Yuval A Gelfand

Surgical Outcome of Transconjunctival Cryosurgical Extraction of Orbital Cavernous Hemangioma

BACKGROUND AND OBJECTIVE Transconjunctival cryosurgical extraction (TCE) is not an accepted method for the removal of most intraorbital tumors, and thus is not routinely performed. This study evaluates TCE for orbital cavernous hemangioma (OCH), which, due to its specific vascular structure, is suitable for this technique. PATIENTS AND METHODS In this retrospective case series, the medical charts of 12 consecutive patients with OCH who underwent TCE were reviewed. The operative complications and the surgical outcome were analyzed. RESULTS Eleven tumors were intraconal and 1 was extraconal. No tumor involved the orbital apex. In 10 patients (83%), the operation was uneventful. One patient lost vision due to intraoperative cilioretinal arterial occlusion. In another patient, the tumor could not be identified and was subsequently removed via lateral orbitotomy. CONCLUSION TCE, a relatively minor operation, is as safe as more extensive surgical procedures for the removal of OCH not located in the posterior third of the orbital space.

Visual disturbances and pathologic ocular findings in primary antiphospholipid syndrome.

OBJECTIVE To delineate the features and prevalence of the systemic and ophthalmic involvement of primary antiphospholipid syndrome (PAS). DESIGN Prospective case series. PARTICIPANTS A total of 39 consecutive patients with PAS. METHODS During an 18-month period, the medical records of all patients with PAS who attended a clinic for thrombosis and hemostasis were reviewed on arrival. The patients were then referred to a retinal clinic and examined prospectively. The first 20 consecutive patients underwent retinal fluoroangiography. MAIN OUTCOME MEASURES The prevalence of the various organs affected by the disease was noted in the group, as well as the prevalence and type of ophthalmic involvement. RESULTS The most common forms of systemic involvement were fetal loss in 11 female patients (46%), central nervous system involvement in 17 patients (44%), and venous thrombosis in 16 patients (41%). Ophthalmic findings were as follows: 13 patients (33%) were symptomatic, and 12 of them complained of visual disturbances. In 10 (83%) of these 12 patients, the visual symptoms were transient, and 7 of them were nonocular in nature. Pathologic signs on ophthalmic examination were found in 5 of the 39 patients (13%), two of whom had intraocular pathologic findings related to PAS, and these were in the form of mild retinopathy. Of the 36 patients who were either asymptomatic or had transient visual disturbances, pathologic ocular findings were detected in only 2 (6%). Routine retinal fluoroangiography did not reveal any additional information that could not otherwise have been detected by funduscopy. CONCLUSIONS Ocular involvement in PAS is uncommon. Transient visual disturbances are common, although most of them are related to central nervous system rather than ocular ischemia. Pathologic ophthalmic findings are unlikely to be found in asymptomatic patients or in patients with transient visual disturbances. Routine retinal fluoroangiography performed on patients with PAS is unproductive.

Multiple retinal arteriolar occlusions associated with coexisting primary antiphospholipid syndrome and factor V Leiden mutation

PURPOSE To investigate a case of a young woman with both primary antiphospholipid syndrome and factor V Leiden mutation who developed multiple retinal arteriolar occlusions. METHOD Case report of a 25-year-old woman with history and laboratory tests confirming the diagnosis of both primary antiphospholipid syndrome and factor V Leiden mutation who presented with blurred vision in both eyes. RESULTS Multiple retinal arteriolar occlusions were observed in both of her eyes. The patient was treated first with heparin and then with warfarin. CONCLUSIONS Primary antiphospholipid syndrome and factor V Leiden mutation, as well as other forms of thrombophilia, should be considered in the differential diagnosis of unexplained retinal vascular occlusions. The coexistence of several thrombophilic disorders may carry a particularly high risk for thrombotic manifestations.

The Application of the Macular Photocoagulation Study Eligibility Criteria for Laser Treatment in Age-Related Macular Degeneration

BACKGROUND AND OBJECTIVE To analyze the application of the Macular Photocoagulation Study eligibility criteria for laser photocoagulation of choroidal neovascularization, in view of the expansion of these criteria in recent years. PATIENTS AND METHODS The authors prospectively analyzed 50 eyes of 47 consecutive patients with exudative age-related macular degeneration (AMD) to determine their suitability for treatment. RESULTS Fifteen eyes (30%) were found to be suitable for laser photocoagulation. Patients eligible for treatment were more likely to have experienced visual symptoms for a months or less (P = .006), to have a visual acuity of 20/200 or better (P = .009), and to be younger in age (P = .02). Visual symptoms experienced for a month or less were more prevalent in extrafoveal exudative lesions compared with the subfoveal type (P = .01) CONCLUSIONS Despite recent advances, laser photocoagulation still can be applied only to a minority of the patients with neovascular AMD. Prompt ocular examination following the onset of visual symptoms is essential.

Nd:YAG laser treatment for premacular hemorrhage.

The authors describe two cases of premacular hemorrhage secondary to retinal macroaneurysm, with significant loss of vision. A few low-energy bursts of ND:YAG laser were applied to perforate the anterior surface of the hemorrhage, subsequently draining the blood into the vitreous cavity. The blood gradually cleared from the vitreous, with restoration of good vision. Nd:YAG laser seems to be a safe and efficient method for treating premacular hemorrhage and should be considered as a therapeutic option.

Cryoextraction of orbital capillary hemangioma diagnosed by technetium-99m-labeled red blood cell scintigraphy.

The authors report a case of an infant in whom orbital capillary hemangioma was diagnosed using technetium-99m-labeled red blood cell scintigraphy. The tumor was subsequently removed by transconjunctival cryoextraction.