Sinogenic Orbital Complications.

BACKGROUND: The term "orbital complication" does not designate an independent nosological entity, but is rather a collective designation for diseases or disease effects that involve the orbit and its internal structures by extension from outside. In general, their most prominent manifestation is swelling of the orbital soft tissues, usually unilaterally. The incidence of sinogenic orbital complications is approximately 1.6 per 100 000 children and 0.1 per 100 000 adults per year. METHODS: This review is based on publications retrieved by a selective search of the literature on the epidemiology, diagnosis, and treatment of sinogenic orbital complications. RESULTS: Acute sinusitis is the most common cause of orbital complications. These are diseases of the orbit with potentially serious consequences for the eye and the risk of intracranial complications such as cavernous sinus thrombosis, meningitis, or brain abscess. Aside from acute sinusitis, many other infectious and non-infectious diseases can extend to and involve the orbit. Because of the complexity and severity of the condition, its diagnosis and treatment are always an interdisciplinary matter. The treatment is primarily conservative, under observation in a hospital, and generally consists of the treatment of acute sinusitis with measures to combat edema along with the administration of broad-spectrum antibiotics. Surgical intervention is needed in severe cases or if there is an abscess. An endonasal approach is usually used for drainage. CONCLUSION: In 95-98% of cases in stages I-IV, healing is complete and without further sequelae. Even if vision is affected preoperatively, it usually recovers fully when therapy is appropriate. Approximately 15% of the patients who undergo surgery need more than one operative procedure.

The artificial iris - Analysis of various implantation techniques after ocular trauma.

PURPOSE: The aim of this study is to analyze the outcome of various techniques for a custom-made iris prosthesis implantation as part of reconstructive anterior segment surgery following traumatic aniridia. METHODS: This retrospective interventional study was done for 6 eyes that received an artificial iris as secondary reconstructive measure for photophobia and unsatisfactory vision following initial globe repair. Different implantation techniques were employed. These included simple sulcus implantation, implantation of a composite (iris prosthesis with attached intraocular lens) implant, and combinations with phacoemulsification, vitrectomy, and penetrating keratoplasty. RESULTS: In all cases, the artificial iris was implanted successfully. In the follow-up period (1-48 months), postoperative complications included rhegmatogenous retinal detachment, prolonged intraocular inflammation, and corneal transplant decompensation due to graft rejection. There was no case of secondary glaucoma. Complications could be managed successfully. All patients showed improved best-corrected visual acuity and were satisfied with functional and cosmetic results. CONCLUSION: This case series highlights the different implantation techniques for reconstruction of the anterior segment after ocular trauma. The versatility of the custom-made iris implant accounts for a wide range of applications and the foldable material reduces the need for large incisions in the already traumatized eye.

Molecular Diagnosis of Human Taenia martis Eye Infection.

Taenia martis, a tapeworm harbored in the intestine of mustelids, is a rarely encountered zoonotic cysticercosis pathogen. The larval stage closely resembles the Taenia solium cysticercus, but the natural host and thus the epidemiology of the disease is different. We here report a human eye infection diagnosed molecularly in a previously healthy female German patient. The case represents the third human infection described worldwide; the two previous cases were also European, involving eye and brain.

Intravitreal r-TPA and gas injection in traumatic submacular hemorrhage.

AIM: To present the technique and efficiency of intravitreal recombinant tissue plasminogen activator (r-TPA) and gas injection in acute submacular hemorrhage (SMH) due to traumatic choroidal rupture. PATIENTS AND METHODS: 0.4 ml of sulfur hexafluoride was injected into the vitreous cavity in 2 patients with SMH due to traumatic choroidal rupture. In 1 patient gas injection was combined with 50 microg r-TPA. Both patients were closely followed. RESULTS: Preoperative visual acuity was 20/125 in one eye and 20/100 in the other. At the end of the follow-up, visual acuity had improved to 20/32 in both eyes. CONCLUSION: r-TPA and gas injection into the vitreous body may be an efficient therapy in patients with submacular hemorrhage due to choroidal rupture.

[General metastases in squamous cell carcinoma of the conjunctiva]. / Fernmetastasen durch Plattenepithelkarzinom der Bindehaut.

BACKGROUND: Squamous cell carcinoma of the conjunctiva is rare. Together with epithelial dysplasia of the conjunctiva the incidence is reported to be 1.9 per 100,000 population and year. After adequate therapy total cure is often achieved. Generalised metastases are however extremely rare. PATIENT AND METHOD: The case of a 71-year old white male patient is presented. Because of a recurrent conjunctival tumour in his right eye local resections had to be performed. The histopathological diagnosis was epithelial dysplasia. After a 3-year history a squamous cell carcinoma developed. In spite of multiple operations total excision of the tumour could not be achieved. Exenteration was refused by the patient. After radiotherapy of the orbit a temporary improvement was observed. However, 9 years later the patient died of general metastases to the long bones, the spine, and the ribs. RESULTS: Histological examination of material obtained during hemilaminectomy of the vertebrate bodies 8 and 9 confirmed the diagnosis of metastases of a squamous cell carcinoma. CONCLUSION: Although extremely rare, general metastases after squamous cell carcinoma of the conjunctiva must be kept in mind. This has to be considered when obtaining informed consent of the patient, planning adequate therapy and follow-up.