Johnathan V. Jeffers, Shehzad Qayum, Asim V. Farooq & Hassan A. Shah
No abstract available
Johnathan V. Jeffers, Shehzad Qayum, Asim V. Farooq & Hassan A. Shah
No abstract available
David Gallagher, Barry Power, Emily Hughes & Tim FulcherRead More
Conjunctival epithelial inclusion cysts are an infrequent complication in anophthalmic sockets. The ocular prosthesis may become difficult to retain or it may cause local discomfort. Treatment options described include surgical resection, marsupialisation, and the use of injected sclerosing agents. We present a case of a 27-year-old female who developed a conjunctival epithelial inclusion cyst two years after a left eye evisceration. This invariably caused the ocular prosthesis to become cosmetically unacceptable. Trichloroacetic acid 20% (TCA) was injected intracystically as a minor procedure at the slit lamp. Four months later there was no recurrence of the cyst and the prosthesis retained an excellent position in the socket. This case highlights the successful treatment of a conjunctival epithelial inclusion cyst with TCA (20%) without the need for a surgical procedure.
Pornpattana Vichitvejpaisal, Lauren A. Dalvin, Sara E. Lally & Carol L. ShieldsRead More
Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.
Methods: Case report with orbital imaging.
Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.
Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.
Jun Fai Yap, Angeline Madatang & Hanida HanafiRead More
A 31-year-old male with no known medical illness presented with painless left eye protrusion for the past 2 years. Radiographic features were of an extraconal superior orbital mass with no invasion of adjacent structures. The patient underwent an excisional biopsy of the left superior extraconal mass a week later. The histopathological examination revealed a well-circumscribed lobulated mass with chondroid and myxoid stroma enveloping benign bland-appearing epithelial and myoepithelial cells. These pathological features were consistent with benign chondroid syringoma of the orbit. The patient had an uneventful recovery with no active ocular complaint post-operatively.
Despite chondroid syringoma of the orbit being a rare tumour, it should be considered in the differential diagnosis of periorbital masses. Excision of the tumour remains the treatment of choice with histopathological examination as the gold standard of diagnosis. Regular follow-up is warranted in view of possible local recurrence or metastasis.
Sombat Tanaboonyawat, Oluwatobi O. Idowu, Thomas S. Copperman, M. Reza Vagefi & Robert C. KerstenRead More
Purpose: To review and summarize the epidemiology, clinical presentations, histopathologic characteristics and management of dacryops.
Methods: A comprehensive PubMed, Embase and Google Scholar search of all articles written in English and non-English language articles with abstract translated to English on dacryops were reviewed. Data reviewed included epidemiology, etiology, pathogenesis, clinical presentations, histopathologic characteristics and management of dacryops.
Results: Lacrimal ductal cysts or dacryops are classified based on locations: palpebral lobe cysts (simple dacryops); orbital lobe cysts; cysts of the accessory lacrimal glands of Krause and Wolfring; and cysts of ectopic (choristomatous) lacrimal glands. The exact etiology of dacryops remains unknown. Dacryops is usually asymptomatic but can present with varied symptoms depending on the type and associated complications. While complete excision of dacryops is generally recommended, marsupialization is also a safe and effective method for the treatment of dacryops in the palpebral lobe of lacrimal gland. Complete surgical excision via orbitotomy is required for deep orbital lesions.
Conclusion: Dacryops is an uncommon benign cystic lacrimal gland tissue neoplasm. Dacryops can be classified into four types based on locations. Lesions could be either superficial that can be seen through the fornix or deep into the orbit. Observation is also an option for small or asymptomatic lesions. Surgery remains the mainstay of treatment for symptomatic cases, but approaches are different depending on the location of the lesions.
Abbas Bagheri, Koroush Shahraki & Shahin YazdaniRead More
Purpose: To evaluate the effect of intra-lesional injection of Trichloroacetic acid (TCA) 10% in patients with conjunctival inclusion cysts.
Methods: This prospective case series study included all patients with conjunctival inclusion cyst who were referred to our referral center from August 2016 to August 2018. All patients received TCA 10% injection into the conjunctival cyst, and outcomes of the intervention were evaluated at least 6 months later.
Results: Ten patients with mean age of 24 ± 17.6 (range 6–65) years including three children received TCA 10% injection into the conjunctival cyst. We included 6 anophthalmic and 4 ophthalmic cases. All patients were treated successfully and no recurrence of the lesion was observed in any case. Mean follow up duration was 18.1 ± 8.3 (range 6–28) months.
Conclusion: Intra-lesional injection of TCA 10% is a safe, simple, and effective treatment in patients with conjunctival inclusion cysts including ophthalmic cases and anophthalmic cases, both in adults and in children. This concentration may avoid ocular surface complications.
Preamjit Saonanon & Panida PotitaRead More
Purpose: To evaluate pre- and post-operative marginal reflex distance 1 (MRD1) when conducting Mueller’s muscle-conjunctiva resection (MMCR) on the normal eyelid of thyroid eye disease (TED) patients with unilateral eyelid retraction.
Methods: This was a retrospective non-comparative case series. Medical records of TED patients with unilateral eyelid retraction, who underwent a contralateral MMCR from November 2015 to September 2017, were reviewed. Standard photographs of pre-operative, post-phenylephrine test and post-operative were measured for eyelid positions including MRD1, MRD2 and inter-palpebral fissure width. MMCR was indicated on the contralateral eyelid only in patients who had a cosmetically acceptable result from phenylephrine test and were willing to receive the operation on the normal eye.
Results: Twelve TED patients who underwent MMCR on the normal eyelid were included in the study. Mean pre-operative MRD1 of retracted and normal eyelid were 5.7 mm (SD = 0.86) and 3.5 mm (SD = 0.65), respectively. Mean post-operative MRD1 of retracted and normal eyelid were 4.4 mm (SD = 0.76) and 4.1 mm (SD = 0.46), respectively. The asymmetry of MRD1 between eyes was significantly decreased from 2.1 mm (inter-quartile range (IQR) = 1.5–2.9 mm) pre-operatively to 0.3 mm (IQR = 0.1–0.7 mm) post-operatively (p = .002). None of these patients needed further eyelid correction surgery and there was no complication.
Conclusions: In TED patients with unilateral eyelid retraction, using phenylephrine test on their normal eyes should be initiated. If eyelid position was satisfactorily equalized, performing MMCR on the normal eyelid is considered an effective alternative treatment with a predictable outcome.
Min Ji Kim, Min Jin Lee, Woo Shik Jeong, Helen Hong, Jong Woo ChoiRead More
Although some data for western norms in orbit shape were reported, the standard norms for Asian orbits were not established yet. The data would be very valuable for the various surgical procedures as well as the production of the appropriate instruments and implants. Therefore, we suggest a Korean orbit mean shape model based on the three-dimensional computer modeling, which includes the analysis of the various parameters with the calculated average value, thereby providing a standard mean shape orbital model that could be used for the Asian patients’ orbital surgeries. This paper would be the first literature that provides the standard orbit model for Asians.
We developed orbit-specific computer software (AMC-SWUⓇ) for the production of an orbit mean shape model. The production steps included semi-automatic segmentation, shape reconstruction, statistical shape model generation, and mean shape and variance model production. The study included records of 48 male and 48 female patients who met the inclusion criteria. Three-dimensional facial bone computed tomography (CT) images of 96 patients were obtained, and these images were used to produce a representative mean shape model.
The mean models had vertical dimensions of 36.93 and 35.11 mm, horizontal dimensions of 38.49 and 36.79 mm, and rim dimensions of 45.76 and 42.90 mm for males and females, respectively. We developed a realistic, visualized three-dimensional Korean orbit mean shape model and compared its parameters with calculated values. There is a variance in orbital dimensions between the sexes and the orbital changes with age. We also demonstrated orbital anatomic differences between ethnic groups.
Young Woong Mo, Sung Woo Kim, Hea Kyeong ShinRead More
Enophthalmos is one of the most distressing complications of orbital fracture, and when faced with a blowout fracture, plastic surgeons often find it difficult to determine the need for surgical correction. Although a number of studies have been conducted on this topic, no study has yet been performed using a set of measurable parameters.
We quantitatively measured orbital fracture areas (OFA), volumes (OFV), and medial rectus muscle cross-sectional ratios in patients with an isolated medial orbital wall fracture defect during a 5-year period from 2014 to 2018. Only conservatively treated patients constituted the study cohort. Enophthalmos was measured by two plastic surgeons at ≥6 months after trauma. We analyzed correlations between various parameters and degrees of late enophthalmos in the study cohort.
Significant correlations were observed between several parameters and late enophthalmos. Multiple regression analysis resulted in the following coefficients: -0.449 is constant (p = 0.017), 0.596 and 0.460 for OFA (p = 0.000) and OFV (p = 0.005), respectively. However, no significant relationship was observed between enophthalmos and medial rectus muscle cross-sectional ratios (p = 0.340).
The results of this study enable the degree of late enophthalmos in conservatively treated patients to be predicted using OFV and OFA values. We suggest five indications that require surgical correction without long-term clinical follow-ups: (1) OFA ≥ 1.90 cm2, (2) OFV ≥ 1.00 cm3, (3) 1.30 OFA + OFV > 5.32, (4) signs of muscle incarceration, and (5) signs of severe retrobulbar hematoma. The more satisfactory the five indications are, the greater is the need for surgery.
Dan Liu, Xueliang Xu, Sha Wang, Chengzhi Jiang, Xinhui Li, Jia Tan & Zhihong DengRead More
Distinguishing between the active and inactive stages of Graves’ ophthalmopathy (GO) is essential for making treatment decisions. 99mTc-DTPA SPECT/CT is sensitive in identifying inflammation in extraocular muscles of GO patients, which we designate 99mTc-DTPA-active. This study aimed to evaluate the response of 99mTc-DTPA-active GO patients to local immunosuppressive therapy.
Materials and methods
Sixty-four 99mTc-DTPA-active GO patients (89 eyes) were retrospectively analyzed. Forty-five patients (64 eyes) received repeated peribulbar triamcinolone injection, and 19 patients (25 eyes) received no immunosuppressive treatment. Ophthalmological assessment, including clinical activity score, eyelid retraction, eyelid aperture, proptosis, diplopia, and ocular mobility, was recorded before and after treatment.
Compared with untreated patients, the clinical activity score decreased significantly (P < 0.001) while eye symptoms (soft-tissue swelling and eyelid retraction and aperture) improved significantly (P = 0.02, P < 0.001, P < 0.001, respectively) in treated patients after six months. The inferior and medial recti were significantly smaller (P < 0.001, P < 0.001, respectively), and 99mTc-DTPA uptake in the two recti was significantly less (P = 0.001, P = 0.01, respectively) in treated patients than in untreated patients after 3 months.
Clinical activity score of < 3 does not indicate inactive GO, as revealed with 99mTc-DTPA SPECT/CT. Patients with 99mTc-DTPA-active GO can improve the symptoms with peribulbar triamcinolone injection.