No abstract

The authors report a penetrating orbitocerebral steel mattress spring injury without permanent ophthalmic or neurologic sequelae. A 44-year-old female mattress factory worker sustained an injury to her right orbit by a high-velocity projectile foreign body. Imaging revealed a metallic spring in the right orbit traversing the optic nerve and superior orbital fissure and lodging in the temporal lobe of the brain. Cerebral angiography demonstrated the steel coil around, but not damaging, the middle cerebral artery and other vessels. With a combined craniotomy and frontal orbitotomy, the spring was removed by meticulous counterclockwise rotation. Postoperatively, the patient had mild left-sided weakness that resolved after several weeks. Ocular examination was normal, including full extraocular movements and a visual acuity of 20/20 in each eye. The authors theorize that the spiral shape and on-axis rotational movement allowed the projectile to follow a path of least resistance penetrating deeply and coiling around, but not injuring, vital structures. Careful counterclockwise rotation under direct intracranial and intraorbital visualization was effective in removing the spring.

PurposeTo emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV).MethodsA retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT.ResultsAfter an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001).ConclusionThis study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.

The authors describe, for the first time, bilateral, sequential large dacryocystoceles during pregnancy and review the literature for this presentation. A 26-year-old, 15-week pregnant woman presented with OD epiphora, diplopia, and pain in the setting of an inferomedial orbital mass. Surgical exploration and histopathology were consistent with a dacryocystocele, and a dacryocystorhinostomy was curative. She returned at 34-week gestation, with an identical presentation on the left side. Review of the literature reveals that dacryocystoceles occasionally present in adults; however, bilateral involvement may be unusual. Bilateral dacryocystoceles have not been previously reported in a pregnant woman.