Multidisciplinary Orbital Tumors

Advances in Ophthalmology and Optometry · 2024-03-06

Hemorrhage Following Muller’s Muscle Conjunctival Resection: Description and Case-Control Study

Ophthalmic Plastic and Reconstructive Surgery · 2024-01-25 · 3 citations

PURPOSE: The purpose of this study was to report a series of patients with postoperative hemorrhage after Muller's muscle conjunctival resection surgery and compare risk factors and outcomes with a control population. METHODS: In this case-control study, records of patients who underwent Muller's muscle conjunctival resection over 5 years were reviewed for a history of postoperative hemorrhage occurring >24 hours after surgery. A 4:1 control population was matched for age and sex. Clinical data collected included demographics, medical history, medications, and subsequent surgery. Preoperative and 3-month postoperative marginal reflex distance 1 were measured digitally using ImageJ. The hemorrhage and control groups were compared using Fisher's exact tests for categorical variables and independent samples t tests for continuous variables. RESULTS: The hemorrhage group contained 10 patients (mean age 66.4 ± 18.5 years). The control group consisted of 40 age and sex-matched controls. Of 350 charts reviewed, there were 10 cases of postoperative hemorrhage (incidence 2.9%). Hemorrhage occurred a mean of 4.2 ± 1.3 (range 2-7) days after surgery and lasted for a mean of 29.3 ± 19.1 (range 12-72) hours. In all 10 cases, the bleeding resolved with conservative measures. There was no difference between the hemorrhage and control groups in terms of medical conditions, blood thinners, and surgical revision. Preoperative, postoperative, and change in marginal reflex distance 1 did not differ between the hemorrhage and control groups. CONCLUSIONS: Hemorrhage occurs approximately 4-5 days postoperatively in a small percentage of patients undergoing Muller's muscle conjunctival resection surgery. This investigation did not identify any consistent risk factors, and outcomes in this patient population appear no different than controls.

Exoscopic Repair of Orbital Meningoencephalocele Causing Pulsatile Proptosis: A 2-Dimensional Operative Video

Operative Neurosurgery · 2024-12-16

A Minimally Invasive Endoscopic Transnasal and Transorbital Approach to Sinonasal Tumor Resection

The Laryngoscope · 2023-08-22 · 1 citations

A 35-year-old female with an extensive biphenotypic sinonasal sarcoma (BSNS) eroding through the left frontal sinus into the orbit required gross total resection of the tumor. We wanted to forgo an open approach and provide a less invasive alternative via combined endonasal and transorbital endoscopic techniques to allow for tumor removal through small, well-disguised incisions. We utilized three portals—nasal, transorbital, and anterior table window—to create interconnected orbit–sinonasal corridors, thus generating alternate pathways for visualization and manipulation of this extensive tumor. Laryngoscope, 2023 Daniel Rootman, MS, MD, is a consultant for Horizon Pharmaceuticals and a member of the Speakers Bureau. Daniel Beswick, MD, is a consultant for Garner Health. The remaining authors have no conflicts of interest and nothing to disclose.

725 A multicenter retrospective analysis of the clinical efficacy of elexacaftor-tezacaftor-ivacaftor in people with cystic fibrosis and advanced lung disease: a follow-up study after 2 years of treatment

Journal of Cystic Fibrosis · 2023-10-01

MALT Lymphoma Presenting as Symptomatic Optic Neuritis: A Case Report (P14-13.001)

Neurology · 2023-04-25 · 1 citations

<h3>Objective:</h3> To report a case of MALT lymphoma presenting as optic neuritis and highlight its inherent diagnostic challenges. <h3>Background:</h3> Optic neuritis (ON) is the inflammation of the optic nerve associated with multiple sclerosis,. ON with atypical clinical features require thorough evaluation. Primary ocular adnexal lymphomas are the most common orbital tumors, and IgG4-related ocular disease also presents with optic neuropathy and consists of morphologically similar immune infiltrates. Their diagnoses are challenging as corticosteroids can incur non-diagnostic biopsies, complicating further workup. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 51-year-old healthy African American woman presented with one month of progressive left monocular blurry vision, color desaturation and_pain. Exam showed left visual acuity of 20/60, afferent pupillary defect, and 0/13 Ishihara plates identified in left eye. Remainder of exam was intact. MRI demonstrated left optic nerve sheath enhancement and enlargement. Another enhancing lesion was identified in the right inferior orbit. Despite visual impairment, corticosteroids were deferred prioritizing diagnostic tests. Workup was negative for autoimmunity, systemic neoplasm, and infection. CSF showed a bland profile without malignant cells. Serum and CSF IL2 receptor levels returned normal. Oligoclonal bands and IgG were elevated in serum and CSF; IgG4 levels were high at 156, raising concern for IgG4-related ocular disease. Right intra-orbital mass biopsy demonstrated atypical CD20+ lymphoid infiltrates with rare germinal centers, but &lt;10% plasma cells expressed IgG4. Further molecular analysis was positive for monoclonal IgH gene rearrangement, diagnosing mucosa-associated lymphoid tissue (MALT) lymphoma in the right orbit and probable left optic nerve involvement. She was initiated on bendamustine and rituximab with stabilization of her ocular symptoms. <h3>Conclusions:</h3> Atypical presentations of ON warrant thorough workup. IgG4-related ocular disease and ocular adnexal MALT lymphoma share similarities that require histologic and molecular analysis to differentiate. Early identification of MALT lymphoma is crucial to initiate proper therapies, maintain disease control, and preserve visual acuity. <b>Disclosure:</b> Dr. Jia has nothing to disclose. Ms. Wyckoff has nothing to disclose. Dr. Cohen has nothing to disclose. Dr. Bryar has nothing to disclose. Dr. Lukas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck and Company, Inc.. Dr. Lukas has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck and Company, Inc.. Dr. Lukas has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novocure. Dr. Lukas has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO. Dr. Lukas has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Neurology. Dr. Lukas has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Lukas has received research support from BMS. The institution of Dr. Lukas has received research support from BrainUp. The institution of Dr. Lukas has received research support from National Cancer Institute. The institution of Dr. Lukas has received research support from National Cancer Institute. The institution of Dr. Lukas has received research support from Ziopharm. Dr. Dixit has nothing to disclose.

Extrascleral extension of choroidal melanoma after iodine-125 brachytherapy treatment: a case series

Eye · 2022-01-05

External carotid artery to ophthalmic artery flow associated with internal carotid artery stenosis

Orbit · 2022-12-05 · 2 citations

Purpose One of the most devastating complications of facial filler injection is sudden ischemic blindness. However, its mechanisms and predisposing factors are poorly understood. The purpose of this study was to investigate the prevalence of external carotid artery (ECA) to ophthalmic artery (OA) anterograde flow in patients with internal carotid artery (ICA) stenosis and in a control population without carotid disease.Methods In this cross-sectional cohort study, two groups of patients who underwent catheter cerebral angiography over a 5-year period were identified: patients with symptomatic ICA stenosis and a control group of patients with refractory epistaxis undergoing embolization. Angiograms were reviewed by an interventional neuroradiologist. The primary outcome measure was the presence of ECA to OA flow, defined as choroidal blush before filling of the circle of Willis. Secondary outcome measures included the percentage and location of ICA stenosis and ECA anastomotic branches involved.Results The study included 149 patients with ICA stenosis and 69 control patients. ECA to OA flow was more prevalent in patients with ICA stenosis (34.9%) compared to controls (2.9%) (p < .001). Logistic regression demonstrated that for each 10% increase in ICA stenosis over 70%, there was 2.8 times increased risk of ECA to OA flow (p < .001).Conclusions ECA to ICA anterograde flow can be demonstrated in approximately 3% of control patients and in over 1/3 of patients with symptomatic carotid stenosis. This provides a plausible pathway for small filler particles to pass with blood flow from the facial to the ophthalmic circulation.

Real-World Cost and Utilization Analysis of Botulinum Toxin Agents in Blepharospasm: A National Retrospective Cohort Study

Toxicon · 2022-07-01

Orbital Vascular Malformations: Determining Outflow with Valsalva Maneuver-Augmented Computed Tomography Angiography

Ophthalmology · 2022-01-11 · 4 citations