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Combined vascular malformations are complex vascular anomalies that have high morbidity and therefore, therapeutic strategies are hard to establish. In this report, we aim to present two pediatric cases of ocular combined vascular malformations successfully treated with rapamycin. [ABSTRACT FROM AUTHOR]

The lateral orbital orbicularis propeller flap (LOOP) is a propeller flap raised on a non-axial orbicularis oculi pedicle. Once mastered, it is speedy to raise, extremely reliable, and capable of transposing thin, supple, and relatively hairless skin and subcutis from the temple region to the periocular region. We aim to present our experience in using the LOOP flap for the reconstruction of a range of periocular defects. Retrospective review utilising our Mohs database, electronic records, and image library. A total of 44 reconstructions were performed. Of the 39 lower lid defects, 22 were full-thickness (bilamellar). Posterior lamella reconstructions in these 22 cases were free tarsoconjunctival graft (20), conchal cartilage with perichondrium (1), and Hewes flap (1). A total of 13 reconstructions of the 22 were total or near-total lid reconstructions. A further 17 patients had anterior lamella defects alone, of which 3 amounted to resurfacing the entire lid. However, 5 patients underwent upper lid reconstruction, 2 of which were 50% lid, 2 required a free tarsal graft, and 1 conchal cartilage graft with buccal mucosa. There were no instances of necrosis of either the flap or the posterior lamella grafts. There were 7 minor complications. In our unit, the LOOP flap has become the reconstruction of choice for laterally based, transversely extensive defects of upper lid, lower lid, and malar areas. Its reliability, relative simplicity, and excellent cosmetic and functional outcomes merit much wider utilisation amongst the plastic and ophthalmic surgery community. [ABSTRACT FROM AUTHOR]

Adenoid Cystic Carcinoma (ACC) is an uncommon malignancy and it's orbital primary presentation with no glandular involvement is exceedingly rare. However, ACC must be considered in the diagnosis of an orbital tumor, since complications such as intracranial spread and recurrence are often described. We present a case of primary orbital ACC treated with surgical excision and the outcome of a long term follow-up in the light of a litterature review.

IntroductionComplicated rhinosinusitis is a rare but life-threatening pathology that requires both medical and surgical treatment as soon as possible. The spread of the infection from the paranasal sinuses affects, most often, the orbit, patients presenting diplopia, preseptal cellulitis, orbital cellulitis, or even blindness alongside exteriorization of puss from the middle meatus and nasal obstruction.Materials and methodsWe carried out a retrospective review of 32 patients that were diagnosed in our clinic with complicated rhinosinusitis from 2015 to 2022. All the patients received at least one intravenous antibiotic, and some also received antifungal drugs. All patients underwent surgery, either endoscopically or combined approach. Nasal washout or nasal swabs during surgery were sent for laboratory examination in all patients, and we studied the microbial etiology in these extensive infections. A database with all the information regarding demographic and medical data was established.Results78% of the patients were male, with a mean age of 50.55. A wide range of antibiotics were used, while some patients, diagnosed with mucormycosis also received antifungal drugs. The mean hospitalization period was 12 days. We correlated the type of antibiotic with the hospitalization period and the outcome but also the degree of involvement of the orbit and the microbial strains identified.DiscussionThe management of patients with complicated rhinosinusitis is complex and dynamic and it must be tailored to every patient, after an interdisciplinary meeting with the infectious disease specialist, ophthalmologist, and rhinologist. The microbial strains that produce such important infections are sometimes multi-resistant or combined, patients usually already had followed a course of antibiotics at home, and choosing the right treatment is sometimes challenging.

Background and Objectives: The aim of this study was to study the prevalence of ocular findings in patients with orbital fractures in a tertiary center in Saudi Arabia. Materials and methods: A cross-sectional observational study was performed. The participants were patients who presented with orbital trauma to the emergency department of King Saud Medical City (Riyadh, Saudi Arabia). Subjects included those diagnosed with isolated orbital fracture using clinical evaluation and CT examination. We performed direct evaluation of ocular findings for all patients. Variables studied included age, gender, site of ocular fracture, cause of trauma, side of fracture, and ocular findings. Results: In total, 74 patients with orbital fractures were included in this study (n = 74). Of the 74 patients, 69 (93.2%) were males and only 5 patients (6.8%) were females. The age range was 8-70 years, with a median age of 27 years. The 27.5–32.6-year age group was the most affected (95.0%). The left orbital bone was involved in the majority of bone fractures 48 (64.9%). The orbital floor (n = 52, 41.9%) and lateral wall (n = 31, 25.0%) were the most prevalent sites of bone fracture among the study patients. Road traffic accidents (RTAs) were the most common causes (64.9%) of orbital fractures, followed by assaults (16.2%) and then sports injuries and falls (9.5% and 8.1%, respectively). Animal attacks were the least cause of trauma (only 1 patient, 1.4%). The occurrence of ocular findings, either alone or in combination, showed that subconjunctival hemorrhage had the highest percentage (52.0%), followed by edema (17.6%) and ecchymosis (13.6%). A statistically significant correlation was reported between the site of bone fracture and orbital findings, with r = 0.251 * and p < 0.05. Conclusions: Subconjunctival bleeding, edema, and ecchymosis were the most frequent ocular abnormalities, in that order. There were a few instances of diplopia, exophthalmos, and paresthesia. Other ocular discoveries were incredibly uncommon. The location of bone fractures was found to be significantly correlated with ocular results.

The d-p orbitals structure is deeply analyzed based on molecular orbital theory. The adsorption energy of intermediates is regulated by covalent interaction mostly and non-covalent interaction methods with a small part. The preparation, performance improvement and mechanism exploration of materials are guided by the combination of physical characterization and theoretical calculation. [Display omitted] • The reaction mechanism of ORR/OER is introduced. • The d-p orbital structure and its covalent interaction control measures are summarized and discussed according to molecular orbital theory. • The development of new ORR catalysts and their active sites are summarized. • The descriptors including electronic structure and coordination structure are summarized. • The hydrogen bond regulation methods, as one kind of noncovalent interaction control measures, are introduced. The oxygen reduction reaction (ORR) and oxygen revolution reaction (OER) show slow reaction kinetics because of the linear relationship that needs to be solved urgently. Transition metal (TM) based ORR/OER catalysts have satisfactory performance and stability, and their orbital structure is of great importance in adjusting the adsorption energy of intermediates. The 3d orbital of TM-based ORR/OER catalysts and the 2p orbital structure of oxygen-containing reactants and intermediates were analyzed in depth, and the results indicated that there is an optimal value or perfect range in orbital structures for satisfactory ORR/OER electrocatalytic activity because the adsorption energy of the reactant needs stronger and the intermediates are weak. According to the above contents, it was explored that the metal-N 4 site (M−N 4) with Fe-N-C catalyst as an example was more likely to react with O 2 and its intermediates. Besides, the latest developments in bimetallic catalysts, high-entropy alloys, and single-atom catalysts were introduced. Moreover, various descriptors are also summarized since the descriptors can link the ORR performance with the catalytic behavior. The related covalent interactions controlling measures including heteroatom doping, defect engineering, stress–strain, potential regulation, and other component regulation methods to break the linear relationship are also written. Considering the larger research space of hydrogen bond (HB) in the breaking linear relationship, this paper described the regulation means of HB interaction, which provides guidance and reference for the construction of more active and tolerant TM-based ORR/OER catalysts in the future. This work is not only applicable to the ORR/OER non-noble metal catalysts, some theories are also applicable to metal-catalyzed other O-containing electrochemical reactions. [ABSTRACT FROM AUTHOR]

An orbital prosthesis is a good alternative to surgical reconstruction for cosmetic and psychological rehabilitation of the patient. It should be aesthetic, durable, light weight, economical, and most importantly retentive. A clinical report explaining the prosthetic rehabilitation of post surgical case of orbital trauma that was followed by orbital exenteration has been described. The aim of the orbital prosthesis was to reinstate the esthetics and boost the psychological and mental state of the patient. The techniques employed along with incorporation of the patient's own hair in eyelashes greatly improved the esthetics.

Rehabilitation of various maxillofacial defects is a time-consuming, complex, and overwhelming task requiring a patient-specific design and technique. Human face disfigurement involving loss of an eye enhances physical and emotional challenges. A wide range of various treatment modalities are being practiced over the period of time, with the recent one being use of ocular implants. Undoubtedly, an implant-supported orbital prosthesis has a superior outcome; it may not be as practical option considering the cost and availability, especially in economically constrained patients. The present case report describes a simplified technique for fabrication of an adhesive-retained silicone orbital prosthesis. [ABSTRACT FROM AUTHOR]

Building a bridge between properties and structures has always been the key focus of any materials research. Nowadays, energy storage materials, especially lithium‐ion batteries, are crucial both in daily life and for the research community. Therefore, there is an urgent need to discover the functionality origin of battery performances to improve and design better material systems. Functionality originates from local symmetry and field. Local symmetry can be described by four fundamental degrees of freedom: lattice, charge, orbital, and spin. On the basis of this, detailed descriptions of the battery's properties in terms of lattice, charge, orbital, and spin are presented from the perspective of frontier transmission electron microscopy in this review. Besides, frontier in situ methods are introduced to record the dynamic structural evolution process during the battery cycle. Future discussion from the perspectives of both materials and characterizations is provided at the end of this review. [ABSTRACT FROM AUTHOR]

The endoscopic endonasal approach (EEA) was originally performed to treat thyroid orbitopathy and proptosis. Since then, this approach also has been used to treat other causes of proptosis. This review systematically identifies surgical outcome and complication rates in patients without thyroid proptosis who underwent endoscopic endonasal orbital decompression. Databases were searched using the following search terms: orbital disease, surgical decompression, and endoscopic endonasal approach. Two independent reviewers screened all abstracts and titles for relevance and all articles passing this screen were subjected to full-text review. To assess risk of bias, we used ROBINS-I (Risk Of Bias in Non-randomized Studies–of Interventions). Eight studies with a total of 74 patients with nonthyroid proptosis were included. Pre- and postoperative eye examination was performed in all studies, but the extent of examination was varying. With a mean age of 35.7 years, most patients were adolescent, and most pathologies induced unilateral proptosis Complications to EEA for orbital decompression were transient diplopia (5 patients/6.8%), transient facial dysesthesia (2 patients/2.7%), ptosis (1 patient/1.4%), infarction (1 patient/1.4%), sinus obstruction (1 patient/1.4%), and enophtalmos (1 patient/1.4%). The authors reported successful reduction of proptosis in all but 2 patients (97.2%), and only 2 authors reported a need for secondary decompression. Medial orbital decompression using EEA is a feasible approach for orbital decompression in patients with nonthyroid proptosis. While being comparable in primary outcome to transorbital approaches, the EEA seems superior in terms of complication rates [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes. Materials and Methods: All patients undergoing atherectomy in the 2010–2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared. Results: Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18–5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09–0.95]). Conclusion: Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds. [ABSTRACT FROM AUTHOR]

Ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (OAML) is the most common type of ocular lymphoma with a higher prevalence in Asia than in Western countries. OAML represents 1%–2% of all non-Hodgkin's lymphoma, 5%–15% of extranodal lymphomas, and approximately 55% of orbital malignancies. "Watch and wait" after biopsy or surgical resection, radiation therapy, and systemic treatment, including antibiotics administration and chemotherapy with various combinations of regimens can be considered for OAML treatment. Radiotherapy is adapted for limited-stage disease with excellent clinical outcomes of 85–100% complete remission and relatively superior local control efficacy and treatment duration. In contrast, chemotherapy has rarely been tested as frontline therapy. Nonetheless, several studies have reported a favorable response and long duration of progression-free survival using chemotherapy adaptations. When the disease involves both eyes or spreads beyond the conjunctiva, the risk of recurrence increases and limited-stage OAML has a recurrence rate of approximately 25% following radiotherapy only. Therefore, although recent consensus in the literature is that patients with limited-stage OAML recommended treating with radiation, physicians may choose the treatment modality not only by its efficiency but also by its adverse events profile and patients' well-being. Herein, we present a large single-center study on OAML that included 292 patients who were followed up for up to 237 months. We collected and analyzed real-world data focusing on treatment outcomes and the role of radiotherapy as frontline therapy, and aimed to compare outcomes and complication profiles of chemotherapy, especially in limited-stage OAML, to identify an optimal treatment strategy. [ABSTRACT FROM AUTHOR]

Context: During the challenging second wave of the COVID-19 pandemic, we encountered a most dreadful fungal infection in the form of COVID-associated mucormycosis (CAM), with a varied pattern of presentation from previous experience. Patients presented with simple fungal sinusitis or more complicated brain abscesses, and newer manifestations such as skull osteomyelitis. We report our findings and innovative treatment strategies used to manage this morbid condition.Objectives: To study the various presentations and surgical strategies in treating post-COVID rhino-orbito-cerebral mucormycosis (ROCM).Settings and Design: Observational cross-sectional study.Methods and Materials: From May to October 2021, 270 patients with CAM were admitted to Andhra Medical College Department of Neurosurgery, King George Hospital, Visakhapatnam, India. A cohort of 61 cases with intracranial involvement was studied in detail. The varied presentations and different or innovative treatment modalities were analyzed.Results: The death rate was 30/270 in the whole cohort, and three deaths (4.9%) occurred in 61 cases with cranial involvement. Thirty-three (54.1%) of the 61 cases were treated surgically: 17 patients required bone excision (for focal osteomyelitis) and 16 cases required abscess drainage/excision.Conclusions: Post-COVID mucormycosis (especially with intracranial involvement) is a highly challenging entity. A multidisciplinary approach with early and aggressive anti-fungal medication combined with timely surgical interventions offers some hope of overcoming this complex infection in CAM patients. We identified some novel techniques during regular follow-up that have proven helpful in combatting this devastating condition. [ABSTRACT FROM AUTHOR]

Masson tumor is a benign vascular lesion characterized by an intravascular papillary endothelial hyperplasia. Peri orbital locations are rare. We report a case of Masson tumor localized in the upper internal angle of the left orbit revealed by progressive ocular proptosis. Orbital computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a vascular mass in the left internal canthus mimicking an arterioveinous malformation. The patient underwent total removal of the lesion with a favorable postoperative follow up. Histological examination found an intravascular papillary endothelial hyperplasia without atypical features corresponding to Masson tumor. A thorough literature review of Masson tumor is presented with a discussion of clinical findings and management. [ABSTRACT FROM AUTHOR]

Oncocytic carcinoma is a malignant tumor characterized by a proliferation of epithelial cells with abundant eosinophilic granular cytoplasm. In this article, we report on the first case of a 61-year-old male patient presenting with oncocytic carcinoma involving the cranio-orbital area. An oncocytic carcinoma in the patient, who reported a sudden decrease in vision in his right eye, was removed through a frontal orbital approach craniotomy. The patient's postoperative development was rapid, and he was admitted to the neurosurgery department for a combined operation after ophthalmological screening. Pathological analysis revealed the tumour cells were large, round or polygonal, and the cytoplasm was finely granular and appeared to be more pleomorphic than the eosinophilic adenoma. Oncocytic carcinoma in the cranio-orbital area is extremely rare. The most effective treatment is early resection to be performed jointly by ophthalmology and neurosurgery, and long-term follow-up and adjuvant chemoradiotherapy are beneficial.

Ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (OAML) is the most common type of ocular lymphoma with a higher prevalence in Asia than in Western countries. OAML represents 1%–2% of all non-Hodgkin’s lymphoma, 5%–15% of extranodal lymphomas, and approximately 55% of orbital malignancies. “Watch and wait” after biopsy or surgical resection, radiation therapy, and systemic treatment, including antibiotics administration and chemotherapy with various combinations of regimens can be considered for OAML treatment. Radiotherapy is adapted for limited-stage disease with excellent clinical outcomes of 85–100% complete remission and relatively superior local control efficacy and treatment duration. In contrast, chemotherapy has rarely been tested as frontline therapy. Nonetheless, several studies have reported a favorable response and long duration of progression-free survival using chemotherapy adaptations. When the disease involves both eyes or spreads beyond the conjunctiva, the risk of recurrence increases and limited-stage OAML has a recurrence rate of approximately 25% following radiotherapy only. Therefore, although recent consensus in the literature is that patients with limited-stage OAML recommended treating with radiation, physicians may choose the treatment modality not only by its efficiency but also by its adverse events profile and patients’ well-being. Herein, we present a large single-center study on OAML that included 292 patients who were followed up for up to 237 months. We collected and analyzed real-world data focusing on treatment outcomes and the role of radiotherapy as frontline therapy, and aimed to compare outcomes and complication profiles of chemotherapy, especially in limited-stage OAML, to identify an optimal treatment strategy.

Orbital metastases secondary to neuroendocrine tumors are exceedingly rare. We present a unique case of a 30-year-old female initially presenting with fever, chills, periorbital swelling, and painful proptosis. CT orbits revealed two ovoid-shaped ring-enhancing lesions in the right lateral and superior rectus muscles and clear sinuses, atypical for infectious post-septal cellulitis. Further work-up included serologic analysis, auto-immune panel, and MRI. Further imaging showed pseudocystic orbital lesions mimicking orbital cysticercosis. Additionally, given the bilateral nature of the lesions and patient's country of origin, this parasitic process was highly suspected. A course of albendazole and steroids led to resolution of symptoms. With a presentation at age 30, this is by far the youngest case reported in literature to date. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Craniofacial injury is of common occurrence following road traffic accidents (RTAs). It often leads to serious disabilities, including significant damage to the visual system. AIM: This study aims to evaluate different ocular and orbital manifestations in patients of craniofacial injury following RTA and estimate the incidence of craniofacial injuries following RTA. MATERIALS AND METHODS: All patients with craniofacial injuries following RTA between August 2014 and August 2016 were included in the study. All patients underwent comprehensive ophthalmic evaluation. Imaging studies were done wherever indicated. RESULTS: Out of 840 cases of RTA, 77 cases presented with craniofacial injuries. Incidence of craniofacial injuries was 9.16%. Of the 77 patients, 65 (85%) were male and 12 (15%) were female. Average age was 31.15 ± 12.57 years. The most common age group affected was 21–30 years age group with 34 (44%) cases. Soft tissue injury to globe and adnexa was the most common injury seen in 69 (89.61%) cases. Injury to the orbital wall was present in 33 (42.85%) cases. The sphenoid bone in 28 (36.36%) cases was most commonly involved followed by frontal bone in 24 (31.16%) cases. Subconjunctival hemorrhage was the most common ocular finding noted on anterior segment examination in 51 (66.23%) cases. Commotio retinae was the most common retinal finding seen in 5 (6.49%) cases. CONCLUSION: Several human and environmental risk factors are associated with increased risk of RTA. If controlled properly, it can lead to reduction in mortality and morbidity associated with RTA.

Abstract Background This study analyzed the clinical features, imaging manifestations, histopathology, immunohistochemistry, and surgical approaches of the orbital solitary fibrous tumor (OSFT), as well as the factors for postoperative recurrence of such disease. Methods The clinical data of 16 patients with OSFT treated in our center from 2003 to 2020 were analyzed retrospectively, and the clinical symptoms, treatment methods, and follow-up results were recorded. Results Of the 16 patients, 8 were females (50.0 %) and 8 were males (50.0 %); the average age of treatment was 37 ± 7 years and the median follow-up time was 74 (8, 228) months. Sixteen patients with OSFT underwent a total of 29 operations, of which 12 were transorbital approach operations and 17 were transfronto-orbital approach operations. Ten patients (10/16, 62.5 %) had recurrence. The recurrence rate of transorbital approach operations was 83.3 % (10/12), and the recurrence rate of transfronto-orbital approach operations was 17.6 % (3/17). No patients had treatment-related complications. Conclusions The main pathological feature of OSFT is a benign tumor. OSFT has a tendency to grow toward the cranio-orbital junction. The postoperative recurrence rate of OSFT is relatively high, so complete tumor resection is very important for prognosis. Inappropriate surgical approaches can lead to incomplete removal of the tumor and cause recurrence. Choosing the correct operation approach according to the position of the OSFT in the orbit and complete removal of the dura mater and bone affected by the tumor is crucial for the prognosis. Nevertheless, regular long-term follow-up after complete resection is necessary.

Orbital tumor surgery can be challenging when the tumor is located in a very narrow surgical field and close to important structures, such as nerves or extraocular muscles that can be damaged during surgery. Advances in technology and special surgical techniques help to avoid such damage. We describe our experience using SONOPET® ultrasonic surgical aspirator to remove 12 different orbital tumors that were difficult to treat due to their poorly defined borders, adhesions, or location. This is a retrospective case series that describes 12 operations that occurred between March 2016 to December 2018 using an ultrasonic device to debulk or remove orbital tumors. Different approaches and handpieces were used for each case depending on the location and consistency of the tumor. All patients experienced an improvement in preoperative signs and symptoms, pain, proptosis, diplopia, or lagophthalmos. Visual acuity, which had been reduced due to the tumor, was also recovered. There were no intraoperative or postoperative complications due to the use of the device. The ultrasonic aspirator is a safe, useful device that can successfully remove or debulk infiltrating orbital masses through any orbital access, regardless of their consistency. It is helpful in cases of difficult anatomical access or difficult extraction due to size or adhesions to the surrounding tissues. [ABSTRACT FROM AUTHOR]

Purpose: To describe the role of localized debridement and instillation of amphotericin B for the management of orbital mucormycosis post COVID-19 infection with a view to avoid exenteration.Methods: The records of all patients with orbital mucormycosis post COVID-19 infection in the last 6 months from December 2020 to June 2021 were evaluated, and ten patients were identified who were successfully managed with localized debridement, that is, removing the fungal tissue and necrotic material and amphotericin B gel instillation locally. MRI scan was used to identify the area of fungal infiltration and presence of necrotic material. Early surgery in the form of transconjunctival orbitotomy was performed for disease in the infraorbital fissure area, and superior transcutaneous lid crease approach was employed for disease in the superomedial orbit or medial orbit. Most patients had lid edema, ptosis, and proptosis; this resolved with the medication. Systemic antifungals were given and the follow-up ranged from 1 to 5 months.Results: The ptosis, proptosis, and lid edema subsided in all, except in one patient who had residual ptosis and in one who had residual ophthalmoplegia. Vision deficit did not occur in any patient. All patients were successfully discharged on oral antifungal medication.Conclusion: Localized clearance of the fungal tissue and the necrotic material is a good option to avoid exenteration in cases of orbital mucormycosis, avoiding disfigurement and mental trauma to the patient. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.Methods: A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.Results: Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.Conclusion: Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation. [ABSTRACT FROM AUTHOR]

We present the clinico-radiological findings of neuroendocrine tumour metastases to the orbit. This was a multicentre, retrospective study of patients with neuroendocrine tumour metastases to the orbit. Data was collected from medical records across five different sites within Australia and the United Kingdom. Nine patients (eleven lesions) were identified. The most common presenting complaint was diplopia (5/9, 56%). Disease occurred bilaterally in two patients. Seven patients (78%) had extraocular muscle involvement. The lateral recti (4/9, 44%) and superior recti (2/9, 22%) were the most commonly affected. Ocular presentation preceded primary tumour diagnosis in three patients (33%). On orbital imaging, metastases were most commonly reported as well circumscribed, ovoid or round, heterogeneous, contrast-enhancing masses. Features of intralesional haemorrhage and bony invasion are uncommonly reported. Neuroendocrine tumour metastasis to the orbit is uncommon. Metastases have a propensity for the extraocular muscles, commonly presenting as heterogeneous, well circumscribed, contrast-enhancing lesions on neuroimaging. New ocular symptoms, a history of neuroendocrine tumours, and these radiological findings, should lead to high clinical suspicion of metastatic disease. Atypical findings warrant biopsy to exclude other causes of orbital lesions. [ABSTRACT FROM AUTHOR]

Abstract Background Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. Case presentation Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. Conclusions Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.

Pranav Shrestha,1 Gulshan Bahadur Shrestha2 1Mechi Eye Hospital, Jhapa, Nepal; 2Department of Ophthalmology, Institute of Medicine, Tribhuwan University Teaching Hospital, Kathmandu, NepalCorrespondence: Pranav ShresthaMechi Eye Hospital, Sainik Mode, Birtamode 7, Jhapa 57204, NepalTel +9779851207295Email stha.pranav@gmail.comAbstract: A 36 year old male presented with a two-month history of a progressively increasing proptosis of the right eye associated with redness. MRI of brain and orbit revealed a mass in the intraconal compartment in the lateral aspect of the right orbit that had T1, T2, and FLAIR high signal intensity and was completely suppressed in the STIR image. Excisional biopsy of the mass resolved the proptosis, and histology revealed encapsulated tumor composed of lobules of mature adipocytes along with fibro collagenous septa. Thus, diagnosis of lipoma was established that has uncommon occurrence in the orbital region.Keywords: orbital, lipoma, proptosis, orbitotomy

AIM: To analyze the clinical imaging characteristics and surgical methods of intraorbitalorganic foreign bodies.METHODS: The materials of 14 patients(14 eyes)with orbital organic foreign bodies from January 2010 to April 2019 in our hospital were retrospectively analyzed, then to summarize their clinical features and imaging characteristics and surgical methods. RESULTS: It had been proved that all of foreign bodies removed from 14 patients's(14 eyes)were organisms. There were 9 patients's(9 eyes)foreign bodies were found with low density and inflammatory response in soft tissue around of 14 patients by orbital three-dimensional reconstruction computed tomography(CT). CT images showed different manifestations due to different properties of foreign bodies, and soft foreign bodies had no characteristic images. Drainage strips were placed after removed foreign bodies. After the operation, the incision healed in the first stage and scar formed. CONCLUSION: Due to the complexity of orbital organic foreign bodies, it is important to make presurgical preparation sufficient and surgical plan individualized for remove the foreign body completely and reduce the difficulty of the surgery.

Purpose: To report a very rare case of silicone oil (SO) migration and emphysema development in the orbit and periorbital tissue, including the lids and subconjunctival space, after a fourth pars plana vitrectomy (PPV) for retinal detachment (RD) treatment. Observations: A 53-year-old woman with a recurrent rhegmatogenous RD in the right eye underwent a fourth PPV under local anesthesia and 23-gauge vitrectomy with fluid-air exchange and SO injection. Localized choroidal detachment occurred during fluid–air exchange near the end of the surgery. High-pressure infusion of air was used as a temporary control measure prior to SO injection. In the early postoperative period, the patient developed hemifacial and periorbital swelling and the air trapped in the upper lid was associated with lid ptosis and conjunctival chemosis. The emphysema resolved with clinical management, and the mechanical ptosis subsided after partial SO removal from the lid. Conclusions and Importance: The SO migration and emphysema in our case were presumably related to the multiple previous sclerotomies. Periorbital emphysema can show spontaneous resolution, but the migrated SO requires surgical management.

Coronary artery disease remains the leading cause of morbidity and mortality worldwide despite advancements in percutaneous coronary intervention (PCI). With an increasing ageing population, there is a significant challenge in addressing severe calcification in atherosclerotic plaque during angioplasty. This review article focuses on atherectomy strategies such as rotational atherectomy (RA), orbital atherectomy (OA) and excimer laser coronary angioplasty (ELCA) aimed at modifying calcified lesions and improving PCI outcomes. RA modifies plaque through rotational ablation, OA uses eccentrically mounted diamond-coated crown and has a reduced entrapment risk compared to RA. ELCA uses pulsatile laser energy to precisely ablate plaque tissue. This review provides insights into the mechanisms, procedural techniques and clinical outcomes associated with these calcium modification techniques. The selection of appropriate devices and adequate training are crucial for optimising lesion modification and enhancing procedural success. Further research and standardised protocols are required to overcome challenges associated with using these devices and expand their usage in clinical practice., Competing Interests: Disclosure: SQK has received honoraria from Abiomed, Novartis and Shockwave Medical, and travel support from Novartis. All other authors have no conflicts of interest to declare., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)

Prior to the initiation of intravenous bisphosphonate therapy for osteoporosis, the impact on ocular health is not routinely discussed with patients. This is due to the scarcity of data on the association between bisphosphonates and ocular side effects, resulting in lack of provider awareness to effectively counsel patients. Furthermore, there is little consensus among clinicians on the safety of re-challenging with intravenous bisphosphonate treatment following ocular complications. This is a case report of a patient who developed orbital inflammation four days after receiving a zoledronate infusion. This case was discussed amongst health care providers and osteoporosis experts during a meeting of Bone Health Extension for Community Healthcare Outcomes (ECHO) virtual platform, which was established in 2015., Competing Interests: Declaration of competing interest There are no disclosures or conflicts of interest for Danielle D'Annibale or for Preethika Ekanayake. E. Michael Lewiecki has the following disclosures: Amgen: investigator, consultant, speaker; Radius: investigator, consultant; Kyowa Kirin: consultant, speaker; Ultragenyx: investigator; Angitia: consultant; Ascendis: consultant., (Published by Elsevier Inc.)

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OBJECTIVE: To determine the frequency of proptosis and associations of proptosis with demographic, clinical and hematological characteristics with acute myeloid leukemia (AML) in children. METHODS: This descriptive study was conducted at Combined Military Hospital, Rawalpindi, Pakistan from January 2018 to July 2020. Patients of AML between 1-12 years of age who presented with and without orbital granulocytic sarcomas (OGS), selected by non-probability convenience sampling technique were evaluated for proptosis. Patients were classified into different subtypes of AML according to French-American-British (FAB) classification. Cytogenetic studies by karyotyping were done to identify different genetic abnormalities associated with AML. Kaplan-Meier survival analysis was used to analyze the overall survival of AML patients. RESULTS: Out of 230 patients diagnosed with AML, 34 (14.78%) patients presented with proptosis. Mean age of presentation was 6.80±3.69 years, with male-female ratio of 2.1:1. Proptosis was unilateral in 19 (55%) and bilateral in 15 (45%) patients. Ten (29.40 %) patients presented primarily with proptosis while 24 (71%) patients presented with proptosis and systemic features of leukemia. Overall AML-M2 was found in 102 (44.3%) cases and other types were observed in 128 (55.6%) cases. Most common FAB AML subtype associated with proptosis was AML-M2 (n=26; 76%). Median duration of survival in AML patients with OGS was 867 days and as compared to 353 days in AML patients without OGS. CONCLUSION: Proptosis is a frequent finding in children with AML. AML-M2 is associated with proptosis in children with AML. Survival in patients with OGS was better than patients without OGS. [ABSTRACT FROM AUTHOR]

Introduction: Kimura disease (KD) is a chronic inflammatory process that can occur within the head and neck region involving deep subcutaneous tissue. Tumour-like nodules were the usual presentations. Albeit rare, there have been reports on orbital KD occurrence in recent years. Case series: We reported seven cases of orbital KD of patients aged 12 to 67 years old from a tertiary referral center in Malaysia. Painless orbital swelling was the most common presentation. The duration of presentation ranges from 2 months up to 6 years. Peripheral blood investigations demonstrated eosinophilia (>5% of white blood cells) and elevated serum immunoglobulin E (IgE) level. The orbital mass measures from 1cm to 5cm in dimension. Differentials include Hodgkin lymphoma, haemangioma, angiolymphoid hyperplasia with eosinophilia (ALHE) or a pseudotumour. In all cases, surgical excision was performed. Histopathological examination showed various degrees of lymphoid hyperplasia with germinal centres, eosinophilic infiltrates, hyalinized vascular proliferation and fibrosis. Diagnoses of KD were made. There were no recurrences seen on available follow up data of 2 cases. Conclusion: Albeit rare, orbital KD alerts to its common existence within the head and neck region. It mimics ALHE microscopically and malignant neoplasm clinically and radiologically. Thus, awareness for this entity, its histological characteristics with clinical and radiological correlations are essential in achieving a correct diagnosis. As there is no consensus on its optimal treatment, and its unpredictable response to the therapeutic interventions, the choice and extent of treatments also varied according to individual response and disease recurrence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19–associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. "R-metafor package" was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041–0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212–4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205–0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful. [ABSTRACT FROM AUTHOR]

With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions. [ABSTRACT FROM AUTHOR]

Calcium-dependent activator protein for secretion 2 (CAPS2; also referred to as CADPS2) is a dense core vesicle-associated protein that promotes the activity-dependent release of neuropeptides including neurotrophins. Addictive drugs appear to prime neurotrophin release in multiple brain regions, but mechanistic factors are still being elucidated. Here, experimenters administered cocaine to adolescent mice at doses that potentiated later cocaine self-administration. Experimenter-administered cocaine elevated the CAPS2 protein content in the orbitofrontal cortex (OFC; but not striatum) multiple weeks after drug exposure. Meanwhile, proteins that are sensitive to brain-derived neurotrophic factor (BDNF) release and binding (phosphorylated protein kinase B and phosphoinositide 3-kinase, and GABAAα1 levels) did not differ between cocaine-exposed and naive mice in the OFC. This pattern is consistent with evidence that CAPS2 primes stimulated release of neurotrophins like BDNF, rather than basal levels. Thus, cocaine administered at behaviorally relevant doses elevates CAPS2 protein content in the OFC, and the effects are detected long after cocaine exposure. [ABSTRACT FROM AUTHOR]

The treatment of orbital lymphaticovenous malformations (OLVMs) has evolved from simple surgical resection to a multimodal approach consisting of sclerosing agents, embolization, and resection depending on the specific components that compose the lesion. Here we present a representative case series of 5 nonconsecutive patients who underwent percutaneous embolization of OLVMs with the Onyx Liquid Embolic System (Medtronic, Dublin, Ireland) before surgical resection between 2019 and 2021. OLVMs are rare, benign, congenital lesions that grow with age and can become symptomatic and disabling. Treatment can be conservative or invasive; depending on the clinical presentation and characteristics of the lesions, treatment modalities can vary. Preoperative percutaneous embolization of OLVMs with the Onyx system is a promising technique, as demonstrated in this case series. [ABSTRACT FROM AUTHOR]

Aim: We report a series of orbital sarcoid in a south Indian patient population and their outcome.Materials & Methods: Retrospective interventional case series.Results: Eleven out of 144cases of biopsy-proven sarcoidosis had orbital involvement. The mean age was 50.64 ± 9.52years and was more commonly seen in women (90.91%). Unilateral presentation with right orbit involvement was more common. Bilateral lacrimal gland enlargement (4cases), inferior orbital mass presenting as proptosis (4cases), preseptal mass above upper eyelid (2cases) and orbital mass encasing the globe (1case) were the different types of orbital presentation. All cases had a dry eye and a negative mantoux test. CT thorax was abnormal in 7cases (63.61%). Biopsy in all cases showed noncaseating granulomatous inflammation. Oral steroids were the standard mode of treatment and none of the cases had recurrences.Conclusions: Orbital sarcoidosis is seen in a high TB endemic country like India and is definitely underreported. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Craniofacial injury is of common occurrence following road traffic accidents (RTAs). It often leads to serious disabilities, including significant damage to the visual system. AIM: This study aims to evaluate different ocular and orbital manifestations in patients of craniofacial injury following RTA and estimate the incidence of craniofacial injuries following RTA. MATERIALS AND METHODS: All patients with craniofacial injuries following RTA between August 2014 and August 2016 were included in the study. All patients underwent comprehensive ophthalmic evaluation. Imaging studies were done wherever indicated. RESULTS: Out of 840 cases of RTA, 77 cases presented with craniofacial injuries. Incidence of craniofacial injuries was 9.16%. Of the 77 patients, 65 (85%) were male and 12 (15%) were female. Average age was 31.15 ± 12.57 years. The most common age group affected was 21-30 years age group with 34 (44%) cases. Soft tissue injury to globe and adnexa was the most common injury seen in 69 (89.61%) cases. Injury to the orbital wall was present in 33 (42.85%) cases. The sphenoid bone in 28 (36.36%) cases was most commonly involved followed by frontal bone in 24 (31.16%) cases. Subconjunctival hemorrhage was the most common ocular finding noted on anterior segment examination in 51 (66.23%) cases. Commotio retinae was the most common retinal finding seen in 5 (6.49%) cases. CONCLUSION: Several human and environmental risk factors are associated with increased risk of RTA. If controlled properly, it can lead to reduction in mortality and morbidity associated with RTA. [ABSTRACT FROM AUTHOR]

CART therapy is an approved therapy in advanced ALL. The mechanism of relapse post‐CART therapy is under vigorous research. We report a 9‐year‐old boy who received CD19‐CART therapy after BM ALL relapse post‐HSCT. He presented with unilateral eye swelling which was initially managed as orbital cellulitis. Later on, it was proven to be an isolated ALL orbital relapse without peripheral blood B‐cell detection or BM involvement. Despite radiotherapy, he subsequently developed refractory CD19 positive ALL BM relapse. This case highlights the possibility of unusual relapse sites after CART‐therapy and that regular peripheral B‐cell monitoring is not enough to assure remission status. Better monitoring tools are needed to detect early disease relapse. Further understanding of the pathophysiology of isolated extramedullary relapse post‐CART therapy is warranted to improve the management of such challenging presentations. [ABSTRACT FROM AUTHOR]

Nodular fasciitis (NF) is a subcutaneous, nodular, pseudo-sarcomatous, fibroblastic proliferation. It is rarely reported in the periorbital region and the management approach is variable. Presented is an eight-year-old female with a three month history of a periorbital mass. Incisional biopsy histologically confirmed nodular fasciitis with a unique gene translocation. The lesion was treated primarily with one intra-lesional injection of triamcinolone acetonide. Four months post-injection, the lesion resolved completely. No recurrence was seen at 12-months follow-up post-injection. No side effects were noted. To our knowledge. this is the first reported use of intra-lesional triamcinolone acetonide as a first-line treatment in periorbital NF. We found this to be a safe and effective treatment, which can obviate the need for surgical excision in a cosmetically sensitive region. [ABSTRACT FROM AUTHOR]

Habits are familiar behaviors triggered by cues, not outcome predictability, and are insensitive to changes in the environment. They are adaptive under many circumstances but can be considered antecedent to compulsions and intrusive thoughts that drive persistent, potentially maladaptive behavior. Whether compulsive-like and habit-like behaviors share neural substrates is still being determined. Here, we investigated mice bred to display inflexible reward-seeking behaviors that are insensitive to action consequences. We found that these mice demonstrate habitual response biases and compulsive-like grooming behavior that was reversible by fluoxetine and ketamine. They also suffer dendritic spine attrition on excitatory neurons in the orbitofrontal cortex (OFC). Nevertheless, synaptic melanocortin 4 receptor (MC4R), a factor implicated in compulsive behavior, is preserved, leading to the hypothesis that Mc4r + OFC neurons may drive aberrant behaviors. Repeated chemogenetic stimulation of Mc4r+ OFC neurons triggered compulsive and not inflexible or habitual response biases in otherwise typical mice. Thus, Mc4r + neurons within the OFC appear to drive compulsive-like behavior that is dissociable from habitual behavior. Understanding which neuron populations trigger distinct behaviors may advance efforts to mitigate harmful compulsions. [Display omitted] • A common way to investigate compulsive behavior is to mutate risk genes in rodents. • Here, we instead investigated intact mice bred to favor inflexible action strategies. • We found that they are prone to habitual and compulsive-like behavior. • Melanocortin 4 receptor in the orbital cortex is intact, despite other alterations. • Mc4r + neurons induce compulsive-like behavior but unexpectedly spare action strategy. [ABSTRACT FROM AUTHOR]