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Yue Z, Liu S, Zhu Y, Shen Y, Zeng C, Li J, Chen Y, Wei R. The role of surgical factors eliciting oculocardiac reflex of patients undergoing orbital tumor surgery: a retrospective study. Graefes Arch Clin Exp Ophthalmol 2024; 262:1295-1303. [PMID: 37950752 DOI: 10.1007/s00417-023-06311-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/18/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE Orbital tumors are an interdisciplinary disease, and surgery is one of the main treatment methods. The oculocardiac reflex (OCR) is a condition of surgery for orbital tumors. The aim of this study was to investigate whether there is an association between many surgical factors and the incidence of OCR in orbital tumor surgery. METHODS Comparisons were made between patients with and without OCR using the Mann-Whitney test, Fisher's exact test, and Chi-square test. When comparing multiple groups (groups > 2), to explain which two groups had differences, post hoc testing was used for analysis, and the differences between groups were judged according to the adjusted standardized residuals. RESULTS The results showed that the incidence of intraoperative OCR was different based on the different exposed operative field locations (p = 0.021). The OCR incidence in those with lesions involving the orbital apex and lesions adhering to extraocular muscles was higher than that of others (p < 0.001 and p = 0.003). In addition, multivariate logistic regression analysis revealed that orbital apex involvement and extraocular muscle adhesion were highly associated with a higher incidence of OCR (p < 0.001 and p = 0.013), while the operative field located in the lateral-superior orbit was highly associated with a lower incidence of OCR (p = 0.029). CONCLUSION In orbital tumor surgery under general anesthesia, lesions involving the orbital apex and lesion adhesion to the extraocular muscles were independent risk factors for OCR, and an operative field located in the lateral-superior orbit was a protective factor for OCR.
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Affiliation(s)
- Zifan Yue
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
| | - Siyu Liu
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
- Department of Ophthalmology, Naval Medical Center of PLA, Shanghai, China
| | - Yanfei Zhu
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
| | - Ya Shen
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
| | - Chengcheng Zeng
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
| | - Jian Li
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
| | - Yuqing Chen
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China
| | - Ruili Wei
- Department of Ophthalmology, Changzheng Hospital of Naval Medical University, Shanghai, China.
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Gishti O, de Keizer ROB, Detiger SE, van Rij C, Slagter C, Paridaens D. Radiation optic neuropathy and retinopathy in patients with presumed benign intraorbital tumours treated with fractionated stereotactic radiotherapy. Eye (Lond) 2023; 37:2470-2474. [PMID: 36513859 PMCID: PMC10397216 DOI: 10.1038/s41433-022-02356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To assess the long-term effects of fractionated stereotactic radiotherapy (fSRT) for the treatment of (presumed) benign intraorbital tumours on visual acuity, visual fields, globe and eyelid position, and complications including radiation retinopathy and deviations of retinal nerve fibre layer (RNFL) on OCT. METHODS Multi-centre retrospective follow-up study of a consecutive series of 25 patients treated in the Rotterdam Orbital Center (collaboration between Erasmus Medical Center and Rotterdam Eye Hospital) between 2002 and 2018. Data on the dose of fSRT, visual acuity, Humphrey field analyser (HFA) perimetry, globe and eyelid position were obtained from the medical records. RESULTS In this retrospective consecutive series of 25 patients with a median follow-up of 104 months (range 48-215 months), 80.0% of the patients had presumed optic nerve sheath meningioma and 20.0 % presumed cavernous haemangioma with signs suggestive of recent growth. In most patients, a better visual acuity and RNFL thickness were observed after stereotactic radiotherapy. Improvement of the visual field defects was observed after treatment, with a mean deviation of -14.98 dB (12.9 SD) before treatment versus -4.56 dB (10.8 SD) after treatment, respectively. Significant, but small changes in exophthalmometry values were observed with a mean of 14.92 mm (7.9 SD) versus 13.79 mm (7.3 SD) after treatment, respectively. Only 3 patients (15.0%) developed radiation retinopathy after stereotactic radiotherapy. All patients with radiation retinopathy had presumed optic nerve sheath meningioma. CONCLUSIONS Based on our results, fSRT is an effective treatment modality for this subset of orbital tumours with few complications and good long-term visual and cosmetic outcomes. FSRT is non-invasive and safer than surgery for lesions in the posterior orbit or around the optic nerve.
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Affiliation(s)
- O Gishti
- Rotterdam Eye Hospital, Rotterdam, The Netherlands.
- Department of Ophthalmology, Anna Hospital, Geldrop, The Netherlands.
| | | | - S E Detiger
- Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - C van Rij
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Slagter
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D Paridaens
- Rotterdam Eye Hospital, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kopecky A, Rokohl AC, Gaca PJ, Matos PAW, Nemcansky J, Heindl LM. Clinical Signs for Differential Diagnosis of Eyelid Tumours. Klin Monbl Augenheilkd 2023; 240:13-23. [PMID: 36706766 DOI: 10.1055/a-1996-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.
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Affiliation(s)
- Adam Kopecky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Olomouc, Czech Republic
| | | | - Piotr Jakub Gaca
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Jan Nemcansky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
| | - Ludwig M Heindl
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) - Aachen - Bonn - Cologne - Düsseldorf, Cologne, Germany
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Gaca PJ, Rejdak R, Doulis A, Wawer-Matos PA, Rokohl AC, Heindl LM. [Uncommon indolent mass in the temporal angle of the right eyelid]. DIE OPHTHALMOLOGIE 2023; 120:89-92. [PMID: 35925333 DOI: 10.1007/s00347-022-01657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/03/2022] [Accepted: 05/02/2022] [Indexed: 01/28/2023]
Affiliation(s)
- P J Gaca
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - R Rejdak
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
| | - A Doulis
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P A Wawer-Matos
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Bonn-Düsseldorf-Köln, Köln, Deutschland
| | - A C Rokohl
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Bonn-Düsseldorf-Köln, Köln, Deutschland
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Gaca PJ, Lewandowicz M, Lipczynska-Lewandowska M, Simon M, Rejdak R, Wawer-Matos PA, Doulis AE, Rokohl AC, Heindl LM. Die embryologische und fetale Entwicklung der Orbita, der Augenlider und des Tränenwegsystems. Klin Monbl Augenheilkd 2022; 239:820-822. [PMID: 35705100 DOI: 10.1055/a-1835-9144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Piotr J Gaca
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Deutschland
| | - Michal Lewandowicz
- Abteilung für onkologische Chirurgie des Multidisziplinären M. Copernicus Woiwodschaftszentrums für Onkologie und Traumatologie in Lodz, Lodz, Polen
| | - Malgorzata Lipczynska-Lewandowska
- Klinik und Poliklinik für Zahn-, Kiefer- und Gesichtschirurgie, Zentrales Klinisches Krankenhaus der Medizinischen Universität zu Lodz, Lodz, Polen
| | - Michael Simon
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Robert Rejdak
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
| | | | - Alexandros E Doulis
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Deutschland
| | - Alexander C Rokohl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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Effective systemic treatment of advanced periocular basal cell carcinoma with sonidegib. Graefes Arch Clin Exp Ophthalmol 2021; 259:3821-3822. [PMID: 34338845 PMCID: PMC8589764 DOI: 10.1007/s00417-021-05311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
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Abstract
BACKGROUND Orbital space-occupying lesions can have a significant impact on the quality of life. Depending on the dignity and etiology of the mass, they can even represent a life-threatening process, which must be timely treated in an interdisciplinary cooperation. OBJECTIVE To achieve a comprehensive overview about the diagnostics and frequency of malignant and benign masses of the orbit. MATERIAL AND METHODS A literature search was carried out in PubMed and Google scholar. RESULTS AND DISCUSSION Clinically, orbital lesions can show symptoms, such as exophthalmos with an increase in the vertical lid fissure, visual impairment and motility dysfunction with diplopia. Depending on the extent, an exposure keratopathy can occur due to failure to close the eyelids. For the diagnostics several tests should be carried out. Following a thorough anamnesis and clinical examination, these should include a blood sample to test for various parameters, an ultrasound examination with subsequent computed tomography (CT) in cases of bone involvement or thin slice magnetic resonance imaging (MRI) of the orbit for assessment of soft tissues. In adults an endocrine orbitopathy is the most frequent cause of an inflammatory orbital process, where lymphomas are the most frequent entity among malignant tumors and vascular space-occupying lesions are the most frequent benign tumors. In children the most frequent benign masses are dermoid cysts and rhabdomyosarcoma is the most frequent primary malignant orbital tumor. The multimodal interdisciplinary treatment can include surgical excision and adjuvant radiotherapy or chemotherapy, depending on the entity.
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Ponto KA, Brockmann MA, Koutsimpelas D, Heider J, Ringel FA, Heindl LM, Kakassery V. [Excisional surgery of orbital tumors]. Ophthalmologe 2021; 118:995-1003. [PMID: 33893529 DOI: 10.1007/s00347-021-01386-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
The indications for orbital tumor surgery are an incisional biopsy to confirm the diagnosis or in malignant operable tumors a complete excision or a debulking to avoid complications in large invasively infiltrating tumors. In the case of benign tumors, the indications for surgery depend mostly on the clinical symptoms and cosmetic esthetic disfigurement. In the present article the preoperative examinations as well as surgical access approaches to different orbital regions, endoscopic procedures and methods of intraoperative navigation are presented. Magnetic resonance imaging is the instrument of choice, whereby in many cases computed tomography (CT) adds further information. Depending on the indications, diffusion-weighted sequences, CT angiography and digital subtraction angiography (DSA, catheter angiography) are added to the preoperative diagnostics. For space-occupying lesions located anterior to the bulbar equator, an anterior orbitotomy can be performed transconjunctivally or transpalpebrally. A lateral orbitotomy is used to reach lateral, laterocranial, and lateroinferior orbital segments, whereas transcranial approaches are suitable for processes located far posterior and for those with retro-orbital intracranial extension as well as for processes in the optic foramen/superior orbital fissure. The indications for an endonasal access approach are processes medial to the bulb or optic nerve and up to the orbital apex. A transantral access can be chosen for caudal, mediolateral, and medioinferior space-occupying lesions. Modern orbital surgery is complemented by endoscopic procedures and intraoperative navigation. Orbital tumors belong to the interdisciplinary relevant diseases. Therefore, an optimal management takes place at specialized multidisciplinary centers.
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Affiliation(s)
- K A Ponto
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. .,Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland.
| | - M A Brockmann
- Klinik und Poliklinik für Neuroradiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - D Koutsimpelas
- Hals-Nasen-Ohren-Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - J Heider
- Klinik für Mund-Kiefer-Gesichtschirurgie, plastische Operationen, Universitätsmedizin Mainz, Mainz, Deutschland
| | - F A Ringel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - V Kakassery
- Klinik für Augenheilkunde, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
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