Clinical profile and management outcomes among patients with Carotid-Cavernous Fistula

Background@#A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the internal carotid artery and/or the external carotid artery and the cavernous sinus. There is a paucity of information on the ophthalmic outcomes of endovascular treatment for CCF in the Philippines.@*Objectives@#This study aimed to describe the clinical experience of CCF in our institution in order to further our understanding of the disease. This study described the demographic profile, risk factors, and clinical features of patients with CCF, and compared the data of patients according to the type of CCF. The study discussed the changes in clinical features over time in CCF patients who chose not to undergo endovascular treatment. The study also discussed the clinical outcomes of CCF patients who underwent endovascular treatment and compared the clinical outcomes to CCF patients who did not undergo endovascular treatment.@*Methods@#A retrospective cohort study design was performed using a medical record review of patients clinically diagnosed with CCF from January 2011 to June 2019.@*Results@#One hundred twenty medical records of patients diagnosed with CCF were included. Based on angiographic findings, patients were grouped according to type of CCF, with 86 patients in Group 1 or Direct CCF, 23 patients in Group 2 or Indirect CCF, and 11 patients in Group 3 or Mixed type of CCF. The patients were also grouped according to treatment, with 109 patients in Group A, or patients who did not undergo endovascular treatment, and 11 patients in Group B, or patients who underwent endovascular treatment. There was a male predominance in CCF, most occurring in the age range of 26 to 35 years. Risk factors for CCF were trauma and hypertension. Clinical features included the presence of blurring of vision, proptosis, corkscrewing of conjunctival vessels, extraocular movement limitation, diplopia, audible bruit, elevated intraocular pressure, and pulsation. Findings on Computed Tomography scan included dilated superior ophthalmic vein, proptosis, and enlarged extraocular muscles. Direct CCF (Group 1) occurred mostly in males, with mean age of 39.1 years, and with trauma as the major risk factor. Indirect CCF (Group 2) occurred mostly in females, with mean age of 52.1 years, and with hypertension as the major risk factor. Regardless of the type of CCF, patients who did not undergo endovascular treatment can exhibit spontaneous improvement or worsening of clinical features. Patients who underwent endovascular treatment generally had favorable clinical outcomes, manifesting as either improvement or no worsening of features. There were minimal ophthalmic complications associated with treatment.@*Conclusion@#Endovascular treatment is safe and effective in the improvement of visual acuity, corkscrewing of conjunctival vessels, amount of proptosis, extraocular movement limitation, diplopia, and presence of audible bruit.

Cholesterol granuloma as a rare differential in bone erosion of the orbit: A case report

Objective@#We report a case of orbitofrontal cholesterol granuloma as a rare differential diagnosis of orbital erosion in the diploe of the frontal bone. @*Methods@#This is a case report. @*Results@#A 50-year-old man presented with right eye proptosis. Computed tomography (CT) scan of the orbit showed a fairly delineated homogeneous mass centered in the diploe of the right frontal bone with calcification and rugged erosion of the frontal bone and with expansion into the right superotemporal orbit. The patient was initially diagnosed with malignant lacrimal gland tumor on the right. He underwent orbitotomy with excision of the mass. Histopathologic studies of the excised mass revealed a cholesterol granuloma.@*Conclusion@#Cholesterol granulomas of the frontal bone in the superotemporal orbit are rare benign lesions that present with bone destruction and can be mistaken for lacrimal gland malignancies. Surgical excision has a high success rate with low incidence of recurrence.

Risk factors associated with the activity and severity of Graves’ Ophthalmopathy among patients at the University of the Philippines Manila-Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

Background@#Asians with Graves’ ophthalmopathy (GO) may have earlier compressive features due to narrower orbital apex and increased orbital volume. @*Objective@#To determine the risk factors associated with activity and severity of GO among adults. @*Methodology@#This was a cross-sectional analytical study of 163 adults with Graves’ disease (GD) from the outpatient clinics of the Philippine General Hospital. Demographics, clinical data, thyrotropin receptor antibody (TRAb) and urine iodine (UIE) levels were obtained. All participants were evaluated for activity and severity of GO by a single ophthalmologist. @*Results@#The population was predominantly composed of females (81%) and nonsmokers (69%), with a mean age of 35 + 11 years and median GD duration of 2 years. Median TRAb was 8.9 U/L while UIE was 171 mcg/L. Eight percent exhibited active GO, with 85% having mild disease. Multivariate analysis showed male sex to be associated with severe disease (OR 3.71, p=0.041), while elevated TRAb was associated with both active (OR 1.03, p=0.002) and severe GO (OR 1.02, p=0.007). @*Conclusion@#Lower rates of active and severe GO were seen compared to previous reports. In this population of predominantly nonsmokers, elevated TRAb emerged as a risk factor for active and severe GO.

Tear and ocular surface profile in adult anophthalmic sockets

Objective@#To determine the tear and ocular surface profile of the anophthalmic socket in relation to the contralateral normal eye.@*Methods@#Twenty-five adult patients with unilateral anophthalmic sockets were included into the study. They were at least 2 months post-enucleation or post-evisceration and without any topical medications on the anophthalmic socket and control eye for at least 2 weeks. Assessment was performed using the following parameters: (1) meibomian gland evaluation, (2) ocular surface staining, (3) degree of conjunctival inflammation, (4) Schirmer I and II, and (5) conjunctival impression cytology. @*Results@#Mucoid discharge (52%) was the most common complaint in anophthalmic sockets, followed by itchiness (40%), tearing (36%), and dryness (4%). Compared to control eyes, the anophthalmic sockets had more pronounced and statistically significant lid wiper epitheliopathy, conjunctival staining, and bulbar inflammation. Meibomian gland dysfunction, Schirmer I and II, and conjunctival impression cytology showed no difference between the 2 groups. There was a correlation between the symptoms complained and the ocular staining patterns of the anophthalmic sockets.@*Conclusion@#Anophthalmia predisposes to various ocular surface problems, such as a change in the composition of tears, specifically an increase in the mucin component and a decrease in the aqueous and lipid components, resulting to increased tear viscosity.

Use of autologous-fat graft in postenucleation-socket syndrome

Objective@#To describe the use of autologous-fat grafting in postenucleation-socket syndrome.@*Methods@#This is a case report.@*Results@#There was marked improvement in the gross appearance of the treated orbit of the patient. There was relief in enophthalmos and superior-sulcus deformity. Bilateral orbital symmetry was achieved. Postoperatively, only minimal bruising and swelling both in the orbit and source site were observed, which resolved in 4 weeks.@*Conclusion@#The use of autologous-fat graft is a novel but highly effective technique and a good alternative in treating patients with postenucleation-socket syndrome.