Cerebrospinal fluid leak as a complication of oculoplastic surgery.

PURPOSE: Cerebrospinal fluid leak is a rare, but potentially morbid complication of orbital surgery. In this review, we analyze the reported cases of CSF leak in such surgeries, determine their causes, clinical presentations and sequellae, and highlight the different methods to detect and manage them. METHODS: A comprehensive literature review was conducted in PubMed. RESULTS: Twenty-one cases of CSF leak occurred with orbital exenteration, 34 with orbital decompression, four with DCR, two with enucleation, and four cases with other skull base surgery. Operating in high-risk areas increased the risk of dural injury. Once detected, CSF leak was either controlled by bed rest and head elevation or required a surgical repair. The various techniques of surgical management are discussed. CONCLUSION: The number of reported surgical CSF leaks in the orbit is relatively low. To prevent this complication, it is essential to have intimate knowledge of orbital anatomy, especially in the setting of pre-existing abnormalities. If CSF leak occurs, it should be rapidly recognized and adequately managed to prevent further morbidity.

Five-decade profile of women in leadership positions at ophthalmic publications.

OBJECTIVE: To evaluate the balance between the sexes of published ophthalmic material at the editorial, reviewer, and author levels. DESIGN: Cross-sectional study of 3 journals, American Journal of Ophthalmology, Archives of Ophthalmology, and Ophthalmology, for 1969, 1979, 1989, 1999, and 2009. The data were compared with ophthalmologist-in-training and physician profile in major contributing states from North America and Europe during the same period. RESULTS: Of the 3 major ophthalmology journals, none had a female editor-in-chief. For all journals, the proportion of editorial board members who were women increased from 3.3% in 1969 to 18.8% in 2009. For all journals and all years, women composed a higher proportion of first authors (29.2% in 2009) compared with senior authors (22.9% in 2009), reviewers (18.9% in 2009), or assistant editors (12.5% in 2009). There was an abrupt shift toward women after 1989 in first authorship in Ophthalmology (1969, 4.6%; 1979, 5.4%; 1989, 12.3%; and 1999, 20.2%), Archives of Ophthalmology (1969, 6.6%; 1979, 5.1%; 1989, 15.6%; and 1999, 28.6%), and American Journal of Ophthalmology (1969, 5.6%; 1979, 4.2%; 1989, 9.2%; and 1999, 23.9%). There was also an abrupt increase in female senior authorship for American Journal of Ophthalmology after 1989 (1979, 8.5%; 1989, 8.1%; and 1999, 18.3%). The increase in female first authorship during the 5 decades was parallel with the increase in US female physicians. CONCLUSIONS: Women ophthalmologists are authoring publications in increasing numbers that match their prevalence in the academic and overall workforce. However, all editors are men. This discrepancy relates to the relatively younger generation of female ophthalmologists or selection bias, a subject that requires further investigation.