ABSTRACT
OBJECTIVE: To report a rare presentation of bilateral optic nerve compression from extra-medullary hematopoiesis in beta thalassemia/Hb E disease. DESIGN: Interventional case report. CLINICAL PRESENTATION: A 13-year-old Thai girl was reported with slowly progressive bilateral visual loss due to optic neuropathy as a result of compression from extra-medullary hematopoiesis. Computed tomography of orbit and brain revealed a homogeneous enhancing midline soft tissue mass originating from the ethmoid and sphenoid sinuses along with extensive involvement of the skull. INTERVENTION: Blood transfusion once every month and low-dose radiotherapy to sphenoid and ethmoid bones with some visual improvement. CONCLUSION: Extra-medullary hematopoiesis in beta thalassemia can involve paranasal sinuses and cause compressive neuropathy. In patients with beta thalassemia that required multiple blood transfusions with progressive visual loss, ectopic marrow compression of optic nerve should be ruled out.
Subject(s)
Hematopoiesis, Extramedullary , Optic Nerve/physiopathology , beta-Thalassemia/complications , Adolescent , Female , Humans , Optic Nerve/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To study the efficacy and safety of amniotic membrane transplantation as an adjunctive therapy after surgical excision of primary pterygium and to compare the clinical outcome with that of conjunctival autograft. METHODS: Eighty-six eyes of 78 patients with primary pterygium were operated on by a single surgeon (N.T.). All patients were randomized to undergo amniotic membrane or conjunctival autograft transplantation as an adjuvant therapy after pterygium excision. Forty-four eyes in 39 patients were treated with amniotic membrane transplantation (AM group), and 42 eyes of 41 patients were treated with conjunctival autograft (CG group). Patients were followed up at 1 week, 1, 3, 6, and 12 months postoperation. The main outcome measurement was a recurrence rate after surgery. RESULTS: The mean follow-up was 14.40 +/- 5.4 months in the AM group and 12.35 +/- 3.13 months in the CG group. There were 18 recurrences (40.9%) in the AM group and two (4.76%) in the CG group, which was significantly different among both groups (P < 0.007). The cumulative proportion that were recurrence-free at 12 months was 0.6 +/- 0.15 for the AM group and 0.95 +/- 0.07 for the CG group (P = 0.0003, Log-rank test). The cumulative nonrecurrence rate at 6 and 12 months in all patients stratified by age and sex was not significantly different (P = 0.28 and P = 0.9, Log-rank test). No major complications were observed in either group. CONCLUSION: The surgical results of primary pterygium excision followed by amniotic membrane and conjunctival autograft transplantation were compared. It was found that amniotic membrane transplantation for pterygium surgery has an unacceptably high recurrence rate.
Subject(s)
Amnion/transplantation , Biological Dressings , Conjunctiva/transplantation , Pterygium/surgery , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Ophthalmologic Surgical Procedures , Prospective Studies , Recurrence , Safety , Transplantation, Autologous , Treatment Outcome , Visual AcuityABSTRACT
Lacrimal sac tumors are rare tumors of the periorbital region. The authors report a case of squamous cell carcinoma of the lacrimal sac in a 47-year-old Thai man. The patient presented with epiphora and a palpable mass in the medial canthal area. The diagnosis was confirmed by the pathological studies. Radical surgery and radiation therapy were given. Early detection and long-term follow-up are necessary.
