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Teng Siew T, Mohamad SA, Sudarno R, Nilamani V. Unilateral Proptosis and Bilateral Compressive Optic Neuropathy in a Meningioma Patient. Cureus 2024; 16:e53728. [PMID: 38455798 PMCID: PMC10918291 DOI: 10.7759/cureus.53728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Unilateral proptosis can be a sign of a potential threat to vision or life. Here, we report a case of unilateral proptosis with bilateral asymmetrical compressive optic neuropathy. A 36-year-old Malaysian indigenous female presented with painless right-eye proptosis associated with progressive blurring of vision for the past month. She had painless progressive left-eye vision loss for eight years. There was marked right-eye proptosis with partial ophthalmoplegia. The optic nerve functions were significantly reduced in the left eye with a positive relative afferent pupillary defect (RAPD). Humphry perimetry showed a right superior nasal field defect. Brain imaging showed two different masses located at the suprasellar and right greater wing of the sphenoid extraaxial lesion likely representing a meningioma. She was diagnosed with bilateral compressive optic neuropathy secondary to intracranial mass and was referred to the neurosurgical team for further intervention. This case highlights that painless proptosis with early vision loss of the fellow eye may be the early presenting symptom of meningioma, without any symptoms of raised intracranial pressure. Brain imaging is warranted to rule out any intracranial pathology if a visual field defect is present.
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Affiliation(s)
- Tan Teng Siew
- Department of Ophthalmology and Visual Science, Universiti Sains Malaysia, School of Medical Sciences, Kota Bharu, MYS
- Department of Ophthalmology, Hospital Tengku Ampuan Rahimah, Klang, MYS
| | - Shahidatul-Adha Mohamad
- Department of Ophthalmology and Visual Science, Universiti Sains Malaysia, School of Medical Sciences, Kota Bharu, MYS
- Department of Ophthalmology, Hospital Universiti Sains Malaysia, Kota Bharu, MYS
| | - Rafidah Sudarno
- Department of Ophthalmology, Hospital Tengku Ampuan Rahimah, Klang, MYS
| | - Vithiaa Nilamani
- Department of Ophthalmology, Hospital Tengku Ampuan Rahimah, Klang, MYS
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, MYS
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2
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Kim JH, Hong CK, Shin HJ, Kong DS. Feasibility and efficacy of endoscopic transorbital optic canal decompression for meningiomas causing compressive optic neuropathy. J Neurosurg 2024; 140:412-419. [PMID: 37542442 DOI: 10.3171/2023.5.jns2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/25/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The endoscopic transorbital approach (ETOA) and transorbital anterior clinoidectomy have been suggested as novel procedures through which to reach the superolateral compartments of the orbit, allowing optic canal decompression. However, there is limited literature describing the technical details and surgical outcomes of these procedures. In this study, the authors aimed to analyze the feasibility and efficacy of endoscopic transorbital decompression of the optic canal through anterior clinoidectomy for compressive optic neuropathic lesions. METHODS Between 2016 and 2022, the authors performed ETOA for compressive optic neuropathic lesions in 14 patients. All these patients underwent transorbital anterior clinoidectomy through the surgically defined "intraorbital clinoidal triangle," which is composed of the roof of the superior orbital fissure, the medial margin of the optic canal, the medial border of the superior orbital fissure, and the optic strut. Demographic data, tumor characteristics, pre- and postoperative imaging, pre- and postoperative visual examinations, and surgical outcomes were retrospectively reviewed. RESULTS The mean age at the time of ETOA was 53.3 years (range 41-64 years), and the mean follow-up was 16.8 months (range 6.7-51.4 months). The inclusion criterion in this study was having a meningioma (14 patients). In the preoperative visual function examination, 7 patients with a meningioma showed progressive visual impairment. After endoscopic transorbital optic canal decompression, visual function improved in 5 patients, remained unchanged in 8 patients, and worsened in 1 patient. No new-onset neurological deficit was associated with ETOA and anterior clinoidectomy in any patients. CONCLUSIONS Endoscopic transorbital decompression of the optic canal with extradural anterior clinoidectomy is a safe and feasible technique that avoids significant injury to the clinoidal internal carotid artery and surrounding neurovascular structures.
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Affiliation(s)
- Jeong-Hwa Kim
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Chang-Ki Hong
- 2Department of Neurosurgery, Asan Medical Center, Ulsan University School of Medicine, Seoul; and
| | - Hyung-Jin Shin
- 3Department of Neurosurgery, Capital Armed Forces Hospital, Seungnam, Gyeonggi-do, Korea
| | - Doo-Sik Kong
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Hu JCW, Abdelhakim AH, North VS, Garcia MD, Lustig MJ, Kazim M, Odel JG. Osteopathia striata with cranial sclerosis causing a compressive optic neuropathy. Ophthalmic Genet 2023; 44:496-500. [PMID: 36446546 DOI: 10.1080/13816810.2022.2144902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Osteopathia striata combined with cranial sclerosis (OS-CS) is an inherited skeletal dysplasia that manifests with macrocephaly, orofacial abnormalities, thickened craniofacial bones, and vertically oriented radiodensities of the long bones. CASE REPORT Here, we present a severe case of OS-CS in a 4-year-old girl causing optic neuropathy as shown by radiographic evidence, ophthalmic findings, and histopathology. Previous genetic testing in this patient revealed a de novo heterozygous mutation in AMER1 (c.1057C>T, p.Arg353Ter). Although the patient had a pre-existing, appropriately functioning, ventriculoperitoneal (VP) shunt, a subsequent MRI of the brain and orbits showed narrowing of the bilateral optic nerve canals secondary to osseous thickening causing bilateral optic nerve atrophy, worse on the left. The patient underwent staged bilateral orbital osteotomies, optic canal decompression, and bilateral frontal craniotomy, and at 11 months postoperatively, her vision remained stable. Conclusions: While up to 50% of the patients with OS-CS may experience hearing loss due to cranial nerve compression, we present a case of severe visual loss secondary to OS-CS-associated optic nerve compression.
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Affiliation(s)
- Jennifer C W Hu
- Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Aliaa H Abdelhakim
- Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Victoria S North
- Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria D Garcia
- Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marc J Lustig
- Pediatric Ophthalmic Consultants of New York, New York, New York, USA
| | - Michael Kazim
- Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey G Odel
- Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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4
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Lee EJ, Han JC, Kee C, Park KA, Kong DS, Hong SD. Peripapillary Vascular Density in Compressive Optic Neuropathy and Normal-Tension Glaucoma: A Severity-Controlled Comparison. Invest Ophthalmol Vis Sci 2023; 64:10. [PMID: 37672287 PMCID: PMC10484018 DOI: 10.1167/iovs.64.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose To investigate the differences in peripapillary vessel density (VD) between compressive optic neuropathy (CON) and normal-tension glaucoma (NTG). Methods We compared patients with chronic CON and NTG, particularly after strictly controlling the mean extent of macular damage by the area of the ganglion cell-inner plexiform layer (GCIPL) loss in optical coherence tomography (OCT). We compared retinal nerve fiber layer (RNFL) and GCIPL thickness from OCT and peripapillary and macular VD from OCT angiography (OCTA) between the CON and NTG groups. Results From the initial 184 patients with CON and 443 patients with OAG, we included 41 patients with CON (57 eyes) and 64 patients with NTG (75 eyes) with a comparable extent of macular GCIPL thinning. Under similar mean macular involvement, the peripapillary VD was significantly lower in the CON group than in the NTG group after considering the effects of age, spherical equivalent, visual field sensitivity, peripapillary RNFL (pRNFL) thickness, GCIPL thickness, and image quality scores (P < 0.001). Marked loss of VD in the temporal and nasal sectors in CON was notable, attributing to the significantly lower peripapillary VD compared to NTG. Conclusions Patients with CON had a significantly lower peripapillary VD than those with NTG under similar mean degrees of pRNFL thickness and GCIPL damage. Our results reveal the potential utility of OCTA VD besides OCT pRNFL thickness, in relation to different topographic patterns of pRNFL loss, and possible differences in the pathogenesis of microvascular compromise between CON and NTG.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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5
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Gosalia H, Kumar KM, Karan AK, Saravanan VR, Shah VM. Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch's membrane opening minimum rim width optical coherence tomography measurements. Indian J Ophthalmol 2023; 71:3005-3009. [PMID: 37530273 PMCID: PMC10538806 DOI: 10.4103/ijo.ijo_3171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Purpose To compare glaucomatous from non-glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch's membrane opening minimum rim width (BMO-MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods This study was conducted in 40 eyes, comprising 20 eyes with non-glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO-MRW. Results The 5-fold cross-validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86-1.00) using BMO-MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion Hence, OCT-based BMO-MRW values could be used as an additional test to compare glaucomatous with non-glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.
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Affiliation(s)
- Hirika Gosalia
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Karthik M Kumar
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - A K Karan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Veerappan R Saravanan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Virna M Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Wang M, Zhu S, Shen B, Fang Y, Xie Q, Dai Q, Chen Z, Li X, Wu W. Long-term Outcomes Following Endoscopic Transnasal Surgery for Optic Neuropathy Due to Craniofacial Fibrous Dysplasia. Laryngoscope 2023. [PMID: 37191080 DOI: 10.1002/lary.30736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the feasibility of endoscopic transnasal optic canal decompression (ETOCD) guided by a navigation surgical system (NSS) for vision recovery in patients with compressive optic neuropathy (CON) caused by craniofacial fibrous dysplasia (CFD), and to explore the underlying cause of visual impairment. METHODS All patients underwent unilateral NSS-guided ETOCD and were followed up periodically for at least six months. Paired sample t-test and Pearson correlation analyses were used to compare continuous variables of the visual outcomes at the final review. A histopathological test of abnormal bone specimens was performed postoperatively. RESULTS Thirty-four patients were finally included, and all surgeries were uneventful. The best corrected visual acuity (BCVA) (logMAR units) decreased from 1.29 ± 0.80 preoperatively to 0.97 ± 0.78 at the last follow-up (p = 0.0012), improving in 28 patients (82.35%). The absolute value of mean defect (MD) significantly decreased (p < 0.001). Color vision was impaired in 17 patients preoperatively and improved in 6 patients. BCVA at the last follow-up was significantly correlated with preoperative BCVA, onset time, preoperative retinal nerve fibril layer thickness, and MD (all p < 0.05). Among 34 patients, 26 had a blunt bony process near the anterior foot of the optic chiasm. Of the total patients, 73.53% patients experienced bony fiber recurrence 6 months or earlier after surgery without visual loss. CONCLUSION NSS-guided ETOCD appeared to be safe and effective for visual recovery in patients with CON due to CFD, and early surgical intervention was critical for long-term recovery. Unbalanced compression of the optic canal by the blunt bony process may be a major cause of visual impairment. LEVEL OF EVIDENCE 4 Laryngoscope, 2023.
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Affiliation(s)
- Min Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Senmiao Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bingyan Shen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yenan Fang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiqi Xie
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qin Dai
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ziwen Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinyu Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wencan Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Orbital and Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
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7
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North VS, Jamerson EC, Tran AQ, Kazim M. Spontaneous regression of a presumed orbital apex cavernous venous malformation. Orbit 2023:1-3. [PMID: 37155262 DOI: 10.1080/01676830.2023.2202731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A 42-year-old non-menopausal, non-pregnant woman presented with an incidentally noted right orbital apex lesion producing mild compressive optic neuropathy. Imaging revealed an apical, intraconal, inhomogenously enhancing mass consistent with a cavernous venous malformation displacing the optic nerve. The patient was monitored over a 15-year period with serial orbital imaging and clinical examinations and ultimately demonstrated significant regression in the size of the lesion, accompanied by the complete resolution of optic neuropathy. She was non-menopausal when the regression was noted and remained non-pregnant throughout the follow-up period.
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Affiliation(s)
- Victoria S North
- Department of Ophthalmology, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Emery C Jamerson
- Oculoplastic and Orbital Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Ann Q Tran
- Department of Ophthalmology, University of Illinois at Chicago, Illinois Eye & Ear Infirmary, Chicago, Illinois, USA
| | - Michael Kazim
- Oculoplastic and Orbital Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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Hutchings KR, Fritzhand SJ, Esmaeli B, Koka K, Zhao J, Ahmed S, Debnam JM. Graves' Eye Disease: Clinical and Radiological Diagnosis. Biomedicines 2023; 11. [PMID: 36830848 DOI: 10.3390/biomedicines11020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
Graves' disease is an autoimmune disorder in which hyperthyroidism results in various systematic symptoms, with about 30% of patients presenting with Graves' eye disease (GED). The majority of patients with GED develop mild symptoms, including eyelid retraction, exposure of the globe, superior rectus-levator muscle complex inflammation, and fat expansion, leading to exophthalmos. More severe cases can result in extraocular muscle enlargement, restricted ocular movement, eyelid and conjunctival edema, and compression of the optic nerve leading to compressive optic neuropathy (CON). GED severity can be classified using the Clinical Activity Score, European Group on Graves' Orbitopathy scale, NO SPECS Classification system, and VISA system. CT and MRI aid in the diagnosis of GED through the demonstration of orbital pathology. Several recent studies have shown that MRI findings correlate with disease severity and can be used to evaluate CON. Mild cases of GED can be self-limiting, and patients often recover spontaneously within 2-5 years. When medical treatment is required, immunomodulators or radiotherapy can be used to limit immunologic damage. Surgery may be needed to improve patient comfort, preserve the orbit, and prevent vision loss from optic nerve compression or breakdown of the cornea.
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Banc A, Biousse V, Newman NJ, Kedar S. Ocular Optical Coherence Tomography in the Evaluation of Sellar and Parasellar Masses: A Review. Neurosurgery 2023; 92:42-67. [PMID: 36519859 PMCID: PMC10158913 DOI: 10.1227/neu.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/15/2022] [Indexed: 12/23/2022] Open
Abstract
Compression of the anterior visual pathways by sellar and parasellar masses can produce irreversible and devastating visual loss. Optical coherence tomography (OCT) is a noninvasive high-resolution ocular imaging modality routinely used in ophthalmology clinics for qualitative and quantitative analysis of optic nerve and retinal structures, including the retinal ganglion cells. By demonstrating structural loss of the retinal ganglion cells whose axons form the optic nerve before decussating in the optic chiasm, OCT imaging of the optic nerve and retina provides an excellent tool for detection and monitoring of compressive optic neuropathies and chiasmopathies due to sellar and parasellar masses. Recent studies have highlighted the role of OCT imaging in the diagnosis, follow-up, and prognostication of the visual outcomes in patients with chiasmal compression. OCT parameters of optic nerve and macular scans such as peripapillary retinal nerve fiber layer thickness and macular ganglion cell thickness are correlated with the degree of visual loss; additionally, OCT can detect clinically significant optic nerve and chiasmal compression before visual field loss is revealed on automated perimetry. Preoperative values of OCT optic nerve and macular parameters represent a prognostic tool for postoperative visual outcome. This review provides a qualitative analysis of the current applications of OCT imaging of the retina and optic nerve in patients with anterior visual pathway compression from sellar and parasellar masses. We also review the role of new technologies such as OCT-angiography, which could improve the prognostic ability of OCT to predict postoperative visual function.
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Affiliation(s)
- Ana Banc
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sachin Kedar
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
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Poślednik KB, Czerwaty K, Ludwig N, Molińska-Glura M, Jabłońska-Pawlak A, Miśkiewicz P, Kantor I, Dżaman K, Cyran AM, Szczepański MJ. Treatment Results of Endoscopic Transnasal Orbital Decompression for Graves' Orbitopathy-A Single-Center Retrospective Analysis in 28 Orbits of 16 Patients. J Pers Med 2022; 12. [PMID: 36294853 DOI: 10.3390/jpm12101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
Graves’ orbitopathy (GO) is an extrathyroidal manifestation of Graves’ disease (GD), which can be associated with corneal ulcerations or optic neuropathy in severe forms. Transnasal endoscopic orbital decompression (TEOD) is a surgical procedure performed in order to decrease the intraorbital pressure by removing part of its bony borders in cases with excessive mass in orbit. The aim of this study was to present the results and evaluate the efficacy of TEOD for GO. The retrospective study included 28 orbits (16 patients) who underwent TEOD from 2017 to 2020. Outcome was evaluated based on visual acuity improvement, clinical activity score (CAS) decrease, proptosis, and intraocular pressure (IOP) reduction. A preoperative best-corrected visual acuity (BCVA) increased from 0.69 ± 0.385 (mean ± standard deviation) to 0.74 ± 0.332 (p = 0.17) postoperatively. CAS decreased in 15 orbits postoperatively. Proptosis decreased from 22.89 ± 1.873 mm to 21.25 ± 2.053 mm (p < 0.05). IOP decreased from a preoperative 16.11 ± 3.93 mmHg to 14.40 ± 3.27 mmHg (p < 0.05) postoperatively. In addition, postoperative relief of exposure keratitis was observed. The analysis of development of iatrogenic diplopia revealed increasing in degree of diplopia. TEOD shows rare complications, but significant improvements in BCVA, CAS, proptosis, and IOP.
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11
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Liu A, Craver EC, Bhatti MT, Chen JJ. Population-Based Incidence and Outcomes of Compressive Optic Neuropathy. Am J Ophthalmol 2022; 236:130-135. [PMID: 34695397 DOI: 10.1016/j.ajo.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Prior studies on compressive optic neuropathy (CON) have come from large tertiary centers, which may contain referral bias toward more severe or atypical disease. To our knowledge, there are no studies to determine the population-based etiologies and clinical outcomes of compressive optic neuropathy (CON). This study aims to bridge that gap using the Rochester Epidemiology Project database. DESIGN Retrospective, population-based cohort. METHODS Medical records of all residents living in Olmsted County, Minnesota, from January 1, 2000, through December 31, 2018, were screened for CON. Demographic and clinical information were collected before and after treatment. RESULTS Twenty-three patients had a confirmed diagnosis of CON during our study period, which provided an overall incidence of 1.14 per 100 000 per year. Average age at onset of CON was 51 years (SD 24), and 39% were male. The most common etiologies were pituitary adenoma and meningioma. There was significant improvement in visual fields (P < .003) but not in visual acuity (P = .08) after patients underwent treatment for CON. There was also a significant relationship between the time until treatment and the degree of visual field improvement at follow-up (Pearson correlation rho = -0.58, P < .047). CONCLUSION To our knowledge, this study provides the first population-based incidence of CON. The finding that earlier treatment leads to better visual outcomes stresses the importance of having CON on the differential diagnosis of patients with optic neuropathy.
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Affiliation(s)
- Alice Liu
- From the Mayo Clinic Alix School of Medicine (A.L.), Department of Ophthalmology (M.T.B., J.C.C.), and Department of Neurology (M.T.B., J.C.C.), Mayo Clinic, Rochester, Minnesota
| | - Emily C Craver
- and the Department of Biostatistics (E.C.C.), Mayo Clinic, Jacksonville, Florida, USA
| | - M Tariq Bhatti
- From the Mayo Clinic Alix School of Medicine (A.L.), Department of Ophthalmology (M.T.B., J.C.C.), and Department of Neurology (M.T.B., J.C.C.), Mayo Clinic, Rochester, Minnesota
| | - John J Chen
- From the Mayo Clinic Alix School of Medicine (A.L.), Department of Ophthalmology (M.T.B., J.C.C.), and Department of Neurology (M.T.B., J.C.C.), Mayo Clinic, Rochester, Minnesota.
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12
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Hassan MN, Wan Hitam WH, Masnon NA, Govindasamy S, Omar AR. Compressive Optic Neuropathy Secondary to Sinonasal Undifferentiated Carcinoma in a Young Male. Cureus 2021; 13:e19042. [PMID: 34858739 PMCID: PMC8612748 DOI: 10.7759/cureus.19042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/05/2022] Open
Abstract
Sinonasal undifferentiated carcinoma (SNUC) is an extremely aggressive malignancy. Extension to the orbit and adjacent structures is common, but isolated visual loss as a presenting symptom is rare. We report a rare case of SNUC with bilateral visual loss as the initial manifestation. A 34-year-old gentleman was presented with acute onset loss of vision in both eyes for one week. It was followed by recurrent headaches and epistaxis. Visual acuity in the right eye was 2/60 and 3/60 in the left eye. Funduscopy showed a bilateral swollen disc. Neuroimaging revealed a large mass in the ethmoidal sinus extended laterally causing compression to recti muscles and the optic nerves. The histopathological examination of nasal tissue biopsy showed features of SNUC with bone and perineural invasion. A diagnosis of SNUC with bilateral compressive optic neuropathy was established. The patient underwent tumor debulking and base of skull reconstruction by the neurosurgical team. This was then followed by chemotherapy and radiotherapy. The patient’s right eye visual acuity initially improved to 6/9. However, his both eye vision developed into no light perception during treatment. In conclusion, SNUC is a highly aggressive tumor that may present with acute blindness. Early treatment may save a life, but the visual prognosis is guarded due to extensive optic nerve damage caused by tumor compression.
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Affiliation(s)
- Maizatul Nadia Hassan
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Wan Hazabbah Wan Hitam
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Nurul Ain Masnon
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Subash Govindasamy
- Department of Ophthalmology, 96 Malaysian Armed Forces Hospital, Royal Malaysian Navy Base, Lumut, MYS
| | - Ahmad Razif Omar
- Department of Ophthalmology, 96 Malaysian Armed Forces Hospital, Royal Malaysian Navy Base, Lumut, MYS
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13
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Herath HMMTB, Alahakoon AMBD, Mohideen MS, Chandrakumara AAR, Senanayaka S, Goonarathne IK. Anterior clinoid mucocoele presenting as progressive fluctuating visual loss mimicking inflammatory optic neuropathy. Saudi J Ophthalmol 2021; 35:78-80. [PMID: 34667939 PMCID: PMC8486029 DOI: 10.4103/1319-4534.325783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 12/09/2020] [Accepted: 06/21/2021] [Indexed: 12/04/2022] Open
Abstract
Optic nerve lesions usually produce monocular visual loss, and in compressive optic neuropathies, gradual vision loss is the more usual presentation. Mucocele in the anterior clinoid process is a rare cause of compressive optic neuropathy that can lead to monocular visual loss. A 19-year-old Sri Lankan girl presented with progressive, painless fluctuating right-sided monocular visual loss over 1-year duration. On presentation, right side visual acuity was 6/60 and fundoscopy revealed pale disk on the right side. Ocular tomography showed right-sided temporal retinal thinning. Magnetic resonance imaging revealed right anterior clinoid process mucocele causing compression and kinking of the right optic nerve. Because the right side, optic disc was already pale and retina was thinned, we decided to manage conservatively. Early imaging in compressive optic neuropathy is useful for the diagnosis and early neurosurgical intervention. Delaying the diagnosis can lead to permanent visual loss.
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Affiliation(s)
- H M M T B Herath
- Department of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A M B D Alahakoon
- Department of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - M S Mohideen
- Department of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - S Senanayaka
- Department of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - I K Goonarathne
- Department of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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14
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Hage R, Alapetite C, Brisse H, Zuber K, Lecler A, Lot G, Le Guerinel C, Vignal-Clermont C, Boissonnet H. Efficacy and Safety of Proton Beam Therapy for Primary Optic Nerve Sheath Meningioma. Eye Brain 2021; 13:219-229. [PMID: 34466049 PMCID: PMC8402992 DOI: 10.2147/eb.s305822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Management of optic nerve sheath meningiomas (ONSM) remains challenging. Photon radiation therapy (PhRT) is the most common treatment for sight-threatening ONSM. Proton beam therapy (PBT) is less commonly used because it is more expensive and because there are questions about its efficacy specifically in relation to ONSM. PBT has the theoretical advantage of reducing radiation exposure to adjacent structures. We report the visual outcome of patients with primary ONSM managed at the Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, and treated with PBT at the Centre de Protonthérapie, Institut Curie, Orsay, France. Methods We conducted a retrospective review of all patients with primary ONSM who received PBT (either by itself or following surgery) between January 2006 and January 2019. Neuro-ophthalmic examinations were performed at presentation and after radiotherapy, and, when applicable, after surgery. Meningiomas were measured at the time of diagnosis and at each follow-up MRI examination. Results Sixty patients (50 women, 10 men; mean age, 45.2±11.1y) were included, of whom 29 underwent surgery. At presentation, 52 (87%) of them had decreased vision (average visual acuity: 0.6 logMAR). Fundus examination showed optic disc swelling (n=27; 46.5%), optic disc pallor (n=22; 37.9%), optic disc cupping (n=2; 3.4%), opto-ciliary shunt (n=8; 13.8%), or choroidal folds (n=5; 8.6%). Otherwise, it was unremarkable (n=7; 12.1%). After treatment, visual function was stable overall. Fundus examination showed pallor (n=47; 83.9%), swelling (n=3; 5.4%), or cupping (n=2; 3.4%) of the optic disc, or was unremarkable (n=5; 8.9%). The visual field of 8 patients worsened, while 3 developed asymptomatic retinal hemorrhages. Tumor shrunk significantly in 8 patients at 1 year after PBT and remained stable in size in all others. Patients with opto-ciliary shunts had significantly worse visual outcome than other patients. Retinal abnormalities were observed in 11 patients during follow-up. Conclusion PBT alone or in association with surgery appears to be a safe and efficient treatment for ONSM, reducing the tumor size and stabilizing visual function. The risk of developing radiation retinopathy seems to be higher when patients had upfront surgery.
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Affiliation(s)
- Rabih Hage
- Neuro-ophthalmology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Claire Alapetite
- Radiation Oncology Department, and Proton Center Institut Curie, Paris-Orsay, France
| | - Hervé Brisse
- Imaging Department, Institut Curie, Paris, France.,Université des Sciences et Lettres, Paris, France
| | - Kevin Zuber
- Department of Statistics and Clinical Research, Hôpital Fondation A. de Rothschild, Paris, France
| | - Augustin Lecler
- Radiology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Guillaume Lot
- Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, France
| | | | | | - Herve Boissonnet
- Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, France
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15
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Parrilla C, Mele DA, Gelli S, Zelano L, Bussu F, Rigante M, Savino G, Scarano E. Multidisciplinary approach to orbital decompression. A review. ACTA ACUST UNITED AC 2021; 41:S90-S101. [PMID: 34060524 PMCID: PMC8172106 DOI: 10.14639/0392-100x-suppl.1-41-2021-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/15/2021] [Indexed: 12/02/2022]
Abstract
Endoscopic orbital surgery has become a highly evolving multidisciplinary surgical field thanks to development in technical skills of ophthalmologists and otolaryngologists. These advances expanded the clinical application of orbital decompression, with a growing body of literature describing the multidisciplinary management of thyroid eye disease and compressive optic neuropathy, since 1990. Although techniques have improved considerably, only few Randomized Control Trials (RCT) provide evidence to support recommendations in clinical practice. This review provides an overview of the current knowledge of orbital decompression to clarify which is the most standardized therapeutic strategy. In the literature, we observed several approaches with contradicting results and the comparison of different surgical techniques was biased by inclusion of patients at different stage of disease (active or inactive), different surgical indications (dysthyroid neuropathy or disfiguring proptosis) and measures of outcomes (such as different system for ocular motility evaluation). The timing of surgical decompression is one of the debated issues. One RCT focusing on Graves’ orbitopathy showed how intravenous corticosteroids achieve better visual recovery than surgical orbital decompression; but in case of absent or poor response to medical therapy the patient should undergo surgery within two weeks. There is slight evidence that the removal of the medial and lateral wall (so-called balanced decompression) with or without fat removal could be the most effective surgical technique, with low complication rate, but an increasing number of authors are promoting, for selected cases, a pure endoscopic surgical approach (with removal of medial and infero-medial orbital wall), less invasive than the balanced one; the latter indicated to more severe proptosis or diplopia after endoscopic procedure. Three-wall decompression is chosen for high degrees of proptosis, but complications are more frequent. Timing of surgical orbital decompression, in particular when a concomitant optic neuropathy is present, is still to be determined. Additional ophthalmological procedures are needed to restore normal eye function and cosmesis. Strabismus surgery to address diplopia and lowering the position of the upper eyelid represent some of the additional steps for the final rehabilitation of Graves’ orbitopathy. The main clinical outcomes including visual acuity, proptosis, and new-onset diplopia are changing. Recent studies focused on the development of imaging measurements in order to objectively evaluate the surgical results and QOL questionnaires are gaining increasing importance.
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Affiliation(s)
- Claudio Parrilla
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Antonio Mele
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Gelli
- Endocrinology Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Lorenzo Zelano
- Endocrinology Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Mario Rigante
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gustavo Savino
- Ophthalmology Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Scarano
- Division of Otolaryngology, Azienda Ospedaliera Pia Fondazione di Culto e Religione Cardinale G. Panico, Tricase, Italy
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16
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Hirokawa T, Mimura M, Tonari M, Sato Y, Fujita Y, Matsuo J, Oku H, Sugasawa J, Ikeda T. Compressive optic neuropathy (CON) in Graves' disease caused by hypertrophy of levator and superior rectus muscles: A case report. Medicine (Baltimore) 2021; 100:e25062. [PMID: 33832074 PMCID: PMC8036063 DOI: 10.1097/md.0000000000025062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Enlargemento of the medial rectus is the most predominant factor of compressive optic neuropathy (CON) in Graves' disease. This case report indicates that CON could develop only from the hypertrophic superior levator and superior rectus (SL/SR) muscle in a patient with poorly controlled Graves' disease, and described the possible risk of FT3-thyrotoxicosis with a prominent goiter to develop the current rare case with a review of the literature. PATIENT CONCERNS A 66-year-old woman undergoing endocrine management of hyperthyroidism with prominent goiter visited the Department of Ophthalmology due to right-eye upper-eyelid retraction. DIAGNOSES At initial presentation, the right and left margin reflex distance-1 (MRD-1) was 3.2 mm and 2.1 mm, respectively, and no proptosis or visual dysfunction was observed. Despite insufficient hormonal regulation, she refused to undergo goiter removal. The upper eyelid retraction gradually worsened to 7.7 mm of MRD-1, followed by the onset of 20 prism diopters (PD) of the right hypertropia, resulting in right-eye CON after 6 months. Her free thyroxin level was 3.88 ng/dl and free triiodothyronine was 24.90 pg/ml. Computed tomography and magnetic resonance imaging showed only SL/SR enlargement in the right orbit. INTERVENTIONS Intravenous steroid and radiation therapy resulted in visual improvement; however, a prominent upper eyelid retraction and 35PD of hypertropia remained in her right eye. Orbital decompression, upper retraction repair, and superior rectus recession were performed to prevent the recurrence of CON and correct any disfigurement. OUTCOMES The combination of conventional intravenous steroid pulse therapy, radiotherapy, and orbital decompression was effective, and no recurrence was observed for more than 1.5-years postoperatively. LESSONS Enlargement of the SL/SR muscle complex may independently induce the CON. We believe that strict attention should be paid to patients with triiodothyronine thyrotoxicosis with progressive eyelid retraction and hypertropia.
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17
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Abstract
Patients with meningiomas of the planum sphenoidale and tuberculum sella often present with insidious vision loss in one or both eyes as the only sign or symptom of their disease, although other sensory, oculomotor, and even endocrine abnormalities may be seen in a minority of cases. Incidentally discovered tumors also are common, as patients may undergo neuroimaging for unrelated symptoms or events. Depending on the size and orientation of the tumor, central vision loss from optic nerve compression may be a later sign, and loss of peripheral vision in one or both eyes may not be recognized until it has progressed to areas closer to fixation. A thorough neuroophthalmologic assessment including visual field testing will help to define the extent of optic pathway involvement. Both fundus examination and optical coherence tomography of the retinal nerve fiber layer and macular ganglion cell complex will aid in determining prognosis after treatment of the tumor. Orbital surgery rarely is indicated as primary therapy for meningiomas in this location, and surgical resection or debulking is usually pursued before consideration is given to radiation therapy. Because of the long-term risk of residual tumor growth or recurrence, neuroophthalmic surveillance along with serial neuroimaging is required for years after tumor resection and/or radiation therapy.
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Affiliation(s)
- Elizabeth L Echalier
- Department of Ophthalmology, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States.,Department of Neurology, and Neurosurgery, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Prem S Subramanian
- Department of Ophthalmology, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States.,Department of Neurology, and Neurosurgery, Sue Anschutz-Rodgers UCHealth Eye Center, University of Colorado School of Medicine, Aurora, Colorado, United States
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18
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Abstract
Thyroid eye disease is an auto-immune mediated orbitopathy which can cause dysthyroid compressive optic neuropathy. Traditional management of active thyroid eye disease includes temporizing high-dose steroids, orbital radiation and surgical decompression, which each possess significant limitations and/or side effects. Teprotumumab is an IGF-IR inhibitor recently FDA-approved for active thyroid eye disease. The authors report reversal of bilateral dysthyroid compressive optic neuropathy managed medically utilizing teprotumumab.
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Affiliation(s)
| | - Erin E Nichols
- Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, OH, USA
| | - Brian H Chon
- Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, OH, USA
| | - Julian D Perry
- Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, OH, USA
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19
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Dallorto L, Lavia C, Jeannerot AL, Shor N, Jublanc C, Boch AL, Bodaghi B, Tadayoni R, Touitou V, Bonnin S. Retinal microvasculature in pituitary adenoma patients: is optical coherence tomography angiography useful? Acta Ophthalmol 2020; 98:e585-e592. [PMID: 31808290 DOI: 10.1111/aos.14322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/07/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To examine retinal vascular changes in the peripapillary and macular areas in patients with pituitary adenoma (PA) using optical coherence tomography angiography (OCTA). METHODS Cross-sectional, retrospective study of 17 consecutive PA patients and 16 healthy subjects. All patients underwent a neuro-ophthalmological examination to assess the presence of optic neuropathy (ON). Static automated perimetry (SAP), macular and optic disc structural OCT [retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses] and OCTA were performed. Pituitary adenoma (PA) patients with ON were compared to those without ON and to healthy subjects. RESULTS Optic neuropathy (ON) was found in 16 eyes of nine PA patients. Peripapillary vessel density (ppVD) and macular vessel density (VD) in the superficial vascular plexus were significantly decreased in PA eyes with ON, compared to healthy eyes (45.21 ± 5.69 versus 50.52 ± 2.14% and 43.79 ± 5.03% versus 48.96 ± 2.94%, respectively). No significant difference in VD was observed in the macular deep vascular complex (DVC) between groups. Pituitary adenoma (PA) patients with ON had a mean ppVD reduction by 10.51% compared to healthy subjects. RNFL and GCC thicknesses were significantly reduced in PA eyes with ON compared to the other groups. Peripapillary VD (ppVD) significantly correlated with RNFL thickness and SAP mean deviation. CONCLUSIONS Optical coherence tomography angiography showed a significant decrease in ppVD and superficial macular VD in PA eyes with ON compared to healthy eyes, according to RNFL and GCC thinning. Together with the absence of DVC alterations, it may provide further insights into neurovascular coupling.
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Affiliation(s)
- Laura Dallorto
- Ophthalmology Department, AP-HP, Sorbonne Université, Paris, France.,Ophthalmology Department, San Lazzaro Hospital, Alba, Italy
| | - Carlo Lavia
- Ophthalmology Department, AP-HP, Université de Paris, Paris, France
| | | | - Natalia Shor
- Neuroradiology Department, Pitié Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Christel Jublanc
- Endocrinology Department, Pitié Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Anne-Laure Boch
- Neurosurgery Department, Pitié Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, AP-HP, Sorbonne Université, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Université de Paris, Paris, France
| | - Valérie Touitou
- Ophthalmology Department, AP-HP, Sorbonne Université, Paris, France
| | - Sophie Bonnin
- Ophthalmology Department, AP-HP, Sorbonne Université, Paris, France.,Ophthalmology Department, AP-HP, Université de Paris, Paris, France
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20
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Mohammad Razali A, Mohd Zain A, Bt Wan Abdul Halim WH, Md Din N. Good Visual Outcome Following Corticosteroid Treatment for Compressive Optic Neuropathy Secondary to Sinonasal Carcinoma. Cureus 2020; 12:e7732. [PMID: 32440379 PMCID: PMC7237059 DOI: 10.7759/cureus.7732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Most patients with sinonasal carcinoma present to the otorhinolaryngologist with nasal symptoms. It is however uncommon for them to present with acute visual loss at first presentation. We report a case of compressive optic neuropathy secondary to sinonasal carcinoma, which presented acutely with right eye blurring of vision upon waking up. Computed tomography (CT) of the brain and orbit with contrast showed a locally invasive nasopharyngeal mass extending into the right orbit and cranial fossa. Histopathological examination revealed squamous cell sinonasal carcinoma. Her visual acuity improved with a three-day course of pulsed intravenous methylprednisolone 1 g per day, followed by a gradual tapering dose of oral prednisolone (1 mg/kg/day).
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Affiliation(s)
| | - Ayesha Mohd Zain
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | | | - Norshamsiah Md Din
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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21
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Braga J, Soares R, Loureiro M, Ribeiro L, Meira D. Bruch's Membrane Opening Minimum Rim Width in the Differential Diagnosis of Optic Neuropathies. Neuroophthalmology 2019; 44:76-88. [PMID: 32395154 DOI: 10.1080/01658107.2019.1650075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 01/11/2023] Open
Abstract
Observing optic disc pallor during a patient's first visit frequently raises a diagnostic challenge, particularly in regards to whether the cause is due to glaucoma or another form of optic neuropathy. Bruch's membrane opening (BMO) was recently discovered as the anatomical border of the optic disc. BMO minimum rim width (BMO-MRW) seems to be a reliable representation of the neuroretinal rim. In our study, we demonstrate the ability of BMO-MRWs to differentiate between glaucomatous and non-glaucomatous. Additionally, we propose an MRW ratio which may allow discrimination of open angle glaucoma from either non-arteritic anterior ischaemic optic neuropathy or compressive optic neuropathy.
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Affiliation(s)
- Joana Braga
- Ophthalmology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Ricardo Soares
- Ophthalmology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Mónica Loureiro
- Ophthalmology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Lígia Ribeiro
- Ophthalmology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
| | - Dália Meira
- Ophthalmology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Porto, Portugal
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22
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Loke JY, Mohd Ali H, Kamalden TA. Osteopetrosis craniopathy: a rare cause of bilateral compressive optic neuropathy and facial nerve palsy. Postgrad Med J 2019; 95:513. [PMID: 31292279 DOI: 10.1136/postgradmedj-2019-136527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/03/2019] [Accepted: 06/07/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Jee Yao Loke
- UM Eye Research Centre, University of Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Haslina Mohd Ali
- Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
| | - Tengku Ain Kamalden
- UM Eye Research Centre, University of Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
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23
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Abstract
Compressive optic neuropathy is an urgent condition that may lead to blindness. We report a rare case of compressive optic neuropathy secondary to lymphoma of the extraocular muscles in which the vision was successfully rescued. A 67-year-old man presented with visual acuity of hand motion in the right eye for 1 month. Magnetic resonance imaging demonstrated enlargement of the medial and inferior rectus muscles with their tendons. Tendon enlargement, which is uncommon as Graves' orbitopathy, motivated us to perform a biopsy. Intravenous steroids following biopsy and chemotherapy after definitive diagnosis allowed for recovery of vision. Clinicians should be aware that enlarged extraocular muscles due to lymphoma can cause compressive optic neuropathy.
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Affiliation(s)
- Yoshiyuki Kitaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsushi Watanabe
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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24
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Abstract
PURPOSE To determine the causes and study the clinical manifestations of compressive optic neuropathy (CON). MATERIAL AND METHODS The study included 24 male and 36 female patients with CON (in total 60 patients, 97 eyes). All patients underwent standard ophthalmic examination, as well as computer perimetry, magnetic resonance imaging (MRI), and/or computed tomography (CT) of the brain and orbit and magnetic resonance angiography (MRA). RESULTS Tumor or infiltrative lesions of the anterior optic pathway were detected in 60 patients (97 eyes). In 2/3 of cases, the brain and orbit diseases were established for the first time as the cause of optic neuropathy. Adenoma of the pituitary gland and meningioma as the most common cause of CON was diagnosed in 66%. According to the results of computed perimetry, in 65.9% of cases patients with CON are diagnosed with hemianopsia, while in other cases, other forms of scotomas characteristic for the defeat of any part of the optic nerve may be observed. CONCLUSION Computed perimetry is the most important study for detection of optic neuropathy. An optic nerve disease of unknown origin is an absolute indication for radiological examination of the brain and eye orbits.
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Affiliation(s)
- N L Sheremet
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N A Khanakova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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25
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Abstract
In this study, we try to explore the effect of orbital decompression treatment on severe dysthyroid optic neuropathy.We retrospectively collected demographic and clinical characteristics of thyroid eye disease patients who performed orbital decompression. Then we analyzed the change of best-corrected visual acuity and exophthalmometry after surgery and the correlations among clinical parameters.A total of 22 cases (30 eyes) were included in the study. After orbital decompression, visual acuities improved in 16 eyes, declined in 8 eyes, and had no change in 5 eyes. Best-corrected visual acuity was significantly improved (0.1 vs 0.4, P = .039) and exophthalmometry was significantly declined (22.0 mm vs 16.5 mm, P = .001) after orbital decompression. Better postoperative best-corrected visual acuity was significantly correlated with better preoperative best-corrected visual acuity (r = 0.718, P < .05), and with normal optic disc (r = 0.568, P < .05), but not with age, exophthalmometry, keratopathy, and clinical activity score.These results showed that orbital decompression is a useful approach to manage dysthyroid optic neuropathy. The optimal time for surgery should be chosen based on clinical parameters, such as visual acuity and degree of crowding of orbital apex.
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Affiliation(s)
- Qiao-Wen Liang
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong
| | - Wenjing Luo
- The Cadre Ward in Department of Neurology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jian-Feng He
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
| | - Yi Du
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
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26
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Jørstad ØK, Wigers AR, Marthinsen PB, Moe MC, Evang JA. Loss of horizontal macular ganglion cell complex asymmetry: an optical coherence tomography indicator of chiasmal compression. BMJ Open Ophthalmol 2018; 3:e000195. [PMID: 30519642 PMCID: PMC6243475 DOI: 10.1136/bmjophth-2018-000195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To estimate the macular ganglion cell complex (GCC) asymmetry in patients with suprasellar tumours, to compare its diagnostic performance to the nasal GCC thickness and visual field (VF) and to investigate how the parameters correlate with magnetic resonance imaging (MRI) findings. Methods and analysis Cross-sectional study of patients with suprasellar tumours affecting the optic chiasm. Macular optical coherence tomography (OCT) scans were evaluated for nasal GCC sector thinning and loss of normal GCC asymmetry between corresponding nasal-temporal sectors. Equivalently, VFs were analysed for defects compatible with chiasm dysfunction. The relationship between optic chiasm and tumour was measured on MRI. Results Thirty-three eyes of 33 patients were included. There were OCT findings in 14 eyes. Nasal GCC thinning was found in 9 eyes and loss of GCC asymmetry in 12 eyes; the two parameters were not significantly different with respect to number of positive findings (p=0.45). Loss of GCC asymmetry, however, occurred in 5 eyes among 24 without GCC thinning (proportion 0.21; 95% confidence interval 0.071 to 0.42). In 8 eyes, VF indicated pathology; of these, 7 had concurring OCT findings. The prevalence of OCT and VF findings increased significantly with suprasellar tumour extension on MRI. Conclusion The diagnostic capabilities of nasal GCC thinning and loss of GCC asymmetry were comparable, whilst their complementary performances increased the proportion of eyes in which OCT suggested compression. The prevalence of both OCT and VF findings grew with suprasellar tumour extension. In several cases, however, structural findings on OCT preceded detectable VF deficits.
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Affiliation(s)
| | - Andreas Reidar Wigers
- Department of Ophthalmology, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | - Johan Arild Evang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
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27
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Lee MJ, Kang MH, Yeom JH, Yeom H, Seong M, Cho H, Shin YU. Compressive optic neuropathy secondary to Ewing sarcoma in the paranasal sinus: A case report. Medicine (Baltimore) 2018; 97:e13027. [PMID: 30383663 PMCID: PMC6221559 DOI: 10.1097/md.0000000000013027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ewing sarcoma localized in the paranasal sinuses, compressing the optic nerve, is very rare, with no prior case reports PATIENT CONCERNS:: A 68-year-old woman presented with decreased visual acuity in her left eye and paresthesia of the left face. Brain magnetic resonance imaging showed heterogeneously enhancing mass in the left paranasal sinuses with adjacent bone destruction, extending to the extraocular muscles and optic nerve of the left orbit. A biopsy of the nasal cavity confirmed Ewing sarcoma. DIAGNOSIS Compressive optic neuropathy secondary to Ewing sarcoma in the paranasal sinuses. INTERVENTION Neoadjuvant chemotherapy and radiotherapy were performed. OUTCOMES Resolution of the tumor and increased visual acuity and field of the left eye. LESSONS Primary head and neck Ewing sarcoma can lead to compressive optic neuropathy, but the tumor responded well to the chemotherapy. Early diagnosis and immediate treatment by close cooperation between the ophthalmologist and oncologist can prevent from permanent visual loss.
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Affiliation(s)
| | | | - Jong Hun Yeom
- Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea
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28
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Kartı Ö, Zengin MÖ, Çelik O, Tokat T, Küsbeci T. Olfactory Neuroblastoma: A Rare Cause of External Ophthalmoplegia, Proptosis and Compressive Optic Neuropathy. Turk J Ophthalmol 2018; 48:92-94. [PMID: 29755824 PMCID: PMC5938484 DOI: 10.4274/tjo.81568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/03/2017] [Indexed: 12/01/2022] Open
Abstract
Olfactory neuroblastoma (ONB), which is a neuroectodermal tumor of the nasal cavity, is a rare and locally aggressive malignancy that may invade the orbit via local destruction. In this study, we report a patient with proptosis, external ophthalmoplegia, and compressive optic neuropathy caused by ONB. A detailed clinical examination including ocular imaging and histopathological studies were performed. The 62-year-old female patient presented to our clinic with complaints of proptosis and visual deterioration in the left eye. Her complaints started 2 months prior to admission. Visual acuity in the left eye was counting fingers from 2 meters. There was relative afferent pupillary defect. She had 6 mm of proptosis and limitation of motility. Fundus examination was normal in the right eye, but there was a hyperemic disc, and increased vascular tortuosity and dilation of the retinal veins in the left eye. Computerized tomography and magnetic resonance imaging of the brain and orbits demonstrated a large heterogeneous mass in the left superior nasal cavity with extensions into the ethmoidal sinuses as well as into the left orbit, compressing the medial rectus muscle and optic nerve. Endoscopic biopsy of the lesion was consistent with an ONB (Hyams’ grade III). Orbital invasion may occur in patients with ONB. Therefore, it is important to be aware of this malignancy because some patients present with ophthalmic signs such as external ophthalmoplegia, proptosis, or compressive optic neuropathy.
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Affiliation(s)
- Ömer Kartı
- University of Health Sciences, İzmir Bozyaka Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Mehmet Özgür Zengin
- University of Health Sciences, İzmir Bozyaka Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Ozan Çelik
- University of Health Sciences, İzmir Bozyaka Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Taşkın Tokat
- University of Health Sciences, İzmir Bozyaka Training and Research Hospital, Otolaryngology Clinic, İzmir, Turkey
| | - Tuncay Küsbeci
- University of Health Sciences, İzmir Bozyaka Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
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29
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Abstract
Orbital apex metastasis from adenoid cystic carcinoma (ACC) is rare. We present a patient with known metastatic ACC presented with a rapidly declining vision with visual acuity oculus dexter (OD) equal to counting fingers at two feet. On imaging, she was found to have a right orbital apex tumor causing compressive optic neuropathy. She received the intensity modulated radiation therapy (IMRT). After completion of the therapy, she had regained essentially a full vision with visual acuity OD of 20/30 without corrective lenses. The treatment rationale and pertinent literature are discussed in this article.
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Affiliation(s)
| | - Sanjeev Sharma
- Department of Radiation Oncology, St. Mary's Medical Center
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30
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Hernández-García E, San-Román JJ, González R, Nogueira A, Genol I, Stoica B, Toledano N, Plaza G. Balanced (endoscopic medial and transcutaneous lateral) orbital decompression in Graves' orbitopathy. Acta Otolaryngol 2017; 137:1183-1187. [PMID: 28741406 DOI: 10.1080/00016489.2017.1354394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To determine the clinical outcomes and morbidity of endoscopic medial wall combined with transcutaneous lateral orbital wall decompression in Graves' orbitopathy. METHODOLOGY A retrospective noncomparative case series of patients who underwent surgical decompression for Graves' orbitopathy at Hospital Universitario de Fuenlabrada between 2004 and 2014 was performed. We reviewed the patients' charts and analyzed before and after the decompression, the visual acuity (Snellen chart), optic nerve compression (fundoscopy and optic coherence tomography), exophthalmometry (Hertel measurement), ocular motility, diplopia, eyelid surgery needed after decompression and its possible complications. RESULTS A total of 20 patients (36 orbits) were operated. The mean follow-up was 44 months (range 18-84). Vision improved dramatically in all compressive optic neuropathy cases (5 cases). Hertel measurements improved on average 3.5 mm (range 1.5-4.5). Diplopia was cured in eight patients (40%) and nine patients with severe preoperative diplopia required strabismus surgery after decompression. Eyelid surgery was further needed in 13 patients. Hyaluronic acid injection was the most used technique for the treatment of eyelid retraction (6 out of 13 patients). Only two major complications were observed: one case had a major post-operative epistaxis and another a cerebrospinal fluid leak. Both were resolved without further sequelae. CONCLUSIONS These results suggest that endoscopic medial wall combined with transcutaneous lateral wall orbital decompression is an effective and safe treatment for the symptomatic dysthyroid eye disease with important proptosis or compressive optic neuropathy.
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Affiliation(s)
| | - J. Javier San-Román
- Department of Ophthalmology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Ramón González
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada Madrid, Spain
| | - Araceli Nogueira
- Department of Ophthalmology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Ignacio Genol
- Department of Ophthalmology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Bazil Stoica
- Department of Ophthalmology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Nicolás Toledano
- Department of Ophthalmology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada Madrid, Spain
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31
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Koh YN, Ho SF, Pathma L, Singh H, Zunaina E. Orbital apex cyst: a rare cause of compressive optic neuropathy post-functional endoscopic sinus surgery. Int Med Case Rep J 2017; 10:263-269. [PMID: 28814902 PMCID: PMC5546777 DOI: 10.2147/imcrj.s124524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There are various causes that can lead to compressive optic neuropathy. We present here orbital apex cyst as an unusual cause of compressive optic neuropathy in a 49-year-old male. He presented with 2 weeks painless loss of vision in the left eye with left-sided headache. He had had left functional endoscopic sinus surgery for left nasal polyps 4 years earlier. Magnetic resonance imaging of brain and orbit revealed a left discrete orbital nodule, possibly orbital cyst or mucocele, which was compressing on the left optic nerve. Left eye vision improved markedly from hand movement to 6/36 pinhole 6/18 after initiation of intravenous dexamethasone. A subsequent endoscopic endonasal left optic nerve decompression found the orbital nodule lesion to be an orbital cyst. Marsupialization was performed instead of excision, as the cyst ruptured intraoperatively. Postoperative vision improved to 6/7.5 with normal optic nerve function postoperatively. Possible cause of orbital apex cyst is discussed.
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Affiliation(s)
- Yi Ni Koh
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Ophthalmology
| | | | - Letchumanan Pathma
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Harvinder Singh
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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32
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Abstract
This article provides a systematic description of visual field changes in thyroid eye disease-compressive optic neuropathy (TED-CON). A retrospective, non-comparative chart review of patients with TED-CON and documented Humphrey Visual Field 24-2 or 30-2 testing was conducted with IRB approval. Ninety-six visual fields in 68 patients were classified into 7 broad categories (superior, inferior, diffuse, temporal, nasal, central/paracentral, enlarged blind spot) and 17 mutually exclusive patterns from the Ocular Hypertension Treatment Study (OHTS) or "other." Fifty-three of 96 visual fields (55%) showed an inferior defect using the broad categories, with the remaining 6 categories ranging from 2% to 14%. The five most common OHTS patterns were other (28%), partial arcuate (28%), partial peripheral rim (9%), arcuate (8%) and altitudinal (7%). Further sub-classification showed a predominance of inferior visual field defects, ranging from 33% to 93% of each category. Of the 78 visual fields in these five categories combined, 52 (67%) were inferior defects. Inferior defect is the most typical TED-CON-associated visual field change. While the OHTS categories are geared toward classification of glaucomatous patterns, the overall predominance of inferior field defects in TED-CON was clearly demonstrated. These "other" visual field changes showing central inferior defect up to but not crossing the horizontal meridian and not contiguous from blind spot to nasal meridian should be designated as "TED-CON pattern." The high proportion of visual fields falling under the "other" category, however, does demonstrate the need for a more specific and tailored visual field classification system for TED-CON.
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Affiliation(s)
- Catherine J Choi
- a Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA
- b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
| | - Susel Oropesa
- c Edward S. Harkness Eye Institute of the New York Hospital Presbyterian Medical Center, and Columbia University , New York , New York , USA
| | - Alison B Callahan
- c Edward S. Harkness Eye Institute of the New York Hospital Presbyterian Medical Center, and Columbia University , New York , New York , USA
| | - Lora R Glass
- a Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA
- b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
| | - Livia Teo
- d Singapore National Eye Centre, Singapore Eye Research Institute , Singapore
| | - Dean M Cestari
- b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
- e Neuro-Ophthalmology Service , Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA
| | - Michael Kazim
- c Edward S. Harkness Eye Institute of the New York Hospital Presbyterian Medical Center, and Columbia University , New York , New York , USA
| | - Suzanne K Freitag
- a Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA
- b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
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33
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Sundaram ANE, Abhayambika A, Kumar S. Bilateral Compressive Optic Neuropathy from Renal Osteodystrophy Caused by Branchio-oto-renal Syndrome Stabilised After Parathyroidectomy. Neuroophthalmology 2017; 41:321-325. [PMID: 29344072 DOI: 10.1080/01658107.2017.1315145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 01/13/2023] Open
Abstract
Renal osteodystrophy can cause calvarial hypertrophy and narrowing of the neural canals and foramina. Compressive optic neuropathy is extremely rare in renal osteodystrophy and was reported once only. The authors report bilateral, simultaneous compressive optic neuropathy secondary to renal osteodystrophy with features of uremic leontiasis ossea in chronic renal failure caused by branchio-oto-renal syndrome. Because of the extensive calvarial hypertrophy and the surgical difficulties envisaged with optic canal decompression, conservative approach was pursued. The patient's visual acuity and fields improved after partial parathyroidectomy. Visual improvement may be explained by the arrest of renal osteodystrophy and reduced optic nerve compression after parathyroidectomy.
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Affiliation(s)
- Arun N E Sundaram
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Archana Abhayambika
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sunil Kumar
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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34
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Tong J, Jefferson N, Chaganti J, Fraser CL. Compressive Optic Neuropathy from Allergic Fungal Sinusitis. Neuroophthalmology 2015; 39:236-239. [PMID: 27928361 DOI: 10.3109/01658107.2015.1056380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/13/2022] Open
Abstract
Ophthalmic manifestations of allergic fungal sinusitis (AFS) are rare, but can occur in advanced disease. A 32-year-old man with advanced AFS presented with severe bilateral vision loss and restricted ocular motility. Magnetic resonance imaging and histological analysis confirmed active chronic AFS. Functional endoscopic sinus surgery was performed, with adjunctive steroid therapy. Although AFS is a reasonably well-recognised entity, severe disease causing bilateral visual deficits is rarely encountered. This can confound the diagnosis and appropriate treatment. Ophthalmologists should thus be aware of compressive optic neuropathy as a complication of advanced AFS to prompt early treatment and mitigate visual loss.
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Affiliation(s)
- Jessica Tong
- Department of Ophthalmology, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia
| | - Niall Jefferson
- Department of Ear, Nose and Throat, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia
| | - Joga Chaganti
- Department of Neuroradiology, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia , and
| | - Clare L Fraser
- Save Sight Institute , Sydney, New South Wales, Australia
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35
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Malalis JF, Lee JM, Jay WM. Primary Osteosarcoma of the Skull Base in a Pregnant Patient. Neuroophthalmology 2013; 37:38-40. [PMID: 28163754 DOI: 10.3109/01658107.2012.753914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/06/2012] [Accepted: 10/08/2012] [Indexed: 11/13/2022] Open
Abstract
An 18-year-old female who was 14 weeks pregnant first noted vision loss in her left eye six days prior to admission. Ophthalmologic examination revealed 20/20 vision in the right eye and count fingers vision in the left eye. A marked relative afferent pupillary defect was present in the left eye. Ophthalmoscopic examination revealed a trace optic nerve pallor temporally in the left eye without associated disc oedema or haemorrhage. Magnetic resonance imaging of the brain demonstrated a heterogeneous mass of the left sphenoid sinus extending superiorly causing compression of the intracranial portion of the left optic nerve, and laterally into the left cavernous sinus. The patient underwent transphenoidal resection of the tumour whose histologic morphology revealed a grade 2 osteosarcoma. Following resection, vision returned to 20/20 in the left eye. The patient has been treated with chemotherapy with close monitoring of her pregnancy.
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Affiliation(s)
| | - John M Lee
- Department of Pathology, Loyola University Medical Center Maywood, IL USA
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36
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Pehere N, Anjaneyulu C, Mittal R, Vemuganti G. Compressive Optic Neuropathy Caused by a Cholesterol Granuloma of the Sphenoidal Sinus. Neuroophthalmology 2011; 35:78-80. [PMID: 30151026 DOI: 10.3109/01658107.2011.558667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/19/2010] [Accepted: 10/19/2010] [Indexed: 11/13/2022] Open
Abstract
Cholesterol granuloma is a foreign body giant cell reaction to cholesterol deposits. The pathology is rarely seen in the paranasal sinuses. In this report we describe a case of compressive optic neuropathy caused by cholesterol granuloma arising from the sphenoidal sinus. A 46-year-old lady presented with painless progressive decrease in vision in her left eye over the past 7 years. Magnetic resonance imaging of the brain and orbit with gadolinium enhancement showed a homogenous T1 and T2 hyperintense lesion causing expansion of the sphenoidal sinus compressing the ethmoidal sinus and also the left optic nerve. An endoscopic marsupialisation of the lesion was performed. Histopathological examination showed multiple characteristic cholesterol clefts surrounded by numerous multinucleated giant cells, histiocytes, lymphocytes, haemosiderin-laden macrophages, and plasma cells. This case emphasises the importance of appropriate neuro-imaging in cases of progressive optic neuropathy: cholesterol granuloma of the paranasal sinuses is a rare cause of optic nerve compression.
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Affiliation(s)
| | | | - Ruchi Mittal
- Ophthalmic Pathology Services, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Geeta Vemuganti
- Ophthalmic Pathology Services, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India
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Abstract
BACKGROUND Sphenoethmoidal sinus mucocele causing uniocular progressive vision loss is a rare entity and was first described by Bery in 1985. It is generally diagnosed in its advanced stage when the patients develop subjective ophthalmic symptoms. CASE A 43-year-old male presented to our institute for further evaluation and treatment of progressive visual deterioration in his left eye. The patient complained of visual impairment in his left eye for the past three months, in the form of a dark area in his left side of the visual field. OBSERVATIONS Magnetic resonance imaging (MRI) revealed a large expansile lesion in the left sided posterior ethmoidal air cells, abutting on the left optic nerve and displacing it in the region of the orbital apex. The patient underwent an urgent endoscopic sinus surgery by an Ear-Nose-Throat surgeon which resulted in stable visual acuity in the sixth postoperative month. CONCLUSIONS Sphenoethmoidal mucocele can cause irreversible blindness. Progressive vision loss with a neurological visual field defect should raise a high index of suspicion and computed tomography and MRI are to be performed to confirm the diagnosis. Collaboration between radiologists, ENT specialists, and ophthalmologists is essential for treating such cases.
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Affiliation(s)
- Harsha Bhattacharjee
- Neuroophthalmology Department, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Ronel Soibam
- Neuroophthalmology Department, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Nilutparna Deori
- Neuroophthalmology Department, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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38
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Ogata N, Imaizumi M, Kurokawa H, Arichi M, Matsumura M. Optic nerve compression by normal carotid artery in patients with normal tension glaucoma. Br J Ophthalmol 2005; 89:174-9. [PMID: 15665348 PMCID: PMC1772506 DOI: 10.1136/bjo.2004.047035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2004] [Indexed: 12/30/2022]
Abstract
AIM To determine whether compression of the optic nerve by the intracranial carotid artery (ICA) can be a causative factor of normal tension glaucoma (NTG). METHODS The medical records of 103 eyes of 54 Japanese patients with NTG and 104 eyes of 52 age matched control patients were reviewed. The neuroradiological findings of magnetic resonance images (MRI) were evaluated to determine the relation between the optic nerve and ICA. The clinical characteristics and general medical conditions, such as diabetes and systemic hypertension, were also compared between the two groups. RESULTS The prevalence of optic nerve compression by the ICA in patients with NTG was 49.5%, which was significantly higher than that in control group with 34.6% (p = 0.035). Bilateral compression of the optic nerve was detected in 22 patients with NTG (40.7%), and this was also significantly higher (p = 0.029) than that in the control group (11 patients, 21.2%). In the NTG group, eyes with cup/disc ratio (C/D ratio) > or =0.7 showed a higher percentage of compression (52.6%) compared with eyes with C/D ratio of <0.7 (12.5%; p = 0. 042). The presence of diabetes and hypertension did not affect the incidence of optic nerve compression by ICA significantly. CONCLUSIONS The significantly higher percentage of NTG patients who had optic nerve compression by the ICA suggests that compression of the optic nerve by ICA may be a possible causative factor or a risk factor for optic nerve damage in some patients with NTG.
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Affiliation(s)
- N Ogata
- Department of Ophthalmology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
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