Euthyroid graves' ophthalmopathy in a Chinese population: A cross-sectional follow-up study.

OBJECTIVES: A subtype of patients with thyroid eye disease (TED) were found to be euthyroid without prior thyroid dysfunction or treatment, known as Euthyroid Graves' Ophthalmopathy (EGO). We report the prevalence, clinical and serological phenotypes of EGO in a Chinese population. METHODS: A cross-sectional follow-up study. Ethnic Chinese TED patients were managed at the Thyroid Eye Clinic(TEC), Prince of Wales Hospital and TEC, the Chinese University of Hong Kong between September 2007 and July 2021. RESULTS: A total of 66 (5%) patients among the 1266 ethnic Han Chinese TED cohort were diagnosed as EGO, and 6 (9%)of them become dysthyroid over an average of 74-month follow-up. EGO patients were associated with a longer duration between onset of the symptoms to our first consultation (P < 0.0001), a higher male-to-female ratio (P = 0.0045) and a higher age of disease onset (P = 0.0092). Family history of thyroid disease was more common in TED patients (P = 0.0216) than in EGO patients. EGO patients were more likely to present unilaterally (P < 0.0001), and they have a larger difference in MRD1 (P < 0.0001), and extraocular motility (P < 0.0001) between the 2 eyes when compared to the TED patients. Notably, the extraocular motility restriction of the worst eye was more affected in EGO patients (P = 0.0113). The percentages of patients who received IVMP, ORT and emergency or elective surgeries(decompression or squint operation) between EGO and TED were similar. CONCLUSIONS: Understanding the important clinical phenotypes of EGO may help the clinician to make the correct diagnosis. Further study to compare EGO and TED is warranted.

Survey of ptosis practice patterns among surgeons in Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS).

OBJECTIVE: To characterize the preferred ptosis practice patterns and variations among oculoplastic surgeons in the Asia-Pacific region. METHODS: A web-based questionnaire was sent to both members and non-members registered under the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery (APSOPRS)'s email database. The survey included preoperative testing practices, surgical preferences for adult aponeurotic and congenital ptosis, various surgical techniques (anterior and posterior approach ptosis procedures, and frontalis sling procedures) and postoperative practices. RESULTS: A total of 386 survey invitations were sent. There was a response rate of 68.7% from respondents from 20 countries in the Asia-Pacific region. There was variation in the preoperative evaluation and management of ptosis. Anterior approach ptosis surgery (96.6%) and frontalis sling procedures (86.8%) were performed by more surgeons than posterior approach ptosis surgery (47.2%). There was a deviation from the traditional frontalis sling procedures for patients with poor levator function. CONCLUSIONS: Our survey results provide insight into the variation in the assessment and management of ptosis amongst oculoplastic surgeons in the Asia-Pacific region. It also demonstrates some differences between practice patterns in Asia-Pacific and America.

Indocyanine Green-Assisted Endoscopic Transorbital Excision of Lateral Orbital Apex Cavernous Hemangioma.

Orbital apex lesions posed operative difficulties to neurosurgeons and ophthalmologists due to limited surgical corridor and close vicinity to cranial nerves and arteries. Lateral orbital apex lesions were traditionally operated via the transcranial route by neurosurgeons. Recently, only a handful of reports have described the use of endoscope alone for excision of lateral orbital apex lesion. Our group, with both endoscopic skull base neurosurgeons and oculoplastic surgeons, has adopted the endoscopic transorbital approach for orbital apex lesions. We also used an indocyanine green (ICG) endoscope to aid identification and dissection of orbital apex cavernous hemangioma, which otherwise can be difficult to differentiate from surrounding intraconal recti muscles. Video 1 captured the first reported case of excision of lateral orbital apex cavernous hemangioma via endoscopic transorbital approach, using a zero-degree ICG endoscope. This was a 64-year-old Chinese woman who presented with right eye painless blurring of vision with visual acuity of 0.6 and right relative afferent pupillary defect. Fundoscopic examination showed absence of right optic disc swelling, and automated visual field testing confirmed a superior and infratemporal visual field defect in the right eye. On magnetic resonance imaging, there was a 1-cm oval mass that was hypointense on T1-weighted and hyperintense on T2-weighted images, with slow enhancement, suggestive of cavernous hemangioma. Optical coherence tomography of the retinal nerve fiber layer showed evidence of subtle right nerve fiber layer thinning. Right endoscopic transorbital excision of the tumor was performed with an ICG-assisted endoscope. Lateral skin crease incision was followed by crescent-shaped superolateral orbital rim removal. Superior and inferior orbital fissures were identified after stripping off the periorbita. The meningoorbital band was divided to release the orbital apex from the middle fossa dura. The greater wing of sphenoid bone was drilled with a 3-mm high-speed diamond burr under irrigation to create space for dissection. Injection of ICG resulted in delayed enhancement of the lesion at around 1 minute and 30 seconds, in contrast to rapid enhancement of surrounding recti muscles at around 30 seconds. Incision of periorbita was guided by ICG enhancement of lesion. The tumor was dissected from the lateral rectus and superior division of oculomotor nerve and was excised en bloc. The supraorbital rim was reconstructed with 2 miniplates. Pathology confirmed the diagnosis of cavernous hemangioma. Postoperatively, the patient had good recovery, with right eye visual acuity of 0.8 and resolution of the relative afferent pupillary defect.

Oculoplastic surgery practice during the COVID-19 novel coronavirus pandemic: experience sharing from Hong Kong.

At present, all parts of the world are hit hard by COVID-19. The first confirmed case of COVID-19 in the territory of Hong Kong was announced on January 23, 2020. Since then, oculoplastic surgeons in Hong Kong have been taking every measure to protect all healthcare workers and patients from contracting the disease. This paper aims to share the experiences of and measures taken by local oculoplastic surgeons in combating COVID-19. Three main aspects are discussed, namely clinical, administrative, and training and educational. We hope our experiences would provide reference to fellow oculoplastic colleagues in other parts of the world in fighting this COVID-19 pandemic.