Evisceration in the modern age

Evisceration is an ophthalmic surgery that removes the internal contents of the eye followed usually by placement of an orbital implant to replace the lost ocular volume. Unlike enucleation, which involves removal of the entire eye, evisceration potentially causes exposure of uveal antigens; therefore, historically there has been a concern about sympathetic ophthalmic [SO] associated with evisceration. However, critical review of the literature shows that SO occurs very rarely, if ever, as a consequence of evisceration. Its clinical applications overlap with those of enucleation in cases of penetrating ocular trauma and blind painful eyes, but it is absolutely contraindicated in the setting of suspected intraocular malignancy and may be preferred for treatment of end-stage endophthalmitis. From a technical standpoint, traditional evisceration has a limitation in the orbital implant size. Innovations with scleral modification have overcome this limitation, and accordingly, due to its simplicity, efficiency, and good cosmetic results, evisceration has once again been gaining popularity

Comparison of humphrey matrix frequency doubling technology to standard automated perimetry in neuro-ophthalmic disease

We compared Humphrey Matrix FDT 30-2 [FDT] and Humphrey Visual Field Analyzer 30-2 SITA standard [SAP] in the assessment of anterior [optic nerve or chiasm] and posterior [retro-chiasmal] afferent visual pathway defects. In this retrospective comparative study, the charts of 37 patients [16 males, range 13-84 years, mean 72.1], with neuro-ophthalmic visual field defects who were tested with both FDT and SAP, were reviewed. Two masked graders assessed the concordance and extent of field defects between the perimeters. The mean concordance between anterior and posterior disease was compared using the Wilcoxon rank sum test. The mean deviation [MD] and pattern standard deviation [PSD] of each perimeter were correlated with the Spearman coefficient. Twenty-eight patients had anterior and nine had posterior disease. Most had a fair or good concordance [89.3% anterior, 88.9% posterior]. When comparing anterior to posterior disease, the mean concordance of the defects of the two parameters was not statistically different [P=0.94 and P=0.61 for total deviation and pattern deviation, respectively]. The MD and PSD between perimeters had a significant correlation. Conclusions: Our series, using 30-2 field analysis, demonstrates fair to good correlation between FDT and SAP in the majority of patients. In roughly 10% findings between FDT and SAP were discordant. This difference was similar for anterior and posterior disease

Long-term management of orbital and systemic reactive lymphoid hyperplasia with rituximab

Rituximab, a monoclonal antibody to the B cell marker CD20, is becoming increasingly popular in the treatment of various orbital disorders. In this university-based interventional case series, we describe two patients with bilateral orbital and extra-orbital reactive lymphoid hyperplasia [RLH] treated with rituximab. Initially both had favorable responses; but roughly a year later recurrent disease necessitated maintenance therapy in both cases. Both again responded to additional courses of rituximab. Although recalcitrant disease may persist after treatment, rituxmab may play a role in the management of RLH with widespread involvement