Intraoperative Suggestions for Documentation of Complex Ocular Surface and Eyelid Biopsies

Hagelstein-Rotman, Marlous; Genders, Stijn W.; Andela, Cornelie D.; Dijkstra, Sander; Majoor, Bas C.J.; Notting, Irene C.; Hamdy, Neveen A.T.; Appelman-Dijkstra, Natasha M.

Purpose:

Craniofacial fibrous dysplasia (CFD) is a subtype of fibrous dysplasia/McCune-Albright syndrome (FD/MAS) characterized by FD lesions in one or more of the skull bones. The orbit is often involved, with facial pain, facial deformity, and increased risk of compressive optic neuropathy as associated clinical manifestations possibly leading to altered illness perceptions and impairments in quality of life(QoL). The aim of this study was to evaluate illness perceptions and QoL in patients with CFD among our FD/MAS cohort.

Methods:

One hundred ninety-one patients were included. Illness perceptions and QoL were assessed by using validated questionnaires, that is, the Illness Perceptions Questionnaire–Revised and the Short-Form 36. Patients were first grouped as CFD versus non-CFD, a second selection was based on the presence of “Isolated CFD” versus “CFD+PFD/MAS.” Non-CFD patients were grouped as monostotic fibrous dysplasia “MFD” versus polyostotic “PFD/MAS.”

Results:

Patients with isolated CFD attributed less symptoms to their disease compared with patients with CFD+PFD/MAS (p < 0.05). Furthermore, patients with isolated CFD reported better QoL on all domains (except role emotional and mental health) compared with patients with CFD+PFD/MAS (p < 0.05). Patients with isolated CFD also reported better QoL compared with non-CFD groups (on 3 out of 8 subscales) (p < 0.05).

Conclusions:

Patients with isolated CFD attribute less symptoms to their disease and report better QoL compared with patients with CFD with extracranial involvement or FD without cranial involvement. These findings indicate that craniofacial involvement alone is not sufficient to cause negative illness perceptions and impairments in QoL. Therefore, it can be postulated that isolated CFD should be considered a unique patient subtype within the spectrum of FD/MAS patients.

https://journals.lww.com/op-rs/Abstract/2020/05000/Patients_With_Isolated_Craniofacial_Dysplasia.16.aspx

Journal : OPRS

Ref : Craniofacial fibrous dysplasia Fibrous dysplasia McCune-Albright syndrome Orbit

Clinical-Radiological Patterns and Histopathological Outcomes in Non-Thyroid Extraocular Muscle Enlargement: Retrospective Case Series and Current Concepts

27 Jun 2020

Savino, Gustavo; Midena, Giulia; Tartaglione, Tommaso; Milonia, Luca; Caputo, Carmela Grazia; Grimaldi, Gabriela

Purpose:

To report a single-center experience with non-thyroid causes of extraocular muscle enlargement (EME), describing the association between clinical-radiological findings at presentation and the final histopathological diagnosis.

Methods:

Retrospective consecutive case series of 59 patients with single or multiple EME on orbital imaging, in the absence of an etiological diagnosis at the time of presentation. All patients were submitted to orbital muscle biopsy in order to achieve a final etiological diagnosis. Patients with a confirmed diagnosis of thyroid-associated orbitopathy and vascular causes of EME which were angiographically and clinically diagnosed were excluded. Orbital ultrasound and radiologic evaluation (CT and/or MRI) were performed before surgery in all cases. Main outcomes measured included initial clinical-radiological findings and final histopathological features of EME.

Results:

A diagnosis of lymphoma was confirmed in 13 cases (22%). Sixteen cases (27%) were diagnosed as orbital inflammatory disease including nonspecific idiopathic orbital inflammatory disease in 9 cases, IgG4-related disease in 4 cases, and sclerosing idiopathic orbital inflammatory disease in 3 cases. In 11 patients (18%), a diagnosis of metastatic tumor was made, whereas sarcoidosis, vascular malformations, Erdheim-Chester, and necrobiotic xanthogranuloma were diagnosed in 8 eyes (13.5%). Three patients (5%) with single muscle enlargement developed Graves disease 10 months later. Four patients (6.7%) were diagnosed with granulomatosis with polyangiitis. In 2 cases (3.3%), the diagnosis was unknown, with inconclusive biopsy results. Differential patterns for inflammatory/vascular, lymphomatous and metastatic EME were identified based on age and gender distribution and clinical-radiological characteristics at presentation.

Conclusions:

Initial clinical and radiological features may orientate the differential diagnosis of non-thyroid EME.

https://journals.lww.com/op-rs/Abstract/2020/05000/Clinical_Radiological_Patterns_and.15.aspx

Journal : OPRS

Ref : Enlarged Extraocular Muscles Erdheim Chester disease Necrobiotic xanthogranuloma Orbit Orbital inflammation

Evaluation of Electronic Health Record Implementation in an Academic Oculoplastics Practice

27 Jun 2020

Chen, Allison J.; Baxter, Sally L.; Gali, Helena E.; Long, Christopher P.; Ozzello, Daniel J.; Liu, Catherine Y.; Korn, Bobby S.; Kikkawa, Don O.

Purpose:

Despite increasing electronic health record (EHR) adoption, perceptions of EHRs are negative among ophthalmologists due to concerns about productivity, costs, and documentation. The authors evaluated the effects of EHR adoption in an oculoplastics practice, which had not been previously studied.

Methods:

Clinical volume, documentation time, time spent with patients, reimbursement, relative value units, and patient satisfaction were examined for 2 academic oculoplastics attendings between April 2018 and April 2019, with EHR implementation in September 2018.

Results:

The mean number of patients seen in a half-day clinic was 31.8 versus 27.7 (p = 0.018) pre- and post-EHR implementation, respectively. EHR implementation had no effect on total monthly reimbursement (p = 0.88) or total monthly relative value units (p = 0.54). Average reimbursement (p = 0.004) and relative value units (p = 0.001) per patient encounter were significantly greater with EHR use. Patient satisfaction scores improved (p = 0.018). Mean physician time per patient increased from 6.4 to 9.0 minutes (p < 0.001). Mean documentation time per patient increased from 1.7 to 3.6 minutes (p < 0.001). Average patient wait times decreased by 9 minutes (p = 0.03) with EHR use. No scribes were used.

Conclusions:

EHR implementation was associated with decreased patient volume without significant differences in total reimbursement. Although EHR adoption was associated with increased physician time devoted to patients and greater time expenditure on documentation, patients experienced decreased wait times. This suggests that EHR use streamlined the overall clinic flow without sacrificing physicians’ time with the patient. The author’s findings suggest that EHR implementation can be accomplished in an academic oculoplastics setting without negative impact on patient experience or reimbursement considerations.

https://journals.lww.com/op-rs/Abstract/2020/05000/Evaluation_of_Electronic_Health_Record.14.aspx

Journal : OPRS

Ref : EMR Oculoplastics

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