Mapping the Posterior Ledge and Optic Foramen in Orbital Floor Blowout Fractures.

Background The posterior ledge (PL) is a vital structure that supports the implant posteriorly during orbital floor reconstruction. This study describes a technique for mapping the PL in relation to the infraorbital margin (IM) in patients with orbital floor blowout fractures. This study establishes the location of the optic foramen in relation to the PL. Methods Facial computed tomography (FCT) scans of 67 consecutive patients with isolated orbital floor blowout fractures were analyzed using Osirix. Planes of reference for orbital fractures, a standardized technique for performing measurements on FCT, was used. Viewed coronally, the orbit was divided into seven equal sagittal slices (L1 laterally to L7 medially) with reference to the midorbital plane. The distances of PL from IM and location of optic foramen were determined. Results The greatest distance to PL is found at L5 (median: 30.1 mm, range: 13.5-37.1 mm). The median and ranges for each slice are as follows: L1 (median: 0.0 mm, range: 0.0-19.9 mm), L2 (median: 0.0 mm, range: 0.0-21.5 mm), L3 (median: 15.8 mm, range: 0.0-31.7 mm), L4 (median: 26.1 mm, range: 0.0-34.0 mm), L5 (median: 30.1 mm, range: 13.5-37.1 mm), L6 (median: 29.0 mm, range: 0.0-36.3 mm), L7 (median: 20.8 mm, range: 0.0-39.2 mm). The median distance of the optic foramen from IM is 43.7 mm (range: 37.0- 49.1) at L7. Conclusion Distance to PL from IM increases medially until the L5 before decreasing. A reference map of the PL in relation to the IM and optic foramen is generated. The optic foramen is located in close proximity to the PL at the medial orbital floor. This aids in preoperative planning and intraoperative dissection.

Clinical spectrum, treatment and outcomes of uveal melanoma in a tertiary centre

INTRODUCTION@#We aimed to describe the clinical characteristics, diagnostic challenges, treatment patterns and outcomes of uveal melanoma (UM) in a tertiary care centre.@*METHODS@#This is a retrospective case series of 11 consecutive patients with UM who were managed in a tertiary referral centre between 2002 and 2017. Epidemiological, clinical, pathological and radiological characteristics were reviewed. Classification of choroidal melanoma as small, medium or large was based on the criteria established by the Collaborative Ocular Melanoma Study.@*RESULTS@#Mean age at presentation was 42.9 (range 27‒67) years. In 7 (64%) patients, a definitive diagnosis of UM was made after a mean follow-up period of 6.4 (range 1‒17) months. There were one, six and four patients with small-, medium- and large-sized choroidal melanomas, respectively. Treatment was enucleation in 5 (45.5%) patients, plaque brachytherapy in 4 (36.4%) patients, transpupillary thermotherapy in 1 (9.1%) patient, and observation in 1 (9.1%) patient. Median follow-up was 29 months. Metastatic disease developed in 5 (45.5%) patients at the mean age of 46.6 (range 38‒56) years, with median overall survival of 20 months. Genetic mutations in three patients were monosomy 3 (n = 2), and gain of 3q and 8q (n = 1).@*CONCLUSION@#Our study supports the finding that UM in Chinese and Asian Indian patients presents at a younger age than in Caucasians. Although it is rare, ophthalmologists should remain mindful of this life-threatening disease. We propose establishing a national and regional registry for ocular tumours with genetic information to characterise the disease spectrum in Southeast Asia.

Pediatric Orbital Blow-Out Fractures: Surgical Outcomes.

PURPOSE: The objective of this study was to evaluate the features, timing of intervention, complications, and outcomes of patients who underwent surgery for pediatric orbital blow-out fractures. DESIGN: This was a retrospective case review studying all cases of pediatric orbital blow-out fractures that underwent surgical intervention from 2000 to 2009 in a tertiary ophthalmic center in Singapore. METHODS: Case notes review of all cases of pediatric orbital blow-out fractures repaired surgically was carried out for demographics, time to intervention, and outcome. How the various factors may affect the outcome was statistically analyzed. RESULTS: A total of 23 patients were reviewed. There were 21 patients (91.3%) with floor fractures, 1 (4.3%) with medial wall fracture, and 1 (4.3%) with combined medial wall and floor fracture. Of the 21 cases of floor fracture, 20 cases had radiological images available for review, 17 (85%) were linear, and 3 (15%) were open. Patients with open fractures were older with a mean age of 14.0 years as compared with 12.6 years in those with linear fractures. The mean duration from injury to intervention was 13.0 days. Preoperatively, 14 (60.9%) had diplopia, but only 4 cases (17.4%) had diplopia in extreme gaze at the last follow-up after surgery (18 months). Outcome was not affected by age, duration between injury and intervention, type of fracture, and nature of implants used. CONCLUSIONS: Our study demonstrated that pediatric orbital blow-out fractures had good outcomes. It might also suggest the possibility of not having to manage all linear fractures as a surgical emergency.

Review of orbital imaging.

CT and MRI are commonly used in the evaluation of patients with suspected orbital disease. Many different diseases may present within this small anatomical space. The purpose of this article is to present a diagnostic strategy based on a compartment model. Localizing pathology to sinus, bone, extraconal space, muscle cone, intraconal space, optic nerve, globe or lacrimal fossa allows significant reduction in the number of differential diagnoses as these compartments contain different tissues which disease may involve or arise from. Certain diseases may also present in multiple compartments. Common diseases which might present in one or multiple compartments will be discussed.

Eye injuries in Singapore--don't risk it. Do more. A prospective study

<p><b>INTRODUCTION</b>The purpose of this study was to characterise and describe the epidemiology of all eye injuries presenting to the National University Hospital (NUH).</p><p><b>MATERIALS AND METHODS</b>A prospective study was conducted over a 7-week period (11/4/2005 to 29/5/2005) on all ophthalmic trauma patients seen by the Department of Ophthalmology in NUH. Data on patient presentation, source of injury and intervention were collected via a standardised interview and examination, and documented using a validated datasheet.</p><p><b>RESULTS</b>A total of 133 patients, and 139 eyes, were included in the study. The average age was 33.5 years, with a range of 5 years to 88 years, and 84.2% (n = 112) were men. Close to half (46.6%, n = 62) of the patients studied were non-Singaporeans. 56.4% (n = 75) of all eye injuries were work-related and only 5% (n = 7) of eyes were open-globe injuries. Common sources of eye trauma included: Use of high-powered tools in activities such as grinding, welding and hammering (38.3%, n = 51), human-inflicted injuries (12.0%, n =16) and road traffic accidents (8.3%, n = 11). Of the work-related eye injuries, 29.3% (n = 22) reported to having used personal protective equipment (PPE) at the time of injury, 38.7% (n = 29) had been issued PPE but had not used them, while 32% (n = 24) reported that PPE had not been issued. An initial visual acuity of 6/12 or better was found in 63.0% (n = 88) of patients and a reading of 6/60 or worse was found in 10.0% (n =14). Superficial foreign bodies (22.4%, n = 55) were the most common clinical finding, followed by periorbital bruise (12.2%, n = 30), lid ecchymoses (6.9%, n = 17), orbital fractures (6.5%, n = 16), lid laceration (6.1%, n = 15) and corneal abrasions (5.7%, n = 14).</p><p><b>CONCLUSION</b>There is a broad spectrum of causes, mechanisms and severity of ophthalmic injuries seen in the hospital, of which work-related trauma makes up a significant proportion. The patients who suffer occupational injuries are a well-defined group: Young, non-Singaporean males, working with power tools in the construction industry are at particular risk. Although preventive strategies are in place for this high-risk group, the lack of awareness and compliance limit their effectiveness. The adequacy and functionality of PPE should be emphasised. In addition, preventive efforts are equally important in domestic, recreational, sports and transport settings. Eye trauma research and prevention can be further aided by a collaborative registry of eye injuries. A long-term islandwide database of all ophthalmic injuries is recommended.</p>

Myxoma of the orbit.

Myxomas are rare, benign neoplasms of mesenchymal origin that usually develop in soft tissues. As the clinical manifestations are non-specific, it is difficult to diagnose the tumour without biopsy and histopathological examination. We report a case of orbital myxoma with histopathological correlation.