Michael Ilsar

Intraoperative Application of Topical Mitomycin C for Pterygium Surgery

BACKGROUND Postoperative recurrence of pterygium occurs in many patients. The authors studied the recurrence rate of pterygium after administration of a single intraoperative dosage of topcial mitomycin C at the completion of pterygium excision. METHODS AND PATIENTS Eighty-one patients underwent excision of the pterygium, leaving the sclera bare. The first 60 patients were randomized into two treatment groups of 30 patients each. Their remaining 21 patients were offered mitomycin C. Group 1 included 49 patients (30 randomized and 19 of the remaining 21 patients) who received an intraoperative application of 0.02% (0.2 mg/ml) mitomycin C for 5 minutes, and group 2 included 32 patients (30 randomized and 2 of the remaining 21 patients) who received NaCl 0.9% instead of mitomycin C. Patients were followed from 12 to 28 months in a masked manner. RESULTS The pterygium recurred in 2 (4%) of 49 patients in group 1 and in 15 (46.7%) of the 32 patients in group 2 (P = 0.0001). A delay of epithelialization for 5 and 10 weeks occurred in two patients in group 2 and granuloma manifested in one patient in group 1. CONCLUSION This study indicates that intraoperative administration of a single dosage of 0.02% mitomycin C is an effective treatment for prevention of recurrence of pterygium.

The Use of Low-dose Mitomycin C for Prevention of Recurrent Pterygium

BACKGROUND The administration of high doses of topical mitomycin C after pterygium excision causes a variety of complications. METHODS Seventy-five patients who had advanced or recurrent pterygia underwent excision of pterygia, leaving the sclera bare. Patients were randomized in a masked fashion into three groups of 25 patients each. Patients in group 1 received topical 0.01% mitomycin C for 5 days, patients in group 2 received 0.02% mitomycin C for 5 days, and those in group 3 were treated with 1200 rad beta-irradiation. Patients were followed by a surgeon who was masked to the patient treatment. The mean follow-up period was 15.3 months. RESULTS The recurrence rate after pterygium surgeries was 8% in group 1, 4% in group 2, and 20% in group 3. There were no statistical differences between the study groups. Delay of epithelialization for 8 weeks in one patient and degenerative calcification of conjunctiva 18 months after surgery in another patient, both from group 2, were the only complications in this study. CONCLUSION This study indicates the advantage of 0.01% mitomycin C for post-operative prevention of recurrence of pterygium.

Proliferative activity and p53 expression in primary and recurrent pterygia

PURPOSE To assess p53 expression and proliferative activity in primary and recurrent pterygia from the same eyes. DESIGN Retrospective comparative human tissue study. PARTICIPANTS Tissue from excised primary pterygia that did not recur (group A, n = 10) was compared with tissue from primary pterygia that recurred (group B, n = 10) and to the recurrent pterygia tissue that was excised from subjects in group B (group C, n = 10). Ten normal conjunctivas served as controls (group D). METHODS Sections from each pterygium were immunostained with the MIB-1 and bp53. 12 monoclonal antibodies that react with Ki-67 and p53 antigens, respectively. MAIN OUTCOME MEASURES Proliferative activity was calculated as the mean of the MIB-1 positive cell count per eyepiece grid in high magnification (x40) (positive cell count/grid). Percentage of positive cells of all cells in the grid area was evaluated in the p53-stained sections. RESULTS Proliferative activity was found in the epithelium overlying the pterygia and normal conjunctiva. The mean MIB-1 positive cell count/grid +/- standard error was 2.84 +/- 1.07, 1.74 +/- 0.82, 3.83 +/- 1.35, and 0.86 +/- 0.33 in groups A, B, C, and D, respectively (P = 0.17, Kruskal-Wallis). P53 staining was found in 50% of pterygia in groups A, B, and C; none of the normal conjunctival tissues showed p53 immunoreactivity. Four of five p53-positive tissues in group B were p53-negative in group C. In the p53-positive pterygia, less than 10% of cells were p53 positive. However, p53-positive pterygia had higher mean MIB-1 positive cell count/grid +/- standard error as compared with the p53-negative lesions, 4.56 +/- 0.94 vs 1.39 +/- 0.59 (P = 0.021, Mann-Whitney). CONCLUSIONS p53 immunoreactivity and high proliferative activity in the epithelium overlying the pterygium are not associated with recurrence of pterygium.

Mitomycin C for pterygium: long term evaluation

Aim: To evaluate long term complications after pterygium excision with mitomycin C (MMC) application. Design: Prospective non-comparative interventional case series. Participants: Ninety nine patients who underwent pterygium surgery and participated in a controlled study for efficacy of MMC for pterygium surgery between 1989 and 1994. Methods: Patients who were located and agreed to come for examination underwent a complete eye examination. The bare sclera area, in particular, was examined for possible complications. The main outcome measures were anatomical findings in area of MMC application. Results: Forty three eyes of 43 patients were examined. Sixty three per cent of patients had pterygium surgery with intraoperative application of 0.02% MMC for 5 minutes and 37% of patients received MMC 1% or 2% drops four times daily for 2 weeks postoperatively. In three patients, pterygium recurred within 18 months. The only complication was mild conjunctival avascularity in areas of pterygium excision in 30% of patients. Conclusion: Long term evaluation revealed that the use of MMC in pterygium surgery is safe, but for a strict selection of patients, controlled use of MMC and long term follow up are required.

Glandular Tumors of the Lacrimal Sac: Their Histopathologic Patterns and Possible Origins

PURPOSE To describe and characterize the primary lacrimal sac epithelial tumors of glandular origin, and to describe their possible source from glands in the lacrimal sac and nasolacrimal duct walls. METHODS The authors conducted a clinicopathologic study on 14 patients with epithelial lacrimal sac tumors of possible glandular origin. In addition, they reviewed 35 surgical specimens of the lacrimal sac and nasolacrimal duct region and 13 cadaver specimens of the lacrimal sac region. RESULTS Six of the tumors were benign: four were oncocytomas and two were pleomorphic adenomas. Eight of the tumors were malignant: three were oncocytic adenocarcinomas, three were adenoid cystic carcinomas, and two were adenocarcinomas. All tumors were from adults, ranging in age from 38 to 87 years. Twenty-eight of the 47 specimens of lacrimal sac and nasolacrimal duct region showed mixed glands of serous and mucous elements. CONCLUSIONS Although rare, benign and malignant glandular lacrimal sac tumors should be considered in the differential diagnosis of lacrimal sac obstruction. Their possible origin is from the normal glands that exist under the lacrimal sac and nasolacrimal duct epithelium.

Eyelid Pilomatrixoma : A Description of 16 cases and a Review of the Literature

Pilomatrixoma is an uncommon benign neoplasm that originates from the matrix of the hair root. It occurs more frequently in the head and neck region of children and adolescents, often involving the eyelid or eyebrow. Pilomatrixoma is often misdiagnosed clinically and the correct diagnosis can be established only after excision and histological examination. Pathologic diagnosis of pilomatrixoma is based on the finding of large masses of shadow cells, combined with basophilic cells, inflammation, foreign body giant cells, calcification, and ossification. We report 16 cases of eyelid pilomatrixoma that were treated in our department, and review the relevant literature.

Conjunctival myxoma: a case report.

A rare case of conjunctival myxoma in an 18-year-old female is reported. Clinically it presented as a painless mass located in the nasal bulbar conjunctiva. It was composed of spindle and stellate shaped cells in a loose mucoid stroma. Some of the cells had intracytoplasmic vacuoles consistent with dilated rough endoplasmic reticulum and/or intranuclear vacuoles of nuclear membrane invaginations. Mast cells were also seen in the stroma. No recurrence has been reported eight months postoperatively.

Report of an unusual case of a conjunctival cyst with Liesegang rings

Liesegang rings are laminated precipitation structures well recognized in the field of chemistry. We present a rare case of a 64‐year‐old man who sought examination for a conjunctival cystic lesion of several months’ duration, located in the right nasal bulbar conjunctiva near the plica semilunaris. The lesion was excised completely and uneventfully under local anaesthesia. Histopathological examination revealed a large folded cyst in the substantia propria. The cyst contained multiple eosinophilic concentrically spherical and oval structures of variable size with an amorphous central core compatible with Liesegang rings. No fungal or parasitic organisms were identified. This is the first photographically documented case of Liesegang rings appearing in the conjunctiva. Liesegang ring formation should be taken into account during histopathological examination of a conjunctival cyst and not be misdiagnosed as a parasitic infection.

Traumatic Displacement of the Globe Into the Paranasal Sinuses: Case Report and Guidelines for Treatment

Orbital wall fractures are a common outcome of facial trauma. Most are a complex type of fracture involving the orbito-zygomatic complex and/or naso-orbito-ethmoidal (NOE) complex. Blowout fractures are orbital fractures that do not involve the orbital rim. The mechanism of these fractures was described by Smith and Regan 50 years ago in a cadaveric study in which they were able to induce orbital floor fractures through a sudden elevation of intraorbital pressure. In this type of fracture, orbital contents may partially collapse into the maxillary sinus (since the orbital floor is most commonly involved). This fracture also alters orbital volume, causing orbital enlargement in most cases. These phenomena result in globe displacement, clinically observed as enophthalmus or dystopia. In some cases, orbital contents are trapped within the fracture, limiting ocular movements (mostly upper gaze) due to muscle entrapment. Both of these situations necessitate surgical intervention. Prolapse of the globe into the adjacent paranasal sinuses is extremely rare, with few cases reported in the literature. It mostly involves the maxillary sinus, but prolapse of the globe into the ethmoid cells also has been reported. In this report, we first describe the management of a patient with traumatic globe displacement into the maxillary sinus, with its functional and anatomic sequelae. We then present guidelines for managing globe displacement that we developed based on this experience and a thorough search and review of previous reports of similar trauma in the English literature. We retrospectively analyzed the medical files of the patient reported herein with regard to the mechanism of trauma, diagnosis, imaging, treatment, and outcome. We compared these data with that of previously reported cases found by an electronic search of the English literature (Medline), using the terms “traumatic prolapsed globe” and “traumatic dislocated globe,” over a 40-year period.