Schwannoma with giant rosettes and hyperchromatic small cells was previously designated a neuroblastoma-like schwannoma by Goldblum et al. (Am J Surg Pathol 1994;18[3]:266-73). In the past, 9 cases of this variant of schwannoma have been reported as a painless subcutaneous nodule in various parts of the body, but none has been reported in the orbit so far. This entity must be distinguished from neuroblastoma, neuroectodermal tumor, and malignant change in schwannoma.
PurposeTo evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia.Materials and MethodsForty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients' experience of the surgery (by questionnaire) were also compared.ResultsMean preoperative deviation for distance in Groups I, II, III was −41.67 prism diopter (pd) ±9.0, −38.93 pd ±11.05 and −41.87 pd ±8.91 (P=0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I (P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable (P=0.5) in all groups. Intraoperative pain (P<0.001) and time taken for surgery (P<0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups (P = 0.5).ConclusionsSSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.
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