Modified vertical lid split orbitotomy: a case series and literature review.

PURPOSE: To describe the modified vertical lid split (VLS) technique for anterior orbitotomy and report surgical outcomes in patients with intraconal lesion removal using this surgical technique. METHOD: Retrospective review of medical records and orbital images. RESULTS: A total of four (female = 3) patients with intraconal orbital lesions underwent modified VLS orbitotomy from January 1, 2019 to June 30, 2021 in Hong Kong East Cluster. The average age was 49.3 years old (range: 35-65). Complete excision of intraconal orbital lesion was performed in all four cases. All cases were cavernous haemangioma histologically. All patients were satisfied with their cosmesis postoperatively and most had satisfactory postoperative extraocular movement. CONCLUSION: Modified VLS approach is simple and provides good intraoperative surgical exposure for intraconal lesions, giving the additional advantage of better scar camouflage.

Acinetobacter baumannii-calcoaceticus Complex-associated Orbital Cellulitis: A Case Report and Literature Review.

Acinetobacter baumannii-calcoaceticus complex is emerging as one of the most common causes of hospital-acquired infection globally. We present a case of orbital cellulitis caused by the A. baumannii-calcoaceticus complex. A 73-year-old Chinese woman with a history of rheumatoid arthritis presented with subacute onset of right upper eyelid swelling for 1 week. Computer tomography revealed a post-septal soft tissue lesion located at the right superior orbit that was enhanced with contrast, compressing on the superior aspect of the globe. Anterior orbitotomy with incisional biopsy of the right superior orbital lesion was performed, and histopathological examination was consistent with nonspecific inflammatory mass. The microbiological culture of the specimen yielded A. calcoaceticus and A. baumannii complex, which was sensitive to ciprofloxacin, ampicillin, and gentamicin. The infection resolved after a 1-week course of intravenous augmentin. Ophthalmologists should be alert to the possibility of patients having A. baumannii and A. calcoaceticus in periorbital cellulitis.

Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications.

PURPOSE OF REVIEW: To review the current surgical practices in endoscopic endonasal dacryocystorhinostomy (EN-DCR) from the studies of last 12 months. RECENT FINDINGS: Success rates in EN-DCR now rival those of the conventional external approach. Indications are expanding beyond primary acquired nasolacrimal duct obstruction to include DCR revisions, acute lacrimal sac abscesses, nasolacrimal duct obstructions in patients who have received chemotherapy or radiation, and common canalicular obstructions. There is limited evidence that intubation with silicone stents improves the outcomes. Mitomycin C appears to improve the success rates of EN-DCR, especially revision surgery. Concomitant procedures, such as septoplasty and anterior middle turbinectomy, are sometimes required in primary as well as revision EN-DCR to achieve high success rates. There is increasing evidence that silicone stents are of limited benefit, whereas mucosal flap formation has been of benefit in case series. SUMMARY: With innovations and improvements in the endonasal approach, EN-DCR has become a viable alternative to external DCR for primary acquired nasolacrimal duct obstruction. EN-DCR has the distinct advantages of no surface scar and a lack of damage to the pump mechanism that often occur with external DCR. Recent evidence indicates a comparable success rate to external DCR.