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Vandeurzen J, Vander Poorten V, de Jong M, Mombaerts I. Customized Nasal Prosthesis for a Jones Lacrimal Bypass Tube Using 3-Dimensional Planning and Printing Technology. Ophthalmic Plast Reconstr Surg 2023; 39:e179-e182. [PMID: 37405752 DOI: 10.1097/iop.0000000000002427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
A 35-year-old woman was treated for extensive squamous cell carcinoma of the nasal septal mucosa with total rhinectomy, including removal of the nasal septum, and chemoradiotherapy. A magnet-retained nasal prosthesis was fitted. She had developed right-sided epiphora from total proximal lacrimal canalicular obstruction, for which an angled Jones lacrimal bypass tube was inserted. The tube, however, intermittently rotated in the nasal cavity, causing recurrent epiphora and irritation at the caruncular site. With the aid of 3-dimensional technology, we designed a septum for the prosthesis that stabilized the tube within the nasal cavity. At the follow-up 2 years later, the patient was satisfied with the nasal prosthesis and lacrimal stent. To our knowledge, this report is the first to describe a patient-specific nasal prosthesis adapted for a Jones tube after total rhinectomy.
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Affiliation(s)
- Jelle Vandeurzen
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | | | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
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Philips C, Terrie L, Muylle E, Van Ginderdeuren R, Vereecke E, Mombaerts I, Thorrez L. The Immunoarchitecture of Human Extraocular Muscles. Invest Ophthalmol Vis Sci 2023; 64:23. [PMID: 37975851 PMCID: PMC10664723 DOI: 10.1167/iovs.64.14.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023] Open
Abstract
Purpose The purpose of this study was to describe the immunoarchitecture of normal extraocular muscles (EOMs) in terms of presence, distribution, and organization of various immune cells. Methods We performed unilateral orbital exenterations in six fresh human cadavers from elderly patients, followed by dissection of the medial, lateral, superior and inferior rectus, superior and inferior oblique, and superior palpebral levator muscle in their entirety. We further cross sectioned each EOM in an anterior, central, and posterior third. After immunohistochemical staining for CD3, CD8, CD20, CD138, CD68, and podoplanin, quantitative analysis was performed. Results We found all EOMs (rectus, oblique, and levator muscles) to harbor both T- and B-lymphocytes, with a B-lymphocyte dominance and an absence of plasma cells. The highest prevalence of immune cells was seen in the muscle bellies, with, on average, 488 ± 63 CD3+ T-lymphocytes and 44 ± 110 CD20+ B-lymphocytes per mm2, and significant differences from the anterior (T-lymphocytes) and posterior (T- and B-lymphocytes) thirds. T- and B-lymphocytes were primarily organized in hotspots in the vicinity of blood vessels. In addition, a small resident population of macrophages scattered throughout the specimens was detected. No lymphatic vessels were found in any of the EOMs. Conclusions These findings can serve as a reference dataset in the assessment of EOM biopsies in the diagnostic process of inflammatory orbital and systemic disorders. Moreover, from a regenerative perspective, our results highlight the importance of taking into account the presence of a resident immune cell population when studying the host immune response on transplanted tissues or engineered constructs.
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Affiliation(s)
- Charlot Philips
- Tissue Engineering Lab, Department of Development and Regeneration, Catholic University Leuven campus Kulak, Kortrijk, Belgium
| | - Lisanne Terrie
- Tissue Engineering Lab, Department of Development and Regeneration, Catholic University Leuven campus Kulak, Kortrijk, Belgium
| | - Ewout Muylle
- Tissue Engineering Lab, Department of Development and Regeneration, Catholic University Leuven campus Kulak, Kortrijk, Belgium
| | | | - Evie Vereecke
- Jan Palfijn Anatomy Lab, Department of Development and Regeneration, Catholic University Leuven campus Kulak, Kortrijk, Belgium
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Catholic University Leuven, Leuven, Belgium
| | - Lieven Thorrez
- Tissue Engineering Lab, Department of Development and Regeneration, Catholic University Leuven campus Kulak, Kortrijk, Belgium
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Mombaerts I, Allen RC. The transconjunctival orbitotomy: A versatile approach to the orbit and beyond. Surv Ophthalmol 2023; 68:265-279. [PMID: 36372115 DOI: 10.1016/j.survophthal.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
In the management of orbital disorders and defects, minimally invasive surgical approaches have become increasingly efficient for their reduction of operative trauma and access without compromise of therapeutic benefit or diagnostic yield. Various approaches have focused on bone- and canthal-sparing techniques and concealed and small skin incisions. We review the current state of knowledge of procedures to enter the orbit via the conjunctiva. Any quadrant of the orbit can be accessed via the conjunctiva. Surgical incisions involve the orbital palpebral, forniceal, and bulbar conjunctiva. According to the location, nature, and size of the lesion, the transconjunctival orbitotomy can be used as a single procedure, in combination with a caruncular approach or as an adjunct in a multidisciplinary procedure for lesions extending deep into or outside the orbit. The working space and field of operating view can be expanded by releasing the horizontal tension of the eyelid with a lateral cantholysis, lateral paracanthal blepharotomy, or medial lid split procedure. Complications related to the conjunctival incision are reduced to dry eye disease.
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Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.; Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Burch HB, Perros P, Bednarczuk T, Cooper DS, Dolman PJ, Leung AM, Mombaerts I, Salvi M, Stan MN. Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid 2022; 32:1439-1470. [PMID: 36480280 PMCID: PMC9807259 DOI: 10.1089/thy.2022.0251] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being determined. Most patients with TED develop eye manifestations while being treated for hyperthyroidism and under the care of endocrinologists. Endocrinologists, therefore, have a key role in diagnosis, initial management, and selection of patients who require referral to specialist care. Given that the need for guidance to endocrinologists charged with meeting the needs of patients with TED transcends national borders, and to maximize an international exchange of knowledge and practices, the American Thyroid Association and European Thyroid Association joined forces to produce this consensus statement.
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Affiliation(s)
- Henry B. Burch
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Endocrinology Division, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Address correspondence to: Henry B. Burch, MD, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Diabetes, Endocrinology, & Metabolic Diseases, National Institutes of Health, 6707 Democracy Blvd, Room 5053, Bethesda, MD 20892-0001, USA
| | - Petros Perros
- Department of Endocrinology, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - David S. Cooper
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter J. Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Mario Salvi
- Department of Clinical and Community Services, Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Marius N. Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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Burch HB, Perros P, Bednarczuk T, Cooper DS, Dolman PJ, Leung AM, Mombaerts I, Salvi M, Stan MN. Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association. Eur Thyroid J 2022; 11:e220189. [PMID: 36479875 PMCID: PMC9727317 DOI: 10.1530/etj-22-0189] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being determined. Most patients with TED develop eye manifestations while being treated for hyperthyroidism and under the care of endocrinologists. Endocrinologists, therefore, have a key role in diagnosis, initial management, and selection of patients who require referral to specialist care. Given that the need for guidance to endocrinologists charged with meeting the needs of patients with TED transcends national borders, and to maximize an international exchange of knowledge and practices, the American Thyroid Association and European Thyroid Association joined forces to produce this Consensus Statement.
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Affiliation(s)
- Henry B Burch
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Endocrinology Division, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Petros Perros
- Department of Endocrinology, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Mario Salvi
- Department of Clinical and Community Services, Graves’ Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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van Renterghem V, Ruiters S, Mombaerts I. Motility of the Ocular Prosthesis in Anophthalmic Patients: Objective and Patient-perceived Findings. Orbit 2022:1-6. [PMID: 35924421 DOI: 10.1080/01676830.2022.2107687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM To study the impact of the prosthesis motility on the Quality of Life (QoL) in anophthalmic patients. METHODS Cross-sectional, observational study of 100 anophthalmic patients, of whom 64% had an acryl implant, 6% an Allen implant, 1% a hydroxyapatite implant, 4% a dermis fat graft, 16% no implant, and 9% an unknown implant. We quantitatively assessed the motility of the prosthesis with Kestenbaum glasses and the QoL with a validated questionnaire covering five domains: General functional abilities and care, wearing comfort, physical appearance, psychological and social functioning. Associations between measured prosthetic eye motility, patient-perceived motility, and satisfaction were made. RESULTS Motility of the prosthesis was impaired with an average loss of 76%, and correlated with Cosmetic satisfaction (adduction P = .02, abduction P = .008, elevation P = .04) and Social satisfaction (adduction P = .03, abduction P = .003). The patient-perceived motility of the prosthesis correlated with General functioning abilities (horizontal P = .0004, vertical P = .0004), Comfort (horizontal P = .001, vertical P = .003), Cosmetic satisfaction (horizontal P = .0002, vertical P = .0002), Psychological satisfaction (horizontal P = .001, vertical P = .001), and Social satisfaction (horizontal P = .002, vertical P = .003). CONCLUSIONS Ocular prosthetic motility has a significant impact on patient-perceived satisfaction and physical appearance, and predicts coping with the prosthetic condition on the psychosocial level. This highlights the need of introducing patient-reported outcome measures in the prosthetic rehabilitation of the anophthalmic patient.
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Affiliation(s)
| | - Sébastien Ruiters
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Ruiters S, Shujaat S, Faria Vasconcelos K, Shaheen E, Jacobs R, Mombaerts I. Three-dimensional design of a geometric model for an ocular prosthesis in ex vivo anophthalmic socket models. Acta Ophthalmol 2021; 99:221-226. [PMID: 32701212 DOI: 10.1111/aos.14549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Fitting a customized ocular prosthesis for anophthalmic patients entails an artisanal labour-exhausting process and is standardly based on impression moulding of the socket, which may be anatomically inaccurate. The objective of the study was to design an impression-free socket mould with three-dimensional (3D) technology. METHODS The ex vivo anophthalmic socket models included one silicone, one fresh pig cadaver head and three fresh-frozen human cadaver heads. After intra-socket application with iodine substance, five observers obtained eighteen low-dose cone beam computed tomography (CBCT) scans and one observer one high-dose CBCT scan of each model. The observers designed non-impression 3D moulds of the socket with 3D software. For the human cadaver sockets 3D geometric models of the ocular prosthesis were rendered from the 3D mould of the socket and the mirrored cornea of the contralateral eye. RESULTS The posterior surface of the 3D mould was highly accurate, with a mean absolute deviation of 0.28 mm, 0.53 mm, 0.37 mm and mean upper deviation of 0.53 mm, 0.86 mm, 1.17 mm, respectively, for the phantom, pig and human model. The intra- and interobserver repeatability and reproducibility of the 3D moulds and designs was good (<0.35 mm). The largest variation in the 3D geometric model was found at the junction of the 3D mould and mirrored cornea. CONCLUSION 3D design of an impression-free geometric model for an ocular prosthesis with low-dose CBCT is highly accurate in ex vivo anophthalmic socket models. This novel method is a critical step towards the manufacturing of 3D printed ocular prostheses and requires validation in anophthalmic patients.
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Affiliation(s)
- Sébastien Ruiters
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
| | - Sohaib Shujaat
- OMFS ‐ IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine Catholic University Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
| | - Karla Faria Vasconcelos
- OMFS ‐ IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine Catholic University Leuven Leuven Belgium
| | - Eman Shaheen
- OMFS ‐ IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine Catholic University Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
| | - Reinhilde Jacobs
- OMFS ‐ IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine Catholic University Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
| | - Ilse Mombaerts
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
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8
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Ruiters S, De Jong S, Mombaerts I. Measuring quality of care and life in patients with an ocular prosthesis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2017-2025. [PMID: 33547966 DOI: 10.1007/s00417-021-05088-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In patients with an anophthalmic condition, the primary determinants of success of ocular prosthetic rehabilitation are satisfaction with care and quality of life (QoL). The aim of this study is to develop a condition-specific questionnaire as a patient-reported outcome measure for patients with an ocular prosthesis. METHODS Observational cross-sectional prospective study. We included 100 patients (52 female, 48 male, > 18 years old) with an anophthalmic and ocular prosthetic condition existing for 2 years or more. The patients completed a pre-tested 72-item questionnaire regarding their experience on living with an ocular prosthesis in four domains of QoL: single vision and care, wearing comfort, physical appearance and motility, and psychosocial functioning. Associations with demographic factors and condition- and prosthesis-related variables were investigated with multivariate analysis. The questionnaire was reduced with principal component analysis to obtain the Global Ocular Prosthesis Score (GOPS). RESULTS Satisfaction scores for each QoL domain were high with a mean visual analogue score between 7.2 and 7.6. Patients were generally satisfied with the physical appearance of the artificial eye and reported adequate psychosocial functioning. Patients described the reduced peripheral visual field and socket discharge as chief complaints. The test was reduced to a 20-item questionnaire. The mean GOPS was 70.87 (median 75.00). CONCLUSIONS Patients with longstanding ocular prosthetic wear are satisfied with their physical appearance and report adequate psychosocial functioning. A concise 20-item questionnaire for the anophthalmic condition is a valuable tool to quantitatively measure patient-reported outcome of ocular prosthetic rehabilitation. TRIAL REGISTRATION NUMBER NCT04321382, 03/2020, retrospectively registered.
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Affiliation(s)
- Sébastien Ruiters
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
| | | | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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9
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Demaerel V, Mombaerts I, Van Ginderdeuren R, Dehem J, Demaerel P. Delayed orbital fibrosing inflammation from a retained crayon. Neuroradiology 2021; 63:817-820. [PMID: 33410947 DOI: 10.1007/s00234-020-02615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
A 39-year-old woman presented with sudden onset of double vision, right upper eyelid swelling and ptosis, and orbital pain. Imaging revealed an irregular mass of the upper right orbit with central non-enhancing areas. Upon inquiry, the patient recalled an intraorbital trauma with a crayon in her childhood, 35 years ago. Via translid anterior orbitotomy, remnants of a blue crayon embedded in an orbital fat mass were removed. Histopathology showed scavenger reaction of macrophages and sclerosis. Energy-dispersive X-ray spectroscopy revealed the presence of silicate particles. Repeated courses of corticosteroids were given. The patient deteriorated with reduced vision and frozen globe owing to severe orbital fibrosis of the entire orbit.
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Affiliation(s)
- Victor Demaerel
- Department of Radiology, University Hospital KU Leuven, Leuven, Belgium
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospital KU Leuven, Leuven, Belgium
| | | | - Johan Dehem
- Department of Radiology, Jan Yperman Hospital, Ieper, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospital KU Leuven, Leuven, Belgium.
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Mombaerts I. Coloring between the Treatment Guidelines for Graves’ Orbitopathy. Ophthalmology 2020; 127:S158-S159. [DOI: 10.1016/j.ophtha.2019.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/27/2022] Open
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Willaert R, Shaheen E, Deferm J, Vermeersch H, Jacobs R, Mombaerts I. Three-dimensional characterisation of the globe position in the orbit. Graefes Arch Clin Exp Ophthalmol 2020; 258:1527-1532. [PMID: 32140924 DOI: 10.1007/s00417-020-04631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Current methods to analyse the globe position, including Hertel exophthalmometry and computed tomography (CT), are limited to the axial plane and require the lateral orbital rim and cornea as landmarks. This pilot study aimed to design a method to measure the position of the globe in the axial, coronal and sagittal plane and independent from orbital bony and corneal references. METHODS With the aid of three-dimensional CT reconstruction technology, we determined the globe position in the orbit based on the centre of the globe. Method validation was performed using data of consecutive orbital CT scans from the control group and from the patients with Graves' orbitopathy who underwent orbital decompression surgery with removal of the lateral orbital margin. RESULTS The inter- and intra-observer reliability was excellent with a high intraclass correlation coefficient (> 0.99, 95% CI [0.97; 1.00]). In the decompressed orbits, there was a statistically significant globe position shift along the anterior-posterior axis (P = 0.0005, 95% CI [0.63; 3.66]), but not along the medial-lateral and superior-inferior axis. CONCLUSION The 3D CT method can accurately and reliably characterise the globe position shift in the three dimensions without using orbital and corneal anatomical landmarks. The method can be useful to determine the globe shift in proptosis, enophthalmos, hypoglobus and hyperglobus, even in the presence of strabismus and orbital bone defects.
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Affiliation(s)
- Robin Willaert
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium. .,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Julie Deferm
- Department of Oral and Maxillofacial Surgery, Radboud University Hospital, Nijmegen, The Netherlands
| | - Hubert Vermeersch
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Abstract
PURPOSE OF REVIEW To comprehensively review the applications of advanced three-dimensional printing technology in the management of orbital abnormalities. RECENT FINDINGS Three-dimensional printing has added value in the preoperative planning and manufacturing of patient-specific implants and surgical guides in the reconstruction of orbital trauma, congenital defects and tumor resection. In view of the costs and time, it is reserved as strategy for large and complex craniofacial cases, in particular those including the bony contour. There is anecdotal evidence of a benefit of three-dimensional printing in the manufacturing of prostheses for the exenterated and anophthalmic socket, and in the fabrication of patient-specific boluses, applicators and shielding devices for orbital radiation therapy. In addition, three-dimensional printed healthy and diseased orbits as phantom tangible models may augment the teaching and learning process of orbital surgery. SUMMARY Three-dimensional printing allows precision treatment tailored to the unique orbital anatomy of the patient. Advancement in technology and further research are required to support its wider use in orbital clinical practice.
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Affiliation(s)
- Sébastien Ruiters
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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13
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Mombaerts I, Ramberg I, Coupland SE, Heegaard S. Diagnosis of orbital mass lesions: clinical, radiological, and pathological recommendations. Surv Ophthalmol 2019; 64:741-756. [PMID: 31276737 DOI: 10.1016/j.survophthal.2019.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023]
Abstract
The orbit can harbor mass lesions of various cellular origins. The symptoms vary considerably according to the nature, location, and extent of the disease and include common signs of proptosis, globe displacement, eyelid swelling, and restricted eye motility. Although radiological imaging tools are improving, with each imaging pattern having its own differential diagnosis, orbital mass lesions often pose a diagnostic challenge. To provide an accurate, specific, and sufficiently comprehensive diagnosis, to optimize clinical management and estimate prognosis, pathological examination of a tissue biopsy is essential. Diagnostic orbital tissue biopsy is obtained through a minimally invasive orbitotomy procedure or, in selected cases, fine needle aspiration. The outcome of successful biopsy, however, is centered on its representativeness, processing, and interpretation. Owing to the often small volume of the orbital biopsies, artifacts in the specimens should be limited by careful peroperative tissue handling, fixation, processing, and storage. Some orbital lesions can be characterized on the basis of cytomorphology alone, whereas others need ancillary molecular testing to render the most reliable diagnosis of therapeutic, prognostic, and predictive value. Herein, we review the diagnostic algorithm for orbital mass lesions, using clinical, radiological, and pathological recommendations, and discuss the methods and potential pitfalls in orbital tissue biopsy acquisition and analysis.
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Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
| | - Ingvild Ramberg
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Section of Eye Pathology, Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK; Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Section of Eye Pathology, Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Ruiters S, de Jong S, Mombaerts I. Bespoke ocular prostheses. Eye (Lond) 2019; 33:1158-1160. [PMID: 30837709 DOI: 10.1038/s41433-019-0385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the customized approach of patients with anophthalmia or microphthalmia with bespoke ocular prosthesis. METHODS Retrospective analysis of case series. RESULTS The study included cases with anophthalmia with upper eyelid deformity (one patient), microphthalmia and contralateral corectopia (one patient), microphthalmia with contralateral corneal graft (one patient), and congenital clinical anophthalmia with contralateral sclerocornea (one patient). Using techniques of embedded autologous hair and coating of adhesive pigment emulsion in the ocular prosthesis, the physical appearance of, respectively, an upper eyelid, corectopia, corneal graft, and sclerocornea was reproduced. CONCLUSION Tailoring the ocular prosthesis to the distinct condition of the anophthalmic socket and contralateral eye adds to the success of rehabilitative prosthetic treatment of the patient.
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Affiliation(s)
- Sébastien Ruiters
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Stéphan de Jong
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Affiliation(s)
- Liesbeth Wellens
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | | | - Ilse Mombaerts
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
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Mombaerts I, Witters E. Jones lacrimal bypass tubes in children and adults. Br J Ophthalmol 2018; 103:1248-1252. [DOI: 10.1136/bjophthalmol-2018-313039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/30/2018] [Accepted: 10/21/2018] [Indexed: 11/04/2022]
Abstract
Background/aimsAlthough a Jones tube is considered the mainstay for epiphora in patients with total blockage of the canalicular system, it has been discouraged in children for reasons of inadequate self-care and maintenance. The purpose of this study is to compare the long-term outcome of Jones tube surgery in paediatric versus adult patients.MethodsRetrospective, interventional case series of a single academic institution. The medical records of all children (≤16 years old) and adults (>16 years old) who underwent conjunctivorhinostomy with placement of a 130° angled extended Jones tube were reviewed. The outcome measures were patency and anatomical position of the tube, type and frequency of complications and subjective relief of epiphora.ResultsThe study included 10 children (11 eyes) (range, 5.1–16.0 years old) and 102 adults (127 eyes) (range, 19.7–82.4 years old). The success and complication rate did not differ between the two age groups. Tube dislodgement and obstruction occurred in 4 (36.4%) of the paediatric tubes with an incidence rate of 6.1%/year and in 47 (37.0%) of the adult tubes with an incidence rate of 9.3%/year (p=0.3867). Two adults required routine self-irrigation of the tube. The median follow-up was 6.7 years for the children and 8.7 years for the adults (p=0.3430).ConclusionWith a similar outcome profile and minimal self-care, young age is not a prognostic nor limiting factor for surgery with angled Jones tubes. Exchange with tubes of a longer length is not required during growth.
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Affiliation(s)
- Ilse Mombaerts
- a Department of Ophthalmology , University Hospitals Leuven , Leuven , Belgium
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Van Ginderdeuren R, Sciot R, Mombaerts I. Orbital tumor associated with a microphthalmic eye and colobomatous cleft: Pilocytic astrocytoma (glioma) or massive retinal gliosis. Saudi J Ophthalmol 2018; 32:79-82. [PMID: 29755278 PMCID: PMC5943822 DOI: 10.1016/j.sjopt.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/11/2018] [Accepted: 02/11/2018] [Indexed: 12/01/2022] Open
Abstract
A 11-year-old boy with congenital microphthalmos of the right eye presented with gradual protrusion of his ocular prosthesis. MRI showed an orbital mass adjacent to the microphthalmic eye. After removal of the eye and the orbital soft tissue mass a gliotic mass, resembling a pilocytic astrocytoma WHO grade 1 (glioma) was diagnosed. Through a colobomatous cleft in the eye the tumour spread in the orbit. There were no clinical signs of neurofibromatosis 1. This case showed a very rare association between a microphthalmic and colobomatous eye and pilocytic astrocytoma, grade 1. However a far advanced and infiltrative massive retinal gliosis cannot be definitively excluded as differential diagnosis.
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Affiliation(s)
- Rita Van Ginderdeuren
- Dept of Ophthalmology, and Pathology, Kapucijnenvoer 33, UZ Leuven, B3000 Leuven, Belgium
| | - Rafael Sciot
- Pathology Department, University Hospitals Leuven, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - Ilse Mombaerts
- Ophthalmology Department, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
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Mombaerts I, Bilyk JR, Rose GE, McNab AA, Fay A, Dolman PJ, Allen RC, Devoto MH, Harris GJ. Consensus on Diagnostic Criteria of Idiopathic Orbital Inflammation Using a Modified Delphi Approach. JAMA Ophthalmol 2017; 135:769-776. [PMID: 28570731 DOI: 10.1001/jamaophthalmol.2017.1581] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Current practice to diagnose idiopathic orbital inflammation (IOI) is inconsistent, leading to frequent misdiagnosis of other orbital entities, including cancer. By specifying criteria, diagnosis of orbital inflammation will be improved. Objective To define a set of criteria specific for the diagnosis of IOI. Design, Setting, and Participants A 3-round modified Delphi process with an expert panel was conducted from June 8, 2015, to January 25, 2016. Fifty-three orbital scientist experts, identified through membership in the Orbital Society, were invited to participate in on online survey and they scored, using 5-point Likert scales, items that are eligible as diagnostic criteria from the literature and from personal experience. The items were clustered around the anatomic subtypes of IOI: idiopathic dacryoadenitis and idiopathic orbital fat inflammation (2 nonmyositic IOIs), and idiopathic orbital myositis (myositic IOI). Items with dissensus were rescored in the second round, and all items with consensus (median, ≥4; interquartile range, ≤1) were ranked by importance in the third round. Main Outcomes and Measures Consensus on items to be included in the criteria. Results Of the 53 experts invited to participate, a multinational panel of 35 (66%) individuals with a mean (SD) years of experience of 31 (11) years were included. Consensus was achieved on 7 of 14 clinical and radiologic items and 5 of 7 pathologic items related to diagnosis of nonmyositic IOI, and 11 of 14 clinical and radiologic items and 1 of 5 pathologic items for myositic IOI. There was agreement among panelists to focus on surgical tissue biopsy results in the diagnosis of nonmyositic IOI and on a trial with systemic corticosteroids in myositic IOI. Panelists agreed that a maximum number of 30 IgG4-positive plasma cells per high-power field in the orbital tissue is compatible with the diagnosis of IOI. Conclusions and Relevance An international panel of experts endorsed consensus diagnostic criteria of IOI. These criteria define a level of exclusion suggested for diagnosis and include tissue biopsy for lesions not confined to the extraocular muscles. This consensus is a step toward developing guidelines for the management of IOI, which needs to be followed by validation studies of the criteria.
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Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - Geoffrey E Rose
- Moorfields Eye Hospital & Institute of Ophthalmology, London, England
| | - Alan A McNab
- Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Aaron Fay
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Peter J Dolman
- Eye Care Center, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard C Allen
- Section of Ophthalmology, MD Anderson Cancer Center, Houston, Texas
| | | | - Gerald J Harris
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
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Jellema HM, Saeed P, Mombaerts I, Dolman PJ, Garrity J, Kazim M, Dhrami-Gavazi E, Lyons C, Nieuwkerk P, Mourits MP. Objective and subjective outcomes of strabismus surgery in Graves' orbitopathy: a prospective multicentre study. Acta Ophthalmol 2017; 95:386-391. [PMID: 28133945 DOI: 10.1111/aos.13367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the change and interrelationship of the field of binocular single vision (BSV) and the quality of life (QoL), tested with two different tools, after one or two strabismus surgeries in patients with Graves' orbitopathy (GO). METHODS Prospectively, consecutive patients with GO who were scheduled for their first strabismus surgery were recruited from five centres specialized in the treatment of GO. One week preoperatively and 3 months after the last operation, a full ophthalmic and orthoptic examination was performed. Change in field of BSV, GO-QoL and thyroid eye disease-QoL (TED-QoL) was recorded. RESULTS A total of 59 met all the eligibility criteria of whom 15 underwent two strabismus operations. The median (interquartile range) preoperative score of the field of BSV was 0 (0-0), which improved to 73 (53-85) after the correction(s) (p < 0.001). After the first surgery, a significant higher score of the field of BSV was found in the patients who underwent one operation (76; 60-86) compared with those who underwent two 0 (0-63) operations (p < 0.001). After the second surgery, this score increased to 62 (40-76; p = 0.05). A moderate correlation was found between the score of the field of BSV and the GO-QoL visual functioning (VF) questionnaires (r = 0.485; p < 0.001). Both the GO-QoL and TED-QoL for VF and appearance (AP) showed significantly higher scores after the treatment (p < 0.001). CONCLUSION After strabismus surgery in GO patients, both the field of BSV and quality of life questionnaires increase. In approximately 30% of the patients, an additional strabismus surgery is performed. This second surgery significantly expands the field of BSV and the quality of life.
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Affiliation(s)
| | - Peerooz Saeed
- Department of Ophthalmology; University of Amsterdam; Amsterdam The Netherlands
| | - Ilse Mombaerts
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Peter J. Dolman
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Jim Garrity
- Department of Ophthalmology; Mayo Clinic; Rochester New York USA
| | - Mike Kazim
- Department of Ophthalmology; Columbia University; College of Physicians and Surgeons; New York New York USA
| | - Elona Dhrami-Gavazi
- Department of Ophthalmology; Columbia University; College of Physicians and Surgeons; New York New York USA
| | - Christopher Lyons
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Pythia Nieuwkerk
- Department of Medical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | - Maarten P. Mourits
- Department of Ophthalmology; University of Amsterdam; Amsterdam The Netherlands
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Mombaerts I, Rose GE, Garrity JA. Reply re: Dr. Kubota's Letter to the Editor, Corticosteroids or biopsy for idiopathic orbital inflammation. Surv Ophthalmol 2016; 62:255-256. [PMID: 27984070 DOI: 10.1016/j.survophthal.2016.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Geoffrey E Rose
- Moorfields Eye Hospital and Institute of Ophthalmology, London, UK
| | - James A Garrity
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Ruiters S, Sun Y, De Jong S, Politis C, Mombaerts I. Manufacturing of an ocular prosthesis based on the 3D printed anophthalmic socket. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mombaerts I, Rose GE, Garrity JA. Orbital inflammation: Biopsy first. Surv Ophthalmol 2016; 61:664-9. [DOI: 10.1016/j.survophthal.2016.03.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/23/2022]
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Veys MC, Delforge M, Mombaerts I. Treatment With Doxycycline for Severe Bortezomib-Associated Blepharitis. Clinical Lymphoma Myeloma and Leukemia 2016; 16:e109-12. [DOI: 10.1016/j.clml.2016.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/06/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022]
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Jakobiec FA, Syed ZA, Stagner AM, Harris GJ, Rootman J, Yoon MK, Mombaerts I. Orbital Inflammation in Pregnant Women. Am J Ophthalmol 2016; 166:91-102. [PMID: 27038895 DOI: 10.1016/j.ajo.2016.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To analyze overlaps between pregnancy and orbital inflammation (OI). DESIGN Retrospective observational case series. METHODS Eight new cases from 1997 to 2015 and 2 previously published cases were identified for inclusion in this investigation to provide the fullest clinical picture. Medical records, imaging studies, and the results of biopsies were reviewed. RESULTS Three categories of association were discovered: (1) OI arising for the first time during pregnancy (5 cases); (2) OI arising within 3 months of delivery (2 cases); and (3) previously diagnosed OI reactivated or exacerbated by pregnancy (3 cases). One patient had a preexistent systemic autoimmune disease and another's was later diagnosed. One patient had attacks during sequential pregnancies. Findings included eyelid swelling and erythema, conjunctival chemosis, pain on eye movement, minimal diplopia, the usual absence of proptosis, and general preservation of visual acuity. Imaging studies disclosed extraocular muscle swelling (8 cases), most frequently of a single lateral rectus muscle. There were 2 cases of dacryoadenitis; 1 of these and an additional case displayed inflammation of the retrobulbar fat. Corticosteroids effected resolution of most symptoms. Singleton births were normal with the exceptions of an intrauterine fetal demise owing to acrania and a molar pregnancy. CONCLUSION OI usually affects a single rectus muscle (typically the lateral) and, less often, the lacrimal gland and is often mild when it arises during or after pregnancy. Independent systemic autoimmune disease is an uncommon feature. Corticosteroids were efficacious except in 1 case with severe orbital scarring. No definitive causal relationships between pregnancy and OI could be established based on the clinical data.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
| | - Zeba A Syed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Anna M Stagner
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Gerald J Harris
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jack Rootman
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
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Ruiters S, Sun Y, de Jong S, Politis C, Mombaerts I. Computer-aided design and three-dimensional printing in the manufacturing of an ocular prosthesis. Br J Ophthalmol 2016; 100:879-881. [DOI: 10.1136/bjophthalmol-2016-308399] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/31/2016] [Accepted: 04/09/2016] [Indexed: 11/03/2022]
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Mombaerts I, Tousseyn T, Van Limbergen E, Demaerel P. Clinically Recognizing Enlarged Extraocular Muscles from Lymphoid Origin. Ophthalmology 2015; 122:217-8. [DOI: 10.1016/j.ophtha.2014.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/15/2014] [Indexed: 11/29/2022] Open
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Termote K, Decallonne B, Mombaerts I. The influence of prior hyperthyroidism on euthyroid graves' ophthalmopathy. J Ophthalmol 2014; 2014:426898. [PMID: 25045529 PMCID: PMC4090466 DOI: 10.1155/2014/426898] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/09/2014] [Indexed: 12/01/2022] Open
Abstract
Background. To investigate the influence of previous exposure to elevated thyroid hormones in euthyroid Graves' ophthalmopathy. Design. Retrospective, observational case series in university setting Median follow-up of 1 year with ranges of 0,8-7,6 years. Study performance of 10 years. Participants. We reviewed the clinical records of 731 Graves' ophthalmopathy patients. There were 88 (12%) patients with onset of Graves' ophthalmopathy during euthyroidism: 37 (5%) patients had ophthalmopathy without known history of thyroid dysfunction (group A) and 51 patients (6%) had onset of ophthalmopathy 6 months or more euthyroid after completion of antithyroid therapy (group B). Main Outcome Measures. Graves' ophthalmopathy was graded using the EUGOGO severity criteria. Unilaterality was investigated. TSH receptor antibody and thyroid peroxidase antibody were measured as markers of Graves' disease. Results. Group A had more often a normal ocular motility (46%) and less proptosis (14 ± 4 mm) compared to group B (22%, 16 ± 4 mm) (P = 0.032 and 0.028, resp.). TSH receptor antibody was more frequently elevated in group B (94%) than in group A (17%) (P < 0.001). Conclusion. Patients with euthyroid Graves' ophthalmopathy present more often with ocular muscle restriction and proptosis when previously exposed to elevated thyroid hormones.
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Affiliation(s)
- Karolien Termote
- Orbital Clinic, Department of Ophthalmology, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Brigitte Decallonne
- Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Ilse Mombaerts
- Orbital Clinic, Department of Ophthalmology, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
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Termote K, Dierickx D, Verhoef G, Jorissen M, Tousseyn T, Mombaerts I. Series of extranodal natural killer/T-cell lymphoma, nasal type, with periorbital involvement. Orbit 2014; 33:245-51. [PMID: 24831171 DOI: 10.3109/01676830.2014.902478] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the clinical presentation, diagnosis and treatment of periorbital extranodal natural killer/T-cell lymphoma, nasal type. METHODS Case series of three patients with periorbital involvement of extranodal natural killer/T-cell lymphoma, nasal type, of whom clinical data, orbital imaging and immunohistochemical analysis were collected. For the purpose of this study, all histopathological and immunohistochemical slides were re-examined. RESULTS All patients presented with painless eyelid swelling and a history of sinonasal disease, of whom one with bilateral panuveitis, not responding to systemic antibiotics. Extraocular muscle involvement was present in 2 cases upon presentation and in 1 case later on. Initial paranasal and orbital biopsies were negative in 2 patients, with only the second orbital biopsy leading to the diagnosis. Natural killer/T-cell and cytotoxic markers were present in all cases, as well as Epstein-Barr virus encoded RNA in situ hybridization. The patients died respectively 5, 9 and 35 months from diagnosis despite treatment with chemotherapy and radiotherapy. CONCLUSION Extranodal natural killer/T-cell lymphoma, nasal type, should be suspected in a painless periorbital cellulitis with chronic sinusitis, not responding to conventional therapy. A high index of suspicion is necessary in biopsies showing angiodestruction and necrosis. Epstein-Barr virus encoded RNA in situ hybridization and expert hematopathologist consultation is necessary to decrease the delay in diagnosis.
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Mombaerts I, Cameron JD, Chanlalit W, Garrity JA. Surgical Debulking for Idiopathic Dacryoadenitis. Ophthalmology 2014; 121:603-9. [DOI: 10.1016/j.ophtha.2013.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/22/2013] [Accepted: 09/08/2013] [Indexed: 12/24/2022] Open
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Mombaerts I. Efficacy of radiotherapy in the treatment of orbital pseudotumor: in regards to Matthiesen et al. (Int J Radiat Oncol Biol Phys 2011;79:1496-502). Int J Radiat Oncol Biol Phys 2011; 81:901; author reply 901-2. [PMID: 21982206 DOI: 10.1016/j.ijrobp.2011.04.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Indexed: 11/25/2022]
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Abstract
BACKGROUND The midline forehead flap is used in the reconstruction of large, deep defects of the medial canthal area and lower eyelid. Drawbacks are a cosmetically unfavorable skin bulge at the nasal bridge and obliteration of the natural medial canthal concavity, requiring correction in a second stage. OBJECTIVE We adopted a modification of the technique to avoid these drawbacks. METHODS We reviewed the medical records and photographs of patients who received the tunneled midline forehead flap procedure in the repair of medial canthal defects and in the anterior lamellar repair of eyelid defects. The forehead flap was elevated in the subdermal plane, and the pedicle was de-epithelialized and transferred through a subgaleal tunnel from the pivot point of the flap into the primary defect. RESULTS Nine patients had defects of the medial canthal area, medial part of the eyelids, or both after surgical removal of malignant tumors. Follow-up ranged from 5 months to 6.1 years (mean 2.1 years, median 11 months). In all cases, flap viability was maintained, globe protection was achieved, and the concave architecture of the medial canthus was preserved. CONCLUSION The tunneled midline forehead flap can be an advantageous single-stage technique in medial canthal and medial eyelid repair.
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Affiliation(s)
- Ilse Mombaerts
- Eyelid Clinic, Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
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Leyssens B, Wildiers H, Lobelle J, Gillis A, Paridaens R, Mombaerts I. A double-blind randomized phase II study on the efficacy of topical eye treatment in the prevention of docetaxel-induced dacryostenosis. Ann Oncol 2010; 21:419-423. [DOI: 10.1093/annonc/mdp319] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leyssens B, Wildiers H, Lobelle J, Paridaens R, Mombaerts I. A double blind randomized phase II study on the efficacy of topical eye treatment in the prevention of docetaxel induced dacryostenosis. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #6144
Introduction: Weekly docetaxel, which is secreted in lacrimal tears, can cause dacryostenosis and eye tearing in up to 60% of patients. We hypothesized that eye drops containing corticosteroids may prevent the formation of fibrosis and hence stenosis of the lacrimal system. In addition, eye drops may wash out Docetaxel from the ocular surface and therefore decrease the occurrence of dacryostenosis. This study was designed to determine the efficacy of corticosteroid (CS) versus artificial tears (AT) topical eye treatment in patients on a weekly Docetaxel regimen.
 Patients and methods: Prospective, double-blind randomised, single-centre trial. Twenty patients who received a weekly Docetaxel (Doc) regimen for locally advanced or metastatic cancer, were enrolled. In a double blinded fashion, AT (Lacrystat®) were administered in one eye and dexamethasone sodium phosphate (CS)(Maxidex®) in the other eye, 6 times daily, from day 1 of cycle 1, continued throughout the Docetaxel administration, and stopped 2 weeks after the last Docetaxel administration. Before therapy and at week 3, 6 and 9, the patients were assessed for the following: watering, eye adnexes, irrigation and probing of the lacrimal drainage apparatus, and intra-ocular eye pressure. The primary endpoint was the incidence of dacryostenosis in each arm at 9 weeks in one eye treated with corticosteroid eye drops versus the other eye treated with artificial tears.
 Results: 1 pt with prostate cancer (Doc 36 mg/m2 qw 8w consecutively) and 19 pts with breast cancer entered the study (3 with LABC treated with Doc 36 mg/m2 d1-8 q3w plus capecitabine, +/- trastuzumab, 16 with metastatic BC treated with Doc 36 mg/m2 qw 8w consecutively). 9/20 eyes treated with CS and also 9/20 eyes treated with AT developed dacryostenosis at 9 week evaluation. Most cases of stenosis were grade 1 (narrowed punctum and/or canaliculus or impaired syringing of the outflow system after dilation of punctum) while only 2 eyes in CS and 1 eye in AT developed gr II stenosis (narrowed punctum impossible to dilate or narrowed canaliculus impossible to probe). Eye watering at week 9 was present in 9/20 eyes in CS (2 eyes discordant with stenosis) and 8/20 eyes in AT group (2 eyes discordant with stenosis).
 Conclusion: When prophylactic eye drops are administered during chemotherapy with weekly docetaxel, 45% of patients develop dacryostenosis after 9 weeks of docetaxel treatment. Although this study does not allow a comparison with a group without eye drops, the percentage of dacryostenosis in the eye drop group is quite high. There was no difference in the development of dacryostenosis in pts receiving corticosteroid or artificial tears (45% in both groups). This prospective double blind randomized phase II study does not confirm the hypothesis that eye drops containing corticosteroids prevent the formation of fibrosis and hence stenosis of the lacrimal system.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6144.
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Affiliation(s)
- B Leyssens
- 1 Department of Ophtalmology, University Hospitals Leuven, Leuven, Belgium
| | - H Wildiers
- 2 Multidisciplinary Breast Centre/General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - J Lobelle
- 2 Multidisciplinary Breast Centre/General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - R Paridaens
- 2 Multidisciplinary Breast Centre/General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - I Mombaerts
- 1 Department of Ophtalmology, University Hospitals Leuven, Leuven, Belgium
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Mombaerts I, Colla B. Author reply. Ophthalmology 2008. [DOI: 10.1016/j.ophtha.2007.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mombaerts I, Colla B. Modified Jones’ Lacrimal Bypass Surgery with an Angled Extended Jones’ Tube. Ophthalmology 2007; 114:1403-8. [PMID: 17289148 DOI: 10.1016/j.ophtha.2006.10.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Revised: 10/01/2006] [Accepted: 10/05/2006] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To analyze the outcome of modified Jones' lacrimal bypass surgery with an angled extended tube. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Patients with epiphora due to severe canalicular obstruction or dysfunction. Seventy-one Caucasian patients (90 tubes), operated between 1995 and 2005, were followed over a mean period of 3.2 years, ranging from 2 months to 10.4 years after surgery. INTERVENTION A modified Jones' tube, with a 130-degree angled middle and extended length, was inserted using a transcaruncular technique without a dacryocystorhinostomy. In 6 tubes, an additional external dacryocystorhinostomy was performed for reasons of concurrent dacryomucocele. MAIN OUTCOME MEASURES Patency and anatomic position of the tube and subjective relief of epiphora. RESULTS The tube complications included nasal displacement in 12% of the tubes, lateral displacement in 11%, and nonpatency in 4%. The conjunctival complications were conjunctival overgrowth and caruncular granuloma, observed in 6% of the tubes. In all but 4 eyes, complications occurred within 2.7 months after the first tube implantation. After secondary surgery for a complication, 40% of the eyes needed a third intervention or more. The patients reported a comfortable relief of epiphora in 89% of the well-positioned patent tubes. CONCLUSION The modified Jones' tube offers a good long-term outcome, with a tube displacement rate of 23%, mainly occurring within the first 3 months after surgery.
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Affiliation(s)
- Ilse Mombaerts
- Lacrimal Clinic, Department of Ophthalmology, University Hospital Leuven, Leuven, Belgium.
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Abstract
PURPOSE To describe corneal astigmatism in patients under the age of 55 years with Graves' ophthalmopathy and to compare it to a control group. METHODS Retrospective, nonrandomized comparative observational case series. A total of 109 patients with inactive Graves' ophthalmopathy and 109 age- and gender-matched control individuals without Graves' ophthalmopathy were examined with manual corneal keratometry. In the Graves' patients, 52% had a CT scan available for review, and 41% underwent orbital, strabismus, and/or eyelid surgery with a follow-up of keratometry over a mean period of 1.7 years after surgery. RESULTS For the dioptres, there was a statistically significant difference between the Graves' and the control eyes at 3-3.25 dioptres in both eyes (t-test, right eyes, P=0.042; left eyes, P=0.041). For the meridians, the astigmatism was found to be greater at the meridians 95-100 degrees (t-test, P=0.044) and 105 degrees -110 degrees (t-test, P=0.017) in the right eyes only. In 10 (9%) Graves' patients, the astigmatism had caused newly acquired reduced visual acuity. Greater astigmatism in dioptres did not correlate with specific CT scan findings (chi(2)-test, df=2, P=0.187). Following orbital, strabismus, and eyelid surgery, the dioptres and meridians of the astigmatism did not change in 56 (68%) and 66 (81%) eyes, respectively. CONCLUSIONS Graves' ophthalmopathy may be associated with greater with-the-rule corneal astigmatism, which, overall, is not influenced by orbital, strabismus, or eyelid surgery. The astigmatism may possibly be caused by soft-tissue fibrosis in the superolateral orbital region.
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Affiliation(s)
- I Mombaerts
- Orbital Clinic, Department of Ophthalmology, University Hospital Leuven, Leuven, Belgium.
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Vauterin T, Mombaerts I, Jorissen M, Sciot R, Legius E. Pneumosinus dilatans and orbital meningioma in neurofibromatosis type 2. B-ENT 2005; 1:89-92. [PMID: 16044740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
We report on a 9-year-old boy with neurofibromatosis type 2 and a progressive proptosis of the left eye. Imaging studies revealed a pneumosinus dilatans of the left ethmoidal and frontal sinuses and an adjacent left orbital mass. Incision biopsy of the orbital mass showed a meningiothelial meningioma. Orbital and intracranial meningiomas are frequently associated with pneumosinus dilatans. This report illustrates the relationship of pneumosinus dilatans, intra-orbital meningioma and neurofibromatosis type 2.
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Affiliation(s)
- T Vauterin
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital KULeuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
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Abstract
OBJECTIVE To evaluate the effect of partial surgical excision of enlarged lacrimal caruncles, termed megalocaruncles, in patients with epiphora from functional lacrimal drainage obstruction. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS From May 1995 through December 1999, 88 patients (46 women and 42 men; mean age, 68 years) with epiphora, patent lacrimal drainage system on irrigation, and a megalocaruncle underwent a partial lacrimal carunculectomy procedure. In 26 patients, a bilateral partial lacrimal carunculectomy was performed. INTERVENTION Lacrimal caruncular tissue, with its overlying mucosa, was partially excised, and the wound was closed with interrupted sutures. MAIN OUTCOME MEASURES Symptomatology and patient satisfaction. RESULTS After a partial lacrimal carunculectomy procedure, epiphora was subjectively improved in 77% of the patients, ranging from complete relief in 33% to significant improvement in 44% of the patients. Twenty-three percent of the patients had no change in symptoms. The mean follow-up was 12.7 months. CONCLUSIONS Megalocaruncles can be the cause of epiphora in patients with functional lacrimal drainage obstruction, for whom a partial lacrimal carunculectomy is an effective surgical procedure in 77% of the cases.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, University Hospital Leuven, Catholic University Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
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Wilms G, Demaerel P, Lagae L, Casteels I, Mombaerts I. Direct caroticocavernous fistula and traumatic dissection of the ipsilateral internal carotid artery: endovascular treatment. Neuroradiology 2000; 42:62-5. [PMID: 10663476 DOI: 10.1007/s002340050016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After severe craniocerebral trauma a 14-year-old boy developed progressive exophthalmos with venous congestion and chemosis, due to a direct caroticocavernous fistula. Angiography revealed traumatic occlusion of the ipsilateral internal carotid artery and absence of the inferior petrosal sinus. After failure of an approach via the anterior and posterior communicating arteries, the cavernous sinus was successfully catheterised through the occluded internal carotid artery, and embolisation performed with coils.
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Affiliation(s)
- G Wilms
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Mombaerts I, Wilmink JM, Goldschmeding R, Koornneef L. A man with a Hippocratic syndrome? Lancet 1998; 351:1486. [PMID: 9605806 DOI: 10.1016/s0140-6736(97)11311-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Netherlands
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Abstract
PURPOSE Orbital myositis is described as exquisitely sensitive to therapy with systemic corticosteroids. However, it may turn into a recurrent or chronic disease, requiring repeated courses or maintenance of corticotherapy that often is complicated with serious side effects. The authors conducted this study to evaluate their experience and the current status in the literature as to treatment of orbital myositis with corticosteroids and corticosteroid-sparing alternatives. METHODS The clinical records and computed tomography scans of patients with orbital myositis who presented at the Orbital Center Amsterdam between 1977 and 1991 were studied for the clinical course and therapeutic outcome. Recurrences were defined as a new attack of the same or another extraocular muscle as the primary affected, in the same or the other orbit. RESULTS The study group comprised 16 patients. All patients responded to initial treatment with oral corticosteroids (14/16) or nonsteroidal anti-inflammatory drugs (NSAID) (2/16). Of these 16 patients, 9 (56%) had 1 or more recurrences. Recurrences responded to repeated courses of corticosteroids, NSAID, or 20 Gy irradiation. Despite radiotherapy in six patients, recurrences continued to occur within a mean period of 2.7 years (range, 0.5 month-8.8 years). The mean follow-up after initial therapy in general was 9.7 years (range, 2.6-16.9 years), and after radiotherapy, in particular, was 7.4 years (range, 4.1-10.5 years). CONCLUSIONS Orbital myositis responds well to oral corticosteroids, but recurs in 50% of the cases. Based on a long-term follow-up of six patients who received irradiation of 20 Gy, radiotherapy appears ineffective in stopping recurrent orbital myositis.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, University of Amsterdam, The Netherlands
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Abstract
PURPOSE Granulomatous orbital inflammation may occur as an isolated condition of unknown origin. These idiopathic granulomatous lesions are believed to belong to the orbital pseudotumor group by some authors, whereas others consider them sarcoidosis limited to the orbit. The aim of this study is to define the clinicotherapeutic aspects of these lesions. METHODS The records of all patients with diagnosis of orbital pseudotumor and orbital sarcoidosis from the Orbital Center Amsterdam in the period between 1976 and 1994 were reviewed to define those with idiopathic granulomatous orbital inflammation. The authors studied the clinicotherapeutic aspects and histopathology of idiopathic granulomatous orbital inflammation by analysis of their own series and the literature. RESULTS Their study group encompassed seven patients with idiopathic granulomatous orbital inflammation. The mean follow-up was 9.5 years (range, 3.5-16.0 years). All had unilateral orbital presentation, with localization in the lacrimal gland in three patients. The lesions clinically presented with signs of mass effect or inflammation or both and were treated successfully with surgery, systemic corticosteroids, a combination of surgery and systemic corticosteroids, or systemic corticosteroids followed by irradiation. Histopathologic analysis showed a spectrum of granulomatous inflammation, admixed with nongranulomatous inflammation and fibrosis. There have been 30 similar cases described in the literature with comparable clinicotherapeutic characteristics. CONCLUSIONS Based on this study and the literature, it appears that idiopathic granulomatous orbital inflammation is more related to orbital pseudotumor than to orbital sarcoidosis.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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Abstract
PURPOSE Lacrimal gland pseudotumors belong to the group of orbital pseudotumor. Systemic corticosteroids are advocated as the primary treatment of choice in orbital pseudotumor, but recurrent and refractory cases are commonly described. In this retrospective study, the authors evaluate alteerative treatment options such as surgical excision or debulking of lacrimal gland pseudotumors. METHODS The records of 26 patients referred to the Orbital Center of Amsterdam between 1976 and 1994 with a diagnosis of lacrimal gland pseudotumor were reviewed with special reference to computed tomography scans, histopathologic specimens (in 23 patients), treatment regimens, and final clinical outcome. RESULTS Histopathologic review showed 15 nonsclerosing (classic) and 8 sclerosing lacrimal gland pseudotumors. Initial treatment consisted of corticosteroids alone (9/26), surgery alone (7/26), a combination of surgery and irradiation (5/26), a combination of surgery and corticosteroids (4/26), or indomethacin alone (1/26). Surgery comprised tumor excision or tumor debulking. Of the patients treated with corticosteroids alone, 55% (5/9) responded initially but only 22% (2/9) obtained a cure. However, all patients treated with surgery combined with corticosteroids/irradiation (9/9), with surgery alone (7/7), or with indomethacin alone (1/1) responded well without recurrences. The main complication of therapy was dry eye syndrome, the incidence being highest in patients who received surgery of the palpebral lobe or irradiation. The mean follow-up was 4.9 years. CONCLUSION Surgical excision or debulking is a safe and effective treatment option in lacrimal gland pseudotumors, even in the histopathologic sclerosing variant.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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Abstract
We have reviewed the literature in order to delineate the clinicopathologic definition of orbital pseudotumor, also called idiopathic nonspecific orbital inflammation. The clinical picture of orbital pseudotumor varies widely, with signs of mass effect, inflammation and/or infiltration. On computed tomography, orbital pseudotumor presents as a unilateral focal or diffuse mass. The histopathologic hallmark of orbital pseudotumor is a mixed inflammatory infiltrate with fibrosis of varying degree. Contrary to an old belief, orbital pseudotumor is not related to orbital reactive lymphoid hyperplasia (pseudolymphoma) and is not a lymphoid tumor. Atypical histopathologic findings of orbital pseudotumor include dominant sclerosis, granulomatous inflammation, vasculitis, and tissue eosinophilia. In the absence of systemic fibroinflammatory, granulomatous, and vasculitic disease, these atypical histopathologic patterns can be considered to represent subclasses of orbital pseudotumors rather then distinct entities. Clinical and prognostic characteristics of both histopathologically classical and atypical orbital pseudotumors appear to be heterogeneous. The etiology of orbital pseudotumor is unknown, but infection, autoimmune disorder, and aberrant wound healing have all been put forward as possibilities. In conclusion, orbital pseudotumor is one distinct disease albeit with many clinical and histopathologic guises.
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Affiliation(s)
- I Mombaerts
- Orbital Center, Department of Ophthalmology, University of Amsterdam, The Netherlands
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Abstract
PURPOSE Systemic corticosteroids are the established primary treatment for orbital pseudotumors, but patients with recurrent and refractory pseudotumors commonly are observed. In this retrospective study, the authors aimed to assess the value of corticosteroids in the management of orbital pseudotumor. METHODS The clinical notes, computed tomography scans, and histologic specimens of patients with orbital pseudotumor seen at the Orbital Center, Amsterdam, between 1976 and 1994 were analyzed with particular regard to the clinical and visual outcome. The patients were categorized according to the anatomic location of the pseudotumor within the orbit. Patients with pseudotumors restricted to the lacrimal gland or an extraocular muscle were excluded. RESULTS The authors studied 32 patients with orbital pseudotumor, 20 of whom had histopathologic confirmation. Twenty-seven of these 32 patients received systemic corticosteroids as an initial treatment. Of these 27 patients, 21 (78%) showed an initial response and 10 (37%) obtained a cure. After the initial response, 11 (52%) of the 21 patients recurred. Optic nerve involvement was present in 13 (41%) of the 32 patients, and all except 1 patient recovered with corticotherapy. The mean follow-up of therapy was 4.3 years (range, 5.3 months-21.5 years). CONCLUSION The authors found a moderate response, a high recurrence, and a low cure rate in patients treated with corticosteroids for orbital pseudotumor, and they therefore challenge the value of corticosteroids in both diagnosing and treating this condition. However, in patients with pseudotumor-induced optic neuropathy, corticosteroids remain of value.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, University of Amsterdam, The Netherlands
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Mombaerts I, Koornneef L, Everhard-Halm YS, Hughes DS, Maillette de Buy WPLJJ. Superior Oblique Luxation and Trochlear Luxation as New Concepts in Superior Oblique Muscle Weakening Surgery. J Neuroophthalmol 1996. [DOI: 10.1097/00041327-199603000-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mombaerts I, Koornneef L, Everhard-Halm YS, Hughes DS, Maillette de Buy Wenniger-Prick LJ. Superior oblique luxation and trochlear luxation as new concepts in superior oblique muscle weakening surgery. Am J Ophthalmol 1995; 120:83-91. [PMID: 7611332 DOI: 10.1016/s0002-9394(14)73762-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We used superior oblique luxation and trochlear luxation as new surgical procedures to treat acquired Brown's syndrome and superior oblique muscle overaction. METHODS We studied nine patients (11 eyes) who underwent trochlear surgery between 1988 and 1993. Four patients had acquired Brown's syndrome and five had superior oblique muscle overaction. In five patients (six eyes) the trochlea was incised to luxate the superior oblique tendon out of the trochlea. In four patients (five eyes) the trochlea was luxated out of its fossa via a periosteal approach without opening the trochlea itself. RESULTS The mean follow-up was 18 months (range, nine to 33 months). Postoperatively, eight patients showed subjective and objective improvement. One patient with painful traumatic acquired Brown's syndrome had no objective improvement but obtained relief of pain. CONCLUSIONS These new techniques are a successful alternative in the treatment of acquired Brown's syndrome and superior oblique muscle overaction.
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Affiliation(s)
- I Mombaerts
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands
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