R, Wen Q, Zhao L, Chen W, Bi S, Meng J, Mao K, Xiao Y, Liang Y, Zeng D, Du Z, Wu Y, Cui T, Liu L, Iao WC, Li X, Cheung CY, Zhou J, Hu Y, Wei L, Lai IF, Yu X, Chen J, Wang Z, Mao Z, Ye H, Xiao W, Yang H, Huang D, Lin X, Zheng WS, Wang R, Yu-Wai-Man P, Xu F, Dai Q, Lin H. A digital mask to safeguard patient privacy. Nat Med 2022; 28:1883-1892. [PMID: 36109638 PMCID: PMC9499857 DOI: 10.1038/s41591-022-01966-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
The storage of facial images in medical records poses privacy risks due to the sensitive nature of the personal biometric information that can be extracted from such images. To minimize these risks, we developed a new technology, called the digital mask (DM), which is based on three-dimensional reconstruction and deep-learning algorithms to irreversibly erase identifiable features, while retaining disease-relevant features needed for diagnosis. In a prospective clinical study to evaluate the technology for diagnosis of ocular conditions, we found very high diagnostic consistency between the use of original and reconstructed facial videos (κ ≥ 0.845 for strabismus, ptosis and nystagmus, and κ = 0.801 for thyroid-associated orbitopathy) and comparable diagnostic accuracy (P ≥ 0.131 for all ocular conditions tested) was observed. Identity removal validation using multiple-choice questions showed that compared to image cropping, the DM could much more effectively remove identity attributes from facial images. We further confirmed the ability of the DM to evade recognition systems using artificial intelligence-powered re-identification algorithms. Moreover, use of the DM increased the willingness of patients with ocular conditions to provide their facial images as health information during medical treatment. These results indicate the potential of the DM algorithm to protect the privacy of patients' facial images in an era of rapid adoption of digital health technologies.
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Grants
- G0701386 Medical Research Council
- G1002570 Medical Research Council
- BRC-1215-20014 Department of Health
- NIHR301696 Department of Health
- National Natural Science Foundation of China (National Science Foundation of China)
- Science and Technology Planning Projects of Guangdong Province (2018B010109008);Guangzhou Key Laboratory Project (202002010006);Hainan Province Clinical Medical Center
- Fight for Sight (UK), the Isaac Newton Trust (UK), Moorfields Eye Charity (GR001376), the Addenbrooke’s Charitable Trust, the National Eye Research Centre (UK), the International Foundation for Optic Nerve Disease (IFOND), the NIHR as part of the Rare Diseases Translational Research Collaboration, the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014), and the NIHR Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology
- the National Key R&D Program of China (2018YFA0704000);Beijing Natural Science Foundation (JQ19015)
- the Institute for Brain and Cognitive Science, Tsinghua University (THUIBCS);Beijing Laboratory of Brain and Cognitive Intelligence, Beijing Municipal Education Commission (BLBCI)
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Affiliation(s)
- Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Junfeng Lyu
- School of Software and BNRist, Tsinghua University, Beijing, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Quan Wen
- School of Software and BNRist, Tsinghua University, Beijing, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenben Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shaowei Bi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jie Meng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Keli Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yu Xiao
- Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingying Liang
- Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Danqi Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zijing Du
- Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yuxuan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Tingxin Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lixue Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wai Cheng Iao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Carol Y Cheung
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jianhua Zhou
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Youjin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lai Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Iat Fan Lai
- Ophthalmic Center, Kiang Wu Hospital, Macao SAR, Macao, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jingchang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhonghao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhen Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Danping Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoming Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei-Shi Zheng
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Ruixuan Wang
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, China
| | - Patrick Yu-Wai-Man
- Cambridge Center for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Feng Xu
- School of Software and BNRist, Tsinghua University, Beijing, China.
- Beijing Laboratory of Brain and Cognitive Intelligence, Beijing Municipal Education Commission, Beijing, China.
| | - Qionghai Dai
- Beijing Laboratory of Brain and Cognitive Intelligence, Beijing Municipal Education Commission, Beijing, China.
- Department of Automation and BNRist, Tsinghua University, Beijing, China.
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China.
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
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11
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Liu Y, Chen T, Huang J, Li W, Chen Y, Huo L. Refractive error characteristics and influence on ocular parameters in patients with unilateral congenital ptosis. BMC Ophthalmol 2022; 22:291. [PMID: 35780098 PMCID: PMC9250722 DOI: 10.1186/s12886-022-02511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background The study aimed to investigate the difference in refractive status and ocular parameters between ptotic and fellow eyes in patients with unilateral congenital ptosis. Methods Thirty patients (53% males, age 22.00 ± 11.41 years) with unilateral congenital ptosis diagnosed and treated at the First Affiliated Hospital of Sun-yat Sen University were enrolled and underwent detailed refractive examinations from March 2019 to February 2022. Ocular biometric measurements were performed by an IOL Master 700 biometer. The differences in refractive error characteristics, best-corrected visual acuity (BCVA), and ocular parameters including axial length (AL), central corneal thickness (CCT), aqueous depth (AQD), anterior chamber depth (ACD), lens thickness (LT), and keratometry values between ptotic and fellow eyes were analysed. Results A lower BCVA (logMAR, median (IQR), 0.00 (− 0.13,0.00), P = 0.009) and a higher incidence of amblyopia (n (%), 7(23%), P = 0.016) were observed in ptotic eyes. The CCT of ptotic eyes was greater than that of fellow eyes (mean ± SD, 539.83 ± 26.73 μm, P < 0.001). The keratometry values at the flat axis (K1) and mean corneal power (Km) were smaller in ptotic eyes (mean ± SD, 42.11 ± 1.49 D, 42.68 ± 1.52 D, respectively, both P = 0.001). There was no significant difference in AL between ptotic and fellow eyes. Conclusions Congenital ptosis influences ocular parameters, mainly causing a thicker and flatter cornea. Patients with unilateral congenital ptosis might have lower BCVA in the ptotic eyes. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02511-x.
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Affiliation(s)
- Yingli Liu
- Department of Ophthalmology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, 510080, P. R. China
| | - Tingting Chen
- Department of Ophthalmology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, 510080, P. R. China
| | - Jingwen Huang
- Department of Ophthalmology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, 510080, P. R. China
| | - Wentao Li
- Department of Ophthalmology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, 510080, P. R. China
| | - Yilin Chen
- Department of Ophthalmology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, 510080, P. R. China
| | - Lijun Huo
- Department of Ophthalmology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, 510080, P. R. China.
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12
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Pérez-Navarro L, Sánchez-Miranda Román I, Martín Santana I, Malo de Molina Zamora R. Bilateral ptosis: when to consider a vascular cause? NEUROLOGÍA (ENGLISH EDITION) 2022; 37:704-705. [DOI: 10.1016/j.nrleng.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022] Open
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13
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Hsia NY, Wen LY, Chou CY, Lin CL, Wan L, Lin HJ. Increased Risk of Refractive Errors and Amblyopia among Children with Ptosis: A Nationwide Population-Based Study. J Clin Med 2022; 11:jcm11092334. [PMID: 35566461 PMCID: PMC9100637 DOI: 10.3390/jcm11092334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to investigate the risk of refractive errors (astigmatism, myopia, and hyperopia) and amblyopia in children with ptosis and association between age at diagnosis of ptosis and subsequent risks of vision problems. Methods: Retrospective claims data from the Taiwan National Health Insurance Research Database (NHIRD) were analyzed. We identified 1799 children aged 0−18 years who were newly diagnosed with ptosis between 2000 and 2012 and 7187 individuals without the disease. Both cohorts were followed up until 2013 to estimate the incidence of refractive errors and amblyopia. Results: Children with ptosis had 5.93-fold, 3.46-fold, 7.60-fold, and 13.45-fold increases in the risk of developing astigmatism, myopia, hyperopia, and amblyopia, respectively, compared with the control cohort (astigmatism: adjusted hazard ratio, aHR = 5.93, 95% confidence interval, CI = 5.16−6.82; myopia: aHR = 3.46, 95% CI = 3.13−3.83; hyperopia: aHR = 7.60, 95% CI = 5.99−9.63; amblyopia: aHR = 13.45, 95% CI = 10.60−17.05). Children diagnosed with ptosis at an age older than 3 years old had a higher risk of myopia than patients diagnosed with ptosis before age 3. There was no significant difference of the risk of astigmatism, amblyopia, and hyperopia between age groups. Conclusions: Children with ptosis may exhibit a higher risk of astigmatism, myopia, hyperopia, and amblyopia than children without ptosis. The risk of myopia is higher in children with ptosis diagnosed at >3 years than those diagnosed at ≤3 years.
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Affiliation(s)
- Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, Taichung 40402, Taiwan;
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Li-Yen Wen
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
| | - Ching-Ying Chou
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan;
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40402, Taiwan
- Correspondence: (L.W.); (H.-J.L.)
| | - Hui-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, Taichung 40402, Taiwan;
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan; (L.-Y.W.); (C.-Y.C.)
- Correspondence: (L.W.); (H.-J.L.)
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14
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Lai CC, Lin CC. Case Report: Botulinum Toxin-A for Complication of Exposure Keratopathy Following Frontalis-Orbicularis Oculi Muscle Flap Shortening. Front Med (Lausanne) 2022; 9:877162. [PMID: 35514756 PMCID: PMC9063448 DOI: 10.3389/fmed.2022.877162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Lagophthalmos with exposure keratopathy is a potential vision-threatening complication following surgery for blepharoptosis. We report three cases successfully treated with botulinum toxin-A (Botox®, Allergan, Irvine, USA) for this complication. Cases Three patients presented with severe blepharoptosis after surgery for orbital and frontal base tumors. They obtained good appearances after frontalis-orbicularis oculi muscle (FOOM) flap shortening. However, exposure keratopathy developed after the surgery despite frequent use of topical lubricants and autologous serum eye drops. We injected 5-10 units of botulinum toxin-A around the central supra-brow area, which was near the origin of the FOOM flap. One week later, they developed ptosis and could close the eye completely. The corneal defect gradually resolved. They recovered from ptosis 3 months later and never required a second injection. Observations Lagophthalmos with exposure keratopathy is a potential vision-threatening complication following FOOM flap surgery. In severe cases, surgical revision should be considered to partially or totally release the FOOM flap attachment, which also decreases its function permanently. In this case series, we demonstrated that injecting botulinum toxin-A may be a promising method to manage this complication without permanently affecting the function of the FOOM flap. Conclusions A botulinum toxin-A injection may be an effective treatment for patients developing exposure keratopathy after FOOM flap surgery.
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Affiliation(s)
- Chun-Chieh Lai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chen Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Chia-Chen Lin
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15
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Igde M, Yilmaz M, Gungor Y, Saglam ME, Salman N, Tapan M, Comert E, Comert A. Neurovascular anatomy of pronator quadratus for reanimation of blepharoptosis. Surg Radiol Anat 2022; 44:207-213. [DOI: 10.1007/s00276-022-02882-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022]
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16
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Jeong S, Choi E, Lee SJ. Double Eyelid Tape as a Treatment Option for Severe Ptosis in Patients With Myotonic Dystrophy Type 1. Am J Phys Med Rehabil 2022; 101:e25-e27. [PMID: 34508057 DOI: 10.1097/phm.0000000000001880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Myotonic dystrophy is a systemic disorder associated with progressive muscle weakness of the limbs and multiorgan dysfunction. This condition commonly affects the levator palpebrae superioris muscle, which leads to ptosis and eventually affects patients' activities of daily living. The effects of ptosis on activities of daily living are usually overlooked; therefore, the importance of treatment is underestimated, and surgical procedures are considered infeasible in patients with preexistent levator palpebrae superioris muscle weakness. This case report describes the case of a middle-aged man with myotonic dystrophy type 1, who presented with ptosis, which significantly restricted his participation in rehabilitation and activities of daily living secondary to a limited visual field. He was evaluated by an ophthalmologist; however, surgery was contraindicated in view of the high risk of complications, such as exposure keratitis and corneal ulcer. Double eyelid tapes were used as a nonsurgical intervention, which significantly increased the palpebral fissure height and improved the visual field, with a higher modified functional index score. Double eyelid tapes may serve as an effective, safe, and reliable therapeutic option for severe ptosis in patients with myotonic dystrophy.
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Affiliation(s)
- Sangah Jeong
- From the Department of Rehabilitation Medicine, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (SJ); and Department of Rehabilitation Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (EC, SJL)
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Zhou L, Wei X. Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer. Front Immunol 2021; 12:701951. [PMID: 34504488 PMCID: PMC8421677 DOI: 10.3389/fimmu.2021.701951] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are novel immunotherapy-based drugs that have become increasingly popular in the treatment of lung cancer. Researchers have recognized ocular immune-related adverse events (irAEs) secondary to ICIs because of their vision-threatening characteristics. However, they are incompletely characterized and no studies have reported the ICI-related ocular irAEs in lung cancer. Therefore, we aimed to comprehensively illustrate the clinical characteristics, contributory factors, diagnosis, and management of ICI-related ocular irAEs in lung cancer, based on previously reported 79 patients. Ophthalmoplegia (40.51%), uveitis (20.25%), and dry eye (17.72%) were the most common ICI-related ocular irAEs in lung cancer. Ptosis was the most common (36.71%) and the highest mortality (23.33%) of ophthalmoplegia. Patients in Asia and patients who underwent combination therapy with programmed cell death-1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors demonstrated significantly higher frequency of ophthalmoplegia than other ocular irAEs. Most ICI-related ophthalmoplegia and uveitis in lung cancer were observed in the first 10 weeks following the initiation of ICIs. Furthermore, the onset time of dry eye and other ocular irAEs was much longer. In addition, 92.31% of the patients with ocular irAEs other than ophthalmoplegia could be remised. In conclusion, ocular irAEs secondary to ICIs in lung cancer are non-negligible, particularly ophthalmoplegia. Ethnicity and the type of ICIs play important roles in the distribution of ocular irAEs. ICI-related ophthalmoplegia in lung cancer presented with early onset and worse prognosis features, thus necessitating further attention.
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Affiliation(s)
- Lin Zhou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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18
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Edavalath M, Kottil S, Hameed F. Psychogenic pseudo-myasthenic ptosis - management with ayurvedic medicines and Smriti meditation. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:481-485. [PMID: 33962505 DOI: 10.1515/jcim-2020-0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients presenting with functional neurological symptoms like non-epileptic seizures and weakness have an underlying psychological component and tend to persist for a prolonged time, despite repeated evaluations and interventions. Ayurveda, with its holistic approach to health and disease, can provide better management for such disorders, in the form of customized treatment protocols and unique methods of psychotherapy. CASE PRESENTATION The patient presented with drooping of both eyelids, initially diagnosed as ocular myasthenia, and later found to have psychogenic pseudo-myasthenic ptosis. She was evaluated based on ayurvedic parameters and managed successfully with ayurvedic treatment modalities of sodhana (dosha elimination), samana (pacifying), and a novel psychotherapy technique of Smriti meditation. CONCLUSIONS A holistic approach to the patient, as expounded by Ayurveda, is vital in evaluating and managing functional neurological complaints. Smriti meditation, in combination with selected ayurvedic medicines, is effective in managing psychosomatic manifestations as demonstrated in the present case.
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Affiliation(s)
- Mukesh Edavalath
- Department of Roganidana, VPSV Ayurveda College, Kottakkal, Kerala, India
| | - Satheesh Kottil
- Department of Manasaroga, VPSV Ayurveda College, Kottakkal, Kerala, India
| | - Febin Hameed
- Department of Manasaroga, VPSV Ayurveda College, Kottakkal, Kerala, India
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Kang JH, Park S, Choi YA. Bilateral Cerebral Ptosis in a Patient with Subdural Hemorrhage: a Case Report. BRAIN & NEUROREHABILITATION 2021; 14:e17. [PMID: 36743436 PMCID: PMC9879497 DOI: 10.12786/bn.2021.14.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/21/2020] [Accepted: 03/28/2021] [Indexed: 11/08/2022] Open
Abstract
Although cerebral ptosis is rare, it is commonly associated with unilateral right cerebral hemisphere lesions. We report a case of a 79-year-old woman who presented with bilateral complete ptosis after a traumatic right fronto-temporo-parietal subdural hemorrhage (SDH). Bilateral ptosis was the primary manifestation of the acute right SDH, and the patient had no parenchymal lesion. Her prognosis was good, and she made a complete recovery. Right hemispheric hypoperfusion, as demonstrated on brain perfusion single-photon emission computed tomography, implied that the lateralization of eyelid control was in the right hemisphere, in line with previous reports.
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Affiliation(s)
- Ji Hye Kang
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sunha Park
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young-Ah Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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20
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Hsieh YY, Tsai CC, Chen CC, Chao TY. Decreased visual acuity after chemotherapy in a case with diffuse large B cell lymphoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2021. [DOI: 10.4103/jcrp.jcrp_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Pan C, Zhou X, Hong A, Fang F, Wang Y. Identification of KRAS mutation in a patient with linear nevus sebaceous syndrome: a case report. BMC Med Genomics 2020; 13:188. [PMID: 33308209 PMCID: PMC7733249 DOI: 10.1186/s12920-020-00847-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background Linear nevus sebaceous syndrome (LNSS) is a rare genetic disease characterized by large linear sebaceous nevus typically on the face, scalp, or neck. LNSS could be accompanied by multisystem disorders including the central nervous system. Herein, we report gene mutational profile via whole exome sequencing of both lesional and non-lesional skin samples in a LNSS patient. Case presentation A 17-year-old girl presented with multisystem abnormalities, including large skin lesions, ocular disorders, abnormal bone development and neurological symptoms. A diagnosis of LNSS was established based on clinical manifestations, histopathological and imaging findings. The skin lesions were resected and no recurrence was noted at the time of drafting this report. Whole exome sequencing of genomic DNA revealed the following 3 mutations in the lesions of the index patient: KRAS (c.35G > A, p.G12D), PRKRIR (c.A1674T, p.R558S), and RRP7A (c. C670T, p.R224W), but no mutation was found in the healthy skin and peripheral blood sample of the index patient, or in the blood samples of her parents and sibling. PCR-mediated Sanger sequencing of DNA derived from lesional skin sample of the index patient verified KRAS mutation, but not PRKRIR (c.A1674T, p.R558S) and RRP7A (c. C670T, p.R224W). None of the 3 mutations was found in Sanger sequencing in skin lesions of 60 other cases of nevus sebaceous patients. Conclusions Our findings show the relevance of KRAS mutation to LNSS, providing new clues in understanding related genetic heterogeneity which could aid genetic counselling for LNSS patients.
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Affiliation(s)
- Chun Pan
- Department of Dermatologic Surgery, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Xiaowei Zhou
- Department of Dermatologic Surgery, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Anlan Hong
- Department of Dermatologic Surgery, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Fang Fang
- Department of Dermatologic Surgery, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Yan Wang
- Department of Dermatologic Surgery, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China.
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Takase R, Hagiya H, Tokumasu K, Nishimura Y, Sakurai A, Hasegawa K, Hanayama Y, Otsuka F. Droopy eyelid due to IgG4-related dacryoadenitis. Postgrad Med J 2020; 97:333-334. [PMID: 32788315 DOI: 10.1136/postgradmedj-2020-138416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ryosuke Takase
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Atsunobu Sakurai
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
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23
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Affiliation(s)
- Ema Avdagic
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Paul O Phelps
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States; Department of Surgery, Northshore University HealthSystem, 2050 Pfingsten Rd., Ste. 280, Glenview, Evanston, IL 60026, United States.
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24
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Alonso-Jimenez A, Kroon RHMJM, Alejaldre-Monforte A, Nuñez-Peralta C, Horlings CGC, van Engelen BGM, Olivé M, González L, Verges-Gil E, Paradas C, Márquez C, Garibaldi M, Gallano P, Rodriguez MJ, Gonzalez-Quereda L, Dominguez Gonzalez C, Vissing J, Fornander F, Eisum ASV, García-Sobrino T, Pardo J, García-Figueiras R, Muelas N, Vilchez JJ, Kapetanovic S, Tasca G, Monforte M, Ricci E, Gomez MT, Bevilacqua JA, Diaz-Jara J, Zamorano II, Carlier RY, Laforet P, Pelayo-Negro A, Ramos-Fransi A, Martínez A, Marini-Bettolo C, Straub V, Gutiérrez G, Stojkovic T, Martín MA, Morís G, Fernández-Torrón R, Lopez De Munaín A, Cortes-Vicente E, Querol L, Rojas-García R, Illa I, Diaz-Manera J. Muscle MRI in a large cohort of patients with oculopharyngeal muscular dystrophy. J Neurol Neurosurg Psychiatry 2019; 90:576-585. [PMID: 30530568 DOI: 10.1136/jnnp-2018-319578] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Oculopharyngeal muscular dystrophy (OPMD) is a genetic disorder caused by an abnormal expansion of GCN triplets within the PABPN1 gene. Previous descriptions have focused on lower limb muscles in small cohorts of patients with OPMD, but larger imaging studies have not been performed. Previous imaging studies have been too small to be able to correlate imaging findings to genetic and clinical data. METHODS We present cross-sectional, T1-weighted muscle MRI and CT-scan data from 168 patients with genetically confirmed OPMD. We have analysed the pattern of muscle involvement in the disease using hierarchical analysis and presented it as heatmaps. Results of the scans were correlated with genetic and clinical data. RESULTS Fatty replacement was identified in 96.7% of all symptomatic patients. The tongue, the adductor magnus and the soleus were the most commonly affected muscles. Muscle pathology on MRI correlated positively with disease duration and functional impairment. CONCLUSIONS We have described a pattern that can be considered characteristic of OPMD. An early combination of fat replacement in the tongue, adductor magnus and soleus can be helpful for differential diagnosis. The findings suggest the natural history of the disease from a radiological point of view. The information generated by this study is of high diagnostic value and important for clinical trial development.
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Affiliation(s)
- Alicia Alonso-Jimenez
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | - Corinne G C Horlings
- Neurology Department, Radboud university Medical Center, Nijmegen, The Netherlands
| | | | - Montse Olivé
- Pathology Department (Neuropathology), Neuromuscular Disorders Unit, IDIBELL, Hospital de Bellvitge, Barcelona, Spain
| | - Laura González
- Pathology Department (Neuropathology), Neuromuscular Disorders Unit, IDIBELL, Hospital de Bellvitge, Barcelona, Spain
| | - Enric Verges-Gil
- Pathology Department (Neuropathology), Neuromuscular Disorders Unit, IDIBELL, Hospital de Bellvitge, Barcelona, Spain
| | - Carmen Paradas
- Neuromuscular Disorders Unit, Neurology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Celedonio Márquez
- Neuromuscular Disorders Unit, Neurology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Matteo Garibaldi
- Neuromuscular Disorders Unit, Department of Neurology, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Ospedale Sant'Andrea, Rome, Italy
| | - Pía Gallano
- Genetic Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | | | - Lidia Gonzalez-Quereda
- Genetic Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Cristina Dominguez Gonzalez
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain.,Neuromuscular Disorders Unit, Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Freja Fornander
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sofie Vibæk Eisum
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Julio Pardo
- Neurology Department, Hospital Clínico, Santiago de Compostela, Spain
| | | | - Nuria Muelas
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain.,Neuromuscular Research Unit, Neurology Department, Instituto de Investigación Sanitaria la Fe, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Juan Jesús Vilchez
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain.,Neuromuscular Research Unit, Neurology Department, Instituto de Investigación Sanitaria la Fe, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | | | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roem, Italy
| | - Mauro Monforte
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roem, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enzo Ricci
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roem, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - María Teresa Gomez
- Neurology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jorge Alfredo Bevilacqua
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Programa de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Diaz-Jara
- Centro de imagenología, Hospital Clínico Universidad de Chile, Universidad de Chile, Santiago, Chile
| | - Ivonne Ingrid Zamorano
- Servicio de Neurología, Hospital de Puerto Montt, Servicio de Salud del Reloncavi, Los Lagos Region, Chile
| | - Robert Yves Carlier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
| | - Pascal Laforet
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service de neurologie, Pôle Neuro-locomoteur, Hôpital Raymond Poincaré, Garches, Hôpitaux Universitaires Paris-Ile-de-France Ouest, Garches, France
| | - Ana Pelayo-Negro
- Neurology Department, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria, and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - Alba Ramos-Fransi
- Neurology Department, Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Chiara Marini-Bettolo
- The John Walton Muscular Dystrophy Research Centre, MRC Centre for Neuromuscular Diseases Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, MRC Centre for Neuromuscular Diseases Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - Gerardo Gutiérrez
- Neurology Department, Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Tanya Stojkovic
- Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Germán Morís
- Neurology Department, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Roberto Fernández-Torrón
- Neurology Department, Hospital Donostia, San Sebastián, Spain.,Neuromuscular Area, Neurology Service, Biodonostia Health Research Institute, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Adolfo Lopez De Munaín
- Neurology Department, Hospital Donostia, San Sebastián, Spain.,Neuromuscular Area, Neurology Service, Biodonostia Health Research Institute, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Elena Cortes-Vicente
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Luis Querol
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ricardo Rojas-García
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Isabel Illa
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Jordi Diaz-Manera
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain .,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
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