Clinical effects of 3-D printing-assisted personalized reconstructive surgery for blowout orbital fractures.

PURPOSE: One of the key challenges during orbital fracture reconstructive surgery, due to the complex anatomy of the orbit, is shaping and trimming the precise contour of the implants. The objectives of this study were to describe and evaluate the use of a three-dimensional (3-D) printing technique for personalized reconstructive surgery for repairing orbital fractures. METHODS: A total of 29 cases which had 3-D technique-assisted surgical reconstruction, and 27 cases which had traditional surgery, were retrospectively analyzed. Preoperative and postoperative CT images were measured using MIMICS software, and the contour of the fracture zone and the Medpor-titanium implant were analyzed and compared. The surgical duration was also compared between the two groups. RESULTS: There were statistically significant differences in the maximum width, depth and area between fracture zone and implant between the two groups, with the absolute value in the 3-D group markedly lower as compared to the control group. In addition, the difference in the medial-inferior wall angle between the surgical eye and healthy eye was also statistically significant between the groups. The average surgical duration in the 3-D group was substantially shorter than in the control group. Additionally, the postoperative clinical evaluation in the 3-D group was superior to that of the control group. CONCLUSION: The 3-D printing technique is of great value for predicting the precise fracture zone before, and during, personalized surgery, and can help surgeons achieve accurate anatomical reconstruction for repairs of blowout orbital fractures. Moreover, the simulated bone template produced by 3-D printing models allows for "true-to-original" orbital reconstruction, which can shorten the surgical duration and improve the accuracy and safety of the operation.

Blockage of NOX2/MAPK/NF-κB Pathway Protects Photoreceptors against Glucose Deprivation-Induced Cell Death.

Acute energy failure is one of the critical factors contributing to the pathogenic mechanisms of retinal ischemia. Our previous study demonstrated that glucose deprivation can lead to a caspase-dependent cell death of photoreceptors. The aim of this study was to decipher the upstream signal pathway in glucose deprivation- (GD-) induced cell death. We mimicked acute energy failure by using glucose deprivation in photoreceptor cells (661W cells). GD-induced oxidative stress was evaluated by measuring ROS with the DCFH-DA assay and HO-1 expression by Western blot analysis. The activation of NOX2/MAPK/NF-κB signal was assessed by Western blot and immunohistochemical assays. The roles of these signals in GD-induced cell death were measured by using their specific inhibitors. Inhibition of Rac-1 and NOX2 suppressed GD-induced oxidative stress and protected photoreceptors against GD-induced cell death. NOX2 was an upstream signal in the caspase-dependent cell death cascade, yet the downstream MAPK pathways were activated and blocking MAPK signals rescued 661W cells from GD-induced death. In addition, GD caused the activation of NF-κB signal and inhibiting NF-κB significantly protected 661W cells. These observations may provide insights for treating retinal ischemic diseases and protecting retinal neurons from ischemia-induced cell death.

Case report repairing orbital skin defects using composite flaps after giant eyelid-derived tumor excision and orbital exenteration.

RATIONALE: Though giant malignant tumors arising in the eyelid are rare, they often require extensive surgery for removal along with orbital exenteration. Because of this, repairing orbital defects is an important factor in the surgical strategy. PATIENT CONCERNS: Case 1 was a 78-year-old nomad man who presented in the Department of Ophthalmology with a giant tumor in his right eyelid, which had developed over three years. Clinical examination revealed a huge pigmented, nonhealing ulcerated lesion, approximately 52×44×40 mm in size. Case 2 was a 52-year old rural male complaining of a huge tumor in the right eyelid. Patient medical history revealed that the mass was initially the size of a soybean and gradually grew over 3 years to the size of a fist. DIAGNOSES: Histopathological examination of the tumors revealed that one was a basal cell carcinoma and the other a sebaceous gland carcinoma. INTERVENTIONS: The two cases of giant malignant eyelid tumors were surgically excised using rapid frozen section margin control. Different pedicle myocutaneous flaps were used to repair the orbital skin defects. OUTCOMES: Postoperative follow-up showed perfect healing of the pedicle flaps and good patient compliance. The results of these cases indicate that covering exposed orbital cavities with composite pedicle mycuaneous flaps is a simple and practical strategy for orbital reconstruction. Not only does this help maintain orbital stability, but it also provides opportunities for patients to return to normal lives. LESSONS: Although surgical management is often the first option for treatment of giant eyelid tumors, recurrence and mortality due to the tumors is still high after long-term follow-up. Therefore, early discovery and treatment is the best way to control the progression of giant eyelid tumors and enhance survivability.