Orbital mucosa-associated lymphoid tissue (MALT) lymphoma as the initial presentation in patients with hepatitis C virus infection

ABSTRACT Hepatitis C virus infection may be implicated in 12.7% of ocular adnexal marginal zone lymphomas. We present the first case of an orbital-systemic mucosa-associated lymphoid tissue lymphoma that responded to hepatitis C virus medical treatment. A 62-year-old male with a right-sided orbital mass was diagnosed with stage IIA orbital marginal zone lymphoma in addition to hepatitis C virus infection based on clinical, imaging, laboratory, and histological examinations. The systemic and orbital responses were achieved 1 year after undergoing hepatitis C virus treatment with glecaprevir/pibrentasvir. The association between the hepatitis C virus infection and orbital-systemic mucosa-associated lymphoid tissue lymphoma is relevant. Accordingly, patients with orbital mucosa-associated lymphoid tissue lymphoma should be assessed for hepatitis C virus seroreactivity for therapeutic and prognostic purposes.

Guidelines for the operation of imaging equipment in orbital diseases(2024) / 国际眼科杂志(Guoji Yanke Zazhi)

Orbital disorders include conditions originating from the orbital bones, surrounding tissues, and post-orbital septum. They also include systemic ailments affecting the orbit. Different clinical symptoms make up the complex range of orbital disorders. Because these disorders mostly impact the orbital area instead of the intraocular compartment, there is little diagnostic usefulness for typical ophthalmic visual tests. As such, the primary instruments for diagnosing and evaluating orbital illnesses have become ophthalmic imaging modalities, including ocular ultrasonography(B-scan), computed tomography(CT), and magnetic resonance imaging(MRI). One way to improve the precision and promptness of diagnosing orbital diseases is to standardize the functioning of widely used imaging equipment and define the radiological features of orbital abnormalities. Such programs are crucial for the care of patients with orbital disorders since they considerably reduce the number of misdiagnoses and missed diagnoses in these individuals. The underlying concepts, operational techniques, and normal and pathological imaging findings associated with common diagnostic tools for orbital illnesses are all thoroughly reviewed in this guideline. The objective is to improve primary healthcare settings' diagnostic competence in the field of orbital pathology and to standardize procedures for diagnosing orbital disorders.

Research progress of finite element method in the biomechanics of the orbit / 国际眼科杂志(Guoji Yanke Zazhi)

The finite element method(FEM)is a widely employed mathematical technique in mechanical research that divides an object into discrete and interacting finite elements. Medically, finite element analysis(FEA)enables the simulation of biomechanical experiments that are challenging to conduct. Orbital surgery poses significant challenges to ophthalmologists due to its inherent difficulty and steep learning curve. FEM enables the simulation and analysis of the mechanical properties of orbital tissue, offering a novel approach for diagnosing and treating orbital-related diseases. With technological advancements, FEM has significantly matured in the diagnosis and treatment of orbital diseases, becoming a popular area of research in orbital biomechanics. This paper reviewed the latest advancements in orbital FEM, encompassing the development of orbital FEA models, simulation of orbital structure, and its application in orbital-related diseases. Additionally, the limitations of FEM and future research directions are also discussed. As a digital tool for auxiliary diagnosis and treatment, orbital FEA will progressively unlock its potential for diagnosing and treating orbital diseases alongside technological advancements.

Analysis of clinical histopathological composition of 699 cases with orbital tumors and tumor-like lesions / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical and histopathological composition of orbital tumors and tumor-like lesions.METHODS: Retrospective case-series study. The clinical histopathological data of 699 cases(707 eyes)with orbital tumor and tumor-like lesions who treated in the orbital disease and ophthalmic plastic department of Tianjin Eye Hospital between January 2010 and December 2020 were collected. All the pathology diagnosis results were divided into three categories which were benign tumor, borderline tumor and malignant tumor according to the eighth edition of the American Joint Committee on Cancer staging system and the 2018 World Health Organization Classification of tumors of the eye. All cases were divided into four groups according to age, including 0～17 years old, 18～39 years old, 40～59 years old, 60 years and above. The histological composition of each group was analyzed.RESULTS: Among the 699 cases(707 eyes), 311 patients(316 eyes)were male and 388 patients(391 eyes)were female. The patient's age at diagnosis ranged from 1 to 84 years(mean 39.9±2.2)years. The right orbit was involved in 307 patients, the left orbit in 384 patients, and 8 patients in bilateral orbit. There were 598 patients(604 eyes, 85.6%)with benign tumor and tumor-like lesions, 7 patients(7 eyes, 1.0%)with borderline tumor, and 94 patients(96 eyes, 13.4%)with malignant tumors. The top 5 benign tumor and tumor-like lesions were cavernous hemangioma(110 cases, 15.7%), dermoid cysts(96 cases, 13.7%), pleomorphic adenomas(54 cases, 7.7%), inflammatory pseudotumors(38 cases, 5.4%), and schwannomas(29 cases, 4.1%)respectively. The top 5 borderline and malignant tumors were non-Hodgkin lymphomas(42 cases, 41.6%), solitary fibrous tumors(12 cases, 11.9%), adenoid cystic carcinomas(11 cases, 10.9%), metastatic tumor(9 cases, 8.9%), and rhabdomyosarcoma(8 cases, 7.9%), respectively. Among the common orbital benign tumors and tumor-like lesions, cavernous hemangioma and pleomorphic adenoma showed a female predominance. Among the common borderline and malignant tumors, non-Hodgkin lymphoma and mesenchymal chondrosarcoma showed a male predominance. The most common benign and malignant tumors were dermoid cysts, rhabdomyosarcomas respectively in group under 18 years old. And dermoid cysts and solitary fibrous tumors were the most common benign and malignant tumors respectively in patients between 18 and 39 years old. Cavernous hemangioma and non-Hodgkin lymphomas were the most common benign and malignant tumors respectively in patients between 40 and 59 years old. While cavernous hemangioma and non-Hodgkin lymphomas were the most common benign and malignant tumors respectively in cases over 60 years old.CONCLUSION: Most orbital tumors and tumor-like lesions are benign. The most common benign orbital tumor is cavernous hemangioma, followed by dermoid cyst. Non-Hodgkin lymphoma is the most common malignant orbital tumor.

A case of permanent vision loss due to a carotidcavernous fistula: importance of early diagnosis / Relato de caso de perda visual secundária a fístuda carótido-cavernosa: a importância de um diagnóstico adequado

ABSTRACT A 97-year-old female presented with spontaneous acute-onset palpebral hyperemia and edema of the right eye that had progressively worsen over the previous three days. These signs did not suggest possible carotid-cavernous fistula until a second examination 72 h later, during which the patient exhibited significant progression. Despite embolization, the patient exhibited sustained corneal edema, clots, and turbidity in the aqueous humor, which resulted in permanent visual loss. A greater level of clinical suspicion for possible carotid-cavernous fistula is warranted on initial presentation of palpebral hyperemia and edema to prevent possible irreversible vision loss.

RESUMO O objetivo deste relato é apresentar o caso de uma paciente de 97 anos com início agudo e espontâneo de hiperemia e edema palpebral. Estes sinais não levaram a uma suspeita diagnóstica de fístula carótido-cavernosa até um segundo momento, quando a paciente apresentou progressão importante do quadro clínico. Apesar da realização de tratamento efetivo com embolização da fístula, a paciente manteve alterações oculares como edema de córnea, coágulos e turvação no humor aquoso, e manteve perda visual definitiva.

Analysis of the spectrum of orbital diseases and diagnosis and treatment experiences in large general hospital outpatient service / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the changes of disease spectrum and characteristics of orbital disease distribution in orbital outpatients, introduce the procedures and methods of diagnosis and treatment of orbital diseases in our hospital and define the work focus and social needs in orbital disease. METHODS: Prospective observational study. A registration form was designed to record the gender, age and diagnosis of orbital outpatients in our treatment group. The orbital diseases were divided into seven categories for statistical analysis. The composition ratio, male to female ratio, age of onset, subtypes of dominant diseases and the top three common diseases were analyzed. This paper introduces the diagnosis and treatment process of the orbital disease specialty clinic of our hospital.RESULTS: A total of 1 059 patients with orbital diseases were registered from April 1 to December 31, 2021. The most common orbital diseases were thyroid-related ophthalmopathy(TAO)in 325 cases(30.7%), followed by orbital tumors in 282 cases(26.6%), orbital trauma in 213 cases(20.1%), orbital inflammation in 205 cases(19.4%). Orbital vascular malformation, congenital and genetic venereal diseases and other orbital diseases were 34 cases(3.2%). Pathological diagnosis: orbital tumors in 150 cases(72.8%)were benign, the first three benign tumors were hemolymphangioma, orbital cyst and neurogenic tumor. Orbital tumors in 56 cases were malignant(27.2%), the first three malignant tumors were orbital lymphoma, adenoid cystic carcinoma of the lacrimal gland and rhabdomyosarcoma. The most common orbital injury was orbital blowout fracture, followed by optic nerve injury and orbital soft tissue injury. Orbital non-infectious inflammation accounted for 89.8% and 10.2% with infectious inflammation.CONCLUSION: The spectrum of orbital diseases has changed, and the most common and dominant diseases are TAO, orbital tumor, orbital trauma and orbital inflammation, accounting for 96.8% of the total, which are the main work content in orbital profession. Medical resources of orbital diseases should be rationally allocated according to the changes of disease spectrum to meet the needs of social development.

Superior oblique myositis mimics a subperiosteal abscess in a patient with sinusitis / Miosite oblíqua superior mimetiza abscesso subperiosteal em paciente com sinusite

ABSTRACT Isolated superior oblique myositis is a rare variant of idiopathic orbital myositis. We are reporting for the first time the case of a 19-year-old woman who had isolated superior oblique myositis with sinusitis that mimics a subperiosteal abscess. Despite the typical history of upper respiratory tract infection and laboratory test results and initial radiological findings suggestive of orbital cellulitis secondary to sinusitis, the initial response to systemic steroid with subsequent imaging changes and the relapse after cessation of steroid therapy helped us reach the diagnosis.

RESUMO A miosite oblíqua superior isolada é uma variante muito rara da miosite orbital idiopática. Trata-se do primeiro relato de uma mulher de 19 anos como um caso de miosite oblíqua superior isolada com sinusite que mimetiza abscesso subperiosteal. Apesar da história típica de infecção do trato respiratório superior, exames laboratoriais e achados radiológicos iniciais sugestivos de celulite orbital secundária à sinusite, a resposta inicial ao esteróide sistêmico com subsequentes alterações de imagem e recaída, após a cessação do esteróide, nos ajudou a alcançar o diagnóstico.

Proptosis ocular como una manifestación de la granulomatosis con poliangeítis (Wegener): Reporte de un caso y revisión de la literatura / Ocular proptosis as a manifestation of Wegener's granulomatosis: A case report

RESUMEN La granulomatosis con poliangeítis (Wegener) es considerada como una enfermedad granulomatosa sistémica, no infecciosa, caracterizada histológicamente por una vasculitis necrosante de pequeño vaso. El tracto respiratorio superior e inferior son los más frecuentemente afectados, en asociación a manifestaciones renales. Sin embargo, también se describe el compromiso aislado de un solo órgano, como es el caso del globo ocular y la órbita. Presentamos el caso de una mujer cuya principal manifestación consistió en un proceso inflamatorio de tejido periorbitario y proptosis del globo ocular izquierdo. La paciente fue valorada en manejo conjunto con el servicio de plástica ocular, otorrinolaringología y finalmente se derivó a reumatología para inicio de terapia inmunosupresora. Se realizó una revisión de la literatura, en búsqueda de reportes de caso y series de caso que permitieran comparar las presentaciones clínicas y desenlaces más frecuentes.

A B S T R A C T Granulomatosis with polyangiitis (Wegener) is considered as a systemic, non-infectious granulomatous disease, histologically noted for its small vessel necrotising vasculitis. The upper and lower respiratory tracts are the most frequently affected, in association with renal manifestations. However, the isolated involvement of a single organ, such as the eyeball and the orbit is also described. The case is presented of a woman whose main manifestation was an inflammatory process of periorbital tissue and proptosis of the left eyeball. The patient was evaluated jointly with eye plastic surgery, and the ear, nose and throat, and rheumatology departments. A literature review was carried out, looking for case reports and case series that allowed comparisons to made between the clinical manifestations and the most frequent outcomes.

Research progress in the mechanism of selenium supplement therapy for thyroid associated ophthalmopathy / 中华实验眼科杂志

Thyroid associated ophthalmopathy (TAO) is an organ-specific autoimmune-inflammatory disorder,ranking top among the orbital diseases with highest incidences.TAO is characterized by a complex pathogenesis,including glycosaminoglycan and hyaluronic acid deposition,fibrosis of extraocular muscle and adipose degeneration of ocular tissue.The physical manifestations of the disease include periorbital edema,double vision,ophthalmoptosis,ocular dryness,eyelid retraction and on occasion vision loss secondary to optic nerve compression.Selenium evolves in the diversified pathogenesis of TAO.Although the therapeutic effects for TAO of selenium have already been proven,some problems appear to be no clear among the clinicians,such as its optimum dose,duration of the treatment,and safety to date,etc.Nowadays,the mechanism of selenium supplementation in TAO treatment includes neutralization of reactive oxygen,inhibition of HLA-DR expression,inhibition of secretion of TSHR-Ab and TPO-Ab.The aim of the review was to summarize the studies of selenium supplementation theray for TAO.

Quantitative Assessment of Orbital Volume and Intraocular Pressure after Two-Wall Decompression in Thyroid Ophthalmopathy

BACKGROUND: Surgical outcomes after orbital wall decompression have focused on the degree of exophthalmos and intraocular pressure. The aim of this research was to evaluate intraorbital volume using computed tomography (CT) images following two-wall decompression using a combined subcilliary and endoscopic approaches. METHODS: A retrospective review was performed for all patients who had undergone the two-wall decompression method. The pre/postoperative CT images were used to evaluate changes in intraocular volume. Intraocular pressure was evaluated using applanation tonometry. Surgical details are discussed within the body of text. RESULTS: Two-wall decompression thru the medial wall and floor was associated with an average intraorbital volume change of 7.3 cm3, with maximal accommodation up to 13 cm3. Changes in intraocular pressures were not statistically significant. CONCLUSION: Two-wall decompression was effective in accommodation of up to 13 cm3 of soft tissue herniation. There was no statistically significant association between changes in volume to pressure.

Current research of immunoglobulin G4-related orbital disease / 中华实验眼科杂志

In recent years,immunoglobulin G4-related disease (IgG4-related disease) has received increasingly attention in medical community as a novel clinical entity.Although its clinical manifestation varies,high serum IgG4 concentration and numerous IgG4-positive plasma c(c)ll infiltration are the common characteristics.IgG4-related disease involves many human organs,and most one is pancreas,followed by parotid gland,bile duct,liver,lung,lymph node and so on,and orbital involvement is relatively rare.Current initial research shows that there is certain association between orbital disease with IgG4,and these diseases mainly include benign lymphoepithelial lesion,idiopathic orbital inflammatory pseudotumor,Castleman ' s disease,xanthogranuloma,Rosai-Dorfman disease etc..The researching progression in the relationship between IgG4 and orbital diseases is reviewed.

Clinical analysis of exophthalmos caused by brain-related diseases / 中华实验眼科杂志

Background Exophthalmos caused by brain-related diseases will result in the serious outcome if treated improperly.It will be helpful for the diagnosis of the disease correctly when signs and symptoms are taken into consideration.Objective This study was to analyze the cause and clinical manifestations of exophthalmos due to brain-related diseases.Methods The elinical data from 38 patients with exophthalmos caused by brain-related diseases was collected and analyzed retrospectively.The sex,age,cause,exophthalmos range,symptom and sign of patients were considered. Results The gender of 38 patients was 21 males(55.26％)and 17 females(44.74％),aged from 16 to 71 years old with the average age 37.21.Four types of brain-related diseases were associated with the exophthalmos of eyeballs,including benign tumor 65.79％(25/38)containing the meningioma 60.53％(23/38),chordoma 5.26％(2/38)；malignant tumor 5.26％(2/38)containing the malignant meningioma 2.63％(1/38),choroid tong one cases of papillary carcinoma 2.63％(1/38)；carotid-cavernous fistula 26.32％(10/38)；meningoencephalocele 2.63％(1/38).Exophthaimos ranged from 18 to 35 mm in the patients with the average value of 22.17 mm.In all of the 38 patients,the right eyes were 36.84％(14/38),and left eyes were 55.26％(14/38)and bilateral eyes 7.89％(3/38).Accompanying signs and symptoms of meningioma included long-term headache (65.22％),nausea and vomiting(21.74％).declined vision(17.39％),elevated intraocular pressure,visual field shrink and loss,etc..Accompanying signs and symptoms of carotid cavernous fistula were loss of vision,pulsatile exophthalmos,noise over the orbit,ocular limitation of movement,eyelid edema(80％),bulbar conjunctival congestion,episodes of eyelid,diplopia(80％),headache(60％). Conclusion Some brain diseases are often accompanied by exophthalmos.Exophthaimos can provide useful clues to the diagnosis of brain diseases.

Imaging diagnosis of superior ophthalmic vein enlargement associated with orbital arteriovenous malformation / 眼科

Objective To investigate the radiologic and angiographic findings of dilated superior ophthalmic vein(SOV)associat- ed with orbital arteriovenous malformations(AVM).Design Retrospective case series.Participants Six cases of orbital AVM patients, with clinical symptoms and signs mimicking a carotid cavernous fistula(CCF).Methods Examinations of the six cases,such as CT, MRI,and selective cerebral angiography,were summarized and analyzed.Main Outcome Measures Images findings and hemodynam- ics.Results All patients were found with dilated SOV on CT and MRI.Additional radiographic findings included proptosis and AVM. All six AVM were located at the orbit,and one of them was also found with AVM in brain.The main draining vein was SOV in all cas- es.The branches contributing to the fistula's blood supply were the middle meningeal artery,the internal maxillary artery,and the oph- thalmic artery.Conclusions Orbital AVM can cause similar clinical signs and radiologic features to those associated with a CCF.How- ever,the bulging cavernous sinus cannot be found in most AVM.Angiography is necessary for definitive management,non-invasive techniques have an important role in pre-angiographic diagnostic decisions.(Ophthalmol CHN,2007,16:395-398)

Research on the Teaching Mode for Experts in Orbital Diseases / 中华医学教育探索杂志

As a frontier branches of science,a significant progress in orbital diseases has been achieved in the last several years.In view of the existing problems in current teaching mode for experts in orbital diseases and their characteristics,a series of initiatives for researching a new mode have been taken,and some achievements have been made.

Analysis on the hospitalization expenses of 81 orbital cavernous hemangioma patients / 医学研究生学报

Objective The analysis of hospitalization expenses contributes to effective measures for reducing medical costs.The authors investigated the hospitalization expenses and the influencing factors in orbital cavernous hemangioma (OCH) patients in Shanghai Changzheng Hospital.Methods In view of clinical diagnosis and treatment and social economics,we conducted a single factor analysis and a stepwise multiple linear regression analysis on the influencing factors of the hospitalization expenses of 81 OCH patients from 2002 to 2007.Results The six-year hospitalization expenses of the OCH patients averaged RMB $7 071.4 and the median was RMB $7 038.7,with the costs of surgical materials (54.3%),Western medicine (13.3%) and laboratory examinations (8.1%) as the top three figures.The single factor analysis and stepwise multiple linear regression analysis showed 8 factors to be statistically significant in influencing the hospitalization expenses of the OCH patients,namely,marital status,occupation,complications,anterior orbitotomy,previous treatment,proptosis,hospitalization year and preoperative hospital stay (P

Separated Intraorbital Mucopyocele of Frontoethmoidal Sinus Origin

Intraorbital expansion is not rare in frontoethmoidal mucoceles and various rhinological surgeries have been reported for the management of this condition. However, although intraorbital mucoceles are apt to be accompanied by ophthalmological or neurological complications, their treatment by neurosurgical procedures has been reported considerably less frequently than that by rhinological approach. The authors report a patient with intraorbital mucopyocele that was extended from the frontoethmoidal sinus but separated by the thick fibrous septum. The patient had suffered from progressive proptosis with orbital pain and was successfully treated with transorbital complete removal of cyst by the subfrontal extradural approach. We suggest that an subfrontal transorbital approach such as this method is needed for complete marsupialization of an intraorbital mucocele and to prevent recurrence, especially in cases like our presentation.

Construction and Application of Resources Bank in Orbital Disease / 中华医学教育探索杂志

By relating the construction of orbital diseases’ resources bank,the clinical data became useful teaching resources.This paper introduces the construction requirements,its application in teaching for experts in orbital disease and some problems to be solved.

Research on Teaching Mode for by Internet Resources Experts in Orbital Disease / 中华医学教育探索杂志

As a frontier branches of science,a significant progress in orbital diseases has been achieved in the last few years.In view of the existing problems in current teaching mode for experts in orbital disease and their characteristics,a series of initiatives for researching a new mode have been taken,and some achievements have been made.

A Case of Orbital Apex Syndrome Caused by Mucocele in the Sphenoid Sinus / 대한이비인후과학회지

Orbital complications of sinus disease continue to appear in clinical practice. Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. The classification which defines the degree of orbital extension is valuable, therapeutically and prognostically. The orbital apex syndrome is associated with an affection of the vessels and nerves passing through the superior orbital fissure and the optic foramen and characterized by visual loss and ophthalmoplegia. But it has minimal or no signs of orbital inflammation such as proptosis, chemosis, or lid edema. We experienced a case of temporary monocular visual loss and ophthalmoplegia caused by mucocele in the sphenoid sinus. Thus, we report, with a review of literature, a case of orbital apex syndrome caused by mucocele in the sphenoid sinus in a 53 year-old male patient.