Orbital exenteration: an updated review with perspectives

7 Sep 2021

Arnaud Martel, Stephanie Baillif, Sacha Nahon-Esteve, Lauris Gastaud, Corine Bertolotto, Sandra Lassalle, Jacques Lagier, Mehrad Hamedani, Gilles Poissonnet

Journal : Survey of Ophthal

Ref : Orbit Orbital Exenteration

Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

12 Jul 2021

Sen, Mrittika………

Purpose:

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.

https://journals.lww.com/ijo/Fulltext/2021/07000/Epidemiology,_clinical_profile,_management,_and.10.aspx

Journal : IJO

Ref : Amphoteracin B COVID-19 Orbit Orbital Exenteration Rhino-orbito-cerebral mucormycosis

Orbital exenteration: an updated review with perspectives

12 Jul 2021

Arnaud Martel, Stephanie Baillif, Sacha Nahon-Esteve, Jacques Lagier, Mehrad Hamedani, Gilles Poissonnet

Journal : Survey of Ophthal

Ref : Orbit Orbital Exenteration

Periorbital, conjunctival and primary intraorbital carcinomas: Survival and risk factors after orbital exenteration

24 May 2021

Sven Holger Baum, Roman Pförtner, Anke Manthey, Nikolaos Emmanouel Bechrakis & Christopher Mohr

Journal : EYE

Ref : Orbit Orbital carcinoma Orbital Exenteration

Modified types of orbital exenteration, survival, and reconstruction

30 Oct 2020

Sven Holger Baum, Michael Oeverhaus, Franziska Saxe & Christopher Mohr

Journal : Graefe's Archives

Ref : Orbit Orbital Exenteration

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

13 Oct 2020

A. Martel, A. Oberic, A. Moulin, L. Zografos, L. Bellini, F. Almairac & M. Hamedani

Purpose
To report our 14-year experience with orbital exenteration and assess risk factors for poor prognosis by focusing on conjunctival melanoma.

Patients and method
A retrospective study was conducted in our tertiary care centre (Jules Gonin Eye Hospital, Lausanne, Switzerland) between 2003 and 2017. Inclusion criteria were patients aged ≥18 years with a follow-up >12 months, without metastatic spread at the time of surgery. Data recorded were age, gender, tumour histology, surgical technique, postoperative complications, surgical margin status, local recurrence, postoperative radiation beam therapy and metastatic status.

Results
Twenty-five patients with a mean age of 63.2 years (38–92) were included. Conjunctival melanoma was the most frequently identified tumour (n = 14, 56%) followed by conjunctival squamous cell carcinoma (n = 4, 16%), sebaceous carcinoma (n = 3, 12%), choroidal melanoma (n = 2, 8%) and basal cell carcinoma (n = 2, 8%). Eighteen tumours (72%) originated from the conjunctival tissue. Clear surgical margins were achieved in 21 (84%) patients. Fourteen (56%) patients experienced distant metastases and died from metastatic spread after a mean follow-up of 52.3 months (6–120). The 1-, 3- and 5-year overall survival (OS) was 96%, 72% and 60%, respectively. In the univariate analysis, positive surgical margins, local recurrence and metachronous metastases were associated with a decreased OS (p = 0.002, p = 0.005 and p = 0.007, respectively). In the multivariate analysis, positive surgical margins and metachronous metastases were also associated with a decreased OS (p = 0.02 and p = 0.042, respectively). Conjunctival melanoma was not associated with a poorer prognosis (p = 0.280).

Conclusion
Free surgical margins are needed to increase OS. To achieve clearer surgical margins, neoadjuvant targeted therapies/immunotherapies may be considered.

https://www.nature.com/articles/s41433-020-0767-6

Journal : EYE

Ref : Conjunctival Melanoma Conjunctival Squamous cell carcinoma Ocular Oncolgy Orbital Exenteration Sebaceous gland carcinoma

Primary ductal adenocarcinoma of the lacrimal gland: A review and report of five cases

11 May 2020

Thonnie Rose O. See, Gustav Stålhammar, Tina Tang, Joshua S. Manusow, David R. Jordan, Jeffrey A. Nerad, Robert C. Kersten, Marc Yonkers, Nasreen A. Syed, Seymour Brownstein, Hans E. Grossniklaus

Journal : Survey of Ophthal

Ref : Lacrimal gland ductal carcinoma Lacrimal gland tumor Lacrimals Orbital Exenteration

Applications of three-dimensional printing in orbital diseases and disorders

12 Sep 2019

Ruiters, Sébastien; Mombaerts, Ilse

https://journals.lww.com/co-ophthalmology/Abstract/2019/09000/Applications_of_three_dimensional_printing_in.14.aspx

Journal : Current Opinion Ophthal

Ref : 3D printing Anophthalmic socket Orbit Orbital Exenteration

Impact of Food and Drug Administration Approval of Vismodegib on Prevalence of Orbital Exenteration as a Necessary Surgical Treatment for Locally Advanced Periocular Basal Cell Carcinoma

30 Jul 2019

Sagiv, Oded; Ding, Stephanie; Ferrarotto, Renata; Glisson, Bonnie; Altan, Mehmet; Johnson, Faye; Elamin, Yasir; Thakar, Sudip D.; Nagarajan, Priyadharsini; Esmaeli, Bita

Purpose: To test the hypothesis that the US Food and Drug Administration approval of vismodegib in early 2012 has reduced the prevalence of orbital exenteration for locally advanced periocular basal cell carcinoma (BCC).

Methods: Following institutional review board approval, the authors reviewed clinical and pathological data of patients with locally advanced periocular BCC (T4 per the eyelid carcinoma classification in the 8th edition of the AJCC Cancer Staging Manual) treated by the senior author during 2006–2018. Patients were grouped into those who were treated before February 2012 (“before vismodegib approval”) and those who presented later (“after vismodegib approval”).

Results: Forty-two patients with locally advanced periocular BCC were treated during the study period, of whom 31 were men. The median age at presentation was 66 years (range, 43–90). Twenty-two patients had T4a and 20 had T4b tumors. Thirteen patients were treated before and 29 were treated after vismodegib approval. The 2 groups did not differ in age distribution (p = 0.164), sex distribution (p = 0.270), prevalence of recurrent tumor at presentation (p = 0.317), or duration of treatment with vismodegib (p = 0.605). Orbital exenteration was significantly more prevalent in patients treated before vismodegib approval than after (46% vs. 10%, p = 0.016), and vismodegib treatment was significantly more prevalent in patients treated after vismodegib approval than before (when vismodegib was given in clinical trials; 69% vs. 23%, p = 0.008). There was a trend toward more patients retaining their eyes at last follow-up in patients treated after vismodegib approval (83% vs. 54%, p = 0.066).

Conclusions: The prevalence of orbital exenteration as a necessary surgical procedure in patients with a locally advanced periocular BCC has fallen since the Food and Drug Administration approval of vismodegib. Although vismodegib is not specifically approved for organ-sparing, it has changed the authors’ practice and enabled eye preservation in patients with locally advanced periocular BCC, who would otherwise require an orbital exenteration.

https://journals.lww.com/op-rs/Abstract/2019/07000/Impact_of_Food_and_Drug_Administration_Approval_of.8.aspx

Journal : OPRS

Ref : Ocular Oncology Orbital Exenteration Periocular Basal Cell Carcinoma Vismodegib

Periorbital desmoplastic squamous cell carcinoma

20 Jul 2019

Verona E. Botha, Kent T. K. Chow, Paul J. M. Salmon, Rami H. El-Khayat, Michelle T. Sun, Dinesh Selva & Stephen G. J. Ng

https://www.tandfonline.com/doi/full/10.1080/01676830.2018.1490438

Journal : Orbit

Ref : Desmoplastic squamous cell carcinoma Ocular Oncology Orbital Exenteration Squamous cell carcinoma

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