Reconstruction of orbital floor blow-out fractures with autogenous iliac crest bone: a retrospective study including maxillofacial and ophthalmology perspectives.

This is a 10-year retrospective study of patients with an isolated unilateral orbital floor fracture reconstructed with an autogenous iliac crest bone graft. The following inclusion criteria applied: isolated orbital floor fracture without involvement of the orbital rim or other craniofacial injuries, pre-/post-operative ophthalmological/orthoptic follow-up, pre-operative CT. Variables recorded were patient age and gender, aetiology of injury, time to surgery, follow-up period, surgical morbidity, diplopia pre- and post-operatively (Hess test), eyelid position, visual acuity, and the presence of en-/or exophthalmos (Hertel exophthalmometer). Twenty patients met the inclusion criteria. The mean age was 29 years. The mean follow up period was 26 months. No patient experienced significant donor site morbidity. There were no episodes of post-operative infection or graft extrusion. Three patients had diplopia in extremes of vision post-operatively, but no interference with activities of daily living. One patient had post-operative enophthalmos. Isolated orbital blow-out fractures may be safely and predictably reconstructed using autogenous iliac crest bone. The rate of complications in the group of patients studied was low. The value of pre- and post-operative ophthalmology consultation cannot be underestimated, and should be considered the standard of care in all patients with orbitozygomatic fractures, in particular those with blow-out fractures.

The difference in intraocular pressure readings between 3 applanation tonometers is independent of central corneal thickness, in glaucomatous and nonglaucomatous eyes.

PURPOSE: To look at tonometry differences between 3 tonometers and to correlate this difference with central corneal thickness (CCT) in glaucomatous and nonglaucomatous eyes. METHODS: A total of 145 patients were recruited (39 with glaucoma). Intraocular pressure (IOP) was carried out using the Tonosafe (TS), Tono-Pen XL (TP), and Goldmann applanation tonometer (GAT). CCT was also performed using a digital pachymeter. RESULTS: The TS underestimated IOP when compared with the GAT by a mean (±SD) of 1.03±2.14 mm Hg (P<0.001). The TP when compared to the GAT overestimated IOP by a mean (±SD) of +1.09±6.38 mm Hg (P=0.071). We found only 31% of TP readings to be within ±2 mm Hg of the GAT readings and only 60% to be within ±4 mm Hg of the GAT readings. Correlation was poor (F=0.247) between the GAT and TP with the coefficient of determination being 0.061. The difference in IOP was independent of CCT and a diagnosis of glaucoma. CONCLUSIONS: The TS, when compared with the GAT, underestimates IOP with a tendency for this to increase in the higher range of IOP readings. The TP is poorly correlated with the GAT.

Intraocular bevacizumab levels 24 hours after intravitreal injection in a normal eye.

BACKGROUND: To determine intraocular levels of bevacizumab in a normal eye 24 hours after the injection of bevacizumab into the vitreous cavity. METHODS: Fluid and tissue samples were analyzed for unbound bevacizumab levels using microsphere immunoassays. RESULTS: After a loading dose of 2.5 mg (0.1 mL) of bevacizumab, levels of unbound drug could be detected in all tissue extracts 24 hours after its injection. At least 60.2% of the injected bevacizumab could be accounted for in this study. Levels of 0.06 mg (2.4%) of bevacizumab were recorded in the choroid. CONCLUSION: At 24 hours, unbound bevacizumab levels can be detected at the level of the choroid. Therefore, bevacizumab can reach the site where choroidal neovascularization develops. This explains its reported therapeutic effect.