Silent sinus syndrome (SSS) is a rare condition characterized by enophthalmos and hypoglobus that is generally not related to trauma or surgery. We present a 30-year-old man who noticed facial asymmetry during the previous month and was referred to our oculoplastic clinic. His examination revealed right hypoglobus and a 2-mm right enophthalmos. The diagnosis of right SSS was confirmed by orbital and paranasal computed tomography scan. The patient had no otolaryngological symptoms and visual acuity was normal bilaterally. He was treated surgically in a combined approach by a team of oculoplastic and otorhinolaryngology surgeons. Functional endoscopic sinus surgery included uncinectomy, maxillary antrostomy, and orbitotomy, with insertion of an orbital implant. This case demonstrates that a single-step surgery for correction of enophthalmos secondary to SSS is a viable option, leading to quick rehabilitation and excellent aesthetic results.
Purpose: To compare results of two ophthalmic viscosurgical devices (OVDs) - Viscoat (a dispersive OVD, Alcon) and FR-Pro (a viscous-cohesive OVD, Rayner), in phacoemulsification surgery. Methods: A prospective randomized controlled study. Patients undergoing phacoemulsification were randomly assigned to receive one of the two OVDs. Exclusion criteria were age under 40, preoperative endothelial cell count (ECC) below 1,500 cells/mm2 and an eventful surgery. The primary outcome was change in ECC from baseline to postoperative month-one and month-three. Secondary outcomes were the difference between ECC at postoperative month-one and month-three, changes in IOP and occurrence of an IOP spike≥30 mmHg after surgery. Results: The study included 84 eyes - 43 in the Viscoat group and 41 in the FR-Pro group. Mean cell density loss at month-one and month-three was 17.0% and 19.2%, respectively, for the Viscoat group and 18.4% and 18.8%, respectively, for the FR-Pro group, with no statistically significant difference between the groups (p=0.772 and p=0.671, respectively). The mean ECC difference between the month-one and month-three visits was 50.5 cells/mm2 and was not statistically significant (p=0.285). One eye in each group had an IOP spike≥30 mmHg, both normalized by postoperative week-one. Conclusions: Viscoat and FR-Pro have comparable results following phacoemulsification surgery, suggesting that while FR-Pro is not a dispersive OVD, its endothelial cell protection may be comparable to one, perhaps due to the addition of sorbitol. Furthermore, a one-month follow-up of ECC seems sufficient in such trials.
Purpose:To compare the success rate of pars plana vitrectomy (PPV) and scleral buckling in terms of visual outcomes, repeated surgeries and postoperative complications for the treatment of rhegmatogenous retinal detachment. Methods:We collected data of all patients operated in one tertiary medical center in Israel during the year 2019. Patient over the age of 18 years with at least one year of follow-up were included. Retinal attachment rate, visual outcomes and postoperative complications were compared.Results: Included were 30 patients that underwent posterior vitrectomy and 36 that underwent scleral buckling. All patients were operated by the same surgeon. Success rate of retina re-attachment were almost the same in both groups (86.7% vs 86.1 for vitrectomy and scleral buckle respectively, p = 0.948). In both groups there was a significant improvement of the final visual acuity compared to the pre-operative visual acuity (0.146 ± 0.1 vs 0.149 ± 0.1 Log MAR improvement for vitrectomy and scleral buckle respectively, p = 0.411). A strong correlation existed between the number of operations to reattachments -any additional surgery drops the chance of reattachment by 2.4% (odds ratio: 0.024, 95% CI 0.003 -0.208, p ≤ 0.001).Conclusion: Among a modern cohort of patients with retinal detachment, no differences were seen in success rates or visual outcomes between patients treated with posterior vitrectomies compared to scleral buckling.
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