Orbital Infection Research Articles

Seasonal variations, acute rhinosinusitis and orbital infections in children

BackgroundOrbital infections in children are commonly secondary to acute bacterial rhinosinusitis (ABRS). It is unclear whether seasonal variations can predispose to these complications mirroring acute rhinosinusitis incidence. ObjectiveTo determine the incidence of ABRS as a cause of orbital infections and whether seasonality is a risk factor. MethodsA retrospective review of all children who presented to West Virginia University children's hospital between 2012 and 2022 were reviewed. All children with CT evidence of orbital infection were included. Date of occurrence, age, gender, and presence of sinusitis were reviewed. Children with orbital infection secondary to tumors, trauma, or surgery were excluded. Results118 patients were identified with mean age of 7.3 years with 65 (55.1 %) males. 66 (55.9 %) children had concomitant sinusitis on CT scan, and the distribution of orbital complications per season showed 37 (31.4 %) cases occurred in the winter season, followed by 42 (35.6 %) cases in spring, 24 (20.3 %) cases in summer, and 15 (12.7 %) in fall. Children with orbital infections during winter & spring had sinusitis in 62 % of children vs. 33 % in other seasons (P = 0.02). Preseptal cellulitis was present in 79 (67 %) children, 39 (33 %) children with orbital cellulitis, and 40 (33.9 %) children with abscesses. 77.6 % children were treated with IV antibiotics and 94 % with oral antibiotics, and 14 (11.9 %) with systemic steroids. Only 18 (15.3 %) children required surgery. ConclusionsThere seems to be a seasonal predisposition for orbital complications mainly in the winter and spring seasons. Rhinosinusitis was present in 55.6 % of children presenting with orbital infections. Level of evidence4.

Invasive Optic Nerve Aspergillosis with Intracranial Extension in an Immunocompetent Patient (P10-10.004)

<h3>Objective:</h3> To report on an uncommon case of Invasive Optic Nerve Aspergillosis in an Immunocompetent Patient <h3>Background:</h3> Orbital aspergillosis is an uncommon and life-threatening infection. It often affects immunocompromised individuals but can rarely be seen in immunocompetent patients. We present a case of invasive optic nerve aspergillosis with intracranial extension in an immunocompetent male. <h3>Design/Methods:</h3> Case Report <h3>Results:</h3> 59-year-old man presented with a 6-week history of complete left vision loss and left sided facial pain. He was initially diagnosed with optic neuritis and treated with oral prednisone without resolution of symptoms. Initial work including computed tomography (CT) of the head, magnetic resonance imaging (MRI) of the brain, digital subtraction angiography of the head, fluorescence angiography of the left eye, and temporal artery biopsy were all unremarkable. Optical coherence tomography (OCT) demonstrated mild left optic nerve edema. Due to persistent symptoms, an MRI of the orbits was obtained and revealed left optic nerve diffusion restriction with enhancement along the optic tract, suggesting an abscess. Interval OCT revealed worsening left optic nerve layer thinning. The patient was treated initially treated with ceftriaxone, metronidazole, and vancomycin. The optic nerve abscess was surgically decompressed. Cultures grew Aspergillus fumigatus. He was transitioned to oral isavuconazole for a total of 6 months of antifungal therapy. Repeat head CT one month later revealed skull base osteomyelitis with intracranial extension requiring further surgical debridement. The patient was kept on antifungal therapy. Repeat neuroimaging has been stable but there has been no improvement in his vision. <h3>Conclusions:</h3> Orbital aspergillus is a rare entity and as such is a diagnostic challenge. Multiple surgical debridements in addition to appropriate antifungal therapy may be required as recurrent infections are common. Close interval imaging should be obtained to aid in the initial diagnosis and monitoring of orbital fungal infections. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Whiting has nothing to disclose. Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD serono. The institution of Dr. Malik has received research support from National MS Society .

Methicillin-resistant Staphylococcus aureus-associated orbital cellulitis: a case series

PurposeIn recent years, methicillin-resistant Staphylococcus aureus (MRSA) orbital cellulitis (OC) has drawn increasing clinical and public health concern. We present a case series of MRSA OC encountered at four Australian tertiary institutions.MethodsA multi-centre retrospective case series investigating MRSA OC in Australia from 2013 to 2022. Patients of all ages were included.ResultsNine cases of culture-positive non-multi-resistant MRSA(nmMRSA) OC were identified at four tertiary institutions across Australia (7 male, 2 female). Mean age was 17.1 ± 16.7 years (range 13-days to 53-years), of which one was 13 days old, and all were immunocompetent. Eight (88.9%) patients had paranasal sinus disease, and seven (77.8%) had a subperiosteal abscess. Four (44.4%) had intracranial extension, including one (11.1%) case which was also complicated by superior sagittal sinus thrombosis. Empirical antibiotics, such as intravenous (IV) cefotaxime alone or IV ceftriaxone and flucloxacillin, were commenced. Following identification of nmMRSA, targeted therapy consisting of vancomycin and/or clindamycin was added. Nine (100%) patients underwent surgical intervention. Average hospital admission was 13.7 ± 6.9 days (range 3–25 days), with two patients requiring intensive care unit (ICU) admission due to complications related to their orbital infection. All patients had favourable prognosis, with preserved visual acuity and extraocular movements, following an average follow-up period of 4.6 months (range 2–9 months).ConclusionNMMRSA OC can follow an aggressive clinical course causing severe orbital and intracranial complications across a wide demographic. However, early recognition, initiation of targeted antibiotics and surgical intervention when required can effectively manage these complications and achieve favourable visual outcomes.

Successful management of sub-Tenon's abscess in an adult after strabismus surgery

Periocular and orbital infections post-strabismus surgery are uncommon, with most of these cases reported in children. We report a rare case of sub-Tenon's abscess in a 27-year-old female following strabismus surgery, which was successfully managed with systemic and topical antibiotics without any requirement for surgical drainage of the abscess.

Diagnosis and management of orbital and cranial complications of pediatric acute rhinosinusitis

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

ORBITAL CELLULITIS WITH SUBPERIOSTEAL ABSCESS SECONDARY TO ACUTE SINUSITIS - A CASE REPORT

Orbital infection is an ophthalmological emergency as it can lead to blindness and intracranial spread. Imaging is needed to determine the extent of the infection, to detect complications and predisposing factors as well as for surgical planning. We report a case of a 7 year old boy who presented with a short duration history of nasal discharge, headache, fever with swelling and redness over the left eye. On local examination, the child had edema and erythema over the left eyelids, proptosis and painful restricted movements of the left eye. Imaging revealed extensive pansinusitis, marked axial proptosis of the left globe, marked stranding of the preseptal and orbital fat and a peripherally enhancing subperiosteal collection with central restriction in the extraconal space along the left orbital roof (Stage III Chandler classification of orbital infections).

Tc-99m Ubiquicidin Imaging in Orbital Aspergilloma: an Illustration.

Aspergillus infection is relatively rare disease, and we present a case of orbital aspergillus infection who presented with right orbital pain and swelling. Right orbital lesion was identified on CT, MRI, and PET-CT imaging followed by confirmation of aspergillus on histopathological examination. We demonstrate that Tc-99m ubiquicidin scan can yield positive results in aspergillosis too, enabling its differentiation from non-infective pathologies.

Successful Management of an Acute Case of Orbital Cellulitis of Odontogenic Origin.

Sir, Dental infections left untreated can progress through tissue planes into the orbital space through sinuses and result in orbital abscess which is an ophthalmic emergency. We describe the case of a 47-year-old female, a known diabetic who presented with complaints of severe swelling and pain in periorbital region, associated with fever, vomiting, and prostration for 20 days’ duration. She gave a history of repeated episodes of dental pain arising out of her impacted upper third molar tooth for the past 2 months. Ocular examination of the right eye showed significant proptosis of 24 mm, restriction of extraocular movements in all directions, normal pupillary reaction with best-corrected visual acuity of 6/24, and intraocular pressure of 21 mm of Hg [Figure 1a]. Magnetic resonance imaging (MRI) showed heterogeneous multifocal lesions in the right orbit with T1 hypointensity, T2 hyperintensities with internal septation in the intra-conal and extraconal compartments producing compression over the globe [Figure 1b]. Dental X-ray was suggestive of impacted right maxillary third molar tooth [Figure 1c]. On the second day of her hospital stay, she developed multiple upper and lower eyelid pre-septal and post-septal abscesses which were drained, and the pus was sent for culture and sensitivity. Systemic antibiotics were started in the form of intravenous piperacillin/tazobactam (4.0/0.5 g) 8 hourly, metronidazole (500 mg/100 ml) 8 hourly, and oral linezolid (600 mg) 12 hourly. Blood sugars were monitored and insulin was administered as per her requirement. She was referred to dental surgeon for extraction of the impacted molar tooth. She recovered completely with best-corrected visual acuity of 6/9 and intraocular pressure of 16 mm of Hg. She showed remarkable improvement at 2 weeks after tooth extraction [Figure 1d].Figure 1: (a) Clinical photograph at presentation showing severe proptosis, complete ptosis, erythema, restricted extraocular movements, and pus pointing over lower eyelid skin. (b) MRI sagittal section T1 image showing multiloculated abscesses in intraconal and extraconal compartment of right orbit causing compression of eyeball. (c) Right maxillary posterior intraoral periapical radiograph showing impacted upper third molar tooth. (d) Clinical photograph of the same patient after two weeks with complete resolution of edema, proptosis, and extraocular movements. MRI: Magnetic resonance imagingOrbital cellulitis secondary to dental infection is rare accounting for 2%-5% of all cases of orbital infections.[1] To add to its rarity, orbital abscess constitutes less than 1.3% of abscesses seen in maxillofacial region.[2] Surgical drainage of the abscess and pus sample collection is a recommended modality of treatment as reported by many authors.[3,4] Empirical antibiotics and proper intravenous fluid hydration are mainstay of treatment. Systemic corticosteroids fasten the resolution of inflammation and duration of hospital stay.[5] A multidisciplinary approach with dentists, diabetologists, and ophthalmologists is required to prevent serious complications of venous sinus thrombosis. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Orbital mycobacterial infection: a case report

Orbital mycobacterial infection: a case report

Survival and complication rate of zygomatic implants: a systematic review.

To evaluate the available literature reporting the survival and complication rate of zygomatic implants, assessing factors (such as surgical technique, surgical/restorative plan, population, study design and characteristics, etc.) associated with these outcomes. A comprehensive search was performed in three electronic databases, together with a manual search, to identify clinical studies reporting the survival and/or complication rates following zygomatic implant therapy, to quantify relative rates for both stated outcomes. Results: 101 articles were included: 69 were retrospective in nature, 29 were prospective non-randomized studies and 3 were randomized trials (RCTs).The mean survival rate among retrospective studies was 97.61%, while among prospective non-RCTs and RCTs was 98.53% and 95.92%, respectively. The survival rate was not associated with the surgical technique, nor with the surgical/restorative plan. A trend towards higher survival rate, although not statistically significant (p>0.05), was observed in more recent vs less recent studies.Forty-eight articles reported data on complications related to zygomatic implants, with labial laceration, orbital cavity penetration, hematoma, epistaxis, maxillary sinusitis, infection and oro-antral communication being among the most common adverse event. A lower incidence of maxillary sinusitis was observed for zygomatic implants placed using the extrasinus approach compared to the other surgical approaches (p<0.01). The incidence of maxillary sinusitis and oro-antral communications was found to be less likely in "recent" vs "less recent" studies (p<0.05). Zygomatic implant therapy is a reliable treatment option for rehabilitating the severely atrophic maxilla, with high implant survival rate and relatively low complication rate. Several factors were found to be associated with the incidence of post-operative complications. Nevertheless, the evidence from the literature is mainly based on non-RCTs and therefore these findings have to be interpreted with cautions.

124 Utility of Point-of-Care Ocular Ultrasound in the Evaluation of Periorbital and Orbital Infections

Periorbital and orbital infections are one of the frequent reasons for emergency department (ED) visits. Emergency Physician-performed point-of-care ultrasound (POCUS) has become more prevalent in the evaluation of patients presenting to the emergency department (ED). The objective of this study is to determine the utility of POC ocular ultrasound in the assessment of patients presenting to the ED with suspected preseptal and septal (orbital) cellulitis.

Blindness Secondary to Odontogenic Infections: Case Series from a Tertiary Health Care Facility in Sokoto, Northwestern Nigeria

Blindness secondary to odontogenic orbital infection is not uncommon. We report five (5) cases of severe odontogenic orbital cellulitis causing blindness. These patients were seen and managed over a 3-year study period (from July 2019 to August 2022) at the Dental and Maxillofacial surgery clinic of Usmanu Danfodiyo University Teaching Hospital Sokoto. There were 2 male children and a female child in the age range of 6-10years with a mean±SD of 7.7±2.1, a 37-year-old male and a 24-year-old female. Cancrum oris/osteomyelitis was the primary diagnosis in one child, right maxillary osteomyelitis in two children, buccal +temporal space abscess and buccal space abscess in the two adult (male and female) patients respectively. All patients had a preceding history of toothache before the onset of other symptoms. All the patients had visual acuity of no light perception in the affected eye. Additionally, they had a varying degree of proptosis and restricted ocular motility while one child presented with purulent discharge and disorganized globe. Aggressive medical and surgical treatment was instituted in consultation with the ophthalmologists, which resulted in the resolution of the disease in all the patients.

Focus on Ophthalmopathology - Orbital Infections from Hordeolum to Necrotizing Fasciitis.

(Peri)orbital infections comprise a multitude of diagnoses, ranging from common hordeolum to rare but life-threatening necrotizing fasciitis. However, these disease entities are rarely diagnosed by an ophthalmic pathologist because (peri)orbital infections are usually diagnosed clinically, with the help of imaging and microbiological techniques when indicated. In this review article, the role of ophthalmopathology in the diagnosis of (peri)orbital infections is illustrated on the basis of several exemple diagnoses. An infectious hordeolum must be distinguished from a noninfectious chalazion. A nodular thickening of the eyelid, which is diagnosed and treated as a chalazion, can hide a malignant neoplasia. The correct diagnosis and treatment of canaliculitis is often delayed. In this context the most common causative organism, Actinomyces, can be depicted histologically, as can lacrimal stones/dacryoliths. Necrotizing fasciitis is a rapidly worsening infection of the fascia, which can lead to necrosis, sepsis, and death. During the Sars-CoV2 pandemic, an increased incidence of mucormycosis cases was observed, especially in India. This superinfection was facilitated by the widespread use of steroids and immunosuppression. Histologically, it is possible to visualize infiltration of vessel walls by the fungus. Ophthalmopathology contributes to the diagnosis and to understanding the pathophysiology of these diseases.

A prospective case series on rhino orbital cerebral mucormycosis in Egypt: Epidemiology, systemic implications, and treatment

Introduction and importanceTo identify and recognize systemic implications, clinical, characteristics, and management of a group of patients with rhino orbitocerbral mucormycosis infection. Case presentationThe study included twenty-five patients aged range (12–71 years) with rhino orbital cerebral mucormycosis infection who were admitted to the oral and maxillofacial department in Cairo, Egypt from January 2016 to January 2021. The diagnosis was based on clinical examination, radiographic evaluation, and histopathological reports. Cases were managed according to severity and extension of the infection. Clinical discussionsixteen (64%) males and 9 (36%) females mean age was 44.17 years in a presented sample. 98% of orbital involvement was unilaterally always related to the Right eye (for unknown cause) mortality rate of about six patients (25%). Identified risk factors included eighteen patients (72%) who had diabetes mellitus of these patients ten were undiagnosed at the time of examination, while seven (18%) patients with the hematological disorder as Hodgkin or non-Hodgkin lymphoma, aplastic anemia, and Wegener's disease. These patients were managed by aggressive surgical debridement, antifungal drugs (Amphotericin B), and adjunctive treatment with hyperbaric oxygen Hyperbaric oxygen was used in five patients post-surgically. All investigations were done with mean values of blood glucose level, hemoglobin and WBC were noticeably abnormal. ConclusionsEarly identification and reorganization of systemic implications, early clinical diagnosis of patients with mucormycosis infection will facilitate and improve management strategies and outcome of those patients. Understanding this disease will help in rapid and proper management into place to face this lethal opportunistic infection. The most common predisposing factor was diabetes mellitus followed by patients with hematological malignancies.

Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections

To evaluate risk factors associated with surgical intervention and subperiosteal/orbital abscess in hospitalized children with severe orbital infections. We conducted a multicenter cohort study of children 2months to 18years hospitalized with periorbital or orbital cellulitis from 2009 to 2018 at 10 hospitals in Canada. Clinical details were extracted, and patients were categorized as undergoing surgical or medical-only management. Primary outcome was surgical intervention and the main secondary outcome was clinically important imaging. Logistic regression was used to identify predictors. Of 1579 patients entered, median age was 5.4years, 409 (25.9%) had an orbital/subperiosteal abscess, and 189 (12.0%) underwent surgery. In the adjusted analysis, the risk of surgical intervention was associated witholder age (age 9 to <14: aOR 3.9, 95% CI 2.3-6.6; and age 14 to ≤18years: aOR 7.0, 95% CI 3.4-14.1), elevated C-reactive protein >120mg/L (aOR 2.8, 95% CI 1.3-5.9), elevated white blood cell count of 12-20 000/μL (aOR 1.7, 95% CI 1.1-2.6), proptosis (aOR 2.6, 95% CI 1.7-4.0), and subperiosteal/orbital abscess (aOR 5.3, 95% CI 3.6-7.9). There was no association with antibiotic use before hospital admission, sex, presence of a chronic disease, temperature greater than 38.0°C, and eye swollen shut. Complications were identified in 4.7% of patients, including vision loss (0.6%), intracranial extension (1.6%), and meningitis (0.8%). In children hospitalized with severe orbital infections, older age, elevated C-reactive protein, elevated white blood cell count, proptosis, and subperiosteal/orbital abscess were predictors of surgical intervention.

Septic shock induced by latent odontogenic orbital infection: a case report

A 65-year-old patient was admitted to the hospital due to proptosis of the left eye accompanied with ophthalmodynia and toothache for two months. Ophthalmic examination revealed a palpable mass around the lateral orbit and temporal fossa, and maxillofacial CT suggested a malignant tumor invading the left orbital floor wall. One week later, the patient was diagnosed with left orbital cellulitis and septic shock due to peri-orbit redness, eyelid edema, chest tightness, nausea, vomiting, hypotension, and a marked increase in peripheral blood neutrophil count. The infection was well controlled after remission of shock, anti-infective therapy and surgical drainage. At 2 months after surgery, the surgical incision of the upper eyelid skin recovered well and the best corrected visual acuity of the left eye was 1.0.

A Sandwich-Like Oral Mucosa Graft-Conjunctiva In Situ-Dermis-Fat Graft for Reconstruction of the Anophthalmic Socket with Ocular Infection History.

IntroductionA novel technique of using a sandwich-like structure, namely, an oral mucosa graft (OMG)–conjunctiva in situ–dermis-fat graft (DFG) (OMG-C-DFG), to reconstruct a contracted and low-capacity anophthalmic socket for a patient with ocular infection history was evaluated.MethodsThis was retrospective case study of four patients (cases) who underwent anophthalmic socket reconstruction surgery in which the OMG-C-DFG technique was applied. The procedures were performed in the Department of Ophthalmology at the Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (Shanghai, China). Postoperative cosmetic appearance, graft outcome, the ability to wear an ocular prosthesis, and postoperative complications were evaluated.ResultsThe median (± standard deviation) age of patients was 41.5 ± 22.1 (range 10–60) years. All patients suffered from contracted and low-capacity anophthalmic sockets. Three patients had a history of orbital implant infection and one patient had a history of enucleation due to exogenous endophthalmitis after globe rupture. The DFG and OMG were harvested from the abdominal region and lower lip, respectively. All four patients achieved a good postoperative appearance, with dermal surfaces appearing pink and smooth, the orbital areas showing good fullness, the ocular prosthesis showing good wearability, and no narrowing of the sockets. There was no lipid secretion, fat lysate outflow, or infection in the graft bed. There were only small amounts of scars and no infection of the donor site.ConclusionThe sandwich-like structure can be effectively used to reconstruct the contracted and low-capacity anophthalmic socket with a history of orbital infection in one stage.

Development and Evaluation of Chitosan Nanoparticles for Ocular Delivery of Tedizolid Phosphate.

This study investigates the development of topically applied non-invasive chitosan-nanoparticles (CSNPs) for ocular delivery of tedizolid phosphate (TZP) for the treatment of MRSA-related ocular and orbital infections. An ionic-gelation method was used to prepare TZP-encapsulated CSNPs using tripolyphosphate-sodium (TPP) as cross-linker. Particle characterization was performed by the DLS technique (Zeta-Sizer), structural morphology was observed by SEM. The drug encapsulation and loading were determined by the indirect method. In-vitro release was conducted through dialysis bags in simulated tear fluid (pH 7) with 0.25% Tween-80. Physicochemical characterizations were performed for ocular suitability of CSNPS. An antimicrobial assay was conducted on different strains of Gram-positive bacteria. Eye-irritation from CSNPs was checked in rabbits. Transcorneal flux and apparent permeability of TZP from CSNPs was estimated through excised rabbit cornea. Ionic interaction between the anionic and cationic functional groups of TPP and CS, respectively, resulted in the formation of CSNPs at varying weight ratios of CS/TPP with magnetic stirring (700 rpm) for 4 h. The CS/TPP weight ratio of 3.11:1 with 10 mg of TZP resulted in optimal-sized CSNPs (129.13 nm) with high encapsulation (82%) and better drug loading (7%). Release profiles indicated 82% of the drug was released from the TZP aqueous suspension (TZP-AqS) within 1 h, while it took 12 h from F2 to release 78% of the drug. Sustained release of TZP from F2 was confirmed by applying different release kinetics models. Linearity in the profile (suggested by Higuchi’s model) indicated the sustained release property CSNPs. F2 has shown significantly increased (p < 0.05) antibacterial activity against some Gram-positive strains including one MRSA strain (SA-6538). F2 exhibited a 2.4-fold increased transcorneal flux and apparent permeation of TZP as compared to TZP-AqS, indicating the better corneal retention. No sign or symptoms of discomfort in the rabbits’ eyes were noted during the irritation test with F2 and blank CSNPs, indicating the non-irritant property of the TZP-CSNPs. Thus, the TZP-loaded CSNPs have strong potential for topical use in the treatment of ocular MRSA infections and related inflammatory conditions.

Low incidence of hemorrhagic complications both during and after surgical procedures in patients maintained on prasugrel single antiplatelet therapy

Background and purposePrasugrel (Pra) is a third-generation thienopyridine that inhibits platelet aggregation via irreversible blockade of P2Y12 receptors. While several published studies have examined the use of Pra and acetylsalicylic acid (ASA) in coronary and neurovascular stenting procedures, there is only anecdotal evidence regarding the use of Pra as single antiplatelet therapy (SAPT) in open surgical procedures. This topic has become important because previous studies have revealed that neurovascular devices with antithrombotic coatings can be implanted using non-invasive procedures in patients maintained on Pra SAPT. Material and methodsPatients who underwent open surgery under Pra SAPT between March 2020 and February 2022 were evaluated retrospectively. Adequate platelet inhibition both before and after the procedures was verified in all patients using Multiplate (Roche Diagnostics) and VerifyNow (Accriva) tests. Intraoperative and postoperative hemorrhagic events were recorded based on reviews of the procedure reports and interviews with the surgeons. ResultsThe study enrolled 21 patients who underwent 23 open surgical procedures while maintained on Pra SAPT. The procedures included one extirpation of a brain arteriovenous malformation, seven extra-intracranial bypass surgeries, four ventriculoperitoneal shunts, one eye enucleation for an intractable orbital infection, two gastrostomies, one bone flap reinsertion after craniectomy, one decompressive craniectomy, one case requiring cranial surgical wound care, one colporrhaphy, one transurethral resection of urinary bladder cancer, two tumor oophorectomy/hysterectomy procedures, and one aneurysm clipping. None of the 23 procedures resulted in excessive intraoperative or postoperative hemorrhage. ConclusionIn a small retrospective series of patients who required antiplatelet therapy for neurovascular indications, Pra SAPT resulted in no significant increase in the incidence of perioperative and postoperative hemorrhagic complications.

Imaging Findings of Pediatric Orbital Masses and Tumor Mimics.

Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.