International Journal of Ocular Oncology and Oculoplasty

Introducing Gupta?S Needle: An Indigenously Made Needle For Frontalis Suspension Surgery For Ptosis

Author:R.C. Gupta

Volume: 1 | Issue no: 1-2016 | Pagination: 90-91

Background & Objectives: Wright?s needle is used in Frontalis suspension surgery for correction of severe ptosis with poor levator function (congenital or acquired etiologies). It is not easily available and is costly for small setup. For this purpose we have introduced a locally manufactured needle. Methods: We made a needle from a spoke of bicycle wheel. Results: We have used it successfully for more than 25 years with no surgical hassles or complications. It was less time consuming. Conclusions: Our needle is definitely a good alternative to wright?s needle for frontalis suspension surgery

Fish Bones In The Orbit: A Case Report

Author:Puneet Johri, Aparna Johri

Volume: 1 | Issue no: 1-2016 | Pagination: 87-89

It is rare to find fish bones retained in the orbital region. We report here an interesting case of an ocular fish bite injury in a sea diver. We also discuss few peculiar characteristics of a fish species responsible for the same and its probable mechanism of injury.

Synovial Sarcoma Involving Lacrimal Gland: A Rare Clinical Entity

Author:Syeed Mehbub Ul Kadir

Volume: 1 | Issue no: 1-2016 | Pagination: 82-86

Purpose: To report a rare case of synovial sarcoma in the lacrimal gland fossa of the orbit. Patient and methods: A female 70-years in age has presented to the department of orbit and ophthalmic plastic services of tertiary care eye hospital with eccentric proptosis of right eye of one month duration and pain for the past one week. Clinical examination revealed fullness in the right lacrimal gland region. CT scan of the orbit has shown a mass lesion in the fossa of the lacrimal gland. Its margin is irregular and erosion of lateral wall and roof of the orbit is noted. From the clinical picture and imaging, diagnosis of malignant tumor of the lacrimal gland was made. The tumor was excised through lateral orbitotomy. Histopathology and immunohistochemistry revealed that the tumor is synovial sarcoma. Conclusion: Synovial sarcoma is a very rare lacrimal gland malignant tumor in the orbit. Immunohistochemistry is very important to confirm the diagnosis.

Sinonasal Embryonal Rhabdomyosarcoma Presenting As Bilateral Visual Loss: Case Report

Author:Sucheta Parija, Indranil Saha

Volume: 1 | Issue no: 1-2016 | Pagination: 78-81

A 12 year old female, presented with rapidly progressive visual loss following left hemi facial pain for 15 days duration. Anterior segment and fundus examination was normal. She was diagnosed as retro bulbar neuritis and received steroid therapy. CT scan of PNS revealed a mass limited to the nasopharyngeal area and an endoscopic biopsy of mass revealed to be rhabdomyosarcoma, embryonal type. She was enrolled with pediatric oncology group rhabdomyosarcoma, as intermediate risk group to receive chemo-radiotherapy. A repeat MRI of brain done two weeks later, showed an intracranial extension of the tumor involving the optic nerve and chiasma. The fundus examination showed bilateral optic disc pallor. The patient responded well to chemotherapy but there was no visual improvement at four weeks follow-up. This case highlights the aggressive nature of rhabdomyosarcoma and should be kept as a differential diagnosis in cases of sudden loss of vision with normal fundus in children.

Management Of Intra-Operative Bleeding During Dacryocystorhinostomy Surgery

Author:Ramesh Chandra Gupta, Priyanka Gupta

Volume: 1 | Issue no: 1-2016 | Pagination: 76-77

Background & Objectives: Dacryocystorhinostomy (DCR) is the operation of choice for the management of Nasolacrimal duct block in chronic dacryocystitis. Bleeding is the most common complications during the surgery which hampers further procedure. The present paper deals in depth with various techniques and modifications adopted to manage it. Method: In the present study 2386 cases of chronic dacryocystitis were managed by the conventional external DCR surgery. Result: In cases of mucosal bleeding, re-packing of nose by 4% xylocaine and adrenaline soaked cotton spindle in backward and superior direction to ensure packing in close contact with mucosa of middle meatus. Otherwise an adrenaline swab was applied at the site of bleeding and a pressure was applied for a few minutes or warm packs were applied which invariably stopped the bleeding besides some adjuvant. Bleeding from angular vein and adjoining muscle is prevented by compressing it by haemostatic retractors. In few we had to tie it with catgut. In cases of bony bleeding, Osteotomy of bleeding bone or bone wax is the answer. Conclusion: Bleeding encountered in patient of chronic dacryocystitis during DCR surgery is usually easily manageable and leads to post-op success.

Epidemiology And Visual Outcome In Open Globe Injuries In Children

Author:Mary Esther John B, Deepa John, Padma Paul, Renu S. Raju

Volume: 1 | Issue no: 1-2016 | Pagination: 69-75

Background: Ocular trauma is one of the most important causes of unilateral vision loss in children. Children are more susceptible to eye injuries due to their increased physical activity. Visual impairment in children is of great significance due to risk of amblyopia. Aims: A) To study proportion of open globe injuries among patients less than 18 years of age presenting to Ophthalmology department B) To study proportion of various types of penetrating ocular injuries C) To determine factors influencing visual outcome Setting: Department of Ophthalmology, Christian Medical College, Vellore, T.N., India. Methods: Observational study which included retrospective chart review for 4 years and prospective study for 6 months. All children at or below 18 years of age with open globe injury were included. Results: Boys in age group 5-14 years were injured most. Wooden stick injury is the most common mode of injury. Indoor injuries were more common. Visual outcome at 6 months follow up: 44.5% had better than 6/18, 25.1% had 6/18 to 3/60 and 30.3% had poor vision of <3/60. Our study shows significant association between poor vision & blindness and corneal tear involving visual axis (50/156, p=0.001), presence of RAPD (42/156, p=0.000) and presence of IOFB (24/156, p=0.034). Conclusion: Our study showed 30.3% of children with open globe injuries resulted in poor vision and blindness. Childhood ocular trauma can result in amblyopia. Good awareness about prevention should be attained by health education.

A Comparison Of Surgical Outcome Between Modified External Dacryocystorhinostomy With Endoscopic Endonasal Dacryocystorhinostomy

Author:Ankita Mahendra Kabra, Archana Sunil Nikose, Arpita Sthapak, Rachana Kabra

Volume: 1 | Issue no: 1-2016 | Pagination: 61-68

Purpose: A comparison of surgical outcome between modified external dacryocystorhinostomy with endoscopic endonasal dacryocystorhinostomy. Methods: This was a prospective, randomized, interventional study on 84 patients with chronic dacryocystitis. They were divided into two groups; one group underwent modified external dacryocystorhinostomy whereas another group underwent an endoscopic endonasal dacryocystorhinostomy. Follow up period was six months and were evaluated on the basis of sac syringing and Munk?s score. The patients were followed up postoperatively on 1st day, 7th day, 1st month, 3rd month and 6th month. Statistical analysis was done by chi square test. Results: The mean age of the patients in our study in group I was 49.51±5.08 SD years and group II was 44.00±8.11 SD years. The female patients were more in both groups. Surgical success depends upon creating a wide osteotomy and preservation of mucosa around the bony ostium to reduce the chances of post-operative scarring and stenosis and defined on the basis of patency of sac on syringing and improvement in Munk?s score at the end of six months. The overall success rate of external dacryocystorhinostomy was 92.50% and that of endoscopic endonasal dacryocystorhinostomy was 75.67% and the difference was statistically significant (P =0.02, P <0.05). Conclusion: Primary procedures of the surgeries, external dacryocystorhinostomy and EN-DCR have almost comparable success rates. The minimal differences in outcomes between the two techniques are due to advances in technology of endoscopic endonasal dacryocystorhinostomy, experience of the surgeon and patient characteristics.

Diagnostic Value Of Three Dimensional Ct Reconstruction In Various Orbital Disorders

Author:Rajendra P. Maurya, Virendra P. Singh, Mahendra K. Singh, Shrinkhal, Prithvi R. Sen, Ashish Verma, P

Volume: 1 | Issue no: 1-2016 | Pagination: 48-60

Background: The diagnosis of orbital disease is an extremely challenging task. Technological advancement in computer software algorithms have allowed three dimensional (3D) reconstruction of complex orbital and craniofacial skeleton from 2D images. This study was undertaken to assess the diagnostic value of three-dimensional computed tomography (3D CT) in evaluating various orbital disorders. Materials and Methods: Over a five year period, 110 patients (69 males, 41 females) suffering from various orbital disorders were studied between January 2010 to February 2015 at our teaching hospital .After complete clinical examination, each patient was subjected to Multislice (64 slices) 2D CT. Post processing of the volume data so acquired was performed on an off-line workstation to generate multi-planner reconstructions along with maximum intensity projections (MIP) and volume rendered (VR) images wherever essential. Result: Out of 110 patients, 61.82% were male and 38.18% females, ranging in age from 3 months to 79 years. 60 (54.5%) had orbital trauma, 42 (38.18%) had orbital tumor (mass lesion) while rest (7.32%) were suffering from congenital orbital/ craniofacial abnormalities. Among the trauma cases, 12 (10.9%) had isolated orbital trauma, 28 cases (25.45%) had maxillofacial trauma and the rest 20 cases (18.18%) had cranio-orbital trauma. Among the neoplastic disorders, 22.73% had malignant lesions and rest 15.45% had benign lesions, out of them 4.55% were vascular lesion and 10.90% were developmental/ congenital mass. 7.27% had orbital bone dysostosis with craniofacial malformations. In all 110 patients, the 3D CT reformatted images confirmed the findings of conventional CT and radiographs and provided additional information regarding size, shape and extension of mass lesion or any fracture or bony erosion. It also provided depth perception and volumetric assessment. Conclusion: The present day multi-detector row CT scan offers the unique opportunity for evaluation of pathologies in multiple planes. The volume data generated is isotropic in nature and can generate images in any plane without anatomical distortion. The capability is of specific use in complex regions like orbit 3D where the reformatted projections not only remain a valuable problem solving tool but has become an essential pre-requisite for evidence based management. Further the 3D volume images remain of prime importance for a clinician to adequately counsel his patients and for post-operative evaluation of surgical results.

Custom Ocular Prosthesis Fitting Following Evisceration: Staphyloma Vs. Non-Staphyloma Cases

Author:Deepa Diddi Raizada, M.Sc., Kuldeep Raizada, Phd

Volume: 1 | Issue no: 1-2016 | Pagination: 42-47

Purpose: To assess and compare the prosthetic eye fitting in the patients undergoing evisceration with implant in staphyloma vs. non-staphyloma cases. Methods: It was a retrospective, comparative and interventional study. Patients who underwent evisceration with silicone orbital implant placement, and fitted with custom ocular prosthesis between August 2006 and April 2007 were included. Based on the indication for surgery, the patients were grouped under staphyloma and other conditions. Eyelid and socket abnormalities, and additional modifications undertaken to correct these abnormalities during fabrication of custom prosthesis were assessed, and compared between the two groups. Independent samples T-test was used for statistical analysis. Results: In the staphyloma group, 9 of 16 (56.3%) had ptosis (6), eyelid retraction (2), and deep superior sulcus (1) needing prosthesis modification. In contrast, the patients who underwent evisceration for other conditions, only 2 of 27 (7.4%) required modifications for lid sag. Statistical analysis showed significantly greater number of patients needed modifications in staphyloma group as compared to non-staphyloma group (P=0.001). Implant size, and duration between the date of surgery and the prosthesis fitting were compared between two groups, which showed no statistically significant difference (P=0.096 and P=0.108 respectively). Conclusion: The patients with staphyloma undergoing evisceration with implant can have cosmetically concerning eyelid abnormalities, most commonly ptosis that may need attention during fabrication of the prosthetic eye. These eyelid abnormalities could be due to long standing effect of staphyloma, possibly due to levator disinsertion, dehiscence or stretching; or due to insufficient volume replacement by an orbital implant

Current Concepts In Diagnosis And Management Of Grave?S Orbitopathy: An Overview

Author:Shushil Kumar Aggarwal, Rajendra P. Maurya

Volume: 1 | Issue no: 1-2016 | Pagination: 31-41

Dysthyroid orbitopathy or Thyroid associated orbitopathy (TAO) is a heterogeneous autoimmune orbital inflammatory reaction typically manifested in middle age. The various orbital presentations are lid retraction proptosis, dry eyes, strabismus, diplopia, restriction in extraocular ocular movement and compressive optic neuropathy. The mainstay of therapy for the severe cases remains surgical decompression of the orbital contents into an adjacent space. With the advent of nasal endoscopes, endoscopic decompression has now become the procedure of choice for thyroid associated orbitopathy. Orbital decompression surgery has been indicated in patients with compressive optic neuropathy, severe corneal exposure and cosmetic deformity due to proptosis. In this article, we have done a systematic review of the current published literature to have an outlook about the current concepts, diagnosis and management of thyroid-associated orbitopathy (TAO).