Felice Menicacci

Imaging Techniques in the Diagnosis of Lacrimal Sac Diverticulum

Lacrimal sac diverticulum is a rare condition characterized by a cystic structure communicating with the sac. This abnormality may be directly demonstrated by dacryocystography only in a few cases; in the remaining cases, preoperative diagnosis may be arduous. We report 3 cases of lacrimal sac diverticulum. In all patients, symptoms were represented by a palpable mass in the lacrimal sac region, associated with permanent (case 1) or episodic (cases 2 and 3) epiphora. In the first case, CT-dacryocystography revealed an apparently solid mass causing inferior lacrimal obstruction, and ultrasonography disclosed a cystic space, not communicating with the sac. At surgery, a sac diverticulum was identified and excised. In the second patient, CT showed a homogeneous rounded mass, whereas a cystic character was revealed by T1-weighted MRI. Dacryocystography showed a lateral impression on the lateral wall of the sac. Ultrasonography revealed a cystic space communicating with the lacrimal sac. In the third case, ultrasonography demonstrated a diverticulum. CT is often unable to discriminate tumors from lacrimal cysts, both showing a parenchymal density. MRI can differentiate lacrimal cystic spaces from solid tumors by T1 intensity and by demonstration of their walls, but it is nonspecific for diverticula. Only dacryocystography and B-scan ultrasonography can reveal the narrow communication between the sac and the diverticulum. Observation is the recommended management for asymptomatic cases.

Alternated intra-arterial and intravitreal chemotherapy for advanced intraocular retinoblastoma: preliminary successful results without systemic chemotherapy

To describe the efficacy of intravitreal chemotherapy (IViC) preceded by intra-arterial chemotherapy (IAC) for the treatment of advanced stage retinoblastoma. This non-comparative interventional case series retrospectively reviewed the medical records of six patients who presented within months of each other with unilateral retinoblastoma, Reese–Ellsworth stage Vb/D of ABC classification in the affected eye. After clinical and ophthalmoscopic evaluation, they underwent MRI to exclude local and CNS dissemination. The IAC was given to treat retinal masses and intravitreal injections to treat vitreous seeding. Patients had received two cycles (six infusions) of IAC, and from six up to ten melphalan injections into the vitreous, with an interval of 7–10xa0days between them. From one to four intravitreal injections were performed for partial remission or consolidation. No permanent complications of procedures have been reported. All patients underwent to bimonthly MRI examination, during treatment and every 3xa0months for 1xa0year after last injection, to exclude orbital dissemination. Successful control (100xa0%) of tumor masses and vitreous seeds was achieved in all cases at 12xa0months follow-up. Complications were posterior lens opacity, acute ischemic papillitis, partial CVR thrombosis, hypotonia (case 1), partial vitreous hemorrhage (case 4). No complications appeared in cases 2, 3, 5, and 6. No intraocular or orbital tumor recurrence or retinoblastoma metastases (follow-up range, 12–33xa0months) were observed. Sequential IAC and intravitreal melphalan for advanced retinoblastoma allowed to provide retinal and vitreous seed control.

Analysis of aqueous humour proteins in patients with retinoblastoma.

Background:u2002 To investigate aqueous humour protein composition from retinoblastoma patients.

Spindle cell lipoma of the orbit: a case report of an unusual orbital pathology

Spindle cell lipoma is a rare and distinct variant of soft tissue tumour characterised by spindle cells in which the fat content may be scarce or absent. Most spindle cell lipomas arise as a subcutaneous mass of the neck, shoulders or back. Rarely, they can also be found in unusual sites, such as the oral cavity, larynx, bronchus, breast, and extremities. Localisation of spindle cell lipoma in the orbit has been described in a few cases. We report here on a case of an orbital mass surgically excised in an adult male and discuss the differential diagnosis with other soft tissue tumours with a lipomatous component, such as lipomatous haemangiopericytoma, a rare variant of haemangiopericytoma.

A Case of Anterior Chamber Cholesterolosis Due to Coats' Disease and a Review of Reported Cases

Purpose: To present the case of an 18 month old boy with Coats disease who was found to have anterior chamber cholesterolosis. Methods: Case presentation and review of reported cases. Results: An 18 month old boy presented with unilateral stage 3B Coats disease without other clinical findings. Two weeks after presentation he returned with xanthocoria due to anterior chamber cholesterolosis. He subsequently developed hyphema, neovascular glaucoma, and was enucleated. His case is compared to all previously reported cases of Coats disease leading to anterior chamber cholesterolosis. Conclusion: The presentation of anterior chamber cholesterolosis in Coats disease can range from the incidental finding in an asymptomatic patient to acute angle closure glaucoma with pain and acutely decreased vision. Clinicians should be aware of this potential complication of Coats disease as it denotes a poor visual prognosis.

Massive anterior chamber involvement in advanced retinoblastoma following intra-arterial chemotherapy

Purpose to describe retinoblastoma massive anterior chamber involvement after treatment with intra‐arterial chemotherapy. This condition represents an extremely poor prognostic sign for ocular preservation in patients with retinoblastoma. Therefore, anterior chamber retinoblastoma should be considered an absolute indication for enucleation.

Use of hypo-osmolar riboflavin for corneal cross-linking in thin keratoconic corneas

Purpose To evaluate the efficacy of UVA collagen cross linking (CXL) on thin keratoconic corneas with previous application of hypoosmolar riboflavin solution.

Giant orbital retinoblastoma: a case report

Purpose The authors report a case of giant orbital Retinoblastoma following primary enucleation for intraocular tumor. The presence of worms was documented inside the necrotic tumoral mass.