Endoscopic transnasal orbital decompression for thyrotoxic orbitopathy

Objective. To evaluate the efficacy of endoscopic transnasal orbital decompression alone for thyrotoxic orbitopathy. Design. Retrospective review of consecutive procedures. Setting. Tertiary referral otorhinolaryngology centre. Patients. Twenty-three eyes of 14 patients. Intervention. Endoscopic transnasal orbital decompression. Main outcome measures. Proptosis reduction, intra-ocular pressure reduction, exposure keratitis reduction, visual acuity improvement, and complication rate. Results. There were no surgical complications for the 23 orbital decompressions. Proptosis reduction was achieved in 22 (96%) eyes. The mean proptosis reduction was 4.6 mm (median, 5.0 mm; range, 1.0-8.0 mm). The postoperative intra-ocular pressure decreased after surgical decompression in 20 (87%) eyes with a mean reduction of 11 mm Hg (median, 6 mm Hg; range, 1-35 mm Hg). Of the 15 eyes with incomplete closure of the eyelid before the operation, 11 (73 %) had complete eyelid closure after surgical decompression. Of the other four eyes that had incomplete closure, the gaps were reduced. The visual acuity was improved for 16 (70%) eyes with a median improvement of 3 Snellen lines (range, 1-8 lines). Conclusion. Endoscopic transnasal medio-inferior orbital wall decompression is a safe and adequate treatment for thyrotoxic orbitopathy with proptosis, exposure keratitis, and visual loss.published_or_final_versio

Clinical features of 46 eyes with calcified hydrogel intraocular lenses

Purpose: To clarify the clinical features of delayed calcification of hydrogel intraocular lenses (IOLs) based on observation of a large case series. Setting: Ophthalmology department of 2 university teaching hospitals, Hong Kong, China. Methods: The first 44 patients with a known diagnosis of calcified IOL were recruited. Medical and ophthalmic histories were obtained. Surgical details, surgical complications, and visual acuity before and after IOL implantation were also retrieved. Patients then had a visual acuity test, a slitlamp examination of the features of the IOL calcification, and a fundus examination for clarity of view. Results: Forty-six eyes of 44 patients had IOL calcification. All had a Hydroview IOL. The onset was from 4 to 26 months after surgery. Ninety-three percent of eyes had generalized IOL calcification, and 96% had forceps marks on the IOL. Mean visual acuity deteriorated from 0.4 at 3 months to 0.13 at 19 months. Visual loss was more severe in patients with diabetes mellitus or ischemic heart disease and in those in which the IOL calcified earlier after implantation. Conclusion: All cases of IOL calcification were delayed in onset. The presence of forceps marks may provide a clue to the pathogenesis. Bilateral but asymmetric involvement in 2 patients suggests that the IOL was involved in the pathogenesis. Affected patients lost an average of 2.8 Snellen lines of visual acuity. Some eyes progressed more rapidly; however, the modulating factors remain unknown. © 2001 ASCRS and ESCRS.link_to_subscribed_fulltex