Deep lateral wall orbital decompression following strabismus surgery in patients with Type II ophthalmic Graves' disease.

PURPOSE: Surgical management of ophthalmic Graves' disease traditionally involves, in order, orbital decompression, followed by strabismus surgery and eyelid surgery. Nunery et al. previously described two distinct sub-types of patients with ophthalmic Graves' disease; Type I patients exhibit no restrictive myopathy (no diplopia) as opposed to Type II patients who do exhibit restrictive myopathy (diplopia) and are far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. Strabismus surgery involving extra-ocular muscle recession has, in turn, been shown to potentially worsen proptosis. Our experience with Type II patients who have already undergone medial wall and floor decompression and strabismus surgery found, when additional decompression is necessary, deep lateral wall decompression (DLWD) appears to have a low rate of post-operative primary-gaze diplopia. METHODS: A case series of four Type II ophthalmic Graves' disease patients, all of whom had already undergone decompression and strabismus surgery, and went on to develop worsening proptosis or optic nerve compression necessitating further decompression thereafter. In all cases, patients were treated with DLWD. Institutional Review Board approval was granted by the University of Kansas. RESULTS: None of the four patients treated with this approach developed recurrent primary-gaze diplopia or required strabismus surgery following DLWD. CONCLUSIONS: While we still prefer to perform medial wall and floor decompression as the initial treatment for ophthalmic Graves' disease, for proptosis following consecutive strabismus surgery, DLWD appears to be effective with a low rate of recurrent primary-gaze diplopia.

Metastatic prostate carcinoma to the orbit as the first presentation of disease.

Prostate carcinoma is a common tumor of the older adult male. It is associated with bony metastases, particularly to the axial skeleton. We present two case histories; in both cases, the patients had no prior history of prostate carcinoma. Both cases were diagnosed with CT imaging, elevated PSA, and biopsy. Additionally, they were treated with surgical resection and hormone modulation therapy. While bony metastases are frequently associated with advanced disease, they can also be a cause of presenting symptoms. The CT imaging in these two cases showed the classic hyperostotic findings of prostate cancer. Prostate cancer may cause osteoblastic lesions in contrast to other metastatic bone lesions, which cause destructive osteolytic lesions. During excisional surgery, the tumor was inspected and many stalactite-like lesions were present on the gross sample. We present these and compare them to the CT imaging.