Purpose: To study the effect of periocular steroid use on intraocular pressure (IOP). Methods: Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations. Results: Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1–83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg. Conclusions: Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.
Atypical mycobacterial infections as a result of cosmetic tourism come at considerable cost to patients and the health care system. When our results are taken into consideration with other risks of cosmetic tourism, the financial risks likely far outweigh the benefits.
Hidrocystomas are benign, cystic lesions of eccrine and apocrine sweat glands. The literature on hidrocystomas is sparse, consisting of a handful of case reports and limited retrospective reviews. This is the first known bi-institutional, retrospective, chart review aimed to elucidate the demographics and basic clinical presentation of hidrocystomas. Medical records of adult patients with a pathological diagnosis of hidrocystoma from September 1, 2008 to August 1, 2015 in the Oculoplastic and Reconstructive Surgery Service at the Illinois Eye and Ear Infirmary (UIC) and Department of Ophthalmology of Weill Cornell Medical College (Cornell) were reviewed. Children under the age of 18 were not included. Data collection included: gender, race, age at diagnosis, laterality, location, total number of lesions, and recurrence. Results from both institutions were compared against each other and as a whole. A total of 107 patients were diagnosed with hidrocystoma on pathology. The mean age of diagnosis was 56 years (22-85). Hidrocystomas were diagnosed in 69 (64.4%) females and 38 (35.5%) males. Lesions were most commonly found in African American (37.4%), Caucasian (30.8%), and Hispanic (16.8%) patients combined across the two institutions with different patient populations. Lesions were largely unilateral (74.8%) and found on the lower lid (38.6%), lateral canthus (31.2%), upper lid (17.7%), and medial canthus (12.6%). Recurrences were seen in 2.3% of lesions. The majority of recurrences occurred in patients who identified their race as Hispanic (2/5) and Caucasian (3/5). Recurrences were seen in 2 males and 3 females. Apocrine and ecccrine hidrocystomas may be more common in female, African American, Caucasian, and Hispanic patients, presenting most commonly in adults in their mid-fifties. Lesions tend to be unilateral with lower lid lesions being the most prevalent location and medial canthus lesions being the least prevalent location for lesion growth. Recurrences may be most common in Hispanics and Caucasians and less common in African Americans. Although a precise recurrence rate cannot be determined at this time, our data suggests that the recurrence rate is low with current excisional methods.
Dermoid cysts are histologically defined as surface epithelium encapsulating an inner lumen. They are well described in the literature as discrete, single masses, either circumscribed or dumbbell-shaped, with or without a longstanding fistula. Chronic granulomatous inflammation is often a feature of dermoid cysts, contributing to local soft tissue and bony destruction. Isolated multicystic dermoids are not well described. We present a case of a multilobular dermoid characterized both radiographically and histopathologically. These findings may be attributed to repeated rupture and reformation of the dermoid cyst. When possible, our experience favours early excision of orbital dermoid cysts to minimize morbidity.
Superficial subcutaneous lipomas are benign, slow-growing neoplasms comprised mature adipose cells that may be surrounded by a fibrous tissue capsule. While found commonly on the body, simple lipomas are rarely described in the eyelids. Reports of two eyelid lipomas in the literature describe the anatomy to be posterior to the orbital septum. The presenting authors report the case of a simple lipoma of the eyelid found fully in the preseptal plane. Lipomas can occur anterior to the orbital septum and should be considered in the differential when presented with a painless, slow-growing eyelid mass in adults.
2 weeks, both in percentage change and in absolute value of the change.Ixekizumab induced immediate improvement in inflammatory markers in patients with GPP with systemic inflammation. This indicates that ixekizumab is a good treatment option for patients in the acute phase or in a flare of GPP, and that its effectiveness can be expected after a few days. Although BT seemed to decrease 1 day after initiation of ixekizumab, no significant difference was observed. The use of antipyretics may have affected the results. GMA is an extracorporeal circulation therapy that removes activated granulocytes and monocytes. It can be easily introduced in clinics and hospitals where haemodialysis is performed. Its safety profile 5 allows for its administration without screening and for its concomitant use with other therapies. GMA is usually not used as monotherapy but, rather, as adjuvant or neoadjuvant therapy for GPP. We previously reported that GMA induced a significant decrease in BT but not in WBC count or CRP after 2 days, 6 suggesting that GMA could be a good adjuvant therapy with ixekizumab. The main limitation of this study is that ixekizumab was not used as monotherapy.
Purpose: To measure orbital cavernous hemangioma size using 3 segmentation methods requiring different degrees of subjective judgment, and to evaluate interobserver agreement using these methods. Methods: Fourteen patients with orbital cavernous hemangiomas were included in the study. Pretreatment T2-weighted MRIs were analyzed by 2 observers using 3 methods, including 1 user-dependent image segmentation method that required high degrees of subjective judgment (ellipsoid) and 2 parameter-dependent methods that required low degree of subjective judgment (GrowCut and k-means clustering segmentation). Interobserver agreement was assessed using Lin’s concordance correlation coefficients. Results: Using the ellipsoid method, the average tumor sizes calculated by the 2 observers were 1.68 ml (standard deviation [SD] 1.45 ml) and 1.48 ml (SD 1.19 ml). Using the GrowCut method, the average tumor sizes calculated by the 2 observers were 3.00 ml (SD 2.46 ml) and 6.34 ml (SD 3.78 ml). Using k-means clustering segmentation, the average tumor sizes calculated by the 2 observers were 2.31 ml (SD 1.83 ml) and 2.12 ml (SD 1.87 ml). The concordance correlation coefficient for the ellipsoid, GrowCut, and k-means clustering methods were 0.92 (95% CI, 0.83–0.99), 0.12 (95% CI, –0.21 to 0.44), and 0.95 (95% CI, 0.90–0.99), respectively. Conclusions: k-means clustering, a parameter-dependent method with low degree of subjective judgment, showed better interobserver agreement compared with the ellipsoid and GrowCut methods. k-means clustering clearly delineated tumor boundaries and outlined components of the tumor with different signal intensities.
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