1
|
Vongsachang H, Chiou CA, Azad AD, Lin LY, Yoon MK, Lefebvre DR, Stagner AM. Periorbital necrotizing sweet syndrome: A report of two cases mimicking necrotizing soft tissue infections. Am J Ophthalmol Case Rep 2024; 34:102033. [PMID: 38487334 PMCID: PMC10937104 DOI: 10.1016/j.ajoc.2024.102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Purpose Two cases are described of necrotizing Sweet syndrome (nSS), a rare variant of acute febrile neutrophilic dermatosis that mimics necrotizing soft tissue infections. Observation A 74-year-old female with myelodysplastic syndrome (MDS) presented with isolated periorbital nSS that closely mimicked necrotizing fasciitis (NF); she displayed pathergy to debridement, was exquisitely responsive to corticosteroids, and underwent successful first-stage reconstruction of the eyelid with full-thickness skin grafting. A second 40-year-old female patient with relapsed acute myelogenous leukemia (AML) presented with multifocal nSS most prominently involving the eyelid. Positive herpes zoster virus (HSV) PCR and bacterial superinfection complicated the diagnosis. She improved with chemotherapy for AML and corticosteroid therapy. Conclusion nSS is rare and a high level of clinical suspicion as well as an understanding of its distinguishing features is necessary to avoid undue morbidity. Identification of pathergy, histopathology, microbiology, and clinical context are critical to avoid misdiagnosis of infection.
Collapse
Affiliation(s)
- Hursuong Vongsachang
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carolina A. Chiou
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Amee D. Azad
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lisa Y. Lin
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Michael K. Yoon
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Daniel R. Lefebvre
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anna M. Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Jafari A, Simmonds JC, Mitchell MB, Banks CG, Lehmann A, Paz-Lansberg M, Yoon MK, Metson R. A New Patient-reported Outcomes Measure for Surgically Treated Epiphora: Tearing Assessment and Rating Scale-12 (TEARS-12). Am J Rhinol Allergy 2024:19458924241241871. [PMID: 38623636 DOI: 10.1177/19458924241241871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND No widely accepted, validated instrument currently exists to measure clinical outcomes in patients who undergo dacryocystorhinostomy (DCR) for treatment of epiphora. OBJECTIVE To develop a patient-reported outcome measure applicable to this population. METHODS Psychometric evaluations, consultation with experts, and review of the literature informed item generation of a 12-question questionnaire to incorporate the most relevant symptoms experienced by patients with nasolacrimal duct obstruction. This questionnaire, known as the Tearing Assessment and Rating Scale-12 (TEARS-12), was administered to 32 patients before and after intervention, in the form of endoscopic DCR. Statistical analysis was performed to measure internal consistency, responsiveness, and test-retest reliability. RESULTS Pre-operative and post-operative TEARS-12 scores (28.2 [standard error (SE) 3.19] vs 11.8 [SE 3.25], respectively, P = 0.001) demonstrated improved patient outcome within 6 weeks following endoscopic DCR. Cronbach's alpha for the questionnaire was 0.90, indicating high overall reliability. Additionally, each question demonstrated internal reliability, with a corrected item-total correlation greater than 0.30. The intraclass correlation between the two pre-operative scores was 0.858 (P < 0.001), indicating high test-retest reliability. CONCLUSION TEARS-12 is a statistically valid, easy-to-administer instrument to measure clinical outcomes in patients who undergo endoscopic DCR.
Collapse
Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | | | - Margaret B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Catherine G Banks
- Department of Otolaryngology, University of New South Wales, Sydney, Australia
| | - Ashton Lehmann
- Department of Otolaryngology, Geisinger Medical Center, Danville, PA, USA
| | | | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Lu JE, Wolkow N, Lee NG, Lefebvre DR, Freitag SK, Yoon MK. Perceived change in age after functional upper blepharoplasty. Orbit 2024; 43:165-167. [PMID: 37224403 DOI: 10.1080/01676830.2023.2214940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE To evaluate the perceived age of patients before and after functional upper blepharoplasty. METHODS Retrospective chart review of patients who underwent upper blepharoplasty by a single surgeon at an academic center. The inclusion criterion was having external photographs before and after blepharoplasty. Exclusion criteria included any other concurrent eyelid or facial surgery. Primary endpoint: perceived change in age after surgery as judged by the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS) surgeons. RESULTS Sixty-seven patients (14 men, 53 women) were included. Mean pre-operative age was 66.9 years (range 37.8-89.4) and mean post-operative age was 67.4 years (range 38.6-89). The mean perceived age pre-operatively was 68.9 years, and the mean perceived age post-operatively was 67.1 years, a change of 1.8 years (p = 0.0001 by two-tailed paired T-test). Inter-rater reliability of the observers was measured by intraclass correlation coefficient of 0.77 for pre-operative and 0.75 for post-operative photos. The decreased perceived age was 1.9 years for women, 1.4 years for men, 0.3 years for Asians, 1.2 years for Hispanics, and 2.1 years for whites. DISCUSSION Functional upper blepharoplasty by an experienced ASOPRS surgeon was shown to reduce the perceived age of a patient by an average of 1.8 years.
Collapse
Affiliation(s)
- Jonathan E Lu
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - N Grace Lee
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Daniel R Lefebvre
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| |
Collapse
|
4
|
McCoskey M, Yoon MK. Traumatic Ptosis. Int Ophthalmol Clin 2024; 64:1-9. [PMID: 38525978 DOI: 10.1097/iio.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
|
5
|
Lu JE, Ross C, Ivanov A, Hall N, Lorch A, Miller J, Yoon MK. Epidemiology of Orbital Inflammatory Disease: An AAO IRIS Registry Study. Ocul Immunol Inflamm 2024:1-4. [PMID: 38489590 DOI: 10.1080/09273948.2024.2322013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/17/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The current study queries the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) registry for data on the epidemiology, work-up, and management patterns of autoimmune orbital inflammation. METHODS Analysis and description of patient data from the IRIS registry between 2013 and 2019 reviewing patients with autoimmune or idiopathic orbital inflammation with filters based on International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. Patients with thyroid eye disease, orbital cellulitis, and orbital abscess were excluded. MAIN OUTCOME MEASURES Demographic descriptions included gender, age, geographic region, and treatment. Sub-analysis was performed by assessing rates of imaging, biopsy, lab work-up, and diagnostic categories. RESULTS In a final cohort of 20,584 patients, the mean age of onset of orbital inflammation was 51.7 years; 67% female; and 63% Caucasian, 21% unknown, 12% Black, 2.6% Asian, and 1.5% other. Only 49 had imaging, 78 had laboratory work-up, and 1,411 had biopsy codes. Treatment results showed 166 patients receiving antibiotics, 224 patients receiving steroids, and 35 patients receiving both. CONCLUSIONS This study assessed the epidemiology, diagnostic patterns, and treatment patterns for orbital inflammation through the AAO IRIS registry. Practise patterns suggest a relatively low overall rate of imaging and laboratory studies compared to biopsies, although this certainly under-represents the actual number of imaging and laboratory studies and exemplifies the inherent imprecision of using a large database. However, the methodology of this study provides a framework of approaching the IRIS registry for oculoplastic research.
Collapse
Affiliation(s)
- Jonathan E Lu
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Connor Ross
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alexander Ivanov
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Joan Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Rosenblatt TR, Chiou CA, Yoon MK, Lee NG, Wolkow N, Freitag SK. Change in upper eyelid position after teprotumumab treatment for thyroid eye disease. Orbit 2024:1-7. [PMID: 38466206 DOI: 10.1080/01676830.2024.2323543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE Despite the high prevalence, treatment challenges, and significant impact of eyelid retraction on vision and quality of life among patients with thyroid eye disease, the effects of teprotumumab on eyelid retraction are not fully understood. This study evaluated change in upper eyelid position after teprotumumab. METHODS A retrospective study of all patients who completed eight teprotumumab infusions at one institution from January 1 2020 to December 31 2022. Primary outcome was change in upper eyelid position immediately after treatment and at most recent follow-up compared to pre-treatment. RESULTS Among 234 eyes of 118 patients, average margin reflex distance-1 (MRD1) pre-treatment was 5.25 mm (range 0-10.0, SD 1.75), 4.66 mm (1.0-9.0, SD 1.32) immediately post-treatment (p < 0.001), and 4.50 mm (0-10.0, SD 1.52) at most recent follow-up (mean follow-up duration 10.60 months). In total, 136 (58.12%) eyes of 88 patients had MRD1 reduction immediately post-treatment, averaging 1.49 mm (0.5-5.0 mm, SD 0.97). Every 1-mm increase in pre-treatment MRD1 increased the odds of MRD1 reduction by 15.03% (CI 10.52-19.72, p < 0.001) and increased the reduction amount by 0.48 mm (CI 0.39-0.57, p < 0.001). Of 154 eyes of 78 patients with most recent follow-up, 107 (69.48%) eyes had stable or further improved retraction at most recent follow-up compared to immediately post-treatment. CONCLUSIONS This study found a modest but significant reduction in MRD1 in approximately 60% of eyes, independent of proptosis change, which was sustained by most patients over longer-term follow-up. Higher pre-treatment MRD1 corresponded with greater improvement. These results suggest an overall mild benefit of teprotumumab for upper eyelid retraction.
Collapse
Affiliation(s)
- Tatiana R Rosenblatt
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina A Chiou
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nahyoung Grace Lee
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne K Freitag
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Rosenblatt TR, Chiou CA, Yoon MK, Wolkow N, Lee NG, Freitag SK. Proptosis Regression After Teprotumumab Treatment for Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2024; 40:187-191. [PMID: 37791840 DOI: 10.1097/iop.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE This study analyzed the degree and timing of proptosis regression after teprotumumab therapy. METHODS A retrospective study of all patients who completed 8 teprotumumab infusions at 1 institution from January 1, 2020 to December 31, 2022. Change in proptosis was assessed in millimeters and percentages compared with immediate post-treatment and pretreatment proptosis. RESULTS Of 119 patients with post-treatment data (mean follow-up 10.56 months, range: 3.05-25.08), 208 (87.39%) eyes of 110 patients had initial proptosis improvement. Of the 78 patients with multiple follow-up visits, 102 (65.38%) eyes of 59 patients had proptosis regression averaging 12.78% (range: 1.85-58.82%) compared with immediately post-treatment or 2.43 mm (0.5-10.0 mm). Eight (7.84%) eyes had initial documentation of regression more than 1 year after treatment, 40 (39.22%) between 6 months and 1 year, and 54 (52.94%) eyes within 6 months with 25 (46.30%) of these continuing to worsen at subsequent follow-up. Forty (25.64%) eyes of 24 patients had more proptosis at most recent follow-up than before teprotumumab, with an average regression of 1.53 mm (0.5-4.0 mm) or 7.74% (1.85-20.69%) of pretreatment proptosis. In comparison, 99 (63.46%) eyes of 54 patients maintained improvement, with reduction averaging 3.13 mm (0.5-11.0 mm) or 13.19% (1.92-41.67%) of pretreatment proptosis ( p < 0.001). CONCLUSIONS Two-thirds of eyes had regression despite initial teprotumumab response, typically within 1 year of treatment, with ongoing worsening over time. Most patients maintained some proptosis reduction compared with before treatment despite regression, although 25% were worse than pretreatment. The occurrence of regression was independent of the pretreatment duration of clinical thyroid eye disease. Overall, compared with preteprotumumab, there was a greater amount of improvement than regression at most recent follow-up.
Collapse
Affiliation(s)
- Tatiana R Rosenblatt
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | | | | | | | | | | |
Collapse
|
8
|
McCoskey M, Reshef ER, Wolkow N, Yoon MK. Bilateral enlargement of all extraocular muscles: a presenting ophthalmic sign of hematologic malignancy. Orbit 2024; 43:160-163. [PMID: 35734822 DOI: 10.1080/01676830.2022.2090014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
Abstract
Hematologic malignancies such as leukemia and lymphoma can frequently present in the orbit; however, involvement of the extraocular muscles is rare. The authors report two cases of systemic hematologic malignancy presenting with bilateral extraocular muscle enlargement and associated compressive optic neuropathy (CON). Both patients experienced clinical and radiographic improvement of ocular and systemic manifestations of disease with prompt initiation of targeted chemotherapy. These cases highlight the importance of including hematologic malignancy in the differential diagnosis of atypical bilateral extraocular muscle enlargement.
Collapse
Affiliation(s)
- Makayla McCoskey
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Edith R Reshef
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Eye and Ear, Harvard Medical SchoolDavid G. , Boston, Massachusetts, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Stevanovic M, Yoon MK. Isolated lacrimal gland enlargement as a presenting sign of relapse of B-cell acute lymphoblastic leukemia in an adult. Digit J Ophthalmol 2023; 29:73-76. [PMID: 37780037 PMCID: PMC10539004 DOI: 10.5693/djo.02.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A 25-year-old woman with a history of acute lymphoblastic leukemia with Philadelphia chromosome (BCR 22q11.2-ABL1 (9q34)) presented with progressively worsening swelling and pain in her left upper eyelid of 3 months' duration. Magnetic resonance imaging showed a heterogeneously enhancing mass lesion in the left lacrimal gland. An incisional biopsy was performed; histopathology showed atypical lymphocytic cells, and flow cytometry revealed a similar immunophenotype to her previously diagnosed cancer. Her presentation was consistent with recurrence of acute lymphoblastic leukemia in the lacrimal gland, which can rarely be involved in relapse of acute lymphoblastic leukemia.
Collapse
Affiliation(s)
- Marta Stevanovic
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Michael K. Yoon
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Amer MM, Cestari DM, Yoon MK, Armstrong GW. Traumatic rupture of the inferior rectus muscle: case report and review of the literature. Digit J Ophthalmol 2023; 29:45-49. [PMID: 37727467 PMCID: PMC10506612 DOI: 10.5693/djo.02.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Traumatic inferior rectus muscle rupture secondary to blunt injury in the absence of associated orbital or ocular fractures or injury is rarely encountered, and there are limited published reports on subsequent surgical repair. We present the case of a 74-year-old man with complete inferior rectus transection following a fall with facial strike. A computed tomography scan of the face was unremarkable. Surgical exploration and repair of the muscle was performed by hooking the inferior oblique muscle to identify the inferior rectus muscle. Subsequent strabismus surgery was performed for residual binocular diplopia, resulting in excellent anatomic and visual outcomes and postoperative ocular alignment.
Collapse
Affiliation(s)
- Mona M. Amer
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Dean M. Cestari
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Michael K. Yoon
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Grayson W. Armstrong
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
Lu JE, Yoon MK. The Role of Steroids for Pediatric Orbital Cellulitis - Review of the Controversy. Semin Ophthalmol 2023:1-4. [PMID: 36683269 DOI: 10.1080/08820538.2023.2168487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Orbital cellulitis in the pediatric population is treated primarily with antibiotic therapy. This leaves the inflammatory component unchecked. Corticosteroid therapy has been used to accelerate recovery and decrease the long-term morbidity in other infectious conditions. Its use has also been proposed for pediatric orbital cellulitis. The aim of this manuscript is to conduct a literature review to summarize existing evidence and understand ongoing controversies. Overall, prior investigations on corticosteroid therapy for pediatric orbital cellulitis are limited by their study design and sample sizes. One of the most discussed potential benefits is that adjuvant steroid therapy for pediatric orbital cellulitis is associated with shorter hospitalization without major infectious complications. However, decreased hospitalization length is an imperfect metric, especially without standardized criteria for hospital discharge. Future studies are warranted to better guide the use of adjuvant steroid therapy and to optimize its potential in the management of pediatric orbital cellulitis.
Collapse
Affiliation(s)
- Jonathan E Lu
- Department of Ophthalmology, Division of Oculoplastic Surgery Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Michael K Yoon
- Department of Ophthalmology, Division of Oculoplastic Surgery Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| |
Collapse
|
12
|
Gostimir M, Liou V, Yoon MK. Safety of Botulinum Toxin A Injections for Facial Rejuvenation: A Meta-Analysis of 9,669 Patients. Ophthalmic Plast Reconstr Surg 2023; 39:13-25. [PMID: 35353777 DOI: 10.1097/iop.0000000000002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To quantitatively evaluate safety profile for botulinum toxin A (BTX-A) injections among patients undergoing treatment for cosmetic indications is produced, with special attention to clinically relevant covariates and their relative impact on safety. METHODS A systematic literature search was performed using PubMed (1996-January 2020) and Embase (1947-January 2020) to identify all randomized controlled trials (RCTs) that reported safety data for patients receiving BTX-A for cosmetic indications compared to placebo. A meta-analysis was performed to determine pooled risk ratios (RR) for treatment-related adverse events (TRAEs) and for specific adverse events. Meta-regression and additional analyses were performed for significant and/or clinically relevant covariates. RESULTS Following the review of 8,690 studies, 32 RCTs involving 9,669 patients were included. The pooled RR of any TRAE occurring after BTX-A injection compared to placebo injection was 1.53 (95% CI, 1.33-1.77; p < 0.001). Statistically significant covariates included individual injection volume and total injection volume. The type of BTX-A formulation, treatment site, total BTX-A units, and BTX-A units per injection were not significant. Specific adverse events more likely to occur following BTX-A injection rather than placebo injection included eyelid/eyebrow malposition (RR 3.55; p < 0.001), facial paresis (RR 2.42; p = 0.316), and headache (RR 1.45; p = 0.003). Injection site reactions and injection site bruising occurred at similar rates in both groups. CONCLUSIONS The overall safety profile of BTX-A is acceptable and consistent with previous publications. The authors' additional analyses provide a relative comparison of the impact of various treatment parameters on safety.
Collapse
Affiliation(s)
- Mišo Gostimir
- Ivey Eye Institute, Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Victor Liou
- Department of Ophthalmology, Harvard Medical School
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| |
Collapse
|
13
|
Lin LY, Lee NG, Yoon MK, Stagner AM. Clear Cell Syringoma of the Eyelids, a Distinctive Histopathologic Variant Associated with Diabetes Mellitus. Ophthalmic Plast Reconstr Surg 2023; 39:e20-e22. [PMID: 36136737 DOI: 10.1097/iop.0000000000002254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors describe the clinical and histologic findings of the clear cell variant of syringoma. Three adult female patients (age range 39-76 years old) were found to have multiple, flesh-colored lower eyelid papules, clinically consistent with syringomas, but histologically displaying abundant clear cell change. Two patients had known diagnoses of uncontrolled diabetes.
Collapse
Affiliation(s)
| | - Nahyoung Grace Lee
- Department of Ophthalmology
- Division of Ophthalmic Plastic and Reconstructive Surgery Service
| | - Michael K Yoon
- Department of Ophthalmology
- Division of Ophthalmic Plastic and Reconstructive Surgery Service
| | - Anna M Stagner
- Department of Ophthalmology
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| |
Collapse
|
14
|
Hasegawa N, Zhao J, Greninger DA, Lu J, Yoon MK, Chen Y, McCulley TJ. An orbital calcific cyst following exenteration. Orbit 2022:1-4. [PMID: 36573493 DOI: 10.1080/01676830.2022.2151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/20/2022] [Indexed: 02/17/2024]
Abstract
A 77-year-old Asian female with a history of left orbit exenteration and lid-sparing reconstruction for recurrent sebaceous carcinoma presented with fluid-like sensation of the left orbit. Magnetic resonance imaging (MRI) demonstrated bright T2 signal and a cyst-like cavity within the exenterated orbit. Decision was made to proceed with surgical exploration and excision. A calcified, bone-like cavity was encountered intraoperatively and removed. Histopathology revealed dense fibrous connective tissue with areas of calcification without osseous metaplasia, suggestive of retained blood in the orbit that underwent dystrophic calcification. This case report illustrates a rare occurrence of a bone-like calcific cyst following exenteration.
Collapse
Affiliation(s)
- Naomi Hasegawa
- Department of Ophthalmology, University of Texas at Houston, Houston, Texas, USA
| | - Jiawei Zhao
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel A Greninger
- Department of Ophthalmology, Kaiser Permanente Antioch Medical Center, Antioch, California, USA
| | - Jonathan Lu
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ying Chen
- Department of Ophthalmology, University of Texas at Houston, Houston, Texas, USA
| | - Timothy J McCulley
- Department of Ophthalmology, University of Texas at Houston, Houston, Texas, USA
| |
Collapse
|
15
|
Levy M, Chwalisz BK, Kozak BM, Yoon MK, Shih HA, Stagner AM. Case 36-2022: A 30-Year-Old Woman with Decreased Vision and Headache. N Engl J Med 2022; 387:1980-1989. [PMID: 36416771 DOI: 10.1056/nejmcpc2211355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Levy
- From the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Massachusetts General Hospital, the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Ophthalmology (M.K.Y.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (B.K.C., M.K.Y., A.M.S.) - all in Boston
| | - Bart K Chwalisz
- From the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Massachusetts General Hospital, the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Ophthalmology (M.K.Y.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (B.K.C., M.K.Y., A.M.S.) - all in Boston
| | - Benjamin M Kozak
- From the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Massachusetts General Hospital, the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Ophthalmology (M.K.Y.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (B.K.C., M.K.Y., A.M.S.) - all in Boston
| | - Michael K Yoon
- From the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Massachusetts General Hospital, the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Ophthalmology (M.K.Y.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (B.K.C., M.K.Y., A.M.S.) - all in Boston
| | - Helen A Shih
- From the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Massachusetts General Hospital, the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Ophthalmology (M.K.Y.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (B.K.C., M.K.Y., A.M.S.) - all in Boston
| | - Anna M Stagner
- From the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Massachusetts General Hospital, the Departments of Neurology (M.L., B.K.C.), Radiology (B.M.K.), Ophthalmology (M.K.Y.), Radiation Oncology (H.A.S.), and Pathology (A.M.S.), Harvard Medical School, and the Department of Ophthalmology, Massachusetts Eye and Ear (B.K.C., M.K.Y., A.M.S.) - all in Boston
| |
Collapse
|
16
|
Habib LA, North VS, Freitag SK, Yoon MK, Lefebvre DR, Grace Lee N. Medical comorbidities and orbital implant exposure. Acta Ophthalmol 2022; 100:e813-e819. [PMID: 34233090 DOI: 10.1111/aos.14973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate medical conditions and systemic therapies associated with orbital implant exposure in patients with anophthalmic sockets. METHODS Retrospective review of patients who underwent enucleation or evisceration at a single centre between January 1, 2008 and March 1, 2018. Medical comorbidities, including peripheral or coronary artery disease, rheumatologic conditions, diabetes, malignancy and history of smoking were recorded. Use of immunomodulatory and anticoagulation therapy at the time of eye removal was noted. Patients were divided into two groups-those with implant exposure and those without. Univariate and multivariate analysis was used to compare groups. RESULTS Two hundred and twenty-nine patients underwent eye removal surgery over a ten-year period. Implant exposure was seen in 20 (8.7%) patients. Univariate analysis revealed a statistically significant difference between groups in rates of smoking, malignancy, and immunomodulatory therapy at the time of surgery. A history of smoking (HR = 11.72; 95% CI: 2.95, 46.53; p = 0.0001) and immunomodulatory therapy (HR = 8.02; 95% CI: 1.96, 32.87; p = 0.004) were independent predictors of exposure. The probability of exposure was 81.2% when all three risk factors were present versus 4.4% when none were present (c-index = 0.737, 95% CI: 0.608, 0.865; p < 0.001). The model was a good fit to the data (Hosmer-Lemeshow goodness-of-fit test p = 0.475). CONCLUSIONS Smoking and immunomodulatory therapy were associated with orbital implant exposure in patients with anophthalmic sockets. This is the first report examining medical comorbidities in patients with orbital implant exposure. Understanding the pathophysiology of implant exposure is crucial to preoperative planning and postoperative care.
Collapse
Affiliation(s)
- Larissa A. Habib
- Oculoplastic and Reconstructive Surgery Division Department of Ophthalmology Yale Medical School New Haven CT USA
| | - Victoria S. North
- Oculoplastic and Orbital Surgery Edward S. Harkness Eye Institute Columbia University Irving Medical Center New York‐Presbyterian Hospital New York NY USA
| | - Suzanne K. Freitag
- Department of Ophthalmology Harvard Medical School Boston MA USA
- Ophthalmic Plastic Surgery Service Massachusetts Eye and Ear Boston MA USA
| | - Michael K. Yoon
- Department of Ophthalmology Harvard Medical School Boston MA USA
- Ophthalmic Plastic Surgery Service Massachusetts Eye and Ear Boston MA USA
| | - Daniel R. Lefebvre
- Department of Ophthalmology Harvard Medical School Boston MA USA
- Ophthalmic Plastic Surgery Service Massachusetts Eye and Ear Boston MA USA
| | - Nahyoung Grace Lee
- Department of Ophthalmology Harvard Medical School Boston MA USA
- Ophthalmic Plastic Surgery Service Massachusetts Eye and Ear Boston MA USA
| |
Collapse
|
17
|
Chiou CA, Yoon MK. An Update on Fungal Orbital Infections. Int Ophthalmol Clin 2022; 62:55-69. [PMID: 35325910 DOI: 10.1097/iio.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Wai KM, Wolkow N, Yoon MK. Infectious Dacryoadenitis: A Comprehensive Review. Int Ophthalmol Clin 2022; 62:71-86. [PMID: 35325911 DOI: 10.1097/iio.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Liou VD, Yoon MK, Maher M, Chwalisz BK. Orbital Inflammation in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Case Report and Review of the Literature. J Neuroophthalmol 2022; 42:e56-e62. [PMID: 34999653 DOI: 10.1097/wno.0000000000001400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To present 2 patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease with unilateral orbital inflammation, optic nerve head edema, and abnormalities of the optic nerve and nerve sheath on imaging. We review the most current literature on this important and uncommon clinical phenotype. METHODS A case report of 2 patients and a comprehensive review of the relevant literature on orbital inflammation in MOG antibody-associated disease (MOG-AD). RESULTS Two patients presented with decreased vision and unilateral orbital inflammation. Both had optic nerve head edema and abnormalities of the optic nerve and nerve sheath on imaging. The patients were treated with immunosuppressants and had improvement of vision changes as well as their orbital inflammatory signs. MOG antibody was positive in high titers in both patients. Only 3 other cases of orbital inflammation associated with MOG antibody have been described. In all cases, orbital signs responded rapidly to intravenous methylprednisolone, but the improvement in visual acuity was variable and less robust. CONCLUSION Orbital inflammation is a unique and underrecognized phenotype of MOG-AD with only a few reports in the literature. In patients who present with vision loss and orbital inflammation, MOG-AD should be considered in the differential.
Collapse
Affiliation(s)
- Victor D Liou
- Ophthalmic Plastic Surgery (VDL, MKY), Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts; Department of Radiology (MM), Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Neuro-ophthalmology (BKC), Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts; and Department of Neurology (BKC), Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
| | | | | | | |
Collapse
|
20
|
Cohen LM, Liou VD, Cunnane ME, Yoon MK. Radiographic analysis of fatty infiltration of the extraocular muscles in thyroid eye disease. Orbit 2022; 41:53-58. [PMID: 32878536 DOI: 10.1080/01676830.2020.1817100] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Fatty infiltration of the extraocular muscles has been described radiographically in patients with thyroid eye disease (TED), yet it has not been studied on a large scale nor quantified. Our purpose was to define and characterize this entity in patients with TED. METHODS An IRB-approved cross-sectional retrospective review of medical records identified patients with a clinical diagnosis of TED and at least one CT of the orbits. A 2:1 age and sex-matched control population consisted of patients without a history nor radiographic evidence of orbital disease or systemic thyroid abnormality. The presence of fatty infiltration in each extraocular rectus muscle was defined using Hounsfield units (HU). Laterality, muscles involved, and pattern of fatty infiltration were also evaluated. Student's t-tests, Chi-square, and Fisher's exact tests were used to compare TED and control groups. RESULTS The study population consisted of 252 patients with TED and 504 age and sex-matched controls. Fatty infiltration was significantly more prevalent in TED patients (36/252, 14.3%) compared to controls (11/504, 2.2%) (p < .001). The mean density of fat infiltration was significantly lower in TED patients (-40.4 HU) than controls (-34.8 HU) (p = .048). In TED patients, the frequency of muscle involvement was inferior rectus (61.8%), lateral rectus (19.7%), superior rectus (11.8%) and medial rectus (6.6%), which was not significantly different than controls (p > .05). Most muscles (88.2%) in the TED group exhibited a heterogeneous pattern of infiltration, which did not differ from controls (p = .34). CONCLUSIONS This study characterizes fatty infiltration of the extraocular muscles in patients with TED.
Collapse
Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, University of California, Los Angeles, CA, USA
| | - Victor D Liou
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Mary Elizabeth Cunnane
- Neuroradiology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Belinsky I, Creighton FX, Mahoney N, Petris CK, Callahan AB, Campbell AA, Kazim M, Lee HBH, Yoon MK, Dagi Glass LR. Teprotumumab and Hearing Loss: Case Series and Proposal for Audiologic Monitoring. Ophthalmic Plast Reconstr Surg 2022; 38:73-78. [PMID: 34085994 DOI: 10.1097/iop.0000000000001995] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To present a protocol for audiologic monitoring in the setting of teprotumumab treatment of thyroid eye disease, motivated by 4 cases of significant hearing loss, and review the relevant literature. METHODS Cases of hearing loss in the setting of teprotumumab were retrospectively elicited as part of a multi-institutional focus group, including oculoplastic surgeons, a neurotologist and an endocrinologist. A literature review was performed. RESULTS An aggregate of 4 cases of teprotumumab-associated hearing loss documented by formal audiologic testing were identified among 3 clinicians who had treated 28 patients. CONCLUSIONS Teprotumumab may cause a spectrum of potentially irreversible hearing loss ranging from mild to severe, likely resulting from the inhibition of the insulin-like growth factor-1 and the insulin-like growth factor-1 receptor pathway. Due to the novelty of teprotumumab and the lack of a comprehensive understanding of its effect on hearing, the authors endorse prospective investigations of hearing loss in the setting of teprotumumab treatment. Until the results of such studies are available, the authors think it prudent to adopt a surveillance protocol to include an audiogram and tympanometry before, during and after infusion, and when prompted by new symptoms of hearing dysfunction.
Collapse
Affiliation(s)
- Irina Belinsky
- Department of Ophthalmology, New York University Langone Health, New York, New York
| | | | - Nicholas Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, Maryland
| | - Carisa K Petris
- Department of Ophthalmology, University of Missouri, Columbia, Missouri
| | - Alison B Callahan
- Department of Ophthalmology, Tufts University Medical Center, Boston, Massachusetts
| | - Ashley A Campbell
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, Maryland
| | - Michael Kazim
- Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - H B Harold Lee
- Oculofacial Plastic and Orbital Surgery, Indianapolis, Indiana
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Lora R Dagi Glass
- Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
22
|
Habib LA, Yoon MK. Patient specific implants in orbital reconstruction: A pilot study. Am J Ophthalmol Case Rep 2021; 24:101222. [PMID: 34746511 PMCID: PMC8554165 DOI: 10.1016/j.ajoc.2021.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/08/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose Successful repair of the orbital skeleton restores function and cosmesis by normalizing globe position and allowing full motility of the extraocular muscles. Routine repairs are successful with standard implants. However, defects that are irregular or cause volume deficiency can be challenging to repair. The development of patient specific implants (PSI) offers an additional tool in complex cases. Herein, we report our experience using PSI for orbital reconstruction. Methods An IRB-approved review was conducted of consecutive patients who received PSI from 8/2016–9/2018. Demographic and examination findings were recorded. PSI was designed using high-density porous polyethylene or polyetheretherketone (PEEK) and implanted for repair. The postoperative course was reviewed for outcomes and complications. Results Eight patients were identified. Two had silent sinus syndrome, 3 were complex facial fracture revisions, and 3 were post-oncologic reconstruction. Seven received porous polyethylene implants, and 1 had a PEEK implant. Mean follow up time was 10.2 months (3.3–28.3). All had an improved functional and aesthetic result. Diplopia and enophthalmos completely resolved in 60% of fracture and silent sinus patients. All fracture and silent sinus patients were orthotropic without diplopia in primary gaze at last follow up. Tumor patients had improvement in symmetry and functionality. There were no complications. Conclusion and importance Complex orbital skeleton derangements can be difficult to repair and standard implants may incompletely resolve the anatomic problem. In challenging cases, PSI may better achieve an aesthetically and anatomically successful outcome and improve functionality.
Collapse
Affiliation(s)
- Larissa A Habib
- Department of Ophthalmology, Yale School of Medicine, New Haven, CT, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Yoon MK, Habib LA. Spheno-Orbital Dermoid Masquerading as Recurrent Orbital Abscess. Ophthalmic Plast Reconstr Surg 2021; 37:e213-e215. [PMID: 34293785 DOI: 10.1097/iop.0000000000002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 10-month-old girl presented with eyelid edema and erythema that did not improve with systemic antibiotics. Due to a lack of improvement, MRI was performed to avoid ionizing radiation from CT. An orbital abscess was recognized and drained. However, the abscess recurred 2 times. CT scan was performed and a tract in the sphenoid bone helped to diagnose a congenital dural sinus tract with dermoid. Definitive surgery was performed with neurosurgery to remove the entire tract including cutaneous connection. CT scan proved critical to diagnosis and should be considered in infants in select cases despite the concern for ionizing radiation in this vulnerable age group.
Collapse
Affiliation(s)
- Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Larissa A Habib
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Yale University, New Haven, Connecticut, U.S.A
| |
Collapse
|
24
|
Yoon MK, Kelly HR, Freitag SK, Marneros AG, Barshak MB, Brackett DG. Case 12-2021: A 78-Year-Old Man with a Rash on the Scalp and Face. N Engl J Med 2021; 384:1553-1562. [PMID: 33882209 DOI: 10.1056/nejmcpc2100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael K Yoon
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Hillary R Kelly
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Suzanne K Freitag
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Alexander G Marneros
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Miriam B Barshak
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Diane G Brackett
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| |
Collapse
|
25
|
Abstract
Septic cavernous sinus thrombosis (SCST) is a rare, yet severe, process typically arising from infections of the paranasal sinuses (predominately ethmoid and/or sphenoid sinusitis) and less commonly, otogenic, odontogenic, and pharyngeal sources. Clinical symptoms of SCST arise from obstruction of venous drainage from the orbit and compression of the cranial nerves within the cavernous sinus. In the preantibiotic era SCST was considered universally fatal (80-100%); however, with the introduction of antibiotics the overall incidence, morbidity, and mortality of SCST have greatly declined. In spite of dramatic improvements, morbidity and mortality remain high, with the majority of patients experiencing neurological sequalae, highlighting the severity of the disease and the need for prompt recognition, diagnosis, and treatment. Here we review of the literature on SCST with a focus on the current recommendations and recent evidence for diagnostic and medical management of this condition.
Collapse
Affiliation(s)
- Jonathan T Caranfa
- Department of Ophthalmology, New England Eye Center Tufts University School of Medicine, Boston, Massachusetts, USA; Eastern Connecticut Health Network, Manchester Memorial Hospital, Manchester, Connecticut, USA.
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Hu WF, Yoon MK, Wolkow N. Slowly Progressive Unilateral Blepharoptosis in a 37-Year-Old Woman. JAMA Ophthalmol 2021; 138:704-705. [PMID: 32324201 DOI: 10.1001/jamaophthalmol.2020.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Wen Fan Hu
- Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston.,David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| |
Collapse
|
27
|
Abstract
Purpose: To compare the incidence of lower eyelid malposition following repair of isolated orbital floor fractures with that of complex orbitofacial fractures (defined as multi-wall fractures or prior orbital fracture repairs requiring revision) by oculofacial plastic surgeons via a transconjunctival or swinging eyelid approach.Methods: Retrospective review of 175 patients who underwent surgical repair of orbital fractures at our institution. The primary outcomes were the occurrence of lower eyelid malposition (ectropion, entropion, and eyelid retraction) and the need for subsequent surgical correction.Results: Of 95 patients with isolated orbital floor fractures, 4 developed eyelid malposition (4.2%), 1 of which required surgical repair (1.1%). Of 80 patients with complex orbitofacial fractures (48 multi-wall fractures, 32 secondary revisions), 10 had pre-operative eyelid malposition and were excluded from further analysis. Fourteen of the remaining 70 patients developed postoperative eyelid malposition (20%), 3 of which required surgical repair (4.3%). The difference in the occurrence of eyelid malposition between groups was statistically significant (p = .001), but the difference in rates of those requiring subsequent repair was not (p = .182). There was no statistically significant difference in the occurrence of eyelid malposition when considering other surgical factors including lateral canthotomy, conjunctival closure, implant material, or anterior rim screws.Conclusions: The incidence of lower eyelid malposition following orbital fracture repair via a fornix-based approach was significantly higher for the repair of complex orbitofacial fractures than for isolated floor fractures. However, very few patients in either group required surgical repair for eyelid malposition. Surgical factors including implant material did not affect outcomes.
Collapse
Affiliation(s)
- Victoria S North
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Edith R Reshef
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Nahyoung Grace Lee
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel R Lefebvre
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
28
|
Abstract
Orbital surgery can result in damage to ocular and orbital structures, leading to a range of structural and visual sequelae, including corneal abrasions, globe malposition, diplopia, and blindness. Vision loss in particular is the most feared and devastating complication, occurs with an overall incidence of 0.84%, and can occur secondary to direct injury, optic nerve compression, or ischemic events. Different types of orbital surgery and surgical approaches carry their own hazards, and it is important to be mindful of these risks in addition to having a thorough understanding of individual risk factors and anatomical variations for each patient. Although universal guidelines for preserving vision in orbital surgery do not yet exist, there are concrete steps that every surgeon can take at the preoperative, intraoperative, and postoperative stages to minimize the risk of injury and maximize the likelihood of preserving the eye and visual function.
Collapse
Affiliation(s)
- Jenny C Dohlman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| |
Collapse
|
29
|
Abstract
Thyroid eye disease (TED) is an autoimmune inflammatory disease of the orbit and the most common extrathyroidal manifestation of Graves disease. The release of pro-inflammatory cytokines is associated with inflammation of the ocular surface and lacrimal gland along with periorbital skin erythema and edema. Resultant tissue remodeling, fibrosis, and fat deposition can impart permanent physical changes to the ocular adnexa with effects on function and cosmesis. These changes occur in the active phase of disease, and it is during this time that steroids are often relied on to help alleviate symptoms. Due to the common and predictable side effects of long-term and high-dose steroid use, there has been a continuous effort to find alternative steroid-sparing medical management options for TED. This review highlights the various research studies that support the use of these medications.
Collapse
Affiliation(s)
- Victor D Liou
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear , Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School , Boston, MA, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear , Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School , Boston, MA, USA
| |
Collapse
|
30
|
Wai KM, Wolkow N, Yoon MK. Displaced bone fragment simulating an orbital foreign body. Orbit 2020; 40:344-345. [PMID: 32524877 DOI: 10.1080/01676830.2020.1775263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen M Wai
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,David G Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Yoon
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
31
|
Habib LA, Wolkow N, Cohen L, Ma L, Yoon MK, Lee NG. Pyoderma gangrenosum of the eyelid associated with inflammatory bowel disease. Am J Ophthalmol Case Rep 2020; 18:100623. [PMID: 32195439 PMCID: PMC7075799 DOI: 10.1016/j.ajoc.2020.100623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/02/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Pyoderma gangrenosum (PG) of the eyelid can be difficult to diagnosis and may mimic other, more common pathologies, thereby delaying proper treatment and management. PG may be associated with systemic disorders that have significant comorbidities. Observations The authors present two cases of pyoderma gangrenosum of the eyelid associated with inflammatory bowel disease. Conclusions and importance This case series highlights the importance of early recognition of eyelid pyoderma gangrenosum to avoid local and systemic comorbidities with timely and appropriate management.
Collapse
Affiliation(s)
- Larissa A Habib
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School Boston, MA, USA
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School Boston, MA, USA.,Department of Pathology, Harvard Medical School Boston, MA, USA
| | - Liza Cohen
- Department of Ophthalmology, Harvard Medical School Boston, MA, USA
| | - Lina Ma
- Department of Pathology, Harvard Medical School Boston, MA, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School Boston, MA, USA
| | - Nahyoung Grace Lee
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School Boston, MA, USA
| |
Collapse
|
32
|
Affiliation(s)
- Debora H. Lee
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Liza M. Cohen
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Michael K. Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jeremiah P. Tao
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| |
Collapse
|
33
|
Abstract
PURPOSE To investigate via volumetric analysis whether orbital fat atrophy occurs in late post-traumatic enophthalmos. METHODS An IRB-approved retrospective cohort study identified patients with diagnoses of both orbital fracture and enophthalmos with a CT orbits >3 months after injury. Exclusion criteria were surgical repair, other orbital disease or surgery, adjacent sinus disease, and an abnormal contralateral orbit. Images were analyzed using OsiriX imaging software (v.9.0.2, Pixmeo, Switzerland). Total orbital volume and orbital fat volume for the fractured and normal contralateral orbits were measured via three-dimensional volume rendering assisted region-of-interest computation. Enophthalmos was measured radiographically. Paired samples t-tests were used to compare orbital fat and total orbital volumes between the fractured and normal contralateral orbits. RESULTS Thirteen patients met the inclusion criteria. The numbers of patients with each fracture pattern were floor (4), medial wall (4), floor/medial wall (3), zygomaticomaxillary complex (floor+lateral wall) (1), zygomaticomaxillary complex+medial (inferior/medial/lateral walls) (1). Mean time from injury to CT scan was 21.8 ± 16.3 months. Comparing the fractured and normal contralateral orbits, there was a statistically significant decrease in orbital fat volume (mean difference 0.9 ml (14.2%), p = .0002) and increase in total orbital volume (mean difference 2.0 ml (7.0%), p = .0001). One ml orbital volume change was responsible for 0.83 mm enophthalmos. CONCLUSIONS In addition to an increase in total orbital volume, orbital fat loss occurs with late post-traumatic enophthalmos due to unrepaired fractures. This suggests correction of bony change alone may be insufficient in some cases, and the use of custom implants may compensate for fat atrophy.
Collapse
Affiliation(s)
- Liza M Cohen
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear , Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts, USA
| | - Larissa A Habib
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear , Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear , Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts, USA
| |
Collapse
|
34
|
Tainsh LT, Jakobiec FA, Wolkow N, Yoon MK. Doxycycline‐associated conjunctival cysts. Clin Exp Ophthalmol 2019; 48:134-136. [DOI: 10.1111/ceo.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Laurel T. Tainsh
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear InfirmaryHarvard Medical School Boston Massachusetts
| | - Frederick A. Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear InfirmaryHarvard Medical School Boston Massachusetts
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear InfirmaryHarvard Medical School Boston Massachusetts
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear InfirmaryHarvard Medical School Boston Massachusetts
| | - Michael K. Yoon
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear InfirmaryHarvard Medical School Boston Massachusetts
| |
Collapse
|
35
|
Affiliation(s)
- Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| |
Collapse
|
36
|
Affiliation(s)
- Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Larissa A. Habib
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Michael K. Yoon
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Suzanne K. Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
37
|
Abstract
Immunotherapy has significantly advanced the field of oncology in recent decades. Understanding normal immunosurveillance, as well as the ways in which tumor cells have evolved to evade it, has provided the knowledge for development of drugs that allow one's own immune system to target and destroy malignant cells (immunotherapy). Cutaneous malignancies are particularly sensitive to this class of drugs. In a very sensitive anatomic region such as the periocular tissue, where surgical excision may come with significant morbidity, this technology has had a strong impact in the successful treatment of historically challenging tumors.
Collapse
Affiliation(s)
- Larissa A Habib
- a Ophthalmic Plastic Surgery , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Natalie Wolkow
- a Ophthalmic Plastic Surgery , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Suzanne K Freitag
- a Ophthalmic Plastic Surgery , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Michael K Yoon
- a Ophthalmic Plastic Surgery , Massachusetts Eye and Ear Infirmary , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| |
Collapse
|
38
|
Roelofs KA, Starks V, Yoon MK. Reply re: “Orbital Emphysema: A Case Report and Comprehensive Review of the Literature”. Ophthalmic Plast Reconstr Surg 2019; 35:204-206. [DOI: 10.1097/iop.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Moein HR, Saeed HN, Jacobs DS, Rapoport Y, Yoon MK, Shah AS, Khan H, Raoof D, Jurkunas UV. Exposure, entropion, and bilateral corneal ulceration in a newborn as a manifestation of chromosome 22 q11.2 duplication syndrome. Am J Ophthalmol Case Rep 2019; 13:16-19. [PMID: 30505980 PMCID: PMC6247406 DOI: 10.1016/j.ajoc.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 01/24/2023] Open
Abstract
Purpose Chromosome 22q11.2 micro-duplication syndrome (MDS), is a rare autosomal dominant condition, with a highly variable phenotype that ranges from unremarkable and asymptomatic, to fatal due to cardiovascular defects. Hypertelorism, downslanting palpebral fissures, superior displacement of the eyebrows, and ptosis are the most commonly reported ocular manifestations. Here, we report a newborn with bilateral exposure, entropion, and corneal ulceration related to 22q11.2 MDS. Observation A newborn girl presented with bilateral upper eyelid entropion, bilateral lower eyelid ectropion, and lagophthalmos. She subsequently developed bilateral corneal ulcers. Topical antibacterial drops, bandage contact lenses, medroxyprogesterone 1%, and fluorometholone 0.1%, together with partial tarsorrhaphy and correction of eyelid malposition, were used to treat the ulcers and address the underlying issues of exposure and entropion. Genetic testing revealed chromosome 22q11.2.MDS; further evaluation revealed systemic manifestations of this syndrome. The ocular surface healed well with gradual improvement of corneal opacification as well as bilateral partial tarsorrhaphy. Conclusion and importance This report is the first that describes a newborn with 22q11.2 MDS presenting with sight-threatening corneal ulceration. Entropion, ectropion, and lagophthalmos were identified and treated, allowing for healing of the corneal surface. Genetic testing revealed a syndrome not known to be associated with eyelid abnormalities and corneal ulceration, but with other important systemic and ocular implications. Bilateral partial tarsorrhaphy should not be excluded as a treatment option for infants who fail more conservative measures for the treatment of exposure.
Collapse
Affiliation(s)
- Hamid-Reza Moein
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Deborah S Jacobs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,BostonSight, Needham, MA, USA
| | - Yuna Rapoport
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Haumith Khan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Duna Raoof
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ula V Jurkunas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| |
Collapse
|
40
|
|
41
|
Affiliation(s)
- Daniel R Lefebvre
- From the Departments of Ophthalmology (D.R.L., M.K.Y.) and Radiology (K.L.R.), Massachusetts Eye and Ear, the Departments of Medicine (J.H.S.) and Pathology (A.M.S.), Massachusetts General Hospital, and the Departments of Ophthalmology (D.R.L., M.K.Y.), Radiology (K.L.R.), Medicine (J.H.S.), and Pathology (A.M.S.), Harvard Medical School - all in Boston
| | - Katherine L Reinshagen
- From the Departments of Ophthalmology (D.R.L., M.K.Y.) and Radiology (K.L.R.), Massachusetts Eye and Ear, the Departments of Medicine (J.H.S.) and Pathology (A.M.S.), Massachusetts General Hospital, and the Departments of Ophthalmology (D.R.L., M.K.Y.), Radiology (K.L.R.), Medicine (J.H.S.), and Pathology (A.M.S.), Harvard Medical School - all in Boston
| | - Michael K Yoon
- From the Departments of Ophthalmology (D.R.L., M.K.Y.) and Radiology (K.L.R.), Massachusetts Eye and Ear, the Departments of Medicine (J.H.S.) and Pathology (A.M.S.), Massachusetts General Hospital, and the Departments of Ophthalmology (D.R.L., M.K.Y.), Radiology (K.L.R.), Medicine (J.H.S.), and Pathology (A.M.S.), Harvard Medical School - all in Boston
| | - John H Stone
- From the Departments of Ophthalmology (D.R.L., M.K.Y.) and Radiology (K.L.R.), Massachusetts Eye and Ear, the Departments of Medicine (J.H.S.) and Pathology (A.M.S.), Massachusetts General Hospital, and the Departments of Ophthalmology (D.R.L., M.K.Y.), Radiology (K.L.R.), Medicine (J.H.S.), and Pathology (A.M.S.), Harvard Medical School - all in Boston
| | - Anna M Stagner
- From the Departments of Ophthalmology (D.R.L., M.K.Y.) and Radiology (K.L.R.), Massachusetts Eye and Ear, the Departments of Medicine (J.H.S.) and Pathology (A.M.S.), Massachusetts General Hospital, and the Departments of Ophthalmology (D.R.L., M.K.Y.), Radiology (K.L.R.), Medicine (J.H.S.), and Pathology (A.M.S.), Harvard Medical School - all in Boston
| |
Collapse
|
42
|
Wolkow N, Jakobiec FA, Yoon MK. Intratarsal keratinous eyelid cysts in Gorlin syndrome: A review and reappraisal. Surv Ophthalmol 2018; 63:711-718. [DOI: 10.1016/j.survophthal.2017.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/08/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
|
43
|
Cohen LM, Shaye DA, Yoon MK. Isolated Orbital Floor Fracture Management: A Survey and Comparison of American Oculofacial and Facial Plastic Surgeon Preferences. Craniomaxillofac Trauma Reconstr 2018; 12:112-121. [PMID: 31073360 DOI: 10.1055/s-0038-1639350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022] Open
Abstract
This article aimed to characterize, compare, and contrast the management of isolated orbital floor fractures among oculofacial and facial plastic surgeons in the United States. An anonymous 17-question multiple-choice web-based survey was distributed to all 590 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and all 1,300 members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) using each society's email database from November 2016 to January 2017. Two-hundred twenty-five oculofacial and 135 facial plastic surgeons completed the survey. The most important indications for surgery among both oculofacial and facial plastic surgeons were motility restriction, enophthalmos, and diplopia at 2 weeks. The most common preferred time to surgical intervention was 8 to 14 days; however, facial plastic surgeons were more likely to operate after 4 to 7 days ( p < 0.001). The most common choices of orbital implant material were porous polyethylene and porous polyethylene plus titanium for both oculofacial and facial plastic surgeons, nylon for oculofacial surgeons, and titanium for facial plastic surgeons. The majority rarely/never used intraoperative computed tomography imaging or navigation. Facial plastic surgeons were more likely to perform postoperative imaging ( p < 0.001). We report results of the first survey of isolated orbital floor fracture management among oculofacial and facial plastic surgeons in the United States. This survey characterizes practice patterns and areas of similarities/differences among oculofacial and facial plastic surgeons in the management of isolated orbital floor fractures, which may help define the current standard of care.
Collapse
Affiliation(s)
- Liza M Cohen
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Massachusetts
| | - David A Shaye
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Michael K Yoon
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Massachusetts
| |
Collapse
|
44
|
Houston KE, Tomasi M, Amaral C, Finch N, Yoon MK, Lee H, Paschalis EI. The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy. Transl Vis Sci Technol 2018; 7:7. [PMID: 29367892 PMCID: PMC5777174 DOI: 10.1167/tvst.7.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance First group data in patients showing successful reanimation of the eyelid with magnetic force.
Collapse
Affiliation(s)
- Kevin E Houston
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Matteo Tomasi
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Christina Amaral
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Nicole Finch
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Michael K Yoon
- Oculoplastics Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I Paschalis
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Schepens Eye Research Institute - Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.,Disruptive Technology Laboratory (DTL), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
45
|
Nguyen HV, Jakobiec FA, Zakka FR, Yoon MK. Bilateral upper and lower eyelid margin swelling and madarosis due to lymphoma. Surv Ophthalmol 2017; 63:589-594. [PMID: 28986312 DOI: 10.1016/j.survophthal.2017.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 01/10/2023]
Abstract
Over a 2-year period, swellings of all 4 eyelid margins developed in a 32-year-old woman and was accompanied by complete loss of eyelashes. An inflammatory dermatologic condition was considered the most likely cause. A full-thickness right lower eyelid biopsy revealed a multinodular lymphoid tumor at the eyelid margin which immunophenotypically and genetically was diagnosed as an extranodal marginal zone lymphoma. The mode of presentation of the disease was considered to be most unusual, as was its B cell lineage, since the majority of primary cutaneous lymphomas are of T-cell origin. Systemic workup demonstrated bilateral involvement of the external auditory canals.
Collapse
Affiliation(s)
- Huy V Nguyen
- The David Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick A Jakobiec
- The David Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
| | - Fouad R Zakka
- The David Cogan Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, The Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Michael K Yoon
- Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, The Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| |
Collapse
|
46
|
Homer N, Jakobiec FA, Stagner A, Cunnane ME, Freitag SK, Fay A, Yoon MK. Periocular breast carcinoma metastases: correlation of clinical, radiologic and histopathologic features. Clin Exp Ophthalmol 2017; 45:606-612. [DOI: 10.1111/ceo.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/11/2016] [Accepted: 01/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Natalie Homer
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
- Department of Ophthalmology; Harvard Medical School; Boston Massachusetts USA
| | - Frederick A Jakobiec
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
- Department of Ophthalmology; Harvard Medical School; Boston Massachusetts USA
- David G. Cogan Ophthalmic Pathology Laboratory; Boston Massachusetts USA
| | - Anna Stagner
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
- Department of Ophthalmology; Harvard Medical School; Boston Massachusetts USA
- David G. Cogan Ophthalmic Pathology Laboratory; Boston Massachusetts USA
| | - Mary Elizabeth Cunnane
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
- Department of Radiology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
| | - Suzanne K Freitag
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
- Department of Ophthalmology; Harvard Medical School; Boston Massachusetts USA
| | - Aaron Fay
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
| | - Michael K Yoon
- Massachusetts Eye and Ear Infirmary; Boston Massachusetts USA
- Department of Ophthalmology; Harvard Medical School; Boston Massachusetts USA
| |
Collapse
|
47
|
Lin GC, Freitag SK, Kocharyan A, Yoon MK, Lefebvre DR, Bleier BS. Comparative techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space. Am J Rhinol Allergy 2017; 30:226-9. [PMID: 27216355 DOI: 10.2500/ajra.2016.30.4307] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and retraction of the MRM is oftentimes necessary for endoscopic removal of intraconal tumors, e.g., orbital hemangioma. We evaluated each of the reported methods of MRM retraction for endoscopic orbital surgery and quantified the degree of intraconal exposure conferred by each method. METHODS Eight orbits from four cadaver heads were dissected. In each orbit, medial orbital decompression was performed and the MRM was retracted by using four previously described techniques: (1) external MRM retraction at the globe insertion point by using vessel loop (external group), (2) transseptal MRM retraction by using vessel loop (transseptal group), (3) transchoanal retraction of the MRM by using vessel loop (choanal group), and (4) transseptal four-handed technique by using double ball retraction by a second surgeon (transseptal double ball group). The length, height, and area of exposure of the medial intraconal space were quantified and compared. RESULTS The average ± standard deviation (SD) anterior-posterior exposures for the external group, transseptal group, and transseptal double ball group were 17.51 ± 3.39 mm, 16.59 ± 4.16 mm, and 18.0 ± 15.25 mm, respectively. The choanal group provided significantly less exposure (12.39 ± 3.44 mm, p = 0.049) than the other groups. The average ± SD vertical exposures for the transseptal group, choanal group, and transseptal double ball group were 12.53 ± 4.38 mm, 13.05 ± 5.86 mm, and 13.57 ± 3.74 mm, respectively. The external group provided significantly less exposure (4.51 ± 1.56 mm, p = 0.0072) than the other groups. The transseptal and transseptal double ball groups provided the greatest total access by surface area (58.88 ± 26.96 mm(2) and 62.94 ± 34.74 mm(2), respectively) compared with the external and choanal groups (34.82 ± 23.37 mm(2) and 43.10 ± 23.68 mm(2), respectively). Although the transseptal trajectory of MRM retraction was optimal, the difference in total area of exposure between the static vessel loop retraction and the dynamic, four-handed technique with double ball instrument retraction was not significant. Of note, the exposure provided by the choanal technique required the surgeon to work both above and below the muscle. CONCLUSION Retraction of the MRM toward the choanae provided the least length of exposure, and external retraction exposed the least height and total area. Transseptal MRM retraction was most favorable and provided the largest endoscopic corridor to the medial intraconal space. A four-handed approach for endoscopic intraconal surgery of the orbit may offer advantages in dynamic adjustments in retraction.
Collapse
Affiliation(s)
- Giant C Lin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Abstract
Natural killer T-cell lymphoma (NKTCL) is a rare and aggressive condition with a high mortality rate. It is most commonly seen in the nasal sinuses, generally affecting the orbit by direct extension. Primary orbital NKTCL is even more rare, with only a few published cases with occasional secondary nasal involvement. This malignancy can present as a "masquerade syndrome," delaying proper diagnosis and treatment. Biopsy is required for diagnosis, which shows specific histopathological characteristics. Radiation and chemotherapy are the mainstay of treatment. Newer chemotherapies show improved prognosis.
Collapse
Affiliation(s)
- Juan C Jiménez-Pérez
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Michael K Yoon
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| |
Collapse
|
50
|
Ban GY, Cho K, Kim SH, Yoon MK, Kim JH, Lee HY, Shin YS, Ye YM, Cho JY, Park HS. Metabolomic analysis identifies potential diagnostic biomarkers for aspirin-exacerbated respiratory disease. Clin Exp Allergy 2016; 47:37-47. [PMID: 27533637 DOI: 10.1111/cea.12797] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/13/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date, there has been no reliable in vitro test to diagnose aspirin-exacerbated respiratory disease (AERD). OBJECTIVE To investigate potential diagnostic biomarkers for AERD using metabolomic analysis. METHODS An untargeted profile of serum from asthmatics in the first cohort (group 1) comprising 45 AERD, 44 patients with aspirin-tolerant asthma (ATA), and 28 normal controls was developed using the ultra-high-performance liquid chromatography (UHPLC)/Q-ToF MS system. Metabolites that discriminate AERD from ATA were quantified in both serum and urine, which were collected before (baseline) and after the lysine-aspirin bronchoprovocation test (Lys-ASA BPT). The serum metabolites were validated in the second cohort (group 2) comprising 50 patients with AERD and 50 patients with ATA. RESULTS A clear discrimination of metabolomes was found between patients with AERD and ATA. In group 1, serum levels of LTE4 and LTE4 /PGF2 α ratio before and after the Lys-ASA BPT were significantly higher in patients with AERD than in patients with ATA (P < 0.05 for each), and urine baseline levels of these two metabolites were significantly higher in patients with AERD. Significant differences of serum metabolite levels between patients with AERD and ATA were replicated in group 2 (P < 0.05 for each). Moreover, serum baseline levels of LTE4 and LTE4 /PGF2 α ratio discriminated AERD from ATA with 70.5%/71.6% sensitivity and 41.5%/62.8% specificity, respectively (AUC = 0.649 and 0.732, respectively P < 0.001 for each). Urine baseline LTE4 levels were significantly correlated with the fall in FEV1 % after the Lys-ASA BPT in patients with AERD (P = 0.008, r = 0.463). CONCLUSIONS AND CLINICAL RELEVANCE Serum metabolite level of LTE4 and LTE4 /PGF2 α ratio was identified as potential in vitro diagnostic biomarkers for AERD using the UHPLC/Q-ToF MS system, which were closely associated with major pathogenetic mechanisms underlying AERD.
Collapse
Affiliation(s)
- G-Y Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - K Cho
- Department of Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea.,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - S-H Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - M K Yoon
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - J-H Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - H Y Lee
- Department of Statistics, Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Y S Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Y-M Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - J-Y Cho
- Department of Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - H-S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|