Survival Analysis and Prognostic Factors for Peri-ocular Malignancies in Malaysia

@#Introduction: This study aims to determine the prognostic factors and survival outcomes of patients that underwent this surgery. Method: A retrospective review of 43 patients who underwent exenteration for periocular malignancies over a 14-year period was carried out. Patient demographics, tumour histology, treatment details, surgical margins’ status and post-operative survival were recorded. The survival outcome examined was the overall survival (OS) rate. Cox regression and Kaplan-Meier analysis were used to evaluate post-exenteration survival. Results: In total, 20 females and 23 males with a median age of 62 ± 17.3 years were identified. The most common indication for exenteration was basal cell carcinoma (20.9%), followed by squamous cell carcinoma (18.6%), adenocystic carcinoma (14%), malignant melanoma (14%) and sebaceous gland carcinoma (11.6%). The independent predictors for worse OS on multivariate analysis were Chinese ethnicity (adjusted hazard ratio [aHR] 4.95, p =0.017), sebaceous gland carcinoma (aHR 57.61 p=0.006), adenocystic carcinoma (aHR 45.87, p=0.008), clear surgical margins (aHR 5.41, p=0.025), receiving only chemotherapy (aHR 169.13, p=0.004), and receiving both adjuvant chemotherapy and radiotherapy (aHR 41.51, p=0.010). Conclusion: We recommend targeted public health initiatives for Chinese patients due to their increased mortality risk from peri-ocular malignancies. In addition, we advise comprehensive adjuvant therapy for all patients regardless of whether a clear surgical margin is achieved. Basal cell carcinoma and adenocystic carcinoma may also benefit from genetic research. We advocate more training for ophthalmologists to identify periocular malignancies earlier for better treatment options and increased chances of survival.

Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India

Purpose: The second wave of coronavirus disease 2019 (COVID?19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino?orbital?cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio?chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods: This retrospective, hospital?based study included all in?patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin?6 (IL?6), C?reactive protein (CRP), and D?dimer levels at presentation and outcome. Results: There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty?two (89.4%) had pre?existing diabetes, and five (10.6%) had steroid?induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL?6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL?6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion: Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL?6 levels are best associated with survival

Demographic and Clinical Profile of Patients Presenting with COVID-19-Associated Rhino-orbito-cerebral Mucormycosis at a Tertiary Care Center

Objectives?Individuals affected with rhino-orbito-cerebral mucormycosis (ROCM) associated with coronavirus disease 2019 (COVID-19) increased enormously in northern India during the second wave of the novel coronavirus disease. This study determined the demographic and clinical profile including the risk factors in patients presenting to a tertiary care hospital in northern India. Materials and Methods?This is a descriptive study involving patients admitted with COVID-19-associated ROCM and were managed from May 2021 to 20th July 2021. Statistical Analysis?The data was analyzed using SPSS (IBM SPSS Statistics 20, SPSS Inc., Chicago, Illinois, United States) software and Microsoft Excel (Version 16.49). The chi-squared and Fisher's exact tests were used to compare various outcomes. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results?One hundred and seventeen (117) patients (males: 70 [59.8%], females:47 [40.2%]) with the average age of 51.85?±?12.80 years presented with orbital involvement. Diabetes mellitus was noted in 100 (86.2%) patients. Of the available data from the records, oxygen supplementation for the management of COVID-19 was received by 37/108 (34.3%) patients for a median average duration of 11 days. Forty-eight patients of one-hundred-seventeen (60%) patients were treated with corticosteroids with a median duration of steroid administration being 10 days. The duration between onset of symptoms related to mucormycosis and diagnosis of COVID-19 was 0 to 75 days for 48 patients. Intravenous amphotericin B was administered in all cases. External sinonasal debridement was performed in 90 of 114 (78.9%) patients, retrobulbar amphotericin B injection was administered in 56 of 117 (47.9%), and orbital exenteration was performed in 17 of 117 (14.5%) of cases. Conclusion?Administration of corticosteroids and diabetes mellitus seem to be the major underlying causes for the development of COVID-19-associated ROCM. Prompt diagnosis and multidisciplinary management approach are essential for a reduction in mortality.

Treatment Strategies of Orbit in Sinonasal Malignancy Patients with Orbital Invasion / 肿瘤防治研究

Due to the paranasal sinuses adjacent to the orbit, the sinonasal malignancy is prone to invade the orbit, which is not only the advanced stage of the tumor, but also one of the poor prognostic factors. Preoperative CT and MRI scan and intraoperative frozen section analysis are used to evaluate the orbital invasion of the tumor. Orbital preservation is adopted if the periorbita is not transgressed by tumor. Orbital preservation can be considered if the tumor invades the periorbita and extraconal fat in a limited range, responds well to neoadjuvant chemotherapy, radiotherapy or other multimodality treatment, or has a negative section margin. Orbital exenteration is performed if the tumor extensively invades the periorbita, and invades the extraocular muscle, eyeball and orbital apex. Whether orbital preservation or orbital exenteration is adopted, it should be evaluated and made decision by a multidisciplinary team, and fully communicate with the patient.

Prosthetic Rehabilitation Technique with an Economical Customized Orbital Prosthesis

@#Post-surgical orbital defects pose a severe effect on patient, psychologically and physically, especially in the eventual return to the society and daily routine. In cases where reconstructive surgery is not possible, prosthetic rehabilitation is crucial in addressing this issue. Implant-supported orbital prosthesis provides superior retention, however, it is not economically acceptable for some cases. Various modes of retention are available to cater to each patient’s diagnosis, treatment need and economical status. This article describes the procedures in the construction of a customized silicone orbital prosthesis using adhesive and spectacles for retention. This technique is cost-effective and simple while providing comfort and satisfaction for the patient.

Rehabilitation of an Orbital Defect with Silicone Orbital Prosthesis: A Case Report

Introduction: Loss of eye, apart from impaired vision has adetrimental effect on psychosocial wellbeing of an individual.The replacement of the lost eye as soon as possible after thesurgery is necessary to improve social acceptance and qualityof life. Multidisciplinary management and team approachbetween surgeon and prosthodontist are essential in providingaccurate and effective rehabilitation and follow-up care for thepatient.Case report: This case report describes a simplified methodfor the fabrication of a custom silicone orbital prosthesisretained with spectacles for rehabilitation of a residual defectpost exenteration of left eye. It highlights the importance ofindepth analysis & comparison of the defect with the normalcontralateral eye which was used as an anatomical guide forfabrication of an aesthetic prosthesis.Conclusion: Advanced digital technology like rapidprototyping and CAD/CAM have made fabrication ofcomplex prosthesis like orbital prosthesis simpler andquicker. However, these contemporary methods are techniquesensitive, equipment dependent and may not be availableeasily. Thus, a maxillofacial prosthodontist should be able toread the available anatomical guides and use them to fabricatean aesthetically acceptable prosthesis using conventionaltechnique to rehabilitate patients and improving quality of lifeas soon as possible.

Tratamiento quirúrgico en las etapas de desarrollo del carcinoma ocular de células escamosas en bovinos del trópico alto del departamento de Nariño / Surgical treatment in the development stages of bovine ocular squamous cell carcinoma in the high tropic of Nariño department / Tratamento cirúrgico nas fases de desenvolvimento do carcinoma ocular de células escamosas em bovinos dos trópicos superiores do departamento de Nariño

Resumen El carcinoma ocular de células escamosas (COCE) es una de las neoplasias oculares más común en bovinos. Este estudio evaluó el tratamiento quirúrgico en los estadios 1, 2, 3 y 4. La ubicación del COCE fue en el limbo esclerocórneal, párpados, córnea y en la membrana nictitante. Para cada caso clínico se realizó una técnica de bloqueo y quirúrgica. En todos los casos se administró una dosis de sedación que mantuviera el animal en pie, utilizando Xilazina 2%, dosis de 0,015- 0,03 mg/kg IV en vena coccígea. En los casos de COCE en tercer párpado se bloqueó el nervio auriculopalpebral, zigomático e intratroclear, en casos de párpados y conjuntiva dependiendo del sitio se bloqueaba determinado nervio. Para la exenteración orbital, se bloqueó con los cuatro puntos y el retrobulbar administrando 10-15 cc de lidocaína al 2%. En casos de COCE en la cuarta etapa donde está involucrado el globo ocular y tejidos adyacentes, se realizó exenteración orbital. En cárcinoma de la membrana nictitante, se realizó la resección de esta en su totalidad, en la córnea, se realizó una queratectomia superficial y en el párpado inferior, la blefaroplastia. Se intervinieron quirúrgicamente 25 vacas, de raza Holstein, Normando, Holstein x Simental y Montbeliarde. La membrana nictitante fue extirpada en 14 casos, exenteración orbital en 9, queratectomía superficial y blefaroplastia en el párpado inferior en un solo caso, respectivamente. Se presentó recidiva en dos casos las cuales fueron descartadas. El tratamiento quirúrgico temprano ayuda como control del COCE permitiendo que los animales sigan en el hato durante su vida productiva.

Abstract Squamous ocular cell ocular carcinoma (SOCC) is one of the most common and important ocular neoplasms of frequent occurrence in cattle. The objec- tive of the work was to evaluate the surgical treatment in stages 1, 2, 3 and 4. Four presentations of the SOCC were evidenced; in the sclerocórneal limb, eyelids, córnea and in the nictitating membrane. For each clinical case, a blocking and surgical technique was performed. In all cases, a sedation dose was administered to keep the animal standing, using 2% Xylazine, a dose of 0.015-0.03 mg/kg IV in the coccygeal vein. In cases of SOCC in the third eye- lid, the atriopalpebral, zygomatic and intratrochlear nerves were blocked, in cases of eyelids and conjunctiva depending on the site, the correspon- ding nerve was blocked. For orbital exenteration, in addition to the blockage of the four points, it is anesthetized behind the eyeball with the retrobulbar technique, administering 10-15 cc of 2% lidocaine. In cases of SOCC in the fourth stage where the eyeball and adjacent tissues are involved, orbital exenteration was performed. The carcinoma on the nictitating membrane, resection was performed, in the córnea, a superficial keratectomy and in the lower eyelid, a blepharoplasty. Twenty-five cows, Holstein, Normando, Holstein x Simental and Montbeliarde were surgically treated. The nictitating membrane was removed in 14 cases, orbital exenteration in nine, superficial keratectomy and blepharoplasty in inferior eyelid in a single case respectively. Recurrence occurred in two cases that were culled. Early surgical treatment helps control SOCC allowing animals to remain in the herd during their pro- ductive life.

Resumo O carcinoma ocular de células escamosas (COCE) é uma das neoplasias oculares mais comuns em bovinos. Este estuq<<do avaliou o tratamento cirúrgico nos estágios 1, 2, 3 e 4. A localização do COCE foi no limbo esclerocórneal, pálpebras, córnea e na membrana nictitante. Para cada caso clínico, foi realizada uma técnica de bloqueio e cirúrgica. Em todos os casos, foi administrada uma dose de sedação para manter o animal em pé, usando Xilazina a 2%, uma dose de 0,015-0,03 mg/kg IV na veia coccígea. Nos casos de COCE na terceira pálpebra, o nervo atriopalpebral, zigomático e intratroclear foi bloqueado; nos casos de pálpebras e conjuntiva, dependendo do local, um determinado nervo foi bloqueado. Para exenteração orbital, foi bloqueado com os quatro pontos e o retrobulbar, administrando 10-15 cc de lidocaína a 2%. Nos casos de COCE no quarto estágio em que o globo ocular e os teci- dos adjacentes estão envolvidos, foi realizada exenteração orbital. No carcinoma da membrana nictitante, foi realizada ressecção do todo; na córnea, foi realizada uma ceratectomia superficial e, na pálpebra inferior, blefaroplastia. Vinte e cinco vacas, Holstein, Normando, Holstein x Simental e Montbeliarde foram operadas cirurgicamente. A membrana nictitante foi removida em 14 casos, exenteração orbital em 9, ceratectomia superficial e blefaroplastia na pálpebra inferior em um único caso, respectivamente. A recorrência ocorreu em dois casos que foram descartados. O tratamento cirúrgico precoce ajuda a controlar o COCE, permitindo que os animais permaneçam no rebanho durante sua vida produtiva.

Rehabilitation of Exenterated Right Eye: A Prosthetic Challenge

Background: Facial defects can be acquired or congenital, but irrespective of etiology, any maxillofacial structure if damaged or missing will result in an unaesthetic and unappealing personality of individual. Orbital defects are very evident and effect the appearance and social front of the individual. Many modalities are available to rehabilitate the defect of an orbit but prosthetic rehabilitation with silicone prosthesis is a simple and effective approach. Retention is generally achieved by engaging available undercuts or using mechanical accessories or skin adhesives etc. This case report describes successful rehabilitation of right orbital defect using a non-surgical approach with room temperature vulcanized silicone and skin adhesives. Case Report: A 45 yr old male reported with, chief complaint of missing right orbit and unaesthetic appearance secondary to gunshot wound. Patient was not ready for any more surgical procedures or additional accessories and available retentive undercuts were minimal. Hence, conventional silicone prosthesis was made using stock eye shell and room temperature vulcanized silicone retained with skin adhesives. The approach was simple to a complex problem and gave reliable result in very limited time. Conclusion: With extensive orbital defect, rehabilitation is difficult and complex as retention is compromised and it is difficult to match the shade of the prosthesis.This case represents a simple and predictable approach to a case of exenterated right orbit with conventional roomtemperature vulcanized silicone and silicone skin adhesives.

Prosthetic Rehabilitation of an Orbital Defect Using Computer Aided Designing and Rapid Prototyping

Introduction: The conventional methods of fabrication oforbital prosthesis by facial moulage fabrication and handsculpting are time consuming, error-prone and very muchsubjective in terms of quality. Prosthesis development usingcontemporary technologies like computer aided designing andrapid prototyping is simple, cost effective and also improvesproductivity ensuring enhancement of the technical quality ofcare.Case report: The present case report describes rehabilitationof a patient of left anophthalmic residual defect with a custommade silicone orbital prosthesis retained with spectacle,developed with the help of computer aided designing andrapid prototyping technology.Conclusion: Consistent good quality prosthesis may beobtained using advanced digital technologies that includeoptical scanning, computer-aided designing and rapidprototyping which are more objective in nature.

Características clínicas y patológicas de los tumores orbitarios / Clinical and pathological characteristics of orbital tumors

Objetivo: describir las características clínico-patológicas de los tumores orbitarios. Métodos: se realizó un estudio descriptivo y retrospectivo de serie de casos en el Instituto de Oncología y Radiobiología desde enero del año 2011 a diciembre de 2017. La muestra se conformó con 241 pacientes sometidos a cirugía de la órbita y fue caracterizada según la edad, el sexo, el origen y la naturaleza de la lesión, el diagnóstico histopatológico y los abordajes quirúrgicos utilizados. Resultados: el 52,7 por ciento de la muestra estudiada fue del sexo masculino; el 36,5 por ciento se encontró en el grupo de 60 a 79 años. El 62,7 por ciento de los casos correspondió a tumores malignos, el 51,9 por ciento a lesiones primarias de la órbita y el 26,6 por ciento a linfoma No Hodgkin. Las lesiones secundarias originadas en los párpados representaron el 58,7 por ciento y el carcinoma epidermoide el 56,5 por ciento. Hubo 11 casos correspondientes a metástasis; las de mama representaron el 72,7 por ciento. El abordaje anterior transpalpebral fue utilizado en el 54,8 por ciento de los casos. Conclusiones: los tumores orbitarios se presentan con mayor frecuencia a partir de los 40 años de edad y con predominio del sexo masculino. Las lesiones malignas son más frecuentes, así como las primarias de la órbita, donde el linfoma No Hodgkin representa el mayor número de casos. Los párpados son la principal estructura de origen de las lesiones secundarias, y el carcinoma epidermoide es la variedad histopatológica predominante. Las metástasis de mama son las que más afectan el espacio orbitario. La vía de abordaje fundamental es la anterior transpalpebral (transeptal), seguido de la exenteración orbitaria(AU)

Objective: describe the clinicopathological characteristics of orbital tumors. Methods: a retrospective descriptive case-series study was conducted at the National Institute of Oncology and Radiobiology from January 2011 to December 2017. A sample of 241 patients undergoing orbital surgery was characterized according to age, sex, origin and type of lesion, histopathological diagnosis and surgical procedures used. Results: 52.7 percent of the study sample was male and 36.5 percent was in the 60-79 age group. 62.7 percent of the cases were malignant tumors, 51.9 percent were primary orbital lesions, and 26.6 percent were non-Hodgkin lymphomas. Secondary lesions originating in the eyelids represented 58.7 percent, and epidermoid carcinomas 56.5 percent. Eleven cases were metastases, 72.7 percent were of the breast type. The anterior transpalpebral approach was used in 54.8 percent of the cases. Conclusions: orbital tumors are more common as of age 40 with a predominance of the male sex. Malignant lesions are more frequent, as well as primary orbital lesions, of which the largest number of cases are non-Hodgkin lymphomas. The eyelids are the main structure of origin of secondary lesions, and epidermoid carcinoma is the prevailing histopathological variety. Breast metastases are the type most commonly affecting the orbital area. The main approach is anterior transpalpebral (transeptal), followed by orbital exenteration(AU)

Exenteración orbitaria: experiencia de seis años / Orbital exenteration: six years of experience

Objetivo: describir las características clínico-patológicas y los resultados obtenidos en pacientes sometidos a exenteración orbitaria. Métodos: se realizó un estudio descriptivo, retrospectivo, de serie de casos, en el Instituto de Oncología y Radiobiología, desde enero del año 2011 a diciembre de 2016. La muestra se conformó con 71 pacientes exenterados y fue caracterizada según la edad, el sexo, el origen de la lesión, el diagnóstico histopatológico, los tratamientos previos, el tipo de exenteración orbitaria, el estado de los bordes de la sección quirúrgica, los tratamientos adyuvantes, los abordajes quirúrgicos asociados, la reconstrucción de la cavidad y las complicaciones posoperatorias. Resultados: el 67,6 por ciento de la muestra estudiada fue del sexo masculino. El 43,7 por ciento se encontró en el grupo de 60 a 79 años de edad; en el 38 por ciento de los pacientes la lesión primaria estuvo localizada en los párpados y en el 56,3 por ciento el diagnóstico histopatológico fue el carcinoma epidermoide. El 100 por ciento de la muestra había recibido algún tipo de tratamiento médico previo. Al 69 por ciento de la muestra se le realizó exenteración orbitaria tipo III, y solo en el 15,5 por ciento se reportaron bordes de la sección quirúrgica positivos. El 29,6 por ciento recibió tratamiento adyuvante con radioterapia. Se necesitó la combinación con otros abordajes quirúrgicos en el 28,2 por ciento de los pacientes y en el 69 por ciento se permitió la cicatrización espontánea de la cavidad orbitaria. La fístula senorbital fue la complicación más frecuente, con el 8,5 por ciento. Conclusiones: el carcinoma epidermoide es el tumor periocular que con mayor frecuencia invade la órbita. En la mayoría de los casos exenterados se logra la resección total del tumor con complicaciones posoperatorias mínimas(AU)

Objective: to describe the clinical and pathological characteristics and the results obtained in patients undergoing orbital exenteration. Methods: a descriptive, case series and retrospective study was carried out at the Institute of Oncology and Radiobiology from January 2011 to December 2016. The sample of 71 exenterated patients was characterized according to age, sex, origin of the lesion, histopathological diagnosis, previous treatments, type of orbital exenteration, state of the surgical section edges, adjuvant treatments, associated surgical approaches, reconstruction of the cavity and postoperative complications. Results: in this sample, 67.6 percent of the studied sample were men, 43.7 % were in the 60-79 age group; the primary lesion of 38 percent was located in the eyelids and and the histopathological diagnosis in 56.3 percent of patients was squamous cell carcinoma. One hundred percent of the sample had received some type of previous medical treatment, 69 percent of the sample underwent type III orbital exenteration, and only in 15.5 percent, the surgical section edges were reported as positive. Also, 29.6 percent received adjuvant treatment with radiotherapy. The combination with other surgical approaches was required in 28.2 percent of patients and percent spontaneous healing of the orbital cavity was allowed in 69 percent. The sino-orbital fistula was the most frequent complication (8.5 percent). Conclusions: squamous cell carcinoma is the periocular tumor that most frequently invades the orbit. Most exenterated cases managed to achieve total resection of the tumor with minimal postoperative complications(AU)

Prosthetic Rehabilitation of Patient With Subtotal Maxillectomy And Orbital Exenteration.

Orbital exenteration presents a unique challenge to the maxillofacial prosthodontist. Prosthetic rehabilitation of the orbit is often complicated by the extent of resection, tissue response and the method of retention. Loss of an eye due to trauma or disease resulting in facial defect has a crippling effect on patients psychology. The placement of good prosthesis serves as a great psychological, social and cosmetic benefit in rehabilitation of the patient. The article discusses the prosthetic rehabilitation in an elderly male patient with orbital defect.

A Case of Orbital Abscess following Porous Orbital Implant Infection

PURPOSE: We present a case of orbital abscess following porous orbital implant infection in a 73-year-old woman with rheumatoid arthritis. METHODS: Just one month after a seemingly uncomplicated enucleation and porous polyethylene (Medpor(R)) orbital implant surgery, implant exposure developed with profuse pus discharge. The patient was unresponsive to implant removal and MRI confirmed the presence of an orbital pus pocket. Despite extirpation of the four rectus muscles, inflammatory granulation debridement and abscess drainage, another new pus pocket developed. RESULTS: After partial orbital exenteration, the wound finally healed well without any additional abscess formation. CONCLUSIONS: A patient who has risk factors for delayed wound healing must be examined thoroughly and extreme care such as exenteration must be taken if there is persistent infection.

Orbital Exenteration in Sinonasal Tumor: Surgical Outcome and Rehabilitation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The decision whether or not to preserve orbital contents during surgical resection of malignant tumors involving the sinonasal tract and the orbit has been an issue of controversy. The purpose of this study is to review our outcomes of the orbital exenteration and rehabilitations, and to present the usefulness of orbital rehabilitations. SUBJECTS AND METHOD: A retrospective analysis was done for 10 patients who underwent orbital exenteration between Feb 1995 and Apr 2003. RESULTS: The age of patients ranged from 23 to 71 years (mean 49.7 years), and the male: female ratio was 1: 1. The follow-up period after orbital exenteration ranged from 3 to 108 months (mean 33.2 months). Rhabdomyosarcoma and squamous cell carcinoma represented the largest group (three patients respectively). Maxillary sinus was the most common primary site (five patients). Local sinonasal recurrence was noted in two patients, and distant metastasis was observed in one patient. Six patients have survived for more than 20 months. No orbital rehabilitation and reconstruction was done in six patients, silicone orbital prosthesis in two patients, artificial eye in one patient, and free flap in two patients. All patients who had orbital rehabilitation showed great satisfaction. CONCLUSION: Rhabdomyosarcoma and squamous cell carcinoma were the two most common malignancy requiring orbital exenteration. More than half of the patients have survived for 20 months or longer. Rehabilitation such as ocular prosthesis can be considered for better cosmetic appearances.

Orbital Reconstruction with Free Flaps after Orbital Exenteration

PURPOSE: To report the results of the orbital reconstruction with microvascular free flap following orbital exenteration in patients with orbital malignancy. METHODS: We performed microvascular free-tissue reconstruction for extensive orbital defects immediately after exenteration in 6 patients. RESULTS: The causes for exenteration were adenocystic carcinoma of the lacrimal gland (2), squamous cell carcinoma of the upper eyelid (1), the nasolacrimal duct (1), maxillary sinus (1), and the ethmoid sinus (1). The extensive orbital defects were reconstructed with the rectus abdominis flaps in 3 patients, with the radial forearm flaps in two, and with the scapular flap in one patient. There was no flap loss. There was no donor site complication. CONCLUSIONS: Microvascular free-tissue transfer allowed successful facial reconstruction in patients with extensive orbital and periorbital defects. It seemed to permit reliable, expeditious, one-stage reconstruction of the orbital defects.

A Case Report of Simplified Cosmetical Correction of Post-Exenterated State

Orbital exenteration has been used as a corrective method to treat lifetreatening neoplasm, life-threatening infection, and pain or deformity. After orbital exenteration, patients have been left with a severely disfiguring facial defect. Nowadays postoperative adjustment is usually better than before, with improved surgical and prosthesis manufacturing techniques. Actually Korean ophthalmologists do not have chances of adequate ocular prosthesis support compared to the other foreign countries. Authors experienced satisfying cosmetic result using a photography glasses frame for the pos-exenterated patient who had a squamous cell carcinoma of the orbit. We report this first case in Korea with review of the literatures.

A Case of the Orbital Aspergillosis

Aspergillus is also a saprophytic, ubiquitous fungus that is normally not pathogenic in humans. When it does appear as a source of infection, the rhinoorbital route of entry seemes to parallel that of the Phacomycetes. We experienced a case of orbital aspergillosis in healthy woman. There was no intracraneal extension. In spite of local infiltration of amphotericin B solution through maxillary sinus and aggressive systemic amphotericin B therapy, ocular symptom and sign was not improved. So we performed orbital exenteration and adjunctive amphotericin B and itraconazol systemically. Six months later the patient is alive without recurrence. We reviewed the available literatures regarding this uncommon disease.

A Case of Orbital Rhabdomyoma Removed by Subtotal Orbital Exenteration with Preservation of Conjunctiva, Cornea and Sclera

Orbital rhabdomyoma is an exceedingly rare, benign, slow growing tumor of mature myofibers. The authors experienced a case of orbital rhabdomyoma in three-year old female who had limitation of eyeball movement with marked proptosis of the left eye. The subtotal orbital exenteration with preservation of lid, conjunctiva, cornea, and sclera through lateral orbitotomy was performed. The removed tumor was consisted of many irregularly shaped fragments of grayish tan soft tissue, me as uring 0.7 X 1.8 X 1.0 cm in size. Pathologically it was proved as orbital rhabdomoma as seen in adult. Postoperatively the conjunctival sac was well preserved and artificial eye could be successfully fitted.