Ocular Perfusion Following Orbital Apex Exenteration.

Area of Science:

• Ophthalmology
• Neurosurgery
• Infectious Diseases

Background:

• A 68-year-old male with type 2 diabetes mellitus and a history of kidney transplantation on immunosuppression presented with proptosis and vision loss.
• The patient had a recent history of invasive sinus aspergillosis, indicating a potential fungal etiology for his orbital symptoms.

Observation:

• MRI revealed abnormal enhancement in the right orbital apex, inferior medial right orbit, anterior cranial fossa floor, and anterior falx cerebri.
• These findings suggested an aggressive inflammatory or infectious process extending into the orbit and cranial base.

Findings:

• The patient underwent extensive surgical management including sinus surgery, bifrontal craniotomy, cribriform plate resection, and right orbital apex exenteration.
• Crucially, the globe and anterior orbital structures were preserved to cover the defect, and orbital perfusion was maintained via external carotid and ophthalmic artery anastomoses.

Implications:

• This case highlights a successful, albeit aggressive, surgical approach to managing complex sinodural-orbital aspergillosis.
• Preserving the globe and anterior orbital structures simplified reconstruction and maintained orbital function.
• Maintaining orbital perfusion through arterial anastomoses was key to the viability of preserved orbital tissues.