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COVID-19 Guidance on the Resumption of Eye Surgery

Jacqueline H. King, MD, FPAO1, Jubaida M. Aquino, MD2, Rachelle G. Anzures, MD3,
John Mark S. de Leon, MD2, Maria Victoria A. Rondaris, MD4, Maria Donna D. Santiago, MD1,
Cynthia V. Verzosa, MD5 for the PAO Committee on Standards 2020

1 Makati Medical Center, Makati City
2 East Avenue Medical Center, Quezon City
3 Ospital ng Makati, Makati City
4 University of Santo Tomas Hospital, Manila
5 Jose Reyes Memorial Medical Center, Manila

Correspondence: Jacqueline H. King, MD, FPAO
Unit 815 Medical Plaza Makati Condominium, Amorsolo St.,
corner De la Rosa St., Makati City, Philippines
e-mail: jacqueline.hernandezking@makatimed.net.ph

Disclaimer: None of the authors above has any financial interest in any of the products mentioned in this manuscript. This guidance was developed based on international and local recommendations to date with the COVID-19 pandemic and expert clinical and system-level advice. However, as the pandemic situation is evolving day to day and information may change rapidly, these recommendations should not be considered as rigid guidelines and are not intended to supplant clinical judgement or institutional policies.

An initial version of this manuscript was posted in the Philippine Academy of Ophthalmology website last June 2020.

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COVID-19 Testing Recommendations prior to Elective Ophthalmic Surgeries

Jacqueline H. King, MD, FPAO1, Jubaida M. Aquino, MD2, Rachelle G. Anzures, MD3,
John Mark S. de Leon, MD2, Maria Victoria A. Rondaris, MD4, Maria Donna D. Santiago, MD1,
Cynthia V. Verzosa, MD5 for the PAO Committee on Standards 2020

1 Makati Medical Center, Makati City
2 East Avenue Medical Center, Quezon City
3 Ospital ng Makati, Makati City
4 University of Santo Tomas Hospital, Manila
5 Jose Reyes Memorial Medical Center, Manila

Correspondence: Jacqueline H. King, MD, FPAO

Unit 815 Medical Plaza Makati Condominium, Amorsolo St.,
corner De la Rosa St., Makati City, Philippines
e-mail: jacqueline.hernandezking@makatimed.net.ph

Disclosure: None of the authors above has any financial interest in any of the products mentioned in this manuscript.

This guidance was developed based on international and local recommendations to date with the COVID-19 pandemic and expert clinical and system-level advice. However, as the pandemic situation is evolving day to day and information may change rapidly, these recommendations should not be considered as rigid guidelines and are not intended to supplant clinical judgement or institutional policies.

An initial version of this manuscript was posted on the Philippine Academy of Ophthalmology website last May 2020 and updated last November 2020.

Download the PDF.

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True Pseudotumors and “Pseudo” – Pseudotumors: A Case Series

ABSTRACT

Objective: To characterize the clinical and pathological features of 4 patients with histopathology-confirmed idiopathic orbital inflammatory disease (OID) initially diagnosed as an orbital neoplasm and 9 patients with histopathology-confirmed orbital neoplasm that presented as idiopathic OID.

Methods: The medical records of 13 patients with orbital mass were reviewed. All biopsies were performed by one orbit surgeon.

Results: There were 4 patients in the histopathology-confirmed idiopathic OID group with preoperative diagnosis of orbital neoplasm. Mean age at presentation was 27 years. Follow-up period ranged from 6 to 41 months. The left orbit was predominantly involved (3/4). The presenting symptoms and signs included proptosis (2/4), diplopia (1/4), and inflammation (1/4). The preoperative best-corrected decimal acuity mean was 0.92. Three of 4 patients retained their preoperative visual acuity postoperatively. There was recurrence of inflammatory signs in only 1 patient, which responded well to oral corticosteroids. In the histopathology-confirmed orbital neoplasm with preoperative diagnosis of idiopathic OID group, there were 9 patients with mean age at presentation of 52 years. Follow-up period averaged 7.5 months (range: 0.5 – 83 months). The presenting symptoms and signs included proptosis (4/9), inflammation (3/9), orbital pain (1/9), and epiphora (1/9). The preoperative best-corrected decimal acuity mean was 0.78. Histopathology and immunohistochemistry of the orbital masses revealed malignancy in 80% (7/9) of these cases.

Conclusions: Idiopathic OID remains a diagnostic dilemma for many physicians. A detailed history, comprehensive physical examination, and appropriate radiological evaluation are essential to differentiate OID and non-inflammatory orbital conditions such as neoplasms. Biopsy is recommended when there is poor or equivocal response to steroids or suspicion of orbital malignancy.

Keywords: Pseudotumor, orbital inflammatory disease, neoplasm, biopsy, histopathology

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Beveled Osteotomies in Lateral Orbitotomy Using a Customized Rotating Bone Saw for Orbital Neoplasms

This study aims to develop a novel method of beveled osteotomy for lateral orbitotomy using a customized 21-mm stainless steel rotating saw in lateral orbitotomy and to evaluate the outcome of a novel beveled osteotomy in lateral orbitotomy. This article presents a case series (19 orbits from 18 patients) of lateral orbitotomies for excision biopsy of orbital neoplasms, over a 10-year period (from September 2001 to October 2011). It is a retrospective observational study. The surgeries were performed under the primary service of one surgeon (M. D. D. S.), the author of this study. All patients were treated via beveled osteotomies in lateral orbitotomy using stainless steel, 21 mm diameter, customized rotating bone saw. Preoperative and postoperative measurements were tabulated and statistically analyzed. The case series demonstrated that beveled osteotomies in lateral orbitotomy using stainless steel, 21 mm diameter, customized rotating bone saw was technically possible and provided access to lateral subperiorbital, peripheral, and central surgical spaces. The exposure was ample for excision biopsy of all neoplasms in this study. No patient needed the use of miniplate hardware in repositioning the lateral orbital wall nor complained of a palpable deformity of the lateral orbital wall. The wound healing was rapid, with minimal tissue distortion or scars. There were two patients who developed skin burns, but neither required cosmetic surgery to correct scarring from the burn. It was concluded that the modified technique of beveled osteotomies in lateral orbitotomy provides excellent access to the lateral subperiorbital, peripheral, and central surgical spaces. The exposure was adequate for excision biopsy of all neoplasms in this study. The technique promotes osseous union without the use of miniplate hardware. The use of a stainless steel 21 mm diameter customized rotating bone saw facilitated the successful outcome of the beveled technique.

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