Ophthal Plast Reconstr Surg, Vol. 31, No. 2, 2015
Letters to the Editor
Marcela M. Estrada, B.A. Meredith S. Baker, M.D. Rachel K. Sobel, M.D. Erin M. Shriver, M.D., F.A.C.S. Richard C. Allen, M.D., Ph.D., F.A.C.S. Correspondence: Erin M. Shriver, M.D., F.A.C.S., 200 Hawkins Dr., 11196-F PFP, Iowa City, IA 52242 ([email protected]) The authors have no financial or conflicts of interest to disclose. Presented at European Society of Ophthalmic Plastic and Reconstructive Surgery annual meeting on September 12, 2014 in Budapest, Hungary.
References 1. Yoo SH, Rootman DB, Goh A, et al. Localization and retrieval of an eyelid metallic foreign body with an oscillating magnet and highresolution ultrasonography. Ophthal Plast Reconstr Surg 2014; Epub ahead of print, August 26, 2014. 2. Ai T, Morelli JN, Hu X, et al. A historical overview of magnetic resonance imaging, focusing on technological innovations. Invest Radiol 2012;47:725–41. 3. Deen HG, Miller DA, Kostick DA, Jaeckle KA. Removal of an orbital metallic foreign body to facilitate magnetic resonance imaging: technical case report. Neurosurgery 2006;58:E999. 4. Finkelstein M, Legmann A, Rubin PA. Projectile metallic foreign bodies in the orbit: a retrospective study of epidemiologic factors, management, and outcomes. Ophthalmology 1997;104:96–103. 5. Callahan AB, Yoon MK. Intraorbital foreign bodies: retrospective chart review and review of literature. Int Ophthalmol Clin 2013;53:157–65.
Reply re: “Localization and Retrieval of an Eyelid Metallic Foreign Body With an Oscillating Magnet and High-Resolution Ultrasonography” To the Editor: We thank Ms. Estrada and colleagues for their insightful comments regarding our article and for sharing their own experience using transillumination to localize metallic foreign bodies in the anterior orbit and eyelid. Although we neglected to specifically discuss this option in our study, we did in fact attempt to localize the foreign body using transillumination prior to the use of the oscillating magnet and ultrasound. Certainly, it is reasonable, and in fact responsible, to use all tools at one’s disposal to identify such lesions. Low cost, resource-light options should be attempted initially for many reasons. However, should these fail, as they did in our case, we would advocate for advancing along the ladder of investigation. The oscillating magnet and ultrasound combination is one such option. Using these tools in the most difficult cases can improve ease of identification and limit collateral damage, as noted in our report. Again, we commend Ms. Estrada and colleagues for their important addition to the literature on this often frustrating clinical problem and reiterate that our technique is a useful adjunct to cases where simpler, noninvasive techniques prove unsuccessful.
Sylvia H. Yoo, M.D. Daniel B. Rootman, M.D. Alice Goh, M.B.B.S. Aaron Savar, M.D. Robert A. Goldberg, M.D.
160
Correspondence: Sylvia H. Yoo, M.D., 800 Washington St, Box 450, Boston, MA 02111 ([email protected]) The authors have no financial or conflicts of interest to disclose.
Re: “Optic Nerve Cyst-Like Formation Presenting as a Delayed Complication of Optic Nerve Sheath Fenestration” To the Editor: We have read the article by Naqvi et al.1 with great interest. The authors reported 2 cases with retrobulbar cyst-like structure following optic nerve sheath decompression (ONSD), requiring a secondary surgery to alleviate symptoms. The authors stated that these are the first such cases to be reported in the English ophthalmologic literature. Previously, in an MRI study,2 retrobulbar perioptic pseudocyst was demonstrated in 9 (75%) of 12 eyes, which underwent ONSD via a transconjunctival medial orbitotomy and with dura-arachnoid excision. In 1 of these cases, secondary surgery was required 23 months after ONSD due to a large perioptic cyst indenting the optic nerve and posterior sclera. Symptoms such as peripapillary hyperemia, retrobulbar pain, and radiologic findings ameliorated after the partial excision of the pseudocystic lesion. Naqvi et al.1 overlooked this publication. Perioptic fluid collection is a common and transient radiologic finding after ONSD; however, it rarely causes complications. We agree with the authors that this observation supports that the action mechanism of ONSD is through cerebrospinal fluid leakage. If this assumption is true, ONSD with dura-arachnoid excision technique can be more effective than the slit incision technique. If sheath excision was performed in the first surgery of the patients with large pseudocyst, we do not think that repeat ONSD would be possible and feasible in secondary surgery for cyst excision.
Bulent Yazici, M.D. Zeynep Yazici, M.D. Correspondence: Bülent Yazici, MD, Uludag University, Bursa, Turkey ([email protected]) The authors have no financial or conflicts of interest to disclose.
REFERENCES 1. Naqvi SM, Thiagarajah C, Golnik K, et al. Optic nerve cyst-like formation presenting as a delayed complication of optic nerve sheath fenestration. Ophthal Plast Reconstr Surg 2014;30:e53–4. 2. Yazici Z, Yazici B, Tuncel E. Findings of magnetic resonance imaging after optic nerve sheath decompression in patients with idiopathic intracranial hypertension. Am J Ophthalmol 2007;144:429–35.
Re: “Safety of Onabotulinum Toxin A Injection to the Central Upper Eyelid and Eyebrow Regions” To the Editor: Authors Huang, Costin, Sakolsatayadorn, and Perry are to be commended for their study on the safety of injecting onabotulinum toxin A in the eyelid and eyebrow regions.1 The authors describe their method of injecting small aliquots of
© 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Letters to the Editor
Marcela M. Estrada, B.A. Meredith S. Baker, M.D. Rachel K. Sobel, M.D. Erin M. Shriver, M.D., F.A.C.S. Richard C. Allen, M.D., Ph.D., F.A.C.S. Correspondence: Erin M. Shriver, M.D., F.A.C.S., 200 Hawkins Dr., 11196-F PFP, Iowa City, IA 52242 ([email protected]) The authors have no financial or conflicts of interest to disclose. Presented at European Society of Ophthalmic Plastic and Reconstructive Surgery annual meeting on September 12, 2014 in Budapest, Hungary.
References 1. Yoo SH, Rootman DB, Goh A, et al. Localization and retrieval of an eyelid metallic foreign body with an oscillating magnet and highresolution ultrasonography. Ophthal Plast Reconstr Surg 2014; Epub ahead of print, August 26, 2014. 2. Ai T, Morelli JN, Hu X, et al. A historical overview of magnetic resonance imaging, focusing on technological innovations. Invest Radiol 2012;47:725–41. 3. Deen HG, Miller DA, Kostick DA, Jaeckle KA. Removal of an orbital metallic foreign body to facilitate magnetic resonance imaging: technical case report. Neurosurgery 2006;58:E999. 4. Finkelstein M, Legmann A, Rubin PA. Projectile metallic foreign bodies in the orbit: a retrospective study of epidemiologic factors, management, and outcomes. Ophthalmology 1997;104:96–103. 5. Callahan AB, Yoon MK. Intraorbital foreign bodies: retrospective chart review and review of literature. Int Ophthalmol Clin 2013;53:157–65.
Reply re: “Localization and Retrieval of an Eyelid Metallic Foreign Body With an Oscillating Magnet and High-Resolution Ultrasonography” To the Editor: We thank Ms. Estrada and colleagues for their insightful comments regarding our article and for sharing their own experience using transillumination to localize metallic foreign bodies in the anterior orbit and eyelid. Although we neglected to specifically discuss this option in our study, we did in fact attempt to localize the foreign body using transillumination prior to the use of the oscillating magnet and ultrasound. Certainly, it is reasonable, and in fact responsible, to use all tools at one’s disposal to identify such lesions. Low cost, resource-light options should be attempted initially for many reasons. However, should these fail, as they did in our case, we would advocate for advancing along the ladder of investigation. The oscillating magnet and ultrasound combination is one such option. Using these tools in the most difficult cases can improve ease of identification and limit collateral damage, as noted in our report. Again, we commend Ms. Estrada and colleagues for their important addition to the literature on this often frustrating clinical problem and reiterate that our technique is a useful adjunct to cases where simpler, noninvasive techniques prove unsuccessful.
Sylvia H. Yoo, M.D. Daniel B. Rootman, M.D. Alice Goh, M.B.B.S. Aaron Savar, M.D. Robert A. Goldberg, M.D.
160
Correspondence: Sylvia H. Yoo, M.D., 800 Washington St, Box 450, Boston, MA 02111 ([email protected]) The authors have no financial or conflicts of interest to disclose.
Re: “Optic Nerve Cyst-Like Formation Presenting as a Delayed Complication of Optic Nerve Sheath Fenestration” To the Editor: We have read the article by Naqvi et al.1 with great interest. The authors reported 2 cases with retrobulbar cyst-like structure following optic nerve sheath decompression (ONSD), requiring a secondary surgery to alleviate symptoms. The authors stated that these are the first such cases to be reported in the English ophthalmologic literature. Previously, in an MRI study,2 retrobulbar perioptic pseudocyst was demonstrated in 9 (75%) of 12 eyes, which underwent ONSD via a transconjunctival medial orbitotomy and with dura-arachnoid excision. In 1 of these cases, secondary surgery was required 23 months after ONSD due to a large perioptic cyst indenting the optic nerve and posterior sclera. Symptoms such as peripapillary hyperemia, retrobulbar pain, and radiologic findings ameliorated after the partial excision of the pseudocystic lesion. Naqvi et al.1 overlooked this publication. Perioptic fluid collection is a common and transient radiologic finding after ONSD; however, it rarely causes complications. We agree with the authors that this observation supports that the action mechanism of ONSD is through cerebrospinal fluid leakage. If this assumption is true, ONSD with dura-arachnoid excision technique can be more effective than the slit incision technique. If sheath excision was performed in the first surgery of the patients with large pseudocyst, we do not think that repeat ONSD would be possible and feasible in secondary surgery for cyst excision.
Bulent Yazici, M.D. Zeynep Yazici, M.D. Correspondence: Bülent Yazici, MD, Uludag University, Bursa, Turkey ([email protected]) The authors have no financial or conflicts of interest to disclose.
REFERENCES 1. Naqvi SM, Thiagarajah C, Golnik K, et al. Optic nerve cyst-like formation presenting as a delayed complication of optic nerve sheath fenestration. Ophthal Plast Reconstr Surg 2014;30:e53–4. 2. Yazici Z, Yazici B, Tuncel E. Findings of magnetic resonance imaging after optic nerve sheath decompression in patients with idiopathic intracranial hypertension. Am J Ophthalmol 2007;144:429–35.
Re: “Safety of Onabotulinum Toxin A Injection to the Central Upper Eyelid and Eyebrow Regions” To the Editor: Authors Huang, Costin, Sakolsatayadorn, and Perry are to be commended for their study on the safety of injecting onabotulinum toxin A in the eyelid and eyebrow regions.1 The authors describe their method of injecting small aliquots of
© 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
