Evaluation of the underlying causes of papilledema in children
Robert A; Hyde, Mehmet C. Mocan , Urmi Sheth, Lawrennce M, Kaufman
ABSTRACT
Objective
The purpose of this retrospective study was to identify the types and relative frequencies of intracranial disorders in pediatric patients who present with papilledema.
Design
Retrospective case series.
Participants and Methods
This study was conducted in 2 pediatric ophthalmology clinics, both providing community-based care in a large inner-city urban center in the U.S. Pediatric patients aged between 0 and 16 years diagnosed with papilledema and who had an underlying etiology identified were included in the study. Patient demographic data, ophthalmologic examination findings, and diagnostic work-up results were identified from clinical records.
Results
The mean age of 38 study patients (19 female, 19 male) was 8.6 ± 4.8 years. Of the 38 patients, 16 (42.1%) had idiopathic intracranial hypertension (IIH) as the underlying cause of the papilledema, 7 (18.4%) had a craniosynostosis disorder, 6 (15.8%) had intracranial tumours, 2 (5.3%) had primary hydrocephalus, and 1 (2.6%) patient each had transverse sinus thrombosis related to sinusitis, hypertensive crisis, subdural hematoma, intracranial abscess, Lyme disease, presumed neurosarcoidosis, and acute disseminated encephalomyelitis. Of the 6 intracranial tumours, 2 (33.3%) presented in the sellar/parasellar region, 2 (33.3%) in the posterior fossa, and 2 (33.3%) were in cortical locations.
Conclusion
Clinicians should have a high index of suspicion for IIH and brain tumours in children presenting with papilledema. Patients with craniosynostosis should have routine eye examinations to monitor for asymptomatic papilledema. Understanding the relative incidence of etiologies for papilledema highlights the urgency of appropriate work-up and the need to consider low-frequency etiologies.
Levator-Muller’s recession using labial mucosa as a spacer in severe eyelid retraction
NeelamPushker; RachnaMeel; Mandeep; S.Bajaj
Abstract
Objective
To evaluate the use of labial mucosa as a spacer for levator-Muller’s recession in correction of severe eyelid retraction.
Design
Retrospective interventional study.
Participants
We retrospectively reviewed records of 4 patients with severe upper eyelid retraction not associated with cicatricial diseases of the conjunctiva.
Method
Surgical correction of eyelid retraction was performed by Levator-Muller’s recession using autologous mucosal graft (from lip) as a spacer through transconjunctival approach. Eyelid height and contour were the main outcome measures evaluated after surgery.
Results
There was resolution of dry eye symptoms in all 4 cases. In 2 cases the corrected eyelid height was within 1 mm of the desired lid position. The lid contour was good in 2 cases and satisfactory in 2 cases because of mild lateral flare. The eyelid height remained stationary till the last follow-up, which ranged from Eyelid height and contour were the main outcome measures evaluated after surgery. 6–30 months (mean: 18 months).
Conclusions
Labial mucosal graft as a spacer for levator-Muller’s recession is a good option for correction of severe upper eyelid retraction. It provides stable eyelid position within 3 months of surgery with no corneal complications.
Fine-needle aspiration biopsy for suspected uveal metastases
Claudine Bellerive, Charles V, Biscotti, Nakul Singh, Arun D, SinghMD
Abstract
Objective
One indication of fine-needle aspiration biopsy (FNAB) is the diagnostic confirmatory of a clinical suspicion of uveal metastasis. We analyzed our experience in this clinical setting to assess the effectiveness of FNAB technique.
Design
Retrospective study.
Participants
28 patients (28 eyes) underwent FNAB biopsy.
Methods
Aspirates were performed using 25-gauge needle and were classified into the following categories: positive, atypical, negative, or nondiagnostic. The electronic medical records provided all clinical data. Subsequent clinical course was considered as the diagnostic standard.
Results
Subsequent clinical course was metastatic tumour in 19 cases (68%) and nonmetastatic tumour in other 9 cases, considered as the diagnostic standard. Cytological interpretations for metastases were positive in 19 cases (68%), atypical in 2 cases (7%), negative in 4 cases (14%), and nondiagnostic in 3 cases (11%). The metastasis-positive cases included 9 adenocarcinoma, 3 uveal lymphoma, 3 small cell carcinomas, 3 non–small cell carcinomas, and 1 metastatic paraganglioma. Both of the atypical cases were suggestive for non-Hodgkin lymphoma. The 4 negative cases for metastases included 2 true negative cases, and 2 false negative aspirates that subsequently proved to be metastatic adenocarcinoma. The 3 nondiagnostic cases included 1 schwannoma, 1 low-grade uveal non-Hodgkin lymphoma, and 1 metastatic adenocarcinoma. The overall sensitivity for FNAB was 87.5%, with a specificity of 100%.
Conclusions
FNAB of suspected uveal metastases is a reliable diagnostic technique.
Evaluation of anxiety and pain in eyelid surgery patients: a pilot study
Stéphanie Lemaître, Miguel González-Candial
ABSTRACT
Objective
A high level of preoperative anxiety may have negative consequences on the medical and psychological outcomes of a surgical intervention. The present study aims to identify the factors associated with high preoperative anxiety in eyelid surgery patients and to determine whether there is a relationship between preoperative anxiety and the pain felt during and after the procedure.
Design
Prospective single-centre pilot study between December 2017 and April 2018.
Participants
Consecutive patients undergoing elective eyelid surgery.
Methods
The Amsterdam Preoperative Anxiety and Information Scale and a numeric rating scale were used to evaluate preoperative anxiety and need for information as well as peroperative and postoperative pain.
Results
Thirty-two patients were included. Mean age at surgery was 65.8 years. Most patients underwent lateral canthoplasty (44%) or ptosis surgery (25%), and all had local anaesthesia. Thirty-eight percent of the patients had a high level of preoperative anxiety (i.e., unsuited to the situation of the surgical stress). Factors associated with higher levels of preoperative anxiety were female sex, age under 65 years, no previous oculoplastic surgery, and unilateral surgery. Patients who felt pain during and after the procedure were found to have had higher levels of preoperative anxiety than the patients who felt no pain.
Conclusions
A high level of preoperative anxiety may increase the pain felt by the patient during and after the surgical procedure. It is therefore important to implement anxiolytic measures before an eyelid surgery is performed, especially in patients who have a risk of elevated preoperative anxiety.