Orbital schwannoma management: a case report, literature review, and potential paradigm shift.

PURPOSE: To present a case of orbital schwannoma and assess the literature on treatment modalities. METHODS: A MEDLINE literature search for cases of orbital schwannomas was performed using the PubMed search tool using the search terms "orbital schwannoma" and "orbital neurilemmoma." Papers were included if they were peer-reviewed, published in English, discussed management, and included the search terms. Each article was rated using the scale developed by the British Centre for Evidence-Based Medicine. In addition, we present a case report of an orbital schwannoma. RESULTS: A total of 428 articles were found. 102 met the criteria for inclusion. Only two articles met Level 1 evidence and 16 were important to the clinical care process. We report a case of a biopsy-proven orbital schwannoma managed conservatively with observation over a 4-year period due to risk of cosmetic disfigurement with tumor removal. There has been no change in tumor size and no associated complications during follow up. CONCLUSIONS: There is a paucity of data on the natural history of orbital schwannomas. Based on our review of the literature, we recommend observation for asymptomatic or minimally symptomatic orbital schwannomas with minimal growth over an extended period of time. For rapidly growing tumors or large tumors affecting key structures causing visual loss, diplopia, aesthetic disfigurement, or patient discomfort, a more aggressive approach may be necessary.

Bilateral Orbital Compartment Syndrome Preceding Cerebellar Herniation in Neuropsychiatric Systemic Lupus Erythematosus.

Orbital compartment syndrome poses a significant risk for vision loss if not promptly treated. The authors report a patient with neuropsychiatric systemic lupus erythematosus presenting with bilateral orbital compartment syndrome and rapid decompensation leading to uncal and tonsillar herniation. While extremely rare, bilateral orbital compartment syndrome should prompt consideration of systemic etiologies including neuropsychiatric systemic lupus erythematosus.

Intraocular lens power calculations in eyes with previous hyperopic laser in situ keratomileusis or photorefractive keratectomy.

PURPOSE: To evaluate the accuracy of 7 intraocular lens (IOL) calculation formulas in patients with previous hyperopic laser in situ keratomileusis (LASIK) or excimer laser photorefractive keratectomy (PRK). DESIGN: Retrospective case series. SETTING: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, and private practice, Mesa, Arizona, USA. METHODS: The 7 formulas evaluated were the adjusted Atlas 0-3, Masket, Modified Masket, Haigis-L, Shammas-PL, Barrett True-K, and Barrett True-K No-History. The Masket and Modified Masket were calculated using the single-K version of Holladay 1 and Hoffer Q formulas; the adjusted Atlas 0-3 was calculated using the double-K version of Holladay 1 and Hoffer Q. The IOL power predicted by each formula was calculated by targeting the postoperative manifest refraction. The IOL prediction error was obtained by subtracting the predicted IOL power from the implanted IOL power. The mean IOL prediction error, median absolute refractive prediction error, and percentages of eyes within ±0.50 diopter (D) and ±1.00 D of the predicted refraction were calculated. RESULTS: Twenty-one eyes of 21 patients were evaluated. There were no significant differences in the median absolute refractive prediction error or percentages of eyes within ±0.50 D or ±1.00 D of the predicted refraction between formulas or methods. The IOL mean prediction errors were comparable between the Holladay 1 and Hoffer Q calculations for all formulas except for a greater error for the double-K version of the Hoffer Q of the adjusted Atlas 0-3. CONCLUSION: In eyes that had hyperopic LASIK or PRK, there were no significant differences in the accuracy between the 7 IOL calculation formulas.

An Update on Lower Lid Blepharoplasty.

Aging changes to the lower eyelids and midface include pseudoherniated orbital fat, tear trough deformity, lid laxity, and dermatochalasis. Surgical repair often aims at treating redundant skin or orbital fat malposition with a lower eyelid blepharoplasty. Either a transcutaneous or transconjunctival approach may be used, though recent trends have favored the transconjunctival technique if procedures require more than simple skin excision. In manipulating the inferior orbital fat pads, a surgeon has many options including excision, repositioning, or augmentation with synthetic dermal filler, autologous fat grafts, or acellular dermal allografts. The authors review and detail indications, preoperative evaluation, techniques, and complications of lower lid blepharoplasty.

Localized Immunoglobulin Light Chain Amyloid of the Conjunctiva Confirmed by Mass Spectrometry Without Evidence of Systemic Disease.

Current guidelines recommend a thorough systemic workup in patients with newly diagnosed immunoglobulin amyloid light chain (AL) amyloidosis because of a close association with an underlying plasma cell proliferative disorder. Rarely, however, AL amyloidosis may present as a localized, benign disease without systemic involvement. Few previous reports have documented localized AL amyloid of the conjunctiva, and all these used immunohistochemistry for amyloid typing, which can be inaccurate. The authors identified 2 cases of AL amyloidosis confirmed by mass spectrometry localized to the conjunctiva and without evidence of systemic disease as determined by thorough systemic workup. Despite the very sensitive diagnostic technique of mass spectrometry, AL amyloidosis of the conjunctiva may not have an association with systemic plasma cell proliferative disorder. It is important to recognize conjunctiva as a site where localized amyloidosis can occur, even with the AL subtypes, as this entity usually exhibits a benign course and may be managed conservatively.

Angiosarcoma of the Eyelid With Superimposed Enterobacter Infection.

Angiosarcoma is a rare, aggressive, malignant endothelial neoplasm with a variable clinical presentation. The authors describe a case of angiosarcoma involving the eyelid that was complicated by a superimposed Enterobacter infection. Following positive cultures for E. aerogenes and multiple biopsies suspicious but not definitive for angiosarcoma, a final biopsy was consistent with angiosarcoma.