The study evaluated changes in extraocular muscles (EOMs) following orbital decompression in patients with thyroid-associated orbitopathy (TAO) using computed tomography (CT)-based volumetric analysis. Patients who underwent orbital decompression with available preoperative and postoperative orbital CT scans were retrospectively reviewed. Decompression procedures were classified as medial, inferomedial, balanced, or three-wall decompression. Volumes of individual EOMs were calculated from coronal CT images, and temporal changes were assessed by locally estimated scatterplot smoothing regression, with associated clinical factors analyzed using multivariate linear regression. A total of 307 orbits from 171 patients were analyzed. Medial rectus muscle volume increased significantly across all surgical groups, while superior rectus volume decreased after three-wall decompression and inferior rectus volume decreased following medial and balanced decompression. EOM volumetric changes stabilized approximately 150 days postoperatively. Female sex, prior high-dose intravenous (IV) steroid therapy, and prolonged duration of TAO were independently associated with increased postoperative EOM volume, whereas smoking showed a borderline association. These findings indicate that orbital decompression induces distinct and time-dependent EOM volumetric changes, reflecting postoperative soft-tissue remodeling influenced by specific clinical factors.

Galactokinase 1 (GALK1) is a metabolic kinase that phosphorylates galactose. Mutations in GALK1 cause type II galactosemia, which manifests as cataracts and extra-ocular symptoms. The mechanisms underlying these symptoms are not fully understood. In this study, we explored a novel function of GALK1 beyond galactose phosphorylation. GALK1 is ubiquitously expressed across human tissues, regardless of developmental stage. GALK1 phosphorylates TIMM13 at the Y73 residue. The phosphorylated Y73 stabilizes TIMM13 by electrostatically interacting with two cationic residues, thereby enhancing its affinity for Zn[2] [+]. This structural change ensures the mitochondrial translocation of TIMM13 in the correct conformation. Disruption of Y73 phosphorylation impairs mitochondrial bioenergetics and dissipates the mitochondrial membrane potential. Furthermore, galactose competitively inhibits GALK1-mediated phosphorylation, suggesting that mitochondrial activity is modulated by carbohydrate availability. Galactosemia-associated GALK1 mutations showed compromised activity in TIMM13 phosphorylation, subsequently repressing mitochondrial respiration. Collectively, the GALK1-TIMM13 axis appears to provide a potential link between galactose metabolism and mitochondrial respiration.

Periorbital swelling can differ from simple allergic conjunctivitis, orbital cellulitis, and cavernous sinus thrombosis, as well as rapidly expanding retrobulbar hemorrhage. An uncommon cause is the carotid-cavernous fistula (CCF), an abnormal arteriovenous connection between the carotid artery and the cavernous sinus. CCFs can cause periorbital swelling, diplopia, cranial nerve palsies, and ultimately vision loss secondary to retinal detachment, vitreous detachment, or intracranial hemorrhage. CCFs are strongly associated with previous head trauma, especially basilar skull fractures, and with connective tissue disorders. However, according to the patient, she had no history of connective tissue disorder or previous trauma. She presented to the clinic with right periorbital swelling, chemosis, and mild, painful extraocular movements of two months' duration and was referred to the emergency department for imaging. CT angiography (CTA) showed a right high-flow CCF. The patient was admitted for cerebral angiography and embolization. The procedure was successful, and her symptoms resolved completely.

Retinal vasculitis is a manifestation observed in various forms of uveitis. However, frosted retinal vasculitis, a severe type of retinal vasculitis, is seen in only a limited number of cases, typically associated with severe infections or autoimmune inflammatory conditions. A 65-year-old woman presented to our hospital after noticing a decline in vision in both eyes over the preceding month. Examination revealed vitritis and frosted retinal vasculitis in both eyes. Fluorescein angiography showed marked leakage from the optic disc and retinal vessels. Optical coherence tomography (OCT) revealed a serous retinal detachment at the right fovea. Sarcoidosis and Behçet's disease were ruled out based on blood tests, chest computed tomography (CT) scans, and the absence of extraocular symptoms or findings. There were no abnormalities in the white blood cell count or differential, and no elevation of C-reactive protein (CRP) was observed. While infections caused by various bacteria, viruses, and Toxoplasma were ruled out, elevated anti-human T-lymphotropic virus type 1 (HTLV-1) antibodies were detected. Based on these findings, the patient was diagnosed with HTLV-1-associated uveitis, and oral prednisolone therapy was initiated at a dosage of 30 mg. The vasculitis improved dramatically, and the dosage was gradually tapered while the condition remained stable. However, 16 months after the initial visit, the vasculitis worsened, necessitating an increase in the prednisolone dosage back to 30 mg. Subsequently, the dosage was tapered again, and treatment was discontinued 27 months after this resumption (43 months after the initial start of prednisolone). There was no recurrence of vasculitis thereafter, and the affected vascular areas transformed into degenerative lesions. Thus, HTLV-1-associated uveitis should be considered as a potential underlying cause of frosted retinal vasculitis.

Intraoperative neurophysiological monitoring (IONM) of extraocular cranial nerves (EOCN) during skull base surgery has expanded to reduce post-operative neurological deficits. However, multiple techniques exist, and comparative evidence supporting their routine use in endoscopic endonasal approaches (EEA) remains limited. The aim of the study is to evaluate the reliability, signal quality, and safety of different IONM techniques for CN III and VI during EEA, integrating a scoping literature review with a single surgeon's clinical experience.