PART TWO
Diagnostic Cytology
Table 17.5
Complications of Orbital Fine-NeedleAspiration
Author
Total
Retrobulbar
hemorrhage
Eye perforation
Kennerdell
156
10
2
Glasgow
83
2
0
Dey
35
2
0
Liua
152
10
2
Total
426
24
4
“Serious complications were reported based on survey data for which the details
were not delineated.
Reproduced from Glasgow BJ, Goldberg RA, Gordon LK, et al. Fine-needle aspira-
tion of orbital masses.
O phthalm ol Clin North Am
1995;8:73-81.
appropriate circumstance, a correct FNA diagnosis may obviate
an open biopsy in cases of lymphoma, plasmacytoma (mye-
loma), and other lesions that would be candidates for medi-
cal/chemical treatment or radiotherapy. Preoperative aspiration
can assist the surgeon in planning the operation, especially in
determining the extent of the lesion, such as in primary lacrimal
gland tumors.
Complications of orbital FNA are not common100 but can be
serious and require that a competent ocular surgeon be available
not only to perform the aspiration but to minimize the sequelae
of unwanted circumstances of needle trauma. Table 17.5 dis-
plays the reported experience of four groups familiar with these
problems.56 The more common complication is retrobulbar
hemorrhage (6%), and the more serious eye perforation fortu-
nately is very infrequent (< 1%).
Concluding Remarks
Many new and sophisticated molecular techniques including
chromosomal array analyses and FISH have emerged to aid
in ophthalmologic diagnoses. At the same time, the advance-
ments in interventional imaging have resulted in smaller and
smaller cytologic specimens. These developments will likely
put added pressure on cytopathologists to increase flexibil-
ity in handling and reporting specimens and to incorporate
molecular techniques into their repertoire. At the same time,
it will be imperative for cytopathologists to retain expertise
in morphological interpretation which will remain necessary
for the utilization of such analyses. With the increase in diag-
nostic information that such techniques will bring, perhaps
the biggest challenge to diagnosing ocular specimens will be
familiarity with the diseases resulting in the specimens. A col-
laborative effort including consultation with ophthalmologists
and ocular pathologists is the best approach to deal with these
future challenges.
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