Factors affecting anophthalmic socket reconstruction outcomes using autologous oral mucosal graft.

BACKGROUND: Limited studies have reported surgical outcomes that are defined by strict criteria following grade 2 or 3 socket reconstruction using an oral mucosal graft (OMG). We aimed to determine factors influencing surgical outcomes of anophthalmic socket reconstruction using OMG in patients with grade 2 or 3 socket contractures. METHODS: Thirty-seven patients who underwent socket reconstruction with autologous OMG between January 2007 and December 2017 were retrospectively analyzed. The successful outcome was defined as an eye prosthesis wearing without experiencing displacement and the absence of any re-operations or additional surgeries following socket reconstruction. Factors affecting surgical outcomes were identified using multivariate analysis. RESULTS: A total of 15 male and 22 female patients (mean age: 40.2 ± 17.2 years) were included. The median duration of socket contracture was 21.5 years. Grade 2 and 3 socket contractures, based on Tawfik's classification, were reported in 20 and 17 patients, respectively. Twenty-eight and eight patients underwent socket reconstruction using OMG alone and OMG combined with a hard palate graft, respectively. The success rates of grades 2 and 3 socket contracture reconstruction were 80.0% and 52.9%, respectively. Multivariate analysis demonstrated that only grade 3 contractures were predictive of worse outcomes. At the final visit (mean follow-up: 6.3 years), 34 patients (91.9%) could wear their eye prostheses. CONCLUSIONS: Socket reconstruction using autologous OMG can provide acceptable results in grade 2 and 3 contractures; however, satisfactory results were more significantly reported in grade 2 than in grade 3 contractures.

Prognostic factors for conversion to generalization in ocular myasthenia gravis.

ABSTRACT: Patients with ocular myasthenia gravis (OMG) are frequently treated to prevent the development of generalized myasthenia gravis (GMG). This retrospective cohort study aimed to assess prognostic factors associated with conversion to GMG.We analyzed the time from the onset of OMG symptoms to GMG in relation to demographic variables, clinical findings, initial investigation results, and treatment regimens using Kaplan-Meier survival curves and multivariate Cox proportional regression analysis.Of 115 patients diagnosed with OMG (median follow-up time, 2.9 years), 28 (30.4%) developed GMG. The 2-year probability of GMG conversion was 23.7%. Patients with thymic abnormalities and a positive response to repetitive facial nerve stimulation had a significantly higher risk than those with negative results (hazard ratios [HR] 4.28, P < .001 and HR 3.84, P = .04, respectively). Treatment with immunosuppressants was found to be a preventive factor for secondary generalization (HR 0.36, P = .02).Patients with OMG had a low risk of developing GMG. Immunosuppressive treatments may mitigate disease progression. Chest imaging and repetitive nerve stimulation should be routinely performed to assess the risk of generalization.

Decompensated Esophoria as a Benign Cause of Acquired Esotropia.

PURPOSE: To determine informative clinical and magnetic resonance imaging (MRI) characteristics of patients with symptomatic adult acquired, comitant esotropia due to decompensated esophoria. DESIGN: Retrospective, interventional case series. METHODS: Setting: Institutional. STUDY POPULATION: Patients with decompensated esophoria who developed acute acquired comitant esotropia. OBSERVATION PROCEDURES: Ophthalmic examination, stereopsis, and strabismus measurements at distance and near using prism cover tests in diagnostic gaze positions were performed. Patients underwent high-resolution surface coil MRI of extraocular muscles with target fixation, and MRI of the brain. Strabismus surgery was performed under topical anesthesia with adjustable sutures wherever possible. Paired t testing was used to evaluate postoperative changes with 0.05 considered significant. MAIN OUTCOME MEASURE: Clinical and MRI characteristics, and surgical outcome of patients with decompensated esophoria. RESULTS: Eight cases were identified involving subjects of mean age 29 ± 9.4 (range: 20-48) years having gradually progressive intermittent horizontal, binocular diplopia for 10 months to 3 years. Mean preoperative esotropia was 31 ± 12 Δ at distance and 29 ± 12 Δ at near, although this was intermittent in 5 patients who exhibited enhanced fusional divergence. Neurologic evaluation and MRI of brain, orbits, and extraocular muscles were unremarkable in all cases. Orthotropia was successfully restored in all by standard or enhanced doses of bimedial rectus muscle recession surgery, improving mean stereoacuity from 535 to 68 arc seconds, although 5 patients exhibited 2-14 Δ asymptomatic residual esophoria. CONCLUSION: Decompensated esophoria is a benign clinical entity causing acute, acquired, comitant esotropia treatable with enhanced medial rectus recession.