Yingbai Chen, Yunhai Tu, Ben Chen, Jieliang Shi, Bo Yu, Wencan Wu
To assess the feasibility and efficacy of endoscopic transnasal removal of cavernous hemangiomas of the optic canal.
Retrospective, noncomparative case series.
Eleven consecutive patients (11 eyes) with cavernous hemangioma of the optic canal underwent endoscopic trans-ethmoidal-sphenoidal removal of the tumor at the Eye Hospital of Wenzhou Medical University from January 2009 to March 2016. In each case, the indication for surgery was decreased visual acuity due to the tumor. The removal was believed to be complete if the tumor was removed en bloc during the surgery. A mucoperiosteal flap was used to cover the defect in the optic nerve sheath after tumor removal. The tumor was pathologically confirmed to be cavernous hemangioma after surgery. The mean follow-up time was 9.9 ± 5.5 months. Visual acuity before and after surgery was compared.
All tumors were completely removed by the endoscopic approach. The best-corrected visual acuity (BCVA) improved after surgery in all patients. The mean preoperative BCVA was 6/30 (95% confidence interval [CI] 6/60–6/20) and the mean postoperative BCVA was 6/10 (95% CI 6/12–6/7.5). All patients showed cerebrospinal fluid rhinorrhea, which resolved with strict bed rest. Other complications included hyposmia in 2 patients; nasal bleeding in 3 patients, which resolved spontaneously; and temporary headache.
Endoscopic trans-ethmoidal-sphenoidal approach is a feasible option for cavernous hemangiomas of the optic canal.
Bipasha Mukherjee, Md. Shahid Alam
Pachydermoperiostosis (PDP) is a multisystem disorder of mesenchymal origin. It is a form of hypertrophic osteoarthropathy. The typical clinical features include pachydermia, cutis verticus gyrata, digital clubbing, and periostosis. Patients present with mechanical ptosis resulting from markedly thickened eye lids. Floppy eye lids have rarely been reported in association with PDP. We describe a rare case of PDP associated with ptosis and floppy eye lids in an adult male. Meibomian gland dysfunction was documented by meibography. The patient underwent bilateral upper lid wedge resection, lateral tarsal strip, tarsectomy and external levator advancement with good cosmetic outcome following surgery.
Anasua Ganguly, Kesarpu Ramarao, Samir Mohapatra, Suryasnata Rath
Purpose: To report the anatomical and cosmetic outcome of transconjunctival dacryocystorhinostomy (TDCR) in an Asian Indian population. Methods: TDCR was initially performed in cadaver eyes followed by patients with primary acquired nasolacrimal duct obstruction (NLDO). This was a prospective noncomparative case series of all consecutive TDCRs performed between April 2013 and June 2015. Outcome measures were anatomical patency, epiphora, presence of diplopia, aesthetic outcome, and health status. Results: A total of 17 (18 eyes) patients with a mean age 43.9 ± 11.8 years (range, 32–75) were included in the study. Eight were males, and one patient underwent TDCR in both eyes. TDCR was successfully performed in 15/18 (82%) eyes under local anesthesia. Procedure converted to transcutaneous external DCR in two and dacryocystectomy in one patient each. Mean duration of surgery was 52.6 (range, 29–110) min. Anatomical patency and relief from epiphora was achieved in all (15/15) eyes after TDCR at a median follow-up of 15.5 months. At final follow-up, objective assessment of the cosmetic outcome graded the surgical scar at the lateral canthus as invisible in all except one and conjunctival fornix as visible only after eyelid eversion in all patients. Disturbance of the medial fat pad was not seen in any patient. A questionnaire-based health status evaluation showed marked improvement in anxiety/depression before and after TDCR with an overall well-being score of 88 on a scale of 0–100 (worst–best) after TDCR. Conclusions: TDCR offers a promising aesthetic approach in patients with primary acquired NLDO and gives excellent functional and cosmetic outcome.
Sukhdeep Bains, Usha Kim, R Shanti
Primary orbital melanoma is rare and has varied initial presentation. A 28-year-old female presented with proptosis and decreased vision in the left eye. Computed tomography scan showed an orbital mass with contrast enhancement and calcification around the optic nerve leading to a diagnosis of meningioma. The patient chose to be on observation. Loss of vision with an increase in proptosis was seen at 6 months follow-up. On surgical exploration, a well-defined pigmented mass was seen encasing the optic nerve. Histopathological analysis revealed a malignant melanoma. Metastatic workup was negative. Left eye lid sparing exenteration was done. A high index of suspicion is necessary in a rapidly growing suspected optic nerve sheath meningioma and a differential diagnosis including orbital melanoma be considered.
Yasuhiro Takahashi, Hidetaka Miyazaki, Akihiro Ichinose, Yoshiyuki Kitaguchi, Yuichiro Ishida, Hirohiko Kakizaki
Nasolacrimal duct obstruction (NLDO) can be caused by injury during maxillary sinus surgery.1–5 Most cases of NLDO are transient, and permanent NLDO rarely occurs.1 Previous studies demonstrated radiological findings of secondary NLDO caused by maxillary sinus surgery.4,5 However, findings from other imaging studies, including dacryoendoscopy and nasal endoscopy, have not yet been comprehensively elucidated in patients with permanent secondary NLDO.
Juan C. Sánchez España, MD, Alberto Tenorio Abreu, MD, PhD, Alejandro Álvarez López, MD, Ligia E. Naranjo González, MD, María C. González Gallego, MD, Carlos Hidalgo Grass, MD, Carlos Ruíz Frutos, MD, PhD
The pathogenesis of basal cell carcinoma (BCC) traditionally has been linked to exposure to ultraviolet light, yet its true cause remains unclear. Several authors recently have examined a possible role played by Demodex folliculorum in both benign skin tumors, such as sebaceous adenoma and malignant tumors, such as BCC1 and melanoma.