The Management of Lumps, Bumps, and Contour Irregularities of the Lower Eyelid and Cheek After Poor Outcome Fat Transfer.

Background: The increasing popularity of fat transfer (FT) to the lower eyelids has led to an increase in unwanted lumps, bumps, and contour irregularities (LBCs). Few studies have addressed the management of LBCs.

Objectives: The aim of this study was to address the management of LBCs.

Change in lacrimal gland volume and aqueous tear production following treatment with teprotumumab.

Background: Dry eye syndrome occurs in up to 85% of patients with thyroid eye disease (TED). Lacrimal gland enlargement correlates with subjective tearing and a reduction in quality of life in patients with TED.

Methods: In this prospective longitudinal study, patients presenting for the treatment of TED were considered for eligible.

A Review of Midface Aging.

Purpose: To review and summarize studies on the anatomy and involutional changes of the midface.

Methods: A PubMed search was performed searching for studies on the anatomy and involutional changes concerning the midface.

Results: The anatomy of the midface is complex.

A Paradigm Shift in the Management of Thyroid Eye Disease How Teprotumumab Has Changed the Therapeutic Interface.

Background: Teprotumumab, a monoclonal antibody that blocks the insulin-like growth factor-1 receptor, has recently been approved by the US Food and Drug Administration (FDA) for the treatment of thyroid eye disease (TED). Since its approval, aside from data on the safety and clinical efficacy of teprotumumab from Phase-2 and Phase-3 trials, only a handful of reports have been published regarding its use in the wider population. In this review, we briefly describe the mechanism of action of teprotumumab and review the literature to provide an overview of published clinical experience.

Expert Consensus on the Use of Teprotumumab for the Management of Thyroid Eye Disease Using a Modified-Delphi Approach.

Background: Teprotumumab is the first treatment for thyroid eye disease (TED), a debilitating autoinflammatory condition, approved by the Food and Drug Administration in the United States, which reduces proptosis and improves quality of life. In the absence of guidelines, clinical recommendations were developed for using teprotumumab in patients with TED in the United States.

Methods: A 3-round modified-Delphi panel was conducted between October 2020 and February 2021 with experts in the management of patients with TED.

Thyroid dermopathy responds to teprotumumab therapy.

Summary: Thyroid dermopathy is an uncommon manifestation of thyroid disease that impairs the quality of life in certain cases. Currently, the available treatments offer limited results and a chance of recurrence. Teprotumumab, a novel medication that results in the regression of thyroid ophthalmopathy, may have similar effects on dermopathy.

Changes to Eye Whiteness and Eyelid/Brow Position With Topical Oxymetazoline in Aesthetic Patients.

Background: Oxymetazoline hydrochloride 0.1% ophthalmic solution has recently been approved in the United States for the treatment of ptosis.

Objectives: The aim of this study was to assess the upper and lower eyelid position as well as the brow position and the color of the sclera following the ophthalmic administration of oxymetazoline hydrochloride 0.

Teprotumumab Efficacy, Safety, and Durability in Longer-Duration Thyroid Eye Disease and Re-treatment: OPTIC-X Study.

Purpose: To evaluate teprotumumab safety/efficacy in patients with thyroid eye disease (TED) who were nonresponsive or who experienced a disease flare.

Design: The Treatment of Graves' Orbitopathy to Reduce Proptosis with Teprotumumab Infusions in an Open-Label Clinical Extension Study (OPTIC-X) is a teprotumumab treatment and re-treatment trial following the placebo-controlled teprotumumab Phase 3 Treatment of Graves' Orbitopathy (Thyroid Eye Disease) to Reduce Proptosis with Teprotumumab Infusions in a Randomized, Placebo-Controlled, Clinical Study (OPTIC) trial.

Participants: Patients who previously received placebo (n = 37) or teprotumumab (n = 14) in OPTIC.

Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab.

Unlabelled: Thyroid eye disease (TED) causes orbital soft-tissue expansion. Recent studies have suggested that brow and temple changes may also occur. Teprotumumab, a monoclonal antibody to the insulin-like growth factor 1 receptor reduces soft-tissue swelling in TED.

Teprotumumab for the treatment of chronic thyroid eye disease.

Background: Teprotumumab, a novel IGF-1R antibody was recently shown to significantly reduce the signs of active Thyroid eye disease (TED). The current study reviews its efficacy in chronic TED.

Methods: In this retrospective review, consecutive patients with chronic stable TED (>2 years), who had received ≥3 infusions of teprotumumab were included.

Teprotumumab for thyroid eye disease: early response is not required for benefit.

Purpose: In recent trials, 50% of patients treated with teprotumumab for thyroid eye disease had significant improvements in proptosis at 6 weeks. However, a small subgroup of patients did not have a significant response by week 12. We examine the outcomes at week 24 in patients from both trials who had little or no proptosis response at week 12.

Quantifying the Digestion of Cross-Linked Hyaluronic Acid Fillers With Hyaluronidase.

Background: Adverse events due to hyaluronic acid fillers (HAFs) may be treated with hyaluronidase, an enzyme that cleaves bonds within hyaluronic acid. This study reviews the efficacy of currently available hyaluronidase preparations in breaking down commercial, cross-linked HAFs.

Methods: Three HAFs were used in this study (Restylane, Juvederm Voluma, and Belotero [BEL] Balance).

Disorders of the Fourth Cranial Nerve.

This review of disorders of the fourth cranial nerve includes discussion on anatomy, examination techniques, congenital and acquired etiologies, differential diagnosis, and management options. The findings of the superior oblique muscle on orbital MRI in patients with fourth nerve palsy have had a major impact on our understanding of this cranial neuropathy. In addition, briefly reviewed are rare disorders of the fourth nerve: superior oblique myokymia, Brown syndrome, and ocular neuromyotonia.

Thrombogenicity of Hyaluronic Acid Fillers: A Quantitative Thrombodynamics Study.

Purpose: At present, there is a paucity of data regarding the thrombogenicity of hyaluronic acid fillers (HAFs). This article quantitatively analyses the thrombogenicity of 2 commonly used HAFs: Restylane Lyft and Juvéderm Ultra.

Methods: Thrombogenicity was assessed using the Thrombodynamics Analyzer System and plasma obtained from healthy controls.

Teprotumumab for non-inflammatory thyroid eye disease (TED): evidence for increased IGF-1R expression.

Purpose: Teprotumumab, a blocking antibody to the insulin like growth factor 1 receptor (IGF-1R) has been shown to significantly reduce proptosis in recent phase 2 and 3 trials in patients with inflammatory thyroid eye disease (TED). Herein, we investigate the impact of teprotumumab on patients with non-inflammatory TED. We also investigate the expression of the IGF-1R on orbital tissues from patients with inflammatory and non-inflammatory TED compared to controls.

Infectious keratitis after lamellar keratoplasty.

Infectious keratitis after lamellar keratoplasty is a potentially devastating complication that may severely limit the visual and anatomical outcomes. The deep-seated location of the infiltrates, sequestration of the pathogenic microorganisms and limited penetration of the currently available antimicrobial agents often results in delayed diagnosis that may jeopardize the management in these cases. Fungal keratitis is more common as compared with bacterial or viral keratitis and classically presents as white interface infiltrates that may not be associated with significant inflammation.

Facial numbness in the ophthalmology clinic. A portentous sign.

Aim: To report a case series of 14 patients presenting with facial numbness primarily to the ophthalmology clinic.

Methods: All patients presenting with facial numbness to the ophthalmology clinic at the University of California, Los Angeles, were reviewed for study entry between 1993 and the present. Patients with a history of trauma or surgery were excluded.

Systemic Diffuse Large B-Cell Lymphoma Presenting as Bilateral Orbital Vasculopathy.

The authors report a case of a 58-year-old man with bilateral proptosis and signs of orbital inflammation without any associated systemic findings. MRI showed diffuse orbital infiltration. An intraconal orbital biopsy revealed polyclonal lymphoplasmacytic infiltration and non-necrotizing lymphoid small-vessel vasculopathy.

Conformational heterogeneity of the allosteric drug and metabolite (ADaM) site in AMP-activated protein kinase (AMPK).

AMP-activated protein kinase (AMPK) is a master regulator of energy homeostasis and a promising drug target for managing metabolic diseases such as type 2 diabetes. Many pharmacological AMPK activators, and possibly unidentified physiological metabolites, bind to the allosteric drug and metabolite (ADaM) site at the interface between the kinase domain (KD) in the α-subunit and the carbohydrate-binding module (CBM) in the β-subunit. Here, using double electron-electron resonance (DEER) spectroscopy, we demonstrate that the CBM-KD interaction is partially dissociated and the interface highly disordered in the absence of pharmacological ADaM site activators as inferred from a low depth of modulation and broad DEER distance distributions.

Expert Evaluation of Visual Field Decay in Glaucoma Correlates With the Fast Component of Visual Field Loss.

Purpose: To compare the assessment of serial visual fields (VFs) based on subjective expert evaluation with the fast and slow VF component rates determined with pointwise exponential regression (PER) and pointwise linear regression (PLR).

Materials And Methods: A total of 5272 VF examinations from 376 eyes diagnosed with open-angle glaucoma were included. Three glaucoma specialists assessed each VF qualitatively to evaluate progression status and the qualitative rate of progression.