Search

Samuel A Cohen,1 Nikhita Yadlapalli,2 Jonathan D Tijerina,3 Chrisfouad R Alabiad,3 Jessica R Chang,4 Benyam Kinde,5 Nicholas R Mahoney,6 Kelsey A Roelofs,1 Julie A Woodward,7 Andrea L Kossler5 1Department of Ophthalmology, Stein Eye Institute at University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA; 2Department of Ophthalmology, FIU Herbert Wertheim College of Medicine, Miami, FL, USA; 3Department of Ophthalmology, Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, Miami, FL, USA; 4Department of Ophthalmology, USC Roski Eye Institute at University of Southern California Keck School of Medicine, Los Angeles, CA, USA; 5Department of Ophthalmology, Byers Eye Institute at Stanford University School of Medicine, Palo Alto, CA, USA; 6Department of Ophthalmology, Wilmer Eye Institute at Johns Hopkins University School of Medicine, Baltimore, MD, USA; 7Department of Ophthalmology, Duke Eye Center at Duke University School of Medicine, Durham, NC, USACorrespondence: Andrea L Kossler, Department of Ophthalmology, Byers Eye Institute at Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, USA, Email akossler@stanford.eduPurpose: To compare the accuracy and readability of responses to oculoplastics patient questions provided by Google and ChatGPT. Additionally, to assess the ability of ChatGPT to create customized patient education materials.Methods: We executed a Google search to identify the 3 most frequently asked patient questions (FAQs) related to 10 oculoplastics conditions. FAQs were entered into both the Google search engine and the ChatGPT tool and responses were recorded. Responses were graded for readability using five validated readability indices and for accuracy by six oculoplastics surgeons. ChatGPT was instructed to create patient education materials at various reading levels for 8 oculoplastics procedures. The accuracy and readability of ChatGPT-generated procedural explanations were assessed.Results: ChatGPT responses to patient FAQs were written at a significantly higher average grade level than Google responses (grade 15.6 vs 10.0, p < 0.001). ChatGPT responses (93% accuracy) were significantly more accurate (p < 0.001) than Google responses (78% accuracy) and were preferred by expert panelists (79%). ChatGPT accurately explained oculoplastics procedures at an above average reading level. When instructed to rewrite patient education materials at a lower reading level, grade level was reduced by approximately 4 (15.7 vs 11.7, respectively, p < 0.001) without sacrificing accuracy.Conclusion: ChatGPT has the potential to provide patients with accurate information regarding their oculoplastics conditions. ChatGPT may also be utilized by oculoplastic surgeons as an accurate tool to provide customizable patient education for patients with varying health literacy. A better understanding of oculoplastics conditions and procedures amongst patients can lead to informed eye care decisions.Keywords: oculoplastics, google, ChatGPT, readability, accuracy

Michael D Yu,1 Ji Kwan Park,2 Andrea L Kossler1 1Oculoplastic Surgery and Orbital Oncology Service, Byers Eye Institute, Stanford University, Palo Alto, CA, USA; 2Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USACorrespondence: Andrea L KosslerOculoplastic Surgery and Orbital Oncology Service, Byers Eye Institute, Stanford University, 2452 Watson Ct, Palo Alto, CA 94303, USATel +1 650-724-0105Email akossler@stanford.eduAbstract: Dry eye disease (DED) affects up to one-third of the global population. Traditional therapies, including topical lubricants, have been employed with variable success in the treatment of DED. Recently, neurostimulation of the lacrimal functional unit (LFU) has emerged as a promising alternative therapy for DED. In this review, we describe the neuroanatomical and pathophysiological considerations of DED and the LFU that make neurostimulation a viable therapeutic alternative. We further detail the various neurostimulatory approaches taken thus far—from implanted stimulators to external devices to chemical neurostimulation. Existing studies reveal the strengths of the neurostimulatory approach in increasing tear volume and improving dry eye symptoms, but further studies are needed to elucidate its true potential in treatment of DED.Keywords: oculoplastics, ocular surface, cornea, lacrimal gland, dry eye disease, tears, neurostimulation

PurposeTo assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM).MethodsIn this retrospective case-control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (-TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality.ResultsAmong eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality.ConclusionsPatients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes.

Teprotumumab is a novel insulin-like growth factor-1 receptor inhibitor approved for the treatment of thyroid eye disease, but growing reports of hearing loss require further investigation. To date, an effective protocol for managing hearing loss in this setting has not been determined. Here, we present the first report of the resolution of teprotumumab-related hearing loss with prompt oral prednisone. A 70-year-old woman on teprotumumab experienced sudden hearing loss and tinnitus after her first infusion. An audiogram demonstrated a mild down-sloping to moderately severe mixed conductive and sensorineural hearing loss that was promptly treated with prednisone 60 mg for 6 days with a 1-week gradual taper. An audiogram 3 weeks later demonstrated return of hearing to normal thresholds, and the whole teprotumumab treatment course was completed without further issue. This case highlights the importance of audiometric monitoring, prompt identification of hearing symptoms, and the potential for oral steroids to reverse teprotumumab-related hearing loss.

Teprotumumab is a novel insulin-like growth factor-1 receptor inhibitor approved for the treatment of thyroid eye disease, but growing reports of hearing loss require further investigation. To date, an effective protocol for managing hearing loss in this setting has not been determined. Here, we present the first report of the resolution of teprotumumab-related hearing loss with prompt oral prednisone. A 70-year-old woman on teprotumumab experienced sudden hearing loss and tinnitus after her first infusion. An audiogram demonstrated a mild down-sloping to moderately severe mixed conductive and sensorineural hearing loss that was promptly treated with prednisone 60 mg for 6 days with a 1-week gradual taper. An audiogram 3 weeks later demonstrated return of hearing to normal thresholds, and the whole teprotumumab treatment course was completed without further issue. This case highlights the importance of audiometric monitoring, prompt identification of hearing symptoms, and the potential for oral steroids to reverse teprotumumab-related hearing loss.

Background: This study aims to compare the surgical outcomes of transorbital versus endonasal endoscopic approaches for orbital subperiosteal abscess drainage. Methods: A retrospective review was conducted at a single institution of patients who underwent orbital subperiosteal abscess drainage from November 2009 to April 2023. Results: Of 64 patients, 44 (68.8%) underwent abscess drainage via an orbital approach, while 20 (31.3%) underwent endonasal endoscopic drainage. No significant difference in operative time or visual acuity improvement was found between the two groups. Abscess drainage via orbitotomy was associated with a longer total (average 8.1 days) and postoperative (average 7.3 days) hospitalization time compared to the endoscopic group (average 5.4 days and 4.2 days, respectively), though this difference was not statistically significant (p = 0.197, 0.136, respectively). For medial orbital abscesses, the average length of total and postoperative hospitalization was greater after orbitotomy (p = 0.028 and 0.019, respectively). At discharge, patients who underwent orbitotomy more commonly reported periorbital swelling (p = 0.0003), while postoperative pain was more common in the endoscopic drainage group (p = 0.009). Reoperation rate was higher after orbitotomy (34.1%) compared to the endoscopic drainage group (15.0%), though this was not statistically significant (p = 0.115). Conclusions: Transorbital and endoscopic surgical approaches for orbital abscess drainage have similar surgical outcomes, with no statistically significant differences noted in terms of visual acuity change or reoperation rate. Longer hospital stays were found for patients with medial orbital abscesses drained via orbitotomy. [ABSTRACT FROM AUTHOR]

Purpose: Patients with Crohn's disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease. Methods: In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities. Results: Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48–2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15–1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89–2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31–1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29–1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33–1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65–2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37–1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11–2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14–1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18–1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22–1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37–1.71, p < 0.001). Conclusions: Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement. [ABSTRACT FROM AUTHOR]

Excited with p-polarized light, the near-edge He 1s photoemission signal from monolayers of He adsorbed on the close-packed surfaces of silver, copper, ruthenium, and platinum shows periodic splitting with photoelectron momentum. By applying a simple single scattering model, we explain this effect by zero-point motion induced variation of the photo hole's image charge screening and interference of the photoelectron's final state wavefunction. Relativistic one-step photoemission calculations support this interpretation. In the second part of our study, we investigate neutral double excitations of He bilayers adsorbed on platinum by monitoring the emission of He+ ions. We identify strong matrix and zero-point motion effects, namely resonances absent for isolated He, density and light polarization dependence, line broadening and a correlation of excitation and kinetic ion-energy. [ABSTRACT FROM AUTHOR]

Background: Amyloidoma is a rare mass lesion formed by abnormal deposition of amyloid proteins. There are 25 reported cases of Meckel's cave amyloidoma primarily involving the trigeminal nerve alone. Case presentation: A 55-year-old woman presented with one year of right-sided trigeminal neuropathy and facial weakness. On examination, there was right-sided V1-V3 dysesthesia and partial right facial paralysis. Magnetic resonance imaging (MRI) showed a right-sided enhancing 1.5 cm × 0.7 cm × 0.4 cm mass in Meckel’s cave. The mastoid segment of the right facial nerve demonstrated focal enhancement. A biopsy of the Meckel’s cave lesion was performed via a right lateral transorbital approach. Results: Histologic sections showed pale eosinophilic amorphous material birefringent to polarized light in Congo red stain. Mass spectrometry confirmed a lambda light chain amyloidoma. Extensive workup did not reveal evidence of systemic amyloidosis, consistent with localized central nervous system (CNS) amyloidoma in Meckel’s cave. The patient remains stable at nine months. Conclusion: This is a rare case of primary Meckel’s cave amyloidoma affecting cranial nerves V and VII. A minimally invasive lateral transorbital approach was employed to access the tumor in the middle cranial fossa. Amyloidoma should be considered in the differential diagnosis of lesions involving Meckel’s cave and multiple cranial nerves.