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Bison HS, Janetos TM, Russell EJ, Volpe NJ. Cranial Nerve Palsies in the Setting of Arachnoid Cysts: A Case Series and Literature Review. J Neuroophthalmol 2024; 44:242-246. [PMID: 37656595 DOI: 10.1097/wno.0000000000001983] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND Arachnoid cysts (ACs) are benign lesions typically believed to not cause neurologic defects in the adult population and are most often found incidentally on imaging. We describe 2 patients with ACs potentially leading to isolated cranial nerve (CN) dysfunction. METHODS We describe 2 patients, 1 with a fourth nerve palsy and the other with a sixth nerve palsy found to have ACs on MRI brain imaging in locations that potentially caused a compressive CN palsy. We review previous literature of ACs presenting with CN III, IV, or VI palsy. RESULTS Patient 1 was a 62-year-old man who presented with a 22-year history of diplopia with strabismus examination consistent with a congenital CN IV palsy. Despite multiple surgeries, his CN IV palsy insidiously worsened. An AC in the posterior fossa with mass effect on the quadrigeminal plate and asymmetric atrophy of the right superior oblique was identified on imaging. Patient 2 was an 80-year-old man who presented with an 18-year history of diplopia and was found to have a left esotropia and abduction deficit consistent with complete CN VI palsy. An AC in the left cavernous sinus was identified on imaging. He underwent strabismus surgery with satisfactory resolution of diplopia. We identified a total of 18 previously published cases: 8 reports of CN III palsy, 4 reports of CN IV palsy, and 6 reports of CN VI palsy. Patient ages ranged from 1 to 67 with a median of 34.5. In 16/18 (89%) cases, the diagnosis of ACs was made within 1 year of symptom onset. Surgical removal of the AC was successful in resolving diplopia in 7/12 (58%) cases. In no case was strabismus surgery performed as primary treatment. CONCLUSIONS Although ACs are typically congenital asymptomatic lesions, we present a case series of 2 patients with ACs in anatomic locations that potentially caused chronic, progressive, isolated CN palsies leading to strabismus. Our literature review revealed that most published cases detailing this clinical scenario resulted in neurosurgical fenestration of ACs with mixed results. Our cases represent 2 patients with AC-associated CN palsy treated with strabismus surgery.
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Affiliation(s)
- Henry S Bison
- Departments of Ophthalmology (HSB, TMJ, NJV) and Radiology (EJR), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Department of Ophthalmology and Visual Sciences (HSB), University of Maryland School of Medicine, Baltimore, Maryland
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Manasyan A, Khachikyan N, Gaytan S, Lee T, Brynes RK, Hashemi N. Rosai-Dorfman Disease Presenting With Diplopia. J Neuroophthalmol 2024; 44:e254-e255. [PMID: 36728087 DOI: 10.1097/wno.0000000000001803] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Artur Manasyan
- Neuro-Ophthalmology Clinic (AM, NK, SG, NH), Hashemi Eye Care, Encino, California; and Hematopathology Section (TL, RKB), Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Blanco López AM, Rodríguez Enríquez M. Ocular neuromyotonia: an unusual case after radiotheraphy for nasopharyngeal carcinoma. Arch Soc Esp Oftalmol (Engl Ed) 2024; 99:209-212. [PMID: 38401598 DOI: 10.1016/j.oftale.2024.01.017] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
Ocular neuromyotonia (ONM) is an infrequent disorder characterised by recurrent episodes of binocular diplopia caused by paroxysmal contraction of one or several extraocular muscles innervated by the same cranial nerve. It can be triggered spontaneously or caused by prolonged contraction of specific eye muscle(s) and is usually related to a local intracranial radiotherapy antecedent. We report the case of a 46-year-old woman who developed intermittent episodes of binocular diplopia eight years after radiotherapy for a nasopharyngeal carcinoma. After a complete neuro-ophthalmic assessment we diagnosed the case as an abducens nerve neuromyotonia. Although it is infrequent, radiotherapy to the nasopharynx is a possible cause of ONM, due to the proximity to the base of the skull and extraocular motor nerve pathways, especially that of the VI cranial nerve, as is the case presented in this article, about a patient whose history is a nasopharyngeal carcinoma treated with local radiotherapy.
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Affiliation(s)
- A M Blanco López
- Departamento de Oftalmología, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - M Rodríguez Enríquez
- Departamento de Estrabismo y Oftalmología Pediátrica, Hospital Universitario Lucus Augusti, Lugo, Spain
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Valko Y, Wirth MA, Fierz FC, Schesny MK, Rosengren S, Schmückle-Meier T, Bockisch CJ, Straumann D, Schreiner B, Weber KP. Accuracy of Repetitive Ocular Vestibular-Evoked Myogenic Potentials to Diagnose Myasthenia Gravis in Patients With Ptosis or Diplopia. Neurology 2024; 102:e209395. [PMID: 38669629 DOI: 10.1212/wnl.0000000000209395] [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: 04/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We developed repetitive ocular vestibular-evoked myogenic potentials (roVEMP) as an electrophysiologic test that allows us to elicit the characteristic decrement of extraocular muscles in patients with ocular myasthenia gravis (OMG). Case-control studies demonstrated that roVEMP reliably differentiates patients with OMG from healthy controls. We now aimed to evaluate the diagnostic accuracy of roVEMP for OMG diagnosis in patients with ptosis and/or diplopia. METHODS In this blinded prospective diagnostic accuracy trial, we compared roVEMP in 89 consecutive patients presenting with ptosis and/or diplopia suspicious of OMG with a multimodal diagnostic approach, including clinical examination, antibodies, edrophonium testing, repetitive nerve stimulation of accessory and facial nerves, and single-fiber EMG (SFEMG). We calculated the roVEMP decrement as the ratio between the mean of the first 2 responses compared with the mean of the sixth-ninth responses in the train and used cutoff of >9% (unilateral decrement) in a 30 Hz stimulation paradigm. RESULTS Following a complete diagnostic work-up, 39 patients (44%) were diagnosed with ocular MG, while 50 patients (56%) had various other neuro-ophthalmologic conditions, but not MG (non-MG). roVEMP yielded 88.2% sensitivity, 30.2% specificity, 50% positive predictive value (PPV), and 76.5% negative predictive value (NPV). For comparison, SFEMG resulted in 75% sensitivity, 56% specificity, 55.1% PPV, and 75.7% NPV. All other diagnostic tests (except for the ice pack test) also yielded significantly higher positive results in patients with MG compared with non-MG. DISCUSSION The study revealed a high sensitivity of 88.2% for roVEMP in OMG, but specificity and PPV were too low to allow for the OMG diagnosis as a single test. Thus, differentiating ocular MG from other neuro-ophthalmologic conditions remains challenging, and the highest diagnostic accuracy is still obtained by a multimodal approach. In this study, roVEMP can complement the diagnostic armamentarium for the diagnosis of MG. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in patients with diplopia and ptosis, roVEMP alone does not accurately distinguish MG from non-MG disorders. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT03049956.
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Affiliation(s)
- Yulia Valko
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Magdalena A Wirth
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Fabienne C Fierz
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Marianne K Schesny
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Sally Rosengren
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Tanja Schmückle-Meier
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Christopher J Bockisch
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Dominik Straumann
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Bettina Schreiner
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
| | - Konrad P Weber
- From the Neurology Department (Y.V., M.K.S., C.J.B., D.S., B.S., K.P.W.), Clinical Neuroscience Center, and Ophthalmology Department (M.A.W., F.C.F., T.S.-M., C.J.B., K.P.W.), University Hospital Zurich, University of Zurich, Switzerland; Neurology Department and Institute of Clinical Neurosciences (S.R.), Royal Prince Alfred Hospital, Camperdown; and Central Clinical School (S.R.), Faculty of Medicine and Health, University of Sydney, Australia
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Skiadopoulos D. Diplopia management in a patient with stiff person syndrome. Clin Exp Optom 2024; 107:473-474. [PMID: 36934459 DOI: 10.1080/08164622.2023.2186216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/24/2023] [Indexed: 03/21/2023] Open
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Affiliation(s)
- Twishaa Sheth
- Colchester Hospital, East Suffolk & North Essex NHS Foundation Trust, Colchester, UK
| | - Maneeta Morarji
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Imran Jawaid
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Marques FF, Rabelo DFO, Marques DMV, Aquino GSAD, Gama DDD, Moscovici BK. Visual rehabilitation after LASIK complication: flap amputation, topo-guided surgery, and phacoemulsification. Arq Bras Oftalmol 2024; 87:e2023. [PMID: 38656032 DOI: 10.5935/0004-2749.2023-0221] [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] [Received: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 04/26/2024] Open
Abstract
We present a case of a patient complaining of monocular diplopia due to a decentered ablation after LASIK. The patient underwent a wavefront-guided retreatment, which resulted in an epithelial ingrowth complication. Additionally, the patient developed cataract, with cataract surgery requiring reliable biometric measurements. Therefore, we opted for corneal treatment and corneal surface regularization. Although we attempted to lift the flap and wash the interface initially, the procedure proved unsuccessful, thereby necessitating immediate flap amputation. Once the corneal surface was regularized in the seventh postoperative month, transepithelial photorefractive keratectomy was successfully performed to homogenize the ocular surface, thereby significantly improving the patient's corrected visual acuity and resolving monocular diplopia. The surface and corneal curvature stabilized by the fifth month after the procedure. Phacoemulsification was then performed along with the implantation of a toric monofocal lens, which was selected using an appropriate formula, resulting in an excellent uncorrected visual acuity.
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Affiliation(s)
- Frederico França Marques
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Marques Eye Institute Oftalmologia, São Paulo, SP, Brazil
| | | | - Daniela Meira Villano Marques
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Marques Eye Institute Oftalmologia, São Paulo, SP, Brazil
| | | | - Daniel Diniz da Gama
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Bernardo Kaplan Moscovici
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, Santos, SP, Brazil
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Lee C, Park JW, Kim YD, Woo KI. Efficacy of tocilizumab in patients with moderate-to-severe corticosteroid-resistant thyroid eye disease: a prospective study. Int Ophthalmol 2024; 44:179. [PMID: 38622479 DOI: 10.1007/s10792-024-03117-6] [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: 12/16/2023] [Accepted: 03/24/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To evaluate the clinical outcomes of intravenous tocilizumab (TCZ) injection in patients with moderate-to-severe active thyroid eye disease (TED). METHODS Patients with active and moderate-to-severe TED who did not respond to conventional therapies were treated with TCZ from June 2019 to January 2021. The medical records of the patients were evaluated before the treatment. We analyzed patient demographics, including the duration of Graves' disease and TED, and assessed subjective symptoms, such as diplopia and ocular movement, clinical activity score (CAS), modified NOSPECS score, and exophthalmos before treatment and at 4, 8, 12, and 16 weeks after the first drug injection. Blood tests, including TSH Rc Ab and TS Ab, were performed before treatment and 24 weeks after the first injection. And orbital computed tomography (CT) was performed and Barrett's Index was calculated at baseline and after completion of all injections. RESULTS Nineteen completed the scheduled treatment. There were no significant side effects, other than herpes zoster in one case and headache and dermatitis in another. Clinical symptoms before and 16 weeks after the treatment showed mean CAS decreased by 2.4 points, mean modified NOSPECS score decreased by 3.7 points, and mean exophthalmos decreased by 0.4 mm. Diplopia and extraocular muscle limitation improved in ten and remained stationary in five of the 15 patients, who presented with extraocular motility abnormalities. Six of 11 patients who underwent orbit CT showed improvement in muscle size. The mean TSH Rc Ab decreased by 7.5 IU/L and TS-Ab decreased by 162.9%. CONCLUSION TCZ can treat active moderate-to-severe TED, showing high drug compliance and reasonable response to inflammation and extraocular motility abnormality.
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Affiliation(s)
- Chaeyeon Lee
- Department of Ophthalmology, Samsung Medical Center, SungkyunkwanUniversitySchool of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ji Woong Park
- Department of Ophthalmology, Seoul Eye Clinic, Anyang, South Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, South Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, SungkyunkwanUniversitySchool of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Oliver-Gutierrez D, Garrido-Marin M, Segura-Duch G, Alonso T, Ros-Sanchez E, Oliveres J. Orbital myositis in a patient with Crohn's disease: A case report of two episodes. J Fr Ophtalmol 2024; 47:104048. [PMID: 38238142 DOI: 10.1016/j.jfo.2023.104048] [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: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 04/08/2024]
Abstract
PURPOSE To describe a case report of a 34 years-old patient with Crohn's Disease and two episodes of Ocular Myositis. METHODS The research methodology employed in this study consisted of a retrospective review of the patient's complete medical history. RESULTS Crohn's Disease is a chronic inflammatory bowel disorder known to be associated with a wide range of extraintestinal manifestations. Ocular abnormalities, such as episcleritis and uveitis, are commonly observed. However, orbital myositis is an extremely rare ocular extraintestinal manifestations characterized by acute ocular pain that worsens with eye movements and is often accompanied by diplopia. In this case report, we present the case of a 34-year-old woman with a confirmed diagnosis of Crohn's Disease, who experienced two episodes of acute orbital pain exacerbated by ocular movements and diplopia. The diagnosis was established through clinical evaluation and radiologic imaging, with confirmation after a good response to systemic corticosteroids. She responded favorably to systemic corticosteroid therapy on both episodes, and no additional treatment was required. As of now, she remains stable without any ocular sequelae. CONCLUSION It is important to note that orbital myositis is an uncommon ocular manifestation associated with Crohn's Disease, and prompt recognition and management are crucial to achieve successful outcomes.
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Affiliation(s)
- D Oliver-Gutierrez
- Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain; Ophthalmology, Innova Ocular ICO Barcelona, Barcelona, Spain.
| | - M Garrido-Marin
- Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - G Segura-Duch
- Ophthalmology, Innova Ocular ICO Barcelona, Barcelona, Spain; Ophthalmology, Centro de Oftalmología Barraquer, Barcelona, Spain; Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Alonso
- Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Ros-Sanchez
- Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Oliveres
- Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
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Khalaf A, Shawky M, Abou-ElFetouh A, Nassar Y, El Hadidy M. Clinical and radiographic assessment of patient-specific transantral reconstruction of orbital floor fractures: A case series. J Craniomaxillofac Surg 2024; 52:464-468. [PMID: 38368205 DOI: 10.1016/j.jcms.2024.01.022] [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: 09/22/2023] [Revised: 11/10/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
To clinically and radiographically evaluate patient-specific titanium meshes via a trans-antral approach for correction of enophthalmos and orbital volume in patients with recent unilateral orbital floor fracture. Seven patients with unilateral orbital floor fractures received patient-specific titanium meshes that were designed based on a mirror-image of the contralateral intact orbit. The patient-specific implants (PSIs) were inserted via a trans-antral approach without endoscopic assistance. The patients were evaluated clinically for signs of diplopia and restricted gaze as well as radiographically for enophthalmos and orbital volume correction. Diplopia was totally resolved in two of the three patients who reported diplopia in the upward gaze. Whereas enophthalmos significantly improved in all but two patients, with a mean value of 0.2229 mm postoperatively compared to 0.9914 mm preoperatively. CT scans showed excellent adaptation of the PSIs to the orbital floor with a mean reduction of the orbital volume from 29.59 cc to 27.21 cc, a mean of 0.6% smaller than the intact orbit. It can be concluded that the proposed PSI can offer good reconstruction of the orbital floor through an isolated intraoral transantral approach with minimal complications. It could of special benefit in extensive orbital floor fractures.
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Affiliation(s)
- Aliaa Khalaf
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Egypt
| | - Mohamed Shawky
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Egypt
| | - Adel Abou-ElFetouh
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Egypt.
| | - Yasmine Nassar
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Egypt
| | - Mona El Hadidy
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Egypt
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Strube YNJ, Cheung K, Germano BR, Hopman WM, Wright KW. Effect of vertical central plication on vertical deviations. J AAPOS 2024; 28:103861. [PMID: 38442849 DOI: 10.1016/j.jaapos.2024.103861] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 03/07/2024]
Abstract
PURPOSE To evaluate the surgical effect of the Wright central plication on vertical rectus muscles to correct vertical strabismus. METHODS In this multicenter, retrospective, observational outcomes study, data were collected from two surgeons in different practice settings (2017-22). All patients who underwent vertical rectus central plication were included; those undergoing any concurrent strabismus surgery for vertical strabismus were excluded. Primary outcome was amount of strabismus correction in prism diopters per vertical rectus central plication. Secondary outcome was to determine factors associated with better or worse surgical outcomes and patient and patient responses. Data were analyzed using descriptive and bivariate statistics. RESULTS A total of 36 patients were included. Mean age was 60 years. Mean follow-up was 8.4 months. Of the 36 patients, 11 (31%) had idiopathic strabismus, and 7 (19%) had congenital superior oblique palsy. The remainder had a history that included prior ocular surgery, trauma, and Brown syndrome; 16 (44 %) had prior strabismus surgery. Of 31 patients with preoperative diplopia, 23 (74%) had postoperative resolution of diplopia, and 10 of 16 patients with preoperative prisms (63%) no longer required prisms postoperatively. Mean vertical deviation change was 4.7Δ. Subgroup analysis removing patients with congenital superior oblique palsy showed a larger response of 5.5Δ. 78% of patients had a final deviation <5Δ. No complications or induced postoperative diplopia was reported. CONCLUSIONS In our study cohort, vertical rectus central plication corrected approximately 5Δ (range, 4.5Δ-5.5Δ) of vertical strabismus due to a variety of causes.
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Affiliation(s)
- Yi Ning J Strube
- Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario.
| | - Kevin Cheung
- School of Medicine, Queen's University, Kingston, Ontario
| | | | - Wilma M Hopman
- Department of Public Health Sciences and KGH Research Institute, Kingston Health Sciences Centre, Kingston, Ontario
| | - Kenneth W Wright
- Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario; California Institute of Technology, Los Angeles, California; Wright Foundation for Pediatric Ophthalmology and Strabismus, Los Angeles, California
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Karaoğlan M, Küçükçay B, İnan LE. Amaurosis and transient diplopia, a rare complication secondary to mandibular nerve block: A case report. Agri 2024; 36:129-132. [PMID: 38558394 DOI: 10.14744/agri.2021.11129] [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: 04/04/2024]
Abstract
Ocular complications are one of the rare side effects that can be seen after a mandibular nerve block and have the most dramatic results. Since the mandibular nerve block is mostly performed by dentists, this complication is mostly seen after an intraoral mandibular nerve block. The mandibular nerve is the third division of the trigeminal nerve. It is the most caudal and lateral part of Gasser's ganglion. It arises from the middle cranial fossa through the foramen ovale. In this region, a block method, which is performed by passing through the coronoid process, has been defined. This block, usually made using anatomical markers, is used in the treatment of trigeminal neuralgia. A 42-year-old female patient was admitted to our department for a maxillary and mandibular block with a diagnosis of trigeminal neuralgia. Immediately after the administration of the local anesthetic, the patient described a complete loss of vision. The complaint of vision loss lasted for about 1 minute, after which the patient's complaint of diplopia continued for 2 hours and 10 minutes. This case report presents the ocular complications after a mandibular block applied with the extraoral technique as an unexpected side effect.
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Affiliation(s)
| | - Bilge Küçükçay
- Department of Anesthesiology and Reanimation, Niksar State Hospital, Tokat, Türkiye
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Balodis A, Kalējs VR, Migunova K. Bilateral Low-Flow Type-D Dural Carotid-Cavernous Fistula: Diagnosis and Treatment with 3D Time-of-Flight Magnetic Resonance Angiography. Am J Case Rep 2024; 25:e942833. [PMID: 38504435 DOI: 10.12659/ajcr.942833] [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: 03/21/2024]
Abstract
BACKGROUND Carotid-cavernous fistula (CCF) is a rare, atypical vascular shunt between the carotid arterial system and the venous channels of the cavernous sinus, classified according to the shunt's anatomy, by etiology (resulting from trauma or occurring spontaneously), or by hemodynamic characteristics (such as low- or high-flow fistulas). CASE REPORT A 62-year-old female patient with poorly controlled arterial hypertension presented with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity. On magnetic resonance angiography (MRA), abnormal arterial flow along the cavernous sinuses was noted, suggestive of bilateral CCF. The diagnosis of indirect dural low-flow CCF (Barrow Type D) was later confirmed by digital subtraction angiography, with feeding arteries from intracavernous internal carotid artery branches, and meningeal branches of the external carotid artery, draining bilaterally to ophthalmic veins, the intracavernous sinus, and the inferior petrosal sinus. The patient was successfully treated with endovascular embolization. At 7-month follow-up, no residual arteriovenous shunting was detected. This case highlights the importance of non-invasive radiological methods for CCF, and presents rarely published radiological findings of bilateral Type-D dural CCFs on 3-dimensional time-of-flight MRA with post-treatment MRA follow-up. CONCLUSIONS Regardless of the patient's history of possible trauma, a patient presenting with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity should have a spontaneous bilateral CCF investigated to prevent delayed treatment. Experienced neuroradiologists are needed to accurately detect indirect CCF, since this condition often does not demonstrate classic symptoms.
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Affiliation(s)
- Arturs Balodis
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Radiology, Riga Stradins University, Riga, Latvia
| | - Verners Roberts Kalējs
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
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Iida K, Goseki T, Kunimi K, Hashimoto R. A Case of Superior Oblique Palsy without Brown Syndrome Induced by a Dog Bite. Am J Case Rep 2024; 25:e943299. [PMID: 38508873 PMCID: PMC10926234 DOI: 10.12659/ajcr.943299] [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: 11/25/2023] [Revised: 01/24/2024] [Accepted: 01/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Pseudo-Brown syndrome is characterized by dysfunction of the superior oblique tendon-trochlear complex. Canine tooth syndrome, which involves superior oblique palsy with pseudo-Brown syndrome, results from damage to the trochlear and superior oblique tendon from dog bites around the eye. This report describes a variant of canine tooth syndrome without pseudo-Brown syndrome following a dog bite around the left upper eyelid. In this case, magnetic resonance imaging (MRI) facilitated early diagnosis and therapeutic intervention. CASE REPORT A 19-year-old man presented with torsional diplopia following a dog bite around the left upper eyelid and forehead. Five days after the injury, an alternate prism cover test revealed 6 prism diopters (Δ) exotropia and 5Δ left hypertropia. Ocular motility showed no significant limitation in elevation or depression during adduction. MRI performed on the same day showed a high-signal area extending from the superior oblique tendon to the trochlear region and the superior oblique muscle belly of the left eye. A diagnosis of canine tooth syndrome without pseudo-Brown syndrome was made and oral steroids were administered. Ocular alignment did not improve, so left inferior oblique myotomy was performed 7 months after the injury. The patient's cyclovertical diplopia resolved postoperatively. CONCLUSIONS Dog bites around the eye can result in abnormalities of the extraocular muscles. Early MRI may be useful for diagnosis and determining treatment strategies. This report has highlighted the importance of rapid assessment and management of patients with dog bites involving the eye.
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Affiliation(s)
- Kie Iida
- Department of Ophthalmology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, Japan
- Department of Ophthalmology, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Keiko Kunimi
- Department of Ophthalmology, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Ryuuya Hashimoto
- Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Chiba, Japan
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15
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Olivarez J, Gutovitz S, Arnold C. Cranial Nerve Six Palsy After Vaginal Delivery with Epidural Anesthesia: A Case Report. J Emerg Med 2024; 66:e338-e340. [PMID: 38413284 DOI: 10.1016/j.jemermed.2023.11.006] [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: 05/15/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND This case report describes a 34-year-old woman who developed diplopia and strabismus 2 weeks after a vaginal delivery and epidural anesthesia. CASE REPORT A 34-year-old women presented to the emergency department (ED) with continued headache and new-onset diplopia after having undergone epidural anesthesia for a vaginal delivery 2 weeks prior. During that time, she underwent two blood patches, rested supine, drank additional fluids, and consumed caffeinated products for her spinal headache. When she developed double vision from a cranial nerve VI palsy, she returned to the ED. At that time, she had a third blood patch performed, and she was evaluated by a neurologist. The medical team felt the cranial nerve VI palsy was due to the downward pull of the brain and stretching of the nerve. Magnetic resonance imaging and neurosurgical closure of the dura were considered as the next steps in treatment; however, they were not performed after being declined by the patient. All symptoms were resolved over the next 3 weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the uncommon complication of a cranial nerve VI palsy from a persistent cerebrospinal fluid leak after a dural puncture. Emergency physicians must be aware that diplopia can be a rare presenting symptom after patients undergo a lumbar puncture. Furthermore, emergency physicians should be aware of the multiple treatment options available. Knowledge of the timeline of resolution of the diplopia is necessary to make shared decisions with our patients about escalating care.
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Affiliation(s)
- Jennifer Olivarez
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Scott Gutovitz
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Caylyne Arnold
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
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16
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Abstract
BACKGROUND Thyroid eye disease (TED) is a condition caused by inflammatory damage to the periocular tissue that often leads to double vision. Teprotumumab is an insulin-like growth factor 1 receptor antibody that was FDA approved for the management of TED in 2020, although much is yet to be elucidated regarding its effects on diplopia outcomes among patients with TED. Diplopia is a significant and life-altering effect of TED. Previous studies have reported the effect of teprotumumab on double vision subjectively using the Gorman diplopia score. However, there is a gap in the literature addressing the effect of teprotumumab treatment on objective ocular alignment measures. The purpose of our study was to address this gap. METHODS We performed a retrospective review of patients who were diagnosed with TED, presented with diplopia, and treated with teprotumumab in a single-center academic ophthalmology practice. The primary outcome was change in ocular alignment in primary gaze position at 6 months (completion of teprotumumab treatment). Secondary outcomes included change in ocular alignment in other gaze positions, proptosis, eyelid position, and clinical activity score (CAS) at 6 months compared with baseline. To determine what factors may predict ocular alignment response to teprotumumab, we analyzed baseline characteristics among 3 groups, divided based on whether ocular alignment was worsened, stable, or improved at 6 months. RESULTS Seventeen patients met inclusion criteria, 3 (18%) worsened, 10 (59%) were stable, and 4 (24%) improved. CAS ( P = 0.02) was significantly different among the groups and was higher in those who worsened and those who improved compared with those who remained stable. Right gaze horizontal prism deviation ( P = 0.01) and left gaze horizontal prism deviation ( P = 0.03) were significantly different among the groups, with a greater degree of left gaze horizontal prism deviation in the worse group than the stable group ( P = 0.04). CONCLUSIONS Our study demonstrated that most patients remained stable after teprotumumab treatment regarding ocular alignment in primary gaze and the number of patients who improved was slightly higher than the number of patients who worsened after teprotumumab treatment. There are some baseline measures, such as CAS and right and left gaze horizontal prism deviation that can help better predict how a patient will respond to teprotumumab treatment. Our results can better inform physicians of how to counsel patients with TED when considering teprotumumab therapy.
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Affiliation(s)
- Shwetha Mudalegundi
- Wilmer Eye Institute (SM, ADH, ARC), Johns Hopkins University School of Medicine, Baltimore, Maryland; and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (PH), Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Saladi N, Anandarajah H, Walsh RD. Acute Onset of Diplopia and Nystagmus. J Neuroophthalmol 2024; 44:e200. [PMID: 38170591 DOI: 10.1097/wno.0000000000002070] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Nikita Saladi
- Departments of Ophthalmology and Visual Sciences, and Neurology, Medical College of Wisconsin-Eye Institute, Milwaukee, Wisconsin
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18
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Menke BA, Ryu C, Chundury RV. Superior Ophthalmic Vein Thrombosis Associated With Asymptomatic COVID-19 Infection. Ophthalmic Plast Reconstr Surg 2024; 40:e41-e42. [PMID: 38427840 DOI: 10.1097/iop.0000000000002540] [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: 03/03/2024]
Abstract
Superior ophthalmic vein thrombosis is a rare condition scarcely described in clinical literature with potentially severe consequences including permanent vision loss. This report details the case of a 70-year-old woman who presented with acute binocular horizontal diplopia, relative proptosis of the OD by 4 mm, and pain OD. On exam, visual acuity was 20/20 OD and 20/30 OS with full extraocular movements. CT revealed proptosis OD with a thrombosed superior ophthalmic varix. Evaluation for etiology of hypercoagulability was unremarkable, although the patient did have an asymptomatic COVID-19 infection 1 month prior. To the authors' knowledge, this is the first reported case of superior ophthalmic vein thrombosis secondary to an asymptomatic COVID-19 infection.
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Affiliation(s)
- Bryant A Menke
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, U.S.A
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19
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Chazal T, Clavel G, Leturcq T, Philibert M, Lecler A, Vignal-Clermont C. Characteristics and Prognosis of Binocular Diplopia in Patients With Giant Cell Arteritis. J Neuroophthalmol 2024; 44:87-91. [PMID: 37342872 DOI: 10.1097/wno.0000000000001912] [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: 06/23/2023]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a large vessel vasculitis associated with a risk of permanent ophthalmologic complications. Data about diplopia prognosis in GCA are scarce. This study was designed to better characterize diplopia in newly diagnosed GCA patients. METHODS All consecutive patients diagnosed with GCA from January 2015 to April 2021 in a French tertiary ophthalmologic center were retrospectively reviewed. GCA diagnosis relied on a positive temporal artery biopsy or high-definition MRI. RESULTS Among 111 patients diagnosed with GCA, 30 patients (27%) had diplopia. Characteristics of patients with diplopia were similar to other GCA patients. Diplopia resolved spontaneously in 6 patients (20%). Diplopia was attributed to cranial nerve palsy in 21/24 patients (88%), especially third (46%) and sixth cranial nerve (42%). Ocular ischemic lesions occurred in 11 of the 30 patients with diplopia (37%); 2 patients developed vision loss after initiation of corticosteroids. In the remaining 13 patients, diplopia resolved after treatment onset in 12 patients (92%) with a median delay of 10 days. Patients treated intravenously tended to have a quicker improvement than those treated orally, but with a similar resolution rate of diplopia at 1 month. Two patients had relapse of diplopia at 4 and 6 weeks after an initial treatment course of 24 and 18 months, respectively. CONCLUSIONS Diplopia is a rare feature at GCA diagnosis, but should raise clinician suspicion for GCA when associated with cephalic symptoms and prompt the initiation of corticosteroids to prevent ocular ischemic complications.
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Affiliation(s)
- Thibaud Chazal
- Internal Medicine Department (TC, GC, TL), Neuro-Ophtalmology Department (MP, CV-C), and Neuroradiology Department (AL), Hopital Fondation Adolphe de Rothschild, Paris, France
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20
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Tan JL, Dhepnorrarat C, Wong D, De Sousa JL. Transorbital and endonasal resection of a rare orbital ectopic atypical meningioma. BMJ Case Rep 2024; 17:e257490. [PMID: 38429059 PMCID: PMC10910577 DOI: 10.1136/bcr-2023-257490] [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] [Indexed: 03/03/2024] Open
Abstract
A female patient in her early 20s presented with increasing proptosis of her left eye over 2 months. She had no other signs of diplopia, pain or visual loss on initial presentation. Subsequent imaging of her orbits revealed a medial rectus tumour. A transorbital open biopsy of this tumour was non-diagnostic/inconclusive, hence a combined transorbital and endonasal resection of this tumour was performed. Histopathology of the resected tumour revealed an unusual inflammatory-rich spindle cell neoplasm, which was determined to be a primary orbital ectopic atypical meningioma. These tumours are exceedingly rare, with only case reports/series reported in the literature. Complete surgical resection with margins is the proposed treatment. The role of radiotherapy is still controversial. More studies are required to improve our knowledge of this condition.
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Affiliation(s)
- Jian Li Tan
- ENT, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Tan Tock Seng Hospital, Singapore
| | | | - Daniel Wong
- Pathology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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21
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Hassan B, Hricz N, Er S, Yoon J, Resnick E, Liang F, Yang R, Manson PN, Grant MP. Development and validation of a risk calculator for postoperative diplopia following orbital fracture repair in adults. Sci Rep 2024; 14:3654. [PMID: 38351033 PMCID: PMC10864303 DOI: 10.1038/s41598-024-54121-w] [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: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Postoperative diplopia is the most common complication following orbital fracture repair (OFR). Existing evidence on its risk factors is based on single-institution studies and small sample sizes. Our study is the first multi-center study to develop and validate a risk calculator for the prediction of postoperative diplopia following OFR. We reviewed trauma patients who underwent OFR at two high-volume trauma centers (2015-2019). Excluded were patients < 18 years old and those with postoperative follow-up < 2 weeks. Our primary outcome was incidence/persistence of postoperative diplopia at ≥ 2 weeks. A risk model for the prediction of postoperative diplopia was derived using a development dataset (70% of population) and validated using a validation dataset (remaining 30%). The C-statistic and Hosmer-Lemeshow tests were used to assess the risk model accuracy. A total of n = 254 adults were analyzed. The factors that predicted postoperative diplopia were: age at injury, preoperative enophthalmos, fracture size/displacement, surgical timing, globe/soft tissue repair, and medial wall involvement. Our predictive model had excellent discrimination (C-statistic = 80.4%), calibration (P = 0.2), and validation (C-statistic = 80%). Our model rules out postoperative diplopia with a 100% sensitivity and negative predictive value (NPV) for a probability < 8.9%. Our predictive model rules out postoperative diplopia with an 87.9% sensitivity and a 95.8% NPV for a probability < 13.4%. We designed the first validated risk calculator that can be used as a powerful screening tool to rule out postoperative diplopia following OFR in adults.
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Affiliation(s)
- Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas Hricz
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seray Er
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joshua Yoon
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Eric Resnick
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fan Liang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paul N Manson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael P Grant
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 110 S Paca Street, Suite 4-S-124, Baltimore, MD, 21201, USA.
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22
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Liebman DL, Weinert MC, Dohlman JC, Hennein L, Gaier ED. Cauterization-mediated restriction from penetrating orbital trauma. J AAPOS 2024; 28:103805. [PMID: 38216116 PMCID: PMC10947871 DOI: 10.1016/j.jaapos.2023.11.008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
A healthy 32-year-old woman presented with binocular diplopia immediately after sustaining a penetrating injury to the left periocular adnexa with a hot metal skewer. Examination revealed an incomitant esotropia, with complete limitation of abduction of the left eye with downshoot in left gaze and normal afferent visual function. Computed tomography and magnetic resonance imaging demonstrated no fracture, but there was mild thickening of the medial rectus muscle and associated fat stranding. Lack of orbitomuscular tethering or hematoma led to the presumptive diagnosis of thermal cauterization injury causing left medial rectus restriction. Given the lack of literature on this mechanism of injury, the patient was monitored closely. She exhibited remarkable spontaneous improvement in motility over 6 months, with near orthophoria in primary gaze. However, bothersome residual esotropic diplopia in left gaze prompted a left medial rectus recession, with a good outcome. This case demonstrates that isolated extraocular muscle thermal injuries and consequential strabismus can recover spontaneously; longitudinal observation before surgical intervention may be appropriate in such cases.
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Affiliation(s)
- Daniel L Liebman
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Marguerite C Weinert
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Jenny C Dohlman
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren Hennein
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; The Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, California; Department of Ophthalmology, Rady Children's Hospital - San Diego, San Diego, California
| | - Eric D Gaier
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Picower Institute for Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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23
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Voss JO, Ziegenrücker P, Doll C, Maier C, Steffen C, Heiland M, Hofmann E, Koerdt S. Diagnostic pitfalls in pediatric orbital entrapment fractures. J Craniomaxillofac Surg 2024; 52:228-233. [PMID: 38142169 DOI: 10.1016/j.jcms.2023.12.006] [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: 06/12/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023] Open
Abstract
Prompt diagnosis and management of orbital entrapment fractures in the pediatric patient have been advocated. This retrospective study analyzed a cohort of orbital entrapment fractures in pediatric patients with regard to diagnostic pitfalls, treatment and outcomes in a Level I trauma center in Germany. Based on medical records and radiological imaging, patients under the age of 18 years who presented with orbital fractures during 2009-2021 were analyzed. Overall, 125 patients presented with orbital fractures, of whom 29 patients (23.2%) had orbital entrapment fractures. The majority of patients presented with monocle hematoma (n = 23), diplopia (n = 20), and/or restricted extraocular eye movement (n = 14). While all patients with orbital entrapment fractures underwent three-dimensional imaging, 10 radiological reports (34.5%) did not include findings on orbital entrapment fractures. All patients underwent surgical exploration in less than 24 h. In 12 patients, clinical symptoms such as diplopia and restricted ocular elevation were documented upon postoperative evaluation before discharge. Considering the significant proportion of orbital entrapment fractures that are not noted on radiological imaging, prompt clinical examination should be initiated in pediatric patients at risk for orbital fractures. Urgent surgical intervention should be recommended in entrapment fractures.
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Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Paula Ziegenrücker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christoph Maier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany; New York University School of Medicine, Dept. of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), 650 1st Avenue, New York, 10016, NY, USA.
| | - Claudius Steffen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Elena Hofmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
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24
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Khanna RK, Thoreau B, Jean-Lechner M, Siben A, Marotte MT, Santallier M, Pisella PJ, Cohen C, Arsene S. Postoperative outcomes for unilateral congenital trochlear nerve palsy: A retrospective cohort study. J Fr Ophtalmol 2024; 47:104012. [PMID: 37925325 DOI: 10.1016/j.jfo.2023.05.034] [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: 04/11/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Congenital trochlear nerve palsy is the most common cause of vertical strabismus. The goal of this study was to investigate surgical outcomes after superior oblique tendon plication with or without inferior oblique recession in children and adults with unilateral congenital trochlear nerve palsy. METHODS Data and outcomes were collected in patients with a diagnosis of unilateral congenital superior oblique palsy during a retrospective single-center study conducted at the University Hospital of Tours. A reproducible, standard ophthalmological and oculomotor examination was performed pre- and postoperatively at 1 year, including presence or absence of diplopia, vertical and horizontal deviations, and compensatory head posture. Surgical success, defined as an endpoint including absence of diplopia in primary position, absence of head tilt, and vertical deviation at distance fixation<5 prism diopters (PD), was analyzed. RESULTS A total of fifty-seven patients (median [IQR] age of 11 years [5-42]) were analyzed. Patients experienced a significant reduction in vertical distance and near deviations (p<0.001), compensatory head tilt (p < 0.001), and diplopia after surgery (p < 0.001). Surgical success was higher in adults (17/24, 70.8%) than in children (15/33, 45.5%), although this did not reach statistical significance (p=0.0657). CONCLUSION This study suggests that plication of the superior oblique muscle tendon, with or without recession of the inferior oblique muscle, can be effective in treating unilateral congenital trochlear nerve palsy. Further studies are necessary to compare surgical procedures and investigate their efficacy in adults compared to children in the short and long term.
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Affiliation(s)
- R K Khanna
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France; Inserm 1253 iBrain « Neurogénomique & Physiopathologie neuronale », Tours, France.
| | - B Thoreau
- Department of Internal Medicine and Clinical Immunology, Bretonneau University Hospital, CHRU Tours, Tours, France; Inserm U1016, Cochin Institute, Paris, France; University of Paris, Paris, France; CNRS UMR 8104, Paris, France
| | - M Jean-Lechner
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France
| | - A Siben
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France
| | - M-T Marotte
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France
| | - M Santallier
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France
| | - P-J Pisella
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France
| | - C Cohen
- Department of Neuroradiology, Bretonneau University Hospital, Tours, France
| | - S Arsene
- Department of Ophthalmology, Bretonneau University Hospital, Tours, France
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Yoshida-Hata N, Mimura M, Aikawa M, Kashima T. A case of bilateral amyloidosis localized to extraocular muscles mimicking thyroid eye disease. BMC Ophthalmol 2024; 24:42. [PMID: 38279160 PMCID: PMC10811829 DOI: 10.1186/s12886-024-03295-y] [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: 09/18/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Amyloidosis is a rare condition characterized by the abnormal deposition of amyloid proteins in various tissues and organs. While systemic amyloidosis has been well-documented, amyloid deposition in extraocular muscles is an exceptionally rare occurrence, with only 35 reported cases. This case report sheds light on the importance of considering amyloidosis in the differential diagnosis of patients presenting with proptosis and diplopia, which are often associated with thyroid eye disease. CASE PRESENTATION A woman in her twenties sought medical attention due to a complaint of diplopia. Her ocular examination revealed almost normal findings except for exotropia and proptosis. Orbital magnetic resonance imaging displayed fusiform enlargement of nearly all eye muscles, a presentation typically observed in thyroid eye disease. However, despite corticosteroid therapy, her symptoms showed no improvement. Given the unusual lack of response to conventional treatment, and inhomogeneous enhancement of the muscle, an extraocular muscle biopsy was conducted. This biopsy yielded a unique finding-amyloid deposition within the muscle tissue. This discovery was particularly intriguing due to the extreme rarity of amyloidosis affecting extraocular muscles, with fewer than three dozen documented cases worldwide. CONCLUSION This unique case underscores the critical need for a comprehensive approach to diagnosing patients with proptosis and diplopia. While these symptoms are commonly attributed to thyroid eye disease, it is essential to consider alternative diagnoses such as amyloidosis, especially when standard treatments fail to yield results. The discovery of amyloid deposition in the extraocular muscles, although exceedingly rare, emphasizes the significance of a thorough differential diagnosis. In conclusion, this case report highlights the importance of vigilance in clinical practice, encouraging ophthalmologists to explore less common diagnostic possibilities when faced with challenging cases. Further research and clinical investigation are warranted to better understand the mechanisms and potential treatments for amyloidosis affecting the extraocular muscles.
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Affiliation(s)
| | - Masashi Mimura
- Oculofacial Clinic Osaka, 1-12-6, Umeda Kita-ku, Osaka-city, 530-0001, Osaka, Japan
| | - Miwa Aikawa
- Oculofacial Clinic Tokyo, 1-15-4 Ginza, Chuo-ku, 104-0061, Tokyo, Japan
| | - Tomoyuki Kashima
- Oculofacial Clinic Tokyo, 1-15-4 Ginza, Chuo-ku, 104-0061, Tokyo, Japan
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van der Meeren SW, van Hulst-Ginjaar SPA, Schalij-Delfos NE. First Intraoperative Trochlea Reconstruction. Ophthalmic Plast Reconstr Surg 2024; 40:e6-e9. [PMID: 37615294 PMCID: PMC10795966 DOI: 10.1097/iop.0000000000002498] [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] [Received: 07/14/2023] [Indexed: 08/25/2023]
Abstract
Traumatic detachment of the superior oblique muscle from the trochlea is very rare. The authors present a case of cyclovertical diplopia in downgaze due to traumatic trochlear damage where they performed surgery more than 40 years later. For the first time ever, they describe the reconstruction of the trochlea using a silicone tube, thereby regaining superior oblique muscle function.
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Affiliation(s)
- Stijn W. van der Meeren
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Hou X, Tu Y, Min X, Du K, Li F, Wang J, Wu X. The effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid ophthalmopathy. J Fr Ophtalmol 2024; 47:103924. [PMID: 37775455 DOI: 10.1016/j.jfo.2023.01.045] [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: 12/12/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To evaluate the effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy. METHODS This retrospective study enrolled 55 eyes of 33 patients treated in our hospital for restrictive strabismus caused by thyroid-associated ophthalmopathy. We performed muscle recession for the obviously restricted extraocular muscles, with 6 weeks of follow-up. Surgical outcomes were compared between the orbital decompression group (DG, n=15) and non-orbital decompression group (NDG, n=18). RESULTS A total of 33 patients with Graves' ophthalmopathy who underwent rectus muscle recession surgery were included. Of these, 15 patients had undergone orbital decompression prior to strabismus surgery, and 18 had not. The two groups did not differ in terms of the preoperative horizontal or vertical ocular deviation, degree of restriction of eye movement, degree of diplopia, or mean number of muscles that underwent surgery (P>0.05). There was no significant difference in the preoperative horizontal or vertical ocular deviation, level of eye movement restriction, degree of diplopia and the success rate of the surgery (P>0.05). CONCLUSION Rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy during the quiescent period could improve the ocular deviation and diplopia, and orbital decompression performed before strabismus surgery had no significant effect on surgical technique or outcomes of rectus muscle recession surgery.
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Affiliation(s)
- X Hou
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - Y Tu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - X Min
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - K Du
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - F Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China
| | - J Wang
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China.
| | - X Wu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008,Hunan Province, China; National Clinical Key Specialty of Ophthalmology,Changsha, 410008,Hunan Province, China; Hunan Key Laboratory of Ophthalmology, Changsha, 410008,Hunan Province, China.
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Nowak M, Nowak W, Marek B, Kos-Kudła B, Siemińska L, Londzin-Olesik M, Kajdaniuk D. Differential diagnosis of thyroid orbitopathy - diseases mimicking the presentation or activity of thyroid orbitopathy. Endokrynol Pol 2024; 75:1-11. [PMID: 38497384 DOI: 10.5603/ep.98156] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 03/19/2024]
Abstract
Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.
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Affiliation(s)
- Mariusz Nowak
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.
| | - Wojciech Nowak
- Science Students' Association, Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Bogdan Marek
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Lucyna Siemińska
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Magdalena Londzin-Olesik
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Dariusz Kajdaniuk
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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Su WY, Lu CJ. The Clinical Course of New-Onset Ocular Myasthenia Gravis Caused by Pfizer-BioNTech COVID-19 Vaccine. Acta Neurol Taiwan 2023; 32(4):218-222. [PMID: 37723915] [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] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Myasthenia gravis (MG) caused by COVID-19 vaccine had been reported, but the clinical course of new-onset ocular MG had never been described. We would like to document the clinical course of a patient with new-onset ocular MG which was caused by Pfizer-BioNTech COVID-19 vaccine. CASE REPORT A 39-year-old woman noticed diplopia one week after she accepted the first dose of Pfizer- BioNTech COVID-19 vaccine. Diagnosis of ocular MG was made after investigation. Despite intravenous immunoglobulins, pyridostigmine and prednisolone therapy, she had no improvement until 10 days after treatment. She then rapidly improved, and almost fully recovered in the following 10 days. We had observed this patient for 8 months. After tapering off steroid, she remained stable to date, though she still suffered from transient diplopia on awakening. CONCLUSION No matter the symptoms at onset, the clinical course or the response to steroid therapy was identical to ocular MG that we had ever known. Ocular MG caused by COVID-19 vaccine could probably be an iatrogenic life-long disease.
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Affiliation(s)
- Wei-Yu Su
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chien-Jung Lu
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan
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Yoshimoto K, Matsubara M, Kobayashi T, Nishio K. A Case of Mycoplasma Infection with an Atypical Presentation of Abducens Nerve Palsy, Erythema Multiforme and Polyarthritis without Respiratory Manifestations. Medicina (Kaunas) 2023; 60:36. [PMID: 38256298 PMCID: PMC10818581 DOI: 10.3390/medicina60010036] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Mycoplasma pneumoniae is a self-propagating microorganism that commonly causes respiratory tract infections. It can also cause a variety of extrapulmonary symptoms with or independently of respiratory symptoms, such as skin lesions, arthralgia, myalgia, hemolysis, cardiac lesions, gastrointestinal symptoms, and central nervous system lesions, which are rare manifestations reported in approximately 0.1% of cases. In this study, we present a unique case of Mycoplasma-related abducens nerve palsy, polyarthritis, and erythema multiforme without respiratory disease. The patient was a 69-year-old woman who presented to our hospital with a skin rash, fever, arthralgia, and diplopia without respiratory symptoms. Brain magnetic resonance imaging showed optic neuritis on the right side, suggesting the diplopia was caused by right abducens nerve palsy. However, the etiologies of abducens nerve palsy were not revealed by the physical examination, blood biochemistry tests, or bacteriological examinations, including the cerebrospinal fluid examination obtained at admission. Mycoplasma infection was suspected from erythema multiforme revealed by a skin biopsy and polyarthralgia, and it was finally diagnosed according to elevated Mycoplasma particle agglutination (PA) antibodies in paired serum. Though minocycline did not improve her diplopia, the daily administration of 30 mg of prednisolone gradually improved her symptoms, and the Mycoplasma PA antibody titer, which was regularly measured in the clinical course, also decreased, suggesting a relationship between Mycoplasma infection and abducens nerve palsy. This is the first case of isolated abducens nerve palsy, which was reported as the only central neurological symptom in an adult patient with Mycoplasma infection. The mechanism or pathogenesis of CNS manifestations caused by Mycoplasma pneumoniae remains to be elucidated, and further investigation is needed. Hence, Mycoplasma infection is a common disease. Clinicians should be aware of the diverse manifestations, including abducens nerve palsy, of Mycoplasma infection and should consider Mycoplasma infection even in the absence of typical respiratory symptoms.
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Affiliation(s)
- Kiyomi Yoshimoto
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (M.M.); (T.K.); (K.N.)
| | - Masaki Matsubara
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (M.M.); (T.K.); (K.N.)
| | - Tadanao Kobayashi
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (M.M.); (T.K.); (K.N.)
- Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (M.M.); (T.K.); (K.N.)
- Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan
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Nakamura K, Fuchigami T, Morioka S. Eye movement training and gaze analysis for a patient with binocular diplopia after traumatic brain injury: a case report. J Med Case Rep 2023; 17:551. [PMID: 38110994 PMCID: PMC10726626 DOI: 10.1186/s13256-023-04221-4] [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: 03/23/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Patients with traumatic brain injury often develop sequelae such as eye movement disorders, including diplopia. Eye movement training is effective in diplopia management. However, few longitudinal follow-up studies have been conducted from the subacute disease stage, owing to the complexity of methods for quantifying diplopia. CASE PRESENTATION The patient is a 30-year-old Japanese man who presented with diplopia and underwent eye movement training for approximately 4 weeks. The angle of diplopia, distance of abduction of the eye, gaze analysis, and self-assessment of diplopia using Holmes' diplopia questionnaire were evaluated. The degree of diplopia increased from 12° to 40° on the right side. The distance of eye abduction increased from 10.4 to 12.8 mm. The self-assessment score improved from 76 to 12 points. Analysis of gaze transition revealed a reduction in the error between the target and gaze. CONCLUSION Eye movement training was successful in ameliorating the symptoms of diplopia in the patient with binocular diplopia. Furthermore, for patients with diplopia symptoms, it was suggested that the oculomotor approach to eye movement training should not only focus on the direction of the diplopia but also on the direction opposite to the diplopia (the weak side).
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Affiliation(s)
- Kaneharu Nakamura
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan.
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan.
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan
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Gugliotta Y, Roccia F, Demo PG, Rossi MB. Characteristics and surgical management of pure trapdoor fracture of the orbital floor in adults: a 15-year review. Oral Maxillofac Surg 2023; 27:625-630. [PMID: 35841436 PMCID: PMC10684415 DOI: 10.1007/s10006-022-01099-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This retrospective study aims to define the optimal timing of the surgical treatment of orbital floor trapdoor fractures (OFTFs) in adults according to clinical and radiological findings. METHODS From January 2006 to December 2020, 382 patients with isolated orbital floor fracture were admitted to the Division of Maxillofacial Surgery of Turin, Italy. The criteria for inclusion were age ≥ 16 years, preoperative computed tomography showing a linear (1a) or medial hinge fracture (1b), diplopia, and 6 months of follow-up data. Aetiology and mechanism of injury, presence of post-traumatic enophthalmos and oculocardiac reflex, time between trauma occurrence and surgery [stratified as < 24 h (urgent treatment), 24-96 h (early treatment), and > 96 h (late treatment)], days of hospitalisation, and clinical outcomes were examinated. RESULTS Twenty-four patients (18 males; mean age, 23.2 years) presented with OFTFs. The most common cause was sport injury (50%). Type 1a fracture was observed in eight patients (mean age, 19.5 years), type 1b fracture in 16 patients (mean age, 23.6 years). Urgent, early, and late treatments were performed in eight patients each. The mean time between trauma occurrence and surgery was 3,8 days (range: 0-17 days). Resolution of diplopia was observed 1 week after surgery in 10 patients, 1 month in 12. Diplopia persisted in 2 patient, both treated > 96 h after trauma. CONCLUSION Although the number of patients was too small to define a standard protocol, the authors recommend early treatment of adult OFTFs to promote complete resolution of diplopia.
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Affiliation(s)
- Ylenia Gugliotta
- Division of Maxillofacial Surgery, Surgical Science Department, Città Della Salute E Delle Scienze Hospital, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy.
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Surgical Science Department, Città Della Salute E Delle Scienze Hospital, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Paolo Garzino Demo
- Division of Maxillofacial Surgery, Surgical Science Department, Città Della Salute E Delle Scienze Hospital, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Maria Beatrice Rossi
- Division of Maxillofacial Surgery, Surgical Science Department, Città Della Salute E Delle Scienze Hospital, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
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Bellini T, Siri L, De Grandis E, Formigoni C, Tortora D, Piccotti E. Multidirectional Nystagmus as the Presenting Sign of Brain Tumor with Hydrocephalus. Neuropediatrics 2023; 54:439-440. [PMID: 37666275 DOI: 10.1055/s-0043-1772462] [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: 09/06/2023]
Affiliation(s)
- Tommaso Bellini
- Pediatric Emergency Room and Emergency Medicine, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Siri
- Neuropsychiatry Unit, Gaslini Children Hospital, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisa De Grandis
- Neuropsychiatry Unit, Gaslini Children Hospital, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Clelia Formigoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Gaslini Children Hospital, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Room and Emergency Medicine, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Kirouac F, Nadeau F, Kalevar A, Evoy F. Acute Diplopia After Vitrectomy: A Revealing MRI. J Neuroophthalmol 2023; 43:e355. [PMID: 37549017 DOI: 10.1097/wno.0000000000001933] [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] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Francois Kirouac
- Division of Ophthalmology (FK, FN, AK), Department of Surgery, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada; and Division of Neurology (FE), Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada
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Xie JS, Micieli JA. Spontaneous Resolution of Diplopia Related to a Frontal Sinus Mucocele. J Neuroophthalmol 2023; 43:e256-e257. [PMID: 35234688 DOI: 10.1097/wno.0000000000001530] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jim S Xie
- Michael G. DeGroote School of Medicine (JSX), McMaster University, Hamilton, Ontario, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Ontario, Canada; Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Ontario, Canada
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Khalili MR, Talebnezhad M, Jalalpour MH, Jahanbani-Ardakani H. Superior divisional third nerve palsy due to breast cancer metastasis to the orbital apex. Int J Neurosci 2023; 133:1129-1131. [PMID: 35313789 DOI: 10.1080/00207454.2022.2056458] [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: 01/23/2021] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a case of breast cancer with metastasis to the orbital apex with manifestation of superior divisional third nerve palsy. CASE DESCRIPTION A 40-year-old female, a known case of breast cancer diagnosed 3 years ago, referred to our neuro-ophthalmology clinic with chief complaint of ptosis and diplopia. In ophthalmic examination, visual acuities of both eyes were 20/20 and there was no significant finding in the anterior and posterior segment ophthalmic examination. There was left eye ptosis with MRD1 of 2 mm. In ocular movement examination, there was limitation of motion in supraduction (-2 to -3) of the left eye. Orbital MRI with contrast was requested for the patient which demonstrated a lesion in the orbital apex of the left eye. At the end, the patient was diagnosed as having superior divisional third nerve palsy. Orbital radiotherapy was recommended for the patient. CONCLUSION In a patient with breast cancer who presents with diplopia, metastasis to the orbital apex with manifestation of divisional third nerve palsy should be kept in mind, and appropriate orbital imaging should be considered.
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Affiliation(s)
- Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Hamidreza Jahanbani-Ardakani
- Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Li B, Kim MG, Dominguez JF, Feldstein E, Kleinman G, Al-Mufti F, Kim M, Hanft S. Intrasellar hemorrhagic chordoma masquerading as pituitary apoplexy: case report and review of the literature. Br J Neurosurg 2023; 37:1685-1688. [PMID: 34148480 DOI: 10.1080/02688697.2021.1941761] [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: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND IMPORTANCE Chordomas are centrally located, expansile soft tissue neoplasms that arise from the remnants of the embryological notochord. Hemorrhagic presentation is exceedingly rare and can resemble pituitary apoplexy. Moreover, a purely intrasellar location of a chordoma is extremely uncommon. We report a case of a hemorrhagic intrasellar chordoma in an adult male, which presented similarly to pituitary apoplexy and was resolved with surgical resection. CLINICAL PRESENTATION A 69-year-old male presented with a 4 week history of acute onset headache and concurrent diplopia, with significantly reduced testosterone and slightly reduced cortisol. His left eye demonstrated a sixth cranial nerve palsy. Magnetic resonance imaging of the brain showed a large hemorrhagic mass in the pituitary region with significant compression of the left cavernous sinus and superior displacement of the pituitary gland. The patient underwent an endoscopic endonasal transsphenoidal approach for the resection of the lesion. Near total resection was achieved. Final pathology revealed chordoma with evidence of intratumoral hemorrhage, further confirmed by immunopositive stain for brachyury. Post-operatively, the patient had improved diplopia and was discharged home on low dose hydrocortisone. At 3-month follow-up, his diplopia was resolved and new MRI showed stable small residual disease. CONCLUSIONS Apoplectic chordomas are uncommon given chordoma's characteristic lack of intralesional vascularity and represent a diagnostic challenge in the sellar region. Our unique case demonstrates that despite our initial impression of pituitary apoplexy, this was ultimately a case of apoplectic chordoma that responded well to endoscopic endonasal surgery.
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Affiliation(s)
- Boyi Li
- New York Medical College School of Medicine, Valhalla, NY, USA
| | - Michael G Kim
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Eric Feldstein
- New York Medical College School of Medicine, Valhalla, NY, USA
| | - George Kleinman
- Department of Pathology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Matthew Kim
- Department of Otolaryngology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Simon Hanft
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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38
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Mungmungpuntipantip R, Wiwanitkit V. Regarding Oculomotor Palsy After the Administration of the Messenger RNA-1273 Vaccine for SARS-CoV-2: Diplopia After the COVID-19 Vaccine. J Neuroophthalmol 2023; 43:e360. [PMID: 35421876 DOI: 10.1097/wno.0000000000001558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rujittika Mungmungpuntipantip
- Private Academic Consultant, Medical Center, Bangkok, Thailand; and Department of Community Medicine, Dr DY Patil University, Pune, India
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39
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Affiliation(s)
- Jacklyn S Mahgerefteh
- Department of Ophthalmology (JM, MDK), Larkin Community Hospital, South Miami, Florida; and Lang Department of Imaging (AGO), Cleveland Clinic Florida, Weston, Florida
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40
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Wee JH, Kim DG, Lee JY, Cho MJ, Shim WS, Jung HJ. A case series of surgical outcomes for orbital blowout fracture with extraocular muscle entrapment. Medicine (Baltimore) 2023; 102:e34879. [PMID: 37933029 PMCID: PMC10627658 DOI: 10.1097/md.0000000000034879] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/20/2023] [Indexed: 11/08/2023] Open
Abstract
Although early surgical intervention to avoid muscle degeneration in patients with blowout fractures (BOFs) and extraocular muscle entrapment is recommended, there is still no gold standard for the surgical timing of extraocular muscle release. This study aimed to present our 10-year experience with surgical outcomes in BOF patients with extraocular muscle entrapment to provide supporting data for determining the surgical timing for better outcomes. We conducted a retrospective study of patients with BOFs with extraocular muscle entrapment who underwent surgery at a tertiary hospital between December 2009 and October 2019. Their demographics, causes of injury and clinical features including limitation of extraocular movement (EOM) and diplopia were collected. Patients diagnosed with BOF with extraocular muscle entrapment accounted for 3.08% (21/681) of all cases of BOFs over a 10-year period. The patients comprised 20 males and 1 female, with a median age of 17.0 years (IQR, 13-25 years). All 21 patients had diplopia preoperatively, and 20 had EOM limitations. Nausea and vomiting were observed in 5 patients (23.8%). Surgery was performed within 48 hours after injury in 19 cases (within 24 hours in 13 cases), with a median of 17.0 hours (IQR, 11-27). The median operative time was 47.5 minutes (IQR, 31.2-73.7 minutes). The median follow-up period was 9.0 months (IQR, 7-12). At the last follow-up, 4 patients still had EOM limitations and 3 had residual diplopia; however, this did not interfere with their daily activities. Early diagnosis through facial computed tomography and physical examinations and early intervention showed successful surgical outcomes of BOF with extraocular muscle entrapment.
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Affiliation(s)
- Jee Hye Wee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Dong Guk Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jun Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Min Jai Cho
- Department of Neurosurgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Woo Sub Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea
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41
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Geizhals S, Van Tuyl A, Hahn B. Woman With Diplopia. Ann Emerg Med 2023; 82:564-572. [PMID: 37865488 DOI: 10.1016/j.annemergmed.2023.05.021] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Solomon Geizhals
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Anna Van Tuyl
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
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42
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Zhang S, Xu Z, Zhang X, Wang X, Ye R. Reconstruction of Medial Orbital Wall Using Autologous Perpendicular Plate of Ethmoid. J Craniofac Surg 2023; 34:2510-2513. [PMID: 37622567 DOI: 10.1097/scs.0000000000009619] [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] [Received: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
The aim of this study is to investigate the feasibility of perpendicular plate of ethmoid as material for the reconstruction of medial orbital wall. The main outcome measurement was preoperative and postoperative orbital volume. The authors performed a study including 17 patients who have isolated medial orbital wall fracture (blow-out fracture). All the patients were fixed the defect using autologous perpendicular plate of ethmoid under endonasal approach. The authors compared the preoperative and postoperative orbital volume difference (unaffected orbit, affected orbit) of all the patients, and observed the improvement of diplopia or ocular motility disorders after operation. All 17 medial orbital wall reconstruction surgeries were successful with no severe postoperative ophthalmic complications. Statistically significant differences were found between the preoperative and postoperative orbital tissue volumes for the affected orbit. There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction. And postoperative computed tomography showed the implant is in place and there is no medial rectus incarceration. Autologous perpendicular plate of ethmoid proved to be safe and effective in the reconstruction of medial orbital wall under endonasal approach with cost-effectivence, low complication rate, high biocompatibility, and minimally invasion.
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Affiliation(s)
- Shiyong Zhang
- Department of Otolaryngology, The South District of The Third Affiliated Hospital of Anhui Medical University, Anhui, China
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43
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Liu Z, Zhang WW, Dai P, Long X, Shen L, Luo YB. Clinical Reasoning: A 74-Year-Old Woman Presenting With Monocular Ptosis and Binocular Diplopia. Neurology 2023; 101:e1753-e1758. [PMID: 37580165 PMCID: PMC10624488 DOI: 10.1212/wnl.0000000000207751] [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] [Received: 05/26/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023] Open
Abstract
A 74-year-old woman presented with acute-onset right ptosis and binocular diplopia. CT scan showed low-density lesions in the bilateral basal ganglia and adjacent to lateral ventricles. Intracranial aneurysm was not detected. This case highlights the importance of neurologic localization of ophthalmoplegia based on physical examination and the microanatomy of the oculomotor nerve.
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Affiliation(s)
- Zhenghui Liu
- From the Departments of Neurology (Z.L., X.L., L.S., Y.-B.L.), Radiology (W.W.Z.), and Nephrology (P.D.), Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (L.S.), and Engineering Research Center of Hunan Province in Cognitive Impairment Disorders (L.S.), Central South University, Changsha; Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases (L.S.), Changsha; Key Laboratory of Hunan Province in Neurodegenerative Disorders (L.S.), Central South University, Changsha; and Key Laboratory of Organ Injury (L.S.), Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Wei Wei Zhang
- From the Departments of Neurology (Z.L., X.L., L.S., Y.-B.L.), Radiology (W.W.Z.), and Nephrology (P.D.), Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (L.S.), and Engineering Research Center of Hunan Province in Cognitive Impairment Disorders (L.S.), Central South University, Changsha; Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases (L.S.), Changsha; Key Laboratory of Hunan Province in Neurodegenerative Disorders (L.S.), Central South University, Changsha; and Key Laboratory of Organ Injury (L.S.), Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Piaoyu Dai
- From the Departments of Neurology (Z.L., X.L., L.S., Y.-B.L.), Radiology (W.W.Z.), and Nephrology (P.D.), Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (L.S.), and Engineering Research Center of Hunan Province in Cognitive Impairment Disorders (L.S.), Central South University, Changsha; Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases (L.S.), Changsha; Key Laboratory of Hunan Province in Neurodegenerative Disorders (L.S.), Central South University, Changsha; and Key Laboratory of Organ Injury (L.S.), Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Xiaoyan Long
- From the Departments of Neurology (Z.L., X.L., L.S., Y.-B.L.), Radiology (W.W.Z.), and Nephrology (P.D.), Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (L.S.), and Engineering Research Center of Hunan Province in Cognitive Impairment Disorders (L.S.), Central South University, Changsha; Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases (L.S.), Changsha; Key Laboratory of Hunan Province in Neurodegenerative Disorders (L.S.), Central South University, Changsha; and Key Laboratory of Organ Injury (L.S.), Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Lu Shen
- From the Departments of Neurology (Z.L., X.L., L.S., Y.-B.L.), Radiology (W.W.Z.), and Nephrology (P.D.), Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (L.S.), and Engineering Research Center of Hunan Province in Cognitive Impairment Disorders (L.S.), Central South University, Changsha; Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases (L.S.), Changsha; Key Laboratory of Hunan Province in Neurodegenerative Disorders (L.S.), Central South University, Changsha; and Key Laboratory of Organ Injury (L.S.), Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Yue-Bei Luo
- From the Departments of Neurology (Z.L., X.L., L.S., Y.-B.L.), Radiology (W.W.Z.), and Nephrology (P.D.), Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (L.S.), and Engineering Research Center of Hunan Province in Cognitive Impairment Disorders (L.S.), Central South University, Changsha; Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases (L.S.), Changsha; Key Laboratory of Hunan Province in Neurodegenerative Disorders (L.S.), Central South University, Changsha; and Key Laboratory of Organ Injury (L.S.), Aging and Regenerative Medicine of Hunan Province, Changsha, China.
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44
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Bireley JD, Santucci J, Li Y, Cohen DA. Clinical Reasoning: An Unusual Cause of Diplopia and Ptosis in a 67-Year-Old Woman. Neurology 2023; 101:e1646-e1651. [PMID: 37527939 PMCID: PMC10585670 DOI: 10.1212/wnl.0000000000207676] [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] [Received: 02/07/2023] [Accepted: 06/06/2023] [Indexed: 08/03/2023] Open
Abstract
Diplopia is a relatively common chief complaint encountered in an outpatient neurology clinic and carries a broad differential diagnosis. In this case, a 67-year-old woman presented with new horizontal, binocular diplopia and ptosis of 8-month duration, which persisted without significant progression. This case highlights the need for a comprehensive list of differential diagnoses for patients with acquired ophthalmoplegia and ptosis. Key learning points include an illustration of the stepwise diagnostic approach to evaluate for common etiologies, the importance of interpreting test results in the appropriate clinical setting, and the significance of recognizing specific signs and symptoms in achieving the correct diagnosis.
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Affiliation(s)
- John Daniel Bireley
- From the Department of Neurology (J.D.B., J.S., Y.L.), Neurological Institute, and Department of Ophthalmology (D.A.C.), Cole Eye Institute, Cleveland Clinic, OH
| | - Joshua Santucci
- From the Department of Neurology (J.D.B., J.S., Y.L.), Neurological Institute, and Department of Ophthalmology (D.A.C.), Cole Eye Institute, Cleveland Clinic, OH
| | - Yuebing Li
- From the Department of Neurology (J.D.B., J.S., Y.L.), Neurological Institute, and Department of Ophthalmology (D.A.C.), Cole Eye Institute, Cleveland Clinic, OH
| | - Devon A Cohen
- From the Department of Neurology (J.D.B., J.S., Y.L.), Neurological Institute, and Department of Ophthalmology (D.A.C.), Cole Eye Institute, Cleveland Clinic, OH.
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45
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Croese R, Kloppenborg R. [A man with hanging eyelids]. Ned Tijdschr Geneeskd 2023; 167:D7867. [PMID: 37823886] [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] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
A 73-year-old man came to the outpatient clinic because of diplopia and hanging eyelids. Neurological examination revealed fatigueable bilateral ptosis. The patient had a strong positive ice pack-test. Myasthenia gravis preached on top of the differential diagnosis. Subsequent blood tests showed antibodies against ACh-receptors and confirmed the diagnosis.
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Affiliation(s)
- Robert Croese
- Medisch Centrum Haaglanden, afd. Neurologie, Den Haag
- Contact: Robert Croese
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46
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Lee J, Vishwanath V, Gill N. Dysphagia, Dysarthria, and Diplopia in a 14-year-old Boy. Pediatr Rev 2023; 44:592-594. [PMID: 37777648 DOI: 10.1542/pir.2021-005366] [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: 10/02/2023]
Affiliation(s)
- July Lee
- Division of Pediatric Emergency Medicine and Transport
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Vijay Vishwanath
- Division of Pediatric Neurology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Natasha Gill
- Division of Pediatric Emergency Medicine and Transport
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
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47
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Cabourne E. 13 Squint hook down: a tale of homeopathic strabismus surgery. BMJ Open Ophthalmol 2023; 8:A5. [PMID: 37798000 DOI: 10.1136/bmjophth-2023-biposa.13] [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: 10/07/2023] Open
Abstract
A 6 year old boy was expected to undergo strabismus surgery for a symptomatic decompensating fully accommodative esotropia. He reported increasingly troublesome double vision.With low hypermetropic correction, his visual acuity was 0.02 right eye and 0.04 left eye, his stereoacuity 85 seconds of arc, he had an 18 PD near esophoria and 8PD distance esophoria. Uncorrected, his visual acuity was 0.12 in both eyes with a 30 PD right esotropia at near and 20 PD at distance.Whilst considering squint surgery, his mother, who is studying homeopathy, initiated treatment with an individualised homeopathic remedy of 30c nitric acid administered once a day on a sugar-coated dissolvable tablet. He completed an initial one-week course with success, although the effect was short lived with diplopia returning after one week. He proceeded with an additional two-week course which allegedly improved his symptoms and ocular alignment.One month following this self-medicated treatment, our patient attended his scheduled outpatient review, to our surprise without diplopia and without spectacle correction. His unaided visual acuity was 0.04 in both eyes and he controlled a 20 PD esophoria for both near and distance fixation. Strabismus surgery was therefore postponed and active monitoring has resumed. At two months, Mum reports he remains asymptomatic.This is the first case described where individualised homeopathic treatment has demonstrated an apparent resolution of a fully accommodative esotropia. The longevity is yet to be determined but as homeopathy becomes ever more popular, Paediatric Ophthalmologists may require some basic awareness of such fascinating cases.
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Affiliation(s)
- E Cabourne
- Kingston Hospital NHS Foundation Trust, UK
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48
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Artzner C, Hauser TK, Grözinger G, Ernemann U. An unusual cause of diplopia and blurred vision in a patient with renal insufficiency. ROFO-FORTSCHR RONTG 2023; 195:929-931. [PMID: 37348531 DOI: 10.1055/a-2061-6728] [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] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Christoph Artzner
- Diagnostic and Interventional Radiology, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
- Diagnostic and Interventional Radiology, University Hospitals Tubingen, Tübingen, Germany
| | - Till-Karsten Hauser
- Diagnostic and Interventional Neuroradiology, University Hospitals Tubingen, Tuebingen, Germany
| | - Gerd Grözinger
- Diagnostic and Interventional Radiology, University Hospitals Tubingen, Tübingen, Germany
| | - Ulrike Ernemann
- Diagnostic and Interventional Neuroradiology, University Hospitals Tubingen, Tuebingen, Germany
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49
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Alsaleh F, Dhillon J, Nassrallah EIB, Gaffar J, Kondoff M, Nassrallah GB, Ross M, Deschenes J. Clinical correlations of extraocular motility limitation pattern in orbital fracture cases: a retrospective cohort study in a level 1 trauma centre. Orbit 2023; 42:487-495. [PMID: 36128974 DOI: 10.1080/01676830.2022.2125536] [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: 01/30/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Ocular pathology (OP) following orbital fracture can vary vastly in complexity and severity. Extra-ocular motility (EOM) limitations are frequently present in orbital trauma cases, with patterns of duction limitations being symmetrical or asymmetrical. The aim of this study was to identify if there was any association between increased OP following orbital fracture cases based on the pattern of EOM deficits. METHODS This is a retrospective cohort study of patients with fractured orbits presenting with or without EOM limitations to a level 1 trauma center between August 2015 to January 2018. All pertinent elements of the ophthalmic examination were recorded. Outcome measures: Chi-square analyses assessed for association between symmetrical or asymmetrical EOM limitation and OP. Odds ratios were calculated with 95% confidence interval. RESULTS 278 orbits with wall fractures were included in this study. A significant correlation between EOM limitation and increased OP following orbital trauma was found (p = 0.000081). Cases with symmetrical and asymmetrical EOM limitation were 7.9 (95%CI: 2.3-27.2) and 5.22 (95%CI: 1.9-13.9) times more likely to have OP than cases with no EOM limitation, respectively. With extraocular muscle entrapment excluded, cases with symmetrical limitations had a significantly higher incidence of OP than cases with asymmetrical limitations (p = 0.0161). CONCLUSIONS OP is frequently observed in cases of orbital fracture. While any EOM limitations should prompt the clinicians to anticipate OP, intra-ocular injury may be more likely in cases of symmetrical EOM limitation. Future prospective studies are needed to further elucidate the relationship between EOM symmetricity and OP following orbital trauma.
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Affiliation(s)
- Fares Alsaleh
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, Quebec, Canada
| | - Jobanpreet Dhillon
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - Judy Gaffar
- Département d'Ophthalmologie, Université de Montréal, Montréal, Quebec, Canada
| | - Matthew Kondoff
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Georges B Nassrallah
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michael Ross
- Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Deschenes
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, Quebec, Canada
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50
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Merino P, Antón V, Chamorro M, Gómez de Liaño P, Yáñez-Merino J. Supraequatorial displacement with lateral rectus myopexy for treatment of myopic sagging/heavy eye. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:553-557. [PMID: 37648208 DOI: 10.1016/j.oftale.2023.06.021] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To describe the outcome of the patients diagnosed of sagging/heavy eye associated to myopia, that were operated on with the supra-equatorial displacement with LR myopexy. METHODS A retrospective study of 9 cases between 2017-2023. The following data were analyzed: horizontal and vertical deviation, diplopia, amblyopia, ductions, ocular torsion, sensorial test, macular pathology, and the orbital magnetic resonance. Treatment was considered Successful if the diplopia was improved or eliminated and a final vertical deviation (VD) ≤5 prism diopters (PD). RESULTS The mean age (SD) was: 62.11 (4.6) years (100% women). A total of 88.88% presented diplopia. The mean preoperative hypotropia was: 11.33 PD (SD 3.16), and the mean final VD 3.44 PD (SD 3.05). After surgery, the hypotropia was overcorrected in one case, under corrected in 5, and orthophoria was achieved in another three. The technique was associated with surgery of another rectus muscle in 4 subjects. The mean follow-up time after surgery was 34 months (SD 34.62). Six of the 9 patients improved with a vertical deviation ≤5 PD. In 3 patients, the diplopia was eliminated, while in 5 it remained intermittent (three with macular pathology). CONCLUSION Supra-equatorial displacement with LR myopexy for treatment of myopic sagging/heavy eye, is a therapeutic option if hypotropia is less than 12 PD or the Yokoyama technique is not indicated. A good result was obtained in most cases, although diplopia could only be totally suppressed in three, and another five remained intermittent.
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Affiliation(s)
- P Merino
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, HGU Gregorio Marañón, Madrid, Spain.
| | - V Antón
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, HGU Gregorio Marañón, Madrid, Spain
| | - M Chamorro
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, HGU Gregorio Marañón, Madrid, Spain
| | - P Gómez de Liaño
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, HGU Gregorio Marañón, Madrid, Spain
| | - J Yáñez-Merino
- Sección de Motilidad Ocular y Diplopía, Servicio de Oftalmología, HGU Gregorio Marañón, Madrid, Spain
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