Maria A. Saornil

Intravitreal silicone and fluorosilicone oils: pathologic findings in rabbit eyes

Abstract The effects of medical‐grade intraocular silicone and commercial‐grade fluorosilicone oils were studied in rabbit eyes. The experimental model consisted of lensectomized and vitrectomized eyes that did not undergo further treatment (Group 1), and three groups of lensectomized and vitrectomized eyes that were injected intravitreously 3 months earlier with medical‐grade silicone oil of 1000 cs (Group 3), and 10 000 cs (Group 4). The silicone oil‐injected eyes developed proliferative membranes. The fluorosilicone oil caused an intravitreous inflammatory reaction with vacuolated macrophages present around the oil that may have been due to the higher concentration of low‐molecular‐weight components found in the oil.

Proliferative vitreoretinopathy: cytologic findings in vitreous samples.

Purpose: To compare the cellularity of vitreous samples obtained from patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (PVR) and from patients with uncomplicated rhegmatogenous retinal detachment (RD) to detect possible variations in cellularity over time. Methods: One hundred and twenty-five vitreous specimens collected from patients with RD (n = 41) and PVR (n = 84) were processed through direct paraffin embedding and cytospin. Different cell types were identified by light-microscopy (hematoxylin-eosin and Papanicolaou stain) according to their morphologic features, and a scale of cellular density was established for each cell type. Student’s t test was used to analyze differences in the cellularity of RD versus PVR. A quadratic model was used to identify variations in the density of each cellular type in the PVR group, based on its evolution time. Results: During the first months after surgery, more macrophages and fibroblast-like cells were observed in the PVR group, but at other times no differences were found. Conclusions: There are some differences in vitreous cellularity in PVR specimens when compared with RD. Especially relevant could be the large number of macrophages in earlier stages and their constant presence over time in PVR samples. The cytology of vitreous samples may shed light on the chronology of PVR cell pathobiology.

High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma

Aims To evaluate episcleral plaque radiotherapy with high-dose 125I for the treatment of circumscribed choroidal haemangioma (CCH). Methods A retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy was performed with ROPES plaques loaded with 125I seeds with a target apex dose of 48 Gy. Main outcome measures were regression of CCH, resolution of retinal detachment, visual acuity changes and frequency of radiation-related complications. Results Eight patients met the inclusion criteria. Mean tumour base was 11.3 (range 7.8–14.3) mm and mean height was 4.4 (range 2.8–6.5) mm. Six patients had an associated retinal detachment and seven macular exudates or oedema. Mean preoperative visual acuity ranged from no light perception to 0.7. Three patients had received prior argon laser treatment. All patients received one radiation treatment, since no new symptoms due to CCH developed during follow-up (mean 83 (range 23–123) months). Tumour regression was found in all cases. Three patients presented radiation retinopathy and one subretinal fibrosis. Visual acuity remained stable in six patients and decreased two or more lines in two patients. Conclusions Episcleral brachytherapy led to tumour regression and resolution of non-rhegmatogenous secondary retinal detachments in this case series that included large CCH. Visual stabilisation was achieved in most cases. Given the acceptable rate of side effects detected, 125I episcleral brachytherapy should be considered in large tumours, in tumours with a subfoveal location or extensive subretinal fluid, and in tumours that have failed to respond to other treatments.

Detecting amblyogenic diseases with the photographic Bruckner test

The authors evaluated the photographic Brückner test for its ability to detect the main causes of amblyopia. One hundred four patients divided into four groups underwent this test: Group I, small deviation esotropia; Group II, large deviation esotropia; Group III, anisometropia; and Group IV, healthy controls. The results show high sensitivity (82%), specificity (91%), and accuracy (84%), indicating that this test could be a potential way to mass-screen pre-verbal and pre-school children to facilitate early detection of the main causes of amblyopia, when treatment is still possible.

Prevalence of ocular and oculodermal melanocytosis in Spanish population with uveal melanoma

PurposeThe aim of this study was to determine the prevalence of ocular and oculodermal melanocytosis (ODM) among patients with uveal melanoma (UM) in a Spanish population.MethodsRetrospective review of the medical records of patients with ODM among patients with UM.ResultsTen (11 eyes) of 400 patients (2.7%) with UM associated had ODM. The mean age at diagnosis of UM among patients with ODM was 62 years. One patient had bilateral tumours. UM was diagnosed during a routine-examination in two cases. All tumours were medium (7/11) or large (4/11) in size, with a mean maximum base of 13 mm and height of 7 mm. No patient had extraocular extension or metastatic disease at diagnosis. Enucleation was done in five cases and I-125-brachytherapy in six. The mean follow-up was 43 months. One patient died because of metastasis 2 years after enucleation; one patient is currently on treatment of systemic metastasis 11 years after.ConclusionsODM is more frequent in spanish population with UM than in American population. Despite the risk of UM in ODM, it is often diagnosed late when a conservative treatment is not indicated.

Conjunctival biopsy in the diagnosis of ocular sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that can affect almost every organ in the body, particularly the lungs, skin, eyes, and thoracic lymph nodes. A definitive diagnosis of sarcoidosis requires that a biopsy be performed. A specimen can be obtained from any affected ocular structure, including conjunctiva, lacrimal gland, eyelid skin, and orbit. Among them, conjunctival biopsy has been suggested as a sensible and safe procedure for confirming suspected sarcoidosis. We describe three patients in whom ocular symptoms were the sole initial manifestations of sarcoidosis and who were diagnosed based on the results of a conjunctival biopsy. We also discuss the efficacy of and indications for conjunctival biopsy.

Cavitary choroidal melanoma

CASE REPORT We report an unusual case of cavitary choroidal melanoma. The results of ultrasonography, magnetic resonance imaging, computed tomography, and immunohistochemical studies are presented for a 38-year-old woman who developed an amelanotic tumor in the posterior choroid. B-scan ultrasonography disclosed intratumoral cavitations. Systemic and extraocular extension studies were negative. Enucleation was performed and histopathologic examination showed a choroidal melanoma of spindle cell type, with intratumoral cavitations lined by flattened tumor cells. COMMENTS The majority of previous reports of intraocular cavitary tumors describe cavitary ciliary body tumors. Uveal melanoma should be included in the differential diagnosis of choroidal cavitary lesions. As far as we know, this is the second documented clinicopathologic correlation of a cavitary choroidal melanoma.

Corneal perforation due to late radiation therapy-induced corneal necrosis--clinicopathological correlation.

A clinicopathological correlation is made between corneal perforation and late radiation therapy-induced corneal necrosis in a male adolescent treated for orbital rhabdomyosarcoma.

Episcleral brachytherapy for uveal melanoma:: analysis of 136 cases

PurposeTo assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival.PatientsProspective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up.ResultsAmong a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date.ConclusionsI-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients.

Original papers: Prevalence of amblyogenic diseases in a preschool population sample of Valladolid, Spain.

OBJECTIVES Amblyopia is the leading cause of monocular vision loss in people under 40 years, and especially in children. The purpose of the present investigation is to determine the prevalence of amblyopia and ocular pathology, specially the most common causes of amblyopia, in a population of 3-to 6-year-old children. PATIENTS AND METHODS From a total of 8167 children, a geographically defined population of 3-to 6-year-old children, 2000 were randomly selected, and 1179 (58.9%) examined. Ophthalmologic examination included: Personal and familial history, visual acuity, extraocular motility, cover test at near distance, cycloplegic refraction with autorefractometer and fundus eye examination. Amblyopia was considered when corrected visual acuity was < 0.5 with Marquez optotypes and difference in visual acuity of 0.2 or more between eyes. Pathology considered as amblyogenic were strabismus, visual acuity asymmetry and anisometropia. RESULTS The family history showed amblyopia in 249 (21.1%), strabismus in 227 (19.2%), and refractive errors in 808 (65.5%). Cover test was positive in 78 children (6.7%). A visual acuity difference of 0.2 or more between eyes was present in 88 (7.5%) children, and anisometropia over 1.5 diopters (in spherical equivalent) was present in 17 (1.4%) subjects. One hundred and twenty-two (10.35%) children did not achieve a normal visual acuity: visual acuity in the better eye was less than 0.5 in 55 children under 5 years and less than 0.6 in 67 children over 5 years. The prevalence of amblyopia was 7.5%. CONCLUSIONS The data support the importance of early detection and treatment of amblyopia and the need for visual screening at an early age.