Phakomatous Choristoma of the Orbit With Involvement of the Inferior Oblique Muscle.

The authors report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. This is the only known case of this rare tumor directly invading and incorporating the inferior oblique. This tumor should be included in the differential of eyelid tumors and orbital tumors in infants. Finally, the authors review the histopathological and embryological characteristics of this lenticular tumor.

Comparing Visual Outcomes of KLEx, PRK, and LASIK Procedures in the Military Population.

PURPOSE: To assess the 6-month visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) as compared to laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in a military population at a Joint Warfighter Refractive Surgery Center. SETTING: Joint Warfighter Refractive Surgery Center (JWRSC), Lackland Air Force Base, San Antonio, TX. DESIGN: Retrospective Study. METHODS: Patients who underwent either KLEx, PRK, or LASIK between 2019-2022 were included. Anonymized data collected included demographics, pre- and post-operative uncorrected and corrected visual acuity, and manifest refraction. RESULTS: Of the 4,466 treated eyes, 737 (16.5%) underwent the KLEx, 2,801 (62.7%) underwent PRK, and 928 (20.8%) underwent LASIK treatment. In terms of efficacy, there was no statistically significant difference at post-operative month (POM)6 between the percentage of eyes reaching an uncorrected distance visual acuity (UDVA) of 20/20 or better between the three procedures. At POM1 (P < 0.001) and POM3 (P < 0.001), there were a greater number of eyes in the KLEx group that achieved the same or 1 line better of distance visual acuity than the PRK group. The efficacy index of KLEx, PRK, and LASIK at POM6 were 1.09, 1.10, and 0.97, respectively. The safety index for KLEx, PRK, and LASIK at POM6 were 0.96, 1.01, and 0.81, respectively. CONCLUSIONS: After the initial recovery period, KLEx demonstrates comparable outcomes in terms of efficacy, safety, and accuracy as compared to LASIK and PRK.

Fusobacterium necrophorum Orbital Cellulitis With Intraconal Abscess.

A 19-year-old male presented to the emergency department with progressive right eye proptosis and was subsequently diagnosed with bacterial orbital cellulitis and acute on chronic allergic fungal sinusitis. He experienced brief symptomatic improvement after endoscopic sinus surgery, initiation of antibiotics, and steroid treatment; however, he re-presented five days after discharge with significantly worsened symptoms and no light perception in the right eye. Cultures resulted in Aspergillus and Fusobacterium necrophorum, a rare, aggressive etiology of bacterial orbital cellulitis. He developed an intraconal abscess requiring multiple orbitotomies for decompression and abscess drainage. To our knowledge, only eight prior cases of F. necrophorum orbital cellulitis have been reported in the literature (excluding the present case) and our patient is the first case of this organism causing an intraconal abscess. The authors discuss the importance of early recognition and close follow-up of F. necrophorum orbital infections.

Open-globe wounds in operation Iraqi Freedom and Operation Enduring Freedom: risk factors for poor visual outcomes and enucleation.

PURPOSE: To determine the rates and types of open-globe wounds in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries. METHODS: Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were patients who suffered open-globe injuries. Open-globe injuries were classified by type of wound: corneal, corneo-scleral or scleral, or type of open-globe injury: perforating, rupture, penetrating or intraocular foreign body. The primary analysis assessed the effect on final visual acuity (VA) and the risk of enucleation. RESULTS: In this study, 285 (32.02%) open-globe injuries were recorded in 890 eyes in the data set. Corneal wounds were noted in 127 (44.56%) eyes, corneo-scleral wounds in 78 (27.37%) and scleral wounds in 129 (45.26%) eyes. The involvement of both the corneal and sclera was associated with poorer visual outcome (BCVA < 20/200) compared to injuries with an injury confined to either the cornea or scleral alone (p = 0.038). At a wound length of greater than approximately 14 mm, patients had 75% chance of having a poor final VA. Enucleation was performed in 64 (22.46%) eyes of patients with wounds. The type of wound was not found to be predictive of enucleation in multivariate analysis, but rather the type of open-globe injury was predictive. Perforating (OR: 1.58, 95% CI: 1.43-1.72) and globe rupture injuries (OR: 1.49, 95% CI: 1.33-1.66) were more likely to undergo enucleation. CONCLUSIONS: Open-globe injuries occur frequently in combat ocular trauma. Poor final VA was noted most with corneo-scleral wounds with approximately 50% of patients having a final VA less than 20/200.