Visual function alterations in cavernous hemangioma of the orbital apex after surgery

Dear Editor,I am Dr.Kang Xue,from the Department of Ophthalmology at the Eye,Ear,Nose and Throat Hospital of Fudan University in Shanghai,China.I am writing to present three case reports of the removal of visual function alterations in cavernous hemangioma of the orbital apex after surgery.Cavernous hemangioma is a relatively common primary benign orbital tumor in adults.

Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital

AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) cases.METHODS: All COVID associated mucormycosis(CAM) patients underwent comprehensive multidisciplinar y examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31(34.8%) had orbital apex syndrome. Sixty-six(74.2%) of such patients had pre-existing diabetes mellitus, 18(58%) patients had prior documented use of steroid use, and 55(61.8%) had no light perception(LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen(19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34(38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.

Orbital apex syndrome after tooth extraction in an immunocompromised patient

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

Orbital apex syndrome secondary to myocysticercosis: a rare case report

Dear Editor,We present a rare case report of orbital apex syndrome secondary to myocysticercosis.Human cysticercosis is caused by larval form(Cysticercus cellulosae)of Taenia solium.The cysts of Cysticercus cellulosae can lodge in the centralnervoussystem,muscles,subcutaneoustissue,or eye,resulting in varied clinical manifestations[1].This case highlights an unusual presentation of orbital apex syndrome secondary to cysticercosis of medial rectus.

Prognostic factors and clinical features of rhino-orbitalmucormycosis cases:an update for patient and visual survivals

AIM:To determine the frequency of patients’vision survival and prognostic factors and evaluate clinical features in rhino-orbital mucormycosis.METHODS:Forty-three eyes of 43 patients followed up with orbital mucormycosis infections were included in the study.Demographic characteristics of the patients,symptoms at admission,ophthalmologic and non-ophthalmologic examination findings,clinical findings during follow-up,medical and surgical procedures,and complications were recorded.Patient survival was determined by assessing the incidence of mortality,and vision survival was defined as achieving a final visual acuity of at least light perception.RESULTS:Twenty-seven(62.8%)patients were male,and 16(37.2%)were female.When the underlying disease status of the patients was examined,it was observed that all patients had an underlying disease and diabetes constituted the majority(65.2%).Periorbital swelling(69.8%)and ophthalmoplegia(53.5%)were the most common symptoms and findings at the admission of patients with mucormycosis infection.The disease resulted in death in 22(51.2%)patients.The presence of fever and shorter duration of antifungal therapy were associated with lower patient survival.Exenteration surgery was not found to be associated with the survival of the patients.Frozen eye,loss of pupillary light reflex,and development of central retinal artery occlusion were associated with lower vision survival.CONCLUSION:This study presents one of the most extensive patient series in the literature on rhino-orbital mucormycosis.Knowing the patients’symptoms at the time of admission and the clinical findings during the infection process will increase awareness about the disease.

Manage orbital apex lesions via posterior lateral orbitotomy

As surgical approaches accessing orbital apex carry .significant risk and require strong expertise and skills, it is important for surgeons to share their know-how and to evaluate the surgical interventions they practiced on a number of patients. We retrospectively studied 9 cases of orbital apex lesions which were excised via posterior lateral orbitotomy.