Orbital exenteration: an updated review with perspectives
Arnaud Martel, Stephanie Baillif, Sacha Nahon-Esteve, Lauris Gastaud, Corine Bertolotto, Sandra Lassalle, Jacques Lagier, Mehrad Hamedani, Gilles Poissonnet
Read MoreArnaud Martel, Stephanie Baillif, Sacha Nahon-Esteve, Lauris Gastaud, Corine Bertolotto, Sandra Lassalle, Jacques Lagier, Mehrad Hamedani, Gilles Poissonnet
Read MoreOrbital exenteration is a radical and disfiguring surgery mainly performed in specialized tertiary care centers. Orbital exenteration has long been considered the treatment of choice for managing periocular tumors invading the orbit or primary orbital malignancies. Over the past decades, attention has been directed toward reducing the perioperative morbidity by developing new surgical devices and new strategies and promoting cosmetic rehabilitation by providing adequate facial prostheses. Despite these advances, several studies have questioned the role of orbital exenteration in improving overall survival. The last decade has been marked by the emergence of a new paradigm: the “eye-sparing” strategies based on conservative surgery with or without adjuvant radiotherapy and/or targeted therapies and immunotherapies. We summarize the data on orbital exenteration, including epidemiology, etiologies, use of surgical ablative and reconstructive techniques, complications, outcomes, and the related controversies.
https://www.surveyophthalmol.com/article/S0039-6257(21)00020-5/fulltext
Journal : Survey of Ophthal
Ref : Orbit Orbital Exenteration
Jeremiah P. Tao, Emily S. Charlson, Yinheng Zhu, Zonglin Guo, Wanli Chen, Xun Zhan, Hongjian Shi, Ian G. Harris
Read MoreThis study aims to improve the apparent motility of ocular prosthetic devices using technology. Prevailing ocular prostheses are acrylic shells with a static eye image rendered on the convex surface. A limited range of ocular prosthetic movement and lack of natural saccadic movements commonly causes the appearance of eye misalignment that may be disfiguring. Digital screens and computational systems may obviate current limitations in eye prosthetic motility and help prosthetic wearers feel less self-conscious about their appearance.
We applied convoluted neural networks (CNNs) to track pupil location in various conditions. These algorithms were coupled to a microscreen digital prosthetic eye (DPE) prototype to assess the ability of the system to capture full ocular ductions and saccadic movements in a miniaturized, portable, and wearable system.
The CNNs captured pupil location with high accuracy. Pupil location data were transmitted to a miniature screen ocular prosthetic prototype that displayed a dynamic contralateral eye image. The transmission achieved a full range of ocular ductions and with grossly undetectable latency. Lack of iris and sclera color and detail, as well as constraints in luminosity, dimensionality and image stability limited the real eye appearance. Yet, the digitally rendered eye moved in the same amplitude and velocity as the native, tracked eye.
Real-time image processing using CNNs coupled to microcameras and a miniscreen DPE may offer improvements in amplitude and velocity of apparent prosthetic eye movement. These developments, along with ocular image precision, may offer a next-generation eye prosthesis.
Journal : AJO
Ref : Ocular prosthesis Orbit Socket
Richard C. Allen, Elizabeth A. Bradley, Robert G. Fante, Mark J. Lucarelli
Read MoreThe arrival of teprotumumab has been hailed as a game-changer in the treatment of thyroid eye disease (TED).
This monoclonal antibody to the insulin-like growth factor-1 receptor is the first Food and Drug Administration (FDA)-approved treatment for TED. Integrating any new therapy into the management of a disease requires an understanding of its efficacy, side effects, and costs relative to other available treatment options.
Thyroid eye disease is an autoimmune disease classically characterized by an acute inflammatory phase, lasting approximately 12 to 18 months, followed by a chronic noninflammatory phase.
Traditional treatment of TED has centered on modifying known risk factors that exacerbate the disease, medical treatment of the acute inflammatory phase of the disease, and possible surgical treatment for the postinflammatory sequelae in the chronic phase of the disease.
Surgical intervention during the acute inflammatory phase of the disease is usually reserved for sight-threatening situations (e.g., compressive optic neuropathy, exposure keratopathy).
Modifiable risk factors for TED include thyroid status, smoking, selenium deficiency, and immune dysfunction. Thyroid function should be normalized. This often involves the attention of an endocrinologist. Hyperthyroidism is present in 90% of patients with TED, hypothyroidism in 5% of patients, and a euthyroid state in approximately 5% of patients. Normalization of thyroid status can be achieved through medications, radioactive iodine, and thyroidectomy. Many endocrinologists, especially in Europe and Asia, prefer thionamide thyroid suppression as the first line of treatment, reserving thyroidectomy and radioactive iodine for persistent hyperthyroidism or recurrence after medical therapy.
There is growing evidence showing that patients with active TED and thyroid dysfunction may benefit more from thyroidectomy than from radioactive iodine ablation.
This is thought to be secondary to the removal of contributing offending antigens with surgery compared to liberation of the antigens with radioactive iodine ablation. American Thyroid Association treatment guidelines give preference to surgical thyroidectomy in moderate/severe TED.
In addition, postsurgical and postablation patients should be treated promptly with thyroid replacement to prevent hypothyroidism, which has been demonstrated to exacerbate TED.
All patients with TED who smoke should be counseled to stop smoking.
Smoking has been shown to worsen the active phase of the disease in patients with TED.
The mechanism for this is not known.
Because TED is an autoimmune disease, medical treatment has centered on modifying the immune response in patients. Design of studies to evaluate the effectiveness of treatments to alter the inflammatory phase of the disease has been difficult because of the heterogeneity of the disease and the fact that many patients will improve without treatment.
The disease tends to behave differently between male and female patients. Although more common in female patients, when male patients are affected, they tend to have a more severe course.
The disease also behaves differently in adults and children. Pediatric patients with TED rarely develop strabismus or compressive optic neuropathy.
Radiographically, 2 types of TED have been described: type I with mostly fat proliferation and type II with more myopathy.
There is a large spectrum of clinical findings within patient populations, with some patients being mildly affected, others moderately affected, and some severely affected. Well-designed studies should ideally subtype patients into homogeneous groups to determine treatment efficacy.
With finite healthcare resources, it is our responsibility to practice cost-effective, evidence-based medicine.
Corticosteroids have been a mainstay in the treatment of TED.
Oral glucocorticosteroids can rapidly reduce the inflammatory soft tissue findings of TED, but significant side effects and difficulty in tapering the treatment without rebound of inflammation are distinct disadvantages of treatment.
A landmark study showing the effectiveness of intravenous (IV) methylprednisolone versus oral prednisone changed the recommended treatment of the active phase of the disease.
This study, sponsored by the European Group on Graves Orbitopathy, demonstrated a superior response and fewer side effects of IV methylprednisolone versus oral prednisone. Serious adverse effects of high-dose corticosteroids include hyperglycemia, hepatic injury, and mental health effects. The European Group on Graves Orbitopathy protocol involves a 12-week course of IV methylprednisolone: 500 mg once weekly for 6 weeks followed by 250 mg once weekly for 6 weeks. This study changed the standard of care in the treatment of patients in the inflammatory phase of the disease.
In 2011, a randomized controlled trial showed that treatment of patients with mild TED in the inflammatory phase of their disease with oral selenium demonstrated an improvement in the inflammatory signs of the disease.
A criticism of this study was that the study subjects came from a geographic area that has a high prevalence of selenium deficiency. It is unclear if the treatment is only effective if patients are selenium deficient. Because selenium is an inexpensive, over-the-counter supplement with few adverse effects, many clinicians include selenium (100 μg twice daily for 6 months) in the treatment of patients with active TED. Some experts recommend checking selenium levels before supplementation.
Orbital radiotherapy is a controversial topic in the treatment of TED. An early randomized clinical trial questioning the effectiveness of radiation showed no beneficial effect for orbits treated with external beam radiation compared with the untreated orbits of study subjects.
Criticisms of this study included the relatively long duration of disease in study subjects, indicating that patients in the chronic phase of the disease may have been included. Other studies demonstrated effectiveness of orbital radiation in patients with significant myopathy. Many experts use radiation regularly in the treatment of active TED.
Additional studies have supported the combined use of radiation and corticosteroids.
Radiation generally should be avoided in patients with diabetes, those who are pregnant, and those aged less than 35 years.
Steroid-sparing agents include methotrexate, cyclosporine, azathioprine, and mycophenolate mofetil, among others. Studies of these agents in the treatment of TED have shown mixed results, and therefore these agents have not been widely embraced in the treatment of active TED.
However, further study of these agents is likely warranted because these agents have a long history of use in other autoimmune diseases and have well-defined side-effect profiles.
The treatment of rheumatologic and oncologic disease underwent a paradigm shift with the introduction of molecularly targeted agents, many of which have been used in orbital disease.
Monoclonal antibodies to circulating factors and to receptors on cells involved in immune function have shown effectiveness in treating rheumatologic diseases that traditionally had a poor prognosis or required long-term treatment with nonspecific anti-inflammatory medications with significant side effects. Monoclonal antibodies investigated in the treatment of TED include rituximab, tocilizumab, and teprotumumab.
Rituximab, a monoclonal antibody to CD20 that is expressed on B-cells, was one of the first biologic agents investigated in the treatment of TED.
Two small randomized clinical trials, one placebo-controlled and the other comparing rituximab with IV methylprednisolone, yielded conflicting results regarding the effectiveness of rituximab for TED.
Tocilizumab, a monoclonal antibody to the interleukin-6 receptor, improved the inflammatory signs of all patients in a case series of 18 patients with active TED refractory to corticosteroids.
A randomized, placebo-controlled study in 32 subjects confirmed the reduction in inflammatory signs in steroid-refractive patients.
Additionally, improvement in 2 severe cases refractory to corticosteroids and orbital decompression has been reported.
Teprotumumab is currently the only FDA-approved treatment for TED.
The studies of teprotumumab, both of which were industry-sponsored, placebo-controlled randomized studies, showed efficacy of the agent versus placebo in proptosis reduction, reduction of the inflammatory score (clinical activity score), and reduction of diplopia.
Patients enrolled were in the inflammatory phase of the disease (<9 months of disease duration) and had moderate-to-severe disease with a clinical activity score of 4 or more.
Although the clinical trials of teprotumumab were limited to patients with clinically active disease, the FDA label approves teprotumumab for “TED,” without reference to disease severity or clinical activity. This has led some clinicians to use teprotumumab in the chronic, noninflammatory phase of the disease.
Whether the drug is beneficial in this group of patients is unclear. Although technically “on-label,” the efficacy of the medication in patients with chronic phase orbitopathy has not been established. There has also been discussion regarding the use of teprotumumab in mild disease. Expanding the therapeutic indications without rigorous clinical trial evidence to support the efficacy and safety of this approach is not recommended at this point.
The cost of teprotumumab is considerable. A single 500 mg vial of teprotumumab costs $14 900 (USD), and 23 vials ($343 000 cost) are required to complete a 24-week treatment course for a 70-kg (150 lbs) patient.
Because teprotumumab is dosed on the basis of total body weight, not lean body mass, a treatment course in an obese patient can approach $500 000. Use of this very expensive drug should be evidence based and reserved for the patient populations in which effectiveness is well established, such as patients with moderate-severe clinically active disease.
There are still questions regarding the durability of treatment. Relapse rates at 72 weeks after cessation of teprotumumab are as high as 40%.
Payors have requested some physicians to consider corticosteroids first, rather than teprotumumab (similar to step therapy). Careful consideration of use and cost is understandable, because the cost of teprotumumab is substantial. In addition, teprotumumab has not been directly compared with IV methylprednisolone in a superiority or noninferiority clinical trial.
Teprotumumab has several side effects that should be discussed with patients when considering its use. The most common side effects reported in the 2 randomized clinical trials of teprotumumab versus placebo were muscle spasms, affecting 25% of subjects in the teprotumumab group, and nausea, affecting 17% subjects in the teprotumumab group.
Common serious side effects included hyperglycemia and hearing impairment, which were both observed in 10% of teprotumumab subjects. The majority of patients who experienced hyperglycemia had preexisting glucose intolerance. Close monitoring of blood glucose is required in these patients. Although both hyperglycemia and hearing impairment appeared to reverse with drug withdrawal, whether some patients will develop long-term adverse sequelae from teprotumumab requires further investigation. Additionally, having been associated with exacerbation of inflammatory bowel disease causing severe diarrhea in 1 subject, teprotumumab should be used with caution in patients with inflammatory bowel disease. Because FDA approval of teprotumumab was based on a small population of 84 TED subjects who received the study drug, postmarketing surveillance will be critical to understanding the extent and severity of other side effects that may not have been encountered in the clinical trials. An important resource for postmarketing surveillance is the FDA Adverse Event Reporting System, the public website to which healthcare providers, consumers, and drug manufacturer can submit adverse event reports.
A total of 463 reports of adverse events associated with teprotumumab were reported in 2020, of which 78 were classified as serious.
The future treatment of TED is promising. The concept of using molecularly targeted agents to treat the specific pathologic pathways in the development of TED is attractive. Physicians now have an FDA-approved medication for TED. On-label use of the medication should be followed, and physicians should monitor the evolving evidence in the literature regarding the appropriate patient selection. With finite healthcare resources, it is our responsibility to practice cost-effective, evidence-based medicine. The design and implementation of additional studies to evaluate the current best treatment of TED may be difficult, but not impossible. Ideally, randomized trials comparing treatment of patients with various subtypes and clinical manifestations with available monoclonal antibodies, IV methylprednisolone, radiation, and steroid-sparing agents will help guide the optimal customized treatment of patients with this challenging disease.
https://www.aaojournal.org/article/S0161-6420(21)00167-6/fulltext
Journal : Ophthalmology
Ref : Orbit Orbital radiotherapy Rituximab Teprotumumab Thyroid Eye Disease
Stefano Ranno, Massimiliano Serafino, Paolo Nucci
Read MorePurpose:
To compare the four-petal evisceration technique and the standard evisceration technique.
Methods:
In this retrospective, comparative case series study, sixteen charts of patients fulfilled the inclusion criteria and were were reviewed. Orbital implant exposition and complication rates between the two surgical techniques were evaluated.
Results:
A total of 16 eye of 16 patients fulfilled the inclusion criteria and were included in the analysis (eight in the four petal group and eight in the standard evisceration group).
During postoperative follow-up there were no cases of implant exposure or migration in the four-petal group and two cases (25%) of implant exposure in the standard evisceration group.
Exposed orbital implants dimension were both 16 mm and patients eviscerated for phtisis bulbi
All surgeries were uneventful, and there were no serious complications during the study.
Conclusion:
Four petal evisceration technique seems particularly useful in patients with phtisis bulbi because it allowed the placement of an implant significantly larger than the standard technique with low rate of esposition.
https://journals.sagepub.com/doi/full/10.1177/1120672120950160
Journal : European J Ophthal
Ref : Evisceration Four petal evisceration Orbit Orbital implant exposure Orbital implant migration Socket
Ish, Pranav; Ish, Somya
Read MoreDear Editor,
There has been an increased realization of rhino-orbito-cerebral mucormycosis (ROCM) in coronavirus disease 2019 (COVID-19) and post-COVID-19 patients in the past few weeks. The editorial published recently in this journal[1] is a consolidated review of the diagnosis, staging, and management of ROCM for the awareness of the medical fraternity. However, there are certain issues regarding the prevention of ROCM that need further evidence before recommending at the national level.
Prevention of ROCM in the COVID-19 era needs judicious use of steroids (both dose and duration), control of comorbidities (especially diabetes), and maintaining hygiene and cleanliness. The use of drugs such as posaconazole for prophylaxis is currently not recommended in the Indian guidelines for COVID-19.[2] Even the international guidelines recommend posaconazole prophylaxis only for patients with neutropenia and in graft-versus-host disease, that too with moderate strength.[3] The editorial discusses the role of posaconazole in high-risk cases of COVID-19. These high-risk factors mentioned include 3 weeks of oxygen, steroids, mechanical ventilation, or comorbidities with immunosuppression. The rationale of these suggestions requires clinical evidence of reduced incidence of ROCM before advocating the same. Posaconazole is an expensive drug with limited availability in India. This will create a huge subset of the population in India affected by the current wave for posaconazole prophylaxis. A reasonable suggestion can be vigilant screening for ROCM in all such patients for early diagnosis and appropriate therapy.
The classification into possible, probable, and proven ROCM has been aptly discussed. Although every attempt must be made to make a proven diagnosis, initiating antifungal therapy even in probable cases has a favorable risk–benefit ratio. When it is recommended by the author to clinically follow up with endoscopy and radiology without any antifungal drugs in possible ROCM,[1] it makes the concept of drug therapy for prophylaxis redundant.
There are multiple therapies that are being used for severe COVID-19, including many immunosuppressants (tofacitinib, baricitinib, bevacizumab, and itolizumab), although only tocilizumab is mentioned in the national guidelines as an off-label therapy in India. Thus, they can be possible risk factors and must also be judiciously used with strict clinical monitoring, and ideally only in a trial mode setting.[4]
The war with COVID-19 has rendered huge morbidity and mortality. ROCM is adding fuel to this fire and spreading across the country. Appropriate clinical practices, judicious use of drugs, early diagnosis, and early treatment are the most important strategies in the current times.
Journal : IJO
Ref : COVID-19 Mucormycosis Orbit Rhino-orbito-cerebral mucormycosis
Wu, Ende; Sun, Jiaying; Zhou, Guangming; Wu, Wencan
Read MoreAn implantation cyst after orbital wall reconstruction may present as a late complication, which can cause local pain, proptosis, diplopia, and vision impairment. Previous surgical strategies prefer transconjunctival or subtarsal approach for cyst drainage, a similar approach to orbital wall reconstruction. These strategies may have risk of secondary infection. Herein, we propose an endoscopic transnasal surgical approach, through which the removal of implant and cyst drainage can be performed conveniently. The residual, medial single-layer cyst wall is generally strong enough to support the orbital soft tissues without the need for a new implant. We believe this surgical approach can simplify the procedure, reduce the complications, and prevent cyst recurrence.
https://journals.lww.com/ijo/Fulltext/2021/07000/Endoscopic_transnasal_drainage_for_orbital.65.aspx
Journal : IJO
Vardizer, Yoav; Sobeh, Tamer; Prat, Daphna Landau; Simon, Guy J Ben; Tomkins-Netzer, Oren
Read MorePurpose:
Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon’s experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success.
Methods:
This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18–89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness.
Results:
The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1–10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables (P < 0.05). A good cosmetic result was correlated with prosthesis movement (P = 0.02), eyelid symmetry (P = 0.001), and prosthesis stability (P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients’ perceptions of the overall cosmetic result and those of the examiners.
Conclusion:
The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.
COMMENTARY:
Dave, Tarjani V
An ideal outcome of anophthalmic socket surgery depends on the volumetric outcome in terms of the superior sulcus deformity and the enophthalmos with prosthesis along with an excellent socket surface area that avoids lagophthalmos and allows for a well-retained prosthesis.[1] Another factor that needs to be looked at is the presence of any eyelid abnormalities such as ptosis, lower eyelid retraction, and entropion that are commonly seen in anophthalmic sockets. The incidence of new-onset ptosis is close to 40% in patients with anophthalmos.[2] It is also known that anophthalmic levator function is greater with an increased anterior projection of the implant and prosthesis.[2] This makes it important for us to understand the concept of making scleral flaps during evisceration and ideal sizing of implants to achieve a symmetric fullness of the superior sulcus and avoid anophthalmic ptosis.[3] Along with this, one of the most important factors that is sub-optimally addressed is the cosmetic outcome of the prosthesis itself.[4] This puts an emphasis on the development of a metric to assess the aesthetic outcome of an anophthalmic socket incorporating all of these factors.
The article details quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and determine correlations between selfreported and thirdparty assessment of cosmetic success. The authors detail that the professional examiners associated good cosmetic results with the ability of the prosthesis to move in comparison to the contralateral eye, eyelid symmetry, and socket fullness. In contrast, the patients mostly rated their own cosmetic result as good according to the eyelid symmetry and prosthesis stability. The only parameter that correlated well between the patients and the examiners was sufficient conjunctival surface.
When compared to this series, data from Indian patients[1] suggest that motility of the prosthesis forms one of the most important factors that patients are concerned about while undergoing socket surgery and fabrication of a prosthetic eye. This could partly be because the mean age of the patients undergoing socket surgery in India is roughly two decades younger than what is published in this article. This also brings out the need for socket surgery to be refined both in terms of technique and technology to match the patients’ expectations. While implantation of a 20 mm implant serves to give an excellent superior sulcus fullness in Asian Indian eyes, this cannot be achieved without incorporating surgical techniques such as 2 and 4 scleral flaps. Technological advances in manufacturing implants that might help increase motility without the need for pegging or a second procedure are the need of the hour.
Journal : IJO
Sen, Mrittika………
Read MorePurpose:
COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India’s second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management.
Methods:
This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021.
Results:
Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05).
Conclusion:
Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
Journal : IJO
Ref : Amphoteracin B COVID-19 Orbit Orbital Exenteration Rhino-orbito-cerebral mucormycosis
Gupta, Amod; Sharma, Aman; Chakrabarti, Arunaloke
Read MoreFor the last several weeks, the Indian media both newspapers and the TV have been reporting patients who developed mucormycosis (majority rhino-orbital-cerebral mucormycosis (ROCM)), wrongly called as “Black fungus,” within short time of COVID-19 recovery or during the disease itself. The reports have emerged from several states such as Maharashtra, Gujarat, Rajasthan, Madhya Pradesh, Uttar Pradesh, Karnataka, Tamil Nadu, Punjab, Haryana, Himachal Pradesh, Chandigarh, Delhi to name a few and have created an alarming situation for want of an effective treatment and extremely high mortality….. FULL TEXT
Journal : IJO
Arnaud Martel, Stephanie Baillif, Sacha Nahon-Esteve, Jacques Lagier, Mehrad Hamedani, Gilles Poissonnet
Read MoreOrbital exenteration is a radical and disfiguring surgery mainly performed in specialized tertiary care centers. Orbital exenteration has long been considered the treatment of choice for managing periocular tumors invading the orbit or primary orbital malignancies. Over the past decades, attention has been directed toward reducing the perioperative morbidity by developing new surgical devices and new strategies and promoting cosmetic rehabilitation by providing adequate facial prostheses. Despite these advances, several studies have questioned the role of orbital exenteration in improving overall survival. The last decade has been marked by the emergence of a new paradigm: the “eye-sparing” strategies based on conservative surgery with or without adjuvant radiotherapy and/or targeted therapies and immunotherapies. We summarize the data on orbital exenteration, including epidemiology, etiologies, use of surgical ablative and reconstructive techniques, complications, outcomes, and the related controversies.
https://www.surveyophthalmol.com/article/S0039-6257(21)00020-5/fulltext
Journal : Survey of Ophthal
Ref : Orbit Orbital Exenteration