Reversible Charles Bonnet Syndrome After Oculoplastic Procedures.

Individuals with Charles Bonnet syndrome (CBS) typically have severe visual loss and experience visual hallucinations yet have no psychiatric disease. Visual impairment often is due to end-stage glaucoma or macular degeneration. We report 3 cases of CBS in patients who underwent an oculoplastic surgical procedure. One patient experienced binocular visual distortion due to excessive topical ophthalmic ointment, and 2 patients experienced monocular visual impairment from patching. Visual hallucinations resolved once vision returned to baseline. We highlight the possibility of transient CBS in postoperative patients who have temporary iatrogenic vision impairment in one or both eyes.

Two-stage rapid exenteration reconstruction to allow early radiation therapy for an aggressive orbital cancer.

PURPOSE: Describe a novel two-stage orbital exenteration technique using an INTEGRA dermal regeneration matrix. METHODS: A 63-year-old Hispanic male presented with multiple invasive right eyelid masses that incisional biopsy revealed was infiltrative basal cell carcinoma. The patient underwent a right orbital exenteration without lid sparing. An INTEGRA graft was sutured in place to cover the defect at the time of surgery and allowed to vascularize for 3 weeks. During this time, frozen section of tumor margins previously read as negative were found to have invasive basal cell carcinoma on permanent section re-evaluation. Three weeks after the initial exenteration, the patient returned to the operating room and the dermal matrix of the INTEGRA graft was found to be well integrated and vascularized. Further resection was performed in the areas which were found to have residual cancer on permanent section evaluation. After preliminary frozen section pathology demonstrated clear margins, full-thickness skin grafts harvested from the right and left supraclavicular regions were thinned, draped, and fixated over the INTEGRA matrix. RESULTS: The patient recovered well and experienced no immediate postoperative complications. Adjuvant radiotherapy began 5 weeks after initial exenteration with a fully epithelized exenterated socket. At postoperative week 16, our patient remained with full epithelization after completing radiation. As of postoperative week 47, our patient has had no complications. CONCLUSION: The use of INTEGRA with full-thickness skin grafting for orbital exenteration reconstruction presents several advantages over traditional reconstruction approaches including: quicker recovery, tumor surveillance by re-examining edges of the resection after INTEGRA dermal placement, easier postoperative care, and earlier initiation of radiation therapy.

Computed tomography dimensions of the lacrimal gland in normal Caucasian orbits.

INTRODUCTION: CT is frequently used to assess the lacrimal gland, yet no published reports exist of normal dimensions using this modality. We retrospectively evaluated CT data from normal orbits and measured the lacrimal gland dimensions. METHODS: Two-hundred ninety-three consecutive orbital CT scans (586 orbits) of 282 patients were identified. Caucasian patients aged 18 years and older without known orbital disease were included. Traumatized orbits were excluded. All repeated scans were excluded. Length and width of the lacrimal gland were measured in axial and coronal sections with GE Centricity Software. The primary outcome was a descriptive analysis of the distribution of dimensions in normal orbits. A random subset of patient scans was measured independently by observers at different levels of training, and intraclass correlation coefficients (ICCs) were established. RESULTS: Three hundred orbits (150 right orbits and 150 left orbits) of 282 patients were included. Normal distributions occurred with axial and coronal length measurements. Mean (10th and 90th percentiles) lacrimal gland axial length in right orbits was 14.7 mm (10.9 mm and 18.3 mm) and 14.5 mm in left orbits (10.3 mm and 18.3 mm). Coronal length averaged 17.7 mm in right eyes (13.9 mm and 21.8 mm) and 16.9 mm in left eyes (12.8 mm and 20.8 mm). Axial and coronal width showed non-normal distributions. No statistically significant difference in dimensions was found between genders, and a significant inverse linear relation occurred between gland size and age. Agreement was significant among the observers (ICC >0.7). CONCLUSION: This study presents a normal range of Caucasian lacrimal gland dimensions seen on CT. Lacrimal gland size decreases with age, and no gender difference exists. This range can aid in differentiating diseased and nondiseased lacrimal glands, especially when correlated with physical examination. This may be useful in clinical trials that involve lacrimal gland size.

Development of a resident training module for systematic optic disc evaluation in glaucoma.

PURPOSE: To determine the impact on ophthalmology residents of a training module to teach systematic optic disc (disc) evaluation. METHODS: A training module for disc evaluation was developed consisting of: (1) a computer-based evaluation course with 100 illustrative disc photographs featuring normal and glaucomatous discs; (2) 2 different disc photograph test sets to be completed before and after taking the course; and (3) a 1-page checklist emphasizing 8 areas of disc evaluation to guide the residents through the test sets. Each area required identification of 2 to 3 key features pertinent to glaucoma. Points were assigned to each correctly answered item on the checklist by ophthalmology residents of 2 training programs. Residents were also asked to evaluate the disc according to a glaucoma scale. Main outcome measures included precourse and postcourse checklist scores and disc glaucoma evaluation scores. RESULTS: Twenty-eight residents from 2 training programs completed the training module. Mean checklist scores improved significantly after taking the evaluation course across all residents and in residents who had 2 years of ophthalmology residency experience (P = 0.019, 0.017, respectively). Precourse disc glaucoma evaluation score increased 4% to 6% per year of ophthalmology residency training (P = 0.023, R = 0.1838). One program had a higher mean postcourse disc glaucoma evaluation score than another (P = 0.038). CONCLUSIONS: A systematic disc evaluation module for resident training may improve disc evaluation, provide an objective method to assess the resident's learning experience, monitor the progress and identify areas of weakness of training, and compare results among groups of residents across different residency programs.