Epidemiology of thyroid-stimulating immunoglobulin in recent-onset symptomatic thyroid eye disease.

Purpose: This study aims to report correlations between thyroid-stimulating immunoglobulin (TSI) and both clinical and radiological parameters in recent-onset symptomatic thyroid eye disease (TED) patients. Methods: A prospective cohort study of TED patients managed at the Chinese University of Hong Kong from January 2014 to May 2022. Serum TSI levels were determined with the functional assay. Outcomes included the Clinical Activity Score (CAS), marginal reflex distance1 (MRD1), extraocular muscle motility restriction (EOMy), exophthalmos, and diplopia. The radiological assessment included cross-sectional areas and signal of extraocular muscles on STIR-sequence MRI. Results: A total of 255 (197 female) treatment-naive patients, with an average onset age of 50 ± 14 years (mean ± s.d.), were included. Elevated pre-treatment TSI level was observed in 223 (88%) patients. There was a weak positive correlation between TSI and CAS (r = 0.28, P = 0.000031), MRD1 (r = 0.17, P = 0.0080), and the size of the levator palpebrae superioris/superior rectus complex (r = 0.25, P = 0.018). No significant correlation existed between TSI and STIR signals. The AUC and optimal cut-off value for clinical active TED were 0.67 (95% CI: 0.60-0.75) and 284% (specificity: 50%, sensitivity: 85%). In total, 64 patients received intravenous methylprednisolone (IVMP) during the study interval, and they had a higher baseline TSI level than those who did not have IVMP (P = 0.000044). Serial post-IVMP TSI among the 62 patients showed a significant reduction compared to the baseline level (P < 0.001). Both the baseline and post-IVMP TSI levels, and percentages of TSI changes were comparable between patients who responded and did not respond to the first course of IVMP. Conclusion: TSI can be a serum biomarker for the diagnosis, prognosis, and treatment response of TED. Further validation should be warranted.

Survey-based Evaluation of the Use of Picture Archiving and Communication Systems in an Eye Hospital-Ophthalmologists' Perspective.

PURPOSE: Picture archiving and communication system (PACS) is a medical imaging system for sharing, storage, retrieval, and access of medical images stored. Our study aimed to identify ophthalmologists' views on PACS, with the comparison between 3 platforms, namely electronic patient record (ePR), HEYEX (Heidelberg Engineering, Switzerland), and FORUM (Zeiss, US), following their implementation in an eye hospital for common ophthalmic investigations [visual field, optical coherence tomography (OCT) of retinal nerve fiber layer and macula, and fluorescein/indocyanine green angiography (FA/ICG)]. METHODS: An online survey was distributed among ophthalmologists in a single center. Primary outcome included comparison of PACS with paper-based system. Secondary outcomes included pattern of use and comparison of different PACS platforms. RESULTS: Survey response rate was 28/37 (75.7%). Images were most commonly accessed through ePR (median: 80% of time, interquartile range: 50 to 90%).All systems scored highly in information display items (median scores ≥7.5 out of 10) and in reducing patient identification error in investigation filing and retrieval during consultation compared to paper (score ≥7.0). However, ePR was inferior to paper in "facilitating comparison with previous results" in all investigation types (scores 3.0 to 4.5). ePR scored significantly higher in all system quality items than HEYEX ( P  < 0.001) and FORUM ( P  < 0.022), except login response time ( P  = 0.081). HEYEX scored significantly higher among vitreoretinaluveitis members (VRU) for information quality items for OCT macula and FA/ICG [VRU: 10.0 (8.0 to 10.0), non-VRU: 8.0 (6.75 to 9.25), P  = 0.042]. CONCLUSIONS: Overall feedback for PACS among ophthalmologists was positive, with limitations of inefficiency in use of information, for example, comparison with previous results. Subspecialty played an important role in evaluating PACS.

Conjunctival Adenosquamous Carcinoma Lacks MAML2 Translocation: A Variant of Squamous Cell Carcinoma With Mucoepidermoid Differentiation and Aggressive Behavior?

Conjunctival adenosquamous carcinoma, also known as mucoepidermoid carcinoma (MEC), is a rare tumor that preferentially affects the perilimbal area of the conjunctiva with aggressive local invasion. Consisting of infiltrative proliferation of squamous cells and mucous cells, its morphologic features are reminiscent of the salivary gland-type MEC except for the absence of intermediate cells and frequent keratin production. We reported 2 cases of conjunctival adenosquamous carcinoma and, for the first time, studied the MAML2 translocation status of this rare entity. The 2 patients were women, aged 45 and 42 years, presenting with an erythematous lesion in the left lower palpebral conjunctiva and a pigmented nodule over the left nasal conjunctiva, respectively. One tumor recurred 6 months after the initial biopsy. Excision with lid reconstruction and postoperative radiotherapy was performed for margin involvement and perineural invasion. This patient was disease free at 3-year follow-up. The other patient was lost to follow-up after tumor excision. Fluorescence in situ hybridization and reverse transcription polymerase chain reaction failed to demonstrate MAML2 translocation and CRCT1-MAML2 transcripts in both tumors. The absence of this characteristic translocation and reappraisal of the cellular composition, morphologic features, and precursor lesion suggest that conjunctival MEC may represent a variant of conjunctival squamous cell carcinoma but not related to the salivary gland-type MEC.

Ocular Sebaceous Carcinoma In Situ With Biphenotypic Differentiation: A Reappraisal of the Alternative Origin of the Tumor.

Ocular sebaceous carcinoma is an uncommon, aggressive tumor arising from the Meibomian gland, Zeis gland, or sebaceous glands in the caruncle or eyelashes. We described a rare case of sebaceous carcinoma in situ in a 51-year-old female that was characterized by intraepithelial growth of sebaceous carcinoma cells with no invasive carcinoma in the underlying sebaceous glands. Early stromal invasion was identified that featured 2 distinctive but focally intermixed populations of sebaceous carcinoma cells and squamous carcinoma cells. The 2 populations of cells exhibited their respective distinct immunophenotype but both showed strong overexpression of p53. This case provides evidence to support the hypothesis that some ocular sebaceous carcinoma may arise from intraepithelial pluripotent stem cells.

Balloon dacryoplasty in internal ostium stenosis after endoscopic dacryocystorhinostomy.

PURPOSE: To determine the effectiveness of balloon dacryoplasty in the treatment of internal ostium stenosis after endoscopic dacryocystorhinostomy (EnDCR). METHODS: A retrospective, noncomparative interventional case series of patients who underwent balloon dacryoplasty for post-EnDCR internal ostium stenosis were included. A balloon catheter was used in all procedures, with bicanalicular silicone intubation. Patient records were reviewed and data analyzed. Anatomical success was defined by functional endoscopic dye test, and functional success was defined as a subjective improvement in symptoms at last follow up. RESULTS: Nineteen lacrimal systems of 18 consecutive patients were studied between July 2007 and September 2012. At a mean follow up of 20 months (range, 3-53 months), anatomical success rate was 84% (16/19 systems), whereas functional success was 74% (14/19 systems). No major complication was observed. CONCLUSIONS: Balloon dacryoplasty is a minimally invasive procedure in the treatment of post-EnDCR internal ostium stenosis. It is a simple, safe procedure and can provide symptomatic relief to some of these patients. It can be considered as a treatment option for patients demonstrated with internal ostium stenosis after EnDCR.