Abstract
P 058
Nondistinctive visus decrease and cephalgia due to haemangioma of the orbit
Verena Engelmann1, Sarah Pfrommer1, Michael Stoffel2, Chris Patrick Lohmann1, Ralph-Laurent Merté1
1Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, Technische Universität München, München; 2Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
Objective
About 25% of all orbital diseases are orbital tumors. In 2/3 of all cases it is a matter of benign, expansive growth and in 1/3 of malign, infiltrative processes.
The cavernous hemangioma with a frequency of 5% is the most prevalent neoplasm of the orbit. The cardinal symptom is the slow progressive painless exophthalmus. Malignant transformation or recurrence is not reported.
Methods
Case report: We refer to a 27-year-old male, who presented to our emergency department because of a three week old cephalgia and a visus decrease on his right eye including blurred vision.
The best adjusted vision with existing hyperopia on the right eye was (+4,50/-1,50/175°) 0,70 and on the left eye (+0,25/-1,00/5°) 0,80. Funduscopic analysis showed a papilledema as well as retinal folds. In the OCT and in the fluorescence angiography the clinical findings were confirmed.
To confirm the suspicion of a retrobulbar tumor a magnet resonance tomography was performed. Retrobulbar and strictly intraorbital on the right eye a round solide tumor with a dimension of 25x18x18 mm presented, displacing the optic nerve to medial. The tumor appeared isointens in T1, hyperintens in T2 and enriched inhomogenously contrast agent.
Results
A combination therapy of lateral and superior orbitotomy was performed displaying any complications. In conclusion the unilateral papilledema and the retinal folds on the right eye degenerated after surgery and the visual acuity of the right eye increased to (+4,50/-1,50/175°) 0,90. In the postoperative magnet resonance tomography a periorbital soft tissue tumescence with GD-enrichment was still present as a matter of residual postinterventional edema. No residual desease was detectible. A controll magnet resonance tomography is planned during the follow-up.
Conclusions
With a rapid progression of the retrobulbar tumor and a progredient vision decrease an immediate operative approach is important. In this case the combination of lateral and superior orbitotomy displayed a satisfying subjective and objective postoperative result.
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