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PURPOSE: To develop and validate neural network (NN) vs logistic regression (LR) diagnostic prediction models in patients with suspected giant cell arteritis (GCA). Design: Multicenter retrospective chart review. METHODS: An audit of consecutive patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at 14 international medical centers. The outcome variable was biopsy-proven GCA. The predictor variables were age, gender, headache, clinical temporal artery abnormality, jaw claudication, vision loss, diplopia, erythrocyte sedimentation rate, C-reactive protein, and platelet level. The data were divided into three groups to train, validate, and test the models. The NN model with the lowest false-negative rate was chosen. Internal and external validations were performed. RESULTS: Of 1,833 patients who underwent TABx, there was complete information on 1,201 patients, 300 (25%) of whom had a positive TABx. On multivariable LR age, platelets, jaw claudication, vision loss, log C-reactive protein, log erythrocyte sedimentation rate, headache, and clinical temporal artery abnormality were statistically significant predictors of a positive TABx (P≤0.05). The area under the receiver operating characteristic curve/Hosmer-Lemeshow P for LR was 0.867 (95% CI, 0.794, 0.917)/0.119 vs NN 0.860 (95% CI, 0.786, 0.911)/0.805, with no statistically significant difference of the area under the curves (P=0.316). The misclassification rate/false-negative rate of LR was 20.6%/47.5% vs 18.1%/30.5% for NN. Missing data analysis did not change the results. CONCLUSION: Statistical models can aid in the triage of patients with suspected GCA. Misclassification remains a concern, but cutoff values for 95% and 99% sensitivities are provided (https://goo.gl/THCnuU).

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OBJECTIVE: To determine if a superior tarsectomy improves the ptosis corrective ability of the super maximum levator resection in cases of severe blepharoptosis with poor levator function (less than 5 mm). DESIGN: Retrospective, consecutive case series. PARTICIPANTS: Patients who underwent super maximum levator resection with (8 eyelids) or without superior tarsectomy (10 eyelids) at one institution. METHODS: Chart review of patients who underwent super maximum levator resection with or without superior tarsectomy. Data regarding eyelid position, surgical outcome, and postoperative complications were evaluated. MAIN OUTCOME MEASURES: Margin reflex distance-1 (distance [mm] between corneal light reflex and upper eyelid margin), bilateral eyelid symmetry, and postoperative complications. RESULTS: A statistically significant improvement in ptosis correction was demonstrated when integrating the superior tarsectomy with the super maximum levator resection (P = 0.029). In addition, the superior tarsectomy significantly decreased the incidence of undercorrection (margin reflex distance-1 values less than 2.0 mm) compared with the super-maximum levator resection alone (12.5% vs. 70%; P = 0.023). Improved postoperative eyelid symmetry within 1.0 and 1.5 mm was demonstrated in cases treated by the superior tarsectomy. Postoperative complications were similar in both treatments. CONCLUSIONS: The super maximum levator resection combined with superior tarsectomy can correct severely ptotic eyelids with Berke levator function ranging from 3 to 4.5 mm.

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A 60-year-old man with myelofibrosis and extramedullary hematopoiesis was referred for evaluation of "swollen lacrimal glands." Examination disclosed bilateral firm, immobile, nontender masses in the lacrimal sac fossa with no associated signs of inflammation. MRI of the orbits disclosed lobulated enhancing mass lesions involving the lacrimal sacs and nasolacrimal ducts bilaterally, with bony scalloping of the lacrimal sac fossa and expansion of the bony walls of the nasolacrimal ducts. Incisional biopsy and subsequent debulking of the tumors confirmed sclerosing extramedullary hematopoiesis lesions. To the authors' knowledge, involvement of the lacrimal drainage system with such tumors has not been previously described.

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The lacrimal drainage apparatus drains tears from the eye. The system is susceptible to a multitude of pathologic findings, including obstruction, infection, inflammation, and neoplasms. The diagnosis of several of these processes is aided by the use of radiologic studies. In conjunction with dacryocystography, cross-sectional modalities, such as CT and MR imaging have improved the ability of diagnostic imaging to characterize the obstructive nature and soft tissue or osseous changes of various disease processes.

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PURPOSE: To investigate the mechanisms producing ptosis in anophthalmic patients by comparing potential risk factors among patients with ptosis with a control group. Specific techniques for achieving optimal aesthetic results in the surgical correction of anophthalmic ptosis are recommended. METHODS: Data from 94 anophthalmic patients with ptosis and 44 control patients without ptosis were retrospectively collected and analyzed. Potential risk factors for ptosis were compared between the two groups of patients by using 2-sample binomial exact tests. Univariate and multivariate logistic regression analyses were also used. RESULTS: A direct relation between percent volume replacement by the primary implant and the occurrence of ptosis was noted (P=0.057; age adjusted, P=0.037). Those patients who had secondary implant surgery were more likely to have levator surgery for ptosis (P=0.005; age adjusted, P=0.039). A greater number of years of prosthesis wear was associated with clinical and intraoperative evidence of levator dehiscence (P=0.061). No relation was observed between the occurrence of trauma (as a reason for enucleation) and the occurrence of levator dehiscence. Thirty percent of patients with ptosis who had secondary intraconal or extraconal implants and no other surgical intervention for ptosis had improvement in ptosis. CONCLUSIONS: The mechanisms producing anophthalmic ptosis should be assessed carefully before surgical repair to achieve optimal aesthetic results. Correction of volume deficiency should be offered before levator surgery for patients with anophthalmic ptosis. The patient should be advised that tilt of the prosthesis is a possible outcome of levator repair and may reflect overcorrection or insufficient volume replacement.

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Blepharoptosis is a common complaint of eyelid malposition in which the upper eyelid is lower than normal. There are multiple types of blepharoptosis based on cause, and important studies have recently been published on one type, myogenic blepharoptosis. There have classically been three methods for correcting blepharoptosis. For the most severe cases, frontalis slings are often performed. New materials, such as polyester mesh, have shown promise as alternatives in forming frontalis slings. A recent paper has suggested a new algorithm for another method of blepharoptosis correction, the conjunctiva-Müller muscle resection. The effectiveness of the third type of procedure for blepharoptosis correction, the external levator advancement, has been reinforced in a study examining the procedure in cases of congenital blepharoptosis.

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