This study describes a transorbital apical approach to the cavernous sinus, where the greater wing of sphenoid (GWS) and superior orbital fissure (SOF) are drilled out to access the interdural incision zone and lateral wall of the cavernous sinus.This was a retrospective series of 3 patients with periocular squamous cell carcinoma (SCC) and radiological evidence of perineural spread to the cavernous sinus. Following an orbital exenteration, the GWS was drilled to reach the lateral border of the SOF. The meningo-orbital band, a periosteal transition between the frontotemporal basal dura and periorbita, was incised to enter the lateral wall of the cavernous sinus. The relevant cranial nerves were biopsied to provide an accurate zonal classification of disease.The transorbital apical approach via the SOF provides a corridor of access to the cranial nerves within the lateral wall of the cavernous sinus. This technique was successfully performed on 3 patients with periocular SCC. One case had radiological evidence of intracavernous oculomotor nerve involvement, 1 patient demonstrated nasociliary nerve enlargement at the SOF, and another had frontal nerve involvement extending into the cavernous sinus. Cerebrospinal fluid leak occurred in 1 case addressed with fat packing and fascial closure.
Ophthalmic manifestations of allergic fungal sinusitis (AFS) are rare, but can occur in advanced disease. A 32-year-old man with advanced AFS presented with severe bilateral vision loss and restricted ocular motility. Magnetic resonance imaging and histological analysis confirmed active chronic AFS. Functional endoscopic sinus surgery was performed, with adjunctive steroid therapy. Although AFS is a reasonably well-recognised entity, severe disease causing bilateral visual deficits is rarely encountered. This can confound the diagnosis and appropriate treatment. Ophthalmologists should thus be aware of compressive optic neuropathy as a complication of advanced AFS to prompt early treatment and mitigate visual loss.
Nano- and micro-scale engineered surface structures are often used to control cell morphology and mimic the extracellular matrix in tissue engineering. However, there is little understanding of how toxins produced by common bacteria might affect cell adhesion to these structures. In this study, human dermal fibroblast (GM5565) cells were incubated on patterned tungsten/silicon oxide nanocomposite in media in the presence or absence of Antimycin A. This composite consists of parallel tungsten and silicon oxide lines with identical widths in the range of 0.18 and 50 μm. The morphology of the cells and of their mitochondria was characterized by using high-resolution scanning electron microscopy and fluorescence confocal microscopy. Results show that cells preferentially align along the line axes in a pattern-dependent manner, with a maximum population of cells oriented within 10° of the line axes on the structures containing 10 μm wide lines. Cells treated with Antimycin A, however, show a smaller proportion of cells oriented in this direction as compared to cells cultured in Antimycin A-free media (34.4% vs 53.0%). The majority of mitochondria in cells growing in Antimycin A-free media are tubular in shape and are preferentially positioned on the tungsten lines, whereas these organelles exhibit a circular geometry and are less attracted to the metal lines in the presence of Antimycin A.
Idiopathic apical orbital inflammation (AOI) is used to describe inflammation involving the posterior third of the orbit where no specific cause can be identified. It is a rare entity in which the presentation can vary widely. We aim to describe a case series of patients with idiopathic AOI and their clinicoradiological features and visual outcomes.
Orbital trauma is commonly complicated by retention of intraorbital foreign bodies. A 39-year-old man presented following a penetrating injury to the right orbit, with CT evidence of foreign bodies in the right anterior and posterior medial orbit. The foreign bodies were found to be a mixed composition of metal and wood. Characterising wood on CT imaging is difficult due to its radiolucency and low density, which can be mistaken for air in the setting of traumatic orbital emphysema. Increasing the window width on bone window settings can be used to distinguish wood from air, which is crucial for facilitating its complete surgical removal.
Purpose: To review and summarize the existing literature surrounding the clinical use of diffusion-weighted imaging and apparent diffusion coefficient (ADC) as diagnostic tools in differentiating common orbital lesions. Methods: A systematic literature review on the use of ADC and diffusion-weighted imaging sequences for orbital imaging was performed. Only original research articles that reported ADC values for benign or malignant lesions were included. Results: Malignant orbital tumors have an overall lower mean ADC value than benign masses. Orbital lymphoma is characterized by consistently lower ADC values compared with other malignant orbital masses; a threshold value less than 0.775 × 10 −3 mm 2 /s has been proposed to distinguish orbital lymphoma from other neoplastic and non-neoplastic orbital masses. To differentiate orbital inflammatory disease from lymphoma, an ADC threshold greater than 0.92 × 10 −3 mm 2 /s has been proposed. Conclusions: Orbital masses encompass a host of benign and malignant etiologies and can present a diagnostic challenge on both clinical and radiological assessment. Recent advanced MRI techniques such as diffusion-weighted imaging and ADC can improve the diagnostic specificity for orbital disease, particularly in differentiating benign from malignant lesions and lymphoma from orbital inflammatory disease.
PURPOSE: To report successful stromal lenticule extraction, 18 weeks after an aborted small incision lenticule extraction (SMILE) procedure. METHODS: Case report. RESULTS: SMILE was planned in both eyes in another center to correct high myopia. The right eye was treated uneventfully with immediate lenticule extraction and normal postoperative corneal and topographic appearance. Femtosecond laser treatment was applied to the left eye, but the lenticule could not be removed and the procedure was aborted. Eighteen weeks later, lenticule extraction was attempted again with success. Uncorrected distance visual acuity improved from counting fingers to 20/15, with a successful refractive outcome as planned. CONCLUSIONS: Delayed lenticule extraction was successful in achieving the target refractive outcome. To the authors' knowledge, this is the first case of successful delayed lenticule extraction following an incomplete SMILE procedure. Target refractive outcomes were achieved and there were no postoperative complications. [ J Refract Surg. 2017;33(3):199–202.]
Abstract Purpose To provide a comprehensive microbiological profile of bacterial dacryocystitis in South Australia. By identifying the specific microorganism and antibiotic susceptibility, this study intends to aid ophthalmologists in choosing appropriate empirical antibiotic therapies and development of evidence-based clinical guidelines. Method A retrospective study was conducted at the Royal Adelaide Hospital (RAH) over five years (2018–2023) of patients with acute dacryocystitis. The study included 43 patients, and data encompassed demographic information, clinical presentation, microbiological analysis, management, and outcomes. Patients with chronic dacryocystitis were excluded. Results Among the 43 patients included in the study (female 28 (65%), mean age: 64 years old), the most common clinical features were pain (74%) and swelling (70%). Organisms were identified in 49% of patients, with the predominant bacteria being Staphylococcus aureus (42%), Streptococcus species (19%), and Escherichia coli (8%). Aggregatibacter species (8%), Morganella morganii (4%), Enterobacter cloaceae (4%), Hafnia alvei (4%), mixed anaerobes (4%), E coliforms (4%) and Pseudomonas aeruginosa (4%) were also identified. The most frequently prescribed empirical antibiotics were amoxicillin-clavulanic acid (50%), flucloxacillin (33%) and cefalexin (18%). Conclusion The microbiological trends of acute dacryocystitis have largely remained consistent, with a predominance of Gram positive organisms. This is the most recent profile analysis of acute dacryocystitis in South Australia and will help form evidence-based clinical guidelines.
Abstract Purpose The purpose of the study was to report three cases of orbital inflammation following administration of the COVID-19 vaccination, manifesting as Tolosa–Hunt syndrome (THS) and orbital myositis. Method A retrospective case series and literature review of patients who developed orbital inflammation following a COVID-19 vaccination. Results One patient presented with Tolosa–Hunt syndrome (THS) 14 days following her third (booster) COVID-19 vaccination, one patient developed orbital myositis 10 days following his first COVID-19 vaccination and one patient developed recurrent orbital myositis 1 and 7 days following her second and fourth COVID-19 vaccination. All patients received the Comirnaty vaccine (Pfizer-BioNTech). A thorough systemic autoimmune disease workup in both patients was unremarkable. Two patients had a prior history of orbital inflammation, with previous involvement of other different orbital structures. Characteristic MRI features for each pathology were observed, supporting the clinical presentation of THS and orbital myositis. There was complete resolution of THS following corticosteroids, with no recurrence at 2 months. Meanwhile, one case of orbital myositis self-resolved at 2 months without use of systemic corticosteroids, while the other patient with orbital myositis required treatment with intra-orbital steroid injections and oral corticosteroids. Conclusion Orbital inflammation has been recognised as a rare adverse effect following COVID-19 vaccination. We present a case series of THS and orbital myositis as varied presentations of this entity.
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