Purpose: Mucormycosis is an infection caused by fungi to the class Zygomycetes that usually appears in immunosuppressed patients. Diagnostic confirmation is often delayed, with fatal prognosis in cases in which treatment is not rapidly established. Case report: We present two clinical cases of rhino-orbito-cerebral mucormycosis with an atypical presentation form, consisting of a unilateral complete sudden vision loss. Intravenous treatment with liposomal amphotericin B was started and total orbital exenteration surgery was performed. The removed surgical area was filled with gauze impregnated with liposomal amphotericin B and was left open for cures every 12 hours. Due to the good clinical evolution, a reconstruction of the orbital exenteration defect was performed in Case 1 with a temporal muscle flap and a skin island pedicled flap. In Case 2, reconstruction was not performed due to the poor evolution of the patient. Discussion: As it is a very aggressive surgery, the aesthetic and functional sequelae are very important. When the survival of the patient is achieved, we should offer reconstructive solutions that improve their quality of life. The reconstruction carried out using a flap of the temporal muscle can be made in a single act without requiring microvascular surgery.

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Mencía-Gutiérrez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Methods:We describe 4 patients suffering from open-angle glaucoma and cataract, and one patient with secondary glaucoma after Fuchs' heterochromic uveitis. All of them underwent phacoemulsification and non-penetrating deep sclerectomy with 5-fluoracil. Two patients presented hematoma in scleral lake 24 h after surgery, other 2 of them presented it one week after the intervention, and one of them presented it 2 weeks after the surgery. The hematoma was found by gonioscopy in all cases. Moreover, all patients had elevated intraocular pressure. Result: Hematoma usually appears within 2 weeks after surgery. Goniopunctures were performed in 5 patients within 5 months of the complication. A second goniopuncture was needed for one of them. Bleb needling was made in one of them. Three of the patients required treatment with beta-blocker eye drops since intraocular pressure exceeded pre-set values. Conclusion: Hematomas in scleral lake are a rare complication that may appear within 2 weeks after non-penetrating deep sclerectomy. They may cause surgery malfunction and antihypertensive eye drops might be required for tensional control. Goniopuncture could be used for solving the complication.

Purpose. To retrospectively describe the clinical characteristics, management, and outcomes of four cases of orbital solitary fibrous tumor (SFT). In one patient, we present an ultrasonic aspirator system for tumor removal. Methods. Four patients with orbital SFT were selected: one patient with orbital SFT, another patient with frontal and ethmoidal SFT and orbital affectation with high rates of recurrence, the third patient with frontal lobe SFT and orbital invasion with multiple recurrences, and the fourth case with a history of craniopharyngioma surgery and SFT located on the orbital apex. Results. All cases showed proptosis, eye movement restriction, and, in three cases, visual acuity alteration. Different treatments were applied: in three cases, excision was performed, one of them with an ultrasonic aspirator system, and in the remaining case, an exenteration was done (in two cases, radiosurgery treatment was also applied). The immunohistochemical study revealed SFT, similar to hemangiopericytomas (HPCs). No recurrence has been observed after surgical treatment. Conclusion. The SFT is a spectrum of different tumors with similar histopathological characteristics. The use of immunohistochemical markers is very helpful in the diagnosis. The main problem of orbital involvement is the risk of damaging important structures adjacent to the tumor during the surgical removal. The ultrasonic aspirator system allows elimination of the tumor without damaging other orbital structures.

Método: Presentamos 4 pacientes con glaucoma de ángulo abierto no controlado y cataratas, y un paciente con glaucoma uveítico secundario a heterocromía de Fuchs. Todos ellos fueron intervenidos mediante facoemulsificación y esclerectomía profunda no perforante con 5-fluoracilo. Dos de los pacientes presentaron hematoma en el lago escleral a las 24 h tras la cirugía, otros 2 a la semana y uno de ellos a las 2 semanas de la intervención. El hematoma se diagnosticó mediante gonioscopia en todos los casos. Además todos presentaron la presión intraocular elevada. Resultado: El hematoma del lago escleral suele aparecer en las 2 primeras semanas tras la cirugía. A todos los pacientes se les realizó goniopuntura en los primeros 5 meses de la complicación y uno de ellos requirió una segunda goniopuntura 3 meses después. A uno de los pacientes se le realizó una cistitomía. Tres de los pacientes requirieron tratamiento con betabloqueantes tópicos para controlar las cifras de presión intraocular. Conclusión: Los hematomas en el lago escleral son una complicación que puede aparecer en las primeras 2 semanas tras una esclerectomía profunda no perforante, pudiendo producir un mal funcionamiento de la cirugía por lo que es necesario la introducción de antihipertensivos oculares para el control de la presión intraocular. La goniopuntura podría ser usada para resolver esta complicación.

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