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C.E. Kloek, M.P. Hatton, P.A. D. Rubin; Alternative Management Strategies for Patients With Orbital Apex Tumors . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5412.
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Purpose: Tumors located in the intraconal portion of the orbital apex, especially those inferior to the optic nerve, can be difficult to access surgically, carrying a significant risk of ocular morbidity. The purpose of this study was to investigate outcomes in three patients with benign–appearing but symptomatic tumors located in the intraconal portion of the orbital apex in which orbital decompression or observation was undertaken as an alternative management strategy to resection. Methods: Retrospective case review. Results: Three patients presented with symptoms of visual decline OD. Each patient exhibited clinical evidence of a right optic neuropathy. Magnetic resonance imaging of the brain and orbits was performed on each patient and showed a benign–appearing orbital apex tumor located intraconal and inferior to the right optic nerve. The radiologic characteristics of each tumor were consistent with schwannoma or hemangioma. Patients 1 and 2 underwent right orbital decompression; neither patient had the tumor biopsied or excised. Patient 3 was seven months pregnant at the time of tumor diagnosis and was observed. Although patient one’s six–month post–operative visual acuity (VA) was stable compared with the pre–operative acuity of 20/40, there was resolution of the dyschromatopsia and afferent pupillary defect (APD) noted pre–operatively. Patient 2 improved from a pre–operative VA of 20/300 to a two year post–operative VA of 20/20. Visual fields (VF) showed improvement from the depression noted pre–operatively. An APD and mild dyschromatopsia persisted. Patient 3 was observed over the course of one year. Her VA remained stable at 20/30 OD; however, she showed spontaneous resolution of an APD, dyschromatopsia, and VF defects that had been noted at the time of diagnosis. Conclusions: Orbital decompression is a therapeutic option for patients with compressive optic neuropathies from benign orbital apex tumors, offering potential improvement in optic nerve function while sparing morbidity from attempts at surgical resection. Moreover, spontaneous improvement in visual function can occur in patients with optic neuropathy from a benign orbital apex tumor.
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