Supero-lateral orbitotomy for resection of spheno-orbital meningioma: a case report.

Spheno-orbital meningioma have traditionally been defined as secondary tumors of the orbit originating from the dura of the sphenoid wing bone. Nevertheless, pathologic findings reveal a distinct periorbital component as a defining feature of these lesions. These tumors are characterized by an intraosseous mass growth leading to a significant hyperostosis involving the sphenoid wing, the orbital roof, the lateral orbital wall and the middle fossa cranial base and to a thin, usually soft-tissue growth at the dura. We report here on the extension of the primary tumor into the orbital cavity and present the surgical approach performed.

Retinal detachment and convexity intracranial meningioma: an uncommon association.

CASE REPORT: A 70-years-old woman presented with a one week history of progressive loss of vision in the right eye (RE) diagnosed as retinal detachment from 7 to 1 o' clock with retinal break at the 10.30 o' clock associated. Gadolinium enhanced magnetic resonance imaging (MRI) scan of the brain and orbits with fat suppression showed a convexity meningioma. Scleral buckling with a segmental sponge, subretinal fluid drainage and cryopexy were performed with detachment repair. CONCLUSION: In our patient with retinal detachment and convexity meningioma without significant neurological symptoms, performing ocular surgery and close follow up care seemed to be the optimal treatment option.

Pterygomaxillary extension of orbital pseudotumor. Case report.

Idiopatic pseudotumor (IP) is a non-specific, non-neoplastic, inflammatory process without identifiable local or systemic causes. IP most commonly affects the orbit, comprising 5% to 8% of all orbital masses with occasional extension to other areas of the skull base. The ophthalmology literature has detailed reviews of IP as a space-occupying intraorbital lesion, but lesion involving only the skull base and sparing the orbit is exceptional. Understanding the presentation, work-up, and characteristics of the lesion is important for proper diagnosis and treatment. We report a rare case of orbital IP with extension into infratemporal fossa. Clinical and radiological findings and surgical approach are discussed.

Benign orbital pseudolymphoma. Case report.

Orbital pseudolymphomas are uncommon benign tumors composed of reactive lymphocytes. The typical clinical presentation is painless onset of ptosis, proptosis, diplopia, or eyelid swelling. Virtually any adnexal structure can be affected, but lacrimal gland, orbital soft tissue, or extraocular muscles are the usual sites of involvement. Historically, treatment has been with oral corticosteroids or localized radiotherapy. We present a case of benign orbital pseudolymphoma.

Ocular manifestations of chronic graft-versus-host disease in patients treated with extracorporeal photochemotherapy.

PURPOSE: Eye involvement has long been appreciated in patients with chronic graft versus host disease (cGVHD). In particular, ocular complications are frequent and can be potentially severe in patients with steroid-refractory cGVHD, and therefore necessitate close monitoring. This prospective study was designed to describe eye manifestations of cGVHD in a large series of patients monitoring them before and after 1 year of extracorporeal photochemotherapy (ECP). ECP is a relatively new therapeutic approach based on the biological effects of psoralen 8-methoxypsoralen (8-MOP) and ultraviolet A light (UVA) on mononuclear cells collected by apheresis, and reinfused into the patient. METHODS: Only patients with steroid-refractory cGVHD under treatment with ECP, who developed cGVHD-related eye symptoms, were selected for the study. Ophthalmologic examination was repeated every 3 months. Only patients with complete recovery of the ocular manifestations and symptoms were considered responsive. RESULTS: In our study we observed eye alterations in 24 out of 140 patients (17%) with cGVHD. After 12 months of ECP, 10 out of 21 patients (48%) completely responded to the therapy. In all these cases the contribution of ECP was also essential in all the other organs subject to cGVHD. CONCLUSIONS: Further studies are necessary to clarify the role of ECP in patients with cGVHD, especially in associated eye manifestations. Although our experience is limited, it suggests that ECP could be a safe and effective therapy for steroid-refractory eye manifestations of cGVHD.

Cell composition and immunohistochemical detection of VEGF, TGF-beta, and TNF-alpha in proliferative vitreoretinopathy.

Formation of vascularized membranes inside the vitreous leads to retinal detachment and blindness. In this paper it is shown that vitreal membranes are composed of newly formed vessels and myofibroblasts, immersed in a loose stroma with sparse histocytes. Vascular endothelial growth factor (VEGF) is clearly present in cellular constituents of the membranes and, therefore, represents a fundamental cytokine in their formation, while transforming growth factor-beta (TGF-beta) and tumor necrosis factor-alpha (TNF-alpha) are not. Considering that the composition of vitreal membranes clearly resembles scar tissue, the absence of TGF-beta in the membranes could explain their peculiar histological appearance.

A rare association of myasthenia gravis and mitochondrial myopathy: a clinical, biochemical and morphologic study of one case.

Myasthenia gravis and mitochondrial myopathy may present with similar clinical symptoms as inconstant palpebral ptosis, ophthalmoparesis, and muscle weakness. A few case initially diagnosed as myasthenia gravis by a positive decremental response on EMG and successful anticholinesterase therapy revealed to be affected by mitochondrial disease. We report a new case initially found to be affected by myasthenia gravis in whom muscle biopsy, performed because of symptom worsening, disclosed a mitochondrial myopathy. It is not clear if the association of mitochondrial myopathy and myasthenia gravis is coincidental or if there is a pathogenic link between the two pathologies. We suggest that muscle biopsy should be performed in cases with atypical myasthenia gravis signs.

Ultrasonographic features and patterns of regression after conservative treatment of retinoblastoma.

The authors analyze the echographic features relative to some cases of retinoblastoma treated with conservative therapy in order to monitor the regression of the tumor consequent to the treatment.

Imaging techniques in the diagnosis of lacrimal sac diverticulum.

Lacrimal sac diverticulum is a rare condition characterized by a cystic structure communicating with the sac. This abnormality may be directly demonstrated by dacryocystography only in a few cases; in the remaining cases, preoperative diagnosis may be arduous. We report 3 cases of lacrimal sac diverticulum. In all patients, symptoms were represented by a palpable mass in the lacrimal sac region, associated with permanent (case 1) or episodic (cases 2 and 3) epiphora. In the first case, CT-dacryocystography revealed an apparently solid mass causing inferior lacrimal obstruction, and ultrasonography disclosed a cystic space, not communicating with the sac. At surgery, a sac diverticulum was identified and excised. In the second patient, CT showed a homogeneous rounded mass, whereas a cystic character was revealed by T1-weighted MRI. Dacryocystography showed a lateral impression on the lateral wall of the sac. Ultrasonography revealed a cystic space communicating with the lacrimal sac. In the third case, ultrasonography demonstrated a diverticulum. CT is often unable to discriminate tumors from lacrimal cysts, both showing a parenchymal density. MRI can differentiate lacrimal cystic spaces from solid tumors by T1 intensity and by demonstration of their walls, but it is nonspecific for diverticula. Only dacryocystography and B-scan ultrasonography can reveal the narrow communication between the sac and the diverticulum. Observation is the recommended management for asymptomatic cases.

[Primary malignant melanoma of the orbit A- and B-scan echographic characteristics]. / Melanoma maligno primitivo dell'orbita: caratteristiche ecografiche A e B-scan.

Authors describe the echographic characteristics A and B-scan of a malignant primitive melanoma of the orbit and the diagnostic difficulties. In fact we do not have, in the scientific literature, abstracts with an echographic description. The A-scan shows us a characteristic pattern: a frontal big echo followed from many lessing echoes not returning to the zero line; finally a big closing echo. The B-scan shows us a neoformation of regular aspect with clear limits, dishomogeneous inside, near the ocular bulb. The echographic pattern is construed like a cystic neoformation because of the final echo and the good echographic transmission. This pattern is very similar to the echographic aspects of the choroideal malignant melanoma.

[Echographic profile of senile disciform macular degeneration and problems of differential diagnosis]. / Profilo ecografico della degenerazione disciforme senile della macula e problemi di diagnosi differenziale.

Authors describe the echographic characteristics A and B-scan of the disciform macular degeneration. They also examine the problems of an echographic differential diagnosis between the upper described pathological pattern and the melanoma of small dimensions growing from the posterior pole. With the B-scan, both pathological patterns show a zone of echoes which is of solid aspect, not so much raised from the retina. The only characteristic element is the choroideal excavation that we always have in the choroideal melanoma and never in the disciform macular degeneration. Even the A-scan is useful mostly if we reduce the amplification level we have a separation of the internal echoes better in the disciform macular degeneration than in the melanoma. Moreover in some cases when the pathological area is small, we cannot have an echographic differential diagnosis in order to recognize the lesion.

[Experimental triethyltin ocular hypertension. Pharmacological and histopathological studies (author's transl)]. / Experimenteller Triäthylzinn-Augenüberdruck. Pharmakologische und histopathologische Prüfungen.

The experiments were prompted by the need felt in pharmacology of eyes with hypertension of easy availability, rather long duration and fairly constant levels, to allow observation of the effects of hypotensive agents and to study their mechanism of action. Single doses of 1 mg Triethyltin, a substance producing a hydrodynamic compromission of the brain, were injected into the anterior chamber of rabbit eyes. A rise in ocular tension, beginning within 24 hours and lasting seven to ten days is obtained in about 70% of eyes. The pressure increase ranged from 12 to 30 mm Hg. Biomicroscopic and histologic examinations evidenced an uveitis-like reaction in the first week after treatment. Neoprene casts evidenced an impaired vascularization in the ciliary processes and choroid. Topical and parenteral administration of the most commonly used antiglaucomatous drugs showed how well this hypertension responded to hypotonizing agents. The occurrence of producing an ocular hypertension in the untreated fellow eye following repeated intra-cameral injections of small dosage (1 microgram) of Triethyltin, every two days for more than one month, in the other eye is described. Hypertension resulted in 40% of eyes.

Possibility of isoproterenol therapy with soft contact lenses: ocular hypotension without systemic effects.

An experimental investigation performed in the rabbit pointed out the possibility of administering isoproterenol at low concentrations with the aid of soft contact lenses presoaked in 0.2% isoproterenol for 60 to 120 minutes. A reduction in intraocular pressure ranging from 23% to 32% was observed in 21 out of 24 glaucomatous patients. Duration of hypotension in 50% of eyes treated was more than 8 hours. Thus, a therapeutic effect was obtained with a concentration (0.2%) approximately 50 times lower than that previously employed clinically (2.4%). No systemic side effects, such as arterial hypotension and increase in heart rate, were noted.

[Fluoroangiography of glaucomatous optic papilla]. / Considerazioni fluoroangiografiche della papilla ottica glaucomatosa.

Authors describe the fluoroangiography of the optic pupil in 15 patients who were suffering from chronic open-angle glaucoma and found a lessening of the fluorescence of the optic disk. It can be attributed to a hypoperfusion of the optic nerve. The results obtained and that is an constant ipofluorescein, even with different levels in relation to the type of glaucoma damage noticed, they look to support this etiopathogenetic hypothesis.

[Fluoroangiography of various pathological pictures in unusual observations of the anterior segment]. / La fluorangiografia di alcuni quadri patologici di insolita osservazione del segmento anteriore.

Fluorangiography is a very important investigation in order to have a differential diagnosis in all pathological pattern of the conjunctiva of scleral corneal limbus of the sclera of the iris of the ciliary-body. We have in the literature two different patterns: A) Fluorescein negative pattern (cystic neoformations, benign tumors with or without pigment) B) Fluorescein positive pattern (inflammatory pseudotumors, malignant tumors). Authors agree more or less with this classification; they have, moreover, worked out some variations. In our case of a localised carcinoma, fluorescein positive, we did not observe less of fluorescein; in the iris melanoma, even this fluorescein positive, in all observed cases has shown only a small loss of fluorescein near his edges. In the other cases as in the leiomyoma and cystis we agree with the literature even with prudence.

Fluorescein retinal angiography in the early diagnosis of optic disc edema.

33 patients hospitalized for suspected intracranial space-occupying lesion with negative or dubious ophthalmoscopic findings underwent fluorescein retinal angiography (FRA). The final diagnosis was based on the clinical and instrumental evidence. In 18 patients FRA showed late fluorescence of the optic disc with blurring of its margins. 17 of them had an intracranial space-occupying lesion and 1 had had a transient attach of cerebral ischemia. The FRA was negative in 15 patients: in 13 the final diagnosis ruled out raised intracranial space-occupying lesion. Comparison of the FRA results with the final diagnosis yields sensitivity, specificity and positive predictability ratings of 94.44, 92.85 and 94.44% for FRA.