ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo determine the efficacy of transcaruncular approach orbital apex decompression for treatment of dysthyroid optic neuropathy.MethodsIn this retrospective noncomparative interventional case series, charts for all patients undergoing orbital decompression surgery for dysthyroid optic neuropathy performed by one author between October 1999 and September 2001 were included in the study. Primary outcome measures included visual acuity, static perimetry, pupillary testing, and color plate testing before and after surgery. Records were also reviewed for changes in extraocular motility and proptosis after surgery and for surgical complications.ResultsSixteen consecutive patients (6 unilateral, 10 bilateral, for a total of 26 cases) underwent orbital apex decompression for dysthyroid optic neuropathy through a transcaruncular approach. In each orbit, the optic neuropathy was refractory to oral corticosteroid therapy. Preoperative visual acuity remained stable or improved in each case. Preoperative Humphrey visual field testing revealed an average mean deviation of −10.3 ± 6.5 (range, +0.76 to −25.45). Average postoperative mean deviation was −2.79 ± 2.4 (range, +0.94 to −9.82). Before surgery, 7 of 23 eyes (30%) had full color plates. After surgery, 22 of 23 eyes (96%) had full color plates. Follow-up ranged from 2 to 26 months (mean, 10 months). New-onset diplopia developed in 2 of 10 (20%) patients without preexisting diplopia.ConclusionsTranscaruncular approach orbital apex decompression effectively treats dysthyroid optic neuropathy.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo review the clinical features and management of patients with orbital roof fractures.MethodsNon-comparative, retrospective case review of 21 patients presenting with orbital roof fractures.ResultsThe orbital roof fractures in our series resulted from motor vehicle accidents, blunt trauma, head injuries, and penetrating orbital injuries. Associated orbital and ocular injuries included other ipsilateral orbital fractures (16 cases), traumatic optic neuropathy (3 cases), ptosis (2 cases), perforating eye injuries (2 cases), intraorbital foreign bodies (2 cases), and oculomotor nerve palsy (1 case). Six patients required surgical intervention for ophthalmic sequelae, which included motility problems (4 cases), lagophthalmos (1 case), and a retained intraorbital foreign body with a cerebrospinal fluid leak (one case). The outcome of surgery was favorable in all cases, with complete resolution of symptoms in five of six patients.ConclusionsOrbital and ocular injuries are common in association with orbital roof fractures. A multidisciplinary approach to management is required because facial and cerebral injuries are also common. Most patients can be managed conservatively. The specific ophthalmic indications for surgical intervention are limited, but the outcome in these cases is gratifying.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo evaluate complications and risk factors associated with the placement of wrapped and unwrapped porous polyethylene (PP) spherical implants after evisceration, enucleation, or secondary implantation.MethodsA retrospective, interventional, noncomparative case series of consecutive cases of PP implant placement after anophthalmic socket surgery performed by three surgeons over a 5-year period. A PP spherical implant was placed in 133 patients, 61 women (2 bilaterally) and 72 men (1 bilaterally). There were 91 enucleations, 30 eviscerations, and 15 secondary implant placements. Sixty-six (48.5%) implants were wrapped prior to placement. Parameters evaluated included: age, sex, prior ocular surgery or radiation treatment, indications for surgery, procedure performed, size of PP sphere, material used to wrap the implant, and complications.ResultsA total of 17 of 136 (12.5%) cases had documented postoperative complications, with implant exposure being the most common. In 5 patients (3.7%), implant exposure developed: 1 after evisceration and 4 after primary enucleation. Three of the five exposures were small and resolved with either observation alone or in one case with surgical revision of the socket. In two cases, the exposures were large enough that removal of the implant was indicated, one after evisceration and the other after enucleation with placement of a wrapped PP sphere.ConclusionsOur series revealed no significant difference in exposure rate between wrapped and unwrapped PP sphere implants, nor was the exposure rate affected by whether an eye was eviscerated or enucleated.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo describe the clinical and morphologic features of patients with orbital xanthogranuloma (XG) with or without Erdheim-Chester disease (E-Cd).MethodsRetrospective, noncomparative case series. A review of 8 consecutive histopathologically proven cases of orbital XG from 3 medical centers. Four male and four female patients with ages ranging from 23 to 79 years presented with 4 bilateral and 4 unilateral orbital XGs.ResultsAge at diagnosis, ocular and systemic manifestations, histopathologic and radiologic features, type of treatment, and prognosis were evaluated for each patient. Six of 8 patients had proptosis and 2 presented with afferent pupillary defect and severe extraocular motility limitations. Other signs and symptoms included eyelid retraction, mechanical ptosis, and chemosis. Planar xanthomas of eyelids were present in 3 individuals. CT and MRI showed infiltrating soft tissue masses within the orbit in 7 and 2 patients, respectively. Histopathology revealed proliferation of foamy histiocytes intermingled with Touton and multinucleated giant cells and lymphocytes. The absence of Birbeck granules within the histiocytic elements of the tumor, indicating that the cell of origin is a non-Langerhans histiocyte, was documented with electron microscopy in 3 cases. The most common treatment was surgical excision combined with oral corticosteroids. Two patients with E-Cd with involvement of the long bones of the upper and lower extremities and retroperitoneal region died of kidney failure within approximately 1 year of diagnosis.ConclusionsOrbital XG is a proliferative lesion of the non-Langerhans histiocytes, which may present as a solitary orbital lesion or may be associated with a systemic condition known as E-Cd with very poor prognosis.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeTo describe the distinct clinical, radiologic, and histopathologic findings of orbitofrontal cholesterol granuloma and treatment approaches. We also present 2 atypical cases of cholesterol granuloma, one of which we believe represents the smallest and one of which the most extensive lesion among the previously reported cases in the literature.MethodsThe records of 8 patients with orbital cholesterol granuloma were reviewed retrospectively.ResultsMean age at presentation was 45 years. Six of 8 patients were male. The most common symptom at presentation was proptosis (50%). Computerized tomography of orbits showed a lytic lesion in the superolateral bony orbit with an extraconal soft tissue mass in 2 patients and a cystic lesion eroding the superolateral orbital roof in 4 patients. One patient had a small lytic lesion in the frontal bone without associated soft tissue mass and one patient had a very large destructive mass with extensive intracranial and orbital extension. Magnetic resonance imaging was obtained in 2 patients and showed a non–contrast-enhancing lesion with high signal intensity on both T1- and T2-weighted images. Seven patients were treated by aspiration of the contents and curettage of the lining by an extraperiosteal approach through a subbrow incision. One patient who was clinically thought to have a frontal mucocele was treated by frontal sinus exploration, removal of the lesion, and obliteration of the sinus. Two of 7 patients required lateral orbitotomy for better exposure of the tumor. Only one patient had recurrent symptoms and required a second surgery.ConclusionsOrbitofrontal cholesterol granulomas have typical clinical and radiologic features. Surgical excision has a high success rate with a low incidence of recurrence.

ISSN:0740-9303    

出版商:OVID    

年代:2003

数据来源: OVID