Visual function alterations in orbital tumors and factors predicting visual outcome after surgery

Abstract

Purpose To study the effect of orbital tumors on visual functions and highlight the factors predictive of visual outcome after surgery. Methods A prospective interventional study compared visual function parameters and fundus changes, before and after surgery, in eyes having well-defined orbital tumors with the normal fellow eye. These included visual acuity (VA), refractive error, keratometry changes, color vision, Goldmann visual field (GVF), and visual evoked response (VER). Results In total 28 cases (age range 7-56 years), of which the majority of tumors were vascular (46%) and lacrimal (18%) in origin, had a mean VA of 0.54±0.33 in the affected eye, which improved postoperatively to 0.66 ± 0.31 (P ¼ 0.002). The affected eye had a median refractive error of þ 0.00 DS (À2.00 to 5.13), which was significantly more hyperopic than the normal eye (median þ 0.00 DS; range À1.25 to þ 1.63 DS) and normalized postoperatively. Keratometry showed higher astigmatism in the involved eye (P ¼ 0.004). The fundus showed disc pallor, edema, and/or choroidal folds, of which disc edema resolved in all cases after surgery. In all, 40% of the affected eyes had a deficient color vision and this partially improved postoperatively (P ¼ 0.25). GVF had abnormalities in 10 cases, half of which normalized postoperatively (P ¼ 0.04). The VER of affected eyes had a mean amplitude of 8.91 ± 4.59 lv and latency of 116.3 ± 14.7 ms, with improvement after surgery (P ¼ 0.005 and 0.001, respectively). Conclusion Orbital tumors adversely affected visual functions. The presenting acuity depended on disc changes, color vision abnormalities, and prolonged VER latency. The postoperative VA depended on VA at presentation, amount of proptosis, degree of hyperopia, and clinically significant VER abnormalities.

Biometric and refractive changes after orbital decompression in Korean patients with thyroid-associated orbitopathy

“…Therefore, we concluded that myopic change was induced by AL elongation. However, in contrast to the presence of tumors, which induce astigmatism, 13,16 there were no significant changes in cylindrical refraction or axis in our study (Table 2), because orbital decompression symmetrically widened the space (Figure 2). We found no significant correlation between AL and exophthalmometric change (Figure 1b).…”

“…Moreover, longstanding proptosis could result in permanent corneal shape changes. 13 Accordingly, corneal shape might not be affected by orbital decompression. In addition, results from the wavefront aberrometer showed that postsurgical changes in highorder aberration were not significant (Table 3).…”

“…One previous study explored the correlation between refractive error and orbital tumors occupying the retrobulbar space and reported that hypermetropic change is induced by the tumor and that tumor removal normalizes the hypermetropic change. 13,14 According to Figure 1 Proportion of biometrical changes and graphs showing the correlation between differences in exophthalmometry, AL, and refractive error before and 2 months after orbital decompression. (a) Only five (12%) of 43 eyes had decreased AL, and one subject (2%) had the same AL before and after orbit decompression.…”

Dobras de coroide

“…Over time they become larger and more pigmented, which facilitates identification (1,4) . Choroidal folds are not an unusual finding on fundus examination (5) and are the most prevalent finding in patients with orbital tumour (6) . They are usually asymptomatic but may cause visual disturbances such as hyperopia, astigmatism, and metamorphopsia (1,2,5) .…”

“…Patients with folds caused by intraconal orbital tumours typically have hyperopia, while astigmatism is more common in those with extraconal tumours (6) .…”