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1.
Br J Ophthalmol ; 2023 Nov 27.
Article in English | MEDLINE | ID: mdl-38041682

ABSTRACT

BACKGROUND: Orbital decompression is commonly performed to correct proptosis in patients with Graves' orbitopathy (GO). In literature, the incidence of new-onset constant diplopia after orbital decompression varies. Few studies have evaluated changes in duction and cyclodeviation after orbital decompression. We evaluated the changes in duction, cyclodeviation, eye position and degree of diplopia after orbital decompression. METHODS: We retrospectively analysed data from patients who underwent orbital decompression at our hospital between January 2016 and July 2020. Data regarding the type of decompression, eye position, duction, cyclodeviation and level of diplopia according to the Gorman score were recorded. RESULTS: Data from 281 eyes/orbits of 156 patients were analysed. Proptosis decreased from 23.8±2.5 to 20.9±2.5 mm. Horizontal and vertical duction range decreased (horizontal d=0.40 and vertical 0.30; p=0.000) after surgery; however, the change was not clinically significant (≤5°). Horizontal deviation changed towards esodeviation (d=-0.45; p=0.000), whereas vertical deviation remained stable (d=0.15; p=0.161). Preoperative cyclotorsion in the primary and downgaze positions changed towards incyclodeviation (primary: d=0.30, p=0.021; downgaze d=0.30, p=0.039). Diplopia improved in 22% (18 patients), whereas new-onset constant diplopia developed in 11% (12 patients). Elevation has an excellent predictive value of causing new-onset constant diplopia when measured preoperatively as <19°, sensitivity 88.0%, specificity 41.7% (area under the curve 0.812 (95% CI 0.660 to 0.963); p=0.000). CONCLUSION: After orbital decompression, incidence of new-onset constant diplopia was 11% and 22% of the patients had partial or complete improvement of their diplopia. The changes in duction, cyclodeviation and horizontal deviation showed a statistical but not clinical difference. Patients with GO and a preoperatively restricted elevation of <19° are at risk of developing new-onset constant diplopia. In addition, preoperative incyclodeviation may worsen after decompression surgery.

2.
Ned Tijdschr Geneeskd ; 1672023 10 25.
Article in Dutch | MEDLINE | ID: mdl-37930160

ABSTRACT

Tear complaints can arise from either an increased tear production or from a disturbed tear drainage. Increased tear production from the lacrimal gland is a neuroregulated response to a dried out or irritated ocular surface. Dryness often results from a reduced quality of the tear film, but can also be caused by eyelid malposition with increased globe exposure. Impaired tear drainage usually occurs when the lacrimal drainage system is blocked at the level of the ductus nasolacrimalis, the canaliculi or the lacrimal punctae. Anatomical knowledge of the lacrimal system is necessary to distinguish between the different causes. Using cases and illustrations, we provide insight into the diagnostic considerations for a patient with a watery eye.


Subject(s)
Eyelid Diseases , Lacrimal Apparatus Diseases , Lacrimal Apparatus , Humans , Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus Diseases/therapy , Tears/physiology
3.
Eur J Ophthalmol ; 32(1): 717-724, 2022 Jan.
Article in English | MEDLINE | ID: mdl-33706571

ABSTRACT

PURPOSE: Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated. METHODS: Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns (n = 3), fireworks (n = 3), trauma (n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma (n = 1) with three average previous socket surgeries (range 2-6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries. RESULTS: Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two. CONCLUSIONS: Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.


Subject(s)
Eye, Artificial , Orbital Implants , Child , Humans , Neoplasm Recurrence, Local , Orbit , Printing, Three-Dimensional , Retrospective Studies
4.
Ophthalmic Genet ; 39(5): 619-624, 2018 10.
Article in English | MEDLINE | ID: mdl-29939822

ABSTRACT

BACKGROUND: Cosmetic dissatisfaction, pain, and chronic discharge may present months till years after enucleation in patients operated because of retinoblastoma. If noninvasive treatment modalities are insufficient, socket reconstruction can be considered. In this study, we discuss the results of dermis-fat exchange to treat these problems. METHOD: Four patients with late onset post enucleation socket problems with a request for treatment were included in this prospective study. Socket inspection was documented and pictures at baseline and at a follow-up of at least 6 months were taken. To quantify the problem 'pain', a VAS score at baseline and at follow up was used. For the problem 'cosmetic dissatisfaction' standardized questionnaires were used. RESULTS: Two patients were included because of cosmetic dissatisfaction; one was included with chronic pain and one with chronic discharge. Reconstruction of the socket using autologous dermis-fat insertion was done in all four. In one of them, severe shrinking of the fat developed. This patient was treated with additional injectable fillers. Both of them, ultimately, had satisfactory results. Autologous fat transplantation also solved the problem of chronic discharge and pain in the two other patients. CONCLUSION: Socket reconstruction by autologous dermis-fat exchange may solve different post enucleation socket problems. However, shrinking of the transplanted fat may occur and require additional procedures.


Subject(s)
Adipose Tissue/transplantation , Dermis/transplantation , Orbital Implants , Plastic Surgery Procedures , Postoperative Complications , Retinal Neoplasms/surgery , Retinoblastoma/surgery , Adult , Age of Onset , Child , Eye Enucleation , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Retinal Neoplasms/pathology , Retinoblastoma/pathology , Young Adult
5.
Am J Otolaryngol ; 38(2): 130-134, 2017.
Article in English | MEDLINE | ID: mdl-27914713

ABSTRACT

BACKGROUND: Pre- or retroseptal bacterial orbital cellulitis (pOC/rOC) is not an uncommon orbital disease. Treatment consists of antibiotics with or without surgical drainage. Several questions regarding course, complications and outcome of treatment are unanswered and the indication for surgery is not well defined. The aim of this study is to: 1. describe the outcome of orbital cellulitis (OC) in a large cohort, 2. assess the significance of Chandler's classification, 3. assess the incidence of abscess formation in OC, and 4. redefine criteria for surgery. METHODS: Retrospective case series of patients with OC seen between 1-1-2007 and 1-1-2014 in a tertiary referral center. RESULTS: Sixty-eight patients presented with (presumed) bacterial pOC. Two out of these 68 developed rOC. All 68 patients had a full recovery. Forty-eight patients presented with rOC. Four out of 48 (8%) had intracranial extension of the infection at the time of admission. No admitted patient developed distant seeding. Only four (8%) patients with rOC had a true orbital abscess. In the other 92% we found a diffuse orbital inflammation or a subperiosteal empyema. Forty-four (92%) patients with rOC had a full recovery. CONCLUSIONS: 1. The prognosis of both pOC and rOC nowadays is generally favorable. 2. Chandler's classification is of little use. 3. True abscess formation in OC is rare. 4. The indication for surgical intervention must be based on the clinical presentation and the assessment of true orbital abscess formation.


Subject(s)
Abscess/surgery , Orbital Cellulitis/surgery , Abscess/diagnostic imaging , Abscess/drug therapy , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Child , Female , Humans , Male , Middle Aged , Orbital Cellulitis/classification , Orbital Cellulitis/diagnostic imaging , Orbital Cellulitis/drug therapy , Prognosis , Retrospective Studies , Sex Factors , Treatment Outcome
6.
Ned Tijdschr Geneeskd ; 159: A9114, 2015.
Article in Dutch | MEDLINE | ID: mdl-26306480

ABSTRACT

BACKGROUND: Metastasis of breast carcinoma to the orbit is characterized by symptoms of altered appearance and double vision. A combination of enophthalmos, ptosis and impairment of eye movements is typical. Sometimes these symptoms are the first manifestation of breast carcinoma. CASE DESCRIPTION: Two female patients, aged 66 and 52, presented with enophthalmos. Both had recently undergone mammography with no abnormalities being observed. CT scans of these patients disclosed an intra-orbital, space-occupying process. Histological examination of biopsies from the abnormal tissue revealed that both patients had metastatic breast carcinoma. CONCLUSION: In a female patient with non-traumatic enophthalmos, metastasis of breast carcinoma must be ruled out and reliance may not be placed on a mammogram revealing no abnormalities.


Subject(s)
Breast Neoplasms/diagnosis , Carcinoma, Lobular/diagnosis , Enophthalmos/etiology , Orbital Neoplasms/diagnosis , Aged , Biopsy , Diplopia , Female , Humans , Mammography , Middle Aged , Neoplasm Metastasis , Orbital Neoplasms/complications , Tomography, X-Ray Computed
7.
Orbit ; 34(2): 84-91, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25836060

ABSTRACT

PURPOSE: To evaluate the surgical effect of unilateral inferior rectus recession (IR-group) with or without a recession of contralateral superior rectus (IR-SR-group) on squint angle and motility restrictions in Graves' Orbitopathy (GO) patients. DESIGN: Retrospective case series. MATERIALS AND METHODS: Primary outcome parameters were the changes of squint angle 3 months and 6-12 months postoperatively. As in a previous study, success was defined as a postoperative vertical squint angle of ≤3° in primary position and on downgaze. Secondary outcome parameters were the influence of surgery on duction range and influence of muscle size on dose-effect response. RESULTS: Fifty-six patients were included in the study; 31 patients in the IR-group and 25 patients in the IR-SR-group. The amount of (fixed suture) recession ranged from 2 mm to 7 mm. Vertical deviations in primary position changed from 8.0° [95% CI 6.6-9.7°] to 1.0° [95% CI -0.4-6.5°] in the IR-group and from 17.0° [95% CI 15.7-20.0°] to 1.5° [95% CI 0.8-2.9°] in the IR-SR-group. The success rate was 74% in the IR-group and 64% in the IR-SR-group. Elevation significantly improved in both groups (IR-group p = 0.007; IR-SR- group p = 0.000). The volume of vertical rectus muscles as assessed on CT-scans did not influence the dose-effect response. CONCLUSIONS: The highest success rate and highest reduction of depression was found in the IR-group. The total duction range remained stable after strabismus surgery (IR-group) or improved (IR-SR-group). Both squint angle and cyclodeviation remained stable during long time follow-up (6-12 months after surgery).


Subject(s)
Graves Ophthalmopathy/surgery , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures , Orbital Diseases/surgery , Strabismus/surgery , Diplopia/physiopathology , Diplopia/surgery , Female , Graves Ophthalmopathy/physiopathology , Humans , Male , Middle Aged , Oculomotor Muscles/physiopathology , Orbital Diseases/physiopathology , Retrospective Studies , Strabismus/physiopathology , Treatment Outcome , Vision, Binocular/physiology
8.
PLoS One ; 10(3): e0121292, 2015.
Article in English | MEDLINE | ID: mdl-25767872

ABSTRACT

PURPOSE: To investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world. METHODS: A digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma. RESULTS: We received a response of 58 surgeons in 32 different countries. A primary artificial implant is routinely inserted by 42 (72.4%) surgeons. Ten (17.2%) surgeons leave the socket empty, three (5.2%) decide per case. Other surgeons insert a dermis fat graft as a standard primary implant (n=1), or fill the socket in a standard secondary procedure (n=2; one uses dermis fat grafts and one artificial implants). The choice for porous implants was more frequent than for non-porous implants: 27 (58.7%) and 15 (32.6%), respectively. Both porous and non-porous implant types are used by 4 (8.7%) surgeons. Twenty-five surgeons (54.3%) insert bare implants, 11 (23.9%) use separate wrappings, eight (17.4%) use implants with prefab wrapping and two insert implants with and without wrapping depending on type of implant. Attachment of the muscles to the wrapping or implant (at various locations) is done by 31 (53.4%) surgeons. Eleven (19.0%) use a myoconjunctival technique, nine (15.5%) suture the muscles to each other and seven (12.1%) do not reattach the muscles. Measures to improve volume are implant exchange at an older age (n=4), the use of Restylane SQ (n=1) and osmotic expanders (n=1). Pegging is done by two surgeons. CONCLUSION: No (worldwide) consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma. Considerations for the use of different techniques are discussed.


Subject(s)
Eye Enucleation/methods , Eye Enucleation/statistics & numerical data , Internationality , Retinoblastoma/surgery , Surveys and Questionnaires , Decision Making , Humans
9.
Orbit ; 34(1): 23-9, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25313439

ABSTRACT

PURPOSE: To present the first parallax-free exophthalmometer design. BACKGROUND: Exophthalmometry is an important clinical tool. We provide a historic overview of clinical exophthalmometer designs, and we review current problems encountered in exophthalmometry. METHODS: We present a new and parallax-free exophthalmometer design that we have evaluated in 49 patients visiting our orbital clinic. RESULTS: The mean age of the patients was 49.8 years and 72% were female. The Pearson interobserver variation was 0.97, and 94% of the Hertel values measured by the two observers were within the limits (1.6 mm) of agreement. CONCLUSION: This meter appears to be a reliable instrument for exophthalmometry. It is the first instrument that allows for a complete parallax-free measurement.


Subject(s)
Diagnostic Techniques, Ophthalmological/instrumentation , Exophthalmos/diagnosis , Diagnostic Techniques, Ophthalmological/history , Equipment Design , Exophthalmos/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans
10.
Strabismus ; 22(4): 182-7, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25310344

ABSTRACT

PURPOSE: To evaluate the effect of uni- and bilateral medial rectus recession on squint angle and ductions in Graves' Orbitopathy (GO) patients. DESIGN: Retrospective case series. MATERIALS AND METHODS: Consecutive GO patients seen between January 2000 and March 2012 who were operated on one or both medial rectus muscles were selected for the study. Data regarding squint angle, abduction, and adduction were collected starting 3 months before surgery and 3 and 6-12 months after surgery. RESULTS: 102 patients were eligible for inclusion. Of these, 24 patients were operated on one medial rectus and 78 on two medial rectus muscles. The dose-effect response was 1.0 [-0.6-3.8]°/mm in the unilateral and 1.4 [0.2-3.0]°/mm in the bilateral group (p=0.000). In the bilateral group, the maximal abduction and adduction changed significantly (p=0.000). However, the total duction range remained unchanged (unilateral: p=0.525; bilateral: p=0.137). The extent of the preoperative abduction did not influence the dose-effect response (r=-0.234; p=0.040), nor did the muscle volume (unilateral p=0.989; bilateral p=0.397). Twenty-three patients (23%) needed additional horizontal squint surgery. CONCLUSION: In this large series of medial rectus recessions in patients with Graves' disease we found significantly lower dose-effect response ratios as compared to other studies. The amount of abduction deficit does not influence outcome.


Subject(s)
Diplopia/surgery , Graves Ophthalmopathy/complications , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures , Strabismus/surgery , Adult , Aged , Diplopia/physiopathology , Female , Humans , Male , Middle Aged , Retrospective Studies , Strabismus/physiopathology , Vision, Binocular/physiology
11.
Eur J Endocrinol ; 170(5): 785-9, 2014 May.
Article in English | MEDLINE | ID: mdl-24493116

ABSTRACT

OBJECTIVE: To evaluate the influence of strabismus surgery on quality of life (QoL) in Graves' orbitopathy (GO) patients. DESIGN: Prospective study of case series. METHODS: Consecutive GO-patients who were scheduled for their first strabismus surgery were included in the study. The patients completed the GO-QoL questionnaire within 3 months before the surgery and 2-4 months after the surgery. A complete orthoptic examination, including the field of binocular single vision (BSV), was performed. Clinically relevant response (CRR) in the QoL was also evaluated. RESULTS: In this study, 28 patients were included. The GO-QoL score for visual functioning was 46.3±24.2 before surgery and 65.7±30.5 after surgery (P=0.009). The GO-QoL score for appearance changed from 60.6±25.9 to 69.5±24.2 (P=0.005). After surgery, the field of BSV increased from 24.3±34.8 to 68.5±36.0 points (P=0.000). A weak correlation was found between the field of BSV and the visual functioning score after surgery (r=0.417; P=0.034). CRR was found in 20 (71%) patients. Those with a CRR showed a larger field of BSV (P=0.002) and better GO-QoL scores (P=0.008). CONCLUSIONS: GO-QoL score increases significantly for both visual functioning and appearance after the first strabismus surgery in GO-patients, showing the highest improvement for the visual functioning questions. Both the GO-QoL and field of BSV outcomes correlate well with the CRR.


Subject(s)
Diplopia/surgery , Graves Ophthalmopathy/physiopathology , Oculomotor Muscles/surgery , Quality of Life , Strabismus/surgery , Adult , Attitude to Health , Beauty , Diplopia/etiology , Diplopia/physiopathology , Female , Humans , Male , Middle Aged , Netherlands , Oculomotor Muscles/physiopathology , Postoperative Period , Preoperative Period , Prospective Studies , Self-Assessment , Strabismus/etiology , Strabismus/physiopathology , Vision, Binocular , Vision, Ocular , Visual Fields
12.
Saudi J Ophthalmol ; 27(3): 167-75, 2013 Jul.
Article in English | MEDLINE | ID: mdl-24227982

ABSTRACT

Rhabdomyosarcoma (RMS) is a highly malignant tumor and is one of the few life-threatening diseases that present first to the ophthalmologist. It is the most common soft-tissue sarcoma of the head and neck in childhood with 10% of all cases occurring in the orbit. RMS has been reported from birth to the seventh decade, with the majority of cases presenting in early childhood. Survival has changed drastically over the years, from 30% in the 1960's to 90% presently, with the advent of new diagnostic and therapeutic modalities. The purpose of this review is to provide a general overview of primary orbital RMS derived from a literature search of material published over the last 10 years, as well as to present two representative cases of patients that have been managed at our institute.

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