Immunotherapy in complex treatment of acute optic neuritis associated with herpesvirus infection

Purpose. Evaluation clinical efficacy of complex treatment of optic neuritis (ON) associated with herpesvirus infection (HVI), including methods of immunotherapy. Material and methods. The clinical study involved 26 people (26 eyes) with acute ON associated with HVI. The treatment regimen for all patients within 10 days included delivery through irrigation system implanted into the retrobulbar space to optic nerve: solutions Dexamethasone on decreasing scheme, Emoxypine 1% 0.5 ml and Dicynone 12.5% 0.5 ml. All patients were divided into 2 groups depending on characteristics of therapy. The 1st group consisted of 12 patients, who were treated according to the standard method. 2nd group consisted of 14 patients who received additional intramuscular Imunofan. The duration of immunotherapy was 10–12 days. Results. Analysis of obtained datas showed that more significant positive dynamics was noted in the clinical course of ON in patients of the 2nd group of observation in comparison with the 1st group. Conclusion. The developed strategy of etiotropic and pathogenetic immunotherapy at ON associated with HVI infection, allows shortening recovery time and improving functional results of treatment in absence of relapses of disease within 1 year of follow-up. Key words: optic neuritis, herpesvirus infection, corticosteroid therapy, immunotherapy.

Evaluation clinical efficacy of immunotherapy in complex treatment of acute optic neuritis associated with herpesvirus infection

Purpose. To study the clinical efficacy of complex treatment of optic neuritis (ON) associated with herpesvirus infection (HVI), including methods of immunotherapy. Material and methods. The clinical study involved 37 people (37 eyes) with acute ON associated with HVI. The treatment regimen for all patients within 10 days included delivery through irrigation system implanted into the retrobulbar space to optic nerve: solutions Dexamethasone on decreasing scheme, Emoxypine 1% 0.5 ml and Dicynone 12.5% 0.5 ml, in combination with administration of drugs neuroprotection. All patients were divided into 2 groups depending on characteristics of therapy. The 1st group consisted of 17 patients, who were treated according to the standard method. 2nd group consisted of 20 patients who received additional intramuscular Imunofan in the regimen and doses according to the manufacturer's instructions. Results. Analysis of obtained datas showed that more significant positive dynamics was noted in the clinical course of ON in patients of the 2nd group of observation in comparison with the 1st group. Conclusion. The strategy of etiotropic and pathogenetic immunotherapy at ON, associated with HVI infection, developed by us, allows to shorten recovery time and improve functional results of treatment in absence of relapses of disease within 1 year of follow-up. Key words: optic neuritis, herpesvirus infection, corticosteroid therapy, immunotherapy.

CT definition of the surgical apex in the orbit

The orbital apex is an undefined but well understood concept of Orbital Surgeons. We sought to determine the surgical apex area specifically where the volume ratio decreases significantly impacting on the optic nerve. A retrospective analysis using PACS program processing, measured the right retrobulbar space volume changes in 100 randomly selected cases without orbital pathology where CT was performed for non-ophthalmic indications. Volume of the retrobulbar space was measured between two recognizable landmarks. The first landmark being the point of exit of the optic nerve from the eye and the second landmark the optic nerve's point of exit from the orbit. The measured length between these two points was divided into five equal segments, V1-V5. The volumes of all 5 segments were compared and the most significant area of volume depletion was established. The mean numeric value of measured orbital volumes was compared. A ratio difference of V1/V2 was less than 2, V2/V3 was 2.32 (± 0.27), V3/4 was 3.24 (± 0.39), and V4/V5 was 5.67 (± 1.66). The most remarkable difference in ratio was between V4 and V5 (mean 5.67 ± 1.66 with p < .0001). The V3 segment (the posterior 3/5 of the retrobulbar space volume) is the location where decrease in orbital volume impacts, and measured ratios are statistically significant. We defined the surgical apex as the posterior 3/5 of the retro-bulbar orbital space. It is consequently the area of higher risk for optic nerve compression. This definition could be routinely utilized by ophthalmologists and neuroradiologists when evaluating masses affecting the orbit.

Damage To Eyes, Orbit And Visual Nerve , Combined With Cranial Injury In Emergency Medicine

The features of the clinical course, symptoms and the difficulty of diagnosing traumatic injuries of the eye, orbit and optic nerve are described. A total of 952 patients with concomitant craniocerebral injuries and injuries to the eye, orbit, optic nerve were studied in 2018. The possibilities of computer tomography in the diagnosis of traumatic injuries of the visual tract combined with traumatic brain injury and differential diagnosis of intracranial injuries of the visual tract before the hospital and hospital stages were studied. In the structure of craniocerebral trauma, craniofacial accounted for 187 (19.6%), of which 118 (6%) eye injuries, 20 (10.6%) orbit injuries, 4 (2.1%) optic nerve injuries, 19 (10 %) of patients were diagnosed with a fracture of the walls of the orbit. In 5 (2.6%) patients, an isolated fracture of the lower orbital wall was revealed. Total: 158 men (84.4%), 29 women (15.5%). The patients underwent examination, including examination by a multidisciplinary team (neurosurgeon, maxillofacial surgeon, ENT and ophthalmologist). Anamnesis was studied in all patients, a comprehensive ophthalmological examination was performed: visometry (with optimal correction), refractometry, biomicroscopy, ophthalmoscopy and neuro-ophthalmological examination. All patients underwent radiography of the orbits and skull in frontal and lateral projections, CT, MRI of the brain and orbits. To obtain additional information, 24 (12.8%) patients underwent a two-dimensional ultrasound examination - ultrasound - B SCAN of the eyeball, extraocular muscles and retrobulbar space. Timely topical diagnostics and qualified reconstructive surgeries performed in the early period of craniofacial trauma allows achieving regression of oculomotor disorders in 86.6%, prevents severe consequences and preserves the patient's vision.

Transconjunctival Extirpation of a Voluminous Orbital Cavernoma: 2-Dimensional Operative Video

Purely intraorbital cavernomas remain rare, but still are the most common benign orbital tumors.1 These expansive lesions are now rapidly detected and adequately treated. Surgical resection is the gold standard and a definitive solution. The choice of approach varies between different possibilities, including orbitotomies, trans-sinusal routes, and transconjunctival accesses.2-4 Because the last technique is less known to the neurosurgeon, we describe here a step-by-step guide to perform it. The technique is illustrated with the case of a 62-yr-old male with a voluminous right retroocular cavernoma. He presented a progressive right exophthalmia without visual acuity or campimetric deterioration. Because the cavernoma was purely medial from the optic nerve in the intraconal space, no osteotomy was deemed necessary to extirpate the lesion. The video shows the conjunctival dissection, followed by the medial rectus muscle being dissected, allowing us to attain the retrobulbar space in the orbit. The cavernoma is then dissected from the surroundings and reduced in volume by coagulation so its removal does not apply hyperpressure on the adjacent fragile structures. We then pursue with the closure by stitching the medial rectus muscle to the eyeball. Finally, the conjunctiva is sutured. Postoperatively, there was no complication. A transient mydriasis due to ciliary nerve manipulation spontaneously resolved. Extirpation of the lesion was total. The patient's exophthalmia normalized over the next months. No visual or campimetric deterioration was noted at follow-up. A slight horizontal diplopia was noted after surgery, which normalized at 1 yr. The patient's consent was obtained for the procedure.

First case of nasal transitional carcinoma in a goat infected with Enzootic Nasal Tumor Virus in Belgium

An eleven-year-old, female goat was presented for evaluation of breathing difficulties and epistaxis. Radiographs and computed tomographic (CT) examination of the head revealed the presence of a space-occupying lesion involving the right nasal passage and invading the cranial vault and retrobulbar space. Histologic examination and detection of viral genome from the nasal mass led to the diagnosis of nasal transitional carcinoma with concomitant infection with Enzootic Nasal Tumor Virus (ENTV-2). In this case report, the presence of a nasal transitional carcinoma is described in a goat; a very rare tumor which, to the authors’ knowledge, has not been previously reported in goats. Reverse transcription polymerase chain reaction (RT-PCR) detected the genome of ENTV-2 within the neoplastic tissue, suggesting an infectious etiology.

First case of nasal transitional carcinoma in a goat infected with Enzootic Nasal Tumor Virus in Belgium

An eleven-year-old, female goat was presented for evaluation of breathing difficulties and epistaxis. Radiographs and computed tomographic (CT) examination of the head revealed the presence of a space-occupying lesion involving the right nasal passage and invading the cranial vault and retrobulbar space. Histologic examination and detection of viral genome from the nasal mass led to the diagnosis of nasal transitional carcinoma with concomitant infection with Enzootic Nasal Tumor Virus (ENTV-2). In this case report, the presence of a nasal transitional carcinoma is described in a goat; a very rare tumor which, to the authors’ knowledge, has not been previously reported in goats. Reverse transcription polymerase chain reaction (RT-PCR) detected the genome of ENTV-2 within the neoplastic tissue, suggesting an infectious etiology.

Removal of a retrobulbar wooden foreign body trapped in the orbital fissure by lateral orbitotomy and mandibular coronoidectomy in a French bulldog

A four-year-old dog is presented with severe ocular pain, right eye swelling and slight exophthalmos, three days after partial removal of a wooden foreign body stuck under the right eye through the canthus medialis. A CT scan showed the presence of the foreign body in the retrobulbar space, trapped into the orbital fissure medially to the right branch of the mandible. Removal of the foreign body was performed by lateral orbitotomy associated with coronoidectomy of the vertical branch of the right hemimandible. The optical nerve was entirely torn by the foreign body. After postoperative recovery, the clinical outcome was good apart from unilateral blindness. The dog lives a normal life according to the owners’ evaluation. This case is the first description of the surgical treatment by the combination of lateral orbitotomy and mandibular coronoidectomy of an identified retrobulbar foreign body, medial to the mandible, stuck into the orbital fissure.