Indications For Orbital Exenteration Research Articles

Indications for orbital exenteration in COVID-19 associated Rhino-orbito-cerebral Mucormycosis

Indications for orbital exenteration in COVID-19 associated Rhino-orbito-cerebral Mucormycosis - IJOOO- Print ISSN No: - 2581-5024 Online ISSN No:- 2581-5016 Article DOI No:- 10.18231/j.ijooo.2021.023, IP International Journal of Ocular Oncology and Oculoplasty-IP Int J Ocul Oncol Oculoplasty

Orbital exenteration: Institutional review of evolving trends in indications and rehabilitation techniques

ABSTRACTPurpose: To determine the changes in indications for orbital exenteration over 20 years and to assess its impact on patient survival. Evolving techniques of rehabilitation of the orbit in our institution were also evaluated.Methods: This was a retrospective review of hospital records of patients who underwent orbital exenteration from 1995 to 2015 in a tertiary care center. Data extracted included primary location of the tumor, preoperative treatments, interval between initial diagnosis and exenteration, status of surgical margins, presence of metastatic disease, and postoperative survival. The types of prosthesis utilized over the years were also reviewed. Cox regression analysis was performed for categorical variables. Kaplan–Meier analysis was used to estimate post-exenteration survival.Results: Over a 20-year period, orbital exenteration was performed on 100 orbits of 100 patients. The mean age was 39.4 years (range: 2 months to 90 years). The most common indications among 98 malignant causes were retinoblastoma, squamous cell carcinoma, basal cell carcinoma, extraocular extension of uveal melanoma, and conjunctival melanoma. Postoperative survival was significantly related to age and tumor location but independent from gender, surgical margin, histopathological diagnosis, previous treatment modality, and preoperative interval. In the whole cohort, 1-year and 5-year survival rates were 97% and 84%, respectively.Conclusions: Exenteration appears to be life-saving in children with orbital extension of retinoblastoma. While patients exenterated for malignant eyelid tumors have the best chance of survival, those with orbital extension of uveal melanoma and adenoid cystic carcinoma of the lacrimal gland have the worst prognosis.

Orbital Preservation in Patients with Esthesioneuroblastoma

Objectives Surgical resection in addition to adjuvant radiation with or without chemotherapy is the mainstay of treatment for esthesioneuroblastoma (ENB). However, management of patients with orbital involvement remains controversial. Historically, orbital exenteration has been advocated when there is evidence of periorbital invasion. Recently, the indications for orbital exenteration have become more selective and orbital preservation has been advocated. We report our experience with anterior craniofacial resection and orbital preservation in patients with ENB. Design Retrospective review of all patients diagnosed with esthesioneuroblastoma who underwent traditional open anterior craniofacial resection at the Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center from 1997 to 2008. Results Sixteen patients were identified with a mean follow-up of 76 months. All patients underwent anterior craniofacial resection via an open approach and adjuvant proton beam radiation. Six of the 16 patients had evidence of either periorbital or lacrimal sac involvement at the time of surgery. All of these patients underwent periorbital resection to negative histologic margins with preservation of the orbit. Conclusion In our study, patients with ENB and periorbital invasion-who were treated with anterior craniofacial resection and periorbital resection with orbital preservation-had no evidence of decreased survival. In all patients, negative histologic margins of the periorbital resection were achieved.

Subconjunctival “Ring” Recurrence of Basal Cell Carcinoma of the Globe

Basal cell carcinoma is the most common indication for orbital exenteration. The recurrence rate of BCC removed with microscopically controlled histology sections is up to 6%. The authors describe the recurrence of a lower eyelid BCC resected with microscopic control that did not manifest itself until 15 years later as a subconjunctival lesion, encircling the globe, and without apparent skin involvement. BCC can present in any manner following surgery, and therefore, judicious follow-up is necessary even after microscopically controlled resection.

Review of Orbital Exenteration from an Eye Care Centre in Western India

Purpose: Indications for orbital exenteration performed over a 10-year period from a tertiary eye care center in Western India.Method: Retrospective review of medical records of all patients who underwent exenteration of orbit over a period from January 1999 to April 2009, at a tertiary eye care center in western India.Result: Out of total 236 major orbital surgeries performed, 15 (6%) underwent orbital exenteration. Age ranged from 19 years to 75 years. Of these 9 were male and 6 female. Except for one case all exenteration were for malignant neoplasm. Lesions originated from eyelid in 8 (54%) cases, orbit in 5 (33%) cases and bulbar conjunctiva in 2 (13%) cases. Histopathological classification of the neoplasm were sebaceous carcinoma (4 cases), basal cell carcinoma (3 cases), squamous cell carcinoma (3 cases), adenoid cystic carcinoma (1 case), transitional cell carcinoma (1 case), malignant fibrous histiocytoma (1 case), lymphoma (1 case) and mucormycosis (1 case).Conclusion: Majority of exenterations performed were for neglected ocular or adnexal malignant lesions that could have been avoided provided patients reported earlier for treatment. Exenterations can be reduced by aggresive patient education about eye malignancy.

Ist eine Exenteratio orbitae bei einem ausgedehnten primären Schleimhautmelanom des sinunasalen Systems angezeigt?

Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.

Indications for Orbital Exenteration in Mucormycosis

To determine whether evidence-based standards exist regarding the indications for orbital exenteration in patients with orbital mucormycosis. A literature review was performed of 113 articles (1943 to 2004). Factors possibly related to patient survival were analyzed. Additionally, a survey was sent to all ASOPRS Fellowship Preceptors to ascertain the frequency, outcome, treatment modalities, and indications for exenteration by these practicing physicians. For published cases, parameter estimates (PE <or= 1.00) indicated that patients with mucormycosis with age >46 years, frontal sinus involvement, and fever were less likely to survive compared with patients without these conditions. Patients treated with amphotericin B (OR, 4.476) and those with diabetes (OR, 4.987) were more likely to survive compared with patients without these conditions. Exenterated patients with fever were more likely to survive compared with nonexenterated patients with fever (P=0.0468). Thirty-four ASOPRS Fellowship Preceptors received surveys; 26 (76%) completed the survey. Responses to specific survey questions showed a varied experience and indication for exenteration throughout the country. : Our study underscores the lack of adequate data regarding the evaluation of treatment of orbital mucormycosis. No standard of care currently exists to guide physicians on when exenteration may benefit a mucormycosis patient. Further study is needed to determine which variables indicate the extent of disease and which variables or analytic scheme might predict the progression of orbital mucormycosis with or without exenteration.