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Orbital and Adnexal Involvement in Sarcoidosis: Analysis of Clinical Features and Systemic Disease in 30 Cases
Orbital and Adnexal Involvement in Sarcoidosis: Analysis of Clinical Features and Systemic Disease in 30 Cases
to be total excision, or near-total excision. The case that was treated with excision and classified as “stable” in Table 3 and had undergone near-total excision; the residual mass did not show any change during the follow-up. Thank you for the opportunity to describe this case in more detail.
EDITOR: WE READ WITH GREAT INTEREST THE RECENT REPORT BY
Demirci and associates describing their experience with orbital and ocular adnexal sarcoidosis.1 We would like to point out what we believe is an incorrect use of the terms excisional biopsy and excision in their article. In the Results section of the abstract, the Methods section, the Statistical Analyses section, and Table 3, the authors report that the sarcoid lesion was excised in 8 patients.1 We believe that the correct description of the procedure performed on some, if not all, of these patients was in fact an incisional biopsy or debulking, as correctly described in the article’s introduction and Discussion.1 In Table 3, the authors describe 1 of 8 patients who underwent “excisional biopsy” as being “stable” in follow-up.1 This terminology is confusing, because after excision, a lesion can be either resolved or recurrent in follow-up, but not “stable.” We remind the readership that an excisional biopsy describes a procedure where the entire pathologic lesion is removed in total, whereas an incisional biopsy describes the removal of a part of the pathologic lesion for diagnostic purposes. We believe that this is an important point because surgical debulking (incisional biopsy) is a treatment option for inflammatory sarcoidosis, whereas complete excision (excisional biopsy) is not standard practice for sarcoid or any other inflammatory orbital or ocular adnexal entity. JUSTIN GUTMAN ROMAN SHINDER
Brooklyn, New York Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
REFERENCE
1. Demirci H, Christianson MD. Orbital and adnexal involvement in sarcoidosis: analysis of clinical features and systemic disease in 30 cases. Am J Ophthalmol 2011;151(6): 1074 –1080.
REPLY WE THANK DRS GUTMAN AND SHINDER FOR THEIR INTER-
est and appreciate their comments about our article.1 We agree with Drs Gutman and Shinder that excision is not standard practice for sarcoid, or for any other inflammatory orbital or ocular adnexal entity. In our series, we had 8 patients who had well-circumscribed, anteriorly located masses that were treated with what, at operation, appeared VOL. 152, NO. 5
HAKAN DEMIRCI
Ann Arbor and Detroit, Michigan MURRAY D. CHRISTIANSON
Detroit, Michigan Conflict of Interest Disclosures: See the original article1 for any disclosures of the authors.
REFERENCE
1. Demirci H, Christianson MD. Orbital and adnexal involvement in sarcoidosis: analysis of clinical features and systemic disease in 30 cases. Am J Ophthalmol 2011;151(6): 1074 –1080.
Long-term Complications Associated With Glaucoma Drainage Devices and Boston Keratoprosthesis EDITOR: IN THEIR RECENT ARTICLE, LI AND ASSOCIATES EVALUATE
the long-term complications associated with glaucoma drainage devices (GDD) in patients who have undergone Boston type 1 keratoprosthesis (KPro) surgery.1 The authors speculate an association between the presence of soft contact lenses (SCL) and GDD erosion in this particular population. In a retrospective, interventional case series that aimed to determine prevalence, progression, treatment, and impact of glaucoma on visual acuity, we reviewed 38 consecutive eyes (38 patients) that have undergone KPro surgeries between 2008 and 2009 at our center. Of these patients, 21% (n ⫽ 8) had, along with their glaucoma, an implanted GDD. Among them, 4 presented with the implanted tube before KPro surgery, and 4 had their tube implanted postoperatively. An SCL was placed after KPro surgery in all our patients. In fact, SCL has been proven beneficial in efficaciously protecting the ocular surface, adequately maintaining its hydration, and decreasing the risk of corneal melts.2 Among patients who underwent KPro surgeries, had an SCL placed, and had an old or new implanted GDD, no tube erosion was recorded over a mean follow-up (FU) period of 24 months since KPro surgery. For the tubes placed postoperatively, the mean FU duration between the placement of the tube and patient’s last visit is 10 months. Regarding the old tubes, placed from 1 year to 14 years before KPro surgery, the mean FU period between the surgery (and therefore SCL placement) and
CORRESPONDENCE
883
to be total excision, or near-total excision. The case that was treated with excision and classified as “stable” in Table 3 and had undergone near-total excision; the residual mass did not show any change during the follow-up. Thank you for the opportunity to describe this case in more detail.
EDITOR: WE READ WITH GREAT INTEREST THE RECENT REPORT BY
Demirci and associates describing their experience with orbital and ocular adnexal sarcoidosis.1 We would like to point out what we believe is an incorrect use of the terms excisional biopsy and excision in their article. In the Results section of the abstract, the Methods section, the Statistical Analyses section, and Table 3, the authors report that the sarcoid lesion was excised in 8 patients.1 We believe that the correct description of the procedure performed on some, if not all, of these patients was in fact an incisional biopsy or debulking, as correctly described in the article’s introduction and Discussion.1 In Table 3, the authors describe 1 of 8 patients who underwent “excisional biopsy” as being “stable” in follow-up.1 This terminology is confusing, because after excision, a lesion can be either resolved or recurrent in follow-up, but not “stable.” We remind the readership that an excisional biopsy describes a procedure where the entire pathologic lesion is removed in total, whereas an incisional biopsy describes the removal of a part of the pathologic lesion for diagnostic purposes. We believe that this is an important point because surgical debulking (incisional biopsy) is a treatment option for inflammatory sarcoidosis, whereas complete excision (excisional biopsy) is not standard practice for sarcoid or any other inflammatory orbital or ocular adnexal entity. JUSTIN GUTMAN ROMAN SHINDER
Brooklyn, New York Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
REFERENCE
1. Demirci H, Christianson MD. Orbital and adnexal involvement in sarcoidosis: analysis of clinical features and systemic disease in 30 cases. Am J Ophthalmol 2011;151(6): 1074 –1080.
REPLY WE THANK DRS GUTMAN AND SHINDER FOR THEIR INTER-
est and appreciate their comments about our article.1 We agree with Drs Gutman and Shinder that excision is not standard practice for sarcoid, or for any other inflammatory orbital or ocular adnexal entity. In our series, we had 8 patients who had well-circumscribed, anteriorly located masses that were treated with what, at operation, appeared VOL. 152, NO. 5
HAKAN DEMIRCI
Ann Arbor and Detroit, Michigan MURRAY D. CHRISTIANSON
Detroit, Michigan Conflict of Interest Disclosures: See the original article1 for any disclosures of the authors.
REFERENCE
1. Demirci H, Christianson MD. Orbital and adnexal involvement in sarcoidosis: analysis of clinical features and systemic disease in 30 cases. Am J Ophthalmol 2011;151(6): 1074 –1080.
Long-term Complications Associated With Glaucoma Drainage Devices and Boston Keratoprosthesis EDITOR: IN THEIR RECENT ARTICLE, LI AND ASSOCIATES EVALUATE
the long-term complications associated with glaucoma drainage devices (GDD) in patients who have undergone Boston type 1 keratoprosthesis (KPro) surgery.1 The authors speculate an association between the presence of soft contact lenses (SCL) and GDD erosion in this particular population. In a retrospective, interventional case series that aimed to determine prevalence, progression, treatment, and impact of glaucoma on visual acuity, we reviewed 38 consecutive eyes (38 patients) that have undergone KPro surgeries between 2008 and 2009 at our center. Of these patients, 21% (n ⫽ 8) had, along with their glaucoma, an implanted GDD. Among them, 4 presented with the implanted tube before KPro surgery, and 4 had their tube implanted postoperatively. An SCL was placed after KPro surgery in all our patients. In fact, SCL has been proven beneficial in efficaciously protecting the ocular surface, adequately maintaining its hydration, and decreasing the risk of corneal melts.2 Among patients who underwent KPro surgeries, had an SCL placed, and had an old or new implanted GDD, no tube erosion was recorded over a mean follow-up (FU) period of 24 months since KPro surgery. For the tubes placed postoperatively, the mean FU duration between the placement of the tube and patient’s last visit is 10 months. Regarding the old tubes, placed from 1 year to 14 years before KPro surgery, the mean FU period between the surgery (and therefore SCL placement) and
CORRESPONDENCE
883