M. A. Blasi

Local chemotherapy with interferon-α for conjunctival mucosa-associated lymphoid tissue lymphoma: A preliminary report1

OBJECTIVE To evaluate the efficacy of subconjunctival interferon-alpha for the treatment of conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma. DESIGN Small, noncomparative, interventional case series. PARTICIPANTS Five patients with histologically proven conjunctival MALT lymphoma were studied prospectively. METHODS Patients were given 1,500,000 international units (IU) of interferon-alpha (IFN-alpha) (Roferon-A) subconjunctivally inside the lesion, three times a week for four weeks. If there was even a minimal response, a further cycle of 1,000,000 IU three times a week for four weeks was administered. Patients received a maintenance dose of 1 million IU, every 15 days for 4 times, after clinical resolution of the lesion. MAIN OUTCOME MEASURES Patients were followed clinically, with slit lamp examination, for evidence of tumor disappearance or recurrence. RESULTS Complete response was obtained in all patients. The lesion resolved completely by the eighth week. Four patients did not show any local recurrence with a median follow-up of 21 months (12-36 months). One patient presented with a recurrence after 11 months, in association with systemic lymphoma progression. CONCLUSIONS Local chemotherapy with IFN-alpha seems to be an effective treatment modality, alternative to radiotherapy, for conjunctival MALT lymphomas.

Does Coenzyme Q10 Play a Role in Opposing Oxidative Stress in Patients with Age-Related Macular Degeneration?

To seek some specific biochemical markers of age-related macular degeneration (AMD), coenzyme Q10 (CoQ10) levels were determined in plasma and platelets from 19 exudative AMD patients and 19 age-matched controls. Lipid peroxidation was followed in plasma in vitro after the addition of a free radical initiator. Most patients had lower plasma CoQ10 content than most controls. Plasma from controls showed greater capacity to oppose the oxidative damage. These results support the concept that free radicals play a pathogenic role in AMD and that CoQ10 may have a protective effect.

Specular microscopy of the corneal endothelium after excimer laser photorefractive keratectomy

Purpose: To evaluate endothelial cell morphology and density after excimer laser photorefractive keratectomy (PRK). Methods: We used a noncontact specular microscope to examine the central corneal endothelium of 50 eyes of 50 patients who had PRK for an attempted correction between −2.5 and −17.0 diopters (D) (mean −7.8 D) beginning 18 to 24 hours postoperatively. Results: After a follow‐up of 11.4 ± 6.1 months (mean ± standard deviation), mean endothelial cell density was 2577.6 ± 402.0 cells/mm2 with rare signs of polymegathism and pleomorphism. Preoperative and untreated fellow eye endothelial cell density values were used as a control. Paired Student’s t‐test and analysis of variance results were not significant (P > .05). Conclusion: Excimer laser PRK did not significantly change cell density and morphology.

Dot-and-fleck retinopathy in Alport syndrome caused by a novel mutation in the COL4A5 gene

PURPOSE To describe an unusual form of dot-and-fleck retinopathy in a slower progressive form of X-linked Alport syndrome, caused by a novel missense mutation in the COL4A5 gene. METHOD Ophthalmic examination, polymerase chain reaction, and single-strand conformational polymorphism analysis of genomic DNA were performed in the proband. RESULTS Ophthalmoscopy revealed classic dot-and-fleck retinopathy but located in an unusual site. A novel COL4A5 gene mutation changing glycine to cysteine at 177 was identified. CONCLUSIONS Although there is no correlation between mutation site and the resulting phenotype in Alport syndrome, our findings suggest that further novel mutations and different ocular manifestations may be associated with Alport syndrome.

Bovine pericardium for scleral closure in transscleral local resection of choroidal melanoma

Bovine Pericardium for Scleral Closure in Transscleral Local Resection of Choroidal Melanoma The current treatment of uveal melanoma aims to conserve the eye as well as useful vision. Conservative therapy includes brachytherapy, charged particle teletherapy, stereotactic radiotherapy, transpupillary thermotherapy, and transscleral local resection. Despite technical advances, local resection of posterior uveal melanoma (choroidectomy and cyclochoroidectomy) remains a challenging procedure, and therefore, it is indicated only in selected cases. Transscleral local resection should be performed for tumors whose larger basal diameter is less than 16 mm and whose thickness exceeds 8 to 9 mm; because in these cases, the incidence of complications related to radiotherapy increases and consequently the chances of conserving vision are reduced.1 Local resection, if performed in selected cases and by an experienced team, has been shown to obtain excellent results in terms of local tumor control and in preserving a good visual function.2,3 Retinal detachment is one of the main complications of this surgical procedure. Its main cause are retinal tears, which are most likely to occur if the tumor is adherent to the retina.4 When a retinal tear occurs, immediate vitreoretinal surgery, performed soon after the removal of the tumor, usually prevents postoperative retinal detachment.4 In addition, the ripping of the scleral flap constitutes a further complication of transscleral local resection. It mainly occurs when the site of a rectus muscle insertion is involved in the dissection because of thinner scleral tissue. In this study, we present our experience of using bovine pericardium patches allografts to strengthen globe stability, repairing possible iatrogenic defects in the scleral flap, and to assist immediate vitrectomy, thus avoiding fluid leakage at the margins of the sutured scleral flap.