Melis Palamar

Retinoblastoma Regression Patterns Following Chemoreduction and Adjuvant Therapy in 557 Tumors

OBJECTIVE To evaluate retinoblastoma regression patterns following chemoreduction and adjuvant therapy. PARTICIPANTS A total of 557 retinoblastomas. METHODS A retrospective medical record review following 6 cycles of chemoreduction and tumor consolidation (thermotherapy or cryotherapy). Regression patterns included type 0 (no remnant), type 1 (calcified remnant), type 2 (noncalcified remnant), type 3 (partially calcified remnant), and type 4 (flat scar). MAIN OUTCOME MEASURES Regression pattern. RESULTS Retinoblastoma regressions were type 0 (n = 10), type 1 (n = 75), type 2 (n = 28), type 3 (n = 127), and type 4 (n = 317). Tumors with an initial thickness of 3 mm or less regressed most often to type 4 (92%), those 3 to 8 mm regressed to type 3 (34%) or type 4 (40%), and those thicker than 8 mm regressed to type 1 (40%) or type 3 (49%). Factors predictive of type 1 regression included larger tumor base and closer foveolar proximity. Factors predictive of type 3 included older age, larger tumor base, macular location, closer foveolar proximity, and lack of consolidation. Factors predictive of type 4 included familial hereditary pattern, smaller tumor base, greater foveolar distance, and tumor consolidation. CONCLUSIONS Following chemoreduction, most small retinoblastomas result in a flat scar, intermediate tumors in a flat or partially calcified remnant, and large tumors in a more completely calcified remnant.

Reply re: "Anterior Segment Ischemia and Retinochoroidal Vascular Occlusion After Intralesional Steroid Injection".

A 19-year-old woman was admitted with sudden severe pain and loss of light perception that began immediately after eyelid injection of the depot form of corticosteroid. Ecchymosis of the lower eyelid, corneal edema, and a fixed dilated pupil were noted. Fundus examination could not be performed because of corneal edema. Embolic material packed in the episcleral vessels was detected. With these findings, the diagnosis was anterior and posterior segment ischemia. Despite administration of an intravenous hyperosmotic agent, in addition to topical and systemic pulse corticosteroid (1.0 g/day), vision was not recovered. The most serious complication of intralesional injection of corticosteroid is vascular occlusion. This catastrophic complication after intralesional steroid injection should prompt immediate ophthalmoscopic fundus examination to allow early recognition of ischemic signs and immediate intervention.

Topical anesthetic abuse keratopathy: a commonly overlooked health care problem.

Purpose: To evaluate the clinical course, treatment modality, factors affecting the epithelization period, and visual outcome in patients with topical anesthetic abuse keratopathy. Methods: The medical records of 19 patients with a confirmed diagnosis of topical anesthetic abuse keratopathy were retrospectively examined; occupation, initiating event, biomicroscopic findings, treatment modality, epithelization period, and best-corrected visual acuity (BCVA) were noted. The Wilcoxon signed rank test was used to compare BCVA before and after treatment; P values <0.05 were considered statistically significant. Results: In all, 26 eyes in 19 men aged 21-44 (mean age: 31 ± 6) years were included. Initiating events included exposure to arc welding flash (8 patients), metallic foreign body injury (8 patients), and chemical injury (3 patients). On admission to hospital, 10 patients (52.6%) reported that they were using topical anesthetics. Upon admission to the hospital, 10 patients (52.6%) self reported that they were using topical anesthetics. The remaining 9 subjects were discovered to be using topical anaesthetic drops during hospitalization. Twelve patients (63.2%) were found to continue using these agents during their hospitalization. Oval corneal epithelial defect, stromal infiltrate, ring-shaped keratitis, and hypopyon were noted in 100%, 46.2%, 57.7%, and 42.3% of the eyes, respectively. Topical antibiotics (fluoroquinolones or combined fortified cephalosporins and aminoglycosides), preservative-free lubricants/autologous serum, and bandage contact lens/eye patches were used for treatment. Mean epithelization period was 19.96 ± 11.16 days (range: 6-50 days). Mean pretreatment and posttreatment BCVA was 0.12 ± 0.16 (range: 0.001-0.7) and 0.66 ± 0.30 (range: 0.0-1.0), respectively (P < 0.001). Conclusions: Ophthalmologists should be suspicious of topical anesthetic abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis, and accompanying severe ocular pain.

Influences of cyclopentolate hydrochloride on anterior segment parameters with Pentacam in children

Purpose:  To investigate the effects of cyclopentolate hydrochloride 1% on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in children.

Evaluation of dry eye and meibomian gland dysfunction with meibography in patients with rosacea.

Purpose: To evaluate the dry eye tests and meibography of patients with ocular rosacea. Methods: Thirty-six eyes of 18 patients with ocular rosacea (group 1) and 38 eyes of 19 healthy individuals (group 2) were enrolled. Besides full-eye examination, corneal and conjunctival fluorescein staining and Oxford scoring, tear film break-up time, Schirmer 1 test, ocular surface disease index score assessment, and evaluation of upper and lower eyelid meibomian glands using infrared captures of an optical coherence tomography (OCT) (Spectralis HRA+OCT; Heidelberg Engineering) device were performed (grade 0: no loss of meibomian glands, grade 1: gland dropout area <1/3 of the total meibomian glands, grade 2: gland dropout area 1/3 to 2/3 of the total meibomian glands, grade 3: gland dropout >2/3 of the total meibomian glands). Results: The mean ages of group 1 and group 2 were 50.2 ± 9.5 (range, 32–65), and 46.3 ± 14.1 years (range, 25–70), respectively (P = 0.225). No significant difference in best-corrected visual acuity and meiboscores of upper eyelids were detected in between groups. Schirmer 1 and tear film break-up time in group 1 were significantly lower than in group 2 (P = 0.005, P < 0.001, respectively). Ocular surface disease index and Oxford scale scores and meiboscores of lower and total (upper + lower) eyelids were significantly higher in group 1 than in group 2 (P = 0.04, P = 0.018, P < 0.001, P = 0.03, respectively). Conclusions: Ocular rosacea causes dry eye and significant meibomian gland loss that can objectively be demonstrated with meibography. The infrared camera of OCT—that is widely found in many ophthalmology departments—might be used to evaluate meibomian gland dysfunction in these individuals.

Evaluation of Ex-PRESS mini glaucoma shunt implantation in refractory postpenetrating keratoplasty glaucoma.

PurposeTo evaluate the intraocular pressure (IOP) control and graft survival after Ex-PRESS mini glaucoma shunt implantation in refractory postpenetrating keratoplasty glaucoma. MethodsThe study included postpenetrating keratoplasty glaucoma cases unresponsive to medical antiglaucomatous therapy in whom 15 Ex-PRESS mini glaucoma shunt implantation was carried out. All glaucoma shunt implantations were performed in a separate session after penetrating keratoplasty. Nine operations were performed under general anesthesia and 6 were performed under local anesthesia. Topical antibiotherapy and topical corticosteroids were used during the postoperative first month. ResultsMean age of the study population was 37.4 years (range: 10 to 80 y). IOP decreased from 41.46 mm Hg (range: 26 to 80 mm Hg) to 12.06 mm Hg (range: 8 to 25 mm Hg) over a mean follow-up of 12.2 months (range: 8 to 19 mo) (P<0.001; Wilcoxon signed rank test). IOP was below 21 mm Hg in 14 of 15 eyes (93.3%) with or without antiglaucomatous drugs. Complete success (IOP<21 mm Hg without medication) rate was 86.6%. Average number of antiglaucomatous drug usage decreased from 3.20 (range: 2 to 4) preoperatively to 0.26 postoperatively (range: 0 to 3) (P<0.001; Wilcoxon signed rank test). In 93.3% of the cases, the decrease in IOP was 30% or above postoperatively. After Ex-PRESS implantation, clear grafts remained clear while edematous grafts became clearer due to IOP decrease. Neither biomicroscopy nor pachymetry showed worsening of preoperatively opaque grafts. ConclusionEx-PRESS mini glaucoma shunt implantation may be an effective procedure for refractory postpenetrating keratoplasty glaucoma with acceptable graft failure rates in short term.

Amniotic membrane transplantation in surgical management of ocular surface squamous neoplasias: long-term results.

ObjectiveTo evaluate the long-term efficacy of amniotic membrane transplantation for ocular surface reconstruction in the surgical management of ocular surface squamous neoplasia (OSSN).MethodsOSSN in 21 patients (7 female, 14 male patients) was managed with excisional biopsy, cryotherapy, corneal epitheliectomy with absolute alcohol application when the cornea is involved, lamellar sclerectomy and adjunctional absolute alcohol application to the base when episclera is involved, and ocular surface reconstruction with cryopreserved amniotic membrane transplantation. Tumor control and complications were evaluated.ResultsThe mean age of the patients was 62.42±20.9 (range, 16–84). The average diameter of the base of the tumors was 13.1±4.8 (range, 9–21) mm and complete removal was achieved in all cases as revealed histopathologically. Ocular surface healing was achieved in all cases. At the postoperative period, limbal stem cell deficiency in three eyes and mild symblepharon in one eye were detected. In a mean follow-up of 30.95±18.8 (range, 13–75) months, no recurrence was detected.ConclusionFor large or multifocal conjunctival tumors, the reconstruction of ocular surface and fornix is challenging. The amniotic-membrane use to repair conjunctival defects larger than 10 mm is a safe and effective technique with minimal complications allowing surgeons to make large enough excisions.

Relationship between IL1β-511C>T and ILRN VNTR polymorphisms and keratoconus.

Purpose: The aim of this study was to evaluate the relationship between keratoconus (KC) and interleukin-1&bgr; (IL1 &bgr;) (–511C>T) and interleukin-1 receptor antagonist (IL1RN) variable number of tandem repeat (VNTR) polymorphisms that are potentially associated in their genetic susceptibility to KC. Methods: A total of 121 patients with KC and 121 healthy individuals were enrolled. Blood samples with ethylenediamine tetraacetic acid were obtained, and IL1&bgr; (−511C>T) (rs16944) (polymerase chain reaction–restriction fragment length polymorphism method) and IL1RN VNTR polymorphisms (rs2234663) (polymerase chain reaction and agarose gel imaging) were investigated. Results: Genotype and allele distribution for IL1&bgr; (−511C>T) and IL1RN VNTR polymorphisms among the KC and healthy groups showed no difference (for all; P > 0.05). Conclusions: Because the genotype and allele frequency of both polymorphisms are identical, it is most likely that IL1&bgr;-511C>T and IL1RN VNTR polymorphisms do not play a role in the development of KC in the Turkish population.

Primary diffuse large B-cell lymphoma of the lacrimal sac simulating chronic dacryocystitis ☆

Primary diffuse large B-cell lymphoma of the lacrimal sac is rare. Herein we report a 55-year-old female presented with epiphora in the right eye. Distention of the lacrimal sac secondary to nasolacrimal duct obstruction was observed. She was scheduled for external dacryocystorinostomy for the next month. When she came for surgery, a growing mass was recognised over the lacrimal sac region. On computer tomography scan, a subdermal mass causing nasal bone destruction was detected. Excisional biopsy of the mass was performed. Histopathologic and immunohistochemical evaluations revealed primary diffuse large B-cell non-Hodgkin lymphoma of the lacrimal sac. She was treated with cyclophospamide, vincristine, adriablastine and prednisone for eight courses combined with rituximab for 6 months. During a follow-up period of 25 months, patient is stable with no systemic disease. Although rare, lacrimal sac tumors can mimic dacryocystitis and must be considered in differential diagnosis. In suspicious cases incisional biopsy is recommended.

Choroidal plasmacytoma in a patient with multiple myeloma. Diagnosis by fine-needle aspiration biopsy.

BackgroundTo report a case of a secondary plasmacytoma of the choroid.MethodsInterventional case report with cytopathologic correlation.ResultsA 61-year-old male with a breast nodule and a 2-year history of multiple myeloma developed blurred vision and was found to have three confluent, ill-defined areas of choroidal thickening in the left eye. Cytopathology and immunohistochemistry of a transocular fine-needle aspiration biopsy of the largest lesion revealed atypical plasma cells diagnostic of plasmacytoma. Following external beam radiotherapy the choroidal tumors resolved completely.ConclusionSecondary plasmacytoma, despite its rarity, should be included in the differential diagnosis of amelanotic choroidal tumors, particularly in patients with multiple myeloma. Radiotherapy is an effective treatment.