"Finger-tip" cryoprobe assisted enucleation

Cryo-assisted anterior approach for surgery of retroocular orbital tumours avoids the need for lateral or transcranial orbitotomy in most cases

PURPOSE

  To describe and evaluate a cryo-assisted, minimally invasive, anterior approach for orbital tumour surgery.

METHODS

  Retrospective, non-comparative, consecutive, interventional case series of 103 patients who were operated on by the same surgeon for retroocular orbital tumours over the last 16 years.

RESULTS

  A cryo-assisted, minimally invasive, anterior approach was employed in 63 out of the 103 patients (61.2%). In 37 patients (35.9%), anterior orbitotomy without the use of cryoprobe was employed for biopsy or excision of small, anteriorly located lesions. Lateral orbitotomy was used in three patients (2.9%). In a subgroup of 61 patients with circumscribed lesions (mainly cavernous haemangiomas and schwannomas), cryoextraction was used in 51 (83.6%). None of the procedures required conversion to lateral orbitotomy and there were no intraoperative complications.

CONCLUSION

  In contrast to other reports on the treatment of orbital lesions, in the current case series surgery of most solid tumours and many other cystic or infiltrative lesions was achieved here via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favourable consideration because the combination of the anterior approach with the use of cryoprobe and surgical microscope can yield successful results, even in patients with large or deeply located tumours - obviating in most of them the need for lateral or transcranial orbitotomies with bone flaps.

Finger's "slotted" eye plaque for radiation therapy: treatment of juxtapapillary and circumpapillary intraocular tumours

AIM

To create "slotted eye plaques" for the treatment of juxtapapillary and circumpapillary intraocular tumours.

METHODS

Eye plaques were altered such that 8 mm-wide slots (variable length) were created to accommodate the orbital portion of the optic nerve. Thus, as the nerve entered the slot, the plaque's posterior margin extended beyond the optic disc. Radioactive seeds were affixed around the slot, surrounding the juxtapapillary and posterior tumour margins.

RESULTS

As proof of principle, three patients with choroidal melanomas that encircled or were in contact with the optic disc (considered untreatable with a notched eye plaque) were considered to be initial candidates for slotted-plaque radiotherapy. Preoperative three-dimensional C-scan imaging of their optic nerve sheath diameters insured that they would fit in the slotted plaque. Intraoperative ultrasound imaging was used to confirm proper plaque placement. Radiation dosimetry modelling showed that all tumour tissue received a minimum of 85 Gy (despite the gap created by the slot). With relatively short-term follow-up, there has been no evidence of ocular ischaemia, tumour growth or complications attributable to the use of slotted-plaque radiation therapy.

CONCLUSION

Slotted plaques accommodate the retrobulbar optic nerve into the device and thereby shift the treatment zone to improve coverage of both juxtapapillary and circumpapillary intraocular tumours.

Early ocular prosthesis insertion improves quality of life after enucleation

BACKGROUND

The aim of this study was to evaluate early insertion of ocular prostheses for aesthetic rehabilitation after enucleation and review current methods of enucleation surgery.

METHODS

Twelve patients with large intraocular malignancies were treated by enucleation with implant. At the end of surgery, a medium-size conformer was inserted onto the closed conjunctival wound (just before applying a pressure dressing). The pressure dressing was removed 3 to 5 days after surgery. Immediately after bandage removal, the patients saw themselves in a mirror and were offered placement of a relatively small ocular prosthesis. Patients were asked if they preferred their aesthetic appearance with or without the prosthesis.

RESULTS

Eight patients (67%) tolerated introduction of the prosthesis at the time of removal of their pressure dressing (3 to 5 days after enucleation surgery). Because of discomfort, 4 were able to receive their prostheses at their second postoperative visit (day 12 or 13). The manipulation at prosthesis insertion and subsequent wearing was found to have no effect on wound closure, final prosthetic fittings, or movement of the permanent prosthesis. All patients were pleased with the cosmetic benefit afforded by early introduction of the prosthesis and preferred their appearance to that of their eye with the conformer.

CONCLUSIONS

Early replacement of the conformer by an ocular prosthesis allows for cosmetic rehabilitation and improved quality of life.