Isolated Intraconal Meningioma.

PURPOSE: To report a rare case of isolated intraconal meningioma. CASE REPORT: A 24-year-old woman presented with painless proptosis in her left eye which started and progressed during her pregnancy about 10 months ago. Hertel exophthalomometry revealed anterior displacement of the globe with 4 mm of proptosis which was remarkable. Magnetic resonance imaging (MRI) demonstrated an intraconal circumscribed oval-shaped mass with hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images, mimicking cavernous hemangioma. This mass, however, was free of any connections to optic nerve or bones. Due to the imaging characteristics, more prevalent diagnoses like cavernous hemangioma were placed on the top of the differential diagnoses list. However, during the surgical excision, the tumor's consistency and gross features were not compatible with cavernous hemangioma. The pathologic findings instead determined meningotheliomatous meningioma, a very rare condition, which was far from our expectations prior to the surgery. CONCLUSION: Ectopic orbital meningiomas are rare tumors that are not easily diagnosed without postoperative histopathology. Despite its low prevalence, they should be considered in the differential diagnosis list of intraconal masses with hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images.

Giant Cell Tumor: Changing Behavior from Intraorbital to Intraosseous Mass.

PURPOSE: To present a patient with giant cell tumor (GCT) of the orbit by changing behavior from an intraorbital mass to an intraosseous tumor. METHODS: A 16-year-old boy presented with pain, swelling, erythematous of the left upper and lower eyelids, proptosis, and diplopia. Ophthalmic examination revealed chemosis, conjunctival injection, limited elevation, depression as well as abduction in the left eye. RESULTS: Multislice computed tomography scan (CT scan) of the orbit and paranasal sinuses showed a hyperdense, oval, extraconal mass with bone erosion. Magnetic resonance imaging of the orbit showed an inferior lateral isointense, oval, extraconal mass that had indented the globe. The patient underwent superior lateral orbitotomy, and the orbital mass was excised. Two months later, the patient developed proptosis, severe chemosis, and eyelid erythema in the same eye. CT scan showed an intraosseous mass in the lateral wall of the orbit that had pushed the globe anteromedially. Intraosseous tumor was resected, and the lateral orbital wall was drilled during the second surgery. GCT was diagnosed based on pathological survey. CONCLUSION: Following the resection of the orbital GCT, the tumor behavior may change to an intraosseous lesion.

Botulinum toxin injection in the patients with Duane syndrome type 1.

PURPOSE: To evaluate the efficacy of botulinum toxin injection in the patients with type 1 Duane syndrome and identify the predictive factors for success. METHODS: Sixteen patients with esotropic type 1 Duane syndrome without history of ocular surgery were selected for this interventional case series. The botulinum toxin was injected in the medial rectus of all patients. Visual acuity, dry refraction, cyclo-refraction, ocular motility, and amount of deviation were measured. Complete success, partial success, and failure were defined as residual deviation/face turn less than 8 prism diopters (PD)/5°, 8-20 PD/5-15°, and equal or greater than 20 PD/15°, respectively. RESULTS: Sixteen cases (6 males) were included in our study. The mean esotropia was 26.27 ± 8.35 (12-40 PD) which was reduced significantly to 13.5 ± 12.39 PD during 6 months follow-up (p < 0.001). Face turn was improved significantly from a preoperative mean of 18.27° to: 0.094° at 1 week, 0.11° at 1 month, 3.31° at 3 months, and 7° at 6 months (p < 0.001). Complete success was seen in 6 patients (37.5%), partial success in 4 patients (25%), and failure in 6 patients (37.5%). There was a significant relation between the amount of forced duction testing (FDT) and the success rate (p: 0.019). No complication was seen during injections. CONCLUSIONS: Botulinum toxin could be an alternative treatment in Duane syndrome with appropriate case selection. FDT could be a predictive factor for response to botulinum toxin.

Hinged Capsulotomy--Does it Decrease Floaters After Yttrium Aluminum Garnet Laser Capsulotomy?

OBJECTIVES: The objective was to compare conventional circular yttrium aluminum garnet (YAG) laser capsulotomy with hinged capsulotomy to manage posterior capsular opacification (PCO). MATERIALS AND METHODS: This prospective, randomized clinical trial enrolled pseudophakic patients with visually significant posterior capsule opacification. Patients were randomized to undergo posterior YAG laser capsulotomy with either conventional circular technique or a new technique with an inferior hinge. At 1-month postoperatively, patients were asked if they had any annoying floaters and the responses were compared between groups. P < 0.05 was considered statistically significant. RESULTS: A total of 83 patients were enrolled. Forty-three patients underwent hinged posterior YAG capsulotomy and 40 patients underwent routine circular capsulotomy. At 1-month postoperatively, there was a statistically significant decrease in annoying floaters in the group that underwent circular capsulotomy (P = 0.02). There was no statistically significant association in the total energy delivered (P = 0.4) or the number of spots (P = 0.2) and patient perception of annoying floaters. CONCLUSION: Hinged YAG capsulotomy was effective at decreasing the rate of floaters in patients with PCO.

Clinical outcomes of botulinum toxin injection in patients with cerebral palsy and esotropia.

PURPOSE: To assess the efficacy of botulinum toxin (Novotox) injection in patients with cerebral palsy (CP) and esotropia. PATIENTS AND METHODS: In a non-comparative, prospective interventional case series botulinum toxin injection was done in 44 patients with CP and esotropia. A single dose of botulinum toxin was injected in both medial rectus muscles of all patients and was repeated in 12 patients. Angle of deviation within 10 prism diopters (PD) of orthotropia was defined as a successful outcome. RESULT: Forty-four patients (21 males) with the mean age of 47.56 ± 35.86 months were included in the study. The mean esotropia in all patients was 52.27 ± 18.40 PD (25-123 PD). The range of follow-up was 12-24 months. Thirty patients (68.18%) were treated successfully one year after surgery. The rates of success, consecutive exotropia, and residual esotropia were 61.4%, 13.63%, and 25% in the last follow-up, respectively. The logistic regression showed statistically significant results between success result and lower age, higher pre-injection deviation, one month post-injection deviation, and severe ptosis. Complications included subconjunctival hemorrhage and ptosis. CONCLUSION: Botulinum toxin injection is reasonably less invasive with light anesthesia, scar free, and a therapeutic alternative for the patient with esotropia and CP. Therefore, it can provide more possible surgical options in future.

Orbital hydatid cyst with diverse locality in the orbit and review of literatures.

PURPOSE: to introduce five different type of orbital involvement by hydatid cyst in 8 consecutive patients. DESIGN: descriptive case series. METHODS: Herein 8 patients with slowly progressive proptosis from 2 to 4months earlier at their first presentation are introduced. Complete ophthalmic examinations were done. Complete blood count, serologic test, ESR (erythrocyte sedimentation rate), CT scan and MRI were requested. Surgical removal of the lesions performed in all patients. RESULT: The hydatid cysts found in the extraconal (2 patients) and intraconal space (3 patients), lacrimal gland (1 patient), medial rectus (1 patient) and intraosseous of orbital wall (1 patient). The diagnosis of the isolated orbital hydatid cyst without any lesion in other parts of the body was confirmed in all patients. The recurrence was not observed in any patients during 2 - 6 years follow up. CONCLUSION: Although the most common site of involvement of orbital hydatid cyst is intraconal, it can invade various locations within the orbit.