A case of branch retinal artery occlusion following orbital cavernous hemangioma excision.

PURPOSE: To report the first case of branch retinal artery occlusion (BRAO) following surgical excision of orbital cavernous hemangioma. METHODS: A 34-year-old man was referred to our department with an orbital cavernous hemangioma compressing the optic nerve, the medial rectus muscle, and the eyeball, and resulting in a hyperemic optic disc, vascular tortuosity, and pronounced choroidal folds at fundus biomicroscopy. The patient underwent transconjunctival inferior orbitotomy and the lesion was excised entirely without intraoperative complications. RESULTS: On the second postoperative day, best-corrected visual acuity (BCVA) decreased from 2/10 to counting fingers and fundus examination showed occlusion of the inferotemporal branch retinal artery. Fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) confirmed the diagnosis. One month of corticosteroid therapy and anticoagulation therapy were prescribed. The patient was followed up for 6 months; SD-OCT showed resolution of the retinal thickening and the retinoschisis but a new hyporeflective space in the outer retina at the fovea had appeared at 6 months follow-up. The patient's BCVA improved to 9/10 after 6 months but an absolute superior visual field defect was still present at the end of the follow-up. CONCLUSIONS: We describe the first reported case of BRAO following orbital cavernous hemangioma excision with significant improvement of the BCVA at 6-month follow-up. The SD-OCT could be a useful tool to monitor morphologic changes of the area corresponding to the retinal ischemia.

Outcome of 110 basal cell carcinomas of the eyelid treated with frozen section-controlled excision: mean follow-up over 5 years.

PURPOSE: To analyze the outcome and risk factors of recurrence in patients with basal cell carcinomas (BCCs) of the eyelid treated by en face frozen section-controlled (FSC) excision with a mean follow-up over 5 years. METHODS: This was a retrospective series of 108 patients with 110 biopsy-proven eyelid BCCs. All lesions were excised with 2 mm margins clinically free from neoplasia at clinical examination. For each tumor, en face frozen section examination of surgical margins was employed for the histologic confirmation before the reconstruction. Subsequently, all margins were submitted for permanent paraffin sections. RESULTS: Of 110 malignancies, 80.9% represented primary carcinomas and 19.1% secondary ones. The overall recurrence rate was 1.8%, with a mean follow-up of 72.4 months (range 30-167). The mean time between the excision of the lesion and the diagnosis of the recurrence was 24 months (range 20-28). No recurrences were observed in 62 tumors followed up for at least 5 years. Secondary BCCs were associated with a higher recurrence rate compared with primary BCCs (4.8% and 1.1%, respectively, p = 0.262). CONCLUSIONS: The FSC excision of eyelid BCCs yields recurrence rates comparable to those of Mohs micrographic surgery at 5-year follow-up. Intraoperative microscopic margin control improves the cure rate of eyelid BCCs, and FSC excision with small margins (2 mm) clinically free from neoplasia is associated with easier reconstruction and better cosmetic and functional outcomes.