Clinical Spectrum and Outcomes of Ocular and Periocular Complications following External-Beam Radiotherapy for Inoperable Malignant Maxillary Sinus Tumors

Abstract

<b><i>Purpose:</i></b> To highlight the clinical spectrum, management, and outcomes of ocular/periocular complications following high-dose external-beam radiotherapy (EBRT) for inoperable malignant maxillary sinus-involving tumors (MMST). <b><i>Methods:</i></b> A retrospective, interventional case series. All patients who were diagnosed with inoperable MMST (with orbital involvement) and treated with high-dose fractionated EBRT (65 Gy in 30 fractions) at James Cook University Hospital, UK, were included. <b><i>Results:</i></b> Seven patients with advanced MMST (T4aN0M0–T4bN2cM0) were included and were followed up for 23.8 ± 10.2 months. Severe lid margin disease, dry eye, and neurotrophic keratopathy were universally observed. Other complications included cicatricial conjunctivitis (71%), corneal perforation (57%), limbal stem cell deficiency (LSCD; 43%), glaucoma (29%), and superimposed candida keratitis (14%). Amniotic membrane transplant (AMT; 71%), tarsorrhaphy (43%), tectonic keratoplasty (29%), and evisceration (14%) were warranted. Intact corneal epithelium was observed in all patients and good corrected-distance visual acuity (≥20/60) was observed in 3 (43%) patients at final follow-up. <b><i>Conclusion:</i></b> High-dose EBRT for inoperable MMST can lead to a wide array of severe ocular/periocular complications. AMT serves as a potentially useful treatment modality to restore the ocular surface integrity after severe radiation keratopathy. We advocate active monitoring for any evolving ophthalmic complications during and after EBRT to enable timely intervention.

Risk Factors, Clinical Outcomes, and Prognostic Factors of Bacterial Keratitis: The Nottingham Infectious Keratitis Study

“…Additionally, we showed that corneal healing was negatively affected by older age, larger infiltrate size and poorer presenting vision. Gaining a better knowledge of these prognostic factors may enable earlier interventions (e.g., temporary tarsorrhaphy or amniotic membrane transplant) to help promote corneal healing and re-epithelialisation (32)(33)(34)(35). The poorer corneal wound healing in older patients with BK is likely related to the presence of co-existing ocular surface diseases (e.g., dry eyes, neurotrophic keratopathy, and others), immunosuppression and the age-related reduction in proliferative ability of the limbal stem cells (36)(37)(38).…”

Efficacy of Plasma Rich in Growth Factors (PRGF) in Stage 1 Neurotrophic Keratitis

“…Its management and accurate diagnosis are challenging due to the diverse underlying ocular and systemic diseases such as dry eye, tear film alteration, limbal stem cell dysfunction, corneal dystrophies, chronic use of topical medications, herpetic infection, and diabetes mellitus ( 49 – 53 ). Ocular and neuro surgeries that affect the cornea such as cataract surgery, refractive surgery, keratoplasty, acoustic neuroma, trigeminal neuralgia, and neoplasms result clinically in NK by impairing trigeminal innervation on the surgical area ( 54 – 56 ). Six (40%) of our patients had previous ocular surgery with the majority having cataract surgery.…”

Neurotrophic Keratopathy in Systemic Diseases: A Case Series on Patients Treated With rh-NGF

“…The effects of the different therapies of cerebral tumors such as surgery ( 19 – 22 ) radiotherapy, ( 23 ) and systemic chemotherapy ( 24 , 25 ) may also alter the nerve fibers or induce limbal stem cell deficiency ( 26 , 27 ) resulting clinically in NK.…”