The impact of COVID-19 on the progression and management of periocular basal cell carcinomas.

PURPOSE: To identify whether the delay caused by COVID-19 had an impact on the peroperative size of lesions and the choice of reconstruction performed in patients with periocular basal cell carcinomas (BCCs). METHODS: We undertook a retrospective study looking at whether the delay caused by COVID-19 had an impact on the lesion size at the time of surgery, and consequently, on the choice of surgical repair. Results were compared to an equivalent time period a year prior to the onset of COVID-19. Elective surgery was stepped down at our hospital between March and June 2020. We collected data on patients that underwent BCC excisions between July 2020 and April 2021 and for an equivalent time period from 2019 to 2020. Measurements at listing were compared with those preoperatively obtained and from histological specimen. RESULTS: Analysis using the paired T-test yielded a p-value 0.005 for the growth of the lesion between listing and surgery after the onset of the pandemic, while pre-COVID the p-value was 0.04. Most patients were able to undergo the same procedure as planned for despite the delay and statistically significant growth while awaiting surgery. CONCLUSION: Literature suggests that BCC operations can be safely delayed up to 3 months. Our longest wait post-COVID was 12 months with a mean wait of 5 months. Only two patients in this group had a more invasive surgery than planned. We conclude that the delay caused by the pandemic, even beyond 3 months, had a minimal impact on the surgical plan and outcomes for patients with BCCs.

Intraorbital aneurysm of the ophthalmic artery.

Intraorbital ophthalmic artery (OA) aneurysms are rare. They can be asymptomatic or present with visual disturbances, exophthalmos and headaches. We present a case of a 57-year-old man who presented with reduced vision, diplopia and exophthalmos. A carotid artery angiogram identified a right OA aneurysm. Due to the low risk of rupture and the patient's comorbidities including cardiac and renal impairment, a conservative approach was followed. A few weeks post presentation, the patient's vision and optic nerve function had improved. This case reiterates the importance of considering conservative treatment for patients with intraorbital OA aneurysms.

Acute Secondary Optic Neuropathy as a Complication of a Single Episode of Acutely Raised Intraocular Pressure: A Case Series.

PURPOSE: The purpose of this case series is to report development of acute secondary optic neuropathy due to optic nerve injury associated with single episode of acutely raised intraocular pressure (IOP) of varying etiologies. PATIENTS AND METHODS: Retrospective review of a series of 3 consecutive cases diagnosed at University hospitals of Coventry and Warwickshire and review of published literature. RESULTS: Three cases, respectively, with Posner Schlossman syndrome, acute idiopathic hypertensive anterior uveitis, and primary acute angle-closure initially presented with raised IOPs of 38 to 68 mm Hg. All cases were treated initially with medical management and the primary acute angle-closure case had subsequent Nd:YAG laser peripheral iridotomy. All 3 cases developed acute optic nerve injury with reduced vision, an afferent pupillary defect and optic disc swelling which subsequently persisted as optic neuropathy with sectoral optic atrophy and disc pallor. CONCLUSIONS: This rare cases series highlights the importance of increased awareness of the possibility of developing acute secondary optic neuropathy in patients with acutely raised IOP. On the basis of the acute clinical features, including disc edema with disc hemorrhages and an afferent pupillary defect the most likely pathophysiology of the resultant optic nerve injury is the acute impact of high IOP on optic nerve head perfusion. This appears similar to nonarteritic anterior oschemic optic neuropathy. Other systemic and local risk factors may also contribute. Appropriate timely management to reduce the acutely raised IOP are essential but may not be sufficient in preventing optic neuropathy due to changes at presentation.