Volume 13 Number 1 / February 2009
025 Diffusion weighted imaging in the analysis of pediatric orbital
tumors. Lea Ann Lope, Kelly A. Hutcheson, Zarir Khademian
Purpose: To identify common radiographic features of pediatric or-
bital tumors using magnetic resonance imaging (MRI) techniques,
particularly diffusion weighted imaging (DWI), fat saturated FSE T2
and pre- and post-gadolinium T1. DWI is hypothesized to help identify
and predict the malignancy of specific brain tumors. To our knowl-
edge similar analysis has not been performed with pediatric orbital
tumors.
Methods: We performed a retrospective chart review at our insti-
tution of all patients diagnosed with an orbital mass lesion, imaged by
MRI using the aforementioned techniques. Twenty seven patients
met inclusion criteria. We reviewed the MRI of these patients from
2005 to 2008, when DWI was most likely to be routinely used. Mass
lesions included rhabdomyosarcoma (n 5 7), myofibroma (n 5 2),
hemangioma (n 5 3), lymphangioma (n 5 1), eosinophilic histiocyto-
sis (n 5 2), giant cell tumor (n 5 1), meningioma (n 5 1) lymphoid hy-
perplasia of the lacrimal gland (n 5 2), neurofibroma (n 5 4), optic
nerve glioma (n 5 1), lipodermoid (n 5 1), dermoid (n 5 1), and Lang-
erhans histiocytosis (n 5 1).
Results: The fibrous orbital tumors, specifically orbital rhabdo-
myosarcoma and myofibroma, demonstrate homogenous diffusion
restriction on DWI. In contrast, nonfibrous orbital lesions, such
as hemangiomas demonstrate no restriction on DWI, and eosino-
philic histiocytosis show a predominance of diffusion restriction
with interspersed areas of increased diffusion. On T1 after gadoli-
nium administration, myofibromas show a unique thickened periph-
eral enhancement with central hypointensity. The eosinophilic
histiocytotic lesions show enhancement of the adjacent muscula-
ture on T1 after gadolinium. Both findings are not seen in other tu-
mors.
Conclusions: Our results give promise to diffusion weighted imag-
ing and conventional MRI techniques, to provide identifying informa-
tion on pediatric orbital tumors. Our study introduces a new
application for this existing imaging technique, in hope of refining
the differential diagnosis of such orbital tumors.
026 Exotropia after hemispherectomy. Iason S. Mantagos,
Deborah K. VanderVeen
Introduction: Children with homonymous hemianopia often de-
velop exotropia, which may be an adaptive mechanism to expand
the visual field. We evaluated the incidence of strabismus in patients
who have had hemispherectomy for intractable seizures at our
tertiary care institution.
Methods: A retrospective chart review of patients who had hemi-
spherectomy from 1995 until 2008 and also were evaluated at the
Department of Ophthalmology was performed. Age at hemispherec-
tomy, and details of ophthalmologic evaluations including visual field
assessment were collected.
Results: A total of 74 patients (17 female, 57 males) ages 6 months
to 16 years at the time of hemispherectomy were identified; 34 of
them also were evaluated by Ophthalmology. A total of 7 of 34
patients had associated ocular comorbidities such as optic nerve co-
lobomas, glaucoma, congenital cataracts. Of the patients without co-
existing ocular abnormalities, 65% developed strabismus, whereas
35% remained orthotropic, with a follow-up range of 6 to 60 months.
Of the patients that developed strabismus 75% had exotropia, 8% hy-
pertropia, and 17% esotropia. Patients with other ocular diagnoses
demonstrated various types of strabismus, and only 28% remained
orthotropic. No clear association between laterality of the surgical
site, age at the time of surgery, or underlying diagnosis and maintai-
nance of orthotropia was found.
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Discussion: Hemispherectomy is an end-stage procedure for con-
trol of intractable seizures and induces a homonymous hemianopia.
We found a high rate of exotropia developing at various time intervals
after hemispherectomy, and visual field testing confirmed expansion
of the binocular visual field with the exotropic deviation.
Conclusions: Because exotropia after hemispherectomy is com-
mon and adaptive, conservative management of their strabismus
should probably be considered.
027 Optokinetic nystagmus and sensorial tests in different types
of strabismus. Fatih Mehmet Mutlu, Alpay Demirel, Halil Ibrahim
Altinsoy
Purpose: To determine the relationship between the sensory fea-
tures and monocular horizontal optokinetic nystagmus (OKN) asym-
metry in different types of strabismus.
Methods: Forty-two esotropic, 37 exotropic, 10 Duane's syndrome
(type 1), 11 congenital superior oblique palsy (SOP) cases with infan-
tile-onset strabismus, and 15 healthy controls were included. Binocular-
ity was tested with the Bagolini glasses, synoptophor, and the stereo-fly
plate of theTitmus and Randot tests. OKN asymmetry was evaluated in
the dominant and nondominant eyes by using Barany drum (graded
from zero to +3) and videonystagmography (at velocities 20 and 30
deg/s), and the correlation between these tests was assessed.
Results: Subjects with no binocularity showed a significant OKN
asymmetry in both eyes (p 5 0.001; for both). OKN asymmetry was
frequent in esotropics with poor or no binocularity. Although good
binocularity was detected in exotropics, OKN asymmetry was signif-
icant in exotropics with no binocularity. Good binocularity and sym-
metric OKN along with low OKN gain in the affected eye were
detected in patients with Duane's syndrome. Excellent binocularity
and symmetric OKN were found in SOP cases. OKN asymmetry
was frequent in amblyopic and strabismic subjects with DVD (p 5
0.001; for both). There were significant (p \0.001, for all) correlations
between asymmetry levels of Barany drum and asymmetry index of
videonystagmography tests for each velocity in both eyes.
Conclusions: There is a relationship between binocularity and
OKN asymmetry. OKN evaluation may be helpful to identify binocular-
ity, and binocular potential in patients with strabismus. Barany drum
can be substituted for videonystagmography in clinical practice to
evaluate OKN.
028 Strabismus surgery on the elderly and the effects on
disability. Kevin D. Merrill, Mary O'Hara, Denise Satterfield
Introduction: In 2005 this journal published an article by Beau-
champ et al showing the effects that strabismus had on disability
of adults. The age range of that study was from 19 to 87 years,
with the average age being 54.9 years. Can these data be extrapo-
lated to adults with an older age range, specifically the Medicare
population? The purpose of our study was to examine the effect of
strabismus surgery on disability of adults in the Medicare age range.
Methods: A total of 56 consecutive patients older than 65 years of
age who had undergone strabismus surgery were asked to complete
a telephone questionnaire rating their before-surgery and after-sur-
gery severity of various problems ranging from specific health, daily
functioning, social interaction problems, concerns about the future,
and self-image to job-related problems. The questionnaire was the
same one given in the 2005 article so results could be compared.
Results: The problem ratings on all 6 items declined after surgery,
with ''specific health'' and ''daily tasks'' yielding the highest percent-
age of improvement. For all items, the number of patients indicating
an improvement was greater than the number of patients indicating