Changes in peripapillary blood vessel density in Graves' orbitopathy after orbital decompression surgery as measured by optical coherence tomography angiography.

The purpose is to evaluate the utility of optical coherence tomography (OCT) angiography in the evaluation of Graves' orbitopathy (GO) and response to orbital decompression in patients with and without dysthyroid optic neuropathy (DON). This was a single-center, prospective case series in a cohort of 12 patients (24 orbits) with GO and ±DON, (6 orbits) who underwent bilateral orbital decompression. All patients underwent pre- and postoperative OCT angiography of the peripapillary area. Vessel density indices were calculated in a 4.5 mm × 4.5 mm ellipsoid centered on the optic disk using split-spectrum amplitude decorrelation angiography algorithm, producing the vessel density measurements. Mean change in vessel density indices was compared between pre- and postoperative sessions and between patients with and without DON. Patient 1, a 34-year-old male with GO and unilateral DON OD, showed a significant reduction in blood vessel density indices oculus dexter (OD) (DON eye) after decompression while a more modest reduction was found oculus sinister (OS) with the greatest change noted intrapapillary. Patient 2, a 50-year-old male with DON OU, showed worsening neuropathy following decompression OD that was confirmed by angiographic density indices. Patient 3, a 55-year-female with DON, showed a reduction in blood vessel density OD and increased density OS. Patients without DON showed overall less impressive changes in indices as compared to those with DON. Using OCT angiography, response to surgical treatment in GO orbits, more so in orbits with DON, can be demonstrated and quantified using vessel density indices with reproducibility.

Complete inferior rectus muscle transection secondary to orbital blowout fracture.

Complete extraocular muscle transection is uncommon in the setting of blunt trauma. We report a case of a 53-year-old male that developed diplopia after hitting his face directly on a concrete slab after a fall. On examination, he had a right hypertropia with a complete infraduction deficit. A CT scan of the face showed an orbital floor blowout fracture with complete inferior rectus transection. On surgical exploration, the distal and proximal ends of the muscle were identified and sutured together, and the floor fracture was repaired. At his post-operative visits, the patient had a persistent infraduction deficit, but subjectively had improved diplopia.

Spontaneous Decompression Fracture in Thyroid Eye Disease.

This is a case of a 44-year-old female with a history of Graves' orbitopathy presented to the emergency department after waking from a nap with sudden onset of left facial and periorbital swelling, ecchymosis, and subconjunctival hemorrhage. A CT scan obtained in the emergency department revealed a left blowout fracture and enlarged extraocular muscles. The patient lives with her mother and both adamantly denied any trauma. The patient had sustained a spontaneous orbital fracture; a process reported but few times in the medical literature.

Conservative treatment of adenoid cystic carcinoma with plaque radiotherapy: a case report.

Adenoid cystic carcinoma is a rare but aggressive malignant tumor of the lacrimal gland. Mortality rates have been found to be quite high (>50%). This has led to the traditional method of treatment with radical surgery including orbital exenteration and bone resection, followed by external beam radiotherapy to the orbital bed. Despite this aggressive treatment strategy, mortality rates still remain high with only a few reported cases with long-term survival. Recently, several cases of successful treatment of adenoid cystic carcinoma with plaque radiotherapy have been documented. These may show promise of a conservative treatment strategy in selected cases. The authors present a functionally monocular patient with a well-circumscribed adenoid cystic carcinoma that was treated with local excision of the tumor with reverse plaque brachytherapy "boost" to the lacrimal tumor bed followed by a lower dose of radiotherapy to the orbit. The patient is alive and without local recurrence at nearly 4 years.