Subhash M. Betharia

Evaluation of polytetrafluoroethylene suture for frontalis suspension as compared to polybutylate-coated braided polyester

Purpose: To evaluate the efficacy of polytetrafluoroethylene (Gore‐Tex) suture as compared to polybutylate‐coated braided polyester (Ethibond) suture as sling materials for frontalis suspension in bilateral congenital ptosis.

Orbital and adnexal cysticercosis

Orbital and adnexal cysticercosis is emerging as a far commoner disease than previously considered, both in endemic and nonendemic areas of cysticercosis. A review of the literature on orbital and adnexal cysticercosis found that it has a predilection for children and young adults with no definite sex predilection. The extraocular muscle form is the commonest type of orbital and adnexal cysticercosis. Lodgement of cysts in the subconjunctival space is another common site, followed by the eyelid, optic nerve, retro‐orbital space and lacrimal gland. Association of orbital cysticercosis with systemic cysticercosis is quite rare. The clinical manifestations of orbital or adnexal cysticercosis are entirely different and depend on the location, size, relation to adjacent structures and stage of evolution of the cyst. Diagnosis of cysticercosis is based mainly on orbital imaging because of its highly specific appearance. Tissue diagnosis is not essential for initiating treatment. Medical therapy is the recommended treatment for the extraocular muscle form and retro‐orbital cysticer‐cosis. Surgical removal is advocated for subconjunctival and eyelid cysticercosis. Because of the limited number of cases of optic nerve and lacrimal gland cysticercosis, their treatment is controversial.

Pattern of orbital exenteration in a tertiary eye care centre in India

Purpose: This study aimed to determine the clinical indications for orbital exenteration, profile of these patients and clinicopathological correlations, and to compare these results with previous published data.

Simple Dacryops: A Case Series and Review of the Literature

In this prospective, small case series, 3 patients with simple dacryops were analyzed along with a review of literature. All 3 patients in this series had classical clinical features of simple dacryops. All of them underwent complete cyst removal with the aid of a cryoprobe. Histopathology was compatible with dacryops. In 2 of the 3 patients, the cyst revealed calcification, which to the best of our knowledge has not been reported. None of the patients developed a recurrence. In conclusion, simple dacryops is an easily recognized clinical entity. This entity has been infrequently reviewed in the older literature, and in the last decade only 6 cases have been reported. Most of the patients underwent complete excision of the cyst with no recurrences.

Pleomorphic adenomas of the lacrimal gland: a clinicopathological analysis

Purpose: To analyse retrospectively 32 cases of pleomorphic adenoma of the lacrimal gland diagnosed over a 10‐year period in a tertiary referral eye centre from North India.

Disseminated Hydatid Disease Involving Orbit, Spleen, Lung and Liver

Orbital hydatid disease is rare, even in endemic areas. We present a case of disseminated hydatid disease involving the orbit, spleen, lung and liver in a lady aged 35 years. Based on a typical clinical presentation, presence of eosinophilia, a positive indirect haemagglutination test for hydatid disease and presence of similar disseminated, anechoic cystic masses in the liver, lung, spleen and orbit on imaging studies, the diagnosis of hydatid cyst was seriously considered before surgery. Aspiration of the cyst, followed by cryo-extraction of the cyst wall through transconjunctival route was safely performed. Histopathological examination confirmed the diagnosis. In conclusion, multisystemic involvement of liver, lung and spleen in a case of orbital hydatid cyst has never been reported before. The surgical technique adopted in this case is safe and effective.

Inverse Bell's phenomenon observed following levator resection for blepharoptosis

BackgroundPtosis surgery is one of the more widely performed surgeries in ophthalmology. Preoperative lagophthalmos, Bells phenomenon, corneal sensation and dry eye are important factors to be assessed in these cases, which influence the functional and cosmetic results. We herein describe the interesting complication of transient inversion of Bells phenomenon observed following extensive levator resection performed for congenital ptosis.MethodsThree patients are described who underwent levator resection and showed an inversion of the Bells phenomenon in the postoperative period, with the eye going down instead of up, during eyelid closure.ResultsThe Bells phenomenon reverted to normal in all three cases within 2 weeks and there were no corneal complications. The patients were given frequent lubricating eye drops during this period.ConclusionsIt is important to look for variations in Bells phenomenon in all cases of congenital ptosis, especially following levator resection. In cases with a poor or ineffective Bells phenomenon, it is imperative to keep a close watch on the cornea along with copious lubrication during the early postoperative period.

The Fat Pad in Dermis Fat Grafts

BACKGROUND Dermis fat grafts are used in orbital reconstruction in a variety of procedures. However, there have been few controlled studies testing their effectiveness. This is a prospective study on 40 patients. METHODS Primary and secondary orbital dermis fat grafts were evaluated with regard to the long-term cosmetic results of two thicknesses, 10 and 20 mm, of fat pad, keeping all other parameters as constant as possible. Adequacy of the socket, lid anomalies; superior sulcus deformity, exophthalmometry, and motility of the prosthesis were assessed periodically. CONCLUSION There was a significantly lower incidence of enophthalmos and superior sulcus deformity with the use of a fat pad thickness of 20 mm, without any compromise in the motility of the prosthesis or take of the graft.

Primary orbital primitive neuroectodermal tumour with immunohistochemical and electron microscopic confirmation

Presentation of two cases of orbital primitive neuroectodermal tumour. Microscopically, the tumours consisted of poorly differentiated cells with dark, oval to irregular nuclei, prominent nucleoli, scant cytoplasm and numerous mitoses. The clinical picture, histopathology, electron microscopy and immunohistochemical findings of these cases are presented in this communication. Also, the histogenesis of such orbital neoplasms in relation to central nervous system is discussed.

Primary orbital plasmacytoma: A case report.

A 50-year-old man presented with a fungating growth in the left eye of 3 months duration. Biopsy of the mass followed by light microscopy was suggestive of plasmacytoma and the diagnosis was con- firmed by immunohistochemical stains, which demonstrated monoclonality to kappa light chains. Systemic investigations ruled out a multiple myeloma. The patient received radiotherapy; however, due to a residual mass, the left orbit had to be exenterated. Solitary plasmacytomas may not always be completely radiosensitive and radical surgery may be required in such cases. Immunohistochemical stains for kappa and lambda light chains can prove useful in confirming the diagnosis of suspected plasmacytomas.