Ophthal Plast Reconstr Surg, Vol. 30, No. 6, 2014
Letters to the Editor
thorough review does reference our article, and if El-Sawy et al. had checked the bibliography of this review, they would have had an additional opportunity to find our article. None of the other 5 references in their bibliography since 2006 cited our publication, so there are clearly difficulties in locating all appropriate references on this topic.
Alejandra A. Valenzuela, M.D. Alan McNab, F.R.A.N.Z.C.O. Timothy J. Sullivan, F.R.A.N.Z.C.O. Correspondence: Alejandra A. Valenzuela, M.D., Department of Ophthalmology, Tulane University & Tulane Health Sciences Centre, 1430 Tulane Ave., SL-69, New Orleans, LA 70112 ([email protected]) The authors have no financial or conflicts of interest to disclose.
REFERENCES 1. El-Sawy T, Frank SJ, Hanna E, et al. Multidisciplinary management of lacrimal sac/nasolacrimal duct carcinomas. Ophthal Plast Reconstr Surg 2013;29:454–7. 2. Valenzuela AA, McNab AA, Selva D, et al. Clinical features and management of tumors affecting the lacrimal drainage apparatus. Ophthal Plast Reconstr Surg 2006;22:96–101. 3. Heindl LM, Jünemann AG, Kruse FE, et al. Tumors of the lacrimal drainage system. Orbit 2010;29:298–306.
Re: “Local Steroid Injection for Management of Different Types of Acute Idiopathic Orbital Inflammation: An 8-Year Study” To the Editor: We read with great interest the recent publication by Mohammad1 on their 8-year experiences on local steroid injection for patient with idiopathic orbital inflammatory disease. The study seems to demonstrate excellent clinical efficacy in treating the disease without significant systemic or local complications. In the study protocol, patients given steroid injection were concomitantly prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs) for 2 weeks after the procedure. However, NSAIDs are well known to be one of the standard treatment options in management of the disease. In the case series published by Mannor et al.,2 17 of the 26 patients (65%) showed complete clinical response with oral NSAIDs alone. We are curious if part of the treatment effect demonstrated in the study could be confounded by the NSAIDs instead of solely from the local steroid injection. A refinement of the study design such as establishing a control arm with patients only on NSAIDs or giving steroid injection without NSAIDs might be able to further validate the results of this study.
Jasper K.W. Wong, M.B.Ch.B., M.R.C.S.Ed Jacky W.Y. Lee, M.B.B.S., F.R.C.S.Ed., F.H.K.A.M.(Ophth) Can Y.F. Yuen, M.B.B.S., F.R.C.S.Ed, F.H.K.A.M.(Ophth) Correspondence: Jasper K.W. Wong, M.B.Ch.B., Department of Ophthalmology, Caritas Medical Centre, Hong Kong ([email protected])
532
The authors have no financial or conflicts of interest to disclose.
REFERENCES 1. Mohammad AEA. Local steroid injection for management of different types of acute idiopathic orbital inflammation: an 8-year study. Ophthal Plast Reconstr Surg 2013;29:286–9. 2. Mannor GE, Rose GE, Moseley IF, et al. Outcome of orbital myositis: clinical features associated with recurrence. Ophthalmology 1997;104:409–14.
Re: “Vascular Malformations of the Orbit: Classification and the Role of Imaging in Diagnosis and Treatment Strategies” To the Editor: In their interesting review article, Rootman et al.1 showed an excellent insight into the orbital vascular malformation based on hemodynamics of the lesions. In the treatment strategies for the cavernous venous malformation of the deep orbital apex, they suggested useful surgical tips and techniques and recommended conformal radiotherapy2 (not radiosurgery) for the cases which were very difficult to access. Of note, the authors described that they “do not prefer radiosurgery because risk of optic nerve damage is greater due to concentrated dosing.” We would like to comment our experience of multisession gamma knife radiosurgery (GKRS) on apical cavernous hemangioma.3 Three patients underwent GKRS for the lesion showing compressive optic neuropathy. Each patient was treated with a total radiation dose of 20 Gy in 4 sessions (5 Gy in each session with an isodose line of 50%) delivered to the tumor margin. The patients showed volume reduction of 73–76% and improvement in visual function for 24–42 months of follow-up period.3 After the case series report, four more patients have been treated with the same protocol. None of the 7 patients demonstrated any radiation-related visual morbidity during 17–79 months of follow-up. For the cases of apical cavernous venous malformations which have high surgical morbidities, multisession GKRS can be considered as one of the treatment strategies for an effective and safe treatment outcome.
Kyung In Woo, M.D., Ph.D. Yoon-Duck Kim, M.D., Ph.D. Correspondence: Yoon-Duck Kim, M.D., Ph.D., Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong Kangnam-ku, 135-710 Seoul, Korea (ydkimoph@ skku.edu) The authors have no financial or conflicts of interests to disclose.
REFERENCES 1. Rootman J, Heran MK, Graeb DA. Vascular malformations of the orbit: classification and the role of imaging in diagnosis and treatment strategies*. Ophthal Plast Reconstr Surg 2014;30:91–104. 2. Rootman DB, Rootman J, Gregory S, et al. Stereotactic fractionated radiotherapy for cavernous venous malformations (hemangioma) of the orbit. Ophthal Plast Reconstr Surg 2012;28:96–102. 3. Goh ASC, Kim YD, Woo KI, Lee JI. Benign orbital apex tumors treated with multisession gamma knife radiosurgery. Ophthalmology 2013;120:635–641.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Letters to the Editor
thorough review does reference our article, and if El-Sawy et al. had checked the bibliography of this review, they would have had an additional opportunity to find our article. None of the other 5 references in their bibliography since 2006 cited our publication, so there are clearly difficulties in locating all appropriate references on this topic.
Alejandra A. Valenzuela, M.D. Alan McNab, F.R.A.N.Z.C.O. Timothy J. Sullivan, F.R.A.N.Z.C.O. Correspondence: Alejandra A. Valenzuela, M.D., Department of Ophthalmology, Tulane University & Tulane Health Sciences Centre, 1430 Tulane Ave., SL-69, New Orleans, LA 70112 ([email protected]) The authors have no financial or conflicts of interest to disclose.
REFERENCES 1. El-Sawy T, Frank SJ, Hanna E, et al. Multidisciplinary management of lacrimal sac/nasolacrimal duct carcinomas. Ophthal Plast Reconstr Surg 2013;29:454–7. 2. Valenzuela AA, McNab AA, Selva D, et al. Clinical features and management of tumors affecting the lacrimal drainage apparatus. Ophthal Plast Reconstr Surg 2006;22:96–101. 3. Heindl LM, Jünemann AG, Kruse FE, et al. Tumors of the lacrimal drainage system. Orbit 2010;29:298–306.
Re: “Local Steroid Injection for Management of Different Types of Acute Idiopathic Orbital Inflammation: An 8-Year Study” To the Editor: We read with great interest the recent publication by Mohammad1 on their 8-year experiences on local steroid injection for patient with idiopathic orbital inflammatory disease. The study seems to demonstrate excellent clinical efficacy in treating the disease without significant systemic or local complications. In the study protocol, patients given steroid injection were concomitantly prescribed with nonsteroidal anti-inflammatory drugs (NSAIDs) for 2 weeks after the procedure. However, NSAIDs are well known to be one of the standard treatment options in management of the disease. In the case series published by Mannor et al.,2 17 of the 26 patients (65%) showed complete clinical response with oral NSAIDs alone. We are curious if part of the treatment effect demonstrated in the study could be confounded by the NSAIDs instead of solely from the local steroid injection. A refinement of the study design such as establishing a control arm with patients only on NSAIDs or giving steroid injection without NSAIDs might be able to further validate the results of this study.
Jasper K.W. Wong, M.B.Ch.B., M.R.C.S.Ed Jacky W.Y. Lee, M.B.B.S., F.R.C.S.Ed., F.H.K.A.M.(Ophth) Can Y.F. Yuen, M.B.B.S., F.R.C.S.Ed, F.H.K.A.M.(Ophth) Correspondence: Jasper K.W. Wong, M.B.Ch.B., Department of Ophthalmology, Caritas Medical Centre, Hong Kong ([email protected])
532
The authors have no financial or conflicts of interest to disclose.
REFERENCES 1. Mohammad AEA. Local steroid injection for management of different types of acute idiopathic orbital inflammation: an 8-year study. Ophthal Plast Reconstr Surg 2013;29:286–9. 2. Mannor GE, Rose GE, Moseley IF, et al. Outcome of orbital myositis: clinical features associated with recurrence. Ophthalmology 1997;104:409–14.
Re: “Vascular Malformations of the Orbit: Classification and the Role of Imaging in Diagnosis and Treatment Strategies” To the Editor: In their interesting review article, Rootman et al.1 showed an excellent insight into the orbital vascular malformation based on hemodynamics of the lesions. In the treatment strategies for the cavernous venous malformation of the deep orbital apex, they suggested useful surgical tips and techniques and recommended conformal radiotherapy2 (not radiosurgery) for the cases which were very difficult to access. Of note, the authors described that they “do not prefer radiosurgery because risk of optic nerve damage is greater due to concentrated dosing.” We would like to comment our experience of multisession gamma knife radiosurgery (GKRS) on apical cavernous hemangioma.3 Three patients underwent GKRS for the lesion showing compressive optic neuropathy. Each patient was treated with a total radiation dose of 20 Gy in 4 sessions (5 Gy in each session with an isodose line of 50%) delivered to the tumor margin. The patients showed volume reduction of 73–76% and improvement in visual function for 24–42 months of follow-up period.3 After the case series report, four more patients have been treated with the same protocol. None of the 7 patients demonstrated any radiation-related visual morbidity during 17–79 months of follow-up. For the cases of apical cavernous venous malformations which have high surgical morbidities, multisession GKRS can be considered as one of the treatment strategies for an effective and safe treatment outcome.
Kyung In Woo, M.D., Ph.D. Yoon-Duck Kim, M.D., Ph.D. Correspondence: Yoon-Duck Kim, M.D., Ph.D., Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong Kangnam-ku, 135-710 Seoul, Korea (ydkimoph@ skku.edu) The authors have no financial or conflicts of interests to disclose.
REFERENCES 1. Rootman J, Heran MK, Graeb DA. Vascular malformations of the orbit: classification and the role of imaging in diagnosis and treatment strategies*. Ophthal Plast Reconstr Surg 2014;30:91–104. 2. Rootman DB, Rootman J, Gregory S, et al. Stereotactic fractionated radiotherapy for cavernous venous malformations (hemangioma) of the orbit. Ophthal Plast Reconstr Surg 2012;28:96–102. 3. Goh ASC, Kim YD, Woo KI, Lee JI. Benign orbital apex tumors treated with multisession gamma knife radiosurgery. Ophthalmology 2013;120:635–641.
© 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
