Funduscopic Examination Research Articles

Prevalence and Clinical Associations of Peripapillary Hyperreflective Ovoid Mass-like Structures in Craniosynostosis.

Patients with craniosynostosis are at high risk of developing elevated intracranial pressure (ICP) causing papilledema and secondary optic atrophy. Diagnosing and monitoring optic neuropathy is challenging because of multiple causes of vision loss including exposure keratopathy, amblyopia, and cognitive delays that limit examination. Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are an optical coherence tomography (OCT) finding reported in association with papilledema and optic neuropathy. We investigated the prevalence of PHOMS in patients with syndromic craniosynostosis and the relationship with known risk factors of optic neuropathy. This was a cross-sectional retrospective study was performed at Boston Children's Hospital and included 118 eyes (60 patients) with syndromic craniosynostosis that had at least one good quality optic nerve OCT volumetry scan between January 2010 and December 2023. Testing was reviewed by 2 neuro-ophthalmologists to determine the presence of PHOMS. Information collected included demographics, and clinical course including possible Chiari malformation, obstructive sleep apnea (OSA), history of elevated ICP, best-corrected visual acuity (VA), spherical equivalent (SE), retinal nerve fiber layer thickness, macular ganglion cell layer volume, and funduscopic examination. Our primary outcome measure was presence of PHOMS, and secondary outcome measure was the relationship between clinical characteristics and the presence of PHOMS. Mean age at imaged OCT was 9.8 ± 5.2 years and 41/60 (68.3%) patients were female. The prevalence of PHOMS was 17/60 patients (28.3%) or 26/118 eyes (22.0%), higher than previously reported in children without craniosynostosis (P < 0.001). PHOMS were significantly associated with a history of elevated ICP (odds ratio [OR] 14.4, 95% CI: 1.9-111.0, P < 0.001) and with concurrent papilledema (OR 40.4, 95% CI: 6.6-248.0, P < 0.001). OSA, Chiari malformation, best-corrected VA, craniosynostosis variant, and SE were not independently associated with PHOMS. Eyes in children with craniosynostosis had a higher prevalence of PHOMS than reported in children without craniosynostosis. PHOMS were significantly more common with a history of elevated ICP and with concurrent papilledema. PHOMS may serve as a clinically useful indicator of optic neuropathy, and of recurrence of papilledema in patients with craniosynostosis and in other populations characterized by multiple sources of vision loss and cognitive changes that limit evaluation.

H syndrome with bilateral choroidal osteoma: Coincidence or association?

To report a case with bilateral corneal arcus and bilateral choroidal osteoma associated with H syndrome. Descriptive case report. A 16-year-old girl with H syndrome was followed up in the pediatric nephrology clinic for chronic renal failure and was consulted to the ophthalmology clinic. She had low vision for more than 5 years. Slit lamp examination revealed bilateral corneal arcus . Lens and iris were normal. Axial length was 19.99 mm in the right eye and 21.85 mm in the left eye. A bilateral orange-yellow plaque was noted in the posterior pole in the funduscopic examination. Fundus autofluorescence (FAF) showed a bilateral diffuse macular hipoautofluorescence area in correspondence with the decalcified portion of the mass. Optical coherence tomography (OCT) showed a bilateral choroidal mass with a dome-shaped pushing effect on the overlying retina and damage to the outer layers of the retina. Fluorescein angiography (FA) with bilateral patchy diffuse late hyperfluorescence and B scan ultrasonography showed a bilateral solid highly reflective choroidal mass with acoustic shadowing. Orbital computerized tomography (CT) scans showed bilateral hyperdense plaques in the posterior pole. A diagnosis of choroidal osteomas was made for both eyes. This report presents a case with bilateral corneal arcus and bilateral choroidal osteoma associated with H syndrome that has not been previously reported in the literature. Patients diagnosed with this syndrome should undergo routine eye examination, and due to the progressive nature of histiocytosis, they should also be followed closely ophthalmologically.

Optic nerve sonographic parameters in idiopathic intracranial hypertension, case-control study

The most common diagnostic error of IIH is inaccurate funduscopic examination. Moreover, IIH could be diagnosed without papilledema. Trans orbital sonography could be used as a non-invasive and cheap tool for discovering increased ICP (intracranial Pressure). Aim of our study was discovering the changes in ultra-sonographic indices and which one could predict the increased ICP. Sixty-eight patients were diagnosed as definite IIH and 68 healthy volunteers are included in the study who had the same sex and age. ONSD, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were estimated by transorbital color Doppler. Multivariate linear regression was used to discover the predictors of increased ICP. ROC curve was plotted for the predictor. A statistically significant difference was found between IIH patients and controls regarding ONSD, EDV and RI. Multivariate linear regression revealed that ONSD is the only predictor of increased CSP pressure. Its cut-off value indicating high ICP was 5.7 mm on Rt and Lt eye (AUC: 0.916; 95% confidence interval 0.867–0.965; p < 0.001; 90% sensitivity, 80% specificity at Rt eye. AUC: 0.902; 95% confidence interval 0.845–0.958; p < 0.001; 91% sensitivity, 80% specificity at Lt eye).

Relationship between fundus of the eye examination and arterial stiffness.

This review addresses the correlation between arterial stiffness, measured by pulse wave velocity (PWV), and retinal microvascular changes, highlighting the retina as an important accessible window for inferences about cardiovascular health. Arterial stiffness, intrinsically linked to vascular aging and several comorbidities, results in damage to the microcirculation, including ocular vasculature, which can act as a predictor of cardiovascular and cerebrovascular outcomes. The review highlights the relationship between PWV assessment and funduscopic examination, with the aim of improving diagnostic accuracy and optimizing the clinical application of these tools in the management of cardiovascular and ophthalmological diseases, thus promoting more effective and early intervention.

X-linked juvenile retinoschisis associated with an RS1 in-frame deletion and bilateral central serous chorioretinopathy.

To report the case of a patient with X-linked juvenile retinoschisis (XLRS), caused by an in-frame deletion of the RS1 gene, who presented visual loss due to bilateral central serous chorioretinopathy (CSC).Methods: Observational case report. A 34-year-old man, with type-A personality, presented with a one-month history of decreased visual acuity and metamorphopsia in his right eye. Funduscopic examination showed a dome-like foveal elevation in both eyes (OU), as well as subtle pigmentary changes of the retinal pigment epithelium with a tapetal reflex in the fovea. Spectral-domain optical coherence tomography revealed intraretinal cystic foveal changes and serous retinal detachment in OU. Fundus fluorescein angiography of OU showed a focal area of intense hyperfluorescence with leakage in late phases. Electroretinogram revealed a markedly attenuated b-wave and a diminished a-wave in photopic and scotopic phases. Genetic testing revealed a hemizygous c.282_284delCTT deletion in the RS1 gene, predicting a p.Ser95del change at the protein level. The patient was diagnosed with XLRS and central serous chorioretinopathy as a coexisting condition. Patient was observed during a 3-month period but showed no improvement. Therefore, subthreshold micropulse laser was applied, achieving complete resolution of signs and symptoms of CSC. CSC can be a cause of acute or subacute visual loss in patients with XLRS when other complications such as vitreous hemorrhage and retinal detachment have been excluded.

An investigation on choroidal and retinal thickness alterations in Posner-Schlossman syndrome patients

BackgroundWe aimed to compare choroidal thickness (ChT) and retinal nerve fiber layer (RNFL) thickness in the affected and contralateral eyes of patients with Posner-Schlossman Syndrome (PSS) during acute, remission, and intermittent phases.MethodsThis prospective observational study included 18 patients(36 eyes) diagnosed with PSS. These patients underwent a comprehensive ophthalmologic evaluation including slit lamp examination, visual acuity testing, intraocular pressure (IOP) measurement, and funduscopic examination, and assessment of RNFL thickness, macular thickness, and macular ChT. Patient data collected included gender, age, number of keratic precipitates (KPs), and number of episodes. Optical coherence tomography (OCT) was used to measure RNFL thickness, macular thickness, and macular ChT in both eyes during the acute, remission, and intermittent phases. The affected eye was compared with the unaffected eye at each phase.ResultsIn affected eyes, macular ChT was lower in the acute phase compared to the remission phase at N1500, N1000, N500, and subfoveal locations (allp < 0.05).The central macular recess ChT was also significantly thinner in the acute phase compared to the intermittent and remission phases. Age significantly correlated with ChT in the central recess (p = .024). Macular thickness was thinner during the acute phase in the affected eye (p = .048). The RNFL in the affected eye was thinner in the intermittent phase than in the acute phase at the inferior-temporal (p = .011) and global sectors (p = .044). During the acute phase, RNFL in the affected eye was thinner at the superior-nasal (p = .049), inferior-temporal (p = .003), and global (p = .041) sectors compared to the unaffected eye. In the intermittent phase, the affected eye’s RNFL was thinner at the superior-nasal, inferior-temporal, inferior-nasal, and global sectors compared to the unaffected eye (allp < 0.05), while no difference was observed in both eyes at the nasal, superior-temporal, and temporal sectors. The number of episodes and age were significantly associated with RNFL thickness (p < .05).ConclusionThis study demonstrated that in eyes affected by PSS, RNFL, macular ChT, and macular thickness thinned during the acute phase. The number of episodes and age are significant factors in the development of PSS.

INTERNUCLEAR OPHTHALMOPLEGIA IN MULTIPLE SCLEROSIS PATIENT

Introduction: Internuclear ophthalmoplegia (INO) characterized by impaired adduction of the affected eye caused by a lesion in the medial longitudinal fasciculus (MLF). The common cause of INO is demyelinating disease including multiple sclerosis. INO arguably the most discrete localizing sign in medicine, has considerable value in predicting multiple sclerosis. Due to its high spatial resolution, MRI has allowed us to depict in vivo the anatomic organization of the human oculomotor nerve complex, the MLF, and related structures in the brainstem. Case Report: A 48-year-old female presented with blurred vision of both eyes for 2 weeks, but then slowly resolved. Best corrected visual acuity presentation on both eyes were 20/20 with normal intraocular pressure (IOP). Adduction deficit observed on the left eye with no nystagmus. Convergence are not impaired in both eyes. Anterior segments was normal except minimal lens cloudiness in both eyes. Funduscopic examination result also within normal limit. Patient had undergone Computerised Tomography (CT-Scan) and the result was normal, no ischemic area or Space occupied lesion (SOL) or intracranial bleeding were found. Brain MRI showed bilateral optic perineuritis and multiple lesion in bilateral frontoparietalis and in the left side of the pons suggested multiple sclerosis. Discussion: Impairment of adduction movement on the patient’s left eye caused by demyelinating plaque related multiple sclerosis on the left side of the pons as shown MRI imaging. Management in this patient is based on the underlying condition. Conclusion: Internuclear ophthalmoplegia in this cases maybe caused by lesion in the medial longitudinal fasciculus could be related with multiple sclerosis.

CHALLENGE IN TREATING OPTIC NEURITIS IN PATIENT WITH CEREBRAL TOXOPLASMOSIS RELATED TO IMMUNOCOMPROMISED CONDITION

Introduction: This study aimed to discuss the prognosis of optic neuritis in a patient with cerebral toxoplasmosis related to an immunocompromised condition. Case Report: A 28-year-old female complained of blurred vision and double vision 2 weeks before admission, accompanied by headache, low extremities weakness, dysphonia, and dysphagia. Visual acuity of both eyes was 6/30 and worsened to 6/60 in a couple of days. Anterior segment examination revealed anisocoria pupil, and RAPD was positive in the left eye. Funduscopic examination showed a blurry margin and hyperemia of the optic nerve head. There was impaired eye movement, indicating oculomotor and abducens nerve palsies. High titer of IgG Antibody Toxoplasma (264) and very low titer of CD4 (&lt;50) with non-reactive HIV rapid test were found in laboratory findings. Multiple ring enhancement was shown in MRI finding. Unfortunately, patient passed away during hospitalization due to respiratory failure. Discussion: Toxoplasmosis-associated optic neuritis is rare and usually becomes potentially serious. Although parasite detection by microscopy and bioassay is considered the gold standard for the diagnosis of toxoplasmosis, clinical diagnosis relies more on serological examination methods. The high proportion of deaths from this disease is mostly caused by late diagnosis of the infection. Conclusion: Optic neuritis that accompanied by systemic disorders needs special attention and comprehensive treatment among multidisciplinary divisions, especially in the immunocompromised condition. Early detection and primary prevention are important to improve prognosis and survival rate.

Analysis of PDE6G mutations in a patient with retinitis pigmentosa

BackgroundMutations in PDE6A and PDE6B are known to cause autosomal recessive RP in humans, On the other hand, mutations in PDE6G are rare but can lead to severe early-onset RP.Case presentationAn 8-year-old Chinese boy was referred to our hospital for poor vision issues. Refraction with cycloplegia showed high hyperopia with astigmatism both eyes. Funduscopic examination revealed typical bone spicule-type pigment deposits in the periphery and midperiphery. The patient was given glasses and a whole exome sequencing containing mitochondrial genes was performed. The results of genetic testing showed that there was a heterozygous frameshift mutation and a segment deletion in the proband’s PDE6G gene. Analysis of the parental genes showed that frameshift mutation was inherited from the proband’s mother and segment deletion from his father.ConclusionsIn this paper, we give a firsthand report that the complex heterozygous mutations of PDE6G gene can causes autosomal recessiveRP (arRP), which expands the understanding of the pathogenic genes of RP.

Two-year follow-up of a post-traumatic choroidal rupture with a lens luxation patient: a case report

Background: A choroidal rupture is a break in the choroid, Bruch membrane, and retinal pigment epithelium (RPE) that occurs most commonly as a result of blunt ocular trauma. It may be a secondary effect of direct or indirect trauma. This case illustrates an indirect post-traumatic choroidal rupture with lens luxation. Three months following the incident, the patient presented with impaired vision. The posterior segment was found to have a luxated lens during the objective examination of the eye. The funduscopy revealed a white, curvilinear, crescent-shaped streak that was concentric to the optic nerve. Case description: A 45-year-old male from East Java visited the ophthalmology outpatient clinic with a chief complaint of blurred vision in the left eye for three months, followed by pain in the left eye. On examination, the visual acuity was a one-meter counting finger. The lens was luxated to the posterior. The funduscopy examination revealed a curvilinear crescent-shaped streak. Vitrectomy and lensectomy were implemented. After four months of aphakia, the patient underwent a scleral fixation intraocular lens (IOL) implantation. The visual acuity was satisfactory, and no complications were observed during the two-year follow-up. Conclusion: We reported a post-traumatic choroidal rupture and a lens luxation with an optimal outcome after a two-year follow-up.

Multiple Evanescent White Dot Syndrome following COVID-19 Vaccination: Two Case Reports

Purpose: We present two cases of multiple evanescent white dot syndrome (MEWDS) following COVID-19 vaccination.Case summary: We present two cases of visual field defects following BNT162b2 (Pfizer-BioNTech, Kronach, Germany) COVID-19 vaccination. A 14-year-old male experienced reduced visual acuity in the temporal field of his left eye after his second dose. Similarly, a 38-year-old woman experienced decreased visual acuity in her right eye after her first dose. Notably, neither patient had pre-existing medical conditions or exhibited COVID-19 symptoms following vaccination. Funduscopic examination revealed multifocal peripapillary hyperreflective lesions in both cases. Visual field defects and hyperreflective lesions spontaneously resolved within 6 weeks, with normal visual acuity and fundus findings at the 7-month follow-up.Conclusions: The recent COVID-19 pandemic has led to a significant increase in vaccination rates. Notably, MEWDS demonstrated a significant association with previous vaccines, including influenza and hepatitis, and the cases describe herein also suggest a potential association between BNT162b2 vaccination and MEWDS.

Acute cerebral venous sinus thrombosis presenting in papilloedema: a case report

Background: Papilloedema has several aetiologies, including brain tumours, central nervous system inflammation, cerebral venous thrombosis, cerebral venous sinus thrombosis (CVST), and idiopathic intracranial hypertension. CVST is a rare condition and a form of stroke with an incidence of 5:1,000,000/year. Case presentation: A 23-year-old female developed impaired vision in her left eye, accompanied by headache, nausea, and vomiting, 5 weeks prior to hospitalization. Visual acuity in the left eye (OS) was 6/12, which improved to 6/9 on pinhole examination, and to 6/6 with S-0.50 and C-0.50 on the 180° axis. OS intraocular pressure (IOP) was 14 mmHg. Bilateral funduscopic examination revealed papilloedema, peripapillary venous tortuosity, and macular exudate. Both computerised tomography scan and magnetic resonance angiography examination detected superior sagittal sinus thrombosis. Conclusion: Acute CVST is a rare condition. A good prognosis depends on early diagnosis and prompt treatment.

Systemic Metastase in Late Management of Group D Retinoblastoma: A Case Report

Background: Retinoblastoma (RB) is a common malignancy that affects children and is fatal if left untreated. This case report aims to raise awareness the importance of starting therapy immediately in RB patients. Case presentation: A girl aged 1 year 9 months, came with complaints that her left eye (LE) appeared white for 2 weeks. Anterior segment examination was normal. On funduscopic examination, optic nerve was difficult to evaluate, covered by a mass, multiple mass scars on the retina, a size of &gt; 6 mm at the posterior pole, and vitreous seeding. Ultrasound examination and CT scan showed an intraocular mass with calcification. The patient was diagnosed with group D intraocular LE RB and was planned for enucleation but was postponed due to cost constraints. The patient came back after 1 year and was diagnosed with extraocular LE RB stage IVB. Conclusion: Early diagnosis without adequate therapy leads to tumor spread and reduces patient survival.

Association between uric acid and referable diabetic retinopathy in patients with type 2 diabetes

Plasmatic uric acid (UA) has been inconsistently associated with diabetic retinopathy (DR). Specific sight-threatening stages of DR have not been studied for their association with UA. Cross-sectional, comparative study. Between 2014 and 2018 we recruited 210 Mexican individuals > 18 years-old with type 2 diabetes (T2D). Clinical, ophthalmological and biochemical assessment was performed with standardized funduscopic examination. Certified readers classified DR stages. The association between DR and UA was assessed by multiple logistic regression analysis, calculating odds ratios (OR) and 95% CI, after adjustment for covariates. Two hundred and ten patients were included, 41 (19.5%) had referable DR. Subjects with referable (severe or worse) DR had longer diabetes duration, 22 (15–28) vs 15 (8–20) years (P < 0.01); higher levels of UA, 6.5 (5.8–8.1) vs 5.4 (4.5–6.6) mg/dL (P < 0.01); higher systolic blood pressure, 130 (120–140) vs 120 (110–130) mmHg (P < 0.01); higher diastolic blood pressure, 78.4 ± 9.7 vs 75.4 ± 9.2 mmHg (P = 0.03); and lower glomerular filtration rate , 54.1 (41.5–69.6) vs 87.3 (66.8–108.3) mL/min/1.73m2 (P < 0.01) compared with those without referable DR. With multiple logistic regression, after adjustment, per each unit of change (mg/dL) in UA the probability of having referable DR increased 45% (OR = 1.45, 95% CI 1.12–1.87, P < 0.01). When UA was evaluated as dichotomous variable, those with levels ≥ 7.8 mg/dL had almost two times (OR = 2.81, 95% CI 1.00–7.9., P = 0.049) the probability of having referable DR compared with those with levels < 7.8 mg/dL. UA may contribute to the microvascular damage in retinal vessels and therefore hyperuricemia could be a therapeutic target to prevent DR progression.

Assessing Neurology Resident Responsiveness to a Combined Didactic and Simulation-based Funduscopic Examination Workshop (S33.007)

Assessing Neurology Resident Responsiveness to a Combined Didactic and Simulation-based Funduscopic Examination Workshop (S33.007)

Andrographis Paniculata (Burm. F.) Flavonoid Compound and Prevention of Diabetic Retinopathy.

To explore the effect of the flavonoid compounds of Andrographis paniculata by evaluating the glycemic profile, oxidative process, and inflammatory values in rats with diabetic retinopathy (DR). An extract of A. paniculata was macerated with ethanol which yielded flavonoid compounds. Streptozotocin was utilized to induce diabetes mellitus in male Wistar rats. Vucetic's methods were used to evaluate the retinal vessel diameters. Antioxidant parameters and inflammatory cytokines were assessed in retinal tissue. A funduscopic examination revealed some alterations in the retinal veins. In comparison to the DR group with no treatment, the diameter of the retinal vessels in the DR group that was treated with the flavonoid component of the A. paniculata extract (FAP) at doses of 20 and 40 mg/kg body weight (BW) was significantly smaller (P 0.05). The DR treatment groups administered with FAP at doses of 20 and 40 mg/kg BW had a greater ability to reduce TNF-alpha and VEGF levels as compared to the DR rats without treatment (P 0.05), Glutathione, superoxide dismutase (SOD), and catalase levels were increased after receiving FAP at doses of 20 and 40 mg/kg BW (P 0.05). Administration of doses of 20 and 40 mg/kg BW of the A. paniculata's flavonoid compoundsimproved DR in rats via retinal vessel diameter reduction, TNF- and VEGF level reduction, and increasing antioxidants, SOD, catalase, and glutathione.

Hemorrhagic unilateral retinopathy: a report of multimodal imaging in three cases.

To report three cases of hemorrhagic unilateral retinopathy, diagnosed by multimodal imaging. Case report of 3 patients, 2 women and one man, aged 51, 74, and 52, respectively. Symptoms were acute floaters, blurred vision, or central scotoma, unilateral in all cases. The best-corrected visual acuity was 20/20 in the affected eye in 2 patients with a paracentral scotoma, and 20/160 in the third patient. Funduscopic examination revealed multiple unilateral posterior hemorrhages located in the Henle fiber layer in the macula and beneath the internal limiting membrane around the optic disc on spectral-domain optical coherence tomography (SD-OCT). Fluorescein angiography and indocyanine green angiography (ICGA) did not show any vascular abnormalities. SD-OCT angiography (SD-OCT-A) did not show any capillary drop-out or choroidal abnormalities. In all patients, the visual symptoms completely disappeared within a few weeks, with spontaneous regression of the hemorrhages. Hemorrhagic unilateral retinopathy is a rarely reported and poorly understood disorder. ICGA and SD-OCT-A did not allow better understanding the condition. No etiology has been associated with this entity so far. The spontaneous resolution of the present cases confirmed the favorable visual prognosis of the condition.

From the past to the present, optical coherence tomography in glaucoma: a practical guide to a common disease.

Glaucoma comprises a group of disorders of the optic nerve that cause degenerative optic neuropathy, characterised by failure of neuroretinal rim tissue in the optic nerve head, retinal nerve fibre layer, and retinal ganglion cells. Glaucoma imposes a serious epidemiological threat, with an steady increase in the global number of cases. In the current ophthalmological practice, glaucoma is diagnosed via a series of examinations, including routine funduscopic examination, ocular tonometry, gonioscopy, measurement of the visual field, and assessment using the optical coherence tomography (OCT) technique. Nowadays, the OCT technique helps in systematising the diagnostic pathway and is a basic diagnostic tool for detection of early glaucomatous eye changes. It is also vital in assessing progression and monitoring treatment results of patients. The aim of this review was to present the OCT technique as a main tool in diagnosing and monitoring glaucoma.

Blindness Management for Retinitis Pigmentosa with Cataract senile immature : A Case Report

Introduction : Retinitis Pigmentosa (RP), also called pigmentary retinal dystrophy, is the term of hereditary retinal diseases that feature degeneration of rod and cone photoreceptors. The most common complication of RP is cataract. Cataract formation is most likely the result of retinitis pigmentosa-related inflammation response. Cataract is an important secondary cause of visual impairment in RP.&#x0D; Case Illustration : A 39-year old female came to the Hospital with complaint of having blurred vision in both eyes since four years ago. Ophthalmologic examination revealed that visual acuity for her right and left eye was 1/300. Anterior segment examination was revealed lens opacification in right and left eye. Funduscopy examination was revealed bone spicula in right and left eye. Patient was diagnosed with retinitis pigmentosa with cataract senile immature in both eyes. Phacoemulsification with intraocular lens (IOL) implantation were done as surgical management for the right eye.&#x0D; Discussion : RP is one of the leading causes of irreversible blindness. The possible explanation of reduced vision in RP can be photoreceptor cell death and treatable complications of RP. Cataract is the most common anterior segment complication described in RP. Visual acuity in RP could be improved for the complications that receive effective treatment, especially with the improvement of the cataract surgery. However, the visual prognosis and surgical risk following cataract surgery is uncertain, the cataract surgery should still be considered in patients with RP. Phacoemulsification with IOL implantation remains the most preferred method to manage cataracts.&#x0D; Conclusion : Cataract surgery in patients with RP leads to significant improvements in visual acuity

Anterior Orbitotomy with Transcutaneous Approach as Management of Orbital Cavernous Hemangioma

Introduction : Orbital cavernous hemangioma is the most common benign orbital lesion in adults. Management of cavernous hemangioma depends on the presented symptoms. Visual impairment is indication of surgical management. Anterior orbitotomy is the preferred surgical technique for cavernous hemangioma.&#x0D; Case Illustration : A 34-years-old male came with chief complaint of mass in the inferior palpebra left eye (LE) accompanied with double vision for three years. Visual acuity of the right eye (RE) was 1.0 and LE was 0.8. Ophthalmology examination revealed hypertropia, non-axial proptosis, mass lesion sized 4 x2 cm in the left inferior palpebra and RAPD grade I in the LE (Figure 1). Funduscopy examination in both eyes was within normal limit. CT-Scan examination showed intraconal and extraconal inhomogen mass lobulated in the left inferomedial which obliterate inferior and medial rectus muscle (Figure 2). Patient was diagnosed with proptosis and compressive optic neuropathy in LE caused by suspected orbital cavernous hemangioma. Anterior orbitotomy with transcutaneous approach was done (Figure 3). Histopathological examination showed proliferation of large blood vessels lined with endothelial cells as characteristic of cavernous hemangioma (Figure 4). There was improvement of visual acuity and no RAPD after surgery (Figure 5).&#x0D; Discussion : Orbital cavernous hemangioma can compress optic nerve which will cause visual disturbances. Anterior orbitotomy with transcutaneous approach provides wider space when surgeon take out hemangioma completely. It will reduce bleeding caused by truncated mass of hemangioma and increase successful rate of surgery.&#x0D; Conclusion : Anterior orbitotomy with transcutaneous approach can correct globe displacement and visual disturbances caused by orbital cavernous hemangioma.