Optic nerve sheath fenestration via a supero-medial eyelid skin crease approach for the treatment of idiopathic intracranial hypertension in a UK population

BACKGROUND/AIMS

Optic nerve sheath fenestration (ONSF) is a surgical intervention in the management of idiopathic intracranial hypertension (IIH) infrequently performed in the United Kingdom. Numerous surgical approaches have been described, including medial transconjunctival, lateral and endoscopic. We describe our outcomes and complications from ONSF via a supero-medial eyelid skin crease incision in patients with IIH.

METHODS

We performed a retrospective review of consecutive patients undergoing ONSF for IIH between January 2011 and December 2017 by a single surgeon.

RESULTS

Thirty patients were included in the analysis with a median follow-up of 14.5 months. Bilateral ONSFs were undertaken in 27 (90%). The data from one eye per patient were analysed. The mean kinetic perimetry score in mean radial degrees of the I4e isopter improved from 27.3° to 35.7°, p = 0.04. After removing cases with optic atrophy, the median modified Frisén grade of papilloedema improved from 2.5 to 1.0, p = 0.007. A total of 5/30 (17%) patients had complications: two (7%) had recurrence/late failure (one managed medically and one with cerebrospinal fluid [CSF] diversion surgery), one had transient cotton wool spots post-operatively, one had transient retinal haemorrhages and one patient had a transiently oval pupil. No patients had repeat ONSF, but CSF diversion surgery was subsequently carried out in 4/30 (13%) patients.

CONCLUSIONS

ONSF via a supero-medial eyelid skin crease approach is effective at improving visual function in patients with IIH. The complication rates are low when compared with CSF diversion surgery and other surgical approaches for ONSF.

Orbital decompression for thyroid eye disease: methods, outcomes, and complications

PurposeTo determine the safety and effectiveness of orbital decompression for thyroid eye disease (TED) in our unit. To put this in the context of previously published literature.Patients and methodsA retrospective case review of all patients undergoing orbital decompression for TED under the care of one orbital surgeon (SMS) between January 2009 and December 2015. A systematic literature review of orbital decompression for TED.ResultsWithin the reviewed period, 93 orbits of 55 patients underwent decompression surgery for TED. There were 61 lateral (single) wall decompressions, 17 medial one-and-a-half wall, 11 two-and-a-half wall, 2 balanced two wall, and 2 orbital fat only decompressions. For the lateral (single) wall decompressions, mean reduction in exophthalmometry (95% confidence interval (CI) was 4.2 mm (3.7-4.8), for the medial one-and-a-half walls it was 2.9 mm (2.1-3.7), and for the two-and-a-half walls it was 7.6 mm (5.8-9.4). The most common complications were temporary postoperative numbness (29% of lateral decompressions, 17% of other bony decompressions, OR 0.50, 95% CI 0.12-2.11) and new postoperative diplopia (9% of lateral decompressions, 39% of other bony decompressions, OR 6.8, 95% CI 1. 5-30.9). Systematic literature searching showed reduction in exophthalmometry for lateral wall surgery of 3.6-4.8 mm, with new diplopia 0-38% and postoperative numbness 12-50%. For other bony decompressions, reduction in exophthalmometry was 2.5-8.0 mm with new diplopia 0-45% and postoperative numbness up to 52%.ConclusionDiffering approaches to orbital decompression exist. If the correct type of surgery is chosen, then safe, adequate surgical outcomes can be achieved.

Failure of intravitreal bevacizumab in the treatment of choroidal metastasis

BACKGROUND

Metastasis to choroid is the most common intraocular malignancy, arising most frequently from carcinoma of breast in women and lung in men. Recent case reports have described successful use of intravitreal bevacizumab to achieve local control of such tumours.

MATERIALS AND METHODS

Five cases of choroidal metastases from varying primaries: breast, lung, and colon were treated with intravitreal bevacizumab, and tumour response observed and documented with serial photographs and B-scans.

RESULTS

Four of the five tumours were seen to progress despite intravitreal bevacizumab treatment.

CONCLUSIONS

Intravitreal bevacizumab as the primary treatment of choroidal metastases is not recommended and should not delay more effective alternative treatments.

Self-injection of dermal filler: an underdiagnosed entity?

Dermal fillers are increasingly used by clinicians (and nonclinicians) in patients requiring facial rejuvenation, as well as for other aesthetic uses such as treatment of age-related wrinkles, skin folds and depressed scars. We report the case of a patient who injected herself with dermal filler purchased over the internet and who required intervention for the undesired effect. We would like to highlight the ease with which these devices can be purchased over the internet, the risks they pose and the necessity of regulating their administration.

Review of lateral orbital wall ossifying fibroma

Significant histological overlap exists between fibro-osseous lesions and diagnosis is made on a clinicopathological basis. Ossifying fibroma is a benign fibro-osseous neoplasm of the jaw and craniofacial complex that has generated a degree of controversy regarding diagnosis and classification, especially with respect to the psammomatoid variant. Orbital lesions mainly arise from the paranasal sinuses affecting the medial or inferior orbital wall. Lateral orbital wall ossifying fibroma is, therefore, a rare condition with only a single previous case report. We present a second case of lateral orbital wall ossifying fibroma and a review of the associated literature.

Ageing changes in the eye

Ageing changes occur in all the structures of the eye causing varied effects. This article attempts to review the parameters of what is considered within the "normal limits" of ageing so as to be able to distinguish those conditions from true disease processes. Improving understanding of the ageing changes will help understand some of the problems that the ageing population faces.

Use of disposable prism tonometry in routine clinical practice

AIM

To establish the reliability, efficacy, and safety of disposable prism tonometry and validate its routine use for screening as well as monitoring of glaucoma.

METHODOLOGY

Intraocular pressure (IOP) of 400 eyes of 200 consecutive patients who attended the general ophthalmic clinic was checked with both the Goldmann applanation tonometer and a disposable tonometer prism by an experienced examiner after obtaining informed consent. The data were statistically analysed.

RESULTS

The mean difference in the IOP between the two types of prisms was 0.1 mmHg (SD+/-1 mmHg).

CONCLUSION

Disposable prism tonometry provides a reliable, effective, and safe alternative to Goldmann reusable prism tonometry for routine screening as well as monitoring of glaucoma with the advantages of eliminating the need for chemical disinfection and therefore eliminating the risk of crossinfection.