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Renbing Jia, Xianqun Fan; Transconjunctival vs. Lateral orbitotomy approach for retrobulbar intraconal orbital cavernous hemangioma - a comparative study of long term outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):740.
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to compare the efficacy of transconjunctival approach and lateral orbitotomy for retrobulbar intraconal orbital cavernous hemangioma
Among a total of 156 patients with orbital cavernous hemangioma, 42 met the inclusion criteria and were analyzed in the study. The tumor volume (length and width) and location were recorded and measured by CT and MRI. Best corrected visual acuity, proptosis, and pain before and after surgery were assessed by blinded investigators.
A very low degree of correlation exists between the tumor size and decrease of visual acuity(r=0.134, P=0.39); The visual acuity was 0.60 ± 0.33vs.0.80 ± 0.26, (t=-2.04, P=0.02). Cavernomas medial to optic nerves had greater impact on best corrected visual acuity, medial vs. lateral, inferior and superior (0.33±0.22) vs. (0.7±0.28), P=0.0001. All patients were satisfied with cosmetic outcomes. The recurrence rate was 5.89% in lateral orbitotomy vs. 5.56% in transconjunctival group (P=0.97); the complete tumor extraction rate were 90.48% (19/21) vs. 95.24% (20/21) P=0.56; while the surgical time of lateral orbitotomy group was 147.50±41.17 minutes vs. 83.31±40.55 minutes in transconjunctival group (t=-4.30, P<0.00001). In transconjunctival group, pre and post-operative visual acuity decreased rate was 33.3% (7/21) vs 5.56% (1/18) ( 2=3.65, P=0.06), local pain was 23.8% (5/21) vs. 16.7% (3/18), ( 2=0.31, P=0.58). However, duration of local symptom such as pain in transconjunctival group complaining was shorter than that of lateral orbitotomy, 12.67±7.02 months vs. 30±35 months. Exophthalmos incidence in transconjunctival group was preoperative 100% (21/21) vs. postoperative 16.7% (3/18), ( 2=28.4, P =0.0007). In lateral orbitotomy group, it was 52.38% (11/21) vs 11.76% (2/17) in visual acuity comparison, ( 2=6.89, P=0.02); 100% (21/21) vs. 11.76% (2/17) in exophthalmos rate comparison ( 2=28.91, P=0.0004); 38.09% (8/21) vs. 35.29% (6/17) of local pain ( 2 =0.03, P=0.86).
Lateral orbitotomy group had more significant visual acuity improvement than that of transconjunctival approach, though it was less time-consuming and duration of local symptom was shorter. Both lateral orbitotomy and transconjunctival approaches significantly improved degrees of proptosis. Moreover, Recurrence rate did not show significantly difference between two groups.
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