Archives of Ophthalmology
Deep Orbital Sub-Q Restylane (Nonanimal Stabilized Hyaluronic Acid) for Orbital Volume Enhancement in Sighted and Anophthalmic Orbits
Objective: To describe a new technique of injecting Restylane Sub-Q (Q-Med, Uppsala, Sweden) into the intraconal and extraconal posterior orbit.
Methods: Retrospective review. Eight injections were performed in 5 patients using 2-mL Sub-Q in the intraconal and extraconal posterior orbit for orbital volume enhancement. Four injections were performed in sighted orbits and the remaining in anophthalmic orbits. The age range was 18 to 36 years; the follow-up time was 5 to 12 months.
Results: Orbital volume enhancement was achieved in all cases with an improvement in upper eyelid sulcus and skin fold. Enophthalmos reduction was 2 mm per 2-mL injection. The procedure was well tolerated. One patient experienced a vasovagal episode lasting 3 hours and 1 patient had postoperative pain. No such episodes occurred after I began injecting local anesthesia before performing the Sub-Q injection. One patient required hyaluronidase for migrating gel, which caused lower eyelid swelling.
Conclusion: This small case series suggested the safety and tolerability of deep orbital Sub-Q. Injections are easily performed in the outpatient setting. The expected volume enhancement was achieved in all cases with no long-term adverse effects to date.
Malhotra R
2007;125(12):1623-1629
Archives of Ophthalmology
Long-term Risk of Recurrence After Intact Excision of Pleomorphic Adenomas of the Lacrimal Gland
Objective: To ascertain the need for follow-up after excision of pleomorphic adenoma of the lacrimal gland.
Methods: Medical records were reviewed for 133 patients and only those patients with 5 years or more of follow-up were classified into the following 5 subgroups: those with intact excision (group IA, n = 46), those with surgically intact excision but areas of complete attenuation of the pseudocapsule at histologic analysis (group IB, n = 7), those with previous inadvertent incisional biopsy (group IIA, n = 9), those with breach of the pseudocapsule during attempted intact excision (group IIB, n = 5), and those undergoing definitive surgery because of tumor recurrence after previous incomplete excision (group III, n = 5).
Results: Seventy-two patients were followed up longer than 5 years; there were no known tumor recurrences among 61 patients excluded with shorter follow-up. Patients in groups IA and IB exhibited no tumor recurrences at 8.2 to 34.1 years of follow-up. A benign recurrence occurred along the superior orbital fissure in 1 patient in group IIA 12
years after the initial surgery and was resected. There were no recurrences in patients in groups IIB or III.
Conclusions: Discharge would seem justified after intact excision of lacrimal gland pleomorphic adenoma, even when histologic examination shows extreme attenuation of the pseudocapsule. Long-term follow-up is, however, necessary when there has been tumor disruption, either inadvertently during previous biopsy or by capsular breach during definitive excision.
Currie ZI, Rose GE
2007;125(12):1643-1646
Archives of Ophthalmology
Noninvasive Dynamic Magnetic Resonance Angiography With Time-Resolved Imaging of Contrast KineticS (TRICKS) in the Evaluation of Orbital Vascular Lesions
Objective: To evaluate the clinical utility of time-resolved contrast-enhanced magnetic resonance angiography (MRA) in the evaluation of vascular orbital tumors.
Methods: Retrospective medical record review of patients with vascular orbital lesions imaged with Time-Resolved Imaging of Contrast KineticS (TRICKS; GE Healthcare [Chalfont St Giles, England]) MRA, a noninvasive dynamic imaging modality.
Results: Five patients with orbital vascular tumors were evaluated using TRICKS MRA. These included 1 patient with a cavernous hemangioma, 2 patients with orbital varices, 1 patient with an orbitocutaneous arteriovenous malformation, and 1 patient who had a solitary fibrous tumor with features of a hemangiopericytoma. In 2 patients, diagnoses were altered as a result of TRICKS MRA. In addition, a young patient with a large orbitocutaneous arteriovenous malformation involving the ophthalmic artery was followed perioperatively and noninvasively usingTRICKS MRA, which produced exquisite images and added substantial value in the care of these patients.
Conclusion: Dynamic MRA in the form of TRICKS is a newly available imaging modality with great potential for improving the evaluation and management of patients with complex orbital tumors.
Kahana A, Lucarelli MJ, Grayev AM, Van Buren JJ, Burkat CN, Gentry LR
2007;125(12):1635-1642
Archives of Ophthalmology
Orbital and Adnexal Sarcoidosis
Objective: To present the clinical features and management in a series of patients with orbital and adnexal sarcoidosis.
Methods: This multicenter retrospective study included patients with biopsy-proven noncaseating granuloma involving the orbit or adnexa and evidence of systemic sarcoidosis. Clinical records were reviewed for initial examination findings, radiological findings, treatment modalities, and outcome.
Results: The study included 26 patients (19 female, 7 male; mean age, 52 years). The most common feature at the first examination was a palpable periocular mass followed by discomfort, proptosis, ptosis, dry eye, diplopia, and decreased vision. The disease affected the lacrimal gland (42.3%), orbit (38.5%), eyelid (11.5%), and lacrimal sac (7.7%). Among orbital lesions, the antero-inferior quadrant was preferentially involved. Treatment modalities included steroids, surgical debulking, and methotrexate. During a mean follow-up of 18.75 months, 84.6% of patients showed a complete response to the treatment, but 19.2% of patients developed further signs of sarcoidosis.
Conclusions: Orbital soft tissue involvement is more common in patients older than 50 years and in women. The anterior inferior quadrants of the orbits appear to be preferentially affected. Although a good response to treatment with oral steroids is seen, long-term follow-up is recommended because active systemic disease can develop months to years later.
Prabhakaran VC, Saeed P, Esmaeli B, et al
2007;125(12):1657-1662
