[Idiopathic orbital inflammation]. / Idiopathische orbitale Entzündungen.

BACKGROUND: Orbital inflammatory disease encompasses a spectrum of disorders. Idiopathic orbital inflammation (IOI) is often a diagnosis of exclusion, which needs to be differentiated from infections, systemic inflammatory disease, and neoplasms. IOI includes anterior inflammation with dacryoadenitis, myositis, perineuritis of the optic nerve, periscleritis, diffuse sclerosing inflammation, and orbital apex inflammation. OBJECTIVE: A differential diagnostic overview of IOI is presented, including its subcategories, diagnosis, and treatment. CONCLUSION: The diagnosis of IOI is often made by exclusion with typical clinical findings, CT and MRI scans, and pathology. Treatment includes corticosteroids, immunomodulators, immunosuppressants, and radiotherapy.

Orbital Hemangiopericytoma in 68Ga-Prostate-Specific Membrane Antigen-HBED-CC PET/CT.

A 76-year-old man with biochemical relapse of prostate cancer underwent Ga-prostate-specific membrane antigen PET/CT. Besides a local lymph node metastasis, a nodular structure inside the left orbit caudal to the optic nerve showed increased uptake. A metastasis in this location is unlikely. The subsequently performed MRI showed the structure being T1 hypointense, T2 indifferent, and strongly gadolinium contrast agent enhancing. Histopathologic examination after surgical removal identified the tumor as hemangiopericytoma, which rarely occurs in the orbit. Regarding the intense uptake observed, prostate-specific membrane antigen-targeting PET tracers could bear potential for staging purposes of this tumor entity.

Congenital cystic eye.

BACKGROUND: Congenital cystic eye is a rare ocular and orbital malformation describing an intraorbital cavity lined by neuroglial tissue. Clinical and histopathologic findings of a 3-year-old boy with a congenital cystic eye are presented. METHODS: A 4-year-old otherwise healthy boy with anophthalmia of the right eye was referred because of progressive volume enlargement of his congenital cystic lesion of the right orbit. Imaging techniques revealed a hyperintense cystic tumor with calcifications of the wall. There was no evidence of a globe, no communication to the intracranial space and a normal bony orbit. The mass was excised and a 20-mm silicone orbital implant inserted. RESULTS: Microscopic examination of the cyst revealed irregularly shaped layers of fibrovascular tissue lined by neuroglial tissue with calcified bodies and positive immunohistochemical staining for glial fibrillary acid protein (GFAP), neuron-specific enolase (NSE) and neurofilament protein (NF). No structures like cornea, lens, retinal pigmented epithelium or rosettes were identified. CONCLUSIONS: Congenital cystic eye is a primary developmental abnormality of the globe caused by an invaginational arrest of the primary optic vesicle between the 2-mm and 7-mm stages of fetal development. The luminal neuroglial tissue contains dystrophic calcified bodies and degenerated primitive nerve fibers. The enlargement of the cyst may be due to fluid produced by glial tissue. The differential diagnoses for cystic anomalies without epithelial lining include microphthalmia with cyst, microphthalmia with cystic teratoma, ectopic brain tissue and meningoencephalocele.

Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177 trabeculectomies.

PURPOSE: To evaluate the long-term outcome of trabeculectomy under the conditions of intensified postoperative care (IPC) compared with conventional follow-up. METHODS: One hundred and seventy-seven consecutive primary trabeculectomies (168 patients) with a median follow-up of 4.5 years were retrospectively analyzed at the University Eye Hospital, Würzburg. Seventy-three trabeculectomies (70 patients) were followed by the surgeon under the conditions of IPC (group 1), and 104 trabeculectomies (98 patients) were followed by other ophthalmologists without IPC (group 2). The following measures to control wound healing were predominantly used in group 1: (1) increase in topical steroid administration if corkscrew vessels were present; (2) repeated injections of 5-fluorouracil (5-FU) at the beginning of bleb scarring; and/or (3) needling plus 5-FU administration if an encapsulated bleb developed. Postoperative intraocular pressure (IOP) was defined as "successful" when it did not exceed 21 mmHg and was at least 20% lower than the treated preoperative IOP. Stable visual acuity was defined as +/-1 line. RESULTS: The success rates of IOP control were about 95% in both groups. In the IPC group 45 of 73 eyes fulfilled all success criteria without additional anti-glaucoma medication (61.6%), whereas in conventional follow-up only 33 of 104 eyes fulfilled all success criteria without medication (31.7%). CONCLUSIONS: This study demonstrates that a much higher proportion of filtering blebs reach target IOP without medication if measures of IPC are consistently used by a glaucoma specialist when necessary.