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Advances in Orbital, Oculoplastic and Lacrimal Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (25 May 2024) | Viewed by 23784

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Dr. Kelvin Kam-Lung Chong

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Guest Editor

Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
Interests: orbital surgery; lacrimal surgery; reconstructive surgery; aesthetic surgery; computer-assisted surgery; endoscopic navigation; 3D-printing; immersive 3D-visualization; robotic surgery; thyroid eye disease; dry eye disease; COVID-19 and eye

Dr. Renbing Jia

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Guest Editor

1. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2. Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
Interests: ocular tumors; orbital diseases; eye plastic surgery

Special Issue Information

Dear Colleagues,

Contemporary orbital, oculoplastic, and lacrimal surgeries have made remarkable progress over the last two decades, thanks to the advancements in technologies and surgical procedures of increasing availability of image-guidance (navigation); endoscopic, exoscopic, and immersive 3-dimensional visualization; 3-dimensional printing; and robotics and microrobotics. Adoptively combining the precision- and technology-driven nature of ophthalmic surgeries with the multidisciplinary and minimally invasive approaches in head and neck surgeries, oculoplastic surgeons are now personalizing approaches, decreasing morbidities, and expanding indications in patients with orbital tumors, malformations, trauma, thyroid eye disease, lacrimal outflow obstruction, as well as socket and eyelid disorders.

In this Special Issue, we invite prominent investigators to contribute original research articles and review articles that focus on the current state-of-the-art orbital, oculoplastic, and lacrimal surgeries and to introduce new theories, next generation technologies, and techniques that move this exciting field forward for the benefits of patient care.

Dr. Kelvin Kam-Lung Chong
Dr. Renbing Jia
Guest Editors

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Keywords

orbitotomy
orbital decompression
orbital fracture repair
lacrimal surgeries
socket reconstruction
navigation-guided surgery
robotic oculoplastic surgery

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Published Papers (11 papers)

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Research

12 pages, 1233 KiB

Open AccessArticle

Treatment Outcomes of Patients with Orbital Inflammatory Diseases: Should Steroids Still Be the First Choice?

by Karim Al-Ghazzawi, Inga Neumann, Mareile Knetsch, Ying Chen, Benjamin Wilde, Nikolaos E. Bechrakis, Anja Eckstein and Michael Oeverhaus

J. Clin. Med. 2024, 13(14), 3998; https://doi.org/10.3390/jcm13143998 - 9 Jul 2024

Viewed by 1789

Abstract

Objective: To clarify the therapy response in orbital inflammatory diseases (OID), we analyzed the treatment effects of steroid therapy, the use of disease-modifying antirheumatic drugs (DMARDS), and biologicals in our tertiary referral center cohort. Methods: We collected the clinical and demographic data of all patients treated for non-specific orbital inflammation (NSOI) (n = 111) and IgG4-ROD (n = 13), respectively at our center from 2008 to 2020 and analyzed them with descriptive statistics. NSOI were sub-grouped according to the location into either idiopathic dacryoadenitis (DAs) (n = 78) or typical idiopathic orbital myositis (n = 32). Results: Mean age at first clinical manifestation was significantly different between subgroups (IOI: 49.5 ± 18, IgG4-ROD: 63.2 ± 14, p = 0.0171). Among all examined OID, 63 patients (50%) achieved full remission (FR) with corticosteroids (NSOI 53%/IgG4-ROD 31%). In contrast, classic myositis showed a significantly higher response (76%). Disease-modifying drugs (DMARDS) for myositis accomplished only 33% FR (NSOI 57%) and 66% did not respond sufficiently (NSOI 43%). The biologic agent (Rituximab) was significantly more efficient: 19 of 23 patients (82%) achieved full remission and only 4 (17%) did not respond fully and needed orbital irradiation or orbital decompressive surgery. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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9 pages, 1901 KiB

Open AccessArticle

Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut

by Steffani Krista Someda, Hidetaka Miyazaki, Hirohiko Kakizaki and Yasuhiro Takahashi

J. Clin. Med. 2024, 13(13), 3682; https://doi.org/10.3390/jcm13133682 - 24 Jun 2024

Cited by 1 | Viewed by 1672

Abstract

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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11 pages, 873 KiB

Open AccessArticle

Effects of Topical Anti-Glaucoma Medications on Outcomes of Endoscopic Dacryocystorhinostomy: Comparison with Age- and Sex-Matched Controls

by Seong Eun Lee, Hyung Bin Lim, Seungjun Oh, Kibum Lee and Sung Bok Lee

J. Clin. Med. 2024, 13(2), 634; https://doi.org/10.3390/jcm13020634 - 22 Jan 2024

Viewed by 1491

Abstract

Background: This study analyzed the effects of topical anti-glaucoma medications on the surgical outcomes of endoscopic dacryocystorhinostomy (EDCR) in nasolacrimal duct obstruction (NLDO). Methods: This retrospective study included patients who underwent EDCR for NLDO between September 2012 and April 2021. Thirty patients with topical anti-glaucoma medications and 90 age- and sex-matched controls were included. Results: The success rate of EDCR was higher in the control group than in the anti-glaucoma group (97.8% vs. 86.7%, p = 0.034). Univariate and multivariate logistic regression analyses identified prostaglandin analogs as the most influential risk factor for EDCR success among anti-glaucoma medication ingredients (p = 0.005). The success rate of the group containing all four anti-glaucoma medication ingredients was statistically significant (p = 0.010). The success rate was significantly different in the group of patients who used anti-glaucoma medication for >24 months (p = 0.019). When multiplying the number of drug ingredients by the duration in months, the group > 69 showed a significantly decreased success rate (p = 0.022). Multivariate logistic regression analysis identified the number of anti-glaucoma medications as the most significant risk factor for EDCR success (odds ratio, 0.437; 95% confidence interval, 0.247 to 0.772; p = 0.004). Conclusions: The authors suggest that the anti-glaucoma medications might cause NLDO and increase the failure rate after EDCR. Therefore, when performing EDCR in patients using topical anti-glaucoma medications, surgeons should consider the possibility of increased recurrence after EDCR in clinical outcomes. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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8 pages, 2860 KiB

Open AccessArticle

Comparison of Outcomes of Silicone Tube Intubation with or without Dacryoendoscopy for the Treatment of Congenital Nasolacrimal Duct Obstruction

by Doah Kim and Helen Lew

J. Clin. Med. 2023, 12(23), 7370; https://doi.org/10.3390/jcm12237370 - 28 Nov 2023

Cited by 1 | Viewed by 1214

Abstract

In this retrospective study, we compared and analyzed two groups of patients who underwent silicone tube intubation (STI) to treat congenital nasolacrimal duct obstruction (CNDO). We employed dacryoendoscopy to visualize the lacrimal pathways of one group. In total, 85 eyes of 69 patients were included (52 of 41 patients in the non-dacryoendoscopy and 33 eyes of 28 patients in the dacryoendoscopy group). Clinical characteristics, dacryoendoscopic findings, and surgical outcomes were evaluated. The overall STI success rate was 91.8%, and the success rate was significantly higher in the dacryoendoscopy versus non-dacryoendoscopy group (97.0% and 88.5%, respectively). For patients < 36 months of age, the success rate was 100% (23 eyes). All patients with Hasner valve membranous obstructions were younger than 36 months and had structural obstructions of the lacrimal drainage system (LDS) (p = 0.04). However, in patients lacking Hasner valve obstructions, LDS secretory (50.0%) and structural (50%) obstructions occurred at similar rates, which did not vary by age. Dacryoendoscopy-assisted STI enhanced the therapeutic efficacy of CNDO and identified diverse CNDO etiologies beyond Hasner valve obstructions. These findings emphasize the potential advantages of dacryoendoscopy in surgical treatment for CNDO patients. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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8 pages, 1193 KiB

Open AccessArticle

Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study

by Yoshiki Ueta, Yuji Watanabe, Ryoma Kamada and Nobuya Tanaka

J. Clin. Med. 2023, 12(22), 7048; https://doi.org/10.3390/jcm12227048 - 12 Nov 2023

Cited by 3 | Viewed by 1178

Abstract

We aimed to evaluate the safety and efficacy of office-based probing with dacryoendoscopy under local anesthesia for congenital nasolacrimal duct obstruction (CNLDO). This single-institution study retrospectively reviewed data on 72 eyes of 64 consecutive children (38 boys, 43 eyes; 26 girls, 29 eyes), aged between 6 and 17 (mean age: 10.0 ± 2.7) months with suspected CNLDO, from July 2016 to February 2022. These patients underwent probing with dacryoendoscopy under local anesthesia. CNLDO was diagnosed clinically based on the presence of epiphora and sticky eyes due to mucous discharge commencing within the first 3 months of life, increased tear meniscus height, and fluorescein dye disappearance test results. A total of 63 of the 72 eyes had narrowly defined CNLDO, and 9 eyes had other types of obstructions. The intervention success rate was 100% (63/63 eyes) for patients with typical CNLDO and 97.2% (70/72 eyes) for the entire study cohort. Moreover, CNLDO was classified into five types based on the features of the distal end of the nasolacrimal duct. Probing with dacryoendoscopy is safe and yields a high success rate in pediatric patients with CNLDO. This is the first study to assess the safety and efficacy of probing with dacryoendoscopy under local anesthesia in pediatric patients with CNLDO. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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13 pages, 1000 KiB

Open AccessArticle

Surgical Outcomes of Bilateral Inferior Rectus Muscle Recession for Restrictive Strabismus Secondary to Thyroid Eye Disease

by Steffani Krista Someda, Naomi Umezawa, Aric Vaidya, Hirohiko Kakizaki and Yasuhiro Takahashi

J. Clin. Med. 2023, 12(21), 6876; https://doi.org/10.3390/jcm12216876 - 31 Oct 2023

Cited by 1 | Viewed by 2128

Abstract

This retrospective, observational study examined the surgical outcomes of bilateral inferior rectus (IR) recession in thyroid eye disease. Twelve patients who underwent bilateral IR muscle recession were included in the study. Surgical success was defined as patient achievement of the following conditions: (1) a postoperative angle of vertical ocular deviation of ≤3°; (2) a postoperative cyclotropic angle of ≤2°; (3) postoperative binocular single vision, including the primary position; and (4) postoperative enlargement of the field of binocular single vision. Linear regression analyses were performed to analyze the relationship between postoperative changes in the vertical and torsional ocular deviation angles and the amount of IR muscle recession and nasal transposition. Consequently, 9 out of 12 patients were deemed to have had successful surgical outcomes. There was a positive correlation between a change in the vertical deviation angle and a side-related difference in the amount of IR muscle recession in successful cases (crude coefficient, 2.524). A positive correlation was also found between a change in the torsional deviation angle and the amount of IR recession (crude coefficient, 1.059) and nasal transposition (crude coefficient, 5.907). The results will be helpful to more precisely determine the amount of recession and nasal transposition of the IR muscle in patients with thyroid-related bilateral IR myopathy. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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10 pages, 1274 KiB

Open AccessArticle

Recovery of the Ratio of Closure Time during Blink Time in Lacrimal Passage Intubation

by Yuri Kim and Helen Lew

J. Clin. Med. 2023, 12(11), 3631; https://doi.org/10.3390/jcm12113631 - 23 May 2023

Cited by 1 | Viewed by 1275

Abstract

(1) Background: We aim to find a novel blink parameter in nasolacrimal duct obstruction (NDO) patients and analyze parameters that could reflect subjective symptoms and objective indicators at the same time through a blink dynamic analysis. (2) Methods A retrospective study was conducted with 34 patients (48 eyes) who underwent lacrimal passage intubation (LPI) and 24 control groups (48 eyes). All patients’ blink patterns were measured using an ocular surface interferometer before and after LPI, including total blink (TB) and partial blink (PB) and the blink indices blink time (BT), lid closing time (LCT), closure time (CT), lid opening time (LOT), interblink time (IBT), closing speed (CS) and opening speed (OS). The tear meniscus height (TMH) was measured, and the questionnaire “Epiphora Patient’s Quality of Life (E-QOL),” which includes daily activity restriction as well as static and dynamic activities, was completed. (3) Results: Compared to CT and the ratio of CT during BT (CT/BT) in control (89.4 ± 20.0 msec, 13.16%), those in NDOs were longer (140.3 ± 92.0 msec, 20.20%) and were also related to TMH. After LPI, CT and CT/BT were recovered to 85.4 ± 22.07 msec, 13.29% (p < 0.001). CT and CT/BT showed a positive correlation with the E-QOL questionnaire score, particularly with dynamic activities. (4) Conclusions: CT and CT/BT, which are objective indicators associated with subjective symptoms of patients, are considered new blink indices for the evaluation of NDO patients with Munk’s score. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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8 pages, 263 KiB

Open AccessArticle

Ocular Surface Changes in Treatment-Naive Thyroid Eye Disease

by Xulin Liao, Kenneth Ka Hei Lai, Fatema Mohamed Ali Abdulla Aljufairi, Wanxue Chen, Zhichao Hu, Hanson Yiu Man Wong, Ruofan Jia, Yingying Wei, Clement Chee Yung Tham, Chi Pui Pang and Kelvin Kam Lung Chong

J. Clin. Med. 2023, 12(9), 3066; https://doi.org/10.3390/jcm12093066 - 23 Apr 2023

Cited by 4 | Viewed by 2732

Abstract

Objective: To investigate the association of meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability in untreated thyroid eye disease (TED) patients. Methods: A cross-sectional study of TED patients from September 2020 to September 2022 was conducted. Ocular surface parameters included ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), partial blinking rate, lipid layer thickness (LLT), meibomian gland dropout (meiboscore), Schirmer’s test, and corneal punctate epithelial erosions (PEE). Ocular surface exposure was assessed by the margin reflex distances of the upper and lower eyelid (MRD1 and MRD2), the amount of exophthalmos, lateral flare, and lagophthalmos. Results: In total, 152 eyes from 76 TED patients (64 females and 12 males, age 42.99 ± 12.28 years) and 93 eyes from 61 healthy controls (51 females and 10 males, age 43.52 ± 17.93 years) were examined. Compared with control eyes, TED eyes had higher OSDI, TMH, LLT, and PEE; shorter NITBUT; and worse meiboscore (all p < 0.05). They also had larger amounts of exophthalmos, longer MRD1, more lateral flare, and lagophthalmos. Multivariate analysis identified an association of the tear film instability with lagophthalmos (β = −1.13, 95%CI: −2.08, −0.18) and severe MGD in the lower eyelid (β = −5.01, 95%CI = −7.59, −2.43). Conclusions: Dry eye in TED is mainly manifested as evaporative dry eye disease. Severe lower eyelid MGD and worse lagophthalmos were significantly associated with tear film instability in treatment-naive TED patients. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

10 pages, 2361 KiB

Open AccessArticle

Clinical Significance of Corneal Striae in Thyroid Associated Orbitopathy

by Xulin Liao, Fatema Mohamed Ali Abdulla Aljufairi, Kenneth Ka Hei Lai, Karen Kar Wun Chan, Ruofan Jia, Wanxue Chen, Zhichao Hu, Yingying Wei, Winnie Chiu Wing Chu, Clement Chee Yung Tham, Chi Pui Pang and Kelvin Kam Lung Chong

J. Clin. Med. 2023, 12(6), 2284; https://doi.org/10.3390/jcm12062284 - 15 Mar 2023

Cited by 2 | Viewed by 3362

Abstract

Purpose: To elucidate the clinical implications of corneal striae (CS) in thyroid associated orbitopathy (TAO) patients. Methods: In this cross-sectional study, the presence of CS was confirmed after topical fluorescein staining on a slit lamp for consecutive treatment-naive TAO patients. Orbital parameters, including margin reflex distances, lagophthalmos, exophthalmos, intraocular pressure and radiological measurements, were compared between eyes with and without CS. The largest cross-sectional areas of each rectus muscle were measured by segmenting the T1-weighted (T1W) magnetic resonance images (MRI). The logistic regression analyses were used to evaluate the associations between CS and orbital parameters and rectus muscle measurements. Results: Fifty-three consecutive TAO patients (presenting age 46.47 ± 14.73 years, clinical activity score 1.77 ± 1.25) who had unilateral CS were enrolled. In univariate analysis, both the degree of lagophthalmos and the area of the levator palpebrae superioris–superior rectus complex (LPS/SR) on T1W MRI were significantly larger in CS eyes compared to eyes without CS (p < 0.05). Multivariate analyses showed that CS in TAO patients were significantly associated with the degree of lagophthalmos (OR = 1.75, 95% CI: 1.18–2.61, p < 0.05) and LPS/SR area (OR = 19.27, 95% CI: 1.43–259.32, p < 0.05) but not with the other parameters. CS could predict LPS/SR enlargement and larger lagophthalmos in TAO (p < 0.05). The largest cross-sectional areas of LPS/SR and inferior rectus were positively correlated with clinical activity scores (p < 0.05). Conclusions: The presence of CS in TAO eye is significantly associated with LPS/SR enlargement and worse lagophthalmos. CS might be evaluated further as a potential ocular surface biomarker to identify upper lid and LPS/SR involvement in TAO. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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9 pages, 1816 KiB

Open AccessArticle

Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature

by Umberto Committeri, Antonio Arena, Emanuele Carraturo, Martina Austoni, Cristiana Germano, Giovanni Salzano, Giacomo De Riu, Francesco Giovacchini, Fabio Maglitto, Vincenzo Abbate, Paola Bonavolontà, Luigi Califano and Pasquale Piombino

J. Clin. Med. 2023, 12(3), 845; https://doi.org/10.3390/jcm12030845 - 20 Jan 2023

Cited by 3 | Viewed by 2790

Abstract

Zygomaticomaxillary complex and isolated orbital walls fractures are one of the most common fractures of the midface, often presenting orbital symptoms and complications. Our study was born with the aim of understanding the trend in the incidence of orbital presurgical symptoms, specifically diplopia, enophthalmos and exophthalmos, in the Campania Region in southern Italy. We conducted a retrospective, monocentric observational study at the Maxillofacial Surgery Unit of the Federico II University Hospital of Naples, enrolling 402 patients who reported a fracture of the zygomaticomaxillary complex and orbital floor region from 1 January 2012 to 1 January 2022. Patients were evaluated by age, gender, etiology, type of fracture, preoperative orbital side effects and symptoms. Pre-surgical side effects were studied, and 16% of patients (n = 66) developed diplopia. Diplopia was most common in patients previously operated on for orbital wall fractures (100%), and least common in patients who reported trauma after interpersonal violence (15%) and road traffic accidents (11%). Exophthalmos appeared only in 1% (six cases); whereas it did not appear in 99% (396 cases). Enophthalmos was present in 4% (sixteen cases), most commonly in interpersonal violence cases (two cases). The frequency of orbital complications in patients with zygomaticomaxillary complex and isolated orbital walls fractures suggests how diplopia remains the most common pre-surgical orbital side effect. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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9 pages, 1137 KiB

Open AccessArticle

Computed Tomography Morphology of Affected versus Unaffected Sides in Patients with Unilateral Primary Acquired Nasolacrimal Duct Obstruction

by Pei-Yuan Su, Jia-Kang Wang and Shu-Wen Chang

J. Clin. Med. 2023, 12(1), 340; https://doi.org/10.3390/jcm12010340 - 1 Jan 2023

Cited by 5 | Viewed by 2420

Abstract

Background: This study aimed to describe the anatomical details of the bony nasolacrimal duct (BNLD) and adjacent nasal structures by analyzing computed tomography (CT) images, and to investigate their effects on the development of primary acquired nasolacrimal duct obstruction (PANDO). Methods: A total of 50 patients with unilateral PANDO who underwent dacryocystorhinostomy, with a mean age of 57.96 years, were included. The preoperative CT images were reviewed to measure the anteroposterior and transverse diameters of the BNLD at the entrance and exit levels, as well as the minimum transverse diameter along the tract. The sagittal CT images were analyzed to classify the shape of the bony canals into columnar, funnel, flare, and hourglass. The associated paranasal abnormalities, including nasal septum deviation (NSD), sinusitis, angle between the bony inferior turbinate and medial wall of the maxillary sinus, and mucosal thickness of the inferior turbinate, were investigated. Results: Fifty CT images were analyzed, and all parameters measured on both sides of the BNLD were not significantly different between the PANDO and non-PANDO sides, except for the minimum transverse diameter, which was significantly smaller on the PANDO side (p = 0.002). Columnar-shaped BNLD was the most common on both sides. No significant difference was observed in the incidence of paranasal abnormalities between sides; however, deviation of the septum toward the non-PANDO side was more common (67.9%). Conclusions: A small minimum transverse diameter of the BNLD may be a risk factor for PANDO. The association between nasal abnormalities and PANDO was not remarkable. Full article

(This article belongs to the Special Issue Advances in Orbital, Oculoplastic and Lacrimal Surgery)

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