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Murayi R, El-Abtah M, Xiao T, Recinos PF, Kshettry VR. Orbital reconstruction and volume in the correction of proptosis after resection of spheno-orbital meningiomas. J Neurosurg 2024; 140:1305-1311. [PMID: 37976510 DOI: 10.3171/2023.8.jns23305] [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: 02/09/2023] [Accepted: 08/24/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of reconstruction and orbital volume on the reduction of proptosis in patients undergoing resection for spheno-orbital meningiomas. Additionally, potential predictors of optimal proptosis reduction after surgery were evaluated. METHODS Patients with spheno-orbital meningiomas who underwent resection at the authors' institution between 2005 and 2020 were evaluated retrospectively. The exophthalmos index (EI) was measured on pre- and postoperative imaging to quantify proptosis and calculate the primary outcome measure of proptosis reduction. Patients were excluded if they had no preoperative proptosis (i.e., EI < 1.1), prior resection, or insufficient imaging available for analysis. Clinical and surgical characteristics were collected, including sex, extent of resection, WHO grade, and rigid orbital reconstruction, and assessed as predictors of greater proptosis reduction. Additionally, orbital volumes of the affected and contralateral orbits were measured to correlate postoperative orbital volumes with proptosis reduction. RESULTS Thirty-three patients, with a mean age of 53 years, met inclusion criteria. The majority of the patients were female (23, 69.7%), and most tumors were classified as WHO grade 1 (29, 87.9%). Six patients (18.2%) underwent rigid orbital reconstruction. The mean EI across all patients decreased from 1.36 ± 0.18 to 1.19 ± 0.15 (p < 0.001). Patients who underwent reconstruction had on average a 76.4% greater reduction in the EI (p = 0.036) and a 9.1 times higher odds of achieving a normal EI (< 1.1) compared with those who did not receive reconstruction (OR 9.1, p = 0.025). Additionally, patients without residual hyperostotic bone compressing the orbit had a 2.16 times greater reduction in EI (p = 0.039). A linear relationship between orbital volume ratios (affected/unaffected orbit) and proptosis reduction was observed (p = 0.029, r = 0.529), including at ratios > 1.0. This suggests that greater orbital volumes postoperatively correlated with greater reductions in proptosis. CONCLUSIONS Three factors were identified that optimize proptosis correction. First, all abnormal bone compressing the orbital contents must be removed completely. Second, rigid orbital reconstruction leads to improved proptosis correction, possibly by preventing frontal lobe and dural reconstruction from descending onto the compressed orbit. Third, aiming for an orbital volume slightly larger than the contralateral normal side leads to improved proptosis correction.
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Affiliation(s)
- Roger Murayi
- 1Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland
- 2Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Mohamed El-Abtah
- 3Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tianqi Xiao
- 3Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pablo F Recinos
- 1Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland
- 2Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
| | - Varun R Kshettry
- 1Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland
- 2Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland; and
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Rana K, Lim WY, Caltabiano C, Tong JY, Chryssidis S, Scroop R, Patel S, Selva D. Extraocular muscle enlargement and proptosis in carotid cavernous fistulas. Orbit 2024; 43:203-207. [PMID: 37772931 DOI: 10.1080/01676830.2023.2252912] [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: 05/25/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE To evaluate the prevalence and pattern of extraocular muscle enlargement and proptosis in patients with carotid cavernous fistulas (CCF). METHODS We conducted a retrospective study on patients with digital subtraction angiography (DSA) confirmed CCFs with neuroimaging (computed tomography or magnetic resonance imaging) performed prior to the DSA. The maximum extraocular muscle diameters were recorded. Extraocular muscles were considered enlarged if they were greater than two standard deviations above the normal muscle diameters. Proptosis was defined as the distance between the interzygomatic line to the anterior globe of ≥2 mm compared to the contralateral orbit or ≥21 mm. RESULTS Forty orbits from 20 patients were included. The mean age of participants was 65 ± 15 years and 13 (65%) were female. Thirteen (65%) fistulas were indirect and seven (35%) were direct. There was enlargement of at least one muscle in 11 (27.5%) orbits, and this was not correlated with the type of fistula (direct/indirect). The inferior rectus was most commonly enlarged in seven orbits (17.5%), followed by the medial rectus in five orbits (12.5%). Proptosis was found in 17 (43%) orbits and was more common ipsilateral to the fistula (58% ipsilateral group vs 19% contralateral group, p < .01). CONCLUSION Extraocular muscle enlargement was observed in over one-fourth of CCFs. When enlarged, the inferior and medial rectus muscles are most commonly involved. These findings may help clinicians and radiologists when evaluating the CT or MRI scans of patients with suspected CCFs.
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Affiliation(s)
- Khizar Rana
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
| | - Wan Yin Lim
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, USA
| | - Carmelo Caltabiano
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
| | - Jessica Y Tong
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
| | - Steve Chryssidis
- Department of Medical Imaging, Flinders Medical Centre, Bedford Park, USA
| | - Rebecca Scroop
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, USA
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, USA
| | - Dinesh Selva
- Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, USA
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, USA
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Sobti M, Brogan K, Patel R, Miller D, Chadha V, Cauchi P. Impact of sphenoid trigone size and extraocular muscle thickness on the outcome of lateral wall orbital decompression for thyroid eye disease. Oral Maxillofac Surg 2024; 28:307-313. [PMID: 36813910 DOI: 10.1007/s10006-023-01143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/06/2022] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND To retrospectively review lateral wall orbital decompression for thyroid eye disease (TED) and to evaluate pre-operative CT scans to analyse the variation in proptosis reduction. METHODS Consecutive lateral wall orbital decompressions performed by a single surgeon were retrospectively reviewed. Pre-operative CT scan features and post-operative proptosis reduction were analysed. The sphenoid trigone cross-sectional areas were summed and multiplied by the slice thickness to yield bone volume. Cumulative extraocular muscle thickness was calculated by combining the maximum thickness of the four recti. "Trigone volume" and "cumulative muscle thickness" were correlated with proptosis reduction at 3 months post-surgery. RESULTS Out of 73 consecutive lateral wall orbital decompressions, 17 orbits had prior endonasal medial wall orbital decompression. In the remaining 56 orbits, the mean pre-operative and post-operative proptosis were 24.3 ± 1.6 mm and 20.9 ± 2.3 mm respectively. The proptosis reduction ranged from 1 to 7 mm (mean of 3.5 mm ± 1.3 (p < 0.001)). Mean sphenoid trigone volume was 895 ± 434.4 mm3. The mean cumulative muscle thickness was 20.4 ± 5 mm. The correlation coefficient between muscle thickness and proptosis reduction was - 0.3 and was statistically significant (p = 0.043). The correlation coefficient between sphenoidal trigone volume and proptosis reduction was 0.2 (p = 0.068). With a multivariate analysis, the coefficient of efficient of regression for muscle thickness was - 0.007 (p = 0.42) and the coefficient of regression for trigone volume was 0.0 (p = 0.046). CONCLUSION Proptosis reduction following lateral wall orbital decompression can be variable. Extraocular muscle thickness had a significant correlation with the outcome, with greater proptosis reduction in orbits with thin muscles. The sphenoidal trigone size had a weak correlation with decompression outcome.
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Affiliation(s)
- Manvi Sobti
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK.
| | - Kerr Brogan
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - Radhika Patel
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - David Miller
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - Vikas Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
| | - Paul Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow, G12 0YN, UK
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Mungroo KA, Song A, Greenstein J, Hahn B. Man With Proptosis. Ann Emerg Med 2023; 82:438-448. [PMID: 37739747 DOI: 10.1016/j.annemergmed.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 09/24/2023]
Affiliation(s)
| | - Alexander Song
- Department of Radiology, Staten Island University Hospital, Staten Island, NY
| | | | - Barry Hahn
- Department of Emergency Medicine, Staten Island, NY
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Sun R, Yin Z, Li L, Zhou H, Song X, Li Y. A novel method of measuring proptosis with computed tomography. Acta Radiol 2023; 64:2603-2610. [PMID: 37501503 DOI: 10.1177/02841851231187859] [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: 07/29/2023]
Abstract
BACKGROUND Computed tomography (CT) can avoid interference factors and has been imported into some software to measure proptosis clinically as the golden standard. PURPOSE To establish a new method for semi-automatically measuring the proptosis on CT and evaluate its accuracy and reproducibility. MATERIAL AND METHODS A total of 50 orbital CT images were collected of healthy individuals, 25 patients with Graves ophthalmopathy (GO), and 25 patients with orbital fracture (OF). A new image processing software, MedrawHDC, was developed to semi-automatically measure the proptosis (MedrawHDC method). The classic radiological (CR) method (measuring proptosis with the software called Mimics) and MedrawHDC method were applied in all three groups (measured by observer S). Hertel's exophthalmometer (HE) method was also applied in the GO group. Moreover, two other observers were asked to measure the proptosis using MedrawHDC, to evaluate its reproducibility. RESULTS The MedrawHDC method was highly consistent with the CR method in measuring proptosis (normal group: intraclass correlation coefficient [ICC] = 0.989; GO group: ICC = 0.979; OF group: ICC = 0.979). In the GO group, the value of proptosis measured by two radiological methods were consistent with that measured by the HE method (CR method: ICC = 0.703; MedrawHDC method: ICC = 0.697). Bland-Altman plots showed similar results. The measurements obtained by three observers were highly reproducible (ICC = 0.995). CONCLUSION The newly established MedrawHDC method, with high accessibility, convenience, and repeatability, is reliable in assessing proptosis. It shows high potential for wide application, having clinical value for scientific evaluation of proptosis.
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Affiliation(s)
- Rou Sun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, PR China
| | - Ziqing Yin
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, PR China
| | - Lunhao Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, PR China
| | - Huifang Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, PR China
| | - Xuefei Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, PR China
| | - Yinwei Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, PR China
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Muller-Lisse UG, Garip-Kuebler A, Murer S, Fuchsgruber F, Braeuninger C, Flatz W, Priglinger S, Hintschich C, Klingenstein A. Hertel-exophthalmometry-like multi-detector-row-CT-exophthalmometry: inter-disciplinary inter-observer reproducibility of measurements. Br J Radiol 2023; 96:20211408. [PMID: 37334789 PMCID: PMC10392662 DOI: 10.1259/bjr.20211408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES To investigate the interdisciplinary interobserver reproducibility of Hertel-exophthalmometry-like protrusion measurements on multidetector-row-computed-tomography- (MDCT-) images of the orbit to facilitate structured evaluation of the orbit and mid-face. METHODS Respective reproducibility of base-length along the interfronto-zygomatic line, right and left ocular protrusion, and deriving interocular difference was measured in this retrospective (04/2009-03/2020) single-centre observational study. MDCT-series and slice-positions were selected independently, using picture-archiving-and-communication-system- (PACS-) tools on tilt-corrected axial MDCT-images (slice-thickness 0.6-3.0 mm, window/centre 350/50 HU) in 37 selected adult patients (24 female, age 57 ± 13 years, average±standard-deviation) with clinical indication for Hertel-exophthalmometry, by one radiology-attending, two ophthalmology-attendings, one critical-care-attending, and one ear-nose-throat-surgery resident, respectively. Bland-Altman plots and Wilcoxon-matched-pairs-signed-rank-tests compared interobserver results. RESULTS Mean and median interobserver and intraobserver (radiology-attending) deviations were within 1 mm of respective averages of base-length (98 ± 4 mm), right and left ocular protrusion (21 ± 4 mm) and interocular difference (2 ± 1 mm). Relative interobserver deviations were within 2.0% of average (all patients) for base-length, and 5.0% (>80% of patients) for ocular protrusion. Pairwise interobserver comparison showed no significant differences between interocular differences of protrusion. CONCLUSIONS Respective measurements of base-length, ocular protrusion, and deriving interocular difference show high interdisciplinary interobserver reproducibility in tilt-corrected axial MDCT-images of the orbit or mid-face. ADVANCES IN KNOWLEDGE Hertel-exophthalmometry-like protrusion measurements did not depend on the years of experience or the medical subspecialty of the observer. Measurements are objective, well reproducible and important for multiple medical disciplines and should thus be included in pertinent radiology reports.
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Affiliation(s)
- Ullrich G Muller-Lisse
- Department of Radiology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Aylin Garip-Kuebler
- Department of Ophthalmology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Sophie Murer
- Department of Ear, Nose and Throat Surgery, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Florian Fuchsgruber
- Department of Anaesthesiology and Critical Care, München Klinik Bogenhausen, Munich, Germany
| | - Christiane Braeuninger
- Department of Radiology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Wilhelm Flatz
- Department of Radiology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Christoph Hintschich
- Department of Ophthalmology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Annemarie Klingenstein
- Department of Ophthalmology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
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Hierl KV, Krause M, Kruber D, Sterker I. 3-D cephalometry of the the orbit regarding endocrine orbitopathy, exophthalmos, and sex. PLoS One 2022; 17:e0265324. [PMID: 35275980 PMCID: PMC8916626 DOI: 10.1371/journal.pone.0265324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed at evaluating the orbital anatomy of patients concerning the relevance of orbital anatomy in the etiology of EO (endocrine orbitopathy) and exophthalmos utilizing a novel approach regarding three-dimensional measurements. Furthermore, sexual dimorphism in orbital anatomy was analyzed. Methods Orbital anatomy of 123 Caucasian patients (52 with EO, 71 without EO) was examined using computed tomographic data and FAT software for 3-D cephalometry. Using 56 anatomical landmarks, 20 angles and 155 distances were measured. MEDAS software was used for performing connected and unconnected t-tests and Spearman´s rank correlation test to evaluate interrelations and differences. Results Orbital anatomy was highly symmetrical with a mean side difference of 0.3 mm for distances and 0.6° for angles. There was a small albeit statistically significant difference in 13 out of 155 distances in women and 1 in men concerning patients with and without EO. Two out of 12 angles showed a statistically significant difference between female patients with and without EO. Regarding sex, statistically significant differences occurred in 39 distances, orbit volume, orbit surface, and 2 angles. On average, measurements were larger in men. Concerning globe position within the orbit, larger distances to the orbital apex correlated with larger orbital dimensions whereas the sagittal position of the orbital rim defined Hertel values. Conclusion In this study, little difference in orbital anatomy between patients with and without EO was found. Concerning sex, orbital anatomy differed significantly with men presenting larger orbital dimensions. Regarding clinically measured exophthalmos, orbital aperture anatomy is an important factor which has to be considered in distinguishing between true exophthalmos with a larger distance between globe and orbital apex and pseudoexophthalmos were only the orbital rim is retruded. Thus, orbital anatomy may influence therapy regarding timing and surgical procedures as it affects exophthalmos.
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Affiliation(s)
| | - Matthias Krause
- Department of Oral & Maxillofacial Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Daniel Kruber
- Department of Informatics and Media, Leipzig University of Applied Sciences, Leipzig, Germany
| | - Ina Sterker
- Department of Ophthalmology, Leipzig University, Leipzig, Germany
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Sulin KA, Ivanov VP, Kim AV, Khachatryan VA, Samochernykh KA. [3D modeling for planning of minimally invasive approach to the orbit]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:103-108. [PMID: 35412719 DOI: 10.17116/neiro202286021103] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To demonstrate own experience in 3D modeling for planning of minimally invasive approach to the orbit and anterior skull base. MATERIAL AND METHODS A 17-year-old patient admitted to the Department of Pediatric Neurosurgery with complaints of decreased visual acuity of the left eye, lacrimation and exophthalmos. MRI revealed a tumor of the left orbit. We have preoperatively modeled frontoorbital region, anterior skull, as well as eyeball and tumor within the same model. Considering young age and potentially favorable prognosis of disease, we preferred a minimally invasive intervention (microsurgical resection of tumor through minimally invasive frontoorbital access). RESULTS Total resection of tumor was followed by examination of anterior skull base. There was postoperative regression of visual disturbances, lacrimation and exophthalmos. Sutures were removed after 5 days, and the patient was discharged. CONCLUSION Minimally invasive frontoorbital access is adequate for approach to the orbit, anterior and middle cranial fossa, adequate resection of orbital tumor and examination of anterior skull base. 3D modeling is an additional preoperative tool to improve the quality of preoperative planning and facilitate intraoperative navigation.
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Affiliation(s)
- K A Sulin
- Polenov Research Neurosurgical Institute, St. Petersburg, Russia
| | - V P Ivanov
- Polenov Research Neurosurgical Institute, St. Petersburg, Russia
| | - A V Kim
- Polenov Research Neurosurgical Institute, St. Petersburg, Russia
| | - V A Khachatryan
- Polenov Research Neurosurgical Institute, St. Petersburg, Russia
| | - K A Samochernykh
- Polenov Research Neurosurgical Institute, St. Petersburg, Russia
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Irawati Y, Pratama A, Paramita C, Bani AP, Primacakti F. Spontaneous Retrobulbar Hemorrhage in a Previously Healthy Infant. J Pediatr Hematol Oncol 2022; 44:e302-e305. [PMID: 34054048 DOI: 10.1097/mph.0000000000002218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/25/2021] [Indexed: 11/26/2022]
Abstract
Spontaneous retrobulbar hemorrhage is a rare yet vision-threatening condition. We reported a 5-month-old male infant with sudden onset of left eye proptosis with no prior history of getting vitamin K injection after birth. Head computed tomography scan revealed retrobulbar and intracranial hemorrhages. Laboratory results showed anemia, prolonged prothrombin and activated partial thromboplastin time, supporting the diagnosis of vitamin K deficiency bleeding. After the bleeding and clotting profile were stabilized, lateral canthotomy and cantholysis; and drainage following orbital decompression were successfully performed, yielded in a completely resolved proptosis. The right timing for surgery with the goal of releasing intraorbital pressure represent the merit of this paper. Our case also led to a crucial emphasis on vitamin K prophylaxis at birth.
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Affiliation(s)
- Yunia Irawati
- Department of Ophthalmology, Division of Plastic and Reconstructive Surgery
| | - Avisena Pratama
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Dr Cipto Mangunkusumo Hospital
| | - Carennia Paramita
- Department of Ophthalmology, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anna P Bani
- Department of Ophthalmology, Division of Pediatric and Strabismus
| | - Fitri Primacakti
- Department of Child Health, Division of Pediatric Hematology-Oncology
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Sieslack J, Farke D, Failing K, Kramer M, Schmidt MJ. Correlation of brachycephaly grade with level of exophthalmos, reduced airway passages and degree of dental malalignment' in Persian cats. PLoS One 2021; 16:e0254420. [PMID: 34288937 PMCID: PMC8294563 DOI: 10.1371/journal.pone.0254420] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
For many years, there has been a trend to breed cats with an increasing degree of brachycephalic head features, which are known to have a severe impact on the animals' health and welfare. The direct relation between different grades of brachycephaly and their negative implications have not been researched in this species. The aim of this study was therefore to establish correlations between the different grades of brachycephaly and reduced upper respiratory airways, exophthalmos of the eye globes and malalignment of the teeth in Persian cats. Sixty-nine Persian cats of various skull dimensions and ten Domestic shorthair cats were recruited for the study. The cats' skulls were examined using three-dimensional reconstructions created from Computed Tomography datasets. Brachycephaly was graded using established craniometric measurements (facial index, cranial index, skull index, craniofacial angle). The flow area of the nasal passageways at different locations, the amount of the eye globe not supported by the bony orbit and the axial deviation of the teeth were quantified and evaluated for a correlation with the grade of brachycephaly. The results of this study clearly show that increased grades of brachycephaly in Persian cats resulted in larger extra-orbital parts of the ocular bulbs. The brachycephalic skull dimension also resulted in a lower height of the naso-osseal aperture, while other areas of the nasal airways were not correlated with the severity of brachycephaly. Persian cats showed a significantly increased occurrence of premolar tooth displacement in the upper jaw with increasing brachycephaly grades. It was interesting to note that the measured values had a broad range and values of some individual Persian cats showed an overlap with those of Domestic shorthair cats.
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Affiliation(s)
- Jana Sieslack
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Neurosurgery, Neuroradiology and Clinical Neurology, Justus-Liebig University-Giessen, Giessen, Germany
| | - Daniela Farke
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Neurosurgery, Neuroradiology and Clinical Neurology, Justus-Liebig University-Giessen, Giessen, Germany
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus-Liebig University, Giessen, Germany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Surgery, Justus-Liebig University-Giessen, Giessen, Germany
| | - Martin J. Schmidt
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Neurosurgery, Neuroradiology and Clinical Neurology, Justus-Liebig University-Giessen, Giessen, Germany
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Togashi K, Nishitsuka K, Hayashi S, Namba H, Goto S, Takeda Y, Suzuki S, Kato T, Yamada Y, Konno E, Yoshioka T, Yamakawa M, Sonoda Y, Suzuki T, Yamashita H. Metastatic Orbital Tumor From Breast Ductal Carcinoma With Neuroendocrine Differentiation Initially Presenting as Ocular Symptoms: A Case Report and Literature Review. Front Endocrinol (Lausanne) 2021; 12:625663. [PMID: 33692758 PMCID: PMC7937957 DOI: 10.3389/fendo.2021.625663] [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] [Received: 11/05/2020] [Accepted: 01/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Orbital metastases from cancers of various organs can arise via the hematogenous route, and many originate from breast, prostate, and lung cancers. Such metastatic orbital tumors may be diagnosed before the primary tumor. We have encountered a case of breast ductal carcinoma with neuroendocrine differentiation that metastasized to the orbit and responded to chemotherapy, with improvement in visual function. CASE PRESENTATION A woman in her fifties visited our ophthalmology department with a chief complaint of foreign body sensation and exophthalmos in her right eye. An elastic soft mass was palpated from the lateral orbit to the temporal region. A systemic examination revealed breast cancer and a metastatic orbital tumor. Excisional biopsy of the breast revealed a diagnosis of invasive ductal carcinoma with neuroendocrine differentiation, and immunohistochemical examination was negative for cytokeratin 7, making the case unusual. Chemotherapy was remarkably effective, and the tumor size decreased, resulting in improvement of visual function. Her general condition and quality of life are still good at present. We searched the PubMed English language literature focusing on metastatic orbital tumors from breast cancer in which ocular symptoms had been the initial presenting sign. No previous reports have documented neuroendocrine differentiation or cytokeratin 7 expression in isolated orbital metastases from breast cancer. Although it is not possible to be certain from this case alone, we speculated that some such cases might involve cytokeratin 7-negative invasive breast cancer with neuroendocrine differentiation. CONCLUSION We have described our experience of a very rare case of cytokeratin 7 negative breast ductal carcinoma with neuroendocrine differentiation that metastasized to the orbit and formed a solitary giant tumor initially manifesting as ocular symptoms.
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Affiliation(s)
- Keita Togashi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
- *Correspondence: Keita Togashi,
| | - Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shion Hayashi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroyuki Namba
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sakiko Goto
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yusuke Takeda
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shuhei Suzuki
- Department of Clinical Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoya Kato
- Department of Pathology, Fukushima Rosai Hospital, Fukushima, Japan
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuki Yamada
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Eriko Konno
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takashi Yoshioka
- Department of Clinical Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mitsunori Yamakawa
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
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Gollakota S, Balijepalli P, Richhariya A, Senthil S. Blebophthalmos: proptosis due to a massive bleb following implant surgery in refractory paediatric glaucoma. BMJ Case Rep 2020; 13:e234454. [PMID: 32404372 PMCID: PMC7228145 DOI: 10.1136/bcr-2020-234454] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2020] [Indexed: 11/03/2022] Open
Abstract
A 5-year-old boy with failed combined trabeculotomy and trabeculectomy underwent Ahmed glaucoma valve (AGV) implantation and presented 5 weeks postoperatively, with sudden onset proptosis downward displacement of the globe, limited extraocular movements and displacement of tube from anterior chamber. CT scan of the orbits showed a large cystic bleb with posterior dislocation of the implant and was explanted. In vitro testing of implant for fluid flow characteristics revealed a dysfunctional valve with anterior leak, which could have possibly lead to anterior and inferior fluid accumulation resulting in displacement of implant, a probable cause for this rare complication. The case was successfully managed later with the Aurolab aqueous drainage device implantation. This case report cautions the surgeon for the possibility of a large cystic bleb following abnormal leak in AGV resulting in orbital complications like proptosis, motility limitation and impending optic nerve compression.
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Affiliation(s)
| | | | | | - Sirisha Senthil
- VST Center for Glaucoma Care, LV Prasad Eye Institute, Hyderabad, India
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Tiong TYV, Sundar G, Young SM, Makmur A, Yong HRC, Wong YLJ, Lang SS, Tan AP. A Novel Method of CT Exophthalmometry in Patients With Thyroid Eye Disease. Asia Pac J Ophthalmol (Phila) 2020; 9:39-43. [PMID: 31990744 PMCID: PMC7004459 DOI: 10.1097/01.apo.0000617908.29733.84] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Conventional computed tomography (CT) exophthalmometry requires an intact lateral orbital wall and is therefore not feasible in patients who have undergone any form of lateral orbital wall surgery where the normal bony landmark may be lost or displaced. The purpose of our study is to validate an alternative method of CT exophthalmometry utilizing the posterior clinoid (PC) process as a new reference point that will allow for reproducible comparison of the anterior-posterior globe position in the preoperative and postoperative settings. DESIGN Cohort study. METHODS This is a retrospective study of 48 patients with clinically diagnosed thyroid eye disease who had undergone cross-sectional CT imaging in the pre- or postoperative settings. CT exophthalmometry was performed using both the conventional interzygomatic method and our proposed PC process method on all pre- and postoperative CT imaging by two independent observers. Interobserver variability analysis was performed with intraclass correlation coefficient. Correlation and agreement between the two methods were analyzed with Pearson correlation coefficient and linear regression method. All analyses were conducted at 5% level of significance with Stata MP V14. RESULTS Interobserver variability analysis showed an intraclass correlation coefficient of >0.9 for both interzygomatic and PC methods. There is good correlation between the two different measurements observed in both the pre- and postoperative groups (r = 0.68 and r = 0.72, respectively, P < 0.001). Linear regression showed good agreement between the two different measurements with most of the points lying within the 95% limits. CONCLUSIONS Our new method agrees well with the conventional method and has the added benefit of being able to reliably assess the anterior-posterior globe position in patients who do not have intact lateral orbital walls after decompressive surgery.
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Affiliation(s)
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital Singapore, Singapore
| | - Stephanie M. Young
- Department of Ophthalmology, National University Hospital Singapore, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital Singapore, Singapore
| | | | | | | | - Ai Peng Tan
- Department of Diagnostic Imaging, National University Hospital Singapore, Singapore
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Oeverhaus M, Copei A, Mattheis S, Ringelstein A, Tiemessen M, Esser J, Eckstein A, Stähr K. Influence of orbital morphology on proptosis reduction and ocular motility after decompression surgery in patients with Graves' orbitopathy. PLoS One 2019; 14:e0218701. [PMID: 31233522 PMCID: PMC6590818 DOI: 10.1371/journal.pone.0218701] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/08/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Orbital decompression surgery is performed in patients with Graves' orbitopathy to treat dysthyroid optical neuropathy (DON) and reduce disfiguring proptosis. The intended proptosis reduction can deviate from the postoperative result and changes of motility with consecutive diplopia can occur. We performed a retrospective study to identify anatomical factors in computed tomography (CT), which influence the surgical effect and postoperative ocular motility and diplopia. METHODS Pre- and postoperative CT-scans of 125 eyes of 68 patients, who mainly underwent a balanced orbital decompression for disfiguring proptosis (≥18mm Hertel Index), have been analyzed. Proptosis, ductions, misalignment and diplopia were assessed before and after surgery. Medial and lateral orbital wall length, conus angle, depth of ethmoidal sinus, orbital surface, length of medial and orbital defect, depth of tissue prolapse and horizontal muscle diameters were analyzed in CT scans before and after surgery. With linear regression and multivariate analyses these parameters have been correlated with postoperative proptosis, abduction deficit, deviation and binocular single vision (BSV). RESULTS Proptosis could be reduced by 5.3±2mm. Patients with <5mm proptosis reduction had significantly less often new onset of diplopia compared to patients with >5mm reduction (13% vs. 56%, p = 0.02). Multiple linear regression showed a significant correlation between tissue prolapse and depth of the ethmoidal sinus as well as age (p<0.001, r = 0.71). Proptosis reduction could not be predicted by tissue prolapse, defect length or depth of ethmoidal sinus. The abduction deficit correlated significantly with tissue prolapse and orbital surface area (p<0.001, r = 0.37) but not with the horizontal muscle diameter. CONCLUSION We were able to show that orbital morphology influences the outcome of balanced orbital decompression surgery in terms of proptosis reduction and motility. However, the rather low coefficients of correlation show that the surgical outcome cannot be predicted with simple CT measurements, although risk factors for postoperative abduction deficit could be found. Therefore, preoperative planning should consider especially the orbital surface area and depth of ethmoidal sinus. Patients should be informed about the higher risk of diplopia with higher proptosis reduction.
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Affiliation(s)
- Michael Oeverhaus
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Anna Copei
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
- Department of Gynecology, University Hospital Oldenburg, Oldenburg, Germany
| | - Stefan Mattheis
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | | | - Madeleine Tiemessen
- Department of Radiology and Neuroradiology, Alfried Krupp Hospital Essen, Essen, Germany
| | - Joachim Esser
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Kerstin Stähr
- Department of Gynecology, University Hospital Oldenburg, Oldenburg, Germany
- * E-mail:
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Rolvien T, Kornak U, Schinke T, Amling M, Oheim R. A novel FAM20C mutation causing hypophosphatemic osteomalacia with osteosclerosis (mild Raine syndrome) in an elderly man with spontaneous osteonecrosis of the knee. Osteoporos Int 2019; 30:685-689. [PMID: 30151622 DOI: 10.1007/s00198-018-4667-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
Abstract
Raine syndrome is characterized by FGF23-mediated hypophosphatemic osteomalacia with osteosclerosis caused by mutations in the FAM20C gene. We report a case of a 72-year-old man who presented with rapid progressive spontaneous osteonecrosis of the knee (SONK). A full osteologic assessment including dual energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and serum analyses revealed a high bone mass in the lumbar spine and hip (DXA T-score + 7.5 and + 4.7/+4.2) with increased bone microstructural parameters in the distal radius and tibia (BV/TV 127%, 140% of the age-matched mean, respectively), as well as a low bone turnover state. Phosphate levels were low due to renal phosphate wasting and high FGF23 levels (126.5 pg/ml, reference range 23.2-95.4 pg/ml). Using gene panel sequencing, we identified a novel FAM20C heterozygous missense mutation in combination with a homozygous duplication that potentially alters splicing. Taken together, this is the first case of mild Raine syndrome with spontaneous osteonecrosis of the knee, phosphate wasting, and a pronounced trabecular high bone mass phenotype.
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Affiliation(s)
- T Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Kornak
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
- FG Development and Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - T Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany.
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Golombek T, Henker R, Rehak M, Quäschling U, Lordick F, Knödler M. A Rare Case of Mixed Adenoneuroendocrine Carcinoma (MANEC) of the Gastroesophageal Junction with HER2/neu Overexpression and Distinct Orbital and Optic Nerve Toxicity after Intravenous Administration of Cisplatin. Oncol Res Treat 2019; 42:123-127. [PMID: 30799422 DOI: 10.1159/000495218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/08/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mixed adenoneuroendocrine carcinomas (MANECs) are rare malignancies with both neuroendocrine and non-neuroendocrine components. To date, the prognosis of gastroenteropancreatic MANECs remains dismal, and treatment options are mainly based on guidelines for the treatment of pure neuroendocrine carcinomas or small cell lung cancer. Established first-line therapy in the metastatic situation is cisplatin and etoposide. Platinum derivatives are known to cause a variety of side effects also involving the visual system. Severe orbital and optic nerve toxicities have been described mainly after intracarotid infusion of cisplatin. CASE REPORT Herein we report a rare case of a 60-year-old male patient suffering from MANEC of the gastroesophageal junction with HER2/neu overexpression who developed severe orbital and ocular neurotoxicity (grade 3 according to CTCAE v4.03) after intravenous cisplatin. CONCLUSION We discuss diagnostic approaches and differential diagnoses in this clinical situation. Before starting treatment with intravenous and topical steroids, it is crucial to rule out meningeal and cerebral spread as well as paraneoplastic and endocrine syndromes.
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Stanzel S, Gyürüs P, Kresnik E, Aigner R. A rare case of Marine-Lenhart syndrome with unilateral endocrine orbitopathy and Hürthle cell carcinoma. Nuklearmedizin 2017; 56:N28-N30. [PMID: 28488725 DOI: 10.3413/nukmed-0862-16-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022]
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Hindley KE, Billson FM, Johnson V. What Is Your Diagnosis? J Am Vet Med Assoc 2016; 249:377-9. [PMID: 27479280 DOI: 10.2460/javma.249.4.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lloyd M, Zhang XC, Joseph S, Baruch J, Siket M, Binder W. Peeping Painless Proptosis. R I Med J (2013) 2016; 99:40-42. [PMID: 27472777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Maureen Lloyd
- Division of Ophthalmology Residency, Alpert Medical School of Brown University
| | - Xiao Chi Zhang
- Department of Emergency Medicine, Alpert Medical School of Brown University
| | - Sarah Joseph
- Department of Emergency Medicine, Alpert Medical School of Brown University
| | - Jay Baruch
- Associate Professor of Emergency Medicine, Alpert Medical School of Brown University
| | - Matthew Siket
- Assistant Professor of Emergency Medicine, Alpert Medical School of Brown University
| | - William Binder
- Associate Professor of Emergency Medicine, Alpert Medical School of Brown University
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Yousuf Tasneem AA, Yousuf HA, Luck NH, Abbas Z, Anis S, Hassan SM. Autoimmune pancreatitis with extraocular muscles involvement. J PAK MED ASSOC 2015; 65:1125-1127. [PMID: 26440848] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Autoimmune pancreatitis is characterised by diffuse enlargement of pancreas, narrowing of pancreatic duct, lymphoplasmacytic infiltrations and fibrosis. The disease is responsive to corticosteroid. We report the case of a 32-year-old male who presented with unilateral exophthalmos and obstructive jaundice secondary to pancreatic head mass and biliary tract stricture. Serum immunoglobulin G level was raised with a very high immunoglobulin G4 subclass. Ophthalmological imaging revealed unilateral thickening of extraocular muscles. The patient responded well to corticosteroid with resolution of biliary strictures, pancreatic head mass and exophthalmos.
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Affiliation(s)
- Abbas Ali Yousuf Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Hamza Aasim Yousuf
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sabiha Anis
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Syed Mujahid Hassan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Mann W, Kahaly G, Lieb W, Rothoff T, Springborn S. Orbital decompression for endocrine ophthalmopathy: the endonasal approach. Dev Ophthalmol 2015; 25:142-50. [PMID: 8359349 DOI: 10.1159/000422433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- W Mann
- Department of Otorhinolaryngology, Mainz Medical School, FRG
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Wu W, Selva D, Bian Y, Wang X, Sun MT, Kong Q, Yan W. Endoscopic medial orbital fat decompression for proptosis in type 1 graves orbitopathy. Am J Ophthalmol 2015; 159:277-84. [PMID: 25448997 DOI: 10.1016/j.ajo.2014.10.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the surgical technique for endoscopic medial orbital fat decompression in type 1 (lipogenic) Graves orbitopathy and report outcomes. DESIGN Retrospective interventional case review. METHODS We reviewed 108 patients (206 orbits) with inactive, type 1 Graves orbitopathy without diplopia, who underwent endoscopic medial orbital fat decompression solely for proptosis reduction. Following endoscopic transethmoid medial orbital wall decompression, extraconal and intraconal orbital fat was removed with a low-suction cutting instrument. All patients were followed up for at least 12 months. Surgical time, preoperative and postoperative Hertel exophthalmometry, incidence of postoperative diplopia within 30-degree visual field in the primary gaze, and other complications were analyzed. RESULTS The mean surgical time was 97.7 ± 16.7 minutes (67-136 minutes). The mean follow-up was 16.0 ± 4.2 months (12-24 months). Preoperative and postoperative proptosis values at final review were 21.1 ± 2.3 mm (17-26 mm) and 13.0 ± 0.9 mm (12-15 mm), respectively (P < .001). Median reduction in proptosis was 8.0 mm with mean of 8.2 ± 1.8 mm (4-11 mm). Symmetry to within 2 mm was achieved in 106 of 108 patients (98.1%). Twenty-five of 108 patients (23.1%) had diplopia within 30-degree visual field of the gaze, and 23 of these had complete resolution within 3 months, while the remaining 2 patients required squint surgery. CONCLUSIONS Endoscopic medial orbital fat decompression may be an effective technique for proptosis in selected patients with type 1 Graves orbitopathy and is associated with a low rate of surgically induced diplopia.
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Affiliation(s)
- Wencan Wu
- Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Dinesh Selva
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Yang Bian
- Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaopeng Wang
- Department of Ophthalmology, Jinhua Center Hospital, Jinhua, China
| | - Michelle T Sun
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Qiao Kong
- Department of Ophthalmology, Lihuili Hospital, Ningbo, China
| | - Wentao Yan
- Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
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Takahashi Y, Kakizaki H. Horizontal eye position in thyroid eye disease: a retrospective comparison with normal individuals and changes after orbital decompression surgery. PLoS One 2014; 9:e114220. [PMID: 25469505 PMCID: PMC4255005 DOI: 10.1371/journal.pone.0114220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022] Open
Abstract
Objective To compare horizontal eye positions between proptotic thyroid eye disease patients and normal individuals, and to examine positional changes after orbital decompression surgery in thyroid eye disease patients. Methods The present case-controlled and retrospective comparative study included 78 proptotic thyroid eye disease patients who underwent bilateral orbital decompression surgery [lateral orbital wall decompression (Group L), 47 patients; medial orbital wall decompression (Group M), 9 patients; and balanced orbital decompression (Group B), 22 patients] and 143 age-matched healthy volunteers as controls. The interpupillary distance was measured to determine horizontal eye positions before and 3 months after surgery in thyroid eye disease patients and was also examined in control eyes. Horizontal eye shifts were calculated by subtracting postoperative from preoperative interpupillary distances. Results Preoperative interpupillary distances in thyroid eye disease patients were significantly larger than in controls. The interpupillary distances were significantly decreased postoperatively in Groups M and B, but were significantly increased in Group L. The order of the magnitude of the horizontal shifts was Groups M>B>L. Conclusions Proptotic thyroid eye disease patients preoperatively showed laterally displaced eyes in comparison with controls. However, the eyes shifted medially after the medial orbital wall decompression and the balanced orbital decompression, although the former showed more shift. Medial orbital wall or balanced orbital decompression can be used to correct both lateral and anterior displacement of the eyes.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
- * E-mail:
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Ciobanu AM, Roşca T, Vlădescu CT, Tihoan C, Popa MC, Boer MC, Cergan R. Frontal epidural empyema (Pott's puffy tumor) associated with Mycoplasma and depression. Rom J Morphol Embryol 2014; 55:1203-1207. [PMID: 25607407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED A 37-year-old male has left exophthalmia, which gradually evolved in the last two years, finally with a deviation of left eye (LE), down side and out, with gradually decrease of visual acuity (VA). These symptoms are accompanied with headache and psychiatric manifestations with irritability, decreased attention, anxiety, insomnia, depressed mood. Brain Computed Tomography (CT) shows a tumor mass in air leakage sinus, bilateral frontal and bilateral ethmoidal, with left orbital invasion. This tumor mass lysis by pressure the supero-posterior wall of the left orbit, with the delimitation of a frontal epidural process with a capsule and calcifications. Additionally, it has been shown there is a bilateral maxillary sinusitis. The surgical intervention removed the infection focal spots rearranging the left eyeball, recovering the VA. The sinuses were drained. The psychiatric symptoms in the post operatory phase disappeared. Histopathological examination of the excised tissue revealed sinus ciliated respiratory mucosa with mixed acute and chronic inflammatory infiltrate and focal squamous metaplasia. The lamina propria is edematous and contains large numbers of neutrophils, lymphocytes and plasma cells. Histopathological diagnosis is acute and chronic sinusitis. CONCLUSIONS An untreated infection of the aerial sinuses can lead to a complication like Pott's puffy tumor. When signs such as ophthalmologic, psychiatric and intense headaches appear, it suggests the presence of the Pott's puffy tumor (PPT). The clinical signs are reversible once the tumor has been removed.
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Affiliation(s)
- Adela Magdalena Ciobanu
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy; 1st Department, "Prof. Dr. Alexandru Obregia" Clinical Psychiatry Hospital, Bucharest, Romania;
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Abstract
BACKGROUND Solitary neurofibroma in the absence of neurofibromatosis is of rare occurrence and very few cases have been reported till date. OBJECTIVE To report a case of a solitary intra-ocular neurofibroma. CASE A 65-year-old man presented to us with a large swelling appearing to arise from right pthisical eye for the past one and a half years. After knowing the extent and origin of mass lesion, right eyeball was enucleated and subjected to histopathological examination which revealed intraocular neurofibroma in the absence of neurofibromatosis which is of very rare occurrence. CONCLUSION The isolated neurofibroma of intraocular origin can present as an isolated orbital mass without systemic features.
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Brovkina AF, Iatsenko OI. [Rationale for distinguishing the lipogenic form of thyroid orbitopathy]. Vestn Oftalmol 2013; 129:30-34. [PMID: 23808177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pathogenesis of lipogenic form of thyroid orbitopathy (TO) is presented. 172 patients with TO are presented, among them 47 males (93 orbits) and 125 females (250 orbits). Features of clinical manifestations of lipogenic form of TO are described. The results of CT of extraocular muscles (EOM) and orbital fat volume are studied in these patients and the density of EOM is assessed.
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Chang M, Baek S, Lee TS. Long-term outcomes of unilateral orbital fat decompression for thyroid eye disease. Graefes Arch Clin Exp Ophthalmol 2012; 251:935-9. [PMID: 23139030 DOI: 10.1007/s00417-012-2195-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/05/2012] [Accepted: 10/25/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the long-term outcomes after unilateral orbital fat decompression in patients with thyroid eye disease. DESIGN Retrospective, comparative, cross-sectional study PARTICIPANTS Thirty-three orbits of 33 patients were included in this study. Of the 33 patients, 13 underwent fat decompression (group A), and the other 20 had bony decompression (group B). METHODS The medical records of patients who underwent orbital decompression to reduce proptosis for thyroid eye disease were retrospectively reviewed. The degrees of proptosis were measured by Hertel exophthalmometry preoperatively and over a follow-up period of more than 3 years. We evaluated the change in proptosis after surgery. MAIN OUTCOME MEASURES Postoperative change in exophthalmos. RESULTS A recurrence in proptosis from fat decompression was seen in ten patients (76.9 %) in group A and in only two patients (10 %) in group B. The amount of regression due to surgery after 3 years was 2.3 ± 1.4 mm and 0.7 ± 0.9 mm in groups A and B respectively. The tendency of regression was more prominent in group A than in group B. CONCLUSION The long-term effect of unilateral orbital fat decompression for the reduction of proptosis in patients with thyroid eye disease may be weak, leading to regression. Care should be taken when determining the extent of fat decompression with consideration for this tendency.
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Affiliation(s)
- Minwook Chang
- Department of Ophthalmology, Guro Hospital, Korea University College of Medicine, 97 Gurodong-gil, Guro-gu, Seoul 152-703, South Korea
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Louati H, Hedhli M, Chebbi A, Ben Hassine L, Douira W, Lahmar L, Ayed S, Bellagha I. [Spontaneous orbital hematoma: two case reports]. J Fr Ophtalmol 2012; 35:533.e1-4. [PMID: 22795759 DOI: 10.1016/j.jfo.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 11/23/2011] [Accepted: 12/05/2011] [Indexed: 11/18/2022]
Abstract
Although rare, spontaneous intra-orbital hematoma can quickly jeopardize vision. It usually presents with painful proptosis. It can result from multiple etiologies, and the diagnosis is based on imaging studies in the absence of known causes. We describe two cases of spontaneous intraorbital hematoma. The first, of unknown etiology, required needle drainage. The second was associated with a subperiosteal hematoma of the orbital roof complicating a periorbital bone infarction in a patient with sickle-thalassemia.
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Affiliation(s)
- H Louati
- Service de Radiopédiatrie, Hôpital d'Enfants, place Bab-Sâadoun, 1007 Tunis Jabbari, Tunisie
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Suwan Y, Punyawattanaporn A, Preechawai P. Rhino-orbital fungal infection: two cases report. J Med Assoc Thai 2012; 95:739-742. [PMID: 22994038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Rhino-orbital fungal infections are serious and life threatening complications of immunocompromised host. The authors reported two cases of rapid progressive proptosis and eyelid necrosis of immunocompromised patients who suffered from highly malignant T-celled lymphoblastic leukemia/lymphoma and congenital heart disease with multiple anomalies. Although early diagnosis was made and prompt treatments including medical and surgical interventions were performed, both patients died.
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Affiliation(s)
- Yanin Suwan
- Department ofOphthalmology, Faculty of Medicine, Prince ofSongkla University, Hat Yai, Songkhla, Thailand.
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Beji S, Fatma LB, Chebbi A, Rais L, Krid M, Smaoui W, Maiz HB, Zouaghi K, Moussa FB. A case of exorbitism in association with Wegener's granulomatosis with renal involvement. Saudi J Kidney Dis Transpl 2012; 23:330-333. [PMID: 22382229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis involving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glomerulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bilateral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.
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Affiliation(s)
- S Beji
- Department of Nephrology, La Rabta Hospital, Tunis, Tunisia.
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Seoane Cruz I, Penín Álvarez M, Rodríguez Ferro F, Luna Cano R. [Unilateral exophthalmos and hypothyroidism]. Endocrinol Nutr 2012; 59:217-218. [PMID: 22154579 DOI: 10.1016/j.endonu.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/04/2011] [Accepted: 09/01/2011] [Indexed: 05/31/2023]
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Azoulay T, Jongh O. [Extraocular myositis and comparative pathology: two case reports in the dog]. J Fr Ophtalmol 2011; 34:737.e1-5. [PMID: 21658791 DOI: 10.1016/j.jfo.2011.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/13/2011] [Accepted: 01/18/2011] [Indexed: 11/20/2022]
Abstract
Two cases of extraocular myositis in dogs are reported in a golden retriever and an Australian shepherd. This condition is characterized by sudden bilateral exophthalmos, the absence of pain and third eyelid protrusion, orbital sonography showing the enlargement of extraocular muscles, and a quick response to systemic steroids at an anti-inflammatory dose. The literature review reports a breed predisposition in the golden retriever, mainly in females. Histopathologic evaluations confirm the inflammation of one or several extraocular muscles. Chronic disease was also described. Canine extraocular myositis shows some resemblance to Graves ophthalmopathy but can better be compared to idiopathic orbital myositis. Both disorders are probably the consequence of an immune dysfunction that still has to be discovered.
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Affiliation(s)
- T Azoulay
- Service d'ophtalmologie, clinique vétérinaire des Halles, 28, rue du Faubourg-de-Saverne, 67000 Strasbourg, France.
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Siah WF, Guerin MB, Flitcroft I, Fulcher T. Surgical management of heavy eye phenomenon. Orbit 2010; 29:259-261. [PMID: 20812831 DOI: 10.3109/01676831003728767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Heavy eye phenomenon can be cosmetically unaccepted due to significant pseudoproptosis and hypotropia. We highlight the salient features of this condition, and report successful cosmetic outcome following a staged procedure comprising orbital decompression and horizontal recti surgery.
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Affiliation(s)
- We Fong Siah
- Institute of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland.
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Yardley AME, Sachdev N, Aburn NS. Unusual cause of presumed orbital cellulitis. Clin Exp Ophthalmol 2010; 38:321-2. [PMID: 20447132 DOI: 10.1111/j.1442-9071.2010.02243.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Imbrasienė D, Jankauskienė J, Stanislovaitienė D. Ultrasonic measurement of ocular rectus muscle thickness in patients with Graves' ophthalmopathy. Medicina (Kaunas) 2010; 46:472-476. [PMID: 20966620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED The aim of this study was to evaluate changes in extraocular muscle thickness and to assess its correlation with the degree of proptosis in patients with Graves' ophthalmopathy (GO). MATERIAL AND METHODS A total of 242 patients (207 females and 35 males) with Graves' ophthalmopathy were enrolled into the study (GO group). Their mean age was 53.83±14.49 years. In addition, we examined an age-matched (53.51±12.79 years) control group of 40 healthy persons. All the participants underwent ophthalmological examination, including eye protrusion measurement and ultrasonographic evaluation of extraocular muscles thickness. RESULTS The mean exophthalmos in the GO and control groups was 17.84±2.79 mm and 16.0±1.58 mm, respectively. The enlargement of inferior rectus muscle was recorded in 92.1% of patients, lateral rectus muscle in 81.2%, and medial rectus muscle in 50.8% (P<0.001). A significant correlation between exophthalmos and muscle thickness sum was found in the GO group (Spearman correlation coefficient, 0.515; P<0.0001). CONCLUSIONS Graves' ophthalmopathy is more frequent in medium-aged women than men. A significant enlargement of inferior, lateral, and medial straight muscles was noticed in the GO group. With increasing proptosis, the sum of the muscle thickness was increasing, and exophthalmos moderately correlated with muscle thickness sum.
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Affiliation(s)
- Daiva Imbrasienė
- Institute for Biomedical Research, Kaunas University of Medicine, Department of Ophthalmology, Eivenių 4, 50161 Kaunas, Lithuania.
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Bakshi J, Panda NK, Saravanan K, Vasishta RK, Sachdeva MUS. Cysticercosis: a rare cause of orbital infection. J Otolaryngol Head Neck Surg 2009; 38:E83-E86. [PMID: 19476757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Jaimanti Bakshi
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Tengroth B. A comparison between the measurements from Hertel's exophthalmometer and a new radio-photographic method, on an exophthalmic population. Acta Ophthalmol 2009; 42:855-63. [PMID: 5899950 DOI: 10.1111/j.1755-3768.1964.tb01737.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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42
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Zhang ZY, Zhang Y, He Y, An JG. [Measurement of the globe proptosis by CT and its accuracy in patients with unilateral orbital fracture]. Zhonghua Zheng Xing Wai Ke Za Zhi 2009; 25:169-172. [PMID: 19803193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the accuracy of measurement of the globe proptosis by CT in patients with unilateral orbital fracture. METHODS 25 patients with unilateral orbital fracture were included. CT was performed before and after operation. The globe proptosis on the unaffected side was measured before and after operation by using Hertel exophthalmometer (HE), CT images with orbital lateral rim (OLR) and the optic nerve foramen (ONF) as reference points. The accuracy was evaluated comparably by statistical analyses. RESULTS The preoperative and postoperative average globe proptosis were (13.9 +/- 3.1) mm and (12.5 +/- 2.2) mm in HE group, (16.1 +/- 2.6) mm and (15.7 +/- 2.3) mm in the OLR group, (45.3 +/- 4.8) mm and (46 +/- 3.9) mm in the ONF group, showing a significant difference between the pre-and post-operative results in HE group, but not in OLR and ONF groups. CONCLUSIONS CT measurement with the orbital lateral rim as reference point is more reliable than Hertel exophthalmometer measurement for globe proptosis.
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Affiliation(s)
- Zhi-Yong Zhang
- Outpatient Department, Peking University School and Hospital of Stomatology, Beijing 100034, China
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Braverman I. Pneumocele of the maxillary sinus with orbital and trigeminal nerve involvement: case report and review of the literature. J Otolaryngol Head Neck Surg 2009; 38:E35-E38. [PMID: 19442351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Itzhak Braverman
- Otolaryngology-Head and Neck Surgery Unit, The Hillel Yaffe Medical Center, Hadera, Israel.
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Borkar SA, Kasliwal MK, Sinha S, Sharma BS. MR imaging in aneurysmal bone cyst of the orbit. Turk Neurosurg 2008; 18:183-186. [PMID: 18597234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Aneurysmal bone cyst is a benign fibro-osseous lesion usually described in the long bones. Intraorbital aneurysmal bone cyst is a rare clinical entity with an entirely different outcome and prognosis as compared to the usual pediatric orbital tumors. The authors report magnetic resonance imaging (MRI) features of an orbital mass lesion in a 4-year-old child who presented with painless proptosis of right eye. Characteristic MRI findings led to a suspicion of an aneurysmal bone cyst that was totally excised via a right frontotemporal craniotomy. Appreciation of characteristic MRI features can be of extreme help for appropriate diagnosis and management of this rare entity.
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Affiliation(s)
- Sachin Anil Borkar
- Department of Neurosurgery, Neuroscience Centre All India Institute of Medical Sciences, New Delhi, India
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Brovkina AF, Iatsenko OI, Aubakirova AS. [Computed tomographic anatomy of the orbit in the view of a clinician]. Vestn Oftalmol 2008; 124:11-14. [PMID: 18318201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The paper deals with the examination of computed tomograms of 72 patients (90 orbits), including 29 males (36 orbits) and 43 females (54 orbits), who had no any orbital pathology. The patients' age ranged from 34 to 65 years. Data on the volume of the bony orbit and its soft tissue contents are given. The dimensions of the transversal opening to the orbit and its depth are shown. The volumes of all the ocular muscles (extraocular muscles, the elevator muscle of the upper eyelid), optic nerve, eyeball, and ocular fat are separately calculated. These indices may be used for both the differential diagnosis of true exophthalmos and pseudoexophthalmos and the planning of any orbital surgery.
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Paza AO, Farah GJ, Passeri LA. Traumatic carotid cavernous fistula associated with a mandibular fracture. Int J Oral Maxillofac Surg 2007; 37:86-9. [PMID: 17822873 DOI: 10.1016/j.ijom.2007.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 05/04/2007] [Accepted: 06/14/2007] [Indexed: 10/22/2022]
Abstract
Carotid cavernous sinus fistula is an abnormal vascular interconnection between a branch of the carotid artery and the cavernous sinus. This is an uncommon complication of craniofacial injuries, as it occurs in only 0.17-0.27% of cases, according to the literature. The differential diagnosis should include superior orbital fissure syndrome, orbital apex syndrome, orbital haematoma and cavernous sinus thrombosis. The case is reported of an 18-year-old white woman who was involved in a motor vehicle accident. Clinical examination revealed only mandibular fractures, with the absence of skull-base, mid-face or any other fractures. Two days after the trauma, her condition deteriorated, and extraocular movements were totally absent. Magnetic resonance angiographic scanning was performed, and a carotid cavernous sinus fistula was found. This was treated by embolization resulting in restoration of eye movement and vision.
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Affiliation(s)
- A O Paza
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Campinas, São Paulo, Brazil
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Abstract
Thyroid dysfunction, particularly hypothyroidism, following interferon-alpha therapy is not uncommon. To our knowledge, this is the first case report of exacerbation of Graves ophthalmopathy during treatment with interferon-alpha for chronic hepatitis C virus.
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Giuliari GP, Cortez MA. Acute myeloid leukemia presenting as unilateral proptosis. Can J Ophthalmol 2007; 42:150-1. [PMID: 17361267 DOI: 10.3129/can] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Kim IK, Kim JR, Jang KS, Moon YS, Park SW. Orbital abscess from an odontogenic infection. ACTA ACUST UNITED AC 2007; 103:e1-6. [PMID: 17178478 DOI: 10.1016/j.tripleo.2006.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 06/03/2006] [Accepted: 07/10/2006] [Indexed: 11/25/2022]
Abstract
An orbital abscess is a rare but serious complication of an odontogenic infection, which can lead to loss of vision or worse. This paper presents a case of orbital abscess secondary to an infection from the upper molar teeth, which extended to the retobulbar and posterosuperior region of the orbit, close to the superior orbital fissure. The infection spreaded to the pterygopalatine and infratemporal fossa and then to the orbit via the inferior orbital fissure. This paper reviews the clinical presentation, differential diagnosis, route of spread, value of serial CT scanning, treatment and possible complications.
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Affiliation(s)
- Il-Kyu Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Inha University, Choong-Gu, Incheon, Korea.
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