Centri di Patologia Orbitaria: distribuzione sul territorio e prospettive

Obiettivo di questo lavoro è stato quello di valutare l'incidenza dei casi affetti da Patologia Orbitaria e l'eventuale variazione negli ultimi anni, e stabilire se questi dati giustificano l'esistenza di un centro specializzato per la diagnosi, la cura e lo studio di queste malattie. Scopo dello studio sarà anche quello di riportare il numero di morti causati dai tumori orbitari e il numero di pazienti con perdita della funzione visiva causate da lesioni orbitarie. Studio retrospettivo basato su una serie di casi affetti da malattie dell'orbita registrati in un singolo centro in un periodo di 26 anni. In questo periodo 4000 casi sono stati osservati provenienti da una area geografica di circa 20000000 abitanti (0,02 incidenza approssimativa). Alcuni tipi di tumori sono aumentati negli ultimi anni, in particolare i linfomi, la cui frequenza si è accresciuta circa il 50%. La mortalità generica causata da una neoformazione orbitaria è risultata essere del 9% e la compromissione della funzione visiva è stata del 7%. Il numero di pazienti esaminato è sufficiente per concludere che la Patologia Orbitaria ha un importante impatto sociale sia per quel che concerne il rischio di vita, sia per il rischio di compromissione della funzione visiva. Per migliorare la conoscenza e il trattamento delle malattie orbitarie è utile la presenza di un centro specializzato ogni 20 milioni di abitanti circa

Orbital dermis-fat graft using periumbilical tissue

Dermis-fat grafts are currently used in orbital reconstruction in,a variety of procedures. The most frequent harvesting site is the gluteal area. However, we encountered some patients with anophthalmic socket who wished to avoid a visible scar on the buttock. In this article, we describe the effort to offer the patient an alternative donor site. Of the last 36 patients with anophthalmic socket who needed a dermal fat implant, 11 wished to avoid a visible scar on the buttock. To satisfy their requests we have endeavored to harvest the dermis graft from the periumbilical area. The rate of absorption, the motility, and the satisfaction of the patients were used as outcome measures and were analyzed carefully. Of 11 patients, 4 were women and 7 were men. The ages of these patients ranged from 24 to 56. The maximum follow-up was 137 months and the minimum 22 months, with a mean follow-up of 79 months. Some degree of absorption of the graft developed in one patient who had a severe absorption and required further operation. Of 11 cases, there were 7 with excellent motility, 3 with good motility, and 1 not evaluated. The motility was measured with the final prosthesis. The results for all patients were satisfactory. The periumbilical area has sufficient concentration of subdermal fat, and it is a relatively hair-free region as the lateral quadrant of the buttock. This area is a suitable alternative donor site of dermal fat implant for anophthalmic socket, especially in young women

Dermoid Cysts - 16-year Survey

A total of 145 patients with orbital dermoid cysts examined at the Orbital Clinic, Institute of Ophthalmology, School of Medicine, University of Naples ''Federico II'' over a period of 16 years were reviewed. The orbital cysts were classified as exophytic and endophytic, according to their site of attachment in relation to the orbital rims. This classification can explain the different natural history of these lesions. The exophytic cysts growing externally are discovered in childhood, whereas the endophytic ones are discovered later in life when they produce bone damage, with or without invasion of the adjacent structures

Epithelioid myoepithelioma of lacrimal gland

we describe a rare case of myoepithelioma of the lacrimal gland composed exclusively of epithelioid cells. Our case showed clear-cut morphological and immunohistochemical features of myoepithelioma that allowed us to easily distinguish it from the above-described benign and malignant proliferation of the lacrimal gland. Myoepithelial cells are generally immunoreactive for S-100, vimentin, cytokeratin, desmin, m-actin and smactin. There is a considerable variation in the immunoreactivity for these antigens in our case, as in the seven previously reported cases. These differences may be dependent on the degree of differentiation. The size of the tumour prompted us to recommend a careful clinical follow-up. The patient had an uneventful post-operative course, and there has been no evidence of relapses over 24 months of follow-up

A case series of Merkel cell carcinoma of the eyelid: a rare entity often misdiagnosed

Merkel cell carcinoma (MCC) is one of the rarest eyelid tumors, with high mortality rate due to lymphatic and metastatic spread. We hereby report six cases of patients with histological diag- nosis of MCC referred to our Orbit Unit between 2012 and 2018, focusing on diagnosis, treatment, and subsequent follow up. All patients underwent surgical excision and systemic work-up. Both MCC TNM and eyelid MCC TNM were used to stage lesions. MCC of the eyelid is usually misdiagnosed as benign or other malignant lesions. A prompt examination and a wide local excision are mandatory. A close follow-up of these patients is advised due to high recurrence rate and lymphatic sprea

Orbital dirofilariasis

Purpose. To warn the ophthalmologist to consider orbital dirofilariasis in the differential diagnosis of inflammatory masses of the orbit. Patients. Two cases with non-specific swelling and pain of the orbit who had a initial diagnosis of "inflammatory pseudotumor of the orbit" Results. These are two new cases of orbital dirofilariasis. Conclusion. In the ophthalmic literature, the highest incidence of ocular dirofilariasis is reported in Italy. Since both these patients had no history of travel in endemic areas of Dirofilaria, this parasitic infection is presumably not rare in Italy and is probably underdiagnosed

Traumatic displacement of the globe into the ethmoid sinus

PURPOSE: To describe displacement of the globe into the ethmoid sinus after an orbital trauma, METHOD: Case report. A 58-year-old man sustained trauma of the left eye and orbit, which resulted in displacement of the globe into the ethmoid sinus. One day after injury, surgery was performed to restore the intact globe into position within the orbit. RESULTS: After operation, the globe held in its anatomical site, and 10 months after surgery the visual acuity was 20/100, slight pallor of the optic disk was present, and there was no limitation of the horizontal and vertical ductions, CONCLUSIONS: To our knowledge, this is the first case of traumatic displacement of the globe into the ethmoid sinus with satisfactory restoration of normal globe position and preservation of vision. (C) 2000 by Elsevier Science Inc, All rights reserved

A Case of Escherichia coli Endogenous Panophthalmitis and Orbital Cellulitis With Normal Workup for Primary Focus

: We describe a case of a poorly controlled diabetic patient with left endogenous panophthalmitis with orbital cellulitis and positive ocular culture of Escherichia coli with negative systemic workup and rare clinical presentation. Was misdiagnosed and mismanaged as acute angle-closure glaucoma. Despite medical treatment with intravenous antibiotics, the patient required evisceration of the left eye as a result of the delay in diagnosis and treatment. A high index of suspicion for endogenous endophthalmitis and awareness of the proper workup and different clinical presentations is needed to avoid vision and life-threatening consequences