Predictive Modeling of New-Onset Postoperative Diplopia Following Orbital Decompression for Thyroid Eye Disease

PurposeTo identify risk factors for the development of new-onset, postoperative diplopia following orbital decompression surgery based on patient demographics, clinical exam characteristics, radiographic parameters, and surgical techniques.MethodsWe conducted a multi-center retrospective chart review of patients who underwent orbital decompression for thyroid eye disease (TED). Patient demographics, including age, gender, smoking history, preoperative exophthalmometry, clinical activity score (CAS), use of peribulbar and/or systemic steroids, and type of orbital decompression were reviewed. Postoperative diplopia was determined at a minimum of 3 months postoperatively and before any further surgeries. Cross-sectional area ratios of each extraocular muscle to orbit and total fat to orbit were calculated from coronal imaging in a standard fashion. All measurements were carried out using PACS imaging software. Multivariable logistic regression modeling was performed using Stata 14.2 (StataCorp, College Station, TX).ResultsA total of 331 patients without preoperative diplopia were identified. At 3 months postoperatively, 249 patients had no diplopia whereas 82 patients developed diplopia. The average postoperative follow-up was 22 months (range 3-156) months. Significant preoperative clinical risk factors for postoperative diplopia included older age at surgery, proptosis, use of peribulbar or systemic steroids, elevated clinical activity score, and presence of preoperative compressive optic neuropathy. Imaging findings of enlarged cross-sectional areas of each rectus muscle to the overall orbital area also conferred a significant risk of postoperative diplopia. Regarding surgical factors, postoperative diplopia was more common among those undergoing medial wall decompression, bilateral orbital surgery, and balanced decompression, whereas endoscopic medial wall decompression was found to be relatively protective.ConclusionsThis study identifies risk factors associated with the development of diplopia following orbital decompression using multivariable data. This study demonstrates that several characteristics including age, clinical activity score, the cross-sectional muscle to orbit ratios, in addition to the type of orbital decompression surgery, are predictive factors for the development of new-onset postoperative diplopia

Transcutaneous retrobulbar amphotericin B for rhino-orbital-cerebral mucormycosis: a multi-center retrospective comparative study

PurposeTo assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM).MethodsIn this retrospective case-control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (-TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality.ResultsAmong eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality.ConclusionsPatients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes

O gênero Hantzschia Grunow (Nitzschiaceae, Bacillariophyta) em ambientes lacustres na Planície Costeira do Rio Grande do Sul, Brasil Genus Hantzschia Grunow (Nitzschiaceae, Bacillariophyta) in lacustrine environments of the Rio Grande do Sul Coastal Plain, Brazil

O estudo do gênero Hantzschia em amostragens realizadas em lagoas, banhados, canal e açudes na Planície Costeira do Rio Grande do Sul (30°40´-30°10´ S e 50°30´-51°30´ W), no outono e primavera de 2003, revelou a presença de um táxon específico e seis infra-específicos, a saber: Hantzschia amphioxys (Ehrenberg) Grunow, suas variedades (var. amphioxys e var. vivax Grunow) e forma (f. capitata O. Müller), H. elongata (Hatzsch) Grunow com duas variedades (var. elongata e var. linearis O. Müller), H. virgata (Roper) Grun. e Hantzschia sp. São apresentadas descrições, ilustrações, chave de identificação e comentários sobre as variações morfológicas e a distribuição dos táxons. Cabe ressaltar a presença de H. elongata var. linearis e Hantzschia sp. como novos registros para o Estado do Rio Grande do Sul.<br>The study of the genus Hantzschia in samples from lakes, wetlands, canals and ponds in the Rio Grande do Sul Coastal Plain (30°40'-30°10' S; 50°30'-50°30' W), during fall and spring of 2003, revealed the presence of one specific and six infra-specific taxa, as follows: Hantzschia amphioxys (Ehrenberg) Grunow, its varieties (var. amphioxys and var. vivax Grunow) and form (f. capitata O. Müller), H. elongata (Hatzsch) Grunow with two varieties (var. elongata and var. linearis O. Müller), H. virgata (Roper) Grunow and Hantzschia sp. Descriptions, illustrations, identification keys and comments on morphological variation and the distribution of the taxa are presented. It is worth mentioning the presence of H. elongata var. linearis and Hantzschia sp. recorded for the first time in the state of Rio Grande do Sul

Social Interaction Effects on Fertility: Intentions and Behaviors

The existing literature shows that social interactions in individuals' networks affect their reproductive attitudes and behaviors through three mechanisms: social influence, social learning, and social support. In this paper, we discuss to what extent the Theory of Planned Behavior (TPB), an individual based theorization of intentions and behavior used to model fertility, takes these social mechanisms into account. We argue that the TPB already integrates social influence and that it could easily accommodate the two other social network mechanisms. By doing so, the theory would be enriched in two respects. First, it will explain more completely how macro level changes eventually ends in micro level changes in behavioral intentions. Indeed, mechanisms of social influence may explain why changes in representations of parenthood and ideal family size can be slower than changes in socio-economic conditions and institutions. Social learning mechanisms should also be considered, since they are crucial to distinguish who adopts new behavioral beliefs and practices, when change at the macro level finally sinks in. Secondly, relationships are a capital of services that can complement institutional offering (informal child care) as well as a capital of knowledge which help individuals navigate in a complex institutional reality, providing a crucial element to explain heterogeneity in the successful realization of fertility intentions across individuals. We develop specific hypotheses concerning the effect of social interactions on fertility intentions and their realization to conclude with a critical review of the existing surveys suitable to test them and their limits