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BACKGROUND: Accurate pre-operative diagnosis of orbital lesions supports appropriate prioritisation of patients into available theatre time. We examine the accuracy of pre-operative clinico-radiological diagnosis in a tertiary centre with weekly dedicated orbital clinics and associated multi-disciplinary team meetings. METHODS: A retrospective case notes review was undertaken for all patients who had an orbital biopsy performed at Bristol Eye Hospital between 2007 and 2017. In this centre, pre-operative clinico-radiological differential diagnoses are discussed during multi-disciplinary team meetings including two orbital specialist ophthalmologists and a specialist neuro-radiologist. Clinico-radiological diagnoses were compared with histopathological outcomes. Subcategory analysis according to histopathological diagnosis was undertaken to look for trends. RESULTS: 172 biopsies were taken from 156 patients, median age 59 years (range 3 months to 91 years). 60.9% of patient were females, with equal numbers of right and left-sided biopsies. 11 patients had inconclusive histopathology. 15 patients did not have a documented preoperative diagnosis or differential offered in available notes. 71 patients (49.0%) demonstrated an exact match between clinico-radiological and histopathological diagnosis, 93 (64.1%) demonstrated a category match (e.g. inflammatory, lymphoproliferative) and for 111 (76.6%), the histopathological diagnosis was considered within the list of proffered clinico-radiological differential diagnoses. CONCLUSIONS: Accuracy of pre-operative diagnosis of orbital lesions undergoing biopsy was higher in our series than previously reported by Koukoulli et al. Specialist head and neck radiology input via regular orbital multi-disciplinary meetings might be reciprocally educational and explain this difference. The authors recommend all surgeons who perform orbital surgery should have access to such multi-disciplinary meetings.

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Radiología , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Radiólogos , Biopsia , Especialización

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BACKGROUND/AIMS: To explore differences in clinical presentations and outcomes between patients with biopsy-proven orbital lymphoma and orbital inflammatory disease. METHODS: Clinical records of all patients who underwent orbital biopsy at Bristol Eye Hospital during a 10-year period were reviewed. Comparisons were made between patients diagnosed with orbital lymphoma and orbital inflammatory disease (OID). RESULTS: 35 patients were diagnosed with orbital lymphoma, undergoing 40 biopsies over the 10-year period studied. 62 patients had OID, undergoing 66 biopsies. Sub-analysis identified six patients with sarcoidosis, four with granulomatosis polyangiitis (GPA), eight with IgG4-related orbital disease, and 44 with idiopathic orbital inflammation (IOI). Patients with sarcoidosis and IOI were statistically younger at presentation than those with lymphoma, with means of 44 and 52 years, respectively, compared with 71 years. Lid swelling/puffiness was more common in OID than lymphoma. More patients with lymphoma lost vision during follow-up than those with OID. CONCLUSIONS: Although younger age of presentation and presence of lid swelling are more likely to indicate orbital inflammation than orbital lymphoma, orbital biopsy remains the gold standard to distinguish these two entities. In the case of orbital inflammation, identification of a specific diagnosis allows appropriate ongoing referral and investigations for potential systemic involvement and helps guide immunosuppressive treatment.

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Linfoma , Enfermedades Orbitales , Sarcoidosis , Humanos , Inflamación/diagnóstico , Linfoma/diagnóstico , Linfoma/patología , Linfoma/terapia , Órbita/patología , Enfermedades Orbitales/patología , Neoplasias Orbitales , Estudios Retrospectivos , Sarcoidosis/patología , Centros de Atención Terciaria

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INTRODUCTION: The aim of this study was to assess the incidence of persistent postoperative cystoid macular edema (pCME) in patients undergoing pars plana vitrectomy with epiretinal membrane peel (ERM) only versus those with ERM peel combined with internal limiting membrane peel (ILM). Secondary endpoints of the study were to review both the central macular thickness (CMT) and visual acuity. METHODS: The patients were divided in two groups, one group in which only the ERM was peeled (n = 36 patients) and another group in which both the ERM and the ILM were removed (n = 62 patients). The results were analyzed retrospectively. Each patient received a complete ophthalmological examination, including best-corrected visual acuity (BCVA) using an ETDRS chart and spectral domain optical coherence tomography, at three time points: prior to surgery and 3 weeks and 3 months after surgery. RESULTS: A total 98 eyes of 98 patients were included in this study. The mean follow-up time was 7.7 months. CMT decreased significantly after surgery in all patients, and none of these changes differed significantly between the two groups. The BCVA increased significantly after surgery across all patients, and there were no significant changes between the two treatment groups. Postoperative pCME occurred in eight patients in each group, representing 22.2% of the 36 patients in the ERM only group and 12.9% of the 62 patients in the ERM/ILM peel group. However, this difference was not statistically significant. CONCLUSIONS: No difference was found between the two groups in terms of incidence of pCME. Both groups experienced had similar decrease in the CMT and improvement in the BCVA postoperatively.