Influence of surgical approach for decompression on lower eyelid position in thyroid eye disease.

Purpose: Orbital decompression for thyroid eye disease (TED) has been noted to improve lower lid retraction by 0.5-1 mm. We hypothesize that orbital decompression via transconjunctival approach may lead to increased reduction in marginal reflex distance 2 (MRD2) as it involves division of the lower lid retractors. The purpose of this study is to evaluate relative changes in lower lid position for patients undergoing lateral and transconjunctival orbital decompression, respectively.Methods: In this cross-sectional study, all TED patients managed with lateral or transconjunctival orbital decompression for a 3-year period were screened for inclusion. Photographs taken in the primary position preoperatively and three months postoperatively were utilized to evaluate the MRD2 from each patient. Measurements were made utilizing NIH ImageJ software standardized to a corneal diameter. Hertel measurements of proptosis were obtained pre and postoperatively. The primary outcome measure was MRD2 in operative eyes.Results: A total of 131 (86 patients) operative eyes were included in the sample. Mean change MRD2 was not significantly different between the surgical groups (p = 0.07). In multivariate modeling, mean change in MRD2 was significantly associated with change in exophthalmometry, independent of surgical approach.Conclusions: The association between decrease in Hertel measurement and decrease in MRD2 is consistent with the existing literature on the topic. It appears that transconjunctival division of the lower eyelid retractors provides no additional benefit in reducing lower lid retraction relative to change in proptosis.

Spontaneous Resolution of Optic Neuropathy in Sphenoid Wing Meningioma.

The authors describe herein a case of optic neuropathy in progesterone receptor positive sphenoid wing meningioma of the greater wing which demonstrated spontaneous recovery with conservative management.

Long-Term Follow-Up of Lateral Canthal Resuspension.

PURPOSE: To evaluate the long-term results of lateral canthal resuspension over time. DESIGN: A cohort study of adults (n = 25, 45 eyelids) undergoing lateral canthal resuspension. METHODS: Marginal reflex distance 2 (MRD2), inferior scleral show, lateral canthal height, lateral canthal angle, horizontal palpebral aperture, and lateral scleral triangle area were measured preoperatively and at postoperative week 1, month 3, and the final follow-up visit. RESULTS: Minimum follow-up time was 6 months (mean, 15.1 months). At the final follow-up visit, MRD2 decreased by 0.41 ± 0.14 mm, inferior scleral show decreased by 0.27 ± 0.05 mm, and lateral canthal height increased by 0.81 ± 0.15 mm. The overall function of time was found to be significant for change in MRD2 (P < 0.01). In multiple comparisons, all time point values were significantly different from one another (Bonferroni corrected, P < 0.05), except for 3 months and the final position, which were not. Similarly, the overall effect of time on lateral canthus position was also significant (P < 0.01). All time points were significantly different from one another (Bonferroni corrected, P < 0.05). The overall effect of time on inferior scleral show was also significant (P < 0.01). Differences were significant from preoperative to final postoperative position, although the other time points were not significant (Bonferroni corrected, P < 0.05). No complications were noted. CONCLUSIONS: Minimally invasive lateral canthal resuspension provides durable, albeit modest, improvements in MRD2, inferior scleral show, and lateral canthal height without significantly changing lateral canthal angle, horizontal palpebral aperture, or lateral scleral triangle area.

Hand-held high-resolution spectral domain optical coherence tomography in retinoblastoma: clinical and morphologic considerations.

PURPOSE: Hand-held spectral domain optical coherence tomography (HHSD OCT) has greatly expanded the imaging/diagnostic capacity for clinicians managing children with intraocular retinoblastoma. We present our early experience with HHSD OCT and conventional spectral domain OCT imaging in these patients. METHODS: In this retrospective cross-sectional observational study, infants were imaged during examination under anaesthesia with HHSD OCT in the supine position. Older cooperative retinoblastoma patients were additionally imaged with upright conventional OCT. Clinical data were derived from patient charts and from a prospectively maintained interinstitutional retinoblastoma database. Complementary imaging techniques, including RetCam™, fluorescein angiography and B-scan ultrasound, were assessed. RESULTS: Twenty-two intraocular lesions in 16 patients were imaged. HHSD OCT was used exclusively in 19 lesions, while conventional OCT was also performed in three cases. Small lesions were imaged in five cases, all of which were localised to the middle retinal layers. Clinical uses for HHSD OCT imaging identified included: diagnosis of new lesions, monitoring response to laser therapy and the identification of edge recurrences. CONCLUSIONS: Although indirect ophthalmoscopy remains the gold standard for diagnosis and treatment of retinoblastoma, HHSD OCT is a valuable tool in better understanding and managing retinoblastoma.