Successful delayed treatment of the traumatic orbital apex syndrome by nasal endoscopic decompression surgery

Tong, Yuhua; Chen, Guohai; Jiang, Fangzheng; Wu, Wencan

doi:10.4103/0301-4738.171005

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…When reviewing the literature, we noticed that different studies are not consistent or even contradictory [2‒5]. According to the orbital apex crowding theory of orbital apex crowding, orbital decompression is an effective treatment for DON, but persistent vision loss has been reported in patients with DON who underwent orbital decompression [6, 7]. Therefore, we hypothesize that in addition to crowding of the orbital apex, other pathogenesis mechanisms may promote the development of the DON.…”

Section: Introductionmentioning

confidence: 99%

Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy

Huang

Mao

et al. 2020

Ophthalmic Res

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[Objective] Functional connectivity density (FCD) mapping was used to investigate abnormalities and factors related to brain functional connectivity (F.C.) in cortical regions of patients with dysthyroid optic neuropathy (DON) and to analyze the pathogenesis of DON further. [Methods] Patients diagnosed with thyroid-associated ophthalmopathy (TAO) in the Eye Hospital were enrolled. All patients underwent comprehensive eye examinations and best-corrected visual acuity, visual field(V.F.) test. MRI data collection and analysis were completed in the 2nd Affiliated Hospital of Wenzhou Medical University. The patients were divided into two groups: the DON group, with an average visual field, mean deviation (M.D.) of both eyes < -5 dB, and the non-DON group (nDON group), with an average visual field M.D. of both eyes ≥ -2 dB. [Results] A total of 30 TAO patients (14 men, 16 women) with complete data who met the experimental requirements were enrolled. The average age was 48.79 (40~ 57) years. There were 16 patients in the DON group and 14 patients in the nDON group. No significant differences in age, gender, education level, and the maximum horizontal diameter of either medial rectus muscle were found between the two groups. The difference of brain FCD between the two groups showed significant abnormal connectivity in the right orbital gyri of the frontal lobe (Frontal_Inf_Orb_R) and the left precuneus in the DON group compared with the nDON group. As demonstrated by decreased FCD values in the right inferior frontal gyrus/orbital part, the relevant brain regions were the left middle temporal gyrus, left precuneus, left middle frontal gyrus, right postcentral gyrus, and brain gyri (excluding the supramarginal gyrus and angular gyrus) below the left parietal bone. The FCD associated with the left precuneus was increased, and the relevant brain areas were the left middle temporal gyrus, right cuneus, superior occipital gyrus, and right fusiform gyrus. A significant correlation was identified between the MD. of the binocular visual field and brain FCD. [Conclusion] The abnormal FCD in the cortex of DON patients suggests that a central nervous system mechanism may be related to the pathogenesis of the DON.

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Section: Introductionmentioning

confidence: 99%

Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy

Huang

Mao

et al. 2020

Ophthalmic Res

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“…Over the last 50 years, a total of 347 articles pertaining to OAS were found in the literature. Of these, only 22 pieces of literature met the inclusion criteria and remained for analysis 2–28,34 ( Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…In this situation, a patient with facial trauma may present with TOAS, in the absence of any clear radiographic evidence of facial fractures trapping the cranial nerves, likely related to compression of these structures by swelling of the retro-bulbar soft tissue or a small hematoma. In practice, each case of TOAS likely has both direct and indirect mechanisms at play 2–25 . Traumatic orbital apex syndrome can result both from primary trauma and iatrogenic trauma as well 26–28 …”

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confidence: 99%

A Meta-Analysis of Traumatic Orbital Apex Syndrome and the Effectiveness of Surgical and Clinical Treatments

Talwar

Ricci

2021

Journal of Craniofacial Surgery

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Purpose: Traumatic orbital apex syndrome (TOAS) commonly occurs secondary to trauma and irreversible ischemic optic neuropathy occurs as early as 2 hours after injury. Multiple treatment options have been described, however, there is a lack of consensus regarding the optimal treatment of these patients. Methods: A systematic review of the PubMed Database from 1970 to 2020 was conducted, using the search terms ''orbital apex,'' ''syndrome,'' and ''traumatic'' with the Boolean operators ''AND'' or ''OR.'' Papers that did not describe TOAS, describe patient outcomes or treatments, and those without available full English text were excluded. Patients were clustered and compared based on treatment received with the primary outcomes of improvement in vision or ophthalmoplegia. Results: Three hundred forty-seven papers were identified, of which 22 were included, representing 117 patients with TOAS. A total of 75.9% patients underwent decompressive surgery, 82.6% received steroids, and 72.2% received nerve growth factors. Fewer than 20% of patients were treated with antibiotics, diuretics, hormones, or hyperbaric oxygen. Overall, 51.7% of patients experienced improvement in vision and 85.2% in ophthalmoplegia at 6 months. Patients treated with surgical decompression (66.7% versus 16.7%, P < 0.01) or steroids (60.0% versus 0%; P < 0.01) were more likely to have improvement in vision than those without treatment. Nerve growth factors did not improve vision. Ophthalmoplegia did not improve with any treatment. Conclusions: Outcomes of TOAS tend to be poor, with overall low recovery of vision, though surgical decompression or steroid treatment did suggest improved visual outcomes. Further standardized patient data is needed to elucidate the comparative effectiveness of these interventions.

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“…However, the nasal approach into the medial wall of the orbit is also an acceptable practice, even though it is mostly used for naso-orbital lesions. 15 , 16 Medial orbital wall decompression is the most common procedure where the endonasal endoscopy is utilized. It is also very effective for drainage of orbital abscess and excision or biopsy of medial orbital pathology.…”

Section: Orbitmentioning

confidence: 99%

Endoscopy in the field of oculo-facial plastic surgery

Kashkouli

Beigi

2018

Journal of Current Ophthalmology

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Successful delayed treatment of the traumatic orbital apex syndrome by nasal endoscopic decompression surgery

Cited by 8 publications

References 5 publications

Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy

Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy

A Meta-Analysis of Traumatic Orbital Apex Syndrome and the Effectiveness of Surgical and Clinical Treatments

Endoscopy in the field of oculo-facial plastic surgery

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