-
Experimental Eye Research May 2023Thyroid-associated ophthalmopathy (TAO), also known as Graves' ophthalmopathy, is an autoimmune disease that is usually accompanied by hyperthyroidism. Its pathogenesis... (Review)
Review
Thyroid-associated ophthalmopathy (TAO), also known as Graves' ophthalmopathy, is an autoimmune disease that is usually accompanied by hyperthyroidism. Its pathogenesis involves the activation of autoimmune T lymphocytes by a cross-antigen reaction of thyroid and orbital tissues. The thyroid-stimulating hormone receptor (TSHR) is known to play an important role in the development of TAO. Because of the difficulty of orbital tissue biopsy, the establishment of an ideal animal model is important for developing novel clinical therapies of TAO. To date, TAO animal modeling methods are mainly based on inducing experimental animals to produce anti-thyroid-stimulating hormone receptor antibodies (TRAbs) and then recruit autoimmune T lymphocytes. Currently, the most common methods are hTSHR-A subunit plasmid electroporation and hTSHR-A subunit adenovirus transfection. These animal models provide a powerful tool for exploring the internal relationship between local and systemic immune microenvironment disorders of the TAO orbit, facilitating the development of new drugs. However, existing TAO modeling methods still have some defects, such as low modeling rate, long modeling cycles, low repetition rate, and considerable differences from human histology. Hence, the modeling methods require further innovation, improvement, and in-depth exploration.
Topics: Animals; Humans; Graves Ophthalmopathy; Orbit; Autoimmune Diseases; Receptors, Thyrotropin; Disease Models, Animal; Hormones
PubMed: 36914000
DOI: 10.1016/j.exer.2023.109436 -
Journal of Clinical Neuroscience :... Jul 2021Dedicated post-operative radiological evaluation following ophthalmologic procedures is relatively uncommon. However, given the ever-growing ophthalmologic procedural... (Review)
Review
Dedicated post-operative radiological evaluation following ophthalmologic procedures is relatively uncommon. However, given the ever-growing ophthalmologic procedural advancements and the increasing utilization of neuroimaging for myriad indications, the orbits are often imaged incidentally in a delayed post-procedural state. Regardless of the clinical scenario, it is important for neuroradiologists and other specialists commonly exposed to orbital imaging to be aware of both expected and abnormal post-operative imaging findings because misinterpreted normal features or unrecognized complications can result in vision-threatening delays in treatment or mismanagement. In this review article, we discuss many common ophthalmologic procedures, their indications, and most likely complications. We also provide illustrative operative photographs and radiological imaging examples. By understanding the surgical intent, recognizing the devices that are commonly used, and developing familiarity with the appearance of post-operative complications, pitfalls in interpretation can be avoided and patient outcomes ultimately improved.
Topics: Diagnostic Imaging; Humans; Ophthalmologic Surgical Procedures; Orbit; Postoperative Complications
PubMed: 34052071
DOI: 10.1016/j.jocn.2021.05.031 -
Der Ophthalmologe : Zeitschrift Der... Oct 2021The indications for orbital tumor surgery are an incisional biopsy to confirm the diagnosis or in malignant operable tumors a complete excision or a debulking to avoid... (Review)
Review
The indications for orbital tumor surgery are an incisional biopsy to confirm the diagnosis or in malignant operable tumors a complete excision or a debulking to avoid complications in large invasively infiltrating tumors. In the case of benign tumors, the indications for surgery depend mostly on the clinical symptoms and cosmetic esthetic disfigurement. In the present article the preoperative examinations as well as surgical access approaches to different orbital regions, endoscopic procedures and methods of intraoperative navigation are presented. Magnetic resonance imaging is the instrument of choice, whereby in many cases computed tomography (CT) adds further information. Depending on the indications, diffusion-weighted sequences, CT angiography and digital subtraction angiography (DSA, catheter angiography) are added to the preoperative diagnostics. For space-occupying lesions located anterior to the bulbar equator, an anterior orbitotomy can be performed transconjunctivally or transpalpebrally. A lateral orbitotomy is used to reach lateral, laterocranial, and lateroinferior orbital segments, whereas transcranial approaches are suitable for processes located far posterior and for those with retro-orbital intracranial extension as well as for processes in the optic foramen/superior orbital fissure. The indications for an endonasal access approach are processes medial to the bulb or optic nerve and up to the orbital apex. A transantral access can be chosen for caudal, mediolateral, and medioinferior space-occupying lesions. Modern orbital surgery is complemented by endoscopic procedures and intraoperative navigation. Orbital tumors belong to the interdisciplinary relevant diseases. Therefore, an optimal management takes place at specialized multidisciplinary centers.
Topics: Biopsy; Endoscopy; Humans; Orbit; Orbital Neoplasms; Tomography, X-Ray Computed
PubMed: 33893529
DOI: 10.1007/s00347-021-01386-5 -
Advances in Experimental Medicine and... 2023Brain tumors affecting the orbit and orbital tumors affecting the brain are a heterogeneous group of lesions, with histological features, behaviors, diagnostic criteria,...
Brain tumors affecting the orbit and orbital tumors affecting the brain are a heterogeneous group of lesions, with histological features, behaviors, diagnostic criteria, and treatments varying from each other. Dermoid cyst and cavernous hemangiomas are considered the most frequent benign lesions, while non-Hodgkin lymphoma is the most common malignant tumor in this region. Sharing the same anatomical region, clinical manifestations of orbital lesions may be often common to different types of lesions. Imaging studies are useful in the differential diagnosis of orbital lesions and the planning of their management. Lesions can be classified into ocular or extra-ocular ones: the latter can be further differentiated into extraconal or intraconal, based on the relationship with the extraocular muscles. Surgical therapy is the treatment of choice for most orbital lesions; however, based on the degree of removal, their histology and extension, other treatments, such as chemotherapy and radiotherapy, are indicated for the management of orbital lesions. In selected cases, chemotherapy and radiotherapy are the primary treatments. This chapter aimed to discuss the orbital anatomy, the clinical manifestations, the clinical testing and the imaging studies for orbital lesions, and the principal pathological entities affecting the orbit together with the principles of orbital surgery.
Topics: Humans; Orbital Neoplasms; Orbit; Diagnostic Imaging; Brain; Brain Neoplasms
PubMed: 37452951
DOI: 10.1007/978-3-031-23705-8_19 -
European Journal of Ophthalmology Jul 2023To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and...
PURPOSE
To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and to assess the potential clinical advantage of EN in orbital decompression surgery.
METHODS
This retrospective cohort study was performed on 227 orbits of 147 GO patients who underwent EN-assisted orbital decompression (185 orbits) or non-EN-assisted orbital decompression (42 orbits). Assessment included proptosis reduction, best-corrected visual acuity (BCVA), diplopia, ocular restriction and surgical complications.
RESULTS
The proptosis reduction in the EN group was 0.9 mm greater than that in the non-EN group in the entire cohort ( = 0.004) and 1.0 mm greater than that in the non-EN group in the propensity score matching cohort ( = 0.025) at 2 years postoperatively. In all, 78.2% of orbits with sight-threatening GO in the EN group and 52.6% of orbits in the non-EN group showed BCVA improvement ( = 0.026). The proportion of patients with improvement in diplopia was significantly greater in the EN group than in the non-EN group ( = 0.026).
CONCLUSIONS
EN offers anatomical localization and deep-seated tissue visualization in orbital decompression and significantly improves the surgical outcomes for GO.
Topics: Humans; Graves Ophthalmopathy; Diplopia; Retrospective Studies; Treatment Outcome; Decompression, Surgical; Orbit; Exophthalmos; Endoscopes
PubMed: 36718496
DOI: 10.1177/11206721231152628 -
Facial Plastic Surgery : FPS Dec 2021The majority of Graves' ophthalmopathy, or thyroid eye disease, can be managed medically; however, in refractory or severe cases, surgical intervention with orbital... (Review)
Review
The majority of Graves' ophthalmopathy, or thyroid eye disease, can be managed medically; however, in refractory or severe cases, surgical intervention with orbital decompression may be necessary. The majority of the published literature is retrospective in nature, and there is no standardized approach to orbital decompression. The purpose of this review is to evaluate the various surgical approaches and techniques for orbital decompression. Outcomes are ultimately dependent on individual patient factors, surgical approach, and surgeon experience.
Topics: Decompression, Surgical; Graves Ophthalmopathy; Humans; Ophthalmologic Surgical Procedures; Orbit; Retrospective Studies
PubMed: 34500489
DOI: 10.1055/s-0041-1735638 -
Orbit (Amsterdam, Netherlands) Jun 2022Ultrasonic instrumentation has recently emerged as an important modality in orbital surgery. This review was designed to assess the current literature and potential... (Review)
Review
PURPOSE
Ultrasonic instrumentation has recently emerged as an important modality in orbital surgery. This review was designed to assess the current literature and potential advantages of this technology.
METHODS
A PubMed search was performed to identify relevant articles. These manuscripts were reviewed, and their data was abstracted.
RESULTS
Three variants of ultrasonic devices are gaining popularity in orbital surgery, including piezoelectric saws, the cavitron system, and ultrasonic bone aspirators and curettes. Previous manuscripts have described a variety of uses for these technologies, and the purported benefits include enhanced intraoperative visualization, improved facility in tight spaces, less damage to the surrounding parenchyma and vasculature, and excellent intraoperative dissection.
CONCLUSIONS
The emerging body of literature strongly supports the use of these devices in orbital surgery, and these instruments carry the promise of providing smoother, more precise, safer surgery.
Topics: Bone and Bones; Humans; Ophthalmologic Surgical Procedures; Orbit; Ultrasonic Therapy; Ultrasonics
PubMed: 34859746
DOI: 10.1080/01676830.2021.2005635 -
MMW Fortschritte Der Medizin Jun 2023
-
Seminars in Ophthalmology May 2021Historically, surgical access to orbital tumors has required a transcutaneous, transconjunctival or transcranial approach. Resection of orbital tumors is notoriously... (Review)
Review
Historically, surgical access to orbital tumors has required a transcutaneous, transconjunctival or transcranial approach. Resection of orbital tumors is notoriously challenging due to the surrounding dense network of critical structures in a confined bony cavity. Advances in endoscopic endonasal surgery, initially used for sinonasal and skull base conditions, have allowed for expansion of its applications beyond the sinorbital interface. In the past decade, the evolution of techniques has enabled a purely endoscopic, minimally invasive approach to medially located orbital pathology with good outcomes. With experience and multidisciplinary collaboration between orbit and rhinologic surgeons, this has expanded to allow for a safe and effective transnasal approach to nearly all regions of the orbit with or without assistance from the orbital side. This review summarizes the relevant anatomy, variations of surgical approaches, and literature regarding outcomes of the endoscopic endonasal approach to orbital tumors.
Topics: Endoscopy; Humans; Nose; Orbit; Orbital Neoplasms
PubMed: 33787454
DOI: 10.1080/08820538.2021.1890794 -
Clinical Imaging Sep 2022The Superior Ophthalmic Vein (SOV) is the largest vein of the orbit and represents an important orbital venous drainage pathway. SOV is well identifiable on CT and MRI,... (Review)
Review
The Superior Ophthalmic Vein (SOV) is the largest vein of the orbit and represents an important orbital venous drainage pathway. SOV is well identifiable on CT and MRI, and its alterations may be a clue for differential diagnosis. In this pictorial work we illustrate the most frequent conditions in which SOV appearance may be influenced by various pathologies, providing a pictorial guide for imaging interpretation.
Topics: Cavernous Sinus; Humans; Magnetic Resonance Imaging; Orbit; Veins
PubMed: 35809476
DOI: 10.1016/j.clinimag.2022.06.019